Low-risk prostate cancer selected for active surveillance with negative MRI at entry: can repeat biopsies at 1 year be avoided? A pilot study

Purpose: In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine “per protocol” repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression. / Methods: Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n = 78) patients had per-protocol 12-month repeat SB; group 2 (n = 71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V) > 0.75 ng/ml/year, or PSA doubling time (PSADT) < 3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression. / Results: Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p = 0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively. / Conclusions: We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings

Identification of lifestyle risk factors in adolescence influencing cardiovascular health in young adults: the BELINDA study

Cardiovascular diseases are the leading cause of mortality worldwide. These diseases originate in childhood, and a better understanding of their early determinants and risk factors would allow better prevention. The BELINDA (BEtter LIfe by Nutrition During Adulthood) study is a 10–14-year follow-up of the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (the HELENA study, a European cross-sectional study in adolescents). The study aims to evaluate cardiovascular risk using the PDAY (Pathobiological Determinants of Atherosclerosis in Youth) risk score during young adulthood (21–32 years), and to examine the impact of risk factors identified during adolescence (12.5–17.5 years). Our secondary objective is to compare the characteristics of the BELINDA study population with the HELENA population not participating in the follow-up study. The HELENA study recruited 3528 adolescents during 2006–2007 and reassessed 232 of them 10–14 years later as young adults. We assessed clinical status, anthropometry, nutrition, physical activity (including sedentary behavior), physical fitness, and mental health parameters, and collected biological samples (blood, stool, and hair). Dietary intake, and physical activity and fitness data were also collected. A multivariable linear regression model will be used for the analysis of the primary outcome. A Chi-square and T-test were conducted for the comparison of the descriptive data (gender, age, weight, height, body mass index (BMI), and maternal school level) between participating and non-participating BELINDA adolescents. When comparing the 1327 eligible subjects with the 232 included in the BELINDA study, no significant differences regarding gender (p = 0.72), age (p = 0.60), height (p = 0.11), and weight (p = 0.083) at adolescence were found. However, the participating population had a lower BMI (20.4 ± 3.1 kg/m2 versus 21.2 ± 3.6 kg/m2; p < 0.001) and a higher maternal educational level (46.8% high school or university level versus 38.6%; p = 0.027) than the HELENA population who did not participate in the BELINDA study. The complete phenotyping obtained at adolescence through the HELENA study is a unique opportunity to identify adolescent risk factors for cardiovascular diseases. This paper will serve as a methodological basis for future analysis of this study

Impact of the skull contour definition on Leksell Gamma Knife^® Icon™ radiosurgery treatment planning.

The Gamma Knife &lt;sup&gt;®&lt;/sup&gt; planning software (TMR 10, Elekta Instruments, AB, Sweden) affords two ways of defining the skull volume, the "historical" one using manual measurements (still perform in some centers) and the new one using image-based skull contours. Our objective was to assess the potential variation of the dose delivery calculation using consecutively in the same patients the two above-mentioned techniques. We included in this self-case-control study, 50 patients, treated with GKRS between July 2016 and January 2017 in Lausanne University Hospital, Switzerland, distributed among four groups: convexity targets (n = 18), deep-seated targets (n = 13), vestibular schwannomas (n = 11), and trigeminal neuralgias (n = 8). Each planning was performed consecutively with the 2 skull definition techniques. For each treatment, we recorded the beam-on time (min), target volume coverage (%), prescription isodose volume (cm &lt;sup&gt;3&lt;/sup&gt; ), and maximal dose (Gy) to the nearest organ at risk if relevant, according to each of the 2 skull definition techniques. The image-based contours were performed using CT scan segmentation, based upon a standardized windowing for all patients. The median difference in beam-on time between manual measures and image-based contouring was + 0.45 min (IQR; 0.2-0.6) and was statistically significant (p &lt; 0.0001), corresponding to an increase of 1.28% beam-on time per treatment, when using image-based contouring. The target location was not associated with beam-on time variation (p = 0.15). Regarding target volume coverage (p = 0.13), prescription isodose volume (p = 0.2), and maximal dose to organs at risk (p = 0.85), no statistical difference was reported between the two skull contour definition techniques. The beam-on time significantly increased using image-based contouring, resulting in an increase of the total dose delivery per treatment with the new TMR 10 algorithm. Other dosimetric parameters did not differ significantly. This raises the question of other potential impacts. One is potential dose modulation that should be performed as an adjustment to new techniques developments. The second is how this changes the biologically equivalent dose per case, as related to an increased beam on time, delivered dose, etc., and how this potentially changes the radiobiological effects of GKRS in an individual patient

Dentoskeletal sequellae after wearing of a mandibular advancement device in an OSAHS setting.

Mandibular advancement devices (MAD) are recommended in certain cases for the treatment of obstructive sleep apnea and hypopnea syndrome (OSAHS). The aim of this study was to make a retrospective investigation into the dental and skeletal effects in patients suffering from OSAHS after wearing an MAD, and according to the type of device, rigid or semi-rigid. Cephalometric criteria on lateral cephalograms before and after at least 6 months of treatment were analyzed. Twenty-two patients were included. We observed average labial tipping of the lower incisors (+4.1 ± 5.6 [P = 0.0023]) and reduced overbite (−1.6 ± 2.0 mm [P = 0.0026]) and overjet (−1.4 ± 2.3 mm [P = 0.0114]). Labial tipping of the mandibular incisors was more pronounced with semi-rigid MAD. Similarly, the decrease in overbite and overjet was more marked with the semi-rigid MAD. Medium-term wearing of MAD gives rise to dentally related occlusal changes, which can only be corrected by orthodontic treatment

Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

PURPOSE: We systematically reviewed the literature on predictive factors for clinically significant prostate cancer diagnosis after prebiopsy negative magnetic resonance imaging in prostate cancer naïve patients. MATERIALS AND METHODS: The MEDLINE® and Scopus® databases were searched up to March 2019. The review protocol was published in the PROSPERO database (CRD42019125549). The clinical factors and markers studied were age, prostate specific antigen, prostate specific antigen isoforms, prostate specific antigen density, PCA3, prostate volume, family history, ethnicity and risk calculators. The primary objective was to determine their predictive ability for clinically significant prostate cancer diagnosis. Secondary objectives included meta-analysis of the negative predictive value of prebiopsy negative magnetic resonance imaging when combined with these predictive factors. RESULTS: A total of 16 studies were eligible for inclusion. Few studies reported negative predictive value of magnetic resonance imaging combined with a marker. Prostate specific antigen density was the best studied and the strongest predictor of clinically significant prostate cancer in men with prebiopsy negative magnetic resonance imaging. There were 8 studies (1,015 patients) eligible for meta-analysis of the added value of prostate specific antigen density less than 0.15 ng/ml/ml to magnetic resonance imaging in reducing the risk of missing clinically significant prostate cancer. When combined with prostate specific antigen density, overall magnetic resonance imaging negative predictive value increased from 84.4% to 90.4% in cancer naïve patients. The increase was from 82.7% to 88.7% in biopsy naïve and from 88.2% to 94.1% in previous negative biopsy subgroups. CONCLUSIONS: The use of prostate specific antigen density less than 0.15 ng/ml/ml in the presence of prebiopsy negative magnetic resonance imaging was the most useful factor to identify men without clinically significant prostate cancer who could avoid biopsy

Metal ion release after hip resurfacing arthroplasty and knee arthroplasty: a retrospective study of one hundred ninety-five cases.

International audiencePurposeHip arthroplasty with metal-on-metal bearings like hip resurfacing results in the release of metallic ions. In parallel, like every metallic implant, knee arthroplasty implants undergo passive corrosion. We analyzed blood levels of cobalt and chromium ions in patients who have a hip resurfacing arthroplasty and compared them to patients who have undergone knee arthroplasty at a minimum follow-up of one year. The hypothesis was that there is no difference in the ion release between hip resurfacing and knee arthroplasty.MethodsSixty-three patients who underwent knee arthroplasty were compared to a cohort of 132 patients who underwent hip resurfacing. The blood levels of cobalt and chromium ions were determined preoperatively and at six and 12 months postoperatively and then compared between groups. We analyzed the relationship between ion release and the change in clinical outcome scores (Harris Hip score, Oxford Hip score, Merle D’Aubigné Postel score, Oxford Knee score, International Knee Society score), the BMI, sex, physical activity, implant size and inclination of the acetabular implant (hip resurfacing patients only). Mixed linear models were used to assess the changes in ion blood levels over time.ResultsThe cobalt blood levels were higher in the first 6 months in the resurfacing group (0.87 ug/L vs 0.67 ug/L; p = 0.011), while it was higher in the knee arthroplasty group at 12 months (1.20 ug/L vs 1.41 ug/L; p = 0.0008). There were no significant differences in chromium levels during the follow-up period.ConclusionThe increase in metal ion release after knee arthroplasty is as high as after hip resurfacing at the one year follow-up. The monitoring of this parameter probably should not be recommended in case of good clinicals outcomes

Do complications following pancreatic resections impact hospital costs in France: Medico-economic study on 127 patients

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High-field intraoperative MRI in glioma surgery: A prospective study with volumetric analysis of extent of resection and functional outcome

International audienceBackground: High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR).Objective: To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis.Methods: A prospective single-center study included consecutive adult patients undergoing glioma surgery with IoMRI. Volumetric evaluation was based on FLAIR hypersignal after gadolinium injection in non-enhancing tumors and T1 hypersignal after gadolinium injection in enhancing tumors. Endpoints comprised: residual tumor volume (RTV), EOR, workflow and clinical outcome on Karnofsky performance score (KPS).Results: Fifty-three surgeries were performed from July 2014 to January 2016. Thirty-four patients underwent one IoMRI, and 19 two IoMRIs. In non-enhancing tumors, intraoperative RTV on 1st IoMRI T2/FLAIR was higher than in enhancing tumors on T1 sequences (7.25cm3 vs. 0.74cm3, respectively; P=0.008), whereas the RTV on 2nd IoMRIs and final RTV were no longer significantly different. After IoMRI, 72% of patients underwent additional resection. In non-enhancing tumors, EOR increased from 77.3% on 1st IoMRI to 97.4% on last MRI (P<0.001). Taking all tumors together, final RTV values were: median=0cm3, mean=3.9cm3. Mean final EOR was 94%. In 25% of patients, KPS was reduced during early postoperative course; at 3 and 6 months postoperatively, median KPS was 90.Conclusion: Intraoperative MRI guidance significantly enhanced the extent of glioma resection, especially for non- or minimally enhancing tumors, while preserving patient autonomy

Gender influences physical activity changes during adolescence: The HELENA study

International audienceBackground: We compared differences in physical activity (PA) between pre/mid-pubertal and post-pubertal participants according to gender.Methods: The study included a total of 1842 healthy participants aged 12.5-17.4 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Participants wore a uniaxial accelerometer (ActiGraph© GT1M, Pensacola, FL, USA) attached to their lower back for seven consecutive days to measure PA. Pubertal status was assessed by physical examination and the population was classified as pre/mid-pubertal (Tanner stages 1-3) or post-pubertal (Tanner stages 4-5). PA was compared between these groups according to gender during the whole week, on school-free days and on school days, before and after school, and during lessons and recesses.Results: When comparing the pre/mid-pubertal group with the post-pubertal group, girls' total PA did not differ between groups. However, a slight difference was observed in boys, among whom PA on school-free days showed a difference of 17.6% between the pre/mid-pubertal group and the post-pubertal group (679 kcounts vs 564 kcounts, respectively; P = 0.0007) and 20% (162 kcount vs 135 kcounts; P = 0.006) for school recess. There was no difference among girls.Conclusions: A reduced level of PA in the post-pubertal groups was only observed in boys during non-organized times such as on school-free days and during school recesses, with a moderate impact on total PA