Exercise and cancer: a position statement from the Spanish Society of Medical Oncology

Due to improvements in the number of cancer survivors and survival time, there is a growing interest in healthy behaviors, such as physical activity (PA), and their potential impact on cancer- and non-cancer-related morbidity in individuals with cancer. Commissioned by the Spanish Society of Medical Oncology (SEOM), in this review, we sought to distill the most recent evidence on this topic, focusing on the mechanisms that underpin the effects of PA on cancer, the role of PA in cancer prevention and in the prognosis of cancer and practical recommendations for clinicians regarding PA counseling. Despite the available information, the introduction of exercise programs into the global management of cancer patients remains a challenge with several areas of uncertainty. Among others, the most effective behavioral interventions to achieve long-term changes in a patient’s lifestyle and the optimal intensity and duration of PA should be defined with more precision in future studies.

Prognostic severity scores for patients with COPD exacerbations attending emergency departments

SETTING

Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations (eCOPD) are various and inconsistent in the bibliography.

OBJECTIVE

To develop clinical prediction rules for short-term outcomes in eCOPD patients attending an emergency department (ED).

DESIGN

Prospective cohort study of patients with an eCOPD. Short-term outcomes were admission to an intensive care unit (ICU), admission to an intermediate respiratory care unit (IRCU) and death in these groups. Multivariate logistic regression models were developed for each of the outcomes.

RESULTS

Predictors of ICU or IRCU admission were use of long-term home oxygen therapy (LT-HOT) or non-invasive mechanical ventilation (NIMV), elevated PCO2 and decreased pH upon ED arrival (area under the curve [AUC] 0.87 in the derivation sample; 0.89 in the validation sample). Among those admitted to an ICU or IRCU, predictors of death were increased age, use at home of LT-HOT or NIMV, use of inspiratory accessory muscles upon ED arrival and altered Glasgow Coma Scale (<15 points) (AUC 0.78).

CONCLUSIONS

Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among eCOPD patients. Such a score can be a tool for clinical practice.

Validity of criteria for hospital admission in exacerbations of COPD

AIMS

To validate a previously developed set of explicit criteria for the appropriateness of hospital admission among these patients using the RAND/UCLA Appropriateness Methodology (RAM).

METHODS

We conducted a prospective cohort study of patients experiencing symptoms of COPD exacerbation seen in the emergency departments (ED) of 16 hospitals belonging to the Spanish National Health Service. Sociodemographic and clinical variables needed to assess appropriateness were recorded. Main outcomes were mortality, severe COPD evolution, complications at follow up, and three patient-reported measures: dyspnoea level, capacity for physical activity and perceived health status.

RESULTS

Appropriately admitted patients were more likely to die (6.70% vs. 2.68%, p = 0.0102) than inappropriately admitted patients, and were more likely to develop severe evolution (27.09% vs. 6.08%, p < 0.0001) and complications (18.72% vs. 11.92%, p = 0.0244). Among discharged patients, no significant differences were observed in clinical outcomes. All patients exhibited worse dyspnoea and capacity for physical activity after exacerbation, but changes among appropriately admitted patients were less than among appropriately discharged patients.

CONCLUSION

Our appropriateness criteria identified patients in worse condition at ED arrival who were more likely to benefit from admission in terms of mortality and COPD evolution.

Paraparesis as initial manifestation of a Prototheca zopfii infection in a dog

A case of protothecosis causing non-ambulatory paraparesis in a dog without clinical evidence of disseminated infection is described. A five-year-old female Labrador retriever was referred with a 10-day history of progressive non-ambulatory paraparesis and lumbar pain as the only physical and neurological abnormalities. Lumbar myelography revealed severe extradural spinal cord compression extending from L4 to L7 vertebrae, and a right hemilaminectomy was performed. Surgical findings included an adherent whitish hard ill-defined mass. Cytology and biopsy results disclosed the presence of algae enclosed in a matrix of chronic inflammatory infiltrate. Culture confirmed the presence of Prototheca species. Neurological improvement occurred within a month, and the dog received antifungal treatment without evidence of clinical disseminated disease for 6 months, but died after a generalised tonic-clonic seizure. Post-mortem examination revealed multiple foci of inflammatory granulomatous infiltrate and algae-like structures in the brain, lumbar intumescence and cauda equina. Prototheca zopfii was identified using molecular biology methods.

Abstract P3-14-15: Nabrax: Neoadjuvant therapy of breast cancer with weekly nab-paclitaxel: Final safety of GEICAM 2011-02

Aims: nab-paclitaxel is an innovative chemotherapy that consists of nano-particles of human serum albumin bound paclitaxel. It exploits the role of albumin as the natural carrier of hydrophobic molecules in human to increase paclitaxel delivery to tumor cells. Weekly nab-paclitaxel showed a superior efficacy compared to every 3-weeks docetaxel in a randomized phase II study in metastatic breast cancer (Gradishar JCO 2009, Clin. Breast Cancer 2012). This single arm phase II trial has been designed to evaluate the activity and safety of weekly nab-paclitaxel as neoadjuvant treatment of early stage breast cancer patients with positive estrogen receptors and negative HER2.

Methods: Stage II-III patients were included and treated with nab-paclitaxel weekly at a dose of 150 mg/m2 on days 1, 8 and 15 every 4 weeks for 4 cycles. Following chemotherapy, patients undergo surgery and adjuvant therapy (with radiation, chemo and endocrine therapy) under the investigator criteria. The primary objective is to determine the residual cancer burden class III as measured by the Symmans criteria (JCO 25:4422,2007). Secondary objectives include pathological complete response, overall response, invasive disease free survival, safety and potential correlative biomarkers.

Results: Eighty-three patients have been recruited in the study in 13 Spanish institutions. Here we report safety data from 77 patients. Median age was 48 years, 62% were postmenopausal and 94% had ECOG PS 0; most patients were stage II (23% IIa and 36% IIb). A total of 259 cycles have been administered to date; 47 patients completed 4 cycles as planned, 5 patients discontinued treatment early (due to grade 2-3 sensory neuropathy in 4 patients), the remaining patients are still under treatment. The treatment was delayed in 8.1% of patients; nab-paclitaxel doses were omitted and reduced in 3.9% and 9.7% of cycles respectively, for a relative dose intensity of nab-paclitaxel of 97.3%. The most frequent reasons for dose modifications were neutropenia (5.4%) and neuropathy (2.7%). The main grade 2/3 adverse events are described in table 1.

Table 1Related adverse events.Per patient (N = 74)Per Cycle (N = 259)NCI-CTCAE vs 4.0. (&gt;5% grade 2-4)Grade 2, N (%)Grade 3, N (%)Grade 2, N (%)Grade 3, N (%)Leukopenia6 (8.1)1 (1.4)11 (4.2)1 (0.4)Neutropenia17(23)7 (9.5)30 (11.6)9 (3.5)Alopecia47(63.5)—121 (46.7)—Fatigue11 (14.9)2 (2.7)17 (6.6)2 (0.8)Neuropathy: Sensory17 (23)2 (2.7)25(9.6)5 (1.9)Musculoskeletal Pain11 (14.9)0 (0)13 (5.0)0 (0)

Conclusions: Neoadjuvant therapy with weekly nab-paclitaxel at dose of 150 mg/m2 on days 1, 8 and 15 every 4 weeks was well tolerated. Final safety data for the entire treated patients will be mature and presented at the meeting.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-15.

Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease

OBJECTIVE

To develop detailed, explicit criteria for determining the appropriateness of admission for patients with exacerbations of chronic obstructive pulmonary disease (COPD).

DESIGN

Using a modified Delphi process, a panel of seven pneumologists and five emergency department (ED) physicians was assembled to establish the appropriateness of hospital admission for 896 distinct theoretical scenarios. To assess the reliability of the criteria, a second national panel of five pneumologists and five ED physicians was assembled. We examined the influence of all variables on the first panel score using linear regression models. The explicit criteria developed were summarised by classification and regression tree analysis.

RESULTS

The appropriateness of the hospitalisation scenarios increased with the severity of COPD. The kappa of agreement between the two panels was 0.79. Predictors of appropriate hospitalisation were severity of current COPD exacerbation, response to previous treatment and expected adherence to treatment. The panel results were synthesised and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel's original ratings, was 6.1%.

CONCLUSIONS

These explicit criteria can be used to help determine the appropriateness of admission for patients with exacerbations of COPD.

Development of a decision tree to assess the severity and prognosis of stable COPD

The aim of this study was to develop and validate a new method: a classification and regression tree (CART) based on easily accessible measures to predict mortality in patients with stable chronic obstructive pulmonary disease (COPD). This was a prospective study of two independent prospective cohorts: a derivation cohort with 611 recruited patients and a validation cohort with 348 patients, all followed for 5 yrs. CART analysis was used to predict 5-yr mortality risk using the following covariates from the derivation cohort: age, % predicted forced expiratory volume in 1 s (FEV(1)), dyspnoea, physical activity, general health and number of hospital admissions for COPD exacerbations in the previous 2 yrs. Age (≥ 75 or <75 yrs) provided the first branch of the COPD-CART. The highest mortality risk (0.74) was seen in patients >75 yrs of age with higher levels of dyspnoea and FEV(1) <50% pred. Patients with the lowest risk of 5-yr mortality (0.04) were <55 yrs of age with FEV(1) >35% pred and one or no recent hospitalisations for COPD exacerbations. A simple decision tree that uses variables commonly gathered by physicians can provide a quick assessment of the severity of the disease, as measured by the risk of 5-yr mortality.

Pharmacokinetics of tetracycline in plasma, synovial fluid and milk using single intravenous and single intravenous regional doses in dairy cattle with papillomatous digital dermatitis

The purpose of this study was to compare the pharmacokinetics of tetracycline in plasma, synovial fluid, and milk following either a single systemic intravenous (i.v.) injection or a single i.v. regional antibiosis (IVRA) administration of tetracycline hydrochloride to dairy cattle with papillomatous digital dermatitis (PDD). To this end, plasma and synovial fluid tetracycline concentrations were compared with the minimal inhibitory concentration (MIC) values of the major bacteria, which are known to cause digital diseases and thus assess its efficacy in PDD. Residual tetracycline concentrations in milk from cows treated by both methods were also determined. Twelve Holstein cows with various stages of PDD were randomly assigned to two groups of six animals. Group 1 received a single systemic i.v. injection of 10 mg/kg of tetracycline hydrochloride. Group 2 received 1000 mg of tetracycline hydrochloride by IVRA of the affected limb. Blood, synovial fluid and milk samples were taken prior to tetracycline administration (time 0 control), and then at 22, 45 and 82 min, and 2, 3, 4, 6, 8, 12, 24, 48, 72, 96, and 120 h following drug administration. Tetracycline concentrations were determined by high-performance liquid chromatography. Mean tetracycline plasma and milk concentrations in Group 1 were higher than Group 2. The opposite was observed for synovial fluid concentrations. Group 2 synovial fluid concentrations were higher than the MIC value over 24 h for the bacteria most frequently responsible for claw disease. Compared with i.v. administration, IVRA administration of tetracycline produced very high synovial fluid and low plasma and milk concentrations.

Comparação entre as administrações tópica e sistêmica de oxitetraciclina no tratamento de vacas com dermatite digital papilomatosa

Comparou-se a eficiência dos tratamentos tópico e sistêmico com oxitetraciclina em vacas com dermatite digital papilomatosa (DDP) e determinaram-se a presença de resíduos desse antimicrobiano no leite e sua concentração no líquido sinovial e no plasma. Utilizaram-se o tratamento tópico com oxitetraciclina em pó (grupo 1) e o sistêmico de longa ação (grupo 2) em 16 vacas holandesas em lactação, acometidas por DDP. Obtiveram-se amostras de plasma, líquido sinovial e leite nos momentos: M0, antes dos tratamentos; M1, seis horas após o tratamento e em intervalos de 12 horas até M23 (264 horas pós-tratamentos). Avaliaram-se o grau de claudicação, a extensão da lesão e a concentração da oxitetraciclina pela cromatografia líquida de alta eficiência. Nas vacas do grupo 1, ocorreu redução das lesões e da claudicação, quando comparadas com as do grupo 2. Nenhuma das amostras de leite, de líquido sinovial e de plasma nos animais do grupo 1 foi positiva para oxitetraciclina. As amostras de leite dos animais do grupo 2, entre M1 e M23, apresentaram valores acima do limite máximo residual permitido para esse antimicrobiano. O tratamento tópico foi eficiente no tratamento de DDP, sem produzir resíduos no leite ou concentrações no plasma e no líquido sinovial. O tratamento sistêmico foi ineficiente para DDP, resultando em resíduos no leite, durante a avaliação.

Vitamin D and growth hormone regulate growth hormone/insulin-like growth factor (GH-IGF) axis gene expression in human fetal epiphyseal chondrocytes

OBJECTIVE

Cell proliferation and gene expression regulation were studied in human fetal epiphyseal chondrocytes to ascertain the involvement of GH-IGF axis components in human fetal growth regulation by 1,25-dihydroxyvitamin D(3) (VitD) and growth hormone (GH).

DESIGN

Chondrocytes from primary cultures were plated in serum-free medium for 48 h and incubated for a further 48 h with VitD (10(-11) to 10(-6)M) and/or IGF-I (100 ng/ml) and/or GH (500 ng/ml). We analyzed (3)H-thymidine incorporation into DNA and IGF-I, IGFBP-3, GHR, SOX9, COL2A1, aggrecan and COMP gene expression by real-time quantitative PCR.

RESULTS

VitD dose-dependently and significantly inhibited (3)H-thymidine incorporation whereas GH had no effect on proliferation and, when combined with VitD, the same inhibition was observed as with VitD alone. IGF-I (100 ng/ml) significantly stimulated proliferation and opposed inhibition by VitD. VitD dose-dependently stimulated IGF-I (11.1+/-19.8 at VitD10(-6)M), IGFBP-3 (2.6+/-0.9), GHR (3.8+/-2.8) and COMP (1.5+/-0.6) expression whereas it inhibited SOX9 (0.7+/-0.2), COL2A1 (0.6+/-0.3) and aggrecan (0.6+/-0.2) expression and had no significant effect on IGF-II. IGF-I stimulated IGF-I, IGFBP-3, SOX9, COL2A1 and aggrecan expression and opposed COL2A1 and aggrecan gene expression inhibition by VitD. GH alone had no effect on gene expression whereas, in the presence of VitD, significantly-increased IGF-I expression stimulation was observed above values obtained with VitD alone (17.5+/-7.4).

CONCLUSIONS

Our results suggest that VitD regulation of fetal growth cartilage could have consisted of parallel enhancing of cell differentiation and conditioning to a phenotype more sensitive to regulation by other hormones such as GH as shown by increased GHR and IGF-I expression, but not by IGF-II expression which was not regulated.

IGF-I and not IGF-II expression is regulated by glucocorticoids in human fetal epiphyseal chondrocytes

OBJECTIVE

To elucidate the involvement of IGF axis components and the potential effects of glucocorticoids (GCs) in human fetal growth regulation.

DESIGN

We studied the regulation by dexamethasone (Dx) and IGF-I of proliferation and IGF axis components and matrix protein gene expression in human fetal epiphyseal chondrocytes.

RESULTS

High Dx concentration (10(-7)-10(-6)M) inhibited (3)H-thymidine incorporation, mifepristone (MF) 10(-6)M limited inhibition by Dx, and IGF-I (100 ng/ml) significantly stimulated proliferation and completely opposed inhibition by Dx. Dx dose-dependently (10(-9)-10(-6)M) inhibited IGF-I, IGFBP3 and SOX9 gene expression and expression of GHR, COL2A1 and aggrecan from 10(-7)M to 10(-6)M whereas it stimulated IGF-IR expression. By contrast, Dx had no significant effect on IGF-II expression. IGF-I stimulated IGF-I, IGFBP3, SOX9, COL2A1 and aggrecan expression whereas it inhibited IGF-IR expression. IGF-I could oppose COL2A1 and aggrecan gene expression inhibition by Dx.

CONCLUSIONS

We demonstrated for the first time by real-time quantitative PCR that human fetal epiphyseal chondrocytes expressed IGF axis components, such as IGF-I, IGF-II, IGFBP3, IGF-IR and GHR and SOX9, COL2A1 and aggrecan, and that their expression was regulated by Dx and IGF-I. Among IGFs, IGF-I and not IGF-II expression was demonstrated to be down-regulated by GCs whereas IGF-I expression was up-regulated by itself.

The exon 3-deleted/full-length growth hormone receptor polymorphism does not influence the effect of puberty or growth hormone therapy on glucose homeostasis in short non-growth hormone-deficient small-for-gestational-age children: results from a two-year controlled prospective study

CONTEXT

The exon 3-deleted/full-length (d3/fl) GH receptor polymorphism (d3/fl-GHR) has been associated with responsiveness to GH therapy in short small-for-gestational-age (SGA) patients, although consensus is lacking. However, its influence on glucose homeostasis, at baseline or under GH therapy, has not been investigated.

OBJECTIVE

Our objective was to evaluate whether the d3/fl-GHR genotypes influence insulin sensitivity in short SGA children before or after puberty onset or during GH therapy.

DESIGN

We conducted a 2-yr prospective, controlled, randomized trial.

SETTING

Thirty Spanish hospitals participated. Auxological, GH secretion, and glucose homeostasis evaluation was hospital based, whereas molecular analyses and data computation were centralized.

PATIENTS

Patients included 219 short SGA children [body mass index sd score (SDS) < or = 2.0]; 159 were prepubertal (group 1), and 60 had entered puberty (group 2).

INTERVENTION

Seventy-eight patients from group 1 were treated with GH (66 microg/kg.d) for 2 yr (group 3).

MAIN OUTCOME MEASURES

Previous and 2-yr follow-up auxological and biochemical data were recorded, d3/fl-GHR genotypes determined, and data analyzed.

RESULTS

In groups 1 and 2, fasting glucose, insulin, homeostasis model assessment (HOMA), and quantitative insulin sensitivity check index (QUICKI) were similar in each d3/fl-GHR genotype. Group 2 glucose, insulin, and HOMA were significantly higher and QUICKI lower than in group 1. In group 3 GH-treated patients, height SDS, growth velocity SDS, fasting glucose, insulin, and HOMA significantly increased as did body mass index SDS at the end of the second year, and QUICKI decreased during the first and second years, with no differences among the d3/fl-GHR genotypes.

CONCLUSION

In short SGA patients, the d3/fl-GHR genotypes do not seem to influence prepubertal or pubertal insulin sensitivity indexes or their changes over 2 yr of GH therapy (66 mug/kg.d).

The exon 3-deleted/full-length growth hormone receptor polymorphism did not influence growth response to growth hormone therapy over two years in prepubertal short children born at term with adequate weight and length for gestational age

CONTEXT

Consensus is lacking as to whether the exon 3-deleted (d3)/full-length (fl) GH receptor (GHR) polymorphism is associated with responsiveness to GH therapy.

OBJECTIVE

Our objective was to evaluate, in short, prepubertal, appropriate-for-gestational age (AGA) patients, 2-yr growth response to GH therapy (31.7+/-3.5 microg/kg.d) according to exon 3-deleted/full-length GHR genotypes.

DESIGN

We conducted a retrospective study.

PATIENTS

We studied 106 short AGA children, 58 boys and 48 girls, 7.8+/-2.3 yr, (d3/d3 n=18, d3/fl n=42, and fl/fl n=46). The GH response to two provocative stimuli were under 10 ng/ml in 65 and one or both over 10 ng/ml in 41 patients.

MAIN OUTCOME MEASURES

Patients were followed by a single clinical team and remained prepubertal during the study. The exon 3-deleted/full-length GHR genotypes were determined and analyzed in the same hospital.

RESULTS

Growth velocity significantly (P<0.0001) increased during the first and second years of therapy, as did height sd score (SDS). These increases were similar in each exon 3-deleted/full-length GHR genotype. Total 2-yr height gain (SDS) did not differ statistically among genotypes: 15.5+/-2.2 cm and 1.2+/-0.5 SDS in d3/d3, 15.9+/-2.0 cm and 1.3+/-0.4 SDS in d3/fl, and 15.4+/-2.1 cm and 1.1+/-0.3 SDS in fl/fl. No significant differences among the three genotypes were found in both sexes or in patients with different GH peak response to provocative stimuli for these parameters. An analysis of previously published studies was also performed.

CONCLUSIONS

These results confirm in AGA patients those previously found by us and others in small-for-gestational-age patients and suggest that neither sex nor GH peaks after provocative stimuli might influence significantly the responsiveness to GH therapy according to the exon 3-deleted/full-length GHR genotypes.

A simple score for assessing stable chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is usually assessed using FEV(1) to establish the diagnosis and the severity of the disease. However, COPD is now considered a systemic disease.

AIM

To evaluate the utility of the Health-Activity-Dyspnoea-Obstruction (HADO) score for classifying the severity of COPD and predicting outcomes.

DESIGN

Prospective longitudinal clinical study.

METHODS

We studied 611 consecutive patients with stable COPD in five out-patient clinics of a teaching hospital. We measured dyspnoea degree, pulmonary function (by spirometry), self-reported level of daily physical activity and overall health condition. Outcome measures included health-related quality of life (HRQoL) parameters (as measured by the generic SF-36 Health Survey and by two specific questionnaires, the St George Respiratory Questionnaire and the Chronic Respiratory Questionnaire) and mortality at 3 years follow-up.

RESULTS

Based on the HADO score, COPD was classified as mild in 26.7% of patients, moderate in 53.3%, and severe in 20%. There were statistically significant correlations between these three levels of severity and HRQoL parameters and vital status. After adjustment for relevant covariates, the HADO score reliably predicted survival and vital status.

DISCUSSION

The HADO score can be easily obtained in an out-patient clinic, and distinguishes groups of COPD patients by their disease severity. The HADO score is better than FEV(1%) alone for predicting mortality at 3 years.

The d3/fl-growth hormone (GH) receptor polymorphism does not influence the effect of GH treatment (66 microg/kg per day) or the spontaneous growth in short non-GH-deficient small-for-gestational-age children: results from a two-year controlled prospective study in 170 Spanish patients

CONTEXT

The d3/fl-GH receptor (d3/fl-GHR, exon 3-deleted/full-length GHR) has recently been associated with responsiveness to GH therapy.

OBJECTIVE

The objective of the study was to evaluate whether the d3/fl-GHR genotypes influence the intensity of spontaneous and/or GH therapy-stimulated growth in small-for-gestational-age (SGA) patients.

DESIGN

This was a 2-yr prospective, controlled, randomized trial.

SETTING

Thirty Spanish hospitals participated. Auxologic and GH secretion evaluation was hospital based, whereas molecular analyses and auxologic data computation were centralized.

PATIENTS

Patients included 170 short SGA children: 140 remained prepubertal and 30 entered puberty during the second follow-up year.

INTERVENTION

Eighty-six were treated with GH (66 microg/kg.d) for 2 yr and 84 were not treated.

MAIN OUTCOME MEASURES

Previous and 2-yr follow-up auxologic data were recorded at each hospital, d3/fl-GHR genotypes determined, and data analyzed for patients who remained prepubertal (group 1, 68 GH treated and 72 non-GH treated) and for all the patients (group 2).

RESULTS

In group 1 GH-treated patients, growth velocity, and height-sd score during the first and second years, total 2-yr height gain (18.5 +/- 2.4 cm in d3/d3; 18.4 +/- 2.6 in d3/fl; 19.5 +/- 2.3 in fl/fl), Delta 2-yr height increase (9.1 +/- 2.4 cm in d3/d3; 9.4 +/- 3.0 in d3/fl; 10.4 +/- 2.1 in fl/fl), first-year growth prediction and studentized residual values (0.08 +/- 1.26 in d3/d3; 0.28 +/- 1.21 in d3/fl; 0.67 +/- 0.95 in fl/fl) did not differ among the d3/fl-GHR genotypes. In group 1 non-GH-treated patients, neither growth velocity nor height-sd score changed significantly, and values were similar in each d3/fl-GHR genotype. Results in all patients (group 2) were similar to those in group 1.

CONCLUSIONS

In short non-GH-deficient SGA children, both spontaneous growth rate and responsiveness to 66 microg/k.d GH therapy were similar for each d3/fl-GHR genotype carried.

[Description of a sample of patients with chronic obstructive pulmonary disease treated at hospital-supervised respiratory clinics at primary care centers]

OBJECTIVE

To study the general characteristics, health perception and limitations of patients with chronic obstructive pulmonary disease (COPD) treated at respiratory clinics at primary care centers staffed by pulmonologists from our hospital service.

METHOD

The study was carried out at 5 primary care centers that enrolled the patients consecutively. Questionnaires were used to collect information on sociodemographic aspects, perception of health, and limitations to activities of daily living. We also collected information on the treatments patients were receiving and comorbidities. Spirometry was also performed.

RESULTS

Six hundred eleven patients with a mean age of 67.2 years were included in the study; 97.7% were male. The most common comorbidities were spinal column pathology (43%) and osteoarthritis (37%). The mean forced expiratory volume in 1 second (FEV1) was 1.37 L and FEV1% was 49.7% of predicted. Medications taken for COPD were mainly beta-adrenergics and anticholinergics; 66% of patients used inhaled steroids. The majority of patients (52.7%) referred to their health as fair and 59.9% declared having some degree of limitation to their activities of daily living which they attributed to their respiratory disease. Statistical differences were found between the degree of limitation and the degree of dyspnea (P<.0001), perception of health (P<.0001), and FEV1 (P=.001).

CONCLUSIONS

Our study outlines the general characteristics of COPD patients and shows that dyspnea is closely related to the perception patients have of their degree of limitation.

[Endovascular resolution of iliac artery pseudoaneurysm in a transplanted patient]

A 58-year-old patient with end-stage idiopatic renal disease underwent kidney transplantation from a cadaveric donor. Approximately one year after the transplant he complained of abdominal pain and presented a pulsating mass in his right pelvic region. Dupplex study and arteriography were performed and showed a large pseudoaneurysm arising from the right common iliac artery. We report the case in which a covered stent placement and an embolization of the right internal iliac artery solved the problem with successful clinical and radiological results.

Nasopharyngeal carcinomas: an update

Among the group of head and neck cancers, nasopharyngeal carcinomas (NPC) represent a distinct entity in terms of their epidemiology, clinical presentation, biological markers, carcinogenic risk factors, prognostic factors, treatment and outcome. Undifferentiated NPC (UCNT), the most frequent histological type, is endemic in certain regions, especially in South East Asia. The disease has also been associated with the presence of the Epstein-Barr Virus (EBV). Although NPC is a radiosensitive and chemosensitive tumour, a substantial number of patients develop local recurrence or distant metastases. For patients with locoregional advanced disease, it is well known that conventional radiotherapy is insufficient in terms of both the local control rates and distant metastases. New techniques of radiation and new combined radiotherapy and chemotherapy modalities have been evaluated in numerous clinical trials in recent years. The purpose of this article is to review the current knowledge in terms of the epidemiology, biology, prognosis, management and outcome of patients with NPC.

Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale

OBJECTIVE

To assess the psychometric properties of the Spanish version of the Hospital Anxiety and Depression Scale(HADS).

METHOD

We administered HADS to 685 participants (256 controls and 429 patients with five different diagnoses). The reliability of the instrument was assessed by a test-retest study. Construct validity studies were carried out through item-subscale correlation and factor analysis for the whole group and by each of the five different diagnoses. Three instruments were used as external criteria to assess concurrent validity.

RESULTS

HADS test-retest reliability presented correlation coefficients above 0.85. The internal consistency was high, with a Cronbach's alpha of 0.86 (anxiety) and 0.86 (depression). Factor analysis showed a clear two-factor structure for all groups. The results showed high concurrent validity with the Beck Depression Inventory and State-Trait Anxiety Inventory and with the mental domains of the Short-Form Health Survey.

CONCLUSION

The Spanish version of the HADS demonstrated good reliability and validity when used in medical patients.

[Reference figures for pulmonary artery pressures after effective treatment of Graves' disease]

We report the case of a 48-year-old woman with a diagnosis of pulmonary hypertension and hyperthyroidism (Graves' disease) in whom pulmonary artery pressures became normal after treatment of thyroid disease. The possible pathogenic mechanisms involved in this association include the presence of hyperdynamic heart failure and/or the presence of immune alterations underlying both conditions.

[Air tissue expansion, as an alternative to physiologic serum expansion: report of 30 cases]

There has been a renewed interest in cutaneous expansion as a plastic surgery procedure. Complications and failures remain considerable despite a more adequate and standardized technique. Based on a study of 30 cases of cutaneous expansion for burns sequelae, the authors emphasize the value of using air instead of physiological saline as filling medium, to reduce the negative repercussions on quality and quantity of cutaneous gain, related to the increasing weight of the prosthesis, even for large and possibly repeated expansion volumes.

Paclitaxel plus vinorelbine: an active regimen in metastatic breast cancer patients with prior anthracycline exposure

PURPOSE

To evaluate the anti-tumour activity and tolerance of the combination of paclitaxel plus vinorelbine in metastatic breast cancer (MBC) patients previously treated with anthracyclines.

PATIENTS AND METHODS

Fifty-six MBC patients who have had at least one previous anthracycline-containing chemotherapy regimen were enrolled in this phase II trial. Patients received paclitaxel (135 mg/m2 over one-hour infusion) and vinorelbine (30 mg/m2) both on day 1 of each three-week course of therapy (maximum eight courses or until disease progression was evident).

RESULTS

Six complete and nineteen partial responses were observed among the fifty-four assessable patients (response rate of 46%, 95% CI: 33%-60%). Responses were observed in all disease sites and in all subsets of patients. The response rates when paclitaxel plus vinorelbine were used as first, second and third-line chemotherapy for metastases were 67%, 41% and 35%, respectively. The response rate among anthracycline-refractory patients was 46% (6 of 13). Median time to progression in the overall patient group was 28 weeks. The main toxicities (CTC grade 2 or more) were alopecia, myelosuppression and peripheral neuropathy (85%, 46% and 19% of patients, respectively). Nine patients (17%) had neutropenic fever in fifteen of the three hundred twenty-eight courses administered (5%).

CONCLUSIONS

The combination of paclitaxel and vinorelbine on day 1 every three weeks is active in MBC patients with prior anthracycline exposure. The regimen is safe, well tolerated and convenient for the patients.

Induced massive star formation in the trifid nebula?

The Trifid nebula is a young (10(5) years) galactic HII region where several protostellar sources have been detected with the infrared space observatory. The sources are massive (17 to 60 solar masses) and are associated with molecular gas condensations at the edges or inside the nebula. They appear to be in an early evolutionary stage and may represent the most recent generation of stars in the Trifid. These sources range from dense, apparently still inactive cores to more evolved sources, undergoing violent mass ejection episodes, including a source that powers an optical jet. These observations suggest that the protostellar sources may have evolved by induced star formation in the Trifid nebula.

Sertoli cell-specific expression of rat androgen-binding protein in transgenic mice: effects on somatic cell lineages

The Sertoli cells of many species produce an androgen binding protein (ABP) which carries testicular androgens to the epididymis and is thought to play a role in sperm maturation. In the present report we analyzed the morphological modifications present in Leydig, Sertoli, and peritubular cells of the testis of young adult male mice transgenic for ABP gene, which overproduce ABP in testis. By in situ hybridization we demonstrated that ABP is specifically produced by Sertoli cells. Using light and electron microscopy, we detected scattered alterations of the seminiferous tubule cells which include cell degeneration and vacuolization. Leydig and Sertoli cells present morphological signs of hyperfunctioning compensatory mechanisms which include increased amounts of lipid droplets probably due to the existence of a stimulated steroid synthesis that in turn could be a consequence of the decreased unbound testosterone and/or a direct paracrine effect of ABP. Peritubular cells also present numerous signs of hyperstimulation.

Pharmacokinetic study of ebrotidine administered in multiple doses to healthy volunteers for 4 days

The safety of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4- thiazolyl]methyl]thio]ethyl]amino] methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542), a new H2-receptor antagonist with gastroprotective activity, was assessed and its main pharmacokinetic parameters were determined in order to establish the dose linearity after the repeated administration of three different dose levels. The study was carried out in a group of 8 healthy volunteers of either sex, aged between 20 to 29 years. Oral doses of ebrotidine were administered in a randomized, single-blind design. Volunteers remained in the Unit for two days at each of the three study phases with washout intervals of 2 weeks and received seven doses of ebrotidine (150, 300 and 500 mg b.i.d). Pharmacological evaluation included vital signs, laboratory tests, adverse events and blood and urine samplings for pharmacokinetic analysis. Ebrotidine was determined by high performance liquid chromatography (HPLC) with UV detection. The results showed a good tolerability of ebrotidine after the administration of seven doses for 4 days, with no changes in the vital signs or laboratory parameters. No clinically significant dose-related adverse events were reported during the study. The absorption of ebrotidine was relatively rapid (tmax approximately 2 h) and linear within the dose range from 150 to 500 mg. Drug biotransformation was linear with doses tested, and no metabolic saturation occurred. The terminal elimination half-life of ebrotidine was between 7 and 11 h or even longer. There was no accumulation of ebrotidine and the steady state was reached, regardless of the dose administered, within the first 24-48 h.

Expression of the alpha-fetoprotein gene in human breast cancer

Recently, evidence was obtained that the ability to take up alpha-fetoprotein (alpha-FP), which is characteristic of fetal cells, may be required both in vivo and in vitro by different types of human and animal tumor cells via expression of specific alpha-FP receptors. Mammary gland carcinomas belong to this class of tumor. In some neoplasms, expression of alpha-FP receptors is concomitant with activation of the alpha-FP gene and synthesis of the protein, suggesting that an autocrine alpha-FP/alpha-FP-receptor pathway is operational in these tumors. In the present work, 18 human breast cancer biopsy specimens were subjected to in situ hybridization with a human alpha-FP cDNA probe. Positive labeling for alpha-FP mRNA transcripts was seen in 8 of the specimens. Surprisingly, strong positive signals were seen in stromal fibroblasts and lymphocytes infiltrating tumor nests and in adipocytes adjacent to tumor areas, while the malignant cells themselves were hardly labeled. This suggest paracrine stimulation of the alpha-FP gene, probably as a result of epithelial-mesenchymal interactions. Pathological implications arise from the ability of alpha-FP to regulate growth, either alone or synergistically with other growth factors, as well as its ability to enhance fatty acid entry into proliferating cells.

Androgen binding protein is tissue-specifically expressed and biologically active in transgenic mice

In view of the inconclusive data concerning the role of androgen-binding protein (ABP) in male reproductive physiology, we thought it would be pertinent to make several transgenic mouse lines overexpressing the rat ABP gene to unravel its role in Sertoli cell and epididymal homeostasis. Heterozygote transgenic mouse lines carrying the 5.5 kb ABP rat genomic DNA were produced by pronuclear microinjection. Northern blot analysis showed overexpression of rat ABP (rABP) mRNA in the testis of transgenic mice compared to rat testis control. rABP was appropriately expressed in Sertoli cells as demonstrated by in situ hybridization analysis. Sertoli cell number is increased in the seminiferous tubules of mice overexpressing rABP compared to non-transgenic littermates and scattered Sertoli cells present vacuolated-like cytoplasms, PAS and osmium negative. Compared to the wild type, the transgenic mice exhibited reduced fertility and focal damage in seminiferous epithelium characterized by morphological features compatible with programmed cell death.