Video self-confrontation as a therapeutic tool in schizophrenia: A randomized parallel-arm single-blind trial.

BACKGROUND: Lack of insight is a barrier to treating psychosis. Preliminary studies have suggested that showing people videos of their psychotic behaviour may improve personal insight. This clinical trial aimed to assess the effect of video self-confrontation. METHODS: Inpatients between 18 and 65 years old with schizophrenia or schizoaffective disorder were filmed upon admission to two psychiatric hospitals while experiencing acute psychosis. After stabilization, individuals were randomized 1:1 to the "self-video" group where they watched their own video or to the "no video" control group. The primary outcome was the Scale to assess Unawareness of Mental Disorder (SUMD) at 48 h by a blinded assessor. Secondary objectives included psychotic and depressive symptoms, medication adherence and functioning using the Functional Remission of General Schizophrenia. Patients were followed up for four months. RESULTS: 60 participants were randomized and the level of insight did not differ between groups at 48 h (p = 0.98). There was no impact on SUMD subscores or the other insight questionnaires at any timepoint, nor on psychopathology or medication adherence. At one month, the level of functioning of those in the "self-video" group (n = 23) was higher (61.8 vs 53.5, p = 0.02), especially concerning "Treatment" and "Daily life". No adverse effects were reported. After video self-confrontation, people expressed more positive than negative emotions and were less lost to follow-up. CONCLUSION: Video self-confrontation did not change levels of insight, but may have a therapeutic impact nonetheless, by improving levels of self-care and adherence to care, indicating that this innovative therapeutic tool requires further study. TRIAL REGISTRATION NUMBER: NCT02664129.

Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study.

AIMS: A large number of people present each day at hospitals for non-fatal deliberate self-harm (DSH). Examination of the short-term risk of non-fatal recurrence and mortality at the national level is of major importance for both individual medical decision-making and global organisation of care. METHODS: Following the almost exhaustive linkage (96%) of two national registries in France covering 45 million inhabitants (i.e. 70% of the whole population), information about hospitalisation for DSH in 2008-2009 and vital status at 1 year was obtained. Individuals who died during the index hospital stay were excluded from analyses. RESULTS: Over 2 years, 136,451 individuals were hospitalised in medicine or surgery for DSH. The sample comprised 62.8% women, median age 38 in both genders, with two peaks at 16 and 44 years in women, and one peak at 37 years in men. The method used for DSH was drug overdose in 82.1% of cases. Admission to an intensive care unit occurred in 12.9%. Following index hospitalisation, 71.3% returned home and 23.7% were transferred to a psychiatric inpatient care unit. DSH recurrence during the following year occurred in 12.4% of the sample, within the first 6 months in 75.2%, and only once in 74.6%. At 1 year, 2.6% of the sample had died. The overall standardised mortality ratio was 7.5 but reached more than 20 in young adults. The causes were natural causes (35.7%), suicide (34.4%), unspecified cause (17.5%) and accident (12.4%). Most (62.9%) deaths by suicide occurred within the first 6 months following index DSH. Violent means (i.e. not drug overdose) were used in 70% of suicide cases. Concordance between means used for index DSH and for suicide was low (30% overall), except for drug overdose. Main suicide risk factors were older age, being male, use of a violent means at index DSH, index admission to an intensive care unit, a transfer to another medical department or to a psychiatric inpatient unit, and recurrence of DSH. However, these factors had low positive predictive values individually (below 2%). CONCLUSIONS: Non-fatal DSH represent frequent events with a significant risk of short-term recurrence and death from various causes. The first 6 months following hospital discharge appear to be a critical period. Specific short-term aftercare programs targeting all people with a DSH episode have to be developed, along other suicide prevention strategies.

Efficacy of shared decision-making on treatment adherence of patients with bipolar disorder: a cluster randomized trial (ShareD-BD).

BACKGROUND: Shared decision-making (SDM) is a model of interaction between doctors and patients in which both actors contribute to the medical decision-making process. SDM has raised great interest in mental healthcare over the last decade, as it is considered a fundamental part of patient-centered care. However, there is no research evaluating the efficacy of SDM compared to usual care (CAU), as it relates to quality of care and more specifically treatment adherence, in bipolar disorder (BD). METHODS/DESIGN: This is a 12-month multi-centre, cluster-randomized controlled trial comparing the efficacy of SDM to CAU. Adult BD patients (n = 300) will be eligible after stabilization for at least 4 weeks following an acute mood episode. The intervention will consist of applying the standardized SDM process as developed by the Ottawa Hospital Research Institute in order to choose the maintenance treatment of BD. A multidisciplinary team developed a decision aid "choose my long-term treatment with my doctor" for BD patients to clarify possible therapeutic options. Primary outcome will assess the patient's level of adherence (based on hetero-evaluation) of ongoing treatment at 12 months. Secondary outcomes will assess the difference between the 2 groups of patients in terms of adherence to maintenance drug therapy based on other measures (self-assessment scale and plasma levels of mood stabilizers). Additionally, other dimensions will be assessed: decisional conflict, satisfaction with care and involvement in decision making, beliefs about treatment, therapeutic relationship, knowledge about information for medical decision and clinical outcomes (depression, mania, functioning and quality of life). The primary endpoint will be analysed without adjustment by comparison of adherence scores between the two groups using Student t-tests or Mann-Whitney tests according to the variable distribution. A set of secondary analyses will be adjusted for covariates of clinical interest using generalized linear mixed regression models. DISCUSSION: This will be the first study evaluating the effect of an SDM intervention on patient adherence in BD. This is also an innovative protocol because it proposes the development of an evidence-based tool that should help patients and clinicians to initiate discussions regarding the use of BD treatment. TRIAL REGISTRATION: The study has been registered with ClinicalTrials.gov as NCT03245593 .

Identification of G2607A mutation in EGFR gene with a significative rate in Moroccan patients with Bladder Cancer.

The epidermal growth factor receptor (EGFR) is involved in the regulation of several cellular processes and in the development of many human cancers. Somatic mutations of EGFR at tyrosine kinase domain have been associated with clinical response to tyrosine kinase inhibitors (TKIs) in lung cancer patients. In this study, we evaluated the frequency of point mutations in EGFR for future use of TKI in clinical treatment of bladder cancer. A total, 50 Moroccan patient specimens with bladder cancer and 48 healthy controls were analysed for EGFR mutations in the region delimiting exons 18-21 by PCR amplification and direct sequencing. Our results showed the absence of mutations in the EGFR kinase domain in these exons in all analysed specimens. However, sequence analysis of the EGFR-TK domain, revealed the presence of (G2607A) polymorphism at exon 20. Statistical analysis showed significant difference in the frequencies of G2607A polymorphism between cancer cases and healthy controls (p=0.0001) and the frequencies of the GG and GA/AA genotypes among the cancer cases were 28% and 72%, respectively. Moreover, allelic frequencies of G2607A polymorphism showed significant difference between cancer cases and healthy controls (p=0.0025). Data analysis showed no significant association between G2607A polymorphism and patients' age, clinical stage and tumor grade (p > 0.05). However, a significant difference was found between this polymorphism and patients' sex that could be a sampling bias due to the very limited number of women with bladder cancer. Our findings highlight that, mutations in EGFR kinase domain is a rare event in bladder cancer, suggesting, that treatment of bladder cancer patients with TKI may not be effective. However, the EGFR G2607A polymorphism in exon 20 is frequent in bladder cancer cases and must be further explored for its relevance in the treatment of this disease.

[Association between the violence in the community and the aggressive behaviors of psychotics during their hospitalizations]. / Relation entre la violence intra-hospitalière des patients avec psychoses et la violence dans la communauté.

BACKGROUND: Violence is a common issue in psychiatry and has multiple determiners. The aim of this study is to assess the psychotic inpatients' violence in association with the violence of the neighborhood from which the patients are drawn and to estimate the impact of this environmental factor with regard to other factors. METHOD: A prospective multicenter study was led in nine French cities. Eligible patients were psychotic involuntary patients hospitalized in the cities' psychiatric wards. During their treatments, any kind of aggressive behavior by the patients has been reported by the Overt Aggression Scale (OAS). RESULTS: From June 2010 to May 2011, 95 patients have been included. Seventy-nine per cent of the patients were violent during their hospitalizations. In a bivariate analysis, inpatient violence was significantly associated with different factors: male gender, patient violence history, substance abuse, manic or mixed disorder, the symptoms severity measured by the BPRS, the insight degree and the city crime rate. In a multivariate analysis, the only significant factors associated with the patients' violence were substance abuse, the symptoms severity and the crime rates from the different patients' cities. CONCLUSION: These results suggest that violence within the psychotic patients' neighborhood could represent a risk of violence during their treatments.

Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África / Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men

Antecedentes: Los hombres norteafricanos (NAF) presentan una alta incidencia de cáncer de próstata (CaP) avanzado en el momento del diagnóstico. Varios estudios han demostrado la existencia de diferencias étnicas en la agresividad del CaP y esto ha dado lugar a algunas preocupaciones relacionadas con la inclusión de algunos grupos étnicos en los protocolos de vigilancia activa. Objetivo: Evaluar los resultados patológicos y la agresividad del CaP de bajo riesgo tratado con prostatectomía radical en un grupo étnico NAF. Sujetos y métodos: Los datos de 147 NAF sometidos a prostatectomía radical por CaP de bajo riesgo diagnosticado por medio de una biopsia de 12 núcleos en 2 centros académicos entre 2011 y 2015 se revisaron retrospectivamente para evaluar las tasas de resultados patológicos peores definidas como: actualización de la puntuación de Gleason a por lo menos 3 + 4, eclipse a pT3a o superior o pN1, y márgenes quirúrgicos positivos. Resultados: El eclipse y/o actualización significativa global se produjo en el 20,2% y se produjeron márgenes quirúrgicos positivos en el 18,3%. En el análisis de regresión logística multivariante, las variables independientes que predijeron eclipse y/o actualización o márgenes quirúrgicos positivos en toda la cohorte fueron: grupo de riesgo NCCN (riesgo bajo > riesgo muy bajo), edad avanzada > 60 años, PSA > 6 ng/ml, densidad de PSA ≥ 0,15, más de 2 núcleos positivos en la biopsia, implicación del cáncer de más del 50% en los núcleos positivos, estadio clínico (T2a > T1c) y puntuación UCSF-CAPRA-S > 3. Conclusiones: Nuestro estudio encontró que, al menos patológicamente, los hombres NAF no tienen una enfermedad más agresiva que los caucásicos y afroamericanos, tanto en CaP de bajo como de muy bajo riesgo. Por lo tanto, creemos que la vigilancia activa es un enfoque adecuado para pacientes seleccionados ya que no hay datos definitivos que muestren una historia natural más agresiva de CaP en hombres NAF

Background: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. Objective: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. Subjects and methods: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3 + 4, upstage to pT3a or higher or pN1, and positive surgical margins. Results: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk > very low risk), advanced age > 60 years, PSA > 6 ng/ml, PSA density ≥ 0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a > T1c) and UCSF-CAPRA-S score > 3. Conclusions: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men

Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men. / Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África.

BACKGROUND: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. OBJECTIVE: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. SUBJECTS AND METHODS: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3+4, upstage to pT3a or higher or pN1, and positive surgical margins. RESULTS: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk>very low risk), advanced age>60 years, PSA>6ng/ml, PSA density≥0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a>T1c) and UCSF-CAPRA-S score>3. CONCLUSIONS: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men.

Association between GPX1 Pro189Leu polymorphism and the occurrence of bladder cancer in Morocco.

Worldwide, Bladder cancer is the most frequent male malignancy. It is the third most common male malignancy in Morocco. The risk factors for developing bladder cancer are multiples including dietary conditions, environmental exposure and oxidative stress. GPX1 gene encoding for the human cellular antioxidant enzyme glutathione peroxidase1 is a key factor in the cell detoxification process. GPX1 Pro198Leu polymorphism is associated with a decrease of enzyme activity and may contribute to bladder cancer susceptibility. The present case-control study was planned to assess the presence of GPX1 Pro198Leu polymorphism in Moroccan population to determine whether it is associated with the risk of developing bladder cancer in Moroccan patients. A total of 32 patients with bladder cancer and 40 healthy controls were enrolled. Genotyping of the GPX1 Pro198Leu polymorphism was carried out by PCR amplification and DNA sequencing. Pro198Leu polymorphism was observed in both bladder cancer patients and healthy controls. No significant association between the polymorphism and bladder cancer occurrence was found (Pro/Leu vs. Pro/Pro: p=0.425; Leu vs. Pro: p=0.435). For the analysis of Pro198Leu polymorphism and progression of bladder cancer, no association was observed neither for stages (Pro/Leu vs. Pro/Pro: p=0.500; Leu vs. Pro: p=0.500) nor grades (Pro/Leu vs. Pro/Pro: p=0.415; Leu vs. Pro: p=0.427). Our results clearly showed no significant association between Pro198Leu polymorphism and risk of bladder cancer in our population, suggesting that the effect of this polymorphism on bladder cancer development might be a result of a combination with other genetic alterations and/or non-genetic variables such as diet and lifestyle factors.

[French Society for Biological Psychiatry and Neuropsychopharmacology task force. Formal consensus for the treatment of bipolar disorder: an update (2014)]. / Recommandations Formalisées d'Experts de l'Association Française de Psychiatrie Biologique et Neuropsychopharmacologie sur le dépistage et prise en charge du trouble bipolaire : mise à jour 2014.

As part of a process to improve the quality of care, the French Society for Biological Psychiatry and Neuropsychopharmacology developed in 2010 formal consensus guidelines for the treatment of bipolar disorder. The evolution of therapeutic options available in France for the treatment of bipolar disorder has justified the update of this guideline. The purpose of this work was to provide an updated and ergonomic document to promote its use by clinicians. This update focuses on two of the six thematic previously published (acute treatment and long-term treatment). Aspects of the treatment of bipolar patients sparking debate and questions of clinicians (use of antidepressant, place of the bitherapy, interest of long-acting antipsychotics…) were also covered. Finally, we proposed graded recommendations taking into account specifically the risk-benefit balance of each molecule.

[French Society for Biological Psychiatry and Neuropsychopharmacology task force: Formal Consensus for the prescription of depot antipsychotics]. / Recommandations Formalisées d'Experts de l'AFPBN : prescription des neuroleptiques et antipsychotiques d'action prolongée.

BACKGROUND: Compliance is often partial with oral antipsychotics and underestimated for patients with serious mental illness. Despite their demonstrated advantages in terms of relapse prevention, depot formulations are still poorly used in routine. As part of a process to improve the quality of care, French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) Task Force elaborated a Formal Consensus for the prescription of depot antipsychotics in clinical practice. METHODS: The Task Force recommends as first-line choice, the use of long-acting injectable (LAI) second-generation antipsychotics in patients with schizophrenia, schizoaffective disorder and delusional disorder. They can be considered as a second-line option as a monotherapy to prevent manic recurrence or in combination with mood stabilizer to prevent depressive recurrence in the maintenance treatment of bipolar disorder. LAI second-generation antipsychotics can also be used after a first episode of schizophrenia. Depot neuroleptics are not recommended during the early course of schizophrenia and are not appropriate in bipolar disorder. They are considered as a second-line option for maintenance treatment in schizophrenia. RESULTS: LAI formulations should be systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated. LAI antipsychotics can be used preferentially for non-compliant patients with frequent relapses or aggressive behaviors. CONCLUSION: A specific information concerning the advantages and inconveniences of the LAI formulations, in the framework of shared-decision making must be delivered to each patient. Recommendations for switching from one oral/LAI form to another LAI and for using LAI antipsychotics in specific populations (pregnant women, elderly patients, subjects in a precarious situation, and subjects having to be treated in a prison establishment) are also proposed.

Epigenetic alterations of adenomatous polyposis coli (APC), retinoic acid receptor beta (RARß) and survivin genes in tumor tissues and voided urine of bladder cancer patients.

The CpG promoter methylation has been reported to occur frequently in bladder cancer. Moreover, analysis of gene methylation has been shown to be feasible from voided urine and can be detected with a high degree of sensitivity. The aim of this present study is to determine how methylation patterns of APC, RARβ and Survivin genes change during bladder carcinogenesis and to evaluate whether DNA methylation could be detected in urine sediment. Using the sensitive assay of MSP, we explored the promoter methylation status for the three genes in tumor specimens and urine sediment DNA from 32 bladder cancer patients. Methylation frequencies of the tested genes in tumor specimens were 100%, 75% and 84.4% for APC, RARβ and Survivin, respectively. Hypermethylation of APC was found in all pathological grades and stages of bladder cancer. More frequent promoter hypermethylation of RARβ and Survivin was observed in high grade tumors and the hypermethylation increased from low to high stages, but there was no significant correlation between stages/grades and hypermethylation of these two gene promoters. In order to investigate clinical usefulness for noninvasive bladder cancer detection, we further analyzed the methylation status in urine samples of bladder cancer patients. Methylation of the tested genes in urine sediment DNA was detected in the majority of cases that were hypermethylated in tumor samples (93.7%) and the frequencies were 79.3% 70.8% and 96.3% for APC, RARβ and Survivin, respectively. Our results indicate that methylation of APC, RARβ and Survivin gene promoters is a common finding in patients with bladder carcinoma. The ability to detect methylation not only in bladder tissue, but also in urine sediments, suggests that methylation markers are promising tools for noninvasive detection of bladder cancer.

Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml / Usefulness and Predictive Value of PSA Density, Adjusted by Transition Zone Volume, in Men With PSA Levels Between 2 and 4 ng/ml

Objetivo: Evaluar la significación diagnóstica del PSA, de su densidad (PSAD) y de la PSAD ajustada por el volumen de la zona de transición (PSATZD) en hombres con valores de PSA entre 2,0 y 4,0 ng/ml. Material y métodos: Entre los años 2000 y 2010, 138 hombres con niveles de PSA entre 2,0 y 4,0 ng/ml fueron sometidos a ultrasonografía transrectal (USTR) y biopsia prostática de 12 fragmentos. Se investigó la precisión diagnóstica de varios puntos de corte de la PSAD y de la PSATZD en rangos de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml. Resultados: La tasa de detección del cáncer de próstata fue del 23,9% (32/134). El porcentaje de pacientes con enfermedad extracapsular fue del 28,1% (10/32) y se obtuvieron primarios de grado Gleason 4 o 5 en 8 de 32 casos (25%). El volumen de la zona de transición y la PSATZD en los casos de cáncer fueron significativamente diferentes en comparación con los obtenidos en los casos sin cáncer. El área bajo la curva de la característica operativa del receptor (ROC) de la PSATZD fue significativamente mayor que la de la PSAD en los mismos rangos de subdivisión del PSA. La eficiencia diagnóstica de la PSATZD fue mayor que la de la PSAD. La eficiencia diagnóstica fue mayor en los niveles de corte de PSATZD de 0,23 y 0,28 en hombres con valores de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml, respectivamente. Conclusiones: El uso de puntos de corte de la PSATZD como indicación para biopsias evitaría muchas biopsias innecesarias sin pasar por alto la mayor parte de cánceres de próstata en el rango de PSA de 2,0 a 4,0ng/ml (AU)

Objective: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0ng/ml. Material and methods: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml. Results: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml, respectively. Conclusions: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0ng/ml (AU)

[Usefulness and predictive value of PSA density, adjusted by transition zone volume, in men with PSA levels between 2 and 4 ng/ml]. / Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml.

OBJECTIVE: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml. MATERIAL AND METHODS: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml. RESULTS: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. CONCLUSIONS: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia / Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy

Objetivo: Numerosos estudios a gran escala realizados en países occidentales han demostrado una relación positiva entre el nivel sérico de antígeno prostático específico (APE) y la prevalencia de hallazgos positivos en la gammagrafía ósea en pacientes recientemente diagnosticados de cáncer de próstata. El objetivo de nuestro estudio es comprobar si esta tendencia aparece también en población norteafricana, así como determinar si se produce una relación entre los niveles de APE, los resultados de la gammagrafía ósea y la escala de Gleason. Material y método: Se revisaron de manera retrospectiva las historias clínicas de 348 pacientes diagnosticados de adenocarcinoma prostático, extrayendo los resultados de las gammagrafías óseas, los niveles de APE y la escala de Gleason. Se llevó a cabo un análisis estadístico mediante la prueba exacta de Fisher, utilizando el programa estadístico SPSS (Paquete Estadístico para las Ciencias Sociales, versión 11.5.1, Chicago), considerando significativa una p<0,05. Resultados: Mediante la gammagrafía ósea se demostró la existencia de metástasis óseas en 102 pacientes. Ninguno de estos pacientes tenía un nivel de APE menor de 10 ng/ml. Seis pacientes con metástasis tenían un nivel de APE entre 11 y 20 ng/ml. En 45 casos con metástasis se hallaron niveles de APE sérico entre 21 y 100. En relación con los niveles de APE superiores a 101 ng/ml, 51 hombres presentaban gammagrafía ósea positiva. Conclusión: Tomando como referencia los niveles de APE, se podría presuponer la probabilidad de un resultado positivo en la gammagrafía ósea. Según los niveles de APE, las investigaciones de estadificación pueden ser más selectivas en el caso de nuestros pacientes. En pacientes con un nivel de APE inferior a 10 ng/ml, el riesgo de presentar una gammagrafía ósea positiva es tan bajo que no sería necesario realizarla. Por otro lado, no se ha establecido una relación con significado estadístico entre la escala de Gleason y el nivel de APE o los resultados de la gammagrafía ósea(AU)

Objective: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. Material and methods: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. Results: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. Conclusion: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established (AU)

Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano) / Bone Mineral Density Change: Comparison Between Prostate Cancer Patients with or Without Metastases and Healthy Men (a North African Ethnic Group)

Objetivo: Evaluar la densidad mineral ósea total y la densidad mineral ósea regional en pacientes de cáncer de próstata con y sin metástasis, estableciendo una relación con los resultados de la escintigrafía ósea. Pacientes y métodos: La investigación se realizó sobre un grupo de 135 pacientes con carcinoma prostático y 50 pacientes sanos empleando escintigrafía ósea y absorciometría de rayos X de doble energía. Los resultados de la escintigrafía ósea se clasificaron como normales (puntuación 0: n=55), anómalos pero no típicos de metástasis (puntuación 1: n=45) y patrón típico de metástasis (puntuación 2: n=35). Resultados: Los pacientes de cáncer de próstata con metástasis ósea presentaban una densidad mineral ósea total y regional muy superior en el tronco y la pelvis que los sujetos control sanos, y que los pacientes de cáncer de próstata sin metástasis óseas. Se encontró una relación positiva significativa entre la puntuación obtenida en la exploración ósea y la densidad mineral ósea total y regional de tronco y pelvis (r=0,328, p<0,05, r=0,60, p<0,001, r=0,480, p<0,001, respectivamente). Conclusión: La metástasis ósea es una de las causas principales de morbilidad en el cáncer de próstata, y la pérdida ósea en el transcurso del tratamiento hormonal tiene eficacia en la actualidad. Nuestros resultados muestran que los pacientes de cáncer de próstata con metástasis ósea presentan una mayor densidad mineral ósea (DMO) en la pelvis y el tronco, lo cual es probable que se deba al predominio de las metástasis osteoblásticas sobre las osteolíticas, como demuestra la exploración ósea 99mTc MDP (AU)

Aim: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. Patients and Methods: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). Results: The patients with bone metastases prostate cancer had significantly higher total bone minera1 density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). Conclusion: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by 99mTc MDP bone scan (AU)

[Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy]. / Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia.

OBJECTIVE: A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. MATERIAL AND METHODS: Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences "SPSS", version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. RESULTS: Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. CONCLUSION: Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente / Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier’s gangrene: usefulness of a severity index score in predicting disease gravity and patient survival

Introducción: La terapia de oxígeno hiperbárico (TOHB) concomitante con la cirugía ha demostrado una mejora en la reducción de la mortalidad por gangrena de Fournier (GF) en comparación con la aplicación exclusiva de desbridamiento quirúrgico. La mayoría de los datos provienen de centros con un número relativamente reducido de pacientes, y en los que se emplea solamente un procedimiento quirúrgico. El objetivo planteado consistía en evaluar la eficiencia del desbridamiento agresivo con TOHB complementaria, así como evaluar el valor predictivo del índice de puntuación de gravedad de la gangrena de Fournier (IGGF). Material y métodos: 70 gangrenas de Fournier (GF) tratadas con desbridamiento quirúrgico y TOHB. Los datos evaluados fueron los resultados de las exploraciones físicas, los análisis de laboratorio tanto en el momento del ingreso como los finales, la extensión del desbridamiento quirúrgico y el antibiótico utilizado. Los pacientes recibieron TOHB complementaria. Se desarrolló un IGGF con el fin de adjudicar una puntuación que describiese la gravedad de la enfermedad. Este índice tiene en cuenta las constantes vitales de los pacientes, los parámetros metabólicos (niveles de sodio, potasio, creatinina y bicarbonato, así como recuento de linfocitos) y calcula una puntuación relativa a la gravedad de la enfermedad en ese momento. Se evaluaron los datos en función de la supervivencia o no del paciente. Todos los pacientes fueron sometidos a desbridamiento quirúrgico, realizándose el desbridamiento de la herida de forma periódica en el periodo postoperatorio. Resultados: De un total de 70 pacientes fallecieron 8 (el 11,4%) y sobrevivieron 62 (el 88,5%). La diferencia de edad entre los supervivientes (edad media 50,0 años) y no supervivientes (edad media 54,5 años) no fue significativa (p = 0,321). La extensión media del área del cuerpo afectada por el proceso de necrosis en los pacientes que sobrevivieron y en los que no sobrevivieron era del 2,4 y del 4,9%, respectivamente (p = 0,001). Excepto en lo referente a la albúmina, no se encontraron diferencias significativas entre supervivientes y no supervivientes. Las puntuaciones medias en el IGGF en el momento del ingreso de los supervivientes y de los no supervivientes fueron de 2,1±2,0 y de 4,2±3,8, (p = 0,331). Conclusión: La puntuación del IGGF no resultó ser un factor de predicción de la gravedad, de la enfermedad ni de la supervivencia del paciente. Sin embargo, tanto las alteraciones metabólicas como la extensión de la enfermedad aparecieron como factores significativos de riesgo en cuanto a predicción de la gravedad de la GF y la supervivencia del paciente (AU)

Introduction: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier’s gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier’s gangrene severity score index (FGSI) predictive value. Material and methods: 70 Fournier’s gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed toa ssign a score describing the acuity of disease, was used. This index presents patients’ vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. Results: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p = 0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p = 0.001). Except for albumin, no significant differences were found between survivors and non survivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p = 0.331).Conclusion: FGSI score did not predict disease severity and the patient’s survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival (AU)

[Bone mineral density change: comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)]. / Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano).

AIM: To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. PATIENTS AND METHODS: 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). RESULTS: : The patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). CONCLUSION: Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by (99m)Tc MDP bone scan.

[Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: usefulness of a severity index score in predicting disease gravity and patient survival]. / Terapia de oxígeno hiperbárico complementaria al desbridamiento en el control de la gangrena de Fournier: utilidad de la puntuación de un índice de severidad en la predicción de la gravedad de la enfermedad y la supervivencia del paciente.

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value. MATERIAL AND METHODS: 70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients' vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period. RESULTS: Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and nonsurvivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p=0.331). CONCLUSION: FGSI score did not predict disease severity and the patient's survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival.

Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia / Evaluation of HER2 protein overexpression in non-muscle invasive bladder cancer with emphasis on tumour grade and recurrence

Objetivo: evaluar el valor pronóstico de la expresión de la HER2 en carcinoma vesical de células transicionales (CCT) no músculo invasivo, poniendo especial énfasis en la población con alto grado. Materiales y métodos (pacientes): se realizaron micromatrices de tejidos (TMA) con especímenes TUR-B representativos de 84 pacientes con CCT vesical no músculo invasivo (40 pT1GII y44 pT1GIII) a los que se trataba en nuestra institución. El mismo patólogo que había llevado a cabo la prueba ciega de análisis inmunohistoquímico con Hercep realizó el proceso de asignación de profundidades de invasión y grados de manera uniforme: se consideró el valor 3+ como signo altamente positivo de sobreexpresión de la HER2. También se evaluaron otras variables clínico-patológicas. Resultados: se detectó sobreexpresión de proteína HER2 en 30/ 44 (68,2%) lesiones pT1GIII, prediciendo recaídas en este subgrupo de CCT vesical (p < 0,01). Se detectó expresión negativa de la HER2 en 26/ 40 (65%) casos con CCT pT1GII, dándose esta situación con mayor frecuencia en tumores unifocales y sin angiogénesis, con baja tasa de recaída y sin evolución. La supervivencia libre de recidiva puede también preverse mediante la expresión de la HER 2 en los tumorespT1GII (p < 0,01). Conclusión: la expresión de la HER2 mediante test Hercep puede ser de utilidad en la predicción de recaídas en CCT vesical no músculo invasivo. El potencial de aplicación de este estudio, sobre todo en lo que se refiere a la predicción de la respuesta a BCG, debe confirmarse de forma prospectiva en ensayos multicéntricos (AU)

Objective: to evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. Materials and methods (patients): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+was considered strong positive HER2 over expression. Other clinico-pathological variables were also assessed. Results: HER2 protein over expression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p < 0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p < 0.01). Conclusion: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials (AU)