The Impact on Ambulance Mobilisations of an Increasing Age Profile of Telecare Service Users Receiving Advanced Proactive, Personalised Telecare in Spain-a Longitudinal Study 2014-2018.

Advanced proactive personalised telecare services in Spain have helped service users to live independently in their own homes for longer. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased. The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n = 202.1 k to 247.9 k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services over the period 2014-2018. For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user's dependency levels, and marginal negative correlation in older age bands. In conclusion, the increasing age at cessation has not correlated with an increased proportion of higher dependency service users. Indeed, the share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands.

Lutetium-177-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer.

BACKGROUND: Metastatic castration-resistant prostate cancer remains fatal despite recent advances. Prostate-specific membrane antigen (PSMA) is highly expressed in metastatic castration-resistant prostate cancer. Lutetium-177 (177Lu)-PSMA-617 is a radioligand therapy that delivers beta-particle radiation to PSMA-expressing cells and the surrounding microenvironment. METHODS: We conducted an international, open-label, phase 3 trial evaluating 177Lu-PSMA-617 in patients who had metastatic castration-resistant prostate cancer previously treated with at least one androgen-receptor-pathway inhibitor and one or two taxane regimens and who had PSMA-positive gallium-68 (68Ga)-labeled PSMA-11 positron-emission tomographic-computed tomographic scans. Patients were randomly assigned in a 2:1 ratio to receive either 177Lu-PSMA-617 (7.4 GBq every 6 weeks for four to six cycles) plus protocol-permitted standard care or standard care alone. Protocol-permitted standard care excluded chemotherapy, immunotherapy, radium-223 (223Ra), and investigational drugs. The alternate primary end points were imaging-based progression-free survival and overall survival, which were powered for hazard ratios of 0.67 and 0.73, respectively. Key secondary end points were objective response, disease control, and time to symptomatic skeletal events. Adverse events during treatment were those occurring no more than 30 days after the last dose and before subsequent anticancer treatment. RESULTS: From June 2018 to mid-October 2019, a total of 831 of 1179 screened patients underwent randomization. The baseline characteristics of the patients were balanced between the groups. The median follow-up was 20.9 months. 177Lu-PSMA-617 plus standard care significantly prolonged, as compared with standard care, both imaging-based progression-free survival (median, 8.7 vs. 3.4 months; hazard ratio for progression or death, 0.40; 99.2% confidence interval [CI], 0.29 to 0.57; P<0.001) and overall survival (median, 15.3 vs. 11.3 months; hazard ratio for death, 0.62; 95% CI, 0.52 to 0.74; P<0.001). All the key secondary end points significantly favored 177Lu-PSMA-617. The incidence of adverse events of grade 3 or above was higher with 177Lu-PSMA-617 than without (52.7% vs. 38.0%), but quality of life was not adversely affected. CONCLUSIONS: Radioligand therapy with 177Lu-PSMA-617 prolonged imaging-based progression-free survival and overall survival when added to standard care in patients with advanced PSMA-positive metastatic castration-resistant prostate cancer. (Funded by Endocyte, a Novartis company; VISION ClinicalTrials.gov number, NCT03511664.).

Morphology of the physiological apical foramen of maxillary premolars / Morfología del foramen apical de premolares maxilares

SUMMARY: The purpose of this study was to determine the shape and diameter of the physiological foramen in maxillary premolars of a Chilean population. The sample consisted of 125 extracted maxillary premolars, in which the apical three to five millimeters were cut and observed under magnification of 40x, photographed (Motic Cam), and analyzed using Motic Images Plus 2.0 ML in order to obtain measurements of the minor and major diameter of each physiological foramen. The average minor and major diameter in maxillary premolars was 0.270 and 0.413 mm, respectively. In terms of shape, 72.19 % had oval shaped physiological foramen; 18.93 % were irregularly shaped and 8.88 % were round. Oval and irregular canals are significantly more difficult to shape and require special attention in order to obtain a thoroughly disinfected root canal system.

RESUMEN: El objetivo del estudio fue determinar la forma y el diámetro del foramen fisiológico de premolares maxilares en una población Chilena. La muestra consistió en 125 premolares maxilares extraídos, a los que se cortó de 3 a 5 milímetros apicales, fueron observados bajo magnificación de 40x, fotografiado (Motic Cam) y analizados utilizando Motic Images Plus 2.0 ML para obtener las mediciones de el diámetro menor y mayor de cada foramen fisiológico. El promedio del diámetro menor y mayor en premolares maxilares fue de 0,270 y 0,413 mm respectivamente. En cuanto a la forma 72,19 % tenía el foramen fisiológico de forma oval; 18,93 % tenía forma irregular y 8,88 % fue redondo. Canales ovales e irregulares son significativamente más difíciles de conformar y requieren especial atención para obtener una adecuada desinfección del sistema de canales radiculares.

Evaluación de la contaminación del aire por hongos microscópicos en dos colecciones biológicas y dos museos de la ciudad de Guatemala / Evaluation of air pollution by microscopic fungi in two biological collections and two museums of Guatemala

Se determinó la calidad del aire en el interior y exterior de la Micoteca Licenciado Rúben Mayorga Peralta (MICG), el Herbario de Biología de Guatemala (Herbario BIGU), el Museo de Historia Natural (MUSHNAT) y el Museo de la Universidad de San Carlos de Guatemala (MUSAC). Para la recolección de los hongos microscópicos se utilizó la técnica volumétrica por impactación haciendo uso de un biocolector. Los muestreos fueron realizados de octubre de 2011 a marzo de 2012, la identificación microscópica se realizó por medio de preparaciones con azul de lactofenol y para la identificación de levaduras se utilizó el API 20C AUX. Los resultados obtenidos en los ambientes Micoteca Licenciado Rúben Mayorga Peralta indican que la mayor concentración fúngica fue de 1,780, (unidad formadora de colonias por metro cúbico UFC/m3) en el exterior y para el interior fue de 1,270 UFC/m3, en el caso del Herbario BIGU en el exterior fue de 2,790 UFC/m3y en el interior de 1,450 UFC/m3, para el MUSAC la mayor concentración observada fue de 990 UFC/m3 para el exterior y de 1,010 UFC/m3 para el interior, y para el MUSHNAT en el caso del ambiente exterior fue de 1,630 UFC/m3 y para el interior fue de 2,850 UFC/m3. Los géneros predominantes durante los muestreos en ambos ambientes en todas las áreas muestreadas fueron Penicillium sp., Cladosporium sp. y Aspergillus sp. Se logró el aislamiento de otros géneros fúngicos de gran importancia Fusarium sp. y Paecilomyces sp. Se llevó a cabo la elaboración de una guía que contiene información acerca de procedimientos de limpieza y bioseguridad acorde a la infraestructura y materia prima de cada establecimiento.

Air quality was determined both inside and outside the Micoteca Licenciado Rubén Mayorga Peralta (MICG), the Herbarium of the School of Biology (BIGU), the Museum of Natural History (MUSHNAT) and the Museum of the University of San Carlos of Guatemala (MUSAC). Volumetric sampling (impaction) with a bio-colector was used to gather microscopic fungi. The samples were collected from Oct 2011 to Mar 2012. Microscopic identification was performed using slides with lactophenol blue; while API 20C AUX was used for the identification of yeasts. The results obtained were 1,780 CFU/m3 outside and 1,270CFU/m3 inside for MICG; 2,790 CFU/m3 outside and 1,450 CFU/m3 inside for BIGU; 990CFU/m3 outside and 1,010 CFU/m3 inside for MUSAC, and finally 1,630 CFU/m3 outside and2,850 CFU/m3 inside for MUSHNAT. The predominant genera found in both environmentsof all sites were Penicillium sp., Cladosporium sp. and Aspergillus sp. It was also possible toisolate other extremely important fungal genera such as Fusarium sp. and Paecilomyces sp. A guide was developed with information about the proper cleaning and biosafety proceduresaccording to the infrastructure and raw materials of each site.