A new approach to prostate cancer screening.

Prostate cancer screening based on prostate-specific antigen (PSA) testing has been a matter of controversy. Although screening for prostate cancer was effective in reducing mortality, it resulted in overdiagnosis, which translated into unnecessary treatments and numerous adverse effects. As a result, recommendations from scientific societies became increasingly restrictive. In the recent years, new approaches to prostate cancer screening have been proposed. These new approaches are aimed at solving the controversy between widespread screening vs. no screening, and reconsidering PSA testing as a screening tool with a good benefit/risk balance. In this context, the European Association of Urology submitted a proposal to the European Commission for prostate cancer screening to be performed as a function of baseline PSA concentrations. The European Commission recently recommended the implementation of organized prostate cancer screening programs for men aged ≤70 years based on PSA values in combination with follow-up magnetic resonance imaging.

Phase IV noninferiority controlled randomized trial to evaluate the impact on diagnostic thinking and patient management and the test-retest reproducibility of the Gaxilose test for hypolactasia diagnosis.

BACKGROUND: The diagnostic accuracy of the Gaxilose test (GT) for hypolactasia diagnosis has already been proved. The objectives of this clinical trial were to demonstrate the noninferiority of the GT compared to the hydrogen breath test (HBT) on the impact on diagnostic thinking and patient management, to evaluate the GT reproducibility with urine accumulated from 0 to 4 hours and from 0 to 5 hours and to assess test safety. METHODS: We conducted a randomized, parallel, noninferiority clinical trial. Patients with clinical symptoms suggestive of lactose intolerance were screened for inclusion and randomly assigned to the GT arm or the HBT arm of the study. The impact on diagnostic thinking and patient management was analyzed with pretest and posttest questionnaires in which the investigators indicated their estimated probability of hypolactasia diagnosis and the intended management before and after the GT or the HBT (noninferiority margin: -10%). The primary outcome of the study was the impact on diagnostic thinking, expressed as the mean of the absolute values of the differences between the pretest and posttest probabilities of hypolactasia diagnosis. Patients randomized to the GT arm performed also the retest to evaluate the reproducibility of the GT. RESULTS: A total of 147 patients were included in the intend-to-treat (ITT) population. Among them, 74 performed the HBT and 73 performed the GT. The results proved the noninferiority of the GT compared to the HBT on the impact on diagnostic thinking (ImpactGT = 31.74 ±â€Š23.30%; ImpactHBT = 24.28 ±â€Š19.87%; ΔGT-HBT = 7.46%; 95% confidence interval of ΔGT-HBT: 1.55%, infinite) and on patient management. The test-retest reproducibility was better for the GT with urine accumulated from 0 to 5 h: the intraclass correlation coefficient (ICC) was 0.5761, and the Kappa coefficient was 0.7548, indicative of substantial agreement between both tests. No serious adverse events were reported during the study. CONCLUSIONS: The GT has an impact on diagnostic thinking and patient management noninferior to that of the HBT, is reproducible and well tolerated. These results prove the clinical benefit of its use in the clinical practice (ClinicalTrials.gov identifier: NCT02636413).

Analytical Validation of a New Enzymatic and Automatable Method for d-Xylose Measurement in Human Urine Samples.

Hypolactasia, or intestinal lactase deficiency, affects more than half of the world population. Currently, xylose quantification in urine after gaxilose oral administration for the noninvasive diagnosis of hypolactasia is performed with the hand-operated nonautomatable phloroglucinol reaction. This work demonstrates that a new enzymatic xylose quantification method, based on the activity of xylose dehydrogenase from Caulobacter crescentus, represents an excellent alternative to the manual phloroglucinol reaction. The new method is automatable and facilitates the use of the gaxilose test for hypolactasia diagnosis in the clinical practice. The analytical validation of the new technique was performed in three different autoanalyzers, using buffer or urine samples spiked with different xylose concentrations. For the comparison between the phloroglucinol and the enzymatic assays, 224 urine samples of patients to whom the gaxilose test had been prescribed were assayed by both methods. A mean bias of -16.08 mg of xylose was observed when comparing the results obtained by both techniques. After adjusting the cut-off of the enzymatic method to 19.18 mg of xylose, the Kappa coefficient was found to be 0.9531, indicating an excellent level of agreement between both analytical procedures. This new assay represents the first automatable enzymatic technique validated for xylose quantification in urine.

Histerocystoplasty: a novel surgical procedure in the rat.

BACKGROUND: Enterocystoplasties are associated to complications. To avoid them, different types of tissue templates have been used to augment the bladder and induce native bladder regeneration. MATERIALS AND METHODS: A novel surgical technique for bladder reconstruction using autologous uterine tissue was evaluated in a rat model. Forty-two female Wistar rats were randomly allocated into three groups: sham-operation hysterocystorrhaphy (n = 12), hysterocystoplasty (n = 18), and control (n = 12). Two weeks after surgery, ultrasound examination of the bladder was performed. At 2, 4, or 6 mo after surgery, the rats were anesthetized and blood and urine samples were taken. They were then euthanized and post-mortem and histologic examination were performed. Ultrasound examination, analytical parameters and weight control, as well as gross and histologic examination were performed in all the operated animals. The statistical analysis was performed using Kruskal-Wallis and the extension of Fisher's exact tests. Significance was set at 5% (P < 0.05). RESULTS: Serum chemistry, blood count and peripheral blood smears, electrolytes, and urinary parameters were all within the normal range for the rat. Histologic sections of the surgically augmented zone between the bladder and uterine horn demonstrated urothelial epithelization, providing adequate coverage of the transition area in 72.22% of the rats that underwent hysterocystoplasty. CONCLUSIONS: The hysterocystoplasty was technically viable in all the cases and proved to be an easy and safe surgical model for bladder reconstruction. All animals were healthy after surgery and all systemic parameters analyzed were within normal physiologic range for the rat.

Blood lead and cadmium levels in a six hospital employee population. PESA study, 2009.

INTRODUCTION: Exposure to lead and cadmium is a public health problem due to the broad exposure to these toxic substances among the general population. The objective of this study is to determine blood lead and cadmium concentrations in a working population drawn from six university hospitals in Madrid, Getafe, Cartagena, Santiago de Compostela, Santander and Palma de Mallorca (Spain) and to identify associated factors. MATERIALS AND METHODS: 951 individuals participated in the study and were administered the standardized PESA® questionnaire regarding exposure to lead and cadmium. The blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction in Perkin-Elmer spectrometers, guaranteeing the transferability of the results. RESULTS: The median overall blood lead concentration was: 1.6 µg/dL (IQR: 0.9-2.7) and that of cadmium was: 0.21 µg/L (IQR: 0.10-0.50). There were significant differences in lead levels between men (2 µg/dL) and women (1.5 µg/dL), postmenopausal (2.6 µg/dL) and premenopausal women (1.1 µg/dL), and between participants who cooked in earthenware (2.1 µg/dL) and those who did not (1.5 µg/dL). The median of cadmium in women (0.24 µg/L) was higher than in men (0.11 µg/L) and was also higher in subjects who smoked (0.70 µg/L) than in non-smokers (0.13 µg/L). CONCLUSIONS: A reduction in blood lead and cadmium levels was observed with respect to previous studies carried out in Spain. Nevertheless, the results suggest there are certain factors which increase risk such as age, gender, menopause, age of housing, cooking in lead-glazed earthenware and exposure to cigarette smoke.

Folato eritrocitario en un grupo de puérperas del Gran Buenos Aires antes de la ley de enriquecimiento de las harinas / Red blood cell folate levels in a group of puerperial women from Great Buenos Aires before the flour enrichment law

El objetivo del trabajo fue analizar retrospectivamente los valores de folato eritrocitario de un grupo de 50 mujeres puérperas atendidas en un hospital de la zona suburbana del Gran Buenos Aires, en el año 2000. En sangre venosa, extraída en ayunas al día posterior al parto, se determinó: Hematocrito (Htc), Recuento de glóbulos rojos (GR), Hemoglobina (Hb), Volumen corpuscular medio (VCM) y Folato eritrocitario (Folato-E). Se registró el peso materno pregestacional y del recién nacido (PRN) y la edad gestacional (EG). Los resultados fueron (promedio ±DE y rangos): Hto (%): 35(5 (2.51-4.80);GR (x106/(L): 3.87(0.50 (23-47); Hb (g/L): 113(18(65-140);VCM (fL): 90(6(63-99); folato_E (nMol/L): 630±233; (ng/mL): 278(103 (126-564); PRN (g):3341 (435 (2370-4500); (EG) (semanas): 39.1± (34.0-41.0). Los resultados evidenciaron valores de Hb inferiores a 110 ng/ml en 4%, en tanto que si se considera un punto de corte de 192 ng/mL, el 20% de las mujeres estudiadas presentarían un estado nutricional deficiente. No se evidenció diferencia significativa en folato_E entre las mujeres con valores de Hb menores o mayores a 110 g/L. Estos resultados obtenidos antes de la promulgación de la Ley de enriquecimiento de la harina con hierro y ácido fólico, en mujeres que no habían tomado suplementos de vitaminas ni de minerales, indican un adecuado estado nutricional durante el embarazo, con respecto a ácido fólico, en el 96% de las puérperas estudiadas.

Changes in lipid profile after biliopancreatic diversion.

BACKGROUND: Bariatric operations have varying degrees of effectiveness and different mechanisms of action. Our objective was to evaluate the efficacy of the biliopancreatic diversion (BPD) in reduction of weight and serum lipids. METHODS: A prospective study was conducted with follow-up from 12 to 72 months (average 39.4 months) of 58 patients with morbid obesity (10 men, 48 women, mean BMI 49.4 kg/m2). Their lipid levels were generally normal or slightly high. All the patients were subjected to subtotal gastrectomy and BPD with jejunoileostomy 50 cm proximal to the ileocecal valve, and they were instructed to maintain the same hypocaloric diet as before BPD. Serum lipoproteins and apolipoproteins B and A1 were measured before BPD and every 6 months during follow-up. RESULTS: Early and very significant reduction (P<0.001) of total cholesterol (32.8%), LDL (46.3%), total cholesterol/HDL ratio (29.7%) and apolipoprotein B (37%), with more moderate decrease of triglycerides (21.3%, P=0.004), were observed. This lipid decrease was maximum at 1 year after BPD. Important and persistent weight reduction that did not correlate with changes in lipids was observed. The youngest patients and those with high basal lipid levels proved to benefit most from BPD. There were no important side-effects. CONCLUSION: BPD, with careful selection of patients, is a well tolerated procedure that offers excellent results in the short- and mid-term in reduction in weight and blood levels of most atherogenic lipoproteins.

Influencia del status en hierro en la atención y rendimiento intelectual de un colectivo de adolescentes espanoles / Influence of iron status on attention and intellectual performance of a population of Spanish adolescents

Dietetic, hematologic and biochemical data were used to asses the iron status of a group of 64 adolescents (37 males and 27 females), aged 15 to 18 (mean age 15.94 +/- 0.76 years), who study in a High School in the comunidad Aut onoma de Madrid. All were asked to keep a dietary record during 5 days, one of which had to be a sunday. Iron intake was estimated using the Food Composition Tables of the Instituto de Nutrici on (1990). The hematologic survey determined hemoglobin hematocrit mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), serum iron and serum ferritin. These data were correlated with the scores obtained in the attention and school capability test (AT), that gave information about the verbal (V), reasoning (R) and calculus (C) capabilities. There is a positive correlation between MCV (r = 0.2705), MCH (r = 0.3370) ferritin (r = 0.3383) and attention. MCV (r = 0.2995), MCH (r = 0.3998), MCHC (r = 0.3134) and ferritin (r = 0.3970) were also correlated with the speed capability shown on the attention test and the hemoglobin level was correlated with the calculus capability (r = 0.2905). The students who obtained higher scores in the school capability test had also better blood parameter values. This was statistically significant for serum ferritin in males students and for hemoglobin and MCHC in female students. 19.6 per cent of the adolescents had ferritin levels lower than 12 ng/ml. Their intelligence test scores were lower to those who had serum ferritin > or = 12 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Influencia de la nutrición en la capacidad funcional de un grupo de ancianos españoles / Influence of the nutritional status on the functional capability of Spanish elderly

Se ha valorado la influencia del estado nutricional (cuantificado mediante datos dietéticos, antropométricos y bioquímicos) en la capacidad funcional (medida por la adiposidad, fuerza de manos y piernas en flexión y extensión y flexibilidad) de un grupo de 11 ancianos institucionados de Madrid (España). Los principales problemas nutricionales que condicionan mermas funcionales son la obesidad, hipercolesterolemia déficit en proteínas y micronutrientes. La influencia adversa de la obesidad e hipercolesterolemia en la capacidad funcional del anciano se pone de relieve por la existencia de relaciones inversas entre la flexibilidad y la fuerza de manos y piernas con el grado de adiposidad, con el espesor de los pliegues cutáneos con la colesterolemia. Respecto a la influecia de la dieta, existen relaciones positivas entre el consumo de alimentos de la dieta, existen relaciones positivas entre el consumo de alimentos y de la mayor parte de los nutrientes con la fuerza de manos y piernas, y la significación estadística se alcanza con frecuencia en el caso de las proteínas, hierro, zinc, magnesio y vitamina B, seguidas de la vitamina C, niacina, tiamina, ácido fólico y vitamina E, En relación con los parámetros sanguíneos las correlaciones de mayor valor son las existentes entre parámetros funcionales y niveles de hierro, ferritina y vitamina C. Nuestros resultados contribuyen a confirmar la influencia de la nutrición en la capacidad funcional del anciano y ponen de relieve la necesidad de mejorar la dieta de las personas de edad, evitando las deficiencias en micronutrientes, así como la conveniencia de incrementar la actividad física del colectivo, ambas medidas supondrán una importante ayuda en la mejora sanitaria y funcional de las personas de edad avanzada