Reirradiation for isolated local recurrence of prostate cancer: Mono-institutional series of 64 patients treated with salvage stereotactic body radiotherapy (SBRT)

objective: To evaluate high-precision external beam reirradiation (re-EBRT) for local relapse of prostate cancer (PCa) after radiotherapy. Methods: This retrospective study included patients with biochemical failure and evidence of isolated local recurrence of PCa after radical/salvage EBRT or brachytherapy that received salvage stereotactic body radiation therapy (SBRT, re-EBRT). Biopsy was not mandatory if all diagnostic elements were univocal (prostate specific antigen evolution, choline-positron emission tomography or magnetic resonance imaging). Salvage SBRT (re-EBRT) was delivered with image-guided radiation therapy (RapidArc\uae, VERO\uae and CyberKnife\uae). results: Data of 64 patients were included, median age at salvage SBRT was 73.2 years, median pre-salvage SBRT prostate specific antigen was 3.89 ng ml 121 . Median total dose was 30 Gy in five fractions, biologically effective dose (BED) of 150 Gy. One acute G3 genitourinary event and one late G3 genitourinary event were observed. No G 65 3 bowel toxicity was registered. At the median follow-up of 26.1 months, tumor progression was observed in 41 patients (64%). 18 patients (28%) experienced local relapse. 2-year local control, biochemical and clinical relapse free survival rates were 75, 40 and 53%, respectively. With BED 65130 Gy 1-year biochemical and clinical progression-free survival rate were 85 and 90%, respectively. conclusions: Salvage SBRT (re-EBRT) for isolated local PCa recurrence is a safe, feasible and noninvasive salvage treatment. Further investigation is warranted to define the optimal patient selection, dose and volume parameters. advances in knowledge: Salvage SBRT reirradiation for the locally recurrent PCa offer a satisfactory tumor control and excellent toxicity profile, if BED 65130 Gy is administered

Accurate and rapid antibiotic susceptibility testing using a machine learning-assisted nanomotion technology platform.

Antimicrobial resistance (AMR) is a major public health threat, reducing treatment options for infected patients. AMR is promoted by a lack of access to rapid antibiotic susceptibility tests (ASTs). Accelerated ASTs can identify effective antibiotics for treatment in a timely and informed manner. We describe a rapid growth-independent phenotypic AST that uses a nanomotion technology platform to measure bacterial vibrations. Machine learning techniques are applied to analyze a large dataset encompassing 2762 individual nanomotion recordings from 1180 spiked positive blood culture samples covering 364 Escherichia coli and Klebsiella pneumoniae isolates exposed to cephalosporins and fluoroquinolones. The training performances of the different classification models achieve between 90.5 and 100% accuracy. Independent testing of the AST on 223 strains, including in clinical setting, correctly predict susceptibility and resistance with accuracies between 89.5% and 98.9%. The study shows the potential of this nanomotion platform for future bacterial phenotype delineation

Severe asthma: One disease and multiple definitions

Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Adherence issues related to sublingual immunotherapy as perceived by allergists

Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd

Medical image of the week: extensive small cell lung cancer with cardiac invasion

A 73 year old woman was seen with a lung mass and acute onset of ataxia. MRI of the brain was notable for multifocal infarcts (Figure 1). Echocardiography (ECHO) was obtained to identify cardiac source of emboli and was notable for freely mobile mass tethered to the lateral left atrial wall, crossing the mitral valve into the left atrium (Figure 2). A contrast enhanced CT scan of the chest was obtained which confirmed the presence of a large right upper lobe mass with extension to the right pulmonary vein, left atrium and into the left ventricle (Figures 3 and 4). The biopsy confirmed small cell lung cancer

Accidentes en la infancia y la adolescencia

 Introducción: Los accidentes en la infancia y adolescencia representan una causa creciente de morbimortalidad en las últimas décadas; es la suma de factores relacionados con un huésped susceptible, un agente agresor, y un ambiente inseguro. El 90% de los accidentes son previsibles y potencialmente evitables, de ahí la necesidad de conocer la realidad local e instalar un sistema de vigilancia y prevención, involucrando a las autoridades sanitarias y a los padres para adoptar conductas seguras en las actividades diarias de los niños/as.   Objetivos: Conocer los accidentes más frecuentes en la infancia y la adolescencia en la ciudad de Encarnación. Caracterizar los accidentes según sexo, edad, sitio de ocurrencia, tipo y gravedad de los mismos.   Materiales y métodos: Estudio de corte transverso, observacional, para lo cual se realizó una encuesta cerrada, anónima, distribuyéndose la misma a padres, en distintos puntos de la ciudad de Encarnación; buscando datos sobre el tipo de accidente sufrido, edad y sexo de los accidentados, tipo de lesión, gravedad y secuelas de los mismos y escolaridad de los padres.   Resultado: De las 406 encuestas realizadas un 77%(n=312) refirió que su hijo/a había sufrido algún tipo de accidente dentro o fuera del hogar; con una edad promedio de los niños en el momento del accidente de 5,7 años (0-19); un 35%(n=108) corresponde a niños entre 3-5 años, se encontró un predominio en el sexo masculino 60%(n=186). Los tipos de accidentes fueron: traumatismos en un 44%(n=137) encontrándose más frecuentemente contusiones en miembros inferiores por caídas, traumatismo de cráneo y las fractura de miembros, heridas cortantes 23%(n=72), quemaduras 15%(n=47), intoxicaciones 5%(n= 16), electrocución 3,5% (n=11), atragantamiento 3,5% (n=11) y otros menos frecuentes que corresponden a un 6% (n=18). Los accidentes ocurrieron con más frecuencia durante la tarde 57% (n=178), al cuidado de la madre 30,5% (n=95) y en el hogar 84% (n=262). Se pudo establecer relación entre menor nivel académico de los padres y mayor número de hijos, con mayor riesgo de padecer accidentes. Un total de 71%(n=221) precisaron atención médica y de estos 36% (n=80) internación. En el 48% (n=150) de los niños quedó algún tipo de secuela, y fueron al óbito un 3,3% (n=5). No hubo reincidencia de los accidentes.   Conclusión: El tipo de accidente sufrido por niños y adolescentes más frecuente fue el ocasionado por traumatismos, ocurridos en el hogar, en mayor número en horas de la tarde. Un alto porcentaje requirió atención médica e internación lo que refleja la severidad de los mismos. La mitad de los niños accidentados quedó con algún tipo de secuela