Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series

Aims 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. Results 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). Conclusions PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging (AU)

Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series.

AIMS: 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. RESULTS: 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). CONCLUSIONS: PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.

Spatial-temporal variations of a SW Atlantic macrobenthic community affected by a chronic anthropogenic disturbance.

The effect of the chronic anthropogenic disturbance in a coastal area of the SW-Atlantic was tested through a multimetric-approach. This study integrates environmental variables, biotic indices of environmental quality, and changes in alpha and beta diversity. The outfall site showed high percentages of organic matter, silt and clay in sediment and high concentration of Enterococcus in seawater. The invasive polychaete Boccardia proboscidea dominated the outfall site, while the ecosystem engineer Brachidontes rodriguezii dominated the non-impacted sites. Regarding partitioning of beta diversity the species loss (nestedness) at outfall site would be the process that drives the patterns found. Moreover, outfall site presented the lowest environmental health values in both spring and autumn. This community-level integrated analysis provides useful tools to consider when making decisions regarding coastal management.

Revision of Cirratulus (Cirratulidae: Polychaeta) from Argentina, with the description of three new species and a key to identify all species of the area

Introduction: The taxonomy of Cirratulidae is not easy due to the diagnostic characters currently accepted change through ontogeny, in some cases, there are even difficulties to separate juveniles from adults. Among the Cirratulus species cited, described and considered as valid for Argentina are Cirratulus jucundus (Kinberg, 1866), Cirratulus patagonicus (Kinberg, 1866) and Cirratulus mianzanii Saracho Bottero, Elías & Magalhães, 2017. Objetive: This study made a revision of Cirratulus includes material deposited in the Museo de Ciencias Naturales de La Plata (MLP) and specimens collected privately by J.M. Orensanz that was donated to the laboratory of Bioindicadores Bentónicos of the National University of Mar del Plata. Methods: The specimens were examined with optical equipment (microscope and stereomicroscope) and also by a scanning electron microscope (SEM). Results: A complete examination of the material, revealed a higher number of species than those already mentioned. In the present work, three new species are described from the intertidal and subtidal areas of the Argentine continental shelf: Cirratulus orensanzii n. sp.; Cirratulus knipovichana n. sp. and Cirratulus alfonsinae n. sp. Conclusions: The knowledge about the taxonomy of the family as well as the updating of the geographic registries contributes to the biodiversity of the region, which is of great importance to carry out both ecological studies and conservation plans.

Introducción: La taxonomía de Cirratulidae no es fácil debido a que los caracteres diagnósticos actualmente aceptados cambian a través de la ontogenia; en algunos casos, incluso existen dificultades para separar a los juveniles de los adultos. Entre las especies de Cirratulus citadas, descritas y consideradas como válidas para Argentina se encuentran Cirratulus jucundus (Kinberg, 1866), Cirratulus patagonicus (Kinberg, 1866) y Cirratulus mianzanii Saracho Bottero, Elias & Magalhães, 2017. Objetivo: El presente estudio hace una revisión de Cirratulus que incluye material depositado en el Museo de Ciencias Naturales de La Plata (MLP) y especímenes recolectados en privado por JM Orensanz que fue donado al laboratorio de Bioindicadores Bentónicos de la Universidad Nacional de Mar del Plata. Métodos: Las muestras se examinaron con equipo óptico (microscopio y estereomicroscopio) y también con microscopio electrónico de barrido (SEM). Resultados: Un examen completo del material, reveló un mayor número de especies que las ya mencionadas. En el presente trabajo, se describen tres nuevas especies de las áreas intermareales y submareales de la plataforma continental argentina: Cirratulus orensanzii n. sp.; Cirratulus knipovichana n. sp. y Cirratulus alfonsinae n. sp. Conclusiones: El conocimiento sobre la taxonomía de la familia, así como la actualización de los registros geográficos, contribuye a la biodiversidad de la región, lo cual es de gran importancia para llevar a cabo estudios ecológicos y planes de conservación.

Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is characterized by the delivery of high doses of ionizing radiation in few fractions. It is highly effective in achieving local control, and, due to the high biological effective dose administered, it seems to overcome the radioresistance of renal cell carcinoma (RCC). Thus, SBRT could constitute a treatment option for the management of localized RCC in patients who are not surgical candidates. In this paper, we report an overview about data from the current evidence about SBRT in patients affected by localized RCC. MATERIALS AND METHODS: A non-systematic review was performed, including data from both retrospective and prospective studies focusing on the use of SBRT for localized RCC and its biological rationale. Furthermore, ongoing trials on this issue are reported. CONCLUSION: Currently, SBRT might be considered a treatment alternative in inoperable patients affected by primary RCC. Currently, dose-escalation to 48 Gy in 3-4 fractions are effective and well tolerated. Emerging role of immune therapies in RCC patients warrant further studies to explore interactions between SBRT and immune response.

Rapid sewage pollution assessment by means of the coverage of epilithic taxa in a coastal area in the SW Atlantic.

The sewage pollution impact over coastal environment represents one of the main reasons explaining the deterioration of marine coastal ecosystems around the globe. This paper aims to detect promptly a putative sewage pollution impact in a Southwestern Atlantic coastal area of Argentina as well as to identify a straightforward way for monitoring, based on the relative abundance coverage of the intertidal epilithic taxa. Four sampling sites were distributed at increased distances from the sewage outfall where the cover of individual epilithic species was visually estimated. The surrounded outfall area (i.e. outfall site) resulted polluted with high percentages of organic matter in sediment and Enterococcus concentration in seawater. The structure of the community showed a remarkable difference between the polluted site (outfall site) and the unpolluted sites. The polychaete Boccardia proboscidea dominated the outfall site with variable abundances of the green algae Ulva sp. during the period of study, decreasing the diversity of the community, while the mussel Brachidontes rodriguezii and variable abundances of several algae species dominated the unpolluted sites. The monitoring of the benthic community represents an effective, non-destructive, relative inexpensive and rapid method to assess the health of the coastal environment in the study area. The large abundance of B. proboscidea along with the absence of B. rodriguezii individuals at <300m to the sewage outfall discharge allowed the success of this classical monitoring method in a temperate marine-coastal ecosystem with certain gradient of pollution.

Sustainable healthcare: how to assess and improve healthcare structures' sustainability.

BACKGROUND: Sustainability is a broad and debated subject, often difficult to be defined and applied into real projects, especially when dealing with a complex scenario as the one of healthcare. Many research studies and evaluation systems have handled this topic from different perspectives, but many limits and criticalities still have to be overcome to properly cope with actual needs. METHODS: The Sustainable Healthcare project has been developed through three main phases: a deep study of the state of the art, unraveling pros and cons of available sustainability scoring systems; an accurate analysis of the stakeholders network and their needs; the realization of an objective evaluation framework, through scientific methods, as the ANP. RESULTS: The newly developed evaluation system takes into consideration all the three pillars of sustainability, analyzing social, environmental and economic sustainability through a set of criteria, specified by measurable indicators. So the system identifies both global sustainability and specific critical areas, pointing out possible strategic solutions to improve sustainability. The evaluation is achieved through technical analyses and qualitative surveys, which eventually allow to quantitatively assess sustainability, through a sound scoring method. CONCLUSIONS: This study proposes an innovative evaluation method to determine the sustainability of a hospital, already existing or in the design phase, within the European context. The Sustainable Healthcare system overcomes some of the current evaluation systems' limits by establishing a multidisciplinary approach and being an easy-to-use tool. This protocol is intended to be of support in the identification of the main hospital's weaknesses and in setting priorities for implementation of the solutions.

Comparison of Lactococcus garvieae strains isolated in northern Italy from dairy products and fishes through molecular typing.

AIMS: To investigate the genetic relatedness between Lactococcus garvieae strains isolated from fish and dairy samples collected in northern Italy, using random-amplified polymorphic DNA (RAPD)-polymerase chain reaction (PCR), Sau-PCR and amplified fragment length polymorphism (AFLP). METHODS AND RESULTS: Eighty-one isolates from bovine and caprine dairy products (n = 53) and from diseased rainbow trouts and other fishes (n = 28) were examined. All methods showed a typeability of 100%, repeatability ranging from 84.4% to 97.5% and discriminatory powers from 0.798 to 0.986. Dairy and fish strains revealed a low genetic relatedness as they are often grouped into distinct clusters. RAPD analysis discriminated 52 genotypes when primer M13 was used, whereas with primer P5 only 27 genotypes were identified. When Sau-PCR was performed, 13 genotypes were detected while AFLP analysis allowed the differentiation of 32 genotypes. CONCLUSION: L. garvieae strains isolated from dairy samples are generally not related to those collected from fish lactococcosis outbreaks. SIGNIFICANCE AND IMPACT OF THE STUDY: L. garvieae strains exhibit a genetic diversity related to the specific animal host they colonize. RAPD M13 fingerprinting proved to be a molecular tool for comparing isolates, whereas Sau-PCR and AFLP analyses were useful techniques to investigate the distribution of L. garvieae populations in the environment.

Management of fluid overload in congestive heart failure: learning from a case report.

A case of refractory fluid overload due to congestive heart failure and consequent renal insufficiency is reported. The case was approached multidisciplinarily, at the beginning with conservative and pharmacological therapy, subsequently with extracorporeal fluid removal in which a specific attention was payed to the maintenance of circulating blood volume and achievement of dry weight, and finally with chronic peritoneal dialysis as a maintenance therapy. The case seems to summarize the pathway of many patients seen initially in intensive care and cardiology departments and subsequently in nephrological wards.

Development of a multiplex PCR assay for the identification of pathogenic genes of Escherichia coli in milk and milk products.

A multiplex PCR for the simultaneous detection of some pathogenic genes of enteropathogenic, enterotoxigenic and verocytotoxin-producing Escherichia coli was developed. In this study primers found in literature as well as primers to the purpose designed were used. In this way, it was possible to generate specific fragments of 96, 170, 229, 285, 348, 414 and 510 bp for Hlya, St, EaeA, Lt, Vt1, UidA and Vt2 genes, respectively. When applied to bacterial strains experimentally inoculated in milk and milk products, the proposed PCR showed a detection limit of 5 x 10(4)CFU/ml for Hyla, St, Eaea, Vt1 primers, while for Lt and Vt2 primers the limit resulted of 10(6)CFU/ml.

A multiplex PCR assay for the identification of animal species in feedstuffs.

A multiplex Polymerase Chain Reaction (PCR) assay was applied to feedstuff analysis for the identification of the most used species in rendering plants (ruminant, poultry, fish and pork materials). Primers were designed in different regions of mitochondrial DNA (12S rRNA, tRNA Val and 16S rRNA) after alignment of the available sequences in the GenBank database. The primers generated specific fragments of 104-106, 183, 220-230 and 290 bp length for ruminants, poultry, fish and pork, respectively. The detection limit was 0.004% for fish primers and 0.002% for ruminants, poultry and pork primers. The multiplex PCR proposed in this study can be considered a valid alternative to the microscopic method for the detection of animal derived materials banned by a European Union Regulation as a preventive measure against the spread of Bovine Spongiform Encephalopathy.

Development of a PCR assay for the detection of animal tissues in ruminant feeds.

The European Community ban on use of meat and bone meal in ruminant feed, as a consequence of the spread of bovine spongiform encephalopathy in Europe, has prompted a number of investigations about the possibility of detecting animal tissues in feedstuff. In this paper, a study on vertebrate primers, designed in the 16S rRNA gene of mitochondrial DNA, is described. These primers were able to amplify fragments that contained between 234 and 265 bp. The fragments were specific for bovine, porcine, goat, sheep, horse, rabbit, chicken, trout, and European pilchard and were confirmed by sequence analysis amplicons. The primers were used in a PCR assay applied to five samples of meat and blood meals of different species and subjected to severe rendering treatments (134.4 to 141.9 degrees C and 3.03 to 4.03 bar for 24 min). The presence of vertebrate tissues was detected in all samples. The assay proved to be rapid and sensitive (detection limit 0.0625%). It can be used as a routine method to detect animal-derived ingredients in animal feedstuff.

Identification of cow's milk in "buffalo" cheese by duplex polymerase chain reaction.

A duplex polymerase chain reaction (PCR) was developed to identify the milk of bovine and buffalo species in cheese products, particularly in mozzarella cheese, a typical Italian cheese made from buffalo's milk. Two sets of primers were designed on the basis of the alignment of the sequence codifying mitochondrial cyt b available in the GenBank database. The primers proved to be species-specific, giving rise to 279-bp (bovine) and 192-bp (buffalo) amplified fragments. Since the amplification conditions for bovine and buffalo primers were identical, a duplex PCR was successfully applied to identify the two species in a single reaction step. This technique, when used to test cheese products from the retail trade, allowed the detection of partial or even total substitution of cow's milk for buffalo's milk, in some cases in samples of cheese misleadingly labeled "pure buffalo" mozzarella.

Abciximab in rescue coronary angioplasty after full-dose tissue-type plasminogen activator.

BACKGROUND: Rescue angioplasty is a complex procedure because of frequent reocclusions secondary to a paradoxical pro-thrombotic effect brought about by thrombolytic therapy. Administration of abciximab may improve procedural results but its utilization in this setting is limited by the potential hemorrhagic risk. Very few data on this approach are currently available in the medical literature. METHODS: After failed full-dose tissue-type plasminogen activator (tPA), 30 patients (23 males, 7 females, mean age 64 +/- 13 years) referred for rescue angioplasty received abciximab (0.25 mg/kg bolus + 0.125 mcg/kg/min x 12 hour infusion) (Abc+ group). The procedural results, hemorrhagic complications and in-hospital outcome observed in these patients were compared to those of 35 patients submitted to rescue angioplasty in the same time period (1997-1999) who did not receive abciximab (Abc- group). RESULTS: In the Abc+ group, 11 patients (37%) were in Killip class 3-4, 14 (47%) had multivessel disease, and 4 (13%) had previous bypass surgery. In all Abc+ patients, factors suggestive of procedural failure were present (i.e. saphenous vein graft occlusion, intraluminal thrombus, dissection, reocclusion, slow flow). The periprocedural heparin dose was 5,000 IU in Abc+ and 100 IU/kg in Abc-patients (range 5,000-10,000 IU). The procedure was successful in 29 Abc+ (97%) and in 34 Abc- patients (97%). A hemoglobin drop > 5 g occurred in 3 Abc+ (10%) and in 4 Abc- patients (11%) with a similar incidence of blood transfusion in the two groups. In all these cases, significant bleeding occurred at the vascular access site. There were 2 in-hospital deaths in Abc+ and 1 in Abc- patients. CONCLUSIONS. Selected patients undergoing rescue angioplasty may be treated with abciximab without an undue increase in hemorrhagic complications. Larger studies are needed to confirm the feasibility of this approach and to assess its potential benefits.

Human dentin production in vitro.

The main hard tissues of teeth are composed of dentin and enamel, synthesized by the mesenchyme-derived odontoblasts and the epithelial-derived ameloblasts, respectively. Odontoblasts are highly differentiated post-mitotic cells secreting the organic matrix of dentin throughout the life of the animal. Pathological conditions such as carious lesions and dental injuries are often lethal to the odontoblasts, which are then replaced by other pulp cells. These cells are able to differentiate into odontoblast-like cells and produce a reparative dentin. In this study we reproduced this physiological event in an in vitro culture system using pulps of human third molars. Pulp cells cultured in presence of beta-glycerophosphate formed mineralization nodules, which grew all over the culture period. The immunohistochemical study revealed that, as odontoblasts, pulp cells contributing to the nodule formation express type I collagen, osteonectin, and nestin. By the exception of nestin, these proteins are also detected in the nodules. The composition of the nodules was also analyzed by Fourier transform infrared microspectroscopy. The spectra obtained showed that both the organic and the mineral composition of the nodules have the characteristics of the human dentin and differ from those of enamel and bone. Taken together, these results show that both the molecular and the mineral characteristics of the human dentin matrix are respected in the in vitro culture conditions.

[Acute changes in the hemodynamic profile and circulating levels of atrial natriuretic peptide induced by dobutamine in severe heart failure]. / Modificazioni acute del profilo emodinamico e dei livelli circolanti di peptide natriuretico atriale indotte dalla dobutamina nello scompenso cardiaco grave.

METHODS: Sixteen patients (15 males, 1 female; mean age 63 years, range 45-78) with severe heart failure (NYHA class III = 5; class IV = 11) secondary to ischemic heart disease (8), dilated cardiomyopathy (5) and valvular heart disease (3), were evaluated for eligibility to intermittent Dobutamine (D) treatment. As a part of this evaluation, they were submitted to an acute dose-ranging test with D, up to 10 micrograms/Kg/min under hemodynamic and electrocardiographic monitoring. By inclusion criteria, all patients had:-cardiac index (CI) < 2.2 L/min/m2;-pulmonary wedge pressure (WP) > 18 mmHg;-left ventricular ejection fraction (EF) < 30%. At each step of the procedure, hemodynamic measurements and blood sampling for atrial natriuretic peptide (ANP) concentration were performed. RESULTS: Peak effect, defined as the dose corresponding to the maximum increase in CI, was reached at a mean of 7.8 +/- 0.5 micrograms/Kg/min. CI increased from 1.7 +/- 0.3 to 2.53 +/- 0.7 L/min/m2 (p < 0.001) and ANP decreased from 234 +/- 112 to 173 +/- 118 pg/ml (p < 0.001). Correspondingly, heart rate, stroke volume index and stroke work index increased, while right atrial pressure (RAP), mean pulmonary artery pressure (PAP), WP, systemic and pulmonary vascular resistance all significantly decreased. Mean arterial pressure was not affected. Changes in ANP concentration correlate significantly with changes in WP and in PAP (r = 0.65, p < 0.05 and r = 0.89, p < 0.001, respectively), but not with changes in RAP (r = 0.26, p = 0.34). Patients showing an increase > 40% in CI or a CI > or = 2.5 L/min/m2 at peak effect (responders) had significantly lower baseline PAP with respect to non-responders. Besides PAP, baseline ANP levels, end-systolic pressure/volume ratio and ejection fraction were also independent predictors of response. The test did not induce complex arrhythmias and was well tolerated in all patients. CONCLUSIONS: Patients with severe heart failure retain the ability to respond to acute administration of D. with a significant improvement in their hemodynamic profile. Response to D. administration is predicted by lower baseline pulmonary pressure and ANP levels and a lesser degree of left ventricular dysfunction. Despite high baseline ANP concentration, a significant decrease is obtained which parallels the decrease in pulmonary artery and pulmonary wedge pressure, but is not related to changes in right atrial pressure. These findings suggest that changes in left ventricular performance induced by D. are the major determinants of the decrease in ANP concentration in this clinical setting.

[Esophageal stimulation in WPW syndrome]. / Jícnová stimulace u WPW syndromu.

Transoesophageal stimulation of the atria combined with bicycle ergometry provides a satisfactory reproducibility of a number of basic electrophysiological parameters at rest and during a load. Due to the good sensitivity and low specificity this test can be recommended in WPW syndrome as a screening examination in particular in active sportsmen and junior subjects. To assess the risk of sudden death in subjects with this syndrome it is, however, necessary to evaluate the complex of all assembled data, as the shortest R-R interval in induced atrial fibrillation is not sufficiently specific.

[Transcatheter fulguration of the atrioventricular junction in supraventricular hyperkinetic arrhythmia. Immediate and long-term results]. / Folgorazione transcatetere della giunzione atrio-ventricolare nelle aritmie ipercinetiche sopraventricolari. Risultati immediati e a distanza.

Transcatheter direct-current ablation of the atrio-ventricular junction is a recently developed technique in the treatment of medically refractory supraventricular tachycardia. Twenty patients underwent this procedure between July 1987 and May 1989 and were followed-up for a mean period of 8.3 +/- 6 months (range 1-23). Indication for ablation included atrial flutter in 4 patients, atrial fibrillation in 8, atrial tachycardia in 1, atrio-ventricular nodal re-entrant tachycardia in 4, atrioventricular re-entrant tachycardia (concealed pathway) in 2, permanent junctional reciprocating tachycardia in 1. These arrhythmias were resistant to a mean of 3.3 +/- 1.7 antiarrhythmic drugs. A mean of 1.4 +/- 0.59 (range 1-3) electrical shocks, with a mean energy of 285 +/- 135J (range 200-700), were delivered during 1-2 sessions. In all patients a persistent complete atrio-ventricular block was achieved. Immediate complications included transient hypotension in 2 pts, acute pulmonary edema in 1, premature ventricular complexes in 4, non sustained ventricular tachycardia in 4, sustained ventricular tachycardia in 1. Late complications included thrombophlebitis of the right femoral vein in 2 pts; one of them died suddenly as a result of massive pulmonary embolism 10 days after the procedure. Follow-up evaluation reveals chronic complete atrio-ventricular block in all patients. Symptoms related to pre-existing arrhythmia are absent in all pts and none of them is currently taking antiarrhythmic drugs. Two patients with DDD pacing had pacemaker mediated re-entrant tachycardia and 1 patient with VVIR pacing developed a pacemaker syndrome. This experience confirms that transcatheter fulguration of atrio-ventricular junction is an effective technique. However, possible severe complications related to the procedure suggest this approach be restricted to patients with very symptomatic and drug-refractory supraventricular tachyarrhythmias.