Diagnóstico diferencial de las enfermedades prostáticas

Este trabajo incluye una revisión de los métodos de diagnóstico de las enfermedades prostáticas; además describe cómo podemos distinguir entre cada una de ellas, dependiendo del método de diagnóstico utilizado.This paper reviews the prostatic pathologies diagnosis methods; it also describes the way we can distinguish between each one depending on the one we use

HER2-Enriched Subtype and ERBB2 Expression in HER2-Positive Breast Cancer Treated with Dual HER2 Blockade

Background: Identification of HER2-positive breast cancers with high anti-HER2 sensitivity could help de-escalate chemotherapy. Here, we tested a clinically applicable RNA-based assay that combines ERBB2 and the HER2-enriched (HER2-E) intrinsic subtype in HER2-positive disease treated with dual HER2-blockade without chemotherapy. Methods: A research-based PAM50 assay was applied in 422 HER2-positive tumors from five II-III clinical trials (SOLTI-PAMELA, TBCRC023, TBCRC006, PER-ELISA, EGF104090). In SOLTI-PAMELA, TBCRC023, TBCRC006, and PER-ELISA, all patients had early disease and were treated with neoadjuvant lapatinib or pertuzumab plus trastuzumab for 12-24 weeks. Primary outcome was pathological complete response (pCR). In EGF104900, 296 women with advanced disease were randomized to receive either lapatinib alone or lapatinib plus trastuzumab. Progression-free survival (PFS), overall response rate (ORR), and overall survival (OS) were evaluated. Results: A total of 305 patients with early and 117 patients with advanced HER2-positive disease were analyzed. In early disease, HER2-E represented 83.8% and 44.7% of ERBB2-high and ERBB2-low tumors, respectively. Following lapatinib and trastuzumab, the HER2-E and ERBB2 (HER2-E/ERBB2)-high group showed a higher pCR rate compared to the rest (44.5%, 95% confidence interval [CI] = 35.4% to 53.9% vs 11.6%, 95% CI = 6.9% to 18.0%; adjusted odds ratio [OR] = 6.05, 95% CI = 3.10 to 11.80, P <. 001). Similar findings were observed with neoadjuvant trastuzumab and pertuzumab (pCR rate of 66.7% in HER2-E/ERBB2-high, 95% CI = 22.3% to 95.7% vs 14.7% in others, 95% CI = 4.9% to 31.1%; adjusted OR = 11.60, 95% CI = 1.66 to 81.10, P =. 01). In the advanced setting, the HER2-E/ERBB2-high group was independently associated with longer PFS (hazard ratio [HR] = 0.52, 95% CI = 0.35 to 0.79, P <. 001); higher ORR (16.3%, 95% CI = 8.9% to 26.2% vs 3.7%, 95% CI = 0.8% to 10.3%, P =. 02); and longer OS (HR = 0.66, 95% CI = 0.44 to 0.97, P =. 01). Conclusions: Combining HER2-E subtype and ERBB2 mRNA into a single assay identifies tumors with high responsiveness to HER2-targeted therapy. This biomarker could help de-escalate chemotherapy in approximately 40% of patients with HER2-positive breast cancer

Living at a geographically higher elevation is associates with lower risk oof metabolic syndrome: prospective analysis of the SUN Cohort

Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456m) exhibited a significantly lower risk of developing MetS compared to those in the lowes ttertile (<122m) of altitude of residence [Model2:Hazardratio=0.75(95%Confidenceinterval:0.58–0.97);pfortrend=0.029]. Living at geographically higher altitude was associated with alower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases

Development and validation of a population-based prediction scale for osteoporotic fracture in the region of Valencia, Spain: the ESOSVAL-R study

<p>Abstract</p> <p>Background</p> <p>Today, while there are effective drugs that reduce the risk of osteoporotic fracture, yet there are no broadly accepted criteria that can be used to estimate risks and decide who should receive treatment. One of the actual priorities of clinical research is to develop a set of simple and readily-available clinical data that can be used in routine clinical practice to identify patients at high risk of bone fracture, and to establish thresholds for therapeutic interventions. Such a tool would have high impact on healthcare policies. The main objective of the ESOSVAL-R is to develop a risk prediction scale of osteoporotic fracture in adult population using data from the Region of Valencia, Spain.</p> <p>Methods/Design</p> <p><it>Study design</it>: An observational, longitudinal, prospective cohort study, undertaken in the Region of Valencia, with an initial follow-up period of five years; <it>Subjects</it>: 14,500 men and women over the age of 50, residing in the Region and receiving healthcare from centers where the ABUCASIS electronic clinical records system is implanted; <it>Sources of data</it>: The ABUCASIS electronic clinical record system, complemented with hospital morbidity registers, hospital Accidents & Emergency records and the Regional Ministry of Health's mortality register; <it>Measurement of results</it>: Incident osteoporotic fracture (in the hip and/or major osteoporotic fracture) during the study's follow-up period. Independent variables include clinical data and complementary examinations; <it>Analysis</it>: 1) Descriptive analysis of the cohorts' baseline data; 2) Upon completion of the follow-up period, analysis of the strength of association between the risk factors and the incidence of osteoporotic fracture using Cox's proportional hazards model; 3) Development and validation of a model to predict risk of osteoporotic fracture; the validated model will serve to develop a simplified scale that can be used during routine clinical visits.</p> <p>Discussion</p> <p>The ESOSVAL-R study will establish a prediction scale for osteoporotic fracture in Spanish adult population. This scale not only will constitute a useful prognostic tool, but also it will allow identifying intervention thresholds to support treatment decision-making in the Valencia setting, based mainly on the information registered in the electronic clinical records.</p

Effectiveness of an mHealth intervention combining a smartphone app and smart band on body composition in an overweight and obese population: Randomized controlled trial (EVIDENT 3 study)

Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. Results: The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m2, 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m2 (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m2 (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m2 (95% CI –0.83 to –0.19). Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect

Plant availability of heavy metals in a soil amended with a high dose of sewage sludge under drought conditions

9 pages, 2 figures, 7 tables.The objective of this research was to study the effect of water deficit on soil heavy metal availability and metal uptake by ryegrass (Lolium multiflorum Lam.) plants grown in a soil amended with a high dose of rural sewage sludge. Three fertility treatments were applied: sewage sludge (SS), mineral fertilizer (M), and control (C); unamended). The levels of irrigation were: well-watered (W) and water deficit (D). Microbial respiration decreased the total organic C (TOC) in sludge-treated soils, but this did not enhance soil DTPA-extractable heavy metal concentrations. Indeed, Zn, Cu, Mn and Ni availability decreased during the experiment. C- and M-treated soils showed either no changes or increases of some trace element concentrations during the incubation. In the plant experiment, ryegrass dry matter (DM) yield, relative water content (RWC) and leaf water potential (PSgrw) decreased in drought conditions. Sludge addition increased metal concentrations in plants. However, in some instances, SS-treated plants showed either similar or lower transfer coefficient (Tc) values than did plants in the C and M treatments. Water deficit decreased the concentration and the Tc of some metals in roots of M and SS plants. Results indicate that sludge-borne heavy metals were maintained in chemical forms of low availability. The lower metal uptake by SS and M plants under dry conditions cannot be attributed to a lower availability of these elements in soil.This work was supported by Cátedra Zurich de Medio Ambiente of the Universidad de Navarra.Peer reviewe

Digestive efficiency in rabbit does according to environment and genetic type

[EN] Ninety lactating rabbit does of three different genetic types [2 from a line differentiating 20 generations by selection for litter size at weaning (lines V16 and V36) and 1 from a line founded under reproductive longevity criteria and then selected by litter size at weaning (line LP)] were subjected to three environmental conditions: NC, females housed under normal conditions (14 to 20oC) and fed with a control diet (333 g NDF/kg DM); HC, females housed under heat conditions (25 to 35oC) and fed with the control diet; or NF, females housed under normal conditions and fed with a fibrous diet (443 g NDF/kg DM). The apparent digestible coefficients of dry matter (DMd), organic matter, crude protein (CPd), gross energy, NDF (NDFd) and acid detergent fibre, as well as the daily intake of dry matter (DM), digestible protein (DP) and digestible energy (DE), were determined (14 to 18 d post-partum). The environment affected all variables analysed. In general, heat conditions reduced the daily feed intake (around -30%; P<0.05) and increased main apparent digestible coefficients (+4.5 percentage points for DMd). In contrast, the use of a fibrous diet led to lower DE intake (-217 kJ/d; P<0.05) and main apparent digestibility coefficients (-13.5 percentage points for DMd). Females from line V, regardless of generation, showed lower daily DM intake (-19.2 g/d; P<0.05) and NDFd (-1.5 percentage points; P<0.05) than line LP. Interactions between genetic type and environment were found for daily DM intake, NDFd and CPd. When receiving fibrous diet, LP females showed a higher increment in daily DM intake (65.6 g/d; P<0.05) than V36 females, compared to control. Under heat conditions, NDFd obtained for LP females were higher to those in normal conditions (+3.14 percentage points), while V females showed similar NDFd. In addition, the increase in CPd observed under heat conditions was higher for LP (+9.87 percentage points) and V36 (+8.74 percentage points) than V16 females (+3.84 percentage points). In conclusion, rabbit females from a line founded for reproductive longevity seem to show a higher flexibility in their digestive capacity under constrained conditions.The authors would like to thanks Luis Rodenas, Eugenio Martinez-Paredes and Juan Carlos Moreno for their technical support and to the Spanish Ministry of Education and Science (Project AGL2011-30170-C02-01) for the economic support to conduct this study.Savietto, D.; Blas Ferrer, E.; Cervera Fras, MC.; Baselga Izquierdo, M.; Friggens, NC.; Larsen, T.; Pascual Amorós, JJ. (2012). Digestive efficiency in rabbit does according to environment and genetic type. World Rabbit Science. 20(3). https://doi.org/10.4995/wrs.2012.1152SWORD20