Age, Gleason Score, and PSA are important prognostic factors for survival in metastatic castration-resistant prostate cancer. Results of The Uroncor Group (Uro-Oncological Tumors) of the Spanish Society of Radiation Oncology (SEOR)

INTRODUCTION

The treatment of metastatic castration-resistant prostate cancer (mCRPC) has changed significantly in recent years. Inhibitors of androgen receptors have shown especially significant benefits in overall (OS) and progression-free survival (PFS), with a good toxicity profile. Treatment selection depends on the patient's individual clinical, radiological, and biological characteristics.

OBJECTIVE

To describe treatment outcomes (efficacy, toxicity) in a cohort of patients with mCRPC in Spain.

MATERIALS AND METHODS

Multicenter, retrospective study of patients with mCRPC included in a database of the Urological Tumour Working Group (URONCOR) of the Spanish Society of Radiation Oncology (SEOR). Metastatic CRPC was defined according to the prostate cancer working group 3 (PCWG3) criteria. The Kaplan-Meier technique was used to evaluate OS and the Common Terminology Criteria for Adverse Events (CTCAE, v.4.0) were used to assess toxicity. Univariate and multivariate Cox regression analyses were performed to identify the factors significantly associated with OS.

RESULTS

A total of 314 patients from 17 hospitals in Spain diagnosed with mCRPC between June 2010 and September 2017 were included in this study. Mean age at diagnosis was 68 years (range 45-89). At a median follow-up of 35 months, OS at 1, 3, and 5 years were 92%, 38%, and 28%, respectively. Grades 1-2 and grade 3 toxicity rates were, respectively, 68% and 19%. No grade 4 toxicities were observed. On the multivariate analysis, the following factors were significantly associated with OS: age (hazard ratio [HR] 0.42, p = 0.010), PSA value at diagnosis of mCRPC (HR 0.55, p = 0.008), and Gleason score (HR 0.61, p = 0.009).

CONCLUSIONS

Age, Gleason score, and PSA at diagnosis of mCRPC are independently associated with overall survival in patients with mCRPC. The efficacy and toxicity outcomes in this patient cohort treated in radiation oncology departments in Spain are consistent with previous reports.

An Individualized Low-Intensity Walking Clinic Leads to Improvement in Frailty Characteristics in Older Veterans

BACKGROUND

Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging.

OBJECTIVES

The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty.

DESIGN

This was a clinical demonstration project/quality improvement project.

SETTING

Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS).

PARTICIPANTS

Older Veterans, aged ≥60 years.

INTERVENTION

A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks.

MEASUREMENTS

Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria.

RESULTS

One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01).

CONCLUSIONS

Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.

Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the "race for the surface" theory

Objectives

Implant-related infection is one of the most devastating complications in orthopaedic surgery. Many surface and/or material modifications have been developed in order to minimise this problem; however, most of the in vitro studies did not evaluate bacterial adhesion in the presence of eukaryotic cells, as stated by the ‘race for the surface’ theory. Moreover, the adherence of numerous clinical strains with different initial concentrations has not been studied.

Methods

We describe a method for the study of bacterial adherence in the presence of preosteoblastic cells. For this purpose we mixed different concentrations of bacterial cells from collection and clinical strains of staphylococci isolated from implant-related infections with preosteoblastic cells, and analysed the minimal concentration of bacteria able to colonise the surface of the material with image analysis.

Results

Our results show that clinical strains adhere to the material surface at lower concentrations than collection strains. A destructive effect of bacteria on preosteoblastic cells was also detected, especially with higher concentrations of bacteria.

Conclusions

The method described herein can be used to evaluate the effect of surface modifications on bacterial adherence more accurately than conventional monoculture studies. Clinical strains behave differently than collection strains with respect to bacterial adherence.

Cite this article: M. Martinez-Perez, C. Perez-Jorge, D. Lozano, S. Portal-Nuñez, R. Perez-Tanoira, A. Conde, M. A. Arenas, J. M. Hernandez-Lopez, J. J. de Damborenea, E. Gomez-Barrena, P. Esbrit, J. Esteban. Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the “race for the surface” theory. Bone Joint Res 2017;6:315–322. DOI: 10.1302/2046-3758.65.BJR-2016-0226.R2.

Two different critical regimes enclosed in the Bean–Rodbell model and their implications for the field dependence and universal scaling of the magnetocaloric effect

In the last few years power laws and universal scaling have been extensively used to study the field dependence of the magnitudes involved in the magnetocaloric effect of materials.

Kaolin exogenous application boosts antioxidant capacity and phenolic content in berries and leaves of grapevine under summer stress

Heat waves, high light intensities and water deficit are becoming important threats in many important viticultural areas worldwide, so the implementation of efficient and cost-effective mitigation strategies is crucial for the production of premium wines while maintaining productivity. In this context, the foliar application of kaolin, a chemically inert mineral with excellent reflective properties, is being developed and experimented as a strategy to reduce the impact of heat and drought in Douro vineyards (Northern Portugal), already revealing promising results. In the present study we investigated if an improved antioxidant capacity is part of the beneficial effects of kaolin, by studying changes in the enzymatic and nonenzymatic antioxidant system in leaves and berries (cv Touriga Nacional). Results showed that mature grape berries contained higher amounts of total phenols (40%), flavonoids (24%), anthocyanins (32%) and vitamin C (12%) than fruits from control vines, and important changes were also measured in leaves. In parallel, kaolin application improved the antioxidant capacity in berries, which was correlated with the observed increased content in secondary metabolites. Kaolin application also regulated secondary metabolism at the transcriptional level through the increase in the transcript abundance of genes encoding phenylalanine ammonia lyase and chalcone synthase.

Prognostic value of glomerular filtration rate estimation equations in acute heart failure with preserved versus reduced ejection fraction

AIMS

Renal function is an important prognostic factor in heart failure. The aim of this study was to compare the predictive value of estimated renal function calculated by the Chronic Kidney Disease-Epidemiology Collaboration equation (CKD-EPI) and the abbreviated Modification of Diet in Renal Disease (MDRD-4) equation for long-term all-cause mortality in patients admitted for acute decompensated heart failure (ADHF) with both preserved ejection fraction (HF-PEF) and reduced ejection fraction (HF-REF).

METHODS AND RESULTS

We evaluated patients included in the Spanish National Registry of Heart Failure (RICA). RICA is a multicentre, prospective, cohort study that included patients admitted to the Internal Medicine units with ADHF. Estimated glomerular filtration rate (eGFR) was calculated with CKD-EPI and MDRD-4 equations. A total of 1805 patients admitted for ADHF were studied (52% women; median age 80 years, interquartile range 73.9-84.6 years); of these, 1044 (58%) had HF-PEF. eGFR values were lower with the CKD-EPI formula than with the MDRD-4 formula (51 ml/min/1.73 m(2) vs. 55.7 ml/min/1.73 m(2) ; p < 0.001). The two formulas provided independent prognostic information over long-term follow-up, in both HF-PEF and HF-REF patients. However, in HF-PEF patients, CKD-EPI equation was associated with a significant improvement in reclassification analyses (net reclassification improvement 6.78%; p = 0.009).

CONCLUSIONS

In this clinical cohort of ADHF patients, eGFR as calculated by both the CKD-EPI and the MDRD-4 formulas offered similar prognostic information, irrespective of ejection fraction status, but in HF-PEF patients specifically, the CKD-EPI formula seems to improve clinical risk stratification as compared with MDRD-4.

Magnetocaloric effect and critical behavior in Pr0.5Sr0.5MnO3: an analysis of the validity of the Maxwell relation and the nature of the phase transitions

The Maxwell relation, the Clausius-Clapeyron equation, and a non-iterative method to obtain the critical exponents have been used to characterize the magnetocaloric effect (MCE) and the nature of the phase transitions in Pr0.5Sr0.5MnO3, which undergoes a second-order paramagnetic to ferromagnetic (PM-FM) transition at TC ~ 247 K, and a first-order ferromagnetic to antiferromagnetic (FM-AFM) transition at TN ~ 165 K. We find that around the second-order PM-FM transition, the MCE (as represented by the magnetic entropy change, ΔSM) can be precisely determined from magnetization measurements using the Maxwell relation. However, around the first-order FM-AFM transition, values of ΔSM calculated with the Maxwell relation deviate significantly from those calculated by the Clausius-Clapeyron equation at the magnetic field and temperature ranges where a conversion between the AFM and FM phases occurs. A detailed analysis of the critical exponents of the second-order PM-FM transition allows us to correlate the short-range type magnetic interactions with the MCE. Using the Arrott-Noakes equation of state with the appropriate values of the critical exponents, the field- and temperature-dependent magnetization [Formula: see text] curves, and hence the [Formula: see text] curves, have been simulated and compared with experimental data. A good agreement between the experimental and simulated data has been found in the vicinity of the Curie temperature TC, but a noticeable discrepancy is present for [Formula: see text]. This discrepancy arises mainly from the coexistence of AFM and FM phases and the presence of ferromagnetic clusters in the AFM matrix.

Magnetic multilayers as a way to increase the magnetic field responsiveness of magnetocaloric materials

The magnetocaloric response of Ni-Cu based multilayers has been studied with the aim of optimizing their magnetic field dependence. In contrast to the behavior of single phase materials, whose peak magnetic entropy change follows a power law with exponents close to 0.75, multilayering leads to exponents of -1 for an extended temperature span close to the transition temperature. This demonstrates that nanostructuring can be a good strategy to enhance the magnetic field responsiveness of magnetocaloric materials.

Corrosion behaviour and biocompatibility of a novel Ni-free intermetallic coating growth on austenitic steel by hot dipping in an Al-12.6%Si alloy

Commercial 316 LVM austenitic stainless steel samples have been coated by immersion in a bath of molten Al-12.6%Si alloy for 120 s. The coating consists of the Al(12)(Fe,Cr)(3)Si(2) intermetallic. In vitro corrosion behaviour has been evaluated in the Ringer's solution by means of potentiodynamic curves and electrochemical impedance spectroscopy. The results reveal that the coated specimens exhibit lower susceptibility to localised corrosion with respect to the substrate. XPS analysis suggests that the ennoblement of the pitting potential is due to the formation of a chromium oxyhydroxide containing passive layer. The intermetallic coating shows a good biocompatibility, as demonstrated by culturing human mesenchymal stem cells isolated from bone marrow which attached, grew and differentiated to the osteoblastic lineage to a similar extent on coated and bare steels. In summary, this study proposes a method that generates Ni-free coatings of the stainless steel with useful properties for biomedical applications.

[Low versus high doses of topiramate in the preventive treatment of migraine]

INTRODUCTION

The efficacy of topiramate in the preventive treatment of migraine is well demonstrated. Clinical trials indicate that the dose of 100 mg/daily is the ideal in terms of efficacy, but doses as low as 50 mg/ daily show some efficacy, which could improve its tolerability in some patients.

OBJECTIVE

To analyse the behaviour of the different doses of topiramate in daily clinical practice.

PATIENTS AND METHODS

Patients with frequent migraine with or without aura episodes who received topiramate in our clinic were treated in a homogeneous way. Initially they were given 50 mg/daily (usually as a nocturnal dose), after increasing the dose in 2-3 weeks. The efficacy was evaluated after 6-8 weeks. If no response (decrease in frequency by at least 50%) was observed the dose of topiramate was increased (25 mg/week) up to 100 mg/daily, The patients were seen at least once every 3 months.

RESULTS

This series includes 182 patients. Globally, 75% of the patients responded, 14% did not respond and 11% did not tolerate the drug. One-quarter of patients (44 cases) responded to low doses, while 92 patients (51%) responded to the 100 mg/dose. Tolerability slightly decreased on increasing the dose.

CONCLUSIONS

These data indicate that one-quarter of the patients respond to low doses in daily clinical practice, though about half of these patients will need doses of 100 mg/day. Given the higher tolerability of low doses, we recommend trying first low doses before giving higher doses, which will be necessary in half of the patients.

[Kaposi sarcoma associated with systemic corticosteroid therapy]

Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi. Its epidemiology is suggestive of an infectious disease and in 1994 Chang and coworkers identified DNA sequences corresponding to a previously unidentified herpes virus--human herpes virus 8 (HHV-8)--in AIDS-associated KS biopsies. It is now believed that the presence of HHV-8 is a necessary condition but not sufficient on its own to cause KS. Other factors such as immunosuppression should also be considered and it is known that immunosuppressive therapy increases the risk of KS. We describe a patient who developed KS after prolonged prednisone therapy for temporal arteritis.

Mean magnetic moment of polydisperse superparamagnetic nanoparticles: correlation between grain size and magnetic moment distributions

The field dependence of magnetization in superparamagnetic systems can be fitted using a set of Langevin contributions characterized by their particle densities and their magnetic moments. In fact, these contributions are just partial average values over the actual magnetic moment distribution of the system. The achievement of the most adequate mean magnetic moment is non-trivial and depends on the characteristics of the moment distribution and the applied magnetic field range. As an example, results have been applied to a nanocrystalline alloy.

Positron emission tomography: indications in lung cancer - prospective experience of a department

Positron emission tomography (PET) is a new technique in nuclear medicine. It uses biological radiotracers such as (18)F-fluoro-2-deoxyglucose (FDG) which permit the detection of suspected lesions with metabolic alterations that take up the glucose isotope too avidly, as is the case with neoplastic cells. PET has become an innovatory and important imaging tool for evaluating patients with lung cancer. The present recommended uses of PET include lung cancer diagnosis and the intrathoracic and extrathoracic staging in N-SCLC.

The diagnostic usefulness of AUDIT and AUDIT-C for detecting hazardous drinkers in the elderly

We compare the diagnostic usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT alcohol consumption questions (AUDIT-C) for detecting hazardous drinkers between the populations over and less than 65 years in primary care settings. To assess weekly alcohol intake an interview on quantity-frequency was administered to 602 patients. Hazardous drinking was defined as a level of consumption of 280 g of alcohol per week for men and 168 g for women. The participants received AUDIT, AUDIT-C and CAGE questionnaires. Gamma-glutamyltransferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were also determined. Average weekly alcohol intake among the population aged 65 and older was 83 g, and 10% were hazardous drinkers. In this age group, the sensitivities of AUDIT and AUDIT-C for detecting this type of drinkers were 67% and 100%, whereas specificities were 95% and 81% respectively. In the younger patient group, the sensitivities were 84% and 100% and the specificities 95% and 79% respectively. In conclusion, both AUDIT and AUDIT-C perform well at detecting hazardous drinkers in the group older than 65 years and that their sensitivities and specificities are comparable to those in younger ages.

Diagnostic usefulness of brief versions of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers in primary care settings

OBJECTIVE

The aim of this study was to evaluate the diagnostic usefulness of the brief versions of the Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers and to compare it with that of the full-AUDIT in primary care settings.

METHOD

Five hundred patients were randomly selected in a primary care center. An interview on quantity-frequency was administered for assessment of weekly alcohol intake. The standard used for classification of hazardous drinkers was a weekly alcohol consumption of 280 g for men and 168 g for women. Cut-off points were 8 for the full-AUDIT, 1 for the AUDIT-3 (third item), 3 for the AUDIT-C (items 1, 2 and 3), 5 for the AUDIT-PC (items 1, 2, 4, 5 and 10) and 3 for the modified Fast Alcohol Screening Test (m-FAST; items 3, 5, 8 and 10). Sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic (AUROC) curves were measured.

RESULTS

Diagnostic usefulness of the questionnaires for detecting hazardous drinkers was for the full-

AUDIT

81.4% sensitivity, 94.6% specificity and 0.97 AUROC curve; for the AUDIT-3: 83.1% sensitivity, 90.9% specificity and 0.89 AUROC curve; for the AUDIT-C: 100% sensitivity, 79.4% specificity and 0.97 AUROC curve; for the AUDIT-PC: 98.3% sensitivity 90.9% specificity and 0.97 AUROC curve; and for the m-FAST: 79.7% sensitivity, 93.7% specificity and 0.93 AUROC curve.

CONCLUSIONS

The AUDIT-C and AUDIT-PC show a higher sensitivity, lower specificity and a similar AUROC curve than the full-AUDIT, thus allowing their use as screening instruments that are as reliable as the original test for detecting hazardous drinkers. The AUDIT-3 and m-FAST, when compared with the full-AUDIT, performed less well, therefore limiting their use for this purpose.