Multidomain interventions for sarcopenia and cognitive flexibility in older adults for promoting healthy aging: a systematic review and meta-analysis of randomized controlled trials.

The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of 2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05, I2 = 57%; 95% CI - 0.63 to - 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the control group (p = 0.02, I2 = 0%; 95% CI - 0.63 to - 0.05). These findings underscore the importance of incorporating physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice multidomain weekly sessions.

Meningoencephalitis caused by Non-O1, non-O139 Vibrio cholerae in an infant from southern Spain.

Non-O1, non-O139 Vibrio cholerae (NOVC) is an emergent pathogen that mainly causes gastroenteritis. Also, it causes ear, wound infections, and bacteremia but the nervous system is rarely affected. We report on a case of NOVC meningoencephalitis in an infant that recovered after antimicrobial therapy but later presented neurologic sequelae.

Development and clinical evaluation of an ionization chamber array with 3.5 mm pixel pitch for quality assurance in advanced radiotherapy techniques.

PURPOSE: To characterize a new air vented ionization chamber technology, suitable to build detector arrays with small pixel pitch and independence of sensitivity on dose per pulse. METHODS: The prototype under test is a linear array of air vented ionization chambers, consisting of 80 pixels with 3.5 mm pixel pitch distance and a sensitive volume of about 4 mm(3). The detector has been characterized with (60)Co radiation and MV x rays from different linear accelerators (with flattened and unflattened beam qualities). Sensitivity dependence on dose per pulse has been evaluated under MV x rays by changing both the source to detector distance and the beam quality. Bias voltage has been varied in order to evaluate the charge collection efficiency in the most critical conditions. Relative dose profiles have been measured for both flattened and unflattened distributions with different field sizes. The reference detectors were a commercial array of ionization chambers and an amorphous silicon flat panel in direct conversion configuration. Profiles of dose distribution have been measured also with intensity modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS), and volumetric modulated arc therapy (VMAT) patient plans. Comparison has been done with a commercial diode array and with Gafchromic EBT3 films. RESULTS: Repeatability and stability under continuous gamma irradiation are within 0.3%, in spite of low active volume and sensitivity (∼200 pC/Gy). Deviation from linearity is in the range [0.3%, -0.9%] for a dose of at least 20 cGy, while a worsening of linearity is observed below 10 cGy. Charge collection efficiency with 2.67 mGy/pulse is higher than 99%, leading to a ±0.9% sensitivity change in the range 0.09-2.67 mGy/pulse (covering all flattened and unflattened beam qualities). Tissue to phantom ratios show an agreement within 0.6% with the reference detector up to 34 cm depth. For field sizes in the range 2 × 2 to 15 × 15 cm(2), the output factors are in agreement with a thimble chamber within 2%, while with 25 × 25 cm(2) field size, an underestimation of 4.0% was found. Agreement of field and penumbra width measurements with the flat panel is of the order of 1 mm down to 1 × 1 cm(2) field size. Flatness and symmetry values measured with the 1D array and the reference detectors are comparable, and differences are always smaller than 1%. Angular dependence of the detector, when compared to measurements taken with a cylindrical chamber in the same phantom, is as large as 16%. This includes inhomogeneity and asymmetry of the design, which during plan verification are accounted for by the treatment planning system (TPS). The detector is capable to reproduce the dose distributions of IMRT and VMAT plans with a maximum deviation from TPS of 3.0% in the target region. In the case of VMAT and SRS plans, an average (maximum) deviation of the order of 1% (4%) from films has been measured. CONCLUSIONS: The investigated technology appears to be useful both for Linac QA and patient plan verification, especially in treatments with steep dose gradients and nonuniform dose rates such as VMAT and SRS. Major limitations of the present prototype are the linearity at low dose, which can be solved by optimizing the readout electronics, and the underestimation of output factors with large field sizes. The latter problem is presently not completely understood and will require further investigations.

Treatment with hydrochlorothiazide and alendronate in patients with stones and bone mineral density loss. Evolution of bone metabolism and calciuria with medical treatment. / Tratamiento con hidroclorotiazida y alendronato en pacientes con litiasis y pérdida de densidad mineral ósea. Evolución de la calciuria y metabolismo óseo en el tratamiento médico.

OBJECTIVES: Treatment of calcium stones is based on diet and pharmacological measures such as the use of thiazides and other drugs. The aim of this study is to assess the effect of alendronate on hydrochlorothiazide on urinary calcium and bone mineral density in patients with calcium stones. METHODS: Prospective observational study involving 77 patients with relapsing calcium stones divided into 2 groups according to treatment received. Group 1: 36 patients treated with alendronate 70 mg/week; Group 2: 41 patients treated with hydrochlorothiazide 50 mg/day. All patients receive diet recommendations and fluid intake. Studied and analyzed among other variables were bone mineral density, bone turnover markers and calciuria before and after 2 years of treatment. Statistical study with SPSS 17.0, statistical significance p<0.05. RESULTS: No statistically significant differences in the distribution by sex or age of the patients between groups. In group 1 statistically a significant decrease was observed in the Β-crosslaps and improvement in bone mineral density, along with decreased urinary calcium after 2 years of treatment. In Group 2 statistically significant decrease in urinary calcium and fasting calcium/creatinine was seen, along with improvement in bone mineral density after 2 years of treatment. In group 1, there is a more obvious and significant improvement in bone mineral density compared to 2 and Β-crosslaps decrease. However, in group 2 the decrease in urinary calcium and calcium/creatinine was more significant than in group 1. CONCLUSION: Treatment with thiazide decrease calciuria and produces an improvement in bone mineral density, although not in the same range as treatment with alendronate.

The predicted relative risk of premature ovarian failure for three radiotherapy modalities in a girl receiving craniospinal irradiation.

In girls and young women, irradiation of the ovaries can reduce the number of viable ovarian primordial follicles, which may lead to premature ovarian failure (POF) and subsequently to sterility. One strategy to minimize this late effect is to reduce the radiation dose to the ovaries. A primary means of reducing dose is to choose a radiotherapy technique that avoids irradiating nearby normal tissue; however, the relative risk of POF (RRPOF) due to the various therapeutic options has not been assessed. This study compared the predicted RRPOF after craniospinal proton radiotherapy, conventional photon radiotherapy (CRT) and intensity-modulated photon radiotherapy (IMRT). We calculated the equivalent dose delivered to the ovaries of an 11-year-old girl from therapeutic and stray radiation. We then predicted the percentage of ovarian primordial follicles killed by radiation and used this as a measure of the RRPOF; we also calculated the ratio of the relative risk of POF (RRRPOF) among the three radiotherapies. Proton radiotherapy had a lower RRPOF than either of the other two types. We also tested the sensitivity of the RRRPOF between photon and proton therapies to the anatomic position of the ovaries, i.e., proximity to the treatment field (2 ≤ RRRPOF ≤ 10). We found that CRT and IMRT have higher risks of POF than passive-scattering proton radiotherapy (PRT) does, regardless of uncertainties in the ovarian location. Overall, PRT represents a lower RRPOF over the two other modalities.

SU-E-T-556: Integration of Lung Blocks in the Inverse Planning Process of Modulated Arc Total Body Irradiation Using Cone Beam CT.

PURPOSE: The sizing and placement of lung blocks for total-body irradiation (TBI) is critical to prevent lung toxicities and maintain effective treatments. During modulated-arc TBI (MATBI) treatment, the patient is stationary near the floor while open-field beams with varying exposures are delivered. The inverse planning process currently aims for a uniform dose to the body, without accounting for the presence of lung blocks. This study investigates the possibility of including the effect of these blocks in the MATBI optimization process. METHODS: Dosimetric comparisons were performed using a water tank and a simple stack of solid water slabs. Lungs blocks made of cerrobend were fabricated and imaged using on-board megavoltage CBCT (MVCBCT). The reconstructed MVCBCT images were precisely registered with the reference CT for inverse planning. The cerrobend blocks were contoured in the planning system and the density was overridden to 9.3 g/cm3 . Simulated doses in Pinnacle were compared to ion chamber, diode array and gaf-chromic film measurements obtained at 1.0, 5.0, 10.0 and 20.0 cm depths. Specific optimization objectives on the lungs were tested on 5 patients including a lung re-treatment. RESULTS: The maximum difference between ion chamber measurements and the treatment planning predictions was 2.4%. The measurements profiles with the diode array correlated reasonably well (<5%) with predictions. Gaf-chromic films demonstrated good accuracy at depth but large differences (>10%) on the surface. Lung blocks reconstructed with MVCBCT were structuraly accurate without significant metal artifacts. A comparison of MATBI plans on patients shows that inclusion of lung blocks during optimization can reduce hot and cold areas in the lungs and the sternum. CONCLUSION: Reasonable predictions of the lung block transmission can be obtained following the developed technique using megavoltage CBCT. Thus, lung blocks can be included in the MATBI inverse planning process, which can help prevent complications and local failure.

SU-E-T-123: Understanding the Meaning of IMRT QA Passing Rates with a 2D Diode Array.

PURPOSE: A lower than ideal tolerance limit is used in intensity-modulated radiation therapy quality assurance (IMRT QA) with a 2D diode array due to passing rate fluctuations. The objective is to identify patterns in the passing rates to predict sources of uncertainty that can affect treatment delivery, for example, the need to re-calibrate the multileaf collimator when the passing rates start to decrease. METHODS: Five complex clinical prostate IMRT plans were evaluated with a 2D diode array. The QA for each plan was repeated five times during one and a half month period. One of the plans was randomly selected and repeated the same day five consecutive times. The planar doses calculated by the treatment planning system were compared to the measurements of the 2D diode array. The individual passing rates per beam per plan were compared. RESULTS: The average passing rate for each plan ranged from 94% to 97%. While the average percent difference of this ranged between -7.67% to 17.61%. Additionally, the minimum and maximum standard deviation among all beams was 0.13% and 9.63% respectively. We also compared the standard deviation of a plan QA repeated during different days versus a plan QA repeated during the same day. For the former the highest standard deviation was 6.05 % while for the later 0.21%. We noticed that the largest discrepancy between the passing rates was for angles at around 155° and 205°. CONCLUSION: These results show some inconsistency in the IMRT QA passing rates from one day to the next. Moreover, lower passing rates for a specific angle like the ones shown here can represent possible mechanical or tuning problems with the linear accelerator at these specific locations. Early identification of these sources of uncertainty can greatly improve the precision of the treatment delivery.

Physical profile of elite young motorcyclists.

The aim of the study was to describe anthropometric and physical characteristics of elite young road-race motorcyclists (MC). 27 riders (15.6±1.1 years, 54.6±6.9 kg, 166.9±6.7 cm) competing at international elite level participated in this study. Anthropometric variables, hand grip and lumbar isometric strength, and lower-body muscular strength were measured. Comparisons of the MC and a reference group of Spanish physically active adolescents (16.0±0.6 years) showed that the riders were significantly lighter (-12.5 kg), and smaller (-4.7 cm). Riders also had significantly lower values for almost all skinfolds, and for all the measured girths (except forearm) than the reference group. Motorcyclists showed significantly less percent body fat (%BF) and higher muscle mass, and differences were observed for somatotype components compared to the reference group, except for the ectomorphy. Somatotype could be defined as mesomorphic-ectomorph (2.5-4.4-3.7). Mean (±SD) values of all riders were 34.8±5.0 cm for vertical jump height, 402.1±74.5 N for the right hand and 370.7±77.5 N for the left hand strengths, and 120.6±19.3 kg for lumbar isometric strength, respectively. Results demonstrate that MC are small and light, with lower body mass index, skinfolds, girth and breadth dimensions, and %BF than a reference group and other athletes, with high values of hand grip and lumbar isometric strength.

Maximum proton kinetic energy and patient-generated neutron fluence considerations in proton beam arc delivery radiation therapy.

Several compact proton accelerator systems for use in proton therapy have recently been proposed. Of paramount importance to the development of such an accelerator system is the maximum kinetic energy of protons, immediately prior to entry into the patient, that must be reached by the treatment system. The commonly used value for the maximum kinetic energy required for a medical proton accelerator is 250 MeV, but it has not been demonstrated that this energy is indeed necessary to treat all or most patients eligible for proton therapy. This article quantifies the maximum kinetic energy of protons, immediately prior to entry into the patient, necessary to treat a given percentage of patients with rotational proton therapy, and examines the impact of this energy threshold on the cost and feasibility of a compact, gantry-mounted proton accelerator treatment system. One hundred randomized treatment plans from patients treated with IMRT were analyzed. The maximum radiological pathlength from the surface of the patient to the distal edge of the treatment volume was obtained for 180 degrees continuous arc proton therapy and for 180 degrees split arc proton therapy (two 90 degrees arcs) using CT# profiles from the Pinnacle (Philips Medical Systems, Madison, WI) treatment planning system. In each case, the maximum kinetic energy of protons, immediately prior to entry into the patient, that would be necessary to treat the patient was calculated using proton range tables for various media. In addition, Monte Carlo simulations were performed to quantify neutron production in a water phantom representing a patient as a function of the maximum proton kinetic energy achievable by a proton treatment system. Protons with a kinetic energy of 240 MeV, immediately prior to entry into the patient, were needed to treat 100% of patients in this study. However, it was shown that 90% of patients could be treated at 198 MeV, and 95% of patients could be treated at 207 MeV. Decreasing the proton kinetic energy from 250 to 200 MeV decreases the total neutron energy fluence produced by stopping a monoenergetic pencil beam in a water phantom by a factor of 2.3. It is possible to significantly lower the requirements on the maximum kinetic energy of a compact proton accelerator if the ability to treat a small percentage of patients with rotational therapy is sacrificed. This decrease in maximum kinetic energy, along with the corresponding decrease in neutron production, could lower the cost and ease the engineering constraints on a compact proton accelerator treatment facility.

Contribution to Neutron Fluence and Neutron Absorbed Dose from Double Scattering Proton Therapy System Components.

Proton therapy offers low integral dose and good tumor comformality in many deep-seated tumors. However, secondary particles generated during proton therapy, such as neutrons, are a concern, especially for passive scattering systems. In this type of system, the proton beam interacts with several components of the treatment nozzle that lie along the delivery path and can produce secondary neutrons. Neutron production along the beam's central axis in a double scattering passive system was examined using Monte Carlo simulations. Neutron fluence and energy distribution were determined downstream of the nozzle's major components at different radial distances from the central axis. In addition, the neutron absorbed dose per primary proton around the nozzle was investigated. Neutron fluence was highest immediately downstream of the range modulator wheel (RMW) but decreased as distance from the RMW increased. The nozzle's final collimator and snout also contributed to the production of high-energy neutrons. In fact, for the smallest treatment volume simulated, the neutron absorbed dose per proton at isocenter increased by a factor of 20 due to the snout presence when compared with a nozzle without a snout. The presented results can be used to design more effective local shielding components inside the treatment nozzle as well as to better understand the treatment room shielding requirements.

Performance of CdTe, HPGe and NaI(Tl) detectors for radioactivity measurements.

The characteristics and performances of the NIST High-Purity Germanium (HPGe), Sodium Iodide (NaI(Tl)) and Cadmium Telluride (CdTe) gamma-ray detectors were studied. The efficiencies, the minimum detectable activities and the energy resolutions of each were measured and compared. The data were analyzed using different software packages. The measurements were performed in a low background radiation environment using calibrated point sources. The CdTe detector showed a higher energy resolution than the NaI(Tl) detector but a lower efficiency than both the HPGe and NaI(Tl) detectors. This makes it a suitable detector only for relatively high activity measurements restricted to the 35 keV to 200 keV energy range.

Paciente en DP con dificultad de aprendizaje / Case report: a patient with learning difficulties under dyalisis

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Relación entre la práctica físico-deportiva y el consumo de alcohol a los 12 y 16 años / Relationship between sports physical practice and the alcohol consumption to 12 and 16 years

Se ha realizado una investigación sobre los hábitos de vida en relación con la salud, concretamente sobre el consumo de alcohol y su relación con la frecuencia (la práctica de actividad física en edad escolar, siendo el principal objetivo conocer el consumo de alcohol al finalizar los estudios de ambos niveles educativos, y cómo incide la práctica físico-deportiva en dicho consumo.Se ha empleado el cuestionario como técnica de análisis. Para su validación se han realizado dos estudios piloto dobles, con las respuestas a un primer y segundo cuestionario readaptado, por medio de un grupo control en dos niveles educativos diferentes (tercer ciclo de Educación Primaria y segundo ciclo de Educación Secundaria Obligatoria).Los resultados del estudio confirman un claro aumento del consumo de alcohol con la edad sin existir diferencias estadísticamente significativas por sexos. Por otra parte, el hábito de practicar actividad física frecuentemente en el joven favorece la abstención en el consumo de alcohol los fines de semana, mientras el sedentarismo juvenil favorece la ingestión de bebidas alcohólicas (AU)