The role of radiotherapy in locally advanced pancreatic cancer

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 35% a locally advanced tumour, non-metastatic but unresectable due to vascular invasion, or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for patients with locally advanced tumours.     

Fetal stem-cell transplantation

Fetal stem-cell transplantation is an attractive approach to the treatment of a variety of hematological, metabolic and immunological diseases before birth. The possibility of delivering a large number of cells in an early stage of life, and of taking advantage of normal fetal stem-cell migration and development, is promising. During fetal life, the capacity to mount an immune response to allogeneic cells is impaired compared with adult life. This provides an opportunity to induce tolerance to alloantigens without the need for myeloablation, although there are possible immune barriers to foreign cells in the fetus.     

Short communication: HIV type 2 dynamics

To gain a better understanding of why HIV-2 is less virulent than HIV-1 the viral dynamics of HIV-2 were studied in two Swedish HIV-2-infected patients after starting antiretroviral therapy. Linear regression analysis of log virus levels in plasma showed that virus decline during the first 2 weeks of therapy followed an exponential decay with half-lives of 2.2 and 2.0 days, respectively. These half-life measurements reflect the decline in the number of cells actively producing the virus, but may represent an underestimation of the true turnover of HIV-2. In one patient, preliminary estimates of the first and second phase of virus decline (halflife 1.3 and 15 days, respectively) were made. The viral dynamics of HIV-2 infection are strikingly similar to those for HIV-1. Thus, HIV-1 and HIV-2 appear to have similar rates of production and clearance in vivo. Consequently, the large differences in plasma virus levels, virulence, and natural course of the disease between the two infections are due to other factors that are yet to be identified.     

Evaluation of comprehensiveness: ascribing meaning to agreements on goals for local health systems

As a policy guideline, ideal, or objective, comprehensiveness is a relevant attribute in the evaluation of quality of care and health systems. The article discusses the meaning of the concept of comprehensiveness in practice in some health services and systems, analyzing various methodologies to implement the concept. In Brazil, what prevails is an expanded perception emphasizing the complete, continuous, and coordinated nature of health care and management. The article highlights the importance of combining the evaluation of comprehensiveness with measures of access, suggesting the selection of indicators pertaining to agreements on goals for local health systems and their monitoring. This initiative could enhance the validity of existing evaluation instruments, from a communications perspective.     

New educational strategies: evaluation of the Jury Trial technique for training council members in women's health in Santa Catarina,Brazil

This article describes and evaluates the Jury Trial technique, an innovative educational instrument used in a pilot workshop on Social Control and Gender by health council members in Greater Metropolitan Florian polis, Santa Catarina, Brazil. The reliability and validity were studied based on the participants' opinions, complemented by qualitative observation of the work. There was consensus in acceptance of the technique based on "acquisition of knowledge" and the fact that it was participatory, democratic, and dynamic. The positive evaluation agrees with a previous study that interviewed municipal health secretaries, with a smaller preference of formal cognitive activities that were also part of the workshop. The article concludes by emphasizing the importance of this innovative technique in training programs, since it is accepted by different target publics, allows for designing the program contents, and is useful in relation to new and controversial issues since it favors practical and reflexive experiences.     

Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function one year after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients

Purpose

A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up.

Methods

Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥?90% in all tests of muscle function as primary outcome.

Results

A total of 263 patients with a mean age of 26.7?±?10.3 years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥?90% in knee extension strength, OR?=?0.49 [(95% CI 0.25–0.97), p?=?0.039] and OR?=?0.30 [(95% CI 0.14–0.67), p?=?0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR?=?0.76 [(95% CI 0.60–0.98), p?=?0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR?=?1.14 [(95% CI 1.01–1.29), p?=?0.037].

Conclusion

Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥?90% in all tests.

Level of evidence

Prospective observational study: Level 2.