Production of carbon-11 for PET preclinical imaging using a high-repetition rate laser-driven proton source.

Most advanced medical imaging techniques, such as positron-emission tomography (PET), require tracers that are produced in conventional particle accelerators. This paper focuses on the evaluation of a potential alternative technology based on laser-driven ion acceleration for the production of radioisotopes for PET imaging. We report for the first time the use of a high-repetition rate, ultra-intense laser system for the production of carbon-11 in multi-shot operation. Proton bunches with energies up to 10-14 MeV were systematically accelerated in long series at pulse rates between 0.1 and 1 Hz using a PW-class laser. These protons were used to activate a boron target via the 11 B(p,n) 11 C nuclear reaction. A peak activity of 234 kBq was obtained in multi-shot operation with laser pulses with an energy of 25 J. Significant carbon-11 production was also achieved for lower pulse energies. The experimental carbon-11 activities measured in this work are comparable to the levels required for preclinical PET, which would be feasible by operating at the repetition rate of current state-of-the-art technology (10 Hz). The scalability of next-generation laser-driven accelerators in terms of this parameter for sustained operation over time could increase these overall levels into the clinical PET range.

El efecto de la hipnoterapia en la calidad de sueño de mujeres con cáncer de mama / The effect of hypnotherapy in the sleep quality of women with breast cancer

Objetivo: El propósito de este estudio es comprobar la eficacia de la hipnoterapia en la calidad de sueño de mujeres con cáncer de mama, mientras recibían tratamiento médico estándar. Método: Participaron 40 pacientes con cáncer de mama en los primeros estadios, programadas para quimioterapia. Se conformaron dos grupos de 20 pacientes cada uno, a uno de los grupos se le aplicó una fase intensiva de 12 sesiones de hipnoterapia grupal durante un mes y una segunda fase de 12 sesiones cada quince días, durante seis meses mientras que el otro grupo (control) solo recibió tratamiento médico estándar. La calidad de sueño de las pacientes de ambos grupos fue evaluada con el Índice de Calidad de Sueño de Pittsburgh (ICSP) que se aplicó antes de la intervención, así como al término de las 12 y 24 sesiones. Resultados: Al finalizar el primer bloque de 12 sesiones, el grupo de hipnoterapia mostró una mejoría clínica y estadísticamente significativa en los componentes de latencia, duración, eficiencia y calidad global de sueño del ICSP. Posteriormente, a las 24 sesiones solo se mantuvo la significancia en el componente de eficiencia de sueño y en los otros tres componentes únicamente se mantuvo la mejoría clínica. En comparación con el grupo control, que a las 12 sesiones mostró un aumento en los componentes lo que indica una peor calidad de sueño, manteniendo estos resultados a las 24 sesiones. Conclusiones: La hipnoterapia es una técnica psicoterapéutica útil para mejorar la calidad de sueño de mujeres con cáncer de mama que reciben quimioterapia. Sin embargo es importante, diseñar un estudio experimental aleatorizado que confirme estos datos

Objective: The purpose of this study is to test the effectiveness of hypnotherapy in sleep quality in breast cancer women while receiving standard medical treatment. Method: Participants were 40 breast cancer patients in the early stages, scheduled for chemotherapy. Two groups of 20 patients each, one group was applied an intensive phase of 12 sessions of group hypnotherapy for a month and a second phase of 12 sessions every fortnight for six months while the other group was formed (control) received only standard medical treatment. Sleep quality of patients in both groups was assessed with the Quality Index Pittsburgh Sleep (ICSP) that was applied before surgery and at the end of 12 and 24 sessions. Results: At the end of the first block of 12 sessions, the hypnotherapy group showed a clinically and statistically significant in the components of latency, duration, efficiency and overall quality of sleep ICSP improvement. Later, at only 24 sessions’s significance in the sleep efficiency component and the other three components shall be maintained clinical improvement was maintained. These results compared with the control group, at 12 sessions that showed an increase in components indicating a poorer quality of sleep, keeping these results to 24 sessions

HE4, Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer.

The aim of this study is to evaluate the diagnostic performance of human epididymis protein 4 (HE4), cancer antigen 125 (Ca125) and the risk of ovarian malignancy algorithm (ROMA) in discriminating ovarian cancer from other benign gynaecological diseases. Serum levels of HE4 and Ca125 were measured in 119 women with benign gynaecological diseases, 29 patients with primary ovarian cancer, 32 patients with ovarian cancer on chemotherapy treatment (18 of them with progressive disease), 6 patients treated and free of disease and 32 healthy women. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios (LR ±) were calculated. Receiver operator characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated. High serum levels for HE4, Ca125 and ROMA were observed in cancer patients. HE4 was elevated in 12.6 %, Ca125 in 21 % and ROMA in 9.2 % in the benign group, but HE4 was not elevated in endometriosis. The AUC values for HE4, Ca125 and ROMA were 0.92, 0.911 and 0.945 respectively. The sensitivity for discriminating ovarian cancer from benign gynaecological diseases was 86.2 % for HE4 and Ca125 and 93.1 % for ROMA. The specificity was 87.4, 78.9 and 90.7 % for HE4, Ca125 and ROMA. The overall positive likelihood ratio (LR+) was 6.84 for HE4, 4.1 for Ca125 and 10.01 for ROMA. In premenopausal women, LR + was 11.86 for HE4, 5.11 for ROMA and 2.02 for Ca125. HE4 might be significant in the differential diagnosis of ovarian cancer. HE4 seems to be superior to Ca125 in terms of diagnostic performance of all premenopausal women. ROMA could help to discriminate in cases with any doubt with a high diagnostic accuracy.

Vacunación frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano o lesión cervical. Encuesta de opinión y recomendaciones / Vaccination against cervical cancer in women outside of routine immunization programs, with or without infection by the human papilloma virus or cervical lesions. Opinion survey and recommendations

Las vacunas frente al cáncer de cérvix se han implementado, en un amplio número de países del mundo, dentro de los programas de vacunación sistemática. Asimismo se ha recomendado la vacunación de rescate en adolescentes y mujeres jóvenes. Desde la perspectiva de salud pública, la vacunación rutinaria en mujeres de mayor edad no se plantea por motivos de coste-efectividad. En estos casos son el médico y la paciente los que, de forma individualizada, deben decidir sobre la vacunación. Una encuesta de opinión dirigida a ginecólogos españoles que desarrollan su actividad asistencial en el ámbito de la patología cervical y colposcopia evidencia que, incluso en este colectivo, hay un relativo desconocimiento sobre aspectos importantes de la vacuna frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano (VPH) o lesión cervical. Además se constata la demanda de mayor información y poder disponer de recomendaciones específicas acerca de este tema. En el presente artículo se revisan las evidencias sobre la infección VPH y el riesgo de cáncer de cérvix a lo largo de la vida, la eficacia de las vacunas en relación con la edad o tras el tratamiento de lesiones cervicales, y la perspectiva del médico y de la mujer. Finalmente se presentan unas recomendaciones, a modo de guía clínica, sobre la vacunación en mujeres fuera de los programas de vacunación sistemática, con o sin infección o lesión cervical (AU)

Vaccines against cervical cancer have been implemented in a wide number of countries around the world as part of systematic vaccination programmes. In addition, rescue vaccination has been recommended for teenagers and young women. From a Public Health perspective, routine vaccination in older women is not proposed for reasons of cost-effectiveness. In these cases, the physician and the patient must decide about the suitability of vaccination in each individual. An opinion poll of Spanish gynaecologists rendering health-care services in the area of cervical pathologies and colposcopy has shown that, even among this group, there is relative lack of knowledge about important aspects of the vaccine against cervical cancer in women outside systematic vaccination programmes, with or without HPV infection or cervical lesions. In addition, the demand for greater information has been confirmed, as has the wish for specific recommendations on this topic. The present article reviews the evidence on HPV infection and the lifelong risk of cervical cancer, the efficacy of vaccines with respect to age or after the treatment of cervical lesions and the perspectives of physicians and women. Finally, some recommendations are made by way of clinical guidance for the vaccination of women outside systematic vaccination programmes, with or without infection or cervical lesion (AU)

¿Hiperplasia endometrial atípica o adenocarcinoma de endometrio? Un reto / Atypical endometrial hyperplasia or endometrial adenocarcinoma? A challenge

Objetivo: Conocer la prevalencia de adenocarcinoma de endometrio en pacientes con diagnóstico de hiperplasia endometrial atípica tras biopsia endometrial. Pacientes y métodos: Veinte pacientes con diagnóstico de hiperplasia endometrial atípica tras biopsia endometrial histeroscópica en consulta y/o tras resección endometrial histeroscópica en quirófano. Resultados: Se realizó una histerectomía a 15 pacientes y se encontraron 8 casos de adenocarcinoma de endometrio. Dos pacientes fueron reintervenidas mediante laparoscopia para realizar una linfadenectomía

Objective: To determine the prevalence of endometrial adenocarcinoma in patients with a diagnosis of atypical endometrial hyperplasia after endometrial biopsy. Patients and methods: Twenty patients with a diagnosis of atypical endometrial hyperplasia after endometrial biopsy by means of office hysteroscopy and/or after endometrial resection by means of operative hysteroscopy. Results: Hysterectomy was performed in 15 patients and eight cases of endometrial adenocarcinoma were found. Reintervention was required in two patients, who underwent laparoscopic lymphadenectomy