Squamous cell carcinoma (SCC) is the second most common type of skin cancer in the UK, affecting 10,000 people in England and Wales alone. The risk factors include prolonged sun or tanning bed exposure, having fair skin, older age and having a family member who has had the condition. It is a slow growing cancer involving the outer layer of the skin but can spread to other areas of the body if untreated. SCCs are treated by removing them and this is usually through surgery, but in milder cases freezing and creams are sometimes used. This study was based in the Netherlands looking back at 579 patients with SCC, comparing the rates of cancer returning after undergoing two different forms of surgical treatment. 292 patients underwent standard excision, whereby the SCC and a small margin of skin was cut out and sent to the laboratory to confirm diagnosis and check that all of the cancer was removed. The other 380 patients underwent a newer, specialist procedure called Mohs micrographic surgery. This involves cutting the cancer out layer by layer, each time examining the sample under the microscope during the surgery to see how much cancer has been removed. While this is a much longer procedure, the aim is to preserve as much normal skin as possible, which is particularly important on the face for cosmetic reasons. The researchers followed up the group that underwent standard excision after 5-7 years and found 8% of the SCCs had returned. In comparison, in the group who had Mohs surgery, only 3% of SCCs came back after 4-9 years. In total, more SCCs came back in the group having standard excision. Adjusting for the size and depth of the cancer, it can be concluded that patients were three times less likely to have their SCC return if they had Mohs surgery in comparison to standard excision. 相似文献
Blood coagulation factor Va serves an indispensable role in hemostasis as cofactor for the serine protease factor Xa. In the presence of an anionic phospholipid membrane and calcium ions, factors Va and Xa assemble into the prothrombinase complex. Following formation of the ternary complex with the macromolecular zymogen substrate prothrombin, the latter is rapidly converted into thrombin, the key regulatory enzyme of coagulation. Over the years, multiple binding sites have been identified in factor Va that play a role in the interaction of the cofactor with factor Xa, prothrombin, or the anionic phospholipid membrane surface. In this review, an overview of the currently available information on these interactive sites in factor Va is provided, and data from biochemical approaches and 3D structural protein complex models are discussed. The structural models have been generated in recent years and provide novel insights into the molecular requirements for assembly of both the prothrombinase and the ternary prothrombinase‐prothrombin complexes. Integrated knowledge of functionally important regions in factor Va will allow for a better understanding of factor Va cofactor activity. 相似文献
Purpose: To evaluate the feasibility of a student-mentored community-based exercise program for youth with disability.
Method: Nineteen youth (nine female; mean age 18 years) with disability (seven cerebral palsy, six Down syndrome, three spina bifida, two autism spectrum disorder, one spinal cord injury) were recruited. Each participant was matched with a student mentor and exercised twice a week for 12?weeks at their local gymnasium. Five domains of feasibility were assessed: demand, implementation, practicality, limited efficacy testing, and acceptability.
Results:Demand comprised 55 expressions of interest. Demonstrating evidence of implementation, 91% of scheduled sessions were attended and training fidelity (comparing training load in weeks 1 and 12) showed exercise intensity significantly increased for strength and aerobic exercises. The program was practical with no major and 17 minor adverse events (e.g., muscle soreness). Limited efficacy testing was demonstrated by increased arm (4?kg, 95% CI: 1–7) and leg strength (43?kg, 95% CI: 24–62), walking endurance (80?m, 95% CI: 24–137), and improvement in three dimensions of health-related quality of life (autonomy, physical, and psychological well-being). The program was accepted very positively by participants.
Conclusions: A student-mentored community-based exercise program feasibly engages youth with disability in community-based exercise.
Implications for Rehabilitation
A 12-week community-based student-mentored exercise program for youth with disability is feasible.
Exercising in a real-world setting with a student mentor has a positive effect on physical and psychological well-being of youth with disability.
Breast sarcomas constitute a rare and heterogeneous group of tumors. Given their aggressive nature and the potential for extensive resections, rates of reconstruction have been low. We retrospectively reviewed subjects derived from our institutional registry presented between 2003 and 2015. Thirty‐four patients with primary breast sarcoma were identified. The average age was 51.9 years and the average follow‐up was 58 months. The most common histological type was malignant phyllodes (61.8%). Two patients suffered cancer recurrence. Twelve patients (35.3%) underwent reconstruction. Four underwent implant‐based reconstruction, seven had autologous‐based reconstruction, and one had combined reconstruction. Major complications were one flap loss and one implant removal. Our relatively high rates of breast reconstruction suggest a newly increased willingness to offer reconstruction to this rarer patient population. 相似文献
The hypothalamic‐pituitary‐adrenal axis, autonomic nervous system, and immune system have been proposed to underlie the antidepressant effect of exercise. Using a population sample of 715 adolescents, we examined whether pathways from exercise to affective and somatic symptoms of depression were mediated by these putative mechanisms. Exercise (hours/week) and depressive symptoms were assessed at age 13.5 (± 0.5) and 16.1 (± 0.6). Cortisol and heart rate responses to a standardized social stress test and C‐reactive protein levels were measured at age 16. Exercise was prospectively and inversely related to affective (B = ?0.16, 95% CI = ?0.30 to ?0.03) but not somatic symptoms (B = ?0.04, 95% CI = ?0.21 to 0.13). Heart rate during social stress partially mediated this relationship (B = ?0.03, 95% CI = ?0.07 to ?0.01). No other mediating effects were found. Hence, the autonomic stress system may play a role in the relationship between exercise and depressive symptoms. 相似文献
ObjectivesCardiovascular disease may be linked to hearing loss through narrowing of the nutrient arteries of the cochlea, but large-scale population-based evidence for this association remains scarce. We investigated the association of carotid atherosclerosis as a marker of generalized cardiovascular disease with hearing loss in a population-based cohort.DesignCross-sectional.SettingA population-based cohort study.Participants3724 participants [mean age: 65.5 years, standard deviation (SD): 7.5, 55.4% female].MethodsUltrasound and pure-tone audiograms to assess carotid atherosclerosis and hearing loss.ResultsWe investigated associations of carotid plaque burden and carotid intima-media thickness (IMT) (overall and side-specific carotid atherosclerosis) with hearing loss (in the best hearing ear and side-specific hearing loss) using multivariable linear and ordinal regression models. We found that higher maximum IMT was related to poorer hearing in the best hearing ear [difference in decibel hearing level per 1-mm increase in IMT: 2.09 dB, 95% confidence interval (CI): 0.08, 4.10]. Additionally, third and fourth quartile plaque burden as compared to first quartile was related to poorer hearing in the best hearing ear (difference: 1.06 dB, 95% CI: 0.04, 2.08; and difference: 1.55 dB, 95% CI: 0.49, 2.60, respectively). Larger IMT (difference: 2.97 dB, 95% CI: 0.79, 5.14), third quartile plaque burden compared to first quartile (difference: 1.24 dB, 95% CI: 0.14, 2.35), and fourth plaque quartile compared to first quartile (difference: 2.12 dB, 95% CI: 0.98, 3.26) in the right carotid were associated with poorer hearing in the right ear.Conclusions and ImplicationsCarotid atherosclerosis is associated with poorer hearing in older adults, almost exclusively with poorer hearing in the right ear. Based on our results, it seems that current therapies for the prevention of cardiovascular disease may also prove beneficial for hearing loss in older adults by promoting and maintaining inner ear health. 相似文献