Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients

Introduction: Lung cancer is the most frequent neoplasm in humans. Surgery is considered the best therapeutic approach for stage I non-small lung cell cancer (NSCLC). However, a remarkable amount of patients are considered as inoperable. Stereotactic body radiotherapy (SBRT) has risen as an option for those patients, rendering excellent results in quality of life and survival. Materials and methods: We analyzed clinical studies published between 2002 and 2015 which included SBRT as a treatment modality. Our own clinical series was analyzed as well. The patterns of failure following SBRT were investigated, together with the outcomes and the toxicity observed. Results: SBRT has proven to maintain an excellent local control. The analysis showed the tumor size and the histology as determinant factors for the response to treatment. Conclusion: According to the published evidence as well as our own experience, SBRT is a safe and feasible approach for early NSCLC. Its results may be comparable with surgery treatment (AU)

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Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients.

INTRODUCTION: Lung cancer is the most frequent neoplasm in humans. Surgery is considered the best therapeutic approach for stage I non-small lung cell cancer (NSCLC). However, a remarkable amount of patients are considered as inoperable. Stereotactic body radiotherapy (SBRT) has risen as an option for those patients, rendering excellent results in quality of life and survival. MATERIALS AND METHODS: We analyzed clinical studies published between 2002 and 2015 which included SBRT as a treatment modality. Our own clinical series was analyzed as well. The patterns of failure following SBRT were investigated, together with the outcomes and the toxicity observed. RESULTS: SBRT has proven to maintain an excellent local control. The analysis showed the tumor size and the histology as determinant factors for the response to treatment. CONCLUSION: According to the published evidence as well as our own experience, SBRT is a safe and feasible approach for early NSCLC. Its results may be comparable with surgery treatment.

A model for the control of malaria using genetically modified vectors.

Recent works have considered the problem of using transgenic mosquitoes to control a malaria epidemic. These insects have been genetically engineered to reduce their capacity to infect humans with malaria parasites. We analyze a model of the mosquito population dynamics when genetically modified individuals are introduced into a wild type population so that the effect of their introduction can be assessed. The model describes the dynamics of gene selection under sexual reproduction in a closed vector population. Our results show that the fitness of the resulting heterozygous population is the key parameter for the success of the invasion, independently of the fitness of homozygous vectors. The vector population dynamics model is then combined with an epidemiological model to study the feasibility of controlling a malaria epidemic. Basic reproductive numbers are calculated for both models, and conditions are obtained for preventing reappearance of the epidemic. Simulations on this model show that it may be possible to reduce or even eradicate the epidemic only if the heterozygous population is better adapted than the wild type. They also show that this can be achieved without completely eliminating the wild type mosquitoes.

[The Latin American Psychiatrist: profile and degree of satisfaction with the specialty]. / El médico psiquiatra latinoamericano: su perfil y su grado de satisfacción con la especialidad.

OBJECTIVES: The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction. METHODS AND MATERIALS: A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey. RESULTS: A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described. CONCLUSIONS: In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries.

El médico psiquiatra latinoamericano: su perfil y su grado de satisfacción con la especialidad / The Latin American Psychiatrist: profile and degree of satisfaction with the specialty

Objetivo. Describir el perfil de los psiquiatras afiliados a las sociedades nacionales de psiquiatría de 19 países latinoamericanos (Argentina, Bolivia, Brasil, Colombia, Costa Rica, Cuba, República Dominicana, Ecuador, Chile, El Salvador, Guatemala, Honduras, México, Nicaragua, Perú, Panamá, Paraguay, Uruguay y Venezuela); evaluar su nivel de satisfacción laboral y explorar los factores asociados con el mismo. Materiales y métodos. Se identificaron 8.028 psiquiatras afiliados en las sociedades nacionales de psiquiatría; se diseñó una muestra probabilística y estratificada de 2.465 psiquiatras a quienes se les solicitó que cumplimentaran un formulario electrónico anónimo. Resultados. Entre abril de 2005 y julio de 2006 se pudo ejecutar una muestra de 1.292 psiquiatras (52,4%). Once países tuvieron tasas de respuesta superiores al 70%. La media de edad fue de 48,2 años; la media de experiencia fue de 18,2 años; el 63,8% fueron hombres y un 99,3% de los encuestados ejercen actualmente. La mayoría de los encuestados se declararon satisfechos con su nivel de calidad de vida (70,8%), un porcentaje ligeramente mayor se declaró satisfecho con el quehacer diario de la práctica psiquiátrica (86,4%); sin embargo, un 35,3% declaró que los ingresos obtenidos a partir de su actividad como psiquiatras no satisfacían sus necesidades. Se describen los factores que se encontraron asociados con la insatisfacción laboral. Conclusiones. En Latinoamérica hay menos satisfacción con los ingresos obtenidos de la práctica y con el nivel de calidad de vida, pero la satisfacción laboral y el grado de compromiso con la profesión permanecen similares a los hallados en países desarrollados (AU)

Objectives. The primary objective is to describe the profile of the psychiatric members of a national psychiatry association in 19 Latin American countries (Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Chile, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru, Panama, Paraguay, Uruguay, and Venezuela). Secondary objectives are to evaluate job satisfaction and examine the factors related with job satisfaction. Methods and materials. A total of 8,028 psychiatrists, members of a national psychiatry association in Latin America, were identified. A probabilistic stratified sample of 2465 psychiatrists was designed and they were asked to fill out an anonymous electronic survey. Results. A sample of 1,292 Latin American psychiatrists was obtained between April 2005 and July 2006 (52.4% of the designed sample). Response rates were superior to 70% in 11 countries. Mean age was 48.2 years, mean experience was 18.2 years; 63.8% were male and 99.9% of the surveyed psychiatrists were working as psychiatrists. Most of the respondents declared being satisfied with their quality of life (70.8%), a slightly larger percentage reported they were satisfied with their work (86.4%). However, 35.3% of the psychiatrists reported being unsatisfied with the income perceived for their economic activity as psychiatrists. Factors associated with job dissatisfaction are described. Conclusions. In Latin America, there is lower satisfaction with the incomes obtained from psychiatric practice and with the quality of life level. Nonetheless, the level of commitment with the profession in itself and job satisfaction remain similar to those reported in developed countries (AU)

Estimulación magnética transcraneal repetitiva en un paciente con tinnitus bilateral crónico / Repeated transcranial magnetic stimulation in a patient with chronic bilateral tinnitus

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Atrial fibrillation: a risk factor for increased mortality--an AVID registry analysis.

Emerging evidence suggests that atrial fibrillation is not a benign arrhythmia. It is associated with increased risk of death. The magnitude of association is controversial and potential causes remain unknown. Patients in the registry of the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial form the basis for this report. Baseline variables, in particular the presence or absence of a history of atrial fibrillation/flutter, were examined in relation to survival. Multivariate Cox regression was used to adjust for differences in important baseline co-variables using 27 pre-selected variables. There were 3762 subjects who were followed for an average of 773+/-420 days; 1459 (39 %) qualified with ventricular fibrillation and 2303 (61 %) with ventricular tachycardia. A history of atrial fibrillation/flutter was present in 24.4 percent. There were many differences in baseline variables between those with and those without a history of atrial fibrillation/flutter. After adjustment for baseline differences, a history of atrial fibrillation/flutter remained a significant independent predictor of mortality, (relative risk=1.20; 95 % confidence intervals=1.03-1.40; p=0.020). Antiarrhythmic drug use, other than amiodarone or sotalol, was also a significant independent predictor of mortality (relative risk 1.34; 95 % confidence intervals 1.07-1.69, p=0.011. Atrial fibrillation/flutter is a significant independent risk factor for increased mortality in patients presenting with ventricular tachyarrhythmias. This risk may have been overestimated in previous studies that could not adjust for the proarrhythmic effects of antiarrhythmic drugs other than amiodarone or sotalol.

Lead- and device-related complications in the antiarrhythmics versus implantable defibrillators trial.

BACKGROUND: Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. METHODS AND RESULTS: Between June 1, 1993, and April 7, 1997, 539 patients received nonthoracotomy ICDs either as initial treatment assignment (477) or as crossover from medical management (62). A total of 62 first complications occurred. The subclavian route of insertion resulted in more complications than the cephalic vein route, 46 of 339 (14%) versus 6 of 135 (4%), P = .005, as did the abdominal versus pectoral generator site, 31 of 238 (13%) versus 17 of 291 (6%), P<.02. Most dislodgements and system infections tended to occur in the 3 months after implantation, whereas lead fractures continued to occur throughout follow-up. Failure to use perioperative antibiotics was a predictor of system infection (P = .001). CONCLUSIONS: These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.