Adjuvant Hypofractionated Whole Breast Irradiation (WBI) vs. Accelerated Partial Breast Irradiation (APBI) in Postmenopausal Women with Early Stage Breast Cancer: 5Years Update of the HYPAB Trial.

Therapeutical strategies in breast cancer are continuously updating. Recent researches assessed the possibility of irradiating only the surgical bed in selected patients (Partial Breast Irradiation, PBI). In 2014 we designed a study to evaluate toxicity and cosmesis of APBI using Volumetric Modulated Arc Therapy-Rapid Arc compared with hypofractionated whole breast irradiation (WBI). We present here the 5-years updated data. HYPAB was a single-institution randomized trial that recruited 172 patients from 2015 to 2018. Patients underwent conserving surgery and were randomized to either adjuvant WBI (40.5Gy/15 fractions with simultaneous boost to 48 Gy to tumoral bed) or APBI (30Gy/5 fractions), both delivered with VMAT-RA technique. Clinical evaluation was performed during the first visit, once a week during radiotherapy and during follow up. Cosmesis was assessed using the Harvard Scale for Breast Cosmesis. At the time of the analysis 161 patients were eligible, 53% in the WBI and 47% in the APBI group, with a median follow-up of 67 months. Most common late skin toxicities were G1 fibrosis (32%) and oedema (28%) and were higher in the WBI group; no G3 toxicities were observed. Cosmesis was rated poor in only 6 cases. 147 patients had no evidence of disease at the last follow-up, and no patients died of the disease. Mature results confirm the safety and efficacy of APBI in selected early stage breast cancer patients. Late toxicity is improved in the APBI arm at the cost of a slight increase in local relapse. Further studies are ongoing to better elucidate the use of APBI as a de-escalation approach.

The pattern of failure after Stereotactic Radiation Therapy (SRT) for oligo-metastases: predictive factors for poly-progression.

PURPOSE: Patients with oligo-metastatic disease (OMD) can be safely treated with Stereotactic Radiation Therapy (SRT). Further disease progression is common in these patients. In most cases, patients relapse again with oligo-metastases, however some can experience a poly-progression after a local ablative treatment (LAT). The purpose of this study was to retrospectively identify factors associated with poly-progression in patients receiving SRT for OMD. METHODS: Data from a monocentric database were retrospectively analyzed. Patients treated with SRT for OMD and who developed progression after LAT were selected. Patients were categorized as oligo- or poly-progressive according to the number of new/progressing metastases (≤ or > 5). Herein, we analyzed data about patients' characteristics, oligo-metastatic presentation and radiation treatment characteristics to evaluate their relationship with progression type. RESULTS: From 2013 to 2021, data on 700 patients progressing after LAT were analyzed. Among them, 227 patients (32.4%) experienced a poly-progression; the median time to poly-progression was 7.72 months (range 1-79.6). Five variables associated with poly-progression were found to be statistically significant in the univariate analysis: performance status (p < 0.001), site of the primary tumor (p = 0.016), ablative dose (p = 0.002), treated site (p = 0.002), single or double organ (p = 0.03). Of those, all but the number of involved organs retained their significant predictive value on the multivariate analysis. CONCLUSION: Our study identified four independent factors associated with poly-progression in patients with OMD receiving SRT. Our data may support comprehensive characterization of OMD, better understanding of factors associated with progression.

An epidemiologic appraisal of the associations between the fatty acids esterifying serum cholesterol and some cardiovascular risk factors in middle-aged men.

The relations between the fatty acids of cholesterol esters and some cardiovascular risk factors have been investigated in a sample of 3,348 middle-aged men examined at entry into the Paris Prospective Study 2. The partial associations between the risk factors and the various fatty acids have been evaluated using a special regression method that takes into account the structural dependencies among the percentages of fatty acids. The results show that palmitoleic acid is strongly associated with alcohol consumption and blood pressure and that its association with blood pressure is absent in nondrinkers. High density lipoprotein cholesterol and apolipoprotein A1 are negatively associated with palmitic and dihomogammalinolenic acids and positively associated with oleic and linoleic acids. An inverse relation of low density lipoprotein cholesterol and apolipoprotein B to these fatty acids is also observed. Simultaneous high levels of palmitic and dihomogammalinolenic acids and low levels of oleic and linoleic acids could then be related to profiles of lipids and apolipoproteins exposing one to a high risk of coronary heart disease. These associations may be of interest in interpreting the relations observed in other studies between the fatty acid composition of cholesterol esters or other lipids and coronary heart disease.

A Parkinson-like neurologic deficit in primates is caused by a novel 4-substituted piperidine.

A neurologic deficit characterized by hypokinesia, postural flexion, and to a lesser extent, rigidity, tremor and myoclonus, has been observed in cynomolgus monkeys following administration of 1-methyl-4-(1-methylpyrrol-2-yl)-4-piperidinol (MMPP), a novel 4-substituted piperidine. The syndrome, similar to that described for 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), developed within 3-7 days after oral or i.v. dosing, and was accompanied by lesions in the substantia nigra. The behavioral syndrome was seen to a lesser extent in dogs but not in rats. MMPP contains a hydroxyl group on the 4-position of the pyridine ring; the corresponding dehydration product was inactive.

Relation between consumption of alcohol and fatty acids esterifying serum cholesterol in healthy men.

The relation between consumption of alcohol (established by interview), two of its typical markers (gamma-glutamyltransferase activity and mean corpuscular volume), and the composition of fatty acids in plasma cholesterol esters was investigated in an epidemiological study of 1467 actively employed men aged 35-45. In this group of subjects mean consumption of alcohol was 34.6 (SD 25.2) g/day. Palmitoleic acid and oleic acid were positively correlated with consumption of alcohol, gamma-glutamyltransferase activity, and mean corpuscular volume, while linoleic acid was negatively correlated with these variables. When these three fatty acids, gamma-glutamyltransferase activity, mean corpuscular volume, and the fat content of the diet were introduced into a multivariate regression analysis, with consumption of alcohol as the dependent variable, only palmitoleic acid, gamma-glutamyltransferase activity, mean corpuscular volume, and the monounsaturated fat content of the diet remained significant. Palmitoleic acid seems to be an independent correlate of consumption of alcohol and could be useful in epidemiological and clinical studies as a variable of consumption.

Nalbuphine.

Nalbuphine is a potent analgesic with a low side effect and dependence profile in animals and man. Nalbuphine is distinguished from other agonist/antagonist analgesics in having greater antagonist activity and fewer behavioral effects at analgesic doses than pentazocine, butorphanol or buprenorphine. At equi-analgesic doses, nalbuphine is quantitatively similar to nalorphine in regard to its large ratio of antagonist to analgetic activity. Clinical studies have confirmed this balance of strong antagonist to analgesic activity. Nalbuphine has been shown to effectively antagonize the respiratory depressant activity of narcotic analgesics while concomitantly adding to their analgetic responses. Unlike nalorphine or pentazocine, nalbuphine produces few overt behavioral or autonomic effects in animals at doses over 300 times its analgesic range. These findings are confirmed by clinical results which show that nalbuphine produces few psychotomimetic effects, even at elevated dose levels, in contrast to nalorphine or pentazocine. Nalbuphine produces limited respiratory depression in animals and in man. Significant cardiovascular effects have not been found. Nalbuphine was found to produce significantly less inhibition of gastrointestinal activity than any of the clinically useful narcotic or agonist/antagonist analgesics tested in animals. Nalbuphine's analgetic effects are reversed by naloxone doses similar to those which reverse nalorphine's agonist effects. Results in this and other tests suggest that nalbuphine is primarily a kappa-agonist/mu-antagonist analgesic. Unlike pentazocine or buprenorphine, nalbuphine does not suppress the narcotic abstinence syndrome in partly-withdrawn morphine-dependent animals or man. Rather, due to nalbuphine's strong antagonist activity, analgesic-range doses of nalbuphine severely exacerbate the withdrawal syndrome in partly-withdrawn mice, monkeys and humans. Nalbuphine also precipitates a strong abstinence response in non-withdrawn morphine-dependent animals and man. In post-addict humans, analgesic-range doses of nalbuphine are perceived as minimally morphine-like, but higher doses are judged to be progressively more nalorphine-like (i.e. dysphoric), which further limits nalbuphine's abuse potential in drug-seeking individuals. Primary dependence studies have demonstrated that physical dependence is possible at high dose levels that produce marked side effects. Other studies show that dependence is unlikely to be of significance within nalbuphine's usual analgesic range. Six-month studies in patients with chronic pain have confirmed that analgesic tolerance or physical dependence is uncommon.(ABSTRACT TRUNCATED AT 400 WORDS)

Amantadine decreases d-amphetamine stimulation and increases d-amphetamine anorexia in mice.

Amantadine hydrochloride (Symmetrel), an antiviral, antiparkinson agent that is most frequently used clinically at oral doses of 2 to 3 mg/kg, significantly decreased d-amphetamine-induced CNS stimulation (motor activity) and simultaneously increased d-amphetamine-induced anorexia (milk intake) in mice. Amantadine did this at oral doses of 2.5 and 5 mg/kg, which alone had no effect on either motor activity or milk intake.

Amantadine-dopamine interaction: possible mode of action in Parkinsonism.

Intravenous doses of amantadine hydrochloride, an antiviral drug, as small as 0.08 milligram per kilogram may release dopamine and other catecholamines from neuronal storage sites in dogs primed with dopamine. This release may account for the reported efficacy of amantadine hydrochloride in the treatment of human parkinsonism.