The efficacy of three-dimensional conformal radiation therapy on pain and quality of life in patients with painful bone metastases: a prospective study.

AIM: To evaluate the efficacy of radiation therapy in alleviating pain and improving the quality of life (QoL) with validated questionnaires in patients with painful bone metastases (BoM). METHODS: This prospective, observational study recruited 167 patients with painful BoM who were treated with palliative radiotherapy (PRT) from February 2015 to February 2018. After the first clinical assessment, the patients filled out specific questionnaires and underwent a fast radiotherapy treatment within 48 hours. The patients were followed up for eight weeks. RESULTS: The median age was 66.30 years. The most common primary cancer was lung cancer (31.1%). The most often prescribed scheme was 8 Gy in one fraction (70%). The patients experienced significant pain response and improved QoL compared with baseline, especially in the first two weeks after radiation. Overall, reduced pain and drug score were reported at two weeks of PRT in 68 (51.5%) and 37 (28%) of patients, respectively. CONCLUSIONS: PRT is an effective treatment option for patients with painful BoM.

Complications of Renal Transplantation That Influence the Presence of Hyperuricemia in Its First Year of Evolution.

INTRODUCTION: Renal transplantation (RT) has evolved to improve its functionality. Some factors have been little studied, one of which is hyperuricemia and its impact on renal graft function. The objective of this study is to determine the prevalence of complications of renal transplantation and its influence on hyperuricemia values in the first year of evolution. MATERIAL AND METHODS: The authors completed a retrospective, observational study of 2 RT units in Mexico from January 2013 to December 2017. In total, 1009 files met the inclusion criteria; the levels of uric acid (UA) and creatinine (Cr) were determined before transplantation and in months 1, 3, 6, 9, and 12 after transplantation. Descriptive analysis was performed with measures of central tendency, measures of dispersion, difference of means with Student t test, and SPSS version 25 (IBM, Armonk, NY, United States). RESULTS: The mean pretransplant UA was 6.24 mg/dL (standard deviation [SD] 1.97); per month was 4.73 mg/dL (SD 1.49). There is a difference in means between categorized groups of UA in the 5 post-RT moments (1, 3, 6, 9, and 12 months). A positive correlation of 0.41 to 0.47 was found with Spearman's test. The delayed function of the graft influenced in the first month after transplant in presenting hyperuricemia and acute dysfunction in month 6 showed that the rejection had no significance at any time. CONCLUSIONS: The relationship between the values of UA and Cr in the RT represents a moderate positive correlation; delayed graft function in the first month impacts the presence of hyperuricemia, as well as acute dysfunction at month 6 after transplantation.

Uncommon Complications in the First Year After Renal Transplantation.

INTRODUCTION: Classic post-transplant complications are highly studied and monitored; however, other unusual complications may occur due to immunosuppression. The objective of this study is to show these rare complications in a kidney transplant center. MATERIAL AND METHODS: Retrospective, observational, longitudinal study of renal transplants carried out from 2013 to 2017 in the Renal Transplant Unit of the National Medical Center Siglo XXI. A total of 790 transplants were performed, with surveillance for 1 year and rare events described. An analysis of frequencies and percentages of the events was performed using the statistical package SPSS version 25. RESULTS: Of the 790 patients, 110 (13.92%) experienced rare events, classified into 9 types of complications. DISCUSSION AND CONCLUSIONS: Complications exist in renal transplantation that are often ignored or minimized. A considerable number have been observed in this study, 110 events (13.92%); this result allows us to consider multiple possibilities in a kidney transplant program, especially infectious complications (34 patients) and surgical complications (29 cases). With the increase in diabetic receptor transplantation, metabolic complications will surely increase in the coming years.

Hypofractionated Breast Radiation: Shorter Scheme, Lower Toxicity.

BACKGROUND: We analyzed the toxicity and cosmetic outcomes for patients who had undergone 3-dimensional conformal radiotherapy with a hypofractionated schedule and identified the risk factors associated with such a schedule. MATERIALS AND METHODS: A total of 143 patients were treated for breast cancer (stage 0-III) with a hypofractionated radiation schedule after breast-conserving surgery from 2006 to 2011. Most patients received 42.4 Gy in 16 daily fractions, 2.65 Gy per fraction to the whole breast plus an additional simultaneous integrated or sequential boost to the tumor bed. RESULTS: The median follow-up period was 36 months. Mild acute skin toxicity was observed in 62%; 7% of the patients developed moderate skin toxicity, but no grade 4 toxicity was observed. The prevalence of fibrosis within the boost area was 5%, but no grade ≥ 2 was observed. The prevalence of fibrosis of any grade was greater in the nonboost (23%) than in the boost area. Of all the patients, 91% had good or excellent cosmetic outcomes. From the multivariate analysis, the incidence of epithelitis correlated with the patient's treated volume (P = .044). The incidence of acute toxicity correlated with the boost type to the tumor bed and the total treatment dose (P = .012 and P = .002, respectively). Also, a poor to fair cosmetic outcome was significantly associated statistically with the surgery type (P = .05), boost type (P = .004), and total dose (P = .001). CONCLUSION: Delivering whole-breast irradiation with a hypofractionated schedule of 42.4 Gy plus a simultaneous integrated boost to the tumor bed appears to be a safe and effective technique, with good cosmetic results and lower toxicity.

Preparation and scintillating properties of Sol-Gel Eu(3+), TB(3+) co-doped Lu(2)O(3) nanopowders.

Nanocrystalline Eu(3+), Tb(3+) co-doped Lu(2)O(3) powders with a maximum size of 25.5 nm were prepared by the sol-gel process, using lutetium, europium and terbium nitrates as precursors, and ethanol as a solvent. Differential thermal analysis (DTA) and infrared spectroscopy (IR) were used to study the chemical changes during the xerogel annealing. After the sol evaporation at 100 °C, the formed gel was annealed from 300 to 900 °C for 30 min under a rich O(2) atmosphere, and the yielded product was analyzed by X-ray diffraction (XRD) to characterize the microstructural behavior and confirm the crystalline structure. The results showed that Lu(2)O(3) nanopowders start to crystallize at 400 °C and that the crystallite size increases along with the annealing temperature. A transmission electron microscopy (TEM) study of samples annealed at 700 and 900 °C was carried out in order to analyze the microstructure, as well as the size, of crystallites. Finally, in regard to scintillating properties, Eu(3+) dopant (5 mol%), Tb(3+) codoped Lu(2)O(3) exhibited a typical red emission at 611 nm (D(°)→(7)F(2)), furthermore, the effect of Tb(3+) molar content (0.01, 0.015 and 0.02% mol) on the Eu(3+) radioluminiscence was analyzed and it was found that the higher emission intensity corresponds to the lower Tb(3+) content.

[Rosenberg projection for the radiological diagnosis of knee osteoarthritis]. / Proyección de Rosenberg en la evaluación radiológica de la osteoartrosis de rodilla.

BACKGROUND: Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. AIM: To compare the diagnostic yield for osteoarthritis of two projections in knee X ray examination. MATERIAL AND METHODS: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. RESULTS: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6+/-11.5 mm and 7.8+/-10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2+/-10.9 mm and 6.7+/-8.6 mm, respectively (p <0.05). CONCLUSIONS: Rosenberg projection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing projection, at least in the medial compartment of the knee. Therefore, Rosenberg projection should be included in the initial study of any patient with suspicion of knee osteoarthritis.

Proyección de Rosenberg en la evaluación radiológica de la osteoartrosis de rodilla / Rosenberg projection for the radiological diagnosis of knee osteoarthritis

Background: Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. Aim: To compare the diagnostic yield for osteoarthritis of two projections in knee Xray examination. Material and Methods: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. Results: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6±11.5 mm and 7.8±10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2±10.9 mm and 6.7±8.6 mm, respectively (p <0.05). Conclusions: Rosenberg projection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing prqjection, at least in the medial compartment ofthe knee. Therefore, Rosenberg prqjection should be included in the initial study of any patient with suspicion ofknee osteoarthritis.

Radiografia con carga en flexion para la deteccion precoz de artrosis de rodilla: mejorando el screening / Flexion weight bearing X ray for early detection of knee osteoarthritis: improving the screening

La osteoartrosis de rodilla es una patología con una elevada prevalencia en nuestro medio cuyo diagnóstico precoz es fundamental para un adecuado y oportuno tratamiento, y eventualmente, retrasar su progresión. En población deportista de la vida media, su detección precoz puede ser muy importante para el consejo médico de una práctica deportiva que no agrave su progresión. Evaluamos las radiografías de 44 rodillas en 32 pacientes (24 mujeres y 8 hombres), entre 26 y 78 años. Todos los pacientes eran sintomáticos y con un diagnóstico presuntivo de gonartrosis. Las proyecciones radiológicas empleadas fueron: convencional (anteroposterior (AP) en extensión, con carga) y Rosenberg (posteroanterior (PA) con carga y flexión de 45 grados). Al analizar y comparar ambas proyecciones se encontró una mayor capacidad de la proyección de Rosenberg para detectar la disminución del espacio articular en la articulación femorotibial, comparado con las proyecciones convencionales AP. Dicha diferencia fue estadísticamente significativa en nuestro estudio. Se concluye que la proyección de Rosenberg debería ser la proyección de elección en el estudio radiológico inicial de todo paciente con sospecha de gonartrosis.

Comparison of comprehensive two-dimensional gas chromatography coupled with sulfur-chemiluminescence detector to standard methods for speciation of sulfur-containing compounds in middle distillates.

The monitoring of total sulfur content and speciation of individual sulfur-containing compounds in middle distillates is required for efficient catalyst selection and for a better understanding of the kinetics of the reactions involved in hydrotreament processes. Owing to higher resolution power and enhanced sensitivity, comprehensive two-dimensional gas chromatography (GCxGC) hyphenated to sulfur chemiluminescence detection (SCD) has recently evolved as a powerful tool for improving characterization and identification of sulfur compounds. The aim of this paper is to compare quantitatively GCxGC-SCD and various other methods commonly employed in the petroleum industry, such as X-ray fluorescence, conventional GC-SCD, and high-resolution mass spectrometry, for total sulfur content determination and speciation analysis. Different samples of middle distillates have been analyzed to demonstrate the high potential and important advantages of GCxGC-SCD for innovative and quantitative analysis of sulfur-containing compounds. More accurate and detailed results for benzothiophenes and dibenzothiophenes are presented, showing that GCxGC-SCD should become, in the future, an essential tool for sulfur speciation analysis.

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes.

INTRODUCTION: Radiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published studies on radiation toxicity have been performed retrospectively. Our prospective study was launched in 1996 to measure the in vitro radiosensitivity of peripheral blood lymphocytes before treatment with radical radiotherapy in patients with breast cancer, and to assess the early and the late radiation skin side effects in the same group of patients. We prospectively recruited consecutive breast cancer patients receiving radiation therapy after breast surgery. To evaluate whether early and late side effects of radiotherapy can be predicted by the assay, a study was conducted of the association between the results of in vitro radiosensitivity tests and acute and late adverse radiation effects. METHODS: Intrinsic molecular radiosensitivity was measured by using an initial radiation-induced DNA damage assay on lymphocytes obtained from breast cancer patients before radiotherapy. Acute reactions were assessed in 108 of these patients on the last treatment day. Late morbidity was assessed after 7 years of follow-up in some of these patients. The Radiation Therapy Oncology Group (RTOG) morbidity score system was used for both assessments. RESULTS: Radiosensitivity values obtained using the in vitro test showed no relation with the acute or late adverse skin reactions observed. There was no evidence of a relation between acute and late normal tissue reactions assessed in the same patients. A positive relation was found between the treatment volume and both early and late side effects. CONCLUSION: After radiation treatment, a number of cells containing major changes can have a long survival and disappear very slowly, becoming a chronic focus of immunological system stimulation. This stimulation can produce, in a stochastic manner, late radiation-related adverse effects of varying severity. Further research is warranted to identify the major determinants of normal tissue radiation response to make it possible to individualize treatments and improve the outcome of radiotherapy in cancer patients.

Characterisation of middle-distillates by comprehensive two-dimensional gas chromatography (GC x GC): A powerful alternative for performing various standard analysis of middle-distillates.

The detailed characterisation of middle distillates is essential for a better understanding of reactions involved in refining process. Owing to higher resolution power and enhanced sensitivity, comprehensive two-dimensional gas chromatography (GC x GC) is a powerful tool for improving characterisation of petroleum samples. The aim of this paper is to compare GC x GC and various ASTM methods -- gas chromatography (GC), liquid chromatography (LC) and mass spectrometry (MS) -- for group type separation and detailed hydrocarbon analysis. Best features of GC x GC are demonstrated and compared to these techniques in terms of cost, time consumption and accuracy. In particular, a new approach of simulated distillation (SimDis-GC x GC) is proposed: compared to the standard method ASTM D2887 it gives unequal information for better understanding of conversion process.

Individualization of radiotherapy in breast cancer patients: possible usefulness of a DNA damage assay to measure normal cell radiosensitivity.

PURPOSE: The purpose of this study was to determine whether the distribution of sensitivities in breast cancer patients, measured using a DNA damage assay on lymphocytes, is likely to provide sufficient discrimination to enable the reliable identification of patients with abnormal sensitivities. MATERIAL AND METHODS: Radiosensitivity (x) was assessed in 226 samples of lymphocytes from unselected women with breast cancer and was quantified as the initial number of DNA double-strand breaks (dsb) induced per Gy and per DNA unit (200 Mbp). RESULTS: The existence of an inter-individual variation in the parameter (x) is described through the range (0.40-4.72 dsb/Gy/DNA unit) of values found, which have been fitted to the mathematical model defined by the log-normal distribution (mu = 0.42+/-0.03; sigma = 0.52+/-0.03; R(2)=0.9475). A total of 189 patients received radiotherapy after surgical treatment. Among them, we have detected 15 patients who developed severe skin reactions and we have compared their radiosensitivity values with the rest of patients treated. CONCLUSIONS: Our results suggest that DNA initial damage measured on lymphocytes offers an approach to predict the acute response of human normal tissues prior to radiotherapy. Values of x higher than 3.20 dsb/Gy/DNA unit theoretically should correspond to the highly radio-sensitive patients. Using the experimental results, we have calculated the strength of the test by means of the area under the receiver operator characteristic curves (A(Z)) to determine whether the radiosensitivity assay can discriminate between patients according to their radiation response. The value found (A(Z)=0.675+/-0.072) is indicative of a fair-poor discriminating capacity of the test to identify the patients with higher risk of developing a severe acute reaction during the radiotherapy treatment.

PARP-1 modifies the effectiveness of p53-mediated DNA damage response.

The tumour suppressor protein p53 plays a key role in the cell's decision to arrest the cell cycle or undergo apoptosis following a genotoxic insult. p53 is stabilized and activated after DNA damage, however the cascade of events signalling from DNA lesions to p53 stabilization and activation is still controversial. Poly (ADP-ribosylation) of different nuclear acceptors by PARP-1 is an early event when a single strand DNA lesion is produced. We present here evidences that interplay between PARP-1 and p53 is dependent on the type of damage induced to DNA. Primary mouse embryonic fibroblasts derived from parp-1 -/- mice exhibited decreased p53 accumulation and activation following gamma-irradiation compared to parp-1 proficient cells. On the other hand, treatment with the single alkylating agent 2'-methyl-2'-nitrose-urea (MNU), resulted in the rapid and sustained accumulation and activation of p53 in parp-1-deficient cells, while very little accumulation was observed in parp-1 +/+ cells. After IR, the turnover of the p53 inhibitory protein MDM-2 is perturbed and the level of phosphorylation of p53 at serine-15 is blunted in parp-1 -/- cells. PARP-1 is determinant in the cytotoxic response to alkylating agents but only partially contributes to radiation-induced cell killing, as determined by colony forming assay. Altogether, these results suggest that PARP-1 participates in the p53 response following irradiation, resides upstream of p53 and indirectly modulates the level of phosphorylation of key substrates in this pathway while treatment with MNU results in an enhanced p53-mediated response in parp-1-null cells.

Endartectomía carotídea sin shunt. Bases anatomofisiológicas / Carotid artery endarterectomy without a shunt. Anatomophysiological bases

Se presentan 26 casos de ateromatosis carotídea con sintomatología variada desde la isquemia cerebral transitoria hasta crisis apopléjica. El diagnóstico se completó con Doppler color, arteriografía en todos los casos; completándose protocolo con electroencefalograma y valoración cardiaca. En todos los casos iniciamos la cirugía de la arteria carótida sin shunt, siguiendo una técnica cuidadosa con las estructuras vecinas y la pared de la arteria intervenida; nuestro tiempo de pinzamiento temporal de la arteria carótida varió entre 11 y 24 minutos. Este es el grupo de pacientes en el que no fue necesario utilizar shunt ni parche, porque tanto la pared arterial y los bordes de la arteriotomía nos permitieron cerrar con surgete continuo. Hasta el momento no hemos tenido ninguna complicación con esta técnica