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588-1.485, respectively). The subgroup analysis revealed that the total PFS with SU/SO was superior to the total PFS with SO/SU in the patients with favorable MSKCC risk and those with less then 5 metastatic sites). SO/SU was superior to SU/SO for patients without previous nephrectomy. Conclusions No statistically significant differences were found in first-line PFS, total PFS, or OS between the 2 treatment arms (ClinicalTrials.gov identifier, NCT01481870).Introduction Alkaptonuria (AKU) is a rare inherited disorder of tyrosine metabolism resulting in an accumulation of homogentisic acid oxidation products in the joints and cardiovascular system. Aortic distensibility may be a non-invasive indicator of cardiovascular complications. Descending thoracic aortic distensibility in alkaptonuria has not been studied. Methods Patients diagnosed with alkaptonuria underwent Magnetic Resonance Imaging (MRI) and gated non-contrast and contrast-enhanced cardiovascular computed tomography. Using MRI cine images, aortic distensibility of the descending thoracic aorta was determined. Results Seventy-six patients with alkaptonuria were imaged. When compared to literature normal values, aortic distensibility in AKU was impaired (5.2 vs 6.2 × 10-3, p less then .001). Aortic distensibility was inversely related to age (r = -0.6, p = .0001). Hypertensive patients with alkaptonuria had impaired distensibility compared to normotensive patients with alkaptonuria (4.6 vs 5.6 × 10-3, isk factor of distensibility. Conclusions Patients with alkaptonuria have impaired aortic distensibility, which is likely an early marker for reduced cardiovascular health. Variables such as age, hypertension, hyperlipidemia, and aortic and coronary calcification were associated with impaired distensibility.Acquiring funding for global health research within pharmacy can be challenging, particularly for new investigators who may have a strong interest in resolving global dilemmas related to health. Moreover, there can be inherent imbalances and ethical issues when navigating the funding process for global partnerships. There exists a lack of literature providing ethical guidance for mitigating dilemmas that may arise. This commentary discusses current funding streams for investigators interested in global pharmacy research, as well as specific recommendations for the funding process. These recommendations include managing award funds, ethical considerations for funding research partnerships, and balancing power between low to middle income countries and high-income countries. Lastly, case examples of funding partnerships involving pharmacy are highlighted, emphasizing important lessons learned. This commentary addresses the critical need for providing global health researchers with both important considerations and experience-based recommendations for navigating global funding partnerships using an ethical approach.Anthropogenic (man-made) sound has the potential to harm marine biota. Increasing concerns about these effects have led to regulation and mitigation, despite there being few data on which to base environmental management, especially for fishes and invertebrates. We argue that regulation and mitigation should always be developed by looking at potential effects from the perspectives of the animals and ecosystems exposed to the sounds. We contend that there is currently a need for far more data on which to base regulation and mitigation, as well as for deciding on future research priorities. This will require a process whereby regulators and researchers come together to identify and implement a strategy that links key scientific and regulatory questions.Background A pig model has been commonly used for technical training for clinical liver transplantation (LT). However, as the healthy pigs have no shunt bypassing the portal vein (PV), it is necessary to complete LT within 30 minutes after shutting off the PV flow. While a model that uses an ex vivo shunt system has been used to alleviate the constraints of the anhepatic phase, it has been often difficult to keep sufficient blood flow rate and prevent the intestinal congestion because the blood vessels were occluded easily with the suction pressure by using the conventional shunt system. Methods We designed a portable shunt system and a novel connector that can prevent the blood vessel from occluding. The system can separately control the flow rate of PV and inferior vena cava (IVC) and detect whether the blood vessels were occluded. By reducing the solution volume in the circuit, the effected blood loss ex vivo could be minimized. The stability of this system was verified with 15 medical doctors in an advanced medical professional education course. Results The system enabled the blood flow to maintain ≥ 20 mL/minute and prevented the intestinal congestion. The perioperative hemodynamics of the recipient were stable without a blood transfusion using 25 to 40 kg pigs. We confirmed that all LT training were completed, even 60 minutes after shutting off the PV flow. Conclusions Our system greatly contributed to training on LT for conducting the survival experiments.Background and aims Assessment is considered a duty, as well as a part of the tasks of social workers; in addition, they have an ethical commitment to improve their working tools. This study aimed at validating the Adapted Social Assessment Instrument used in a transplant center in the state of São Paulo, Brazil, for liver transplantation candidates, requiring its improvement and strengthening. Methods The methodology was based on both Marxian dialectics and the method of content validation. The content validation analysis was performed by 5 social workers from 3 Brazilian transplant centers. They evaluated the 5 domains of the instrument identification, socio-demographic profile, eligibility criteria, evaluation, and social interventions. Descriptive statistics of data were performed, and qualitative analysis was associated to the participant observation. Results The 5 professionals (100%) assigned the scores 3 and 4, which have demonstrated clarity, relevance, and feasibility, pointing out suggestions for improvement, some of which were considered. Conclusions The instrument was evaluated with an approval percentage of above 80%; therefore, the instrument is a valid measure.Introduction The control of all hemodynamic parameters among patients after liver transplantation is critical for better graft survival and to reduce the risk of perioperative complications. The value of cardiac output (CO) and stroke volume (SV) below normal promote the development of cardiovascular diseases. Materials and methods The study was conducted on a group of 43 patients after liver transplantation 16 women and 27 men 0.5 to 29 years after the surgery at the Department of Transplantation Medicine, Nephrology and Internal Diseases, Institute of Transplantology, Medical University of Warsaw, Infant Jesus Clinical Hospital in Warsaw, Poland. The hemodynamic parameters were measured due to 4 electrocardiogram electrodes with the Cardiac Monitor ICON Osypka Medical. Results Patients after liver transplantation (LTx) showed values of CO (average 5.27 L/min, standard deviation [SD] = 0.92) and stroke volume (average 67.08 mL, SD = 10.96) below normal. The average thoracic fluid content value among women is 21.81 (1/kΩ), SD = 3.28, and for men 24.04 (1/kΩ), SD = 4.75. Only 37% of patients had a body mass index with normal values, with 63% above expected values 42% with overwise and 21% with a first stage of obesity. Conclusion The hemodynamic parameters should be controlled among patients after LTx. CO and SV below normal are predictors of a higher risk of cardiovascular diseases.Purpose The purpose of the study is to present the first results of freehand interstitial brachytherapy (ISBT) used to treat patients with carcinoma of the cervix and the vagina. Methods and materials Patients diagnosed with carcinoma of the cervix or carcinoma of the vagina who were not suitable for intracavitary brachytherapy were treated with freehand ISBT. The implant was performed transperineally using C arm or transrectal ultrasound guidance. Patients received an external beam radiotherapy dose of 50 Gy in 25 fractions. The dose delivered by high-dose-rate ISBT was 18 Gy in three fractions, 6 Gy per fraction, 6 h apart. The brachytherapy dose volume parameters were analyzed after CT-based planning using GEC ESTRO image-guided brachytherapy-based guidelines. Results From June 2018 till November 2018, 14 patients were treated with freehand ISBT. The mean dose received by 90% of the high-risk clinical target volume (D90) was 82 Gy EQD210 for patients with carcinoma of the cervix and 80 Gy EQD210 for patients with carcinoma of the vagina. The mean dose received by 2 cc volume of the bladder and rectum was 80 Gy EQD23 and 70 Gy EQD23 for patients with carcinoma of the cervix and 75 Gy EQD23 and 72 Gy EQD23 for patients with carcinoma of the vagina, respectively. The mean dose received by 2 cc of the sigmoid was 65 Gy EQD23 for cervical carcinoma and 58 Gy EQD23 for vaginal carcinoma, respectively. At a median followup of 14 months, 2 patients developed local recurrence. Two patients developed Grade 2 gastro intestinal toxicity, and 1 patient developed Grade 2 genitourinary toxicity. None of the patients developed Grade 3 or 4 toxicities. Conclusion A freehand interstitial implant is feasible in resource limited settings and provides acceptable local control with minimal acute toxicity.The Magnolia denudata flower is used to prepare tea and is often fermented to improve its flavor. Herein, fresh, aged, and browned M. denudata flower extracts were characterized using ultra performance liquid chromatography coupled with a hybrid quadrupole orthogonal time-of-flight mass spectrometer (UPLC-Q-TOF/MS/MS). The 1223 and 458 mass ions of ESI+ and ESI- modes that were significantly changed by the fermentation process were selected using three criteria. Sixteen compounds including flavonoids, phenylethanoid glycoside derivatives (PhGs), caffeoylquinic acids (CQAs), and others were identified based on their accurate mass and MS/MS spectra and analyzed as the main chemical components. The levels of the main chemical components changed after fermentation. The comparative quantity and composition of the phytochemicals differed for the three extract types. For example, flavonols were affected by fermentation, resulting in an increase or decrease (fold change value of negative ion rutin -0.47; keioside 1.00). The CQAs were low during fermentation (1-CQA, -1.62; chlorogenic acid, -1.48). However, the quinic acid content was significantly high (quinic acid, 1.36). Isomers of PhGs like isoverbasoside and isoacteoside were produced during fermentation (isoverbasoside, 5.42; isoacteoside, B 3.33). These observations may provide a basis for studying the physiological effects of non-fermented and fermented M. denudata flower.The content of low molecular weight carbohydrates (LMWC) of six types of tea produced from the leaves of Camellia sinensis were analyzed by hydrophilic interaction chromatography (HILIC) coupled to mass spectrometry. Quantities of sucrose, glucose, fructose, myo-inositol, maltose, mannitol, raffinose, galactinol, and stachyose were determined in samples of white, yellow, green, black, oolong, and dark tea. Sucrose was the most abundant carbohydrate in all types of tea. The concentration of all measured carbohydrates except mannitol was lowest in dark tea samples. Correlation analyses using quantitative data of LMWCs, antioxidant activity, and color parameters were performed on black tea samples to evaluate the interaction of different quality parameters. Carbohydrates depletion was observed during tea processing with formation of Amadori compounds with theanine.
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