Heidepetterson5655

To report outcome (freedom from local progression [FFLP], overall survival [OS] and toxicity) after stereotactic, palliative or highly conformal fractionated (>12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤12 fractions, biologically effective dose [BED10] ≥ 50 Gy), 3DCRT/IMRT (>12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10  less then  50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). selleck chemicals Three hundred twenty-six patients with 366 metastases were included by 21 centers (median follow-up 11.7 months). Treatment was SBRT, 3DCRT/IMRT and Pall-RT in 260, 27 and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%) and melanoma (6.7%). Unadjusted FFLP was higher after SBRT vs Pall-RT (P = .026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR 13.8%, 17.4% and 27.7%). OS was longer after SBRT vs other groups (P  less then  .05) and increased in patients with locally controlled metastases in a landmark analysis (P  less then  .0001). Toxicity was mostly mild; notably, four cases of adrenal insufficiency occurred, two of which were likely caused by immunotherapy or tumor progression. Radiotherapy for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. One-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.Waiting time in hospitals is often studied from one of two perspectives a distributed resource in hospitals or a potential steering and measuring factor. In this article, waiting time in an emergency department is examined from a practice and a narrative perspective, placing time at the core of our analysis. Our article explores patient waiting time as a local practice that builds on the temporal structuring that affects how waiting time is regulated by both normal clock time and event time-as interpretative time. We also consider how individual narratives in situated spaces allow for negotiations, but we also present isolated time experiences. The empirical data derive from an organisational ethnographic study of a newly introduced triage system for incoming patients at an emergency department in Denmark. The analysis shows how waiting time is organised in the formal visitation system as 'colour time' based on the negotiations of the health-care professional as at the 'right time' and as the patient's individual illness experiences with 'wasting time'. The findings indicate the importance of the unequal relationship between clock time and event time and the different contextual situations affecting the possibilities of organising.

Corticosteroids, calcineurin inhibitors, vitamin D, photodynamic therapy, herbal drugs are some of the interventions tried in clinical trials for treating oral lichen planus. We carried out the present network meta-analysis to compare the above-mentioned interventions.

Electronic databases were searched for randomized clinical trials evaluating interventions in patients with symptomatic oral lichen planus. Clinical resolution, clinical score, pain resolution, pain score, and adverse effects were the outcomes evaluated.

Fifty-five (2831 patients) trials were included. Corticosteroids (OR 13.6; 95% CI 1.2, 155.4), pimecrolimus (OR 14.7; 95% CI 1.7, 125), purslane (OR 18.4; 95% CI 3.5, 97), and ozonized water/corticosteroids (OR 52; 95% CI 1.4, 1882.6) had better rates of clinical resolution compared to placebo. Corticosteroids (OR 3.18; 95% CI 1.2, 8.43), ozonized water/corticosteroids (OR 9.9; 95% CI 2.7, 36.2), aloe vera (OR 13; 95% 1.5, 111.8), pimecrolimus (OR 18.8; 95% CI 2, 177.4) and hyaluronic acid (OR 24.8; 95% CI 1.3, 457.6) were significantly associated with superior rates of pain resolution compared to placebo. Pimecrolimus and cyclosporine were associated with significantly higher risk of adverse effects than placebo.

Topical corticosteroids were the most effective drug class for treating oral lichen planus.

Topical corticosteroids should be the first-line drugs for treating oral lichen planus. Although topical pimecrolimus and cyclosporine are effective, significant adverse effects might be a limitation.

Topical corticosteroids should be the first-line drugs for treating oral lichen planus. Although topical pimecrolimus and cyclosporine are effective, significant adverse effects might be a limitation.Technological advancements in the past few decades have made it possible to manufacture nanomaterials at a large scale, and engineered nanoparticles (ENPs) are increasingly found in consumer products, such as cosmetics, sports products, and LED displays. A large amount of these ENPs end up in wastewater and potentially impact the performance of wastewater treatment plants (WWTPs). One important function of the WWTP is nitrification, which is carried out by the actions of two groups of bacteria, ammonia-oxidizing bacteria (AOB), and nitrite-oxidizing bacteria (NOB). Since most ENPs are found to have or are designed to have antimicrobial activities, it is a legitimate concern that ENPs entering WWTPs may have negative impacts on nitrification. In this paper, the effects of ENPs on nitrification are discussed, focusing mainly on autotrophic nitrification by AOBs and NOBs. This review also covers ENP effects on anaerobic ammonium oxidation (anammox). Generally, nitrifiers in pure and mixed cultures can be inhibited by a variety of ENPs, but stress response mechanisms may attenuate toxicity. Long-term studies demonstrated that a wide range of NPs could cause severe deterioration of AOBs and/or NOBs when the influent concentration exceeded an inhibition threshold. Proposed mechanisms include the generation of reactive oxygen species, dissolved metals, physical disruption of cell membranes, bacterial engulfment, and intracellular accumulation of ENPs. Future research needs are also discussed.