PET/CT FAPI: Procedure and evidence review in oncology.

Neoplasms are composed of malignant tumor cells, which are surrounded by other non-tumor cellular elements, in what has been defined as the microenvironment or tumor stroma. Evidence on the importance of the tumor microenvironment has not stopped growing in recent years. It plays a central role in cell proliferation, tissue invasion, angiogenesis and cell migration. The paradigm is the family of new FAPI radiopharmaceuticals that show the density of the fibroblast activation protein (FAP) which is overexpressed in the cell membrane of activated cancer-associated fibroblasts (CAF), and its presence is related to poor prognosis. This educational document includes the procedure for performing PET/CT FAPI, biodistribution and the main potentially clinical applications in oncology to date.

Impact of acute psychosocial stress on attentional control in humans. A study of evoked potentials and pupillary response.

Psychosocial stress has increased considerably in our modern lifestyle, affecting global mental health. Deficits in attentional control are cardinal features of stress disorders and pathological anxiety. Studies suggest that changes in the locus coeruleus-norepinephrine system could underlie the effects of stress on top-down attentional control. However, the impact of psychosocial stress on attentional processes and its underlying neural mechanisms are poorly understood. This study aims to investigate the effect of psychosocial stress on attentional processing and brain signatures. Evoked potentials and pupillary activity related to the oddball auditory paradigm were recorded before and after applying the Montreal Imaging Stress Task (MIST). Electrocardiogram (ECG), salivary cortisol, and subjective anxiety/stress levels were measured at different experimental periods. The control group experienced the same physical and cognitive effort but without the psychosocial stress component. The results showed that stressed subjects exhibited decreased P3a and P3b amplitude, pupil phasic response, and correct responses. On the other hand, they displayed an increase in Mismatch Negativity (MMN). N1 amplitude after MIST only decreased in the control group. We found that differences in P3b amplitude between the first and second oddball were significantly correlated with pupillary dilation and salivary cortisol levels. Our results suggest that under social-evaluative threat, basal activity of the coeruleus-norepinephrine system increases, enhancing alertness and decreasing voluntary attentional resources for the cognitive task. These findings contribute to understanding the neurobiological basis of attentional changes in pathologies associated with chronic psychosocial stress.

Partial hardware removal in guided growth surgery: A convenient strategy? / Retiro parcial del implante en cirugía de crecimiento guiado: ¿Una estrategia conveniente?

BACKGROUND: Tension band plates (TPBs) are frequently used in guided growth (CG) surgeries. Recently, the concept of removing the metaphyseal screw only to stop the growth modulating effect rather than completely removing the implant, has gained popularity. Although this strategy would have certain potential advantages, the associated risks are unknown. The aim of this study is to report the experience of three institutions with this strategy. METHODS: A database was compiled with the demographic information of patients treated by guided growth using TBPs between January 2014 and January 2019 at three institutions. The cases where only the metaphyseal screw was removed were identified. The records were reviewed to analyze the indications, demographic data, characteristics of the procedure, complications and need for additional procedures. RESULTS: We reviewed 28 partial hardware removals, performed in 10 patients (all male). Initial surgery was indicated for angular deformity (N = 6), and leg-length discrepancy (N = 4). The average age at the time of surgery was 9.5 ± 2.9 years (range 4 to 13 years). Three procedures were performed on the distal femur, 3 on the proximal tibia, 2 on the distal tibia, and 20 combined. The average follow-up was 23.3 ± 11 months (range 12 to 52 months). We observed recurrence of deformities in 7 of 28 (22%) limbs that required re-insertion of the metaphyseal screw. Two patients presented complications from the procedure: soft tissue irritation (N = 1) and angular deformity (N = 1). Both patients required unplanned surgery. DISCUSSION: Partial hardware removal in guided growth surgery could favor the presentation of complications. The benefits of this strategy must be considered against the possible undesired effects generated by its application. STUDY DESIGN: Therapeutic study (Level IV).

Differential neurophysiological correlates of retrieval of consolidated and reconsolidated memories in humans: An ERP and pupillometry study.

Consolidated memories can return to a labile state if they are reactivated by unpredictable reminders. To persist, active memories must be re-stabilized through a process known as reconsolidation. Although there is consistent behavioral evidence about this process in humans, the retrieval process of reconsolidated memories remains poorly understood. In this context, one fundamental question is whether the same or different neurophysiological mechanisms are involved in retrieval of consolidated and reconsolidated memories. Because it has been demonstrated that the exposure to the reconsolidation process may restructure and strengthen memories, we hypothesized distinct neurophysiological patterns during retrieval of reconsolidated memories. In addition, we hypothesized that interfering with the reconsolidation process using a new learning can prevent these neurophysiological changes. To test it, consolidated, reconsolidated and declarative memories whose reconsolidation process was interfered (i.e., picture-word pairs) were evaluated in humans in an old/new associative recall task while the brain activity and the pupillary response were recorded using electroencephalography and eyetracking. Our results showed that retrieval of reconsolidated memories elicits specific patterns of brain activation, characterized by an earlier peak latency and a smaller magnitude of the left parietal ERP old/new effect compared to memories that were only consolidated or whose reconsolidation process was interfered by a new learning. Moreover, our results demonstrated that only retrieval of reconsolidated memories is associated with a late reversed mid-frontal effect in a 600-690 time window. Complementarily, memories that were reactivated showed an earlier peak latency of the pupil old/new effect compared to non-reactivated memories. These findings support the idea that reconsolidation has an important impact in how memories are retrieved in the future, showing that retrieval of reconsolidated memories is partially supported by specific brain mechanisms.

68Ga-PSMA PET/CT-based metastasis-directed radiotherapy for oligometastatic prostate cancer recurrence after radical prostatectomy.

PURPOSE: The aim of this communication was to assess the efficacy of directed oligometastatic radiotherapy (RT) based on 68Ga-PSMA PET/CT in patients with prostate cancer (PCa) biochemical relapse (BCR) after primary treatment with curative intent. METHODS: This is a retrospective analysis of a monocentric cohort of PCa patients diagnosed with oligometastatic disease on 68Ga-PSMA PET/CT and treated with metastasis-directed RT. Inclusion criteria were: histologically proven PCa, BCR after primary treatment with curative intent, oligometastatic disease defined as ≤ 3 metastatic lesions. To evaluate the efficacy of the therapy, biochemical response defined as a decrease of > 50% of PSA (PSA50) was measured at 1 and 4 months. Patients were followed up until progression and start of androgen deprivation therapy (ADT). BCR-free survival and ADT-free survival were calculated. RESULTS: 20 patients met the inclusion criteria. Median PSA value: 1.4 ng/ml (IQR, 0.3-2.3 ng/ml). A total of 30 PSMA-positive lesions were treated: 18 lymph nodes (60%), nine bone (30%) and three visceral lesions (10%). Median follow-up was 15 months (range 4-33 months). Biochemical response at 1 and 4 months was found in 3/20 patients (15%) and 14/20 (70%), respectively. BCR-free survival rate at 1 year was 79% and 53% at 2 years. ADT-free survival at 2 years was 74%. CONCLUSION: This retrospective study suggests that metastasis-directed RT based on 68Ga-PSMA PET/CT may be a valuable treatment in patients with PCa oligometastatic disease, providing promising BCR-free survival rates and potentially postponing ADT for at least 2 years in 74% of the patients. Response assessment should not be measured before 4 months after treatment.

PET/TC con 68Ga-PSMA, importancia en la práctica hospitalaria. Visión del oncólogo radioterápico / Importance of 68Ga-PSMA PET/CT in hospital practice. View of the radiation oncologist

La radioterapia es un tratamiento curativo indicado en pacientes con cáncer de próstata (CaP) primario y en aquellos con recurrencia bioquímica tras prostatectomía radical (PR). Además, recientemente, ha habido un aumento en el uso de técnicas de alta precisión como la radioterapia estereotáctica fraccionada corporal para tratar un número limitado de metástasis en pacientes con CaP oligometastásico. Las pruebas de imagen convencional (ecografía transrectal, tomografía computarizada [TC], resonancia magnética morfológica y gammagrafía ósea) tienen un papel menor en estos escenarios, debido a su bajo rendimiento diagnóstico. Recientemente, se ha desarrollado el radiotrazador 68Ga-PSMA, para la tomografía por emisión de positrones (PET), que es un ligando del antígeno de membrana específico de próstata (PSMA), una proteína transmembrana sobrexpresada en las células del CaP. Sus resultados son prometedores, con tasas de detección de lesiones tumorales mayores que la TC y mayor que la mejor técnica disponible actualmente, la PET con colina. Su superioridad es más evidente en pacientes con valores bajos de PSA (< 1 ng/ml). Esta mejora en el rendimiento diagnóstico representa un potencial impacto en el manejo terapéutico, especialmente en radioterapia. A pesar de que la prueba ya está disponible en la práctica clínica diaria de otros países europeos, en España su uso es muy limitado. En esta revisión, analizamos los principales estudios que investigan la utilidad de la PET/TC con 68Ga-PSMA en pacientes con CaP y su potencial impacto en los tratamientos de radioterapia. Además, comparamos la PET/TC con PSMA, con la resonancia magnética multiparamétrica y la PET/TC con colina, en los distintos escenarios clínicos

Radiotherapy is a treatment with curative intent, both in patients with primary diagnosis of prostate cancer (PCa) and in patients presenting with biochemical recurrence after radical prostatectomy (RP). Moreover, the use of stereotactic body radiotherapy as a metastasis directed therapy in patients with oligometastatic PCa has significantly increased in the recent years. Conventional imaging techniques, including transrectal ultrasound, computed tomography (CT), morphologic magnetic resonance and bone scintigraphy have traditionally played a minor role in all those clinical scenarios due to its low diagnostic accuracy. The recent development of the positron emission tomography (PET) radiotracer 68Ga-PSMA binding to the prostate specific membrane antigen (PSMA), a transmembrane glycoprotein overexpressed in PCa cells, has shown promising results. Detection rates for PCa lesions are higher than CT and higher than the best technique available, the PET/CT with choline. Its superiority has been demonstrated even at very low PSA levels (<1 ng/ml). This increase in diagnostic accuracy represents a potential impact on patient management, especially in radiotherapy. Even if this imaging technique is already available for routine clinical practice in some European countries, in Spain, unfortunately, there is very limited access. In this review, we analyze the main studies that investigate the usefulness of 68Ga-PSMA PET/CT in patients with PCa and its potential impact on radiotherapy treatments. In addition, we compared the 68Ga-PSMA PET/CT, with the multiparametric magnetic resonance imaging and the PET/CT with choline, in the different clinical scenarios

Importance of 68Ga-PSMA PET/CT in hospital practice. View of the radiation oncologist. / PET/TC con 68Ga-PSMA, importancia en la práctica hospitalaria. Visión del oncólogo radioterápico.

Radiotherapy is a treatment with curative intent, both in patients with primary diagnosis of prostate cancer (PCa) and in patients presenting with biochemical recurrence after radical prostatectomy (RP). Moreover, the use of stereotactic body radiotherapy as a metastasis directed therapy in patients with oligometastatic PCa has significantly increased in the recent years. Conventional imaging techniques, including transrectal ultrasound, computed tomography (CT), morphologic magnetic resonance and bone scintigraphy have traditionally played a minor role in all those clinical scenarios due to its low diagnostic accuracy. The recent development of the positron emission tomography (PET) radiotracer 68Ga-PSMA binding to the prostate specific membrane antigen (PSMA), a transmembrane glycoprotein overexpressed in PCa cells, has shown promising results. Detection rates for PCa lesions are higher than CT and higher than the best technique available, the PET/CT with choline. Its superiority has been demonstrated even at very low PSA levels (<1 ng/ml). This increase in diagnostic accuracy represents a potential impact on patient management, especially in radiotherapy. Even if this imaging technique is already available for routine clinical practice in some European countries, in Spain, unfortunately, there is very limited access. In this review, we analyze the main studies that investigate the usefulness of 68Ga-PSMA PET/CT in patients with PCa and its potential impact on radiotherapy treatments. In addition, we compared the 68Ga-PSMA PET/CT, with the multiparametric magnetic resonance imaging and the PET/CT with choline, in the different clinical scenarios.

Value of the 68Ga-DOTATATE PET-CT in the diagnosis of endometriosis. A pilot study.

OBJECTIVE: The non-invasive diagnosis of endometriosis remains challenging. Recent data suggested that somatostatin might be involved in its pathogenesis. High sensitive visualization of somatostatin receptors expression is possible using PET-CT imaging after the administration of a 68Ga-labeled somatostatin analog (DOTATATE) that will bind to the somatostatin receptor sub-types 2 and 5. The aim of the present study was to assess the usefulness of 68Ga-DOTATATE PET-CT in the diagnosis of endometriosis. STUDY DESIGN: This is a prospective, single center pilot study. A pre operative 68Ga-DOTATATE PET-CT was performed in all of the patients who presented with suspected endometriosis and who were scheduled for a laparoscopy. Surgical endometriosis staging and histopathological analysis, including somatostatin receptors SST1, 2 and 5 immunohistochemistry (IHC) of removed specimens, were confronted to the results of the 68Ga-DOTATATE PET-CT. RESULTS: 12 patients were included in this study. 68Ga-DOTATATE PET-CT performed pre operatively showed increased pathologic uptake in four patients with a deep infiltrating endometriosis (DIE) recto-vaginal lesion and in another patient with an adenomyoma. Expression of SST1, 2 and 5 receptors in surgical specimens was confirmed by IHC in these five lesions. Neither superficial peritoneal endometriosis, nor ovarian endometrioma were found to show an increased pathologic uptake on 68Ga-DOTATATE PET-CT. IHC analysis confirmed that SST1, 2, and 5 receptors were not present in these lesions. CONCLUSION: The results observed in this small size series of patients seem to confirm expression of somatostatin receptors only in recto-vaginal DIE and focal adenomyosis lesions. The usefulness of 68Ga-DOTATATE PET-CT in the diagnosis of this entity is uncertain. Future research should concentrate on studying the role of somatostatin in the pathogenesis of DIE.

Photoprotection and photoreception of intraocular lenses under xenon and white LED illumination.

OBJECTIVE: To analyze the photoprotection and phototransmission that various intraocular lenses (IOLs) provide under the illumination of a xenon (Xe) lamp and white LEDs (light emitting diode). METHODS: The spectral transmission curves of six representative IOLs were measured using a Perkin-Elmer Lambda 35 UV/VIS spectrometer. Various filtering simulations were performed using a Xe lamp and white LEDs. The spectral emissions of these lamps were measured with an ILT-950 spectroradiometer. RESULTS: The IOLs analyzed primarily show transmission of nearly 100% in the visible spectrum. In the ultraviolet (UV) region, the filters incorporated in the various IOLs did not filter equally, and some of them let an appreciable amount of UV through. The Xe lamp presented a strong emission of ultraviolet A (UVA), and its emission under 300nm was not negligible. The white LED did not present an appreciable emission under 380nm. CONCLUSIONS: The cut-off wavelength of most filters is between 380 and 400nm (Physiol Hydriol60C(®), IOLTECH E4T(®), Alcon SA60AT(®), Alcon IQ SN60WF(®)), so that their UV protection is very effective. Nonetheless, the IOL OPHTEC Oculaid(®) contains a filter that, when a Xe lamp is used, lets through up to 20% for 350nm and up to 15% for 300nm, which at this point is ultraviolet B (UVB). The OPHTEC(®) Artisan IOL has a transmission peak below 300nm, which must be taken into account under Xe illumination. White LEDs do not emit energy below 380nm, so no special protection is required in the UV region.

Hipermetilación del gen supresor de tumores p53 en pacientes pediátricos con leucemia linfoblástica aguda / Hypermethylation of tumor suppressor gene p53 in Chilean pediatrics patients under 15 years with acute lymphoblastic leukemia

La leucemia linfoblástica aguda (LLA) es la neoplasia maligna hematooncólogica más frecuente en pacientes pediátricos contando hasta 75% de las leucemias y 32-35% del total de cánceres infantiles. Aunque la LLA es considerada una enfermedad con base genética, es cada vez más evidente que alteraciones epigenéticas desempeñan un rol central en su patogénia y progresión. La hipermetilación de regiones promotoras de genes es asociada con la pérdida de función génica. El gen supresor de tumores p53 (GST), es uno de los principales genes en el ciclo celular y apoptosis. El objetivo de este trabajo fue determinar el estado de metilación en la región del promotor-exón 1 del GST p53 y la asociación con la supervivencia en menores de 15 años con LLA. Se analizaron 40 pacientes provenientes de la Región de la Araucanía-Chile. La hipermetilación del p53 se determinó combinando enzimas de restricción sensibles a metilación (HpaII y EcoR II) y reacción en cadena de la polimerasa. Los resultados indicaron que 15/40 casos (37,5%) presentaron hipermetilación. Se encontró una diferencia estadística en la supervivencia según estado de metilación de p53 en el grupo de niñas (p=0,02). Considerando el total de pacientes, una tendencia a mejor supervivencia cuando los recuentos de leucocitos fueron <30.000/mm3 (p=0,08). Se encontró frecuentemente hipermetilado el gen p53 en la región del promotor-exon1. Esto indicaría que la hipermetilación del GST p53 puede ser un evento importante en la patogénesis de la LLA.

Acute lymphoblastic leukemia (ALL) is the most common hematology oncology malignancy in pediatric patients counting up to 75% of leukemias and 32­35% of all childhood cancers. Although ALL is considered a disease with a genetic basis, it is increasingly clear that epigenetic alterations play a central role in the pathogenesis and work was to determine the methylation status in promoter-exon1 of the TSG-p53 and association with survival in children under 15 years with ALL. In our study 40 patients from the Araucanía Region, Chile were analyzed. Hypermethylation of p53 was determined by combining restriction enzymes sensitive to methylation (HpaII and EcoR II) and polymerase chain reaction. Results indicated that 15/40 cases (37.5%) showed hypermethylation. Statistical difference was found in survival according to p53 methylation status in the girls group (p=0.02). Considering all patients, there was a trend to improved survival when leukocyte counts were <30.000/ul (p=0.08). We found the p53 gene frequently hypermethylated in the promoter-exon1 region. This would indicate that TSG p53 hypermethylation may be an important event in the pathogenesis of ALL.

Spectral transmission of the pig lens: effect of ultraviolet A+B radiation.

OBJECTIVE: To determine the spectral transmission curve of the crystalline lens of the pig. To analyse how this curve changes when the crystalline lens is irradiated with ultraviolet A+B radiation similar to that of the sun. To compare these results with literature data from the human crystalline lens. PROCEDURES: We used crystalline lenses of the common pig from a slaughterhouse, i.e. genetically similar pigs, fed with the same diet, and slaughtered at six months old. Spectral transmission was measured with a Perkin-Elmer Lambda 35 UV/VIS spectrometer. The lenses were irradiated using an Asahi Spectra Lax-C100 ultraviolet source, which made it possible to select the spectral emission band as well as the intensity and exposure time. RESULTS: The pig lens transmits all the visible spectrum (95%) and lets part of the ultraviolet A through (15%). Exposure to acute UV (A+B) irradiation causes a decrease in its transmission as the intensity or exposure time increases: this decrease is considerable in the UV region. CONCLUSIONS: We were able to determine the mean spectral transmission curve of the pig lens. It appears to be similar to that of the human lens in the visible spectrum, but different in the ultraviolet. Pig lens transmission is reduced by UV (A+B) irradiation and its transmission in the UV region can even disappear as the intensity or exposure time increases. An adequate exposure intensity and time of UV (A+B) radiation always causes an anterior subcapsular cataract (ASC).

Utilidad de la imagen precoz de la gammagrafía de inervación miocárdica en el diagnóstico de la demencia con cuerpos de Lewy / Utility of early imaging of myocardial innervation scintigraphy in the diagnosis of Lewy Body Dementia

La realización de un correcto diagnóstico inicial ayuda al manejo clínico de los pacientes con Demencia con Cuerpos de Lewy (DCLw). La imagen tardía de la gammagrafía cardíaca con 123I-MIBG permite diferenciar entre DCLw y otro tipo de demencias. El objetivo del estudio es valorar la utilidad de la imagen precoz de la gammagrafía cardíaca con 123I-MIBG para el diagnóstico diferencial entre DCLw y otras demencias neurodegenerativas. Material y métodos. Estudio retrospectivo de 106 pacientes (51 hombres, edad media 78 años) a los que se les realizó una gammagrafía de inervación miocárdica por estudio de demencia. Se obtuvieron imágenes planares en proyección anterior a los 15min (precoz) y a las 4h (tardía) de la administración del trazador. La captación miocárdica de 123I-MIBG se semicuantificó mediante la obtención del índice de captación corazón/mediastino (ICM) a los 15min (ICM15m) y a las 4h (ICM4h). Resultados. El diagnóstico clínico a los 4 años fue de 52 pacientes con DCLw. El ICM15m para los pacientes con DCLw fue significativamente inferior al de los otros pacientes (1,27±0,15 vs 1,76±0,15,p<0,05), así como el ICM4h (1,14±0,13 vs 1,68±0,19,p<0,01). A partir del análisis ROC se obtuvo un punto de corte del ICM15m de 1,56 con un área bajo la curva del 0,99, para poder diferenciar DCLw respecto a los otros tipos de demencia, con una sensibilidad y especificidad del 98%. Conclusión. La imagen precoz de la gammagrafía de inervación miocárdica con 123I-MIBG, puede ser útil para diferenciar la DCLw de otro tipo de demencias neurodegenerativas (AU)

The importance of accurate and early diagnosis of dementia with Lewy bodies (DLB) lies in its pharmacological management. Delayed imaging of cardiac 123I-MIBG scintigraphy allows differentiation between DLB and other neurodegenerative diseases with cognitive impairment. The aim of this study was to assess the utility of early imaging of cardiac 123I-MIBG scintigraphy for differentiating DLB from others neurodegenerative disease with cognitive impairment. Material and methods. We assess retrospectively 106 patients (51 men, mean age 78 years) with cognitive impairment that underwent a cardiac 123I-MIBG study. Planar images were acquired in anterior view of the thorax 15min (early) and 4h (delayed) after tracer administration. The heart-to-mediastinum ratios (HMR) at 15m (HMR15m) and at 4h (HMR4h) were obtained. Results. After four years, 52 patients were diagnosed of DLB.HMR15m and HMR4h were significantly inferior in DLB respect to the others neurodegenerative diseases (1,27±0,15 vs 1,76±0,15,p<0,05) and (1,14±0,13 vs 1,68±0,19,p<0.01), respectively. The ROC analysis showed a HMR15m cut off point of 1.56 to differentiated DLB from the other dementias with a sensitivity and a specificity of 98%. Conclusions. Early imaging of cardiac 123I-MIBG scintigraphy can help to differentiate DLB from other neurodegenerative diseases with cognitive impairment (AU)

[Utility of early imaging of myocardial innervation scintigraphy in the diagnosis of Lewy Body Dementia]. / Utilidad de la imagen precoz de la gammagrafía de inervación miocárdica en el diagnóstico de la demencia con cuerpos de Lewy.

UNLABELLED: The importance of accurate and early diagnosis of dementia with Lewy bodies (DLB) lies in its pharmacological management. Delayed imaging of cardiac (123)I-MIBG scintigraphy allows differentiation between DLB and other neurodegenerative diseases with cognitive impairment. The aim of this study was to assess the utility of early imaging of cardiac (123)I-MIBG scintigraphy for differentiating DLB from others neurodegenerative disease with cognitive impairment. MATERIAL AND METHODS: We assess retrospectively 106 patients (51 men, mean age 78 years) with cognitive impairment that underwent a cardiac (123)I-MIBG study. Planar images were acquired in anterior view of the thorax 15min (early) and 4h (delayed) after tracer administration. The heart-to-mediastinum ratios (HMR) at 15m (HMR15m) and at 4h (HMR4h) were obtained. RESULTS: After four years, 52 patients were diagnosed of DLB.HMR15m and HMR4h were significantly inferior in DLB respect to the others neurodegenerative diseases (1,27±0,15 vs 1,76±0,15,p<0,05) and (1,14±0,13 vs 1,68±0,19,p<0.01), respectively. The ROC analysis showed a HMR15m cut off point of 1.56 to differentiated DLB from the other dementias with a sensitivity and a specificity of 98%. CONCLUSIONS: Early imaging of cardiac (123)I-MIBG scintigraphy can help to differentiate DLB from other neurodegenerative diseases with cognitive impairment.

Ultraviolet radiation at Mediterranean latitudes and protection efficacy of intraocular lenses.

PURPOSE: After determining the mean intensity of ultraviolet radiation to which the human eye is exposed at Mediterranean latitudes, this data is used to evaluate the efficacy of the ultraviolet filters incorporated into various intraocular lenses. METHODS: Ultraviolet radiation measured at Mediterranean latitudes was used as a reference for the theoretical calculation of the amount of radiation to which the human eye is exposed. The spectral transmission curve from 290 to 380 nm was measured for 10 IOLs using a UV/VIS Perkins-Elmer Lambda 800 spectrometer. RESULTS: At Mediterranean latitudes, at sea level, with a mean annual solar irradiation of 50 j/cm(2), the human eye receives a quantity of UVA and UVB that is lower than the threshold toxic dose for the rabbit crystalline lens (93 j/cm(2) for UVA and 6.45 j/cm(2) for UVB). However, at higher altitudes and with albedo approaching 0.9 (fresh snow), the amount of radiation increases, with duration of exposure potentially playing a significant role. The UV filters incorporated into the IOLs studied are, in general, protective against such levels of radiation. CONCLUSION: At Mediterranean latitudes, at sea level, the amount of UV radiation to which our eyes are exposed is insufficient to damage the crystalline lens; however, at higher altitudes, the risk of such damage exists. UV filters incorporated into intraocular lenses are generally effective, since they filter all radiation with wavelengths under 380 nm.

Aspirina frente a anticoagulación en pacientes jóvenes con infarto cerebral secundario a síndrome antifosfolípido primario / Aspirin versus anticoagulation in young patients with cerebral infarction secondary to primary antiphospholipid syndrome

Introducción. El síndrome antifosfolípido primario (SAP) es un factor de riesgo independiente para infarto cerebral. Objetivo. Evaluar el riesgo de recurrencia, comparar los diferentes tratamientos y determinar los factores de riesgo asociados con recurrencia y complicaciones hemorrágicas en pacientes con infarto cerebral y SAP. Pacientes y métodos. Los datos prospectivamente recogidos de 92 pacientes menores de 45 años (71% mujeres; media de edad: 33,8 ± 8,9 años), con diagnósticos confirmados de infarto cerebral y SAP, tratados con anticoagulantes (n = 54) o aspirina (n = 38), se analizaron restrospectivamente. El seguimiento se realizó con evaluación neurológica cada 6 a 12 meses. Las medidas de pronóstico fueron: recurrencia de infarto cerebral, hemorragia intracerebral sintomática y sangrado menor. Resultados. Durante una mediana de seguimiento de 54 meses (rango: 12-240 meses), ocurrieron ocho (9%) infartos cerebrales recurrentes, sin diferencia entre el tratamiento con aspirina (n = 0) o anticoagulantes (n = 8). La tasa anual de recurrencia fue de 0,014 personas/año de seguimiento. La historia de trombosis previa y de abortos espontáneos fue más habitual en pacientes con recurrencia. Los pacientes tratados con aspirina provenían con mayor frecuencia de medio rural. Cuatro pacientes anticoagulados desarrollaron complicaciones hemorrágicas; dos, hemorragias menores, y dos, hematomas subdurales. El 76% de los casos evolucionó con buen pronóstico funcional (escala de Rankin modificada: 0-2). Conclusión. Con las limitaciones de un estudio no aleatorizado, nuestros datos sugieren que el riesgo de infarto cerebral arterial recurrente en pacientes jóvenes con infarto cerebral secundario a SAP es bajo, no homogéneo y probablemente independiente del tipo de antitrombótico utilizado (AU)

Introduction. The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. Aim. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with recurrence and hemorrhagic complications in patients with cerebral infarction and PAS. Patients and methods. Prospectively collected data from 92 patients under 45 years (71% female, mean age 33.8 ± 8.9 years) with confirmed diagnoses of cerebral infarction and PAS, treated with anticoagulants (n = 54) or aspirin (n = 38) were retrospectively analyzed. Clinical follow-up was obtained by neurological examination every 6 to 12 months. Outcome measures were: recurrence of CI, symptomatic intracerebral hemorrhage, and minor bleeding. Results. During a median follow-up of 54 months (range: 12-240 months), there were 8 (9%) recurrent cerebral infarctions, with no difference between treatment with aspirin (n = 0) or anticoagulants (n = 8). The annual rate of recurrence was 0,014 person-years of follow-up. The history of previous thrombosis and spontaneous abortions were more frequent in patients with recurrence. Aspirin-treated patients more frequently came from rural areas. Four anticoagulated patients developed bleeding complications, two minor bleeding and two subdural hematomas. 76% of the cases evolved with good outcome (modified Rankin scale: 0-2). Conclusion. With the limitations of a nonrandomized study, our data suggest that the risk of recurrent arterial cerebral infarction in young patients with cerebral infarction secondary to PAS is low, probably non-uniform and independent of the type of antithrombotic (AU)

Cardiac sympathetic impairment parallels nigrostriatal degeneration in Probable Dementia with Lewy Bodies.

AIM: Dementia with Lewy Bodies (DLB) must be distinguished from other types of dementia because of important differences in patient management and outcome. Both reduction in cardiac 123I-metaiodobenzilguanidine (MIBG) uptake and decreased 123I-FP-CIT binding in basal ganglia have been described in DLB. The aim of this study was to assess the relationship between cardiac sympathetic activity and nigrostriatal degeneration in patients with probable DLB. METHODS: Twenty-eight patients (15 males; mean age 77 years, range 64-88 years) with clinical international criteria of probable DLB were included in the study. All patients underwent a cardiac MIBG scintigraphy and a FP-CIT SPECT. Global cardiac MIBG uptake was semiquantified by means of heart-to-mediastinum ratio (HMR) (normal >1.56). FP-CIT binding in basal ganglia was calculated and compared with an age-matched control group. The relation between cardiac MIBG uptake and FP-CIT uptake in basal ganglia, and the relationship of these two techniques with distinctive symptoms of DLB, features of past medical history and data from the neuropsychological examination were assessed. RESULTS: Cardiac MIBG uptake was decreased in 23 of 28 patients (HMR=1.32, range 0.95-1.85). The FP-CIT binding in basal ganglia was significantly lower than in control group (2.01±0.5 vs 2.62±0.2, P<0.05). All patients with reduced cardiac HMR showed decreased FP-CIT binding in basal ganglia. There was a positive correlation between the HMR and specific binding ratio of striatum (P<0.01). A high correlation between FP-CIT SPECT and the presence of parkinsonism also was found. No correlation between cardiac MIBG uptake and demographic, clinical or neuropsychological data was found. CONCLUSION: In probable DLB cardiac MIBG uptake and FP-CIT binding in basal ganglia are reduced. The positive correlation between both measures suggests that cardiac sympathetic degeneration and nigrostriatal degeneration parallel similarly in patients with probable DLB.

Selected Swine viral pathogens in indoor pigs in Spain. Seroprevalence and farm-level characteristics.

A serosurvey on porcine reproductive and respiratory syndrome virus (PRRSV), swine influenza virus (SIV), Aujeszky's disease virus gE protein (ADV gE), porcine parvovirus (PPV) and porcine circovirus type 2 (PCV2) was carried out in Spanish pig herds. The serosurvey consisted of two studies. First, a retrospective study assessed the proportion of seropositive boar, sow and fattening pig herds and their seroprevalences to PRRSV, SIV, ADV gE and PPV from 2003 to 2005 and to PCV2 from 2000 to 2005. Such information was obtained from routine serologic analyses from two veterinary diagnostic laboratory services. Second, a cross-sectional study in sow and fattening pig herds from 44 farms (without vaccination interferences on serologic analyses) was performed to provide information on seroprevalences and co-seropositivity to PRRSV, SIV, ADV gE and PCV2 (PPV was excluded because of widespread vaccination) and to elucidate their relationships with farm characteristics, management and productive parameters. Similar seroprevalences were observed in both studies, although some variations were obtained, probably because of vaccination schedules, number of tested sera, sampling age and regional variations. Percentage of PRRSV and SIV seropositive herds was over 85% for sows, around 80% for fatteners and around 50% for boar studs. The proportion of ADV gE seropositive sow herds decreased from 41% to 30% between 2003 and 2005, whereas such decrease was from 41% to 33% in fattening pig herds and from 13% to 4% in boar studs PCV2 antibodies were widespread as well as those against PPV; in the latter case, if antibodies were elicited by infection and/or vaccination was not assessed. Concurrent presence of PCV2, PRRSV and SIV antibodies was found in 89% and 66% sow and fattening herds, respectively. No statistical associations were obtained between seroprevalences or co-seropositivity and farm characteristics, management or productive parameters.