SpaceOAR Hydrogel in Dose-escalated Prostate Cancer Radiotherapy: Rectal Dosimetry and Late Toxicity.

AIM: To investigate the feasibility, dosimetric benefits and late toxicity of a temporary hydrogel spacer between the rectum and the prostate for prostate intensity-modulated radiotherapy. MATERIALS AND METHODS: Thirty patients with prostate cancer were enrolled on a phase I/II study. All patients underwent magnetic resonance imaging before and after placement of 10 cm(3) of hydrogel. The first 10 patients had an additional magnetic resonance imaging after the completion of radiation treatment. SpaceOAR hydrogel was injected under general anaesthetic using a transperineal approach with transrectal ultrasound guidance. Primary end points were perioperative toxicity and comparison of rectal dosimetry. Secondary end points included cute and late radiation toxicity. All patients were planned on both pre- and post-hydrogel scans to a D95 of 80 Gy in 40 fractions. A contemporary control group of 110 prostate cancer patients treated with the same prescription was identified for comparison. RESULTS: There were no perioperative complications. Rectal doses were significantly lower for the post-hydrogel plans, especially above 65 Gy (V82 = 0.2% versus 1.3%; V80 = 0.8% versus 5.3%; V75 = 2.2% versus 9.5%; V70 = 3.7% versus 12.3%; V65 = 5.4% versus 14.7%; V40 = 22.9% versus 32% and V30 = 42.7% versus 49.4%). There was no significant difference in acute grade 1 and 2 gastrointestinal toxicity, which was 43% versus 51% and 0% versus 4.5% in the hydrogel and control groups, respectively. Late grade 1 was significantly less frequent in the hydrogel group (16.6% versus 41.8%, P = 0.04). CONCLUSION: SpaceOAR hydrogel was inserted with minimal side-effects. Dosimetric benefits were greatest at higher rectal doses (V65 to V82). Late grade 1 gastrointestinal toxicity was significantly lower than that seen in patients treated without hydrogel.

Aspectos relacionados con caídas y equilibrio de los ancianos residentes en un centro sociosanitario / Aspects related to falls and balance of elderly residents in a care system

Introducción. El objetivo de este estudio ha sido evaluar, en los ancianos que están ingresados en un sistema sociosanitario y que realizan rehabilitación, algunas condiciones como equilibrio y movilidad funcional, así como conocer la prevalencia de las caídas y sus factores relacionados. Método. Realizamos un estudio de carácter transversal con individuos de 65 o más años de edad pertenecientes a nuestro hospital. Los que tenían condiciones de caminar con o sin la necesidad de ayudas técnicas realizaron la prueba del test timed up and go y la escala de Tinetti. Resultados. Participaron en este estudio 32 adultos mayores (79,9±8,2 años), 14 no tenían capacidad de marcha. En relación con el tiempo de ejecución del test TUG, la media fue de 45,07±28,18s, y de 8,8±8,1 puntos para la escala de Tinetti. De los 28 sujetos que tenían condiciones patológicas, 22 tenían hipertensión. En este estudio, el 80% de los sujetos se habían caído y la mitad de los ingresos se debió a las consecuencias de las caídas. La pérdida del equilibrio fue la causa principal de las caídas y las fracturas del fémur fueron el resultado más frecuente de estas. Las razones principales para la institucionalización fueron el ictus y las fracturas de fémur. Conclusiones. Hay una alta prevalencia de caídas entre las personas de edad en un sistema sociosanitario. Muchas personas están ingresadas debido a las caídas que han tenido como causa principal la falta de equilibrio(AU)

Introduction. The aim of this study was to evaluate certain conditions such as balance and functional mobility and the prevalence of falls and related factors in the elderly who are admitted to a health care system and who are undergoing rehabilitation. Method. We carried out a cross-sectional study of individuals over 65 belonging to our hospital. The timed up and go test and the Tinetti scale were performed in those who were able to walk with or without assistance. Results. In this study, 32 elderly (79.9±8.2) years, 14 of whom had no ability to walk. Regarding the time of up and go test, the average was 45.07±28.18seconds, and 8.8±8.1 points for Tinetti scale. Of the 28 subjects with medical conditions, 22 had hypertension. In this study, 80% of subjects had fallen and half of the admissions were caused by falls. The main reasons for institutionalization were stroke and femur fractures. Conclusions. There is a high prevalence of falls among the elderly in a health care system. Many of those admitted were because of falls, these basically caused by lack of balance(AU)

Comparison of the safety and efficacy of cyclosporine minimization versus cyclosporine elimination in de novo renal allograft patients receiving sirolimus.

The safety and efficacy of concentration-controlled use of sirolimus (SRL) and cyclosporine (CsA) followed by CsA minimization (CsAm) or elimination (CsAe) beginning at week 13 was compared in a phase 4, open-label, randomized (1:1) trial of renal transplant recipients enrolled between March 2004 and November 2005. The primary endpoint was renal function, measured at 12 months using the Nankivell formula, in patients remaining on therapy. Though a total enrollment of 140 patients in each group was planned to provide an 80% power to detect a difference in means, only 207 subjects were enrolled in this study. Demographic characteristics were similar between groups, with 98.1% recipients of first grafts, 69.1% from living donors, and 7.2% diabetics. At 12 months, there were no differences in renal function (61.08 vs 65.24 mL/min, P = .132); incidence of biopsy-confirmed acute rejection (14.3% vs 22.5%, P = .152); and patient (89.5% vs 92.2%, P = .632), graft (87.6% vs 88.2%, P = .999), and death-censored graft (98.1% vs 94.1%, P = .166) survivals between CsAm and CsAe groups, respectively. There were no differences in the overall rate of study-drug discontinuation (32.4% vs 36.3%, P = .562) but more patients discontinued because of lack of efficacy/graft loss in the CsAe group (4.8% vs 14.7%, P = .018). This study was underpowered to demonstrate the superiority of one regimen over the other. In summary, SRL immunotherapy combined with CsA minimization or elimination showed comparative safety and efficacy. Both regimens offer potential treatment options for de novo renal allograft recipients.

Postural stability of elderly submmitted to multisensorial physical therapy intervention.

The present study investigated the influence of a regular Physical Therapy program with emphasis on proprioceptive stimulation, on the center pressure trajectory and muscle adjustments necessary to maintain balance on orthostatic position. After medical assessment, 29 subjects (63.06 +/- 2.84 years) were submitted to electromyographic and baropodometric evaluation and, subsequently, to a program of 12 weeks of physical therapy intervention focusing on proprioceptive stimulation. The oscillation of the pressure center (Pressure platform-MatScanTekscan) was evaluated concomitantly to electromyographic signal envelopment and median frequency assessment of anterior tibial and gastrocnemius muscles (signal conditioner module--MCS 1000-V2-LYNX ). The Wilcoxon test was used for comparison of means, with the significance level of 5%. The pressure center trajectory unipodal position with open eyes (UO) decreased significantly after physical therapy intervention. In this position, there was a reduction of the electromyographic signal envelopment and an increase on median frequency of the gastrocnemius muscle, while the anterior tibial muscle showed increased median frequency after intervention. For the unipodal position with closed eyes (UC), the anterior tibial muscle showed significant electromyographic signal envelopment decrease and increase of median frequency, which also increased for the gastrocnemius muscle. It is concluded that the physical therapy intervention promoted decrease of body oscillation, recruitment improvement and adjustment of the gastrocnemius and anterior tibial muscles, contributing to the postural balance improvement in orthostatic position on senior population.

Preservation of graft function in low-risk living kidney transplant recipients treated with a combination of sirolimus and cyclosporine

The use of sirolimus (SRL) in combination with full doses of cyclosporin A (CsA) results in reduced one-year kidney allograft function, which is associated with shorter long-term allograft survival. We determined the effect of reduced CsA exposure on graft function in patients receiving SRL and prednisone. Ninety recipients of living kidney transplants receiving SRL (2 mg/day, po) were compared to 35 recipients receiving azathioprine (AZA, 2 mg kg-1 day-1, po). All patients also received CsA (8-10 mg kg-1 day-1, po) and prednisone (0.5 mg kg-1 day-1). Efficacy end-point was a composite of biopsy-confirmed acute rejection, graft loss, or death at one year. Graft function was measured by creatinine, creatinine clearance, and graft function deterioration between 3 and 12 months (delta1/Cr). CsA concentrations in patients receiving SRL were 26 percent lower. No differences in one-year composite efficacy end-point were observed comparing SRL and AZA groups (18 vs 20 percent) or in the incidence of biopsy-proven acute rejection (14.4 and 14.3 percent). There were no differences in mean ± SD creatinine (1.65 ± 0.46 vs 1.60 ± 0.43 mg/dl, P = 0.48) or calculated creatinine clearances (61 ± 15 vs 62 ± 13 ml/min, P = 0.58) at one year. Mean ± SD delta1/Cr (-11 ± 17 vs -14 ± 15 percent, P = 0.7) or the percentage of patients with >20 percent (26 vs 31 percent, P = 0.6) or >30 percent delta1/Cr (19 vs 17 percent, P = 1) did not differ between the two groups. The use of 2-mg fixed oral doses of SRL and reduced CsA exposure was effective in preventing acute rejection and preserving allograft function.

Preservation of graft function in low-risk living kidney transplant recipients treated with a combination of sirolimus and cyclosporine.

The use of sirolimus (SRL) in combination with full doses of cyclosporin A (CsA) results in reduced one-year kidney allograft function, which is associated with shorter long-term allograft survival. We determined the effect of reduced CsA exposure on graft function in patients receiving SRL and prednisone. Ninety recipients of living kidney transplants receiving SRL (2 mg/day, po) were compared to 35 recipients receiving azathioprine (AZA, 2 mg kg-1 day-1, po). All patients also received CsA (8-10 mg kg-1 day-1, po) and prednisone (0.5 mg kg-1 day-1). Efficacy end-point was a composite of biopsy-confirmed acute rejection, graft loss, or death at one year. Graft function was measured by creatinine, creatinine clearance, and graft function deterioration between 3 and 12 months (delta1/Cr). CsA concentrations in patients receiving SRL were 26% lower. No differences in one-year composite efficacy end-point were observed comparing SRL and AZA groups (18 vs 20%) or in the incidence of biopsy-proven acute rejection (14.4 and 14.3%). There were no differences in mean +/- SD creatinine (1.65 +/- 0.46 vs 1.60 +/- 0.43 mg/dl, P = 0.48) or calculated creatinine clearances (61 +/- 15 vs 62 +/- 13 ml/min, P = 0.58) at one year. Mean +/- SD delta1/Cr (-11 +/- 17 vs -14 +/- 15%, P = 0.7) or the percentage of patients with >20% (26 vs 31%, P = 0.6) or >30% delta1/Cr (19 vs 17%, P = 1) did not differ between the two groups. The use of 2-mg fixed oral doses of SRL and reduced CsA exposure was effective in preventing acute rejection and preserving allograft function.

Systemic and hepatic hemodynamics in hepatosplenic Manson's schistosomiasis with and without propranolol.

Systemic and hepatic hemodynamics were prospectively studied in 11 patients with Manson's schistosomiasis and portal hypertension, as well as alterations resulting from the use of propranolol. It was decided that patients whose portal pressure was reduced by 30% with the use of the drug would not undergo surgery and that treatment would consist of the chronic use of propranolol, associated with sclerosis of esophageal varices. This objective was not met by any of the patients whose portal pressure was measured and the study was interrupted. Results show that patients with Manson's schistosomiasis and portal hypertension have hyperdynamic circulation, mild pulmonary hypertension, greatly increased splenic blood flow, and preservation of total hepatic blood flow. Administration of propranolol corrects hyperdynamic circulation, aggravates pulmonary hypertension, does not alter portal pressure and reduces the sectorial portal blood flows, especially of the azygos vein, with maintenance of total hepatic blood flow. These data favor the hypothesis of portal overflow in the physiopathology of portal hypertension of schistosomiasis.

On the occurrence of nuclei in mature sieve elements.

The secondary phloem of 3 species of the Taxodiaceae and 13 species of woody dicotyledons was examined for the occurrence of nuclei in mature sieve elements. Nuclei were found in all mature sieve cells of Metasequoia glyptostroboides, Sequoia sempervirens and Taxodium distichum, and in some mature sieve-tube members in 12 of the 13 species of woody dicotyledons. Except for nuclei of sieve cells undergoing cessation of function, the nuclei in mature sieve cells of M. glyptostroboides, S. sempervirens and T. distichum were normal in appearance. The occurrence and morphology of nuclei in mature sieve-tube members of the woody dicotyledons were quite variable. Only 3 species, Robinia pseudoacacia, Ulmus americana and Vitis riparia, contained some mature sieve elements with apparently normal nuclei.

Observations on albuminous cells in Pinus.

Albuminous cells were examined in seasonal collections of secondary phloem of Pinus banksiana, P. resinosa and P. strobus. It was determined that the only reliable criterion for the identification of albuminous cells is their conspicuous connections with sieve cells. Discrete bodies, which give positive protein reactions, were encountered in young albuminous cells. These bodies, which have been interpreted as slime bodies, eventually elongate in the cytoplasm and disappear. During periods of high starch content in other parenchymatous elements, albuminous cells may also contain starch.