Use of healthcare REsources and associated COsts in controlled versus uncontrolled carcinoid SYndrome in patients with neuroendocrine tumours: the RECOSY study.

PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean €5511.59 vs €1457.22; P = 0.028) and ED costs (€161.25 vs €14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.

Photoluminescence emission from nanostructured porous preparations of CdS-ZnTiO3 assembled nanoparticles.

This study reports the structural and optical properties of CdS/ZnTiO3 nanocomposites prepared using a chemical bath and different titanate concentrations. Commercial ZnTiO3 nanoparticles were introduced into a chemical bath that had been used to produce CdS semiconductor nanoparticles (NPs). Here, the growing CdS crystallites precipitated onto the suspended zinc titanate NPs. X-ray diffraction patterns revealed that samples of CdS/ZnTiO3 nanopowders were made of cubic ZnTiO3 and hexagonal CdS wurtzite. The morphology of the particles was studied using transmission electron microscopy and scanning electron microscopy images. These images demonstrated the different characteristics of the CdS/ZnTiO3 nanocomposites and their dependence on titanate concentration when placed into the CdS-growing solution. Photoluminescence spectra showed three main emission bands for the electron transitions in the CdS/ZnTiO3 composite. This composite produced three photoluminescence bands, the intensities of which depended on composite shape, which in turn depended on the relative concentrations of CdS and ZnTiO3 .

Unveiling optical in-plane anisotropy of 2D materials from oblique incidence of light.

In this work, we present a theoretical study of the dispersion of linearly polarized light between two dielectric media separated by an anisotropic two-dimensional (2D) material under oblique incidence. Assuming that the 2D material is a conducting sheet of negligible thickness, generalized Fresnel coefficients are derived as a function of usual quantities (e.g. refraction indexes and scattering angles) and the anisotropic in-plane optical conductivity of the interstitial 2D material. In particular, we analyzed the modifications due to the 2D material of two classical optical phenomena: the Brewster effect and the total internal reflection. As a application, our general findings are particularized for uniaxially strained graphene. Effects of a uniaxial strain on the Brewster angle and the reflectance (under total internal reflection) are evaluated as a function of the magnitude and direction of strain.

Low Serum Tryptophan Levels as an Indicator of Global Cognitive Performance in Nondemented Women over 50 Years of Age.

Aging is a physiological decline process. The number of older adults is growing around the world; therefore, the incidence of cognitive impairment, dementia, and other diseases related to aging increases. The main cellular factors that converge in the aging process are mitochondrial dysfunction, antioxidant impairment, inflammation, and immune response decline, among others. In this context, these cellular changes have an influence on the kynurenine pathway (KP), the main route of tryptophan (Trp) catabolism. KP metabolites have been involved in the aging process and neurodegenerative diseases. Although there are changes in the metabolite levels with age, at this time, there is no study that has evaluated cognitive decline as a consequence of Trp catabolism fluctuation in aging. The aim of this study was to evaluate the relation between the changes in Trp catabolism and cognitive impairment associated with age through KP metabolites level alterations in women over 50 years of age. Seventy-seven nondemented women over 50 years old were examined with a standardized cognitive screening evaluation in Spanish language (Neuropsi), Beck anxiety inventory (BAI), and the geriatric depression scale (GDS). Also, serum levels of Trp, kynurenine (Kyn), kynurenic acid (KYNA), and 3-hydroykynurenine (3-HK) and the glutathione ratio (GSH/GSSG) were measured. Results showed a negative correlation between age and Trp levels and a positive correlation between age and KYNA/Trp and 3-HK/Trp ratios. The level of cognitive impairment showed a significant positive association with age and with kynurenine pathway activation and a significant negative correlation with Trp levels. The GSH/GSSG ratio correlated positively with Trp levels and negatively with Kyn/Trp and 3-HK/Trp ratios. The depression score correlated negatively with Trp and positively with the 3-HK/Trp ratio. We concluded that KP activation increases with age and it is strongly associated with the level of cognition performance in nondemented women over 50 years of age.

Evaluation of the clinical usefulness of a health-related quality of life questionnaire in patients with prostate cancer.

OBJECTIVES: The PROSQoLI questionnaire evaluates health related quality of life in patients with advanced prostate cancer. Although its utility in different clinical settings has never been assessed, its brevity and good measurement properties make its use recommendable in clinical practice. The objective is to evaluate the clinical usefulness of PROSQoLI in clinical treatment decision-making in patients with prostate cancer. MATERIALS AND METHODS: An observational, prospective longitudinal and multi-center study conducted in different Spanish centers. Sociodemographic and clinical data of patients and researchers were collected. Each patient fulfilled PROSQoLI questionnaire in each visit. Besides, physicians answered a survey about clinical usefulness of PROSQoLI questionnaire. RESULTS: The mean age of patients was 74.7 (7.4) years (standard deviation) and of researchers 51.8 (9.7) years. The usefulness in clinical decision-making was considered high by 66.1% of physicians; regarding questionnaire characteristics 71.3% of physicians considered it highly useful and 73.4% of them regarding doctor-patient communication. CONCLUSIONS: The use of health-related quality of life questionnaires improves doctor-patient communication. It is demonstrated that PROSQoLI can be an additional tool in clinical decision-making as well as a means of facilitating doctor-patient communication.

Evaluation of extraction methods for preparative scale obtention of mangiferin and lupeol from mango peels (Mangifera indica L.).

Bioactive compounds have become very important in the food and pharmaceutical markets leading research interests seeking efficient methods for extracting these bioactive substances. The objective of this research is to implement preparative scale obtention of mangiferin and lupeol from mango fruit (Mangifera indica L.) of autochthonous and Ataulfo varieties grown in Nayarit, using emerging extraction techniques. Five extraction techniques were evaluated: maceration, Soxhlet, sonication (UAE), microwave (MAE) and high hydrostatic pressures (HHP). Two maturity stages (physiological and consumption) as well as peel and fruit pulp were evaluated for preparative scale implementation. Peels from Ataulfo mango at consumption maturity stage can be considered as a source of mangiferin and lupeol using the UEA method as it improves extraction efficiency by increasing yield and shortening time.

[Validation in Spain of the quality of life questionnaire PROSQOLI in patients with advanced prostate cancer]. / Validación en España del cuestionario de calidad de vida PROSQOLI en pacientes con cáncer de próstata avanzado.

OBJECTIVES: Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. MATERIAL AND METHODS: A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. RESULTS: Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. CONCLUSIONS: The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.

[Autoimmune pancreatitis associated with retroperitoneal fibrosis: outcome after 24 months of follow-up]. / Pancreatitis autoinmune asociada a fibrosis retroperitoneal: evolución tras dos años de seguimiento.

INTRODUCTION: Autoimmune pancreatitis is a kind of chronic pancreatitis characterized by the presence of lymphoplasmacytic infiltration and severely elevated serum IgG and IgG4, which has been associated to many extrapancreatic lesions and other autoimmune disorders, leading to the theory of an autoimmune mechanism involved in the pathogenesis of this disease. CASE REPORT: We report the case of a man who simultaneously presented with autoimmune pancreatitis associated with retroperitonal fibrosis, and a lesion of the extrapancreatic bile duct, with total response to corticosteroid treatment for 4 months and absence of recurrence after 24 months of follow-up. DISCUSSION: Autoimmune pancreatitis is a kind of chronic pancreatitis that is probably a part of a systemic autoimmune disease, with retroperitoneal fibrosis and extrapancreatic bile duct lesion being the most commonly associated extrapancreatic lesions. A correct diagnosis and early treatment of this disease may aid in the total resolution of lesions, especially in cases with a low activity grade.

[Interventional radiology, angioplasty and TIPS in Budd-Chiari syndrome]. / Procedimientos radiológicos intervencionistas, angioplastia y DPPI en el tratamiento del síndrome de Budd-Chiari.

INTRODUCTION: Budd-Chiari syndrome consists of complete or partial obstruction of the hepatic veins. Many treatment options are available; new interventional radiology techniques may play an important role as an alternative to surgical shunting. PATIENTS AND METHOD: Of 11 patients diagnosed with Budd-Chiari syndrome, 7 were treated with percutaneous balloon angioplasty or transjugular intrahepatic portosystemic shunt (TIPS) (2 and 5 patients, respectively). The efficacy of both techniques in the treatment of this syndrome was evaluated. RESULTS: Two patients presented significant isolated stenosis of a suprahepatic vein and underwent percutaneous balloon angioplasty. In both patients outcome was favorable with resolution of ascites. Five patients underwent TIPS and four showed clinical improvement with significant reduction in Child-Pugh score (p < 0.05) and resolution of ascites. No shunt malfunction was detected during follow-up. One patient showed no improvement after placement of TIPS and died soon after the procedure and a further two died from their underlying disease during follow-up. CONCLUSIONS: Treatment of Budd-Chiari syndrome requires multidisciplinary evaluation and should be individualized. In patients with Budd-Chiari syndrome uncontrolled by medical therapy, TIPS may become the decompressive method of choice as an alternative to surgical shunting. Liver transplantation may be reserved to patients in whom these techniques are ineffective.

Liver transplantation for fulminant and subfulminant hepatic failure.

AIMS: The aim of this study was to assess the long-term course and outcome after liver transplantation (LTX) for fulminant/subfulminant hepatic failure (FSHF) to determine which factors relate to outcome. PATIENTS AND METHODS: Between April 1990 and October 2002, 30 adult patients with FSHF underwent LTX. King's College criteria were used to decide which patients needed LTX. Pretransplantation parameters (age, sex, degree of hepatic encephalopathy, etiology, and time between onset of symptoms and LTX) were examined as risk factors for LTX outcome. RESULTS: Mean age at LTX was 40.4+/-13.9 years and 46.7% were men. The most frequent causes of FSHF were virus B in 23.3%, autoimmune hepatitis in 23.3%, and cryptogenic in 20%. Fifty percent of the patients with a survival longer than 15 days suffered episodes of acute rejection; chronic rejection occurred in 25%. One- and five-year patient and allograft survival rates for FSHF were 56.3% and 54.7%, respectively. Autoimmune hepatitis was the only factor associated with better posttransplantation outcome, although there were no differences in posttransplant course. Patient survival rates increased during the study period. During the first 5 years (1990-1995) the survival rates were 53.3% (1-year and 5-year), whereas they were 60% at 1 and 5 years in the second interval (1996-2002). CONCLUSIONS: The mortality rate of FSHF is high during the first year post-LTX. LTX for FSHF of autoimmune etiology showed better outcomes with increasing patient survival rates during the study period.

Liver transplantation for autoimmune hepatitis: fulminant versus chronic hepatitis presentation.

AIMS: The aim of this study was to analyse long-term outcomes of patients with liver transplantation for autoimmune hepatitis and to determine if fulminant/subfulminant hepatic failure (FSHF) at presentation was a predictor of outcome after ortothopic liver transplantation. PATIENTS AND METHODS: Between April 1990 and October 2002, 18 patients with autoimmune hepatitis underwent 21 liver transplants. Three patients were excluded because of coexisting causes of hepatitis. Seven patients had FSHF and eight patients had chronic disease. The initial immunosuppressive regimen was cyclosporine based in 80%, and all but one patient received steroids or azathioprine. RESULTS: Mean age at time of transplant was 44.2+/-15.5 years. Patients were followed for 38.9+/-29.6 months. Five patients (33.3%) had seven episodes of acute rejection (two steroid-resistant). Three patients developed chronic rejection. One patient displayed histologically proven recurrent autoimmune hepatitis. Actuarial patient and graft survival rates at 1 and 5 years were 80% and 56% and 78.6% and 51%, respectively. No differences in the clinical characteristics of the patients, rates of acute or chronic rejection episodes, end biliary or arterial complications were observed between FSHF and chronic autoimmune hepatitis. The study suggests a better survival for autoimmune FSHF (P=.003). CONCLUSIONS: Liver transplant is indicated for patients displaying autoimmune chronic liver disease and FSHF with similar clinical courses at however, patients with FSHF at presentation had better survivals.

[Exclusive radiotherapy in bladder cancer]. / Radioterapia exclusiva en el cáncer de vejiga.

OBJECTIVE: The indications for treatment of superficial and infiltrating tumors of the urinary bladder by radiotherapy alone are analyzed. METHODS: The records of 468 patients treated at the Oncological Radiotherapy Department of the Clinica Puerta de Hierro in Madrid and data from the literature were reviewed. RESULTS: Radiotherapy continues to be a conservative alternative to radical cystectomy in infiltrating bladder cancer. Although the survival rates are slightly lower than those of the more recent series of patients treated by cystectomy, the cystectomy series report the results of retrospective studies in patients that were not randomized and with a bias in patient selection. The best results are obtained in young adult patients with T2-T3a tumors and no ureteral obstruction. In superficial bladder tumors, radiotherapy might be useful in recurrences of T1G3 managed conservatively. Its value as an adjuvant therapy has yet to be defined and is currently under study. Palliative radiotherapy for bladder cancer achieves satisfactory results in the control of hematuria and pain. CONCLUSIONS: Radiotherapy is a radical therapeutic option in infiltrating tumor of the bladder that must be considered as an alternative to radical cystectomy, perhaps within the context of current strategies of combination radio and chemotherapy.

[Prognostic factors in prostatic carcinoma treated with radical radiotherapy: stages A, B, and C]. / Factores pronósticos en el carcinoma de próstata tratado con radioterapia radical: estadios A, B y C.

Analysis of a series of 118 patients with histological diagnosis of prostate carcinoma, localized stages A2, B and C, treated with external radiotherapy with radical purpose between July 1964 and December 1991. The 5-year cause-specific survival was 69% years and 62% at 10 years. Disease-free survival was 56% and 48% at 5 and 10 years respectively. Local, locoregional and distant relapse-free survivals were 91%, 75% and 65% at 10 years respectively. Several factors characterize each tumour, influencing the therapy failure. In our series, non-differentiated, stage C tumours with pathological LDH levels at diagnosis and treated with AP-PA fields showed decreased survival and greater relapse ratios. Two separate factors influence on distant failure: LDH pathological levels at diagnosis and non-differentiated tumours. External radiotherapy is a therapeutical alternative in localized stages of prostate carcinoma, which offers little morbidity and good tolerance, similar results to those obtained with surgical treatment.

Congenital Acute Megakaryoblastic Leukaemia in Down's Syndrome.

The case of a newborn with Down's syndrome and congenital leukaemia is reported. The malignant white blood cells displayed the CD41 antigen (glycoprotein Ilb/IIIa) identified by monoclonal antibodies HP1-ld and FMC24 and the CD9/p24 antigen identified by monoclonal antibody FMC27. The number of cells in S-phase was 14%, as assessed by the incorporation of 5-bromo 2-deoxyuridine. No other chromosomal abnormalities were identified in addition to 47 XY + 21. The patient died 15 days after the diagnosis, due to Pneumocystis Carinii pneumonia. Post-mortem examination showed heavy leukaemic infiltration and cardiac abnormalities including inter-atrial septal defect and a patent Ductus arteriosus. This patient appears to be the first identified case of congenital leukaemia with megakaryocytic differentiation, although previous instances of transient abnormal myelopoiesis with megakaryocytic differentiation have been recorded in Down's syndrome.

Individual risk of abdominal disease in patients with stages I and II supradiaphragmatic Hodgkin's disease. A rule index based on 341 laparotomized patients.

A multivariate analysis of the prognostic factors for clinical Stages I and II supradiaphragmatic Hodgkin's disease was carried out with a logistic regression model in 341 patients. The proportion of patients with positive staging laparotomy was greater in males, in individuals with several sites involved, mixed cellularity (MC) or lymphocyte depletion (LD) histologic types, systemic symptoms, or in patients with lower cervical involvement and higher erythrocyte sedimentation rate (ESR), serum copper, and LDH levels. Histology, presence of systemic symptoms (fever and sweats), and number of involved nodal regions were independent predictors of positive laparotomy. Mediastinal involvement is correlated to a significantly lower risk of positive laparotomy. Based on these observations, the individual risk for each patient of occult abdominal disease has been defined.