Brentuximab vedotin in the treatment of cutaneous T-cell lymphomas: Data from the Spanish Primary Cutaneous Lymphoma Registry.

BACKGROUND: Brentuximab vedotin (BV) has been approved for CD30-expressing cutaneous T-cell lymphoma (CTCL) after at least one previous systemic treatment. However, real clinical practice is still limited. OBJECTIVES: To evaluate the response and tolerance of BV in a cohort of patients with CTCL. METHODS: We analysed CTCL patients treated with BV from the Spanish Primary Cutaneous Lymphoma Registry (RELCP). RESULTS: Sixty-seven patients were included. There were 26 females and the mean age at diagnosis was 59 years. Forty-eight were mycosis fungoides (MF), 7 Sézary syndrome (SS) and 12 CD30+ lymphoproliferative disorders (CD30 LPD). Mean follow-up was 18 months. Thirty patients (45%) showed at least 10% of CD30+ cells among the total lymphocytic infiltrate. The median number of BV infusions received was 7. The overall response rate (ORR) was 67% (63% in MF, 71% in SS and 84% in CD30 LPD). Ten of 14 patients with folliculotropic MF (FMF) achieved complete or partial response (ORR 71%). The median time to response was 2.8 months. During follow-up, 36 cases (54%) experienced cutaneous relapse or progression. The median progression free survival (PFS) was 10.3 months. The most frequent adverse event was peripheral neuropathy (PN) (57%), in most patients (85%), grades 1 or 2. CONCLUSIONS: These results confirm the efficacy and safety of BV in patients with advanced-stage MF, and CD30 LPD. In addition, patients with FMF and SS also showed a favourable response. Our data suggest that BV retreatment is effective in a proportion of cases.

Role of sports psychology and sports nutrition in return to play from musculoskeletal injuries in professional soccer: an interdisciplinary approach.

Musculoskeletal injuries are prevalent in professional soccer and can result in lost training time or match play. It is intuitive that the "return to play" (RTP) pathway will depend, in large part, on the expertise of sports medicine practitioners (e.g. surgeons, physicians, physiotherapists) responsible for player's recovery. Consensus statements on returning athletes to sport following injury acknowledge the contributions of sport psychology and sports nutrition. However, specific consideration on how to integrate these two recognized - but often overlooked components of injury rehabilitation - into existing sport medicine approaches has yet to be examined. Using a framework of milestones directed by the medical physician and physical trainer, the evidence is summarized and suggestions provided on the integration of sports psychology and sports nutrition into an interdisciplinary RTP approach. We examine recovery from a phase approach (acute injury and functional recovery) to highlight interdisciplinary opportunities in the management of musculoskeletal soccer injuries. An interdisciplinary approach is understood to achieve outcomes that could not be achieved within the framework of a single discipline. The incorporation of sports psychology and nutrition theoretically compliment milestones used in current medically-based RTP models. Our hope is that this article serves as a catalyst for interdisciplinary practice and research - not only in sports nutrition and sports psychology - but across all sport and exercise disciplines.

Objectively and subjectively measured physical activity and its relation to cardiovascular risk factors in older people-Which is most appropriate?

OBJECTIVES: To determine the strength of the association between objectively and subjectively measured physical activity (PA) and cardiovascular risk factors (CVRF) in a sample of older adults to assess which measure of PA is most appropriate for use in this population. STUDY DESIGN AND OUTCOME MEASURES: The study was a cross-sectional analysis of a community-dwelling sample aged 60 years or more (61 women and 34 men). Data collection included anthropometric measurements, blood analytics, and objective and subjective measurements of PA from accelerometers and Yale PA Survey questionnaires, respectively. RESULTS: Although the questionnaire indicated a higher summary index (total units) of PA in men than in women, objective measurements of total PA (mean counts per minute and steps per day) did not differ by sex. However, we obtained different results between women and men when we analyzed the relation between objective and subjective PA parameters and CVRF. In women, parameters that indicate cardiovascular risk, such as body mass index (BMI), waist circumference (WC), glucose, and total cholesterol, negatively correlated with objective PA parameters, while HDLc positively correlated with objective PA parameters and negatively with subjective PA parameters. In men, BMI and WC were negatively correlated with objective PA parameters, while blood cholesterol, LDLc, and triglycerides negatively correlated with subjective PA parameters. CONCLUSIONS: In women, it seems more appropriate to use objective methods to measure PA, while in men, objective and subjective methods seem to be complementary. Both methods of measurement, accelerometers and questionnaires, should be used simultaneously in research studies in older populations to establish precise relationships between PA and cardiovascular risk.

Detection of muscle gap by L-BIA in muscle injuries: clinical prognosis.

Sport-related muscle injury classifications are based basically on imaging criteria such as ultrasound (US) and magnetic resonance imaging (MRI) without consensus because of a lack of clinical prognostics for return-to-play (RTP), which is conditioned upon the severity of the injury, and this in turn with the muscle gap (muscular fibers retraction). Recently, Futbol Club Barcelona's medical department proposed a new muscle injury classification in which muscle gap plays an important role, with the drawback that it is not always possible to identify by MRI. Localized bioimpedance measurement (L-BIA) has emerged as a non-invasive technique for supporting US and MRI to quantify the disrupted soft tissue structure in injured muscles. OBJECTIVE: To correlate the severity of the injury according to the gap with the RTP, through the percent of change in resistance (R), reactance (Xc) and phase-angle (PA) by L-BIA measurements in 22 muscle injuries. MAIN RESULTS: After grouping the data according to the muscle gap (by MRI exam), there were significant differences in R between grade 1 and grade 2f (myotendinous or myofascial muscle injury with feather-like appearance), as well as between grade 2f and grade 2g (myotendinous or myofascial muscle injury with feather and gap). The Xc and PA values decrease significantly between each grade (i.e. 1 versus 2f, 1 versus 2g and 2f versus 2g). In addition, the severity of the muscle gap adversely affected the RTP with significant differences observed between 1 and 2g as well as between 2f and 2g. SIGNIFICANCE: These results show that L-BIA could aid MRI and US in identifying the severity of an injured muscle according to muscle gap and therefore to accurately predict the RTP.

Physical activity and dietary habits related to cardiovascular risk in independent community-living older women.

A side effect of increased life expectancy is a surge in sequelae of diseases and injuries, which in turn increase the duration of life with disability among the elderly. The aim of this study was to ascertain the physical activity and nutritional parameters that better predict cardiovascular risk in a cohort of older women. A cross-sectional study was designed including 65 women able to independently perform basic activities of daily life. Data collection included anthropometric measurement, blood pressure measurement, blood analytics, objectively measurement of physical activity, and dietary assessment. We were able to generate models that explain the relationship between physical activity, diet, and these health measurement parameters. We observed that the combination of moderate physical activity and a diet including protein-rich foods as nuts, dairy, and eggs were better predictors associated with favorable changes in risk factors for cardiovascular disease than age.

[The validity and reliability of the Spanish version of the Severe Cognitive Impairment Profile (SCIP) for the cognitive assessment of persons with advanced stages of Alzheimer's disease]. / Validez y fiabilidad de la version española de la escala 'perfil de deterioro cognitivo grave' (SCIP) para la evaluacion cognitiva de personas con enfermedad de Alzheimer en estadios avanzados.

INTRODUCTION: Few validated tools exist in Spanish for conducting a precise assessment of the cognitive functioning of persons with advanced dementia. This population is a challenge due to the large number of persons who reach these states and owing to the complexity of the care that they require. This study presents a validated Spanish version of an instrument, the Severe Cognitive Impairment Profile (SCIP), which allows assessment of the cognitive functioning of persons with advanced Alzheimer's disease. PATIENTS AND METHODS: We conducted a cross-sectional study with 133 subjects (29 males and 104 females; mean age: 81.61 ± 7.41 years) diagnosed with Alzheimer's disease in moderate to very severe stages, according to the Global Deterioration Scale (GDS 5-7). The following were performed: discrimination analyses of the items, a study of the internal consistency and interrater reliability and test-retest. Likewise, the factorial structure and the validity of the instrument were also tested. RESULTS: Only 1% of the 160 items on the scale were found to be non-discriminatory. The internal consistency of the scale is adequate, as is the interrater and the test-retest reliability. As regards the validity of the construct, the correlation with the mini-mental state examination is 0.74 (p < 0.01) and significant differences are found between the SCIP and the three levels of the GDS that were analysed. The factorial structure of the scales shows the existence of a single factor that accounts for 66.12% of the variance. CONCLUSIONS: The SCIP scale is a useful, reliable and valid instrument for the exhaustive evaluation in Spanish of the cognitive functions of persons with dementia in moderate to very severe states.

TITLE: Validez y fiabilidad de la version española de la escala 'perfil de deterioro cognitivo grave' (SCIP) para la evaluacion cognitiva de personas con enfermedad de Alzheimer en estadios avanzados.Introduccion. Existen pocas herramientas validadas al castellano para realizar una evaluacion precisa del funcionamiento cognitivo de personas con demencias avanzadas. Esta poblacion supone un reto por el elevado numero de personas que alcanzan estos estadios y por la complejidad de cuidados que requieren. Este trabajo presenta la validacion al castellano de un instrumento, la escala 'perfil de deterioro cognitivo grave' (SCIP), que permite la evaluacion del funcionamiento cognitivo de personas con enfermedad de Alzheimer avanzada. Pacientes y metodos. Estudio transversal con 133 sujetos (29 hombres y 104 mujeres; edad media: 81,61 ± 7,41 años) con diagnostico de enfermedad de Alzheimer en estadios de moderado a muy grave, segun la escala de deterioro global (GDS 5-7). Se realizaron analisis de discriminacion de los items, estudio de la consistencia interna y fiabilidad interjueces y test-retest, y se contrasto la estructura factorial y la validez del instrumento. Resultados. Solo el 1% de los 160 items de la escala resulto no discriminativo. La consistencia interna de la escala es adecuada, asi como la fiabilidad interjueces y test-retest. Respecto a la validez de constructo, la correlacion con el miniexamen cognitivo es 0,74 (p < 0,01), y se encuentran diferencias significativas entre la escala SCIP y los tres niveles de la GDS analizados. La estructura factorial de la escala muestra la existencia de un solo factor que explica el 66,12% de la varianza. Conclusion. La escala SCIP es un instrumento util, fiable y valido para la evaluacion exhaustiva en castellano de las funciones cognitivas en personas con demencia en estadios de moderado a muy grave.

Relationship between physical activity and markers of oxidative stress in independent community-living elderly individuals.

The aim of the present study was to examine the relationship between objective data of physical activity and markers of oxidative stress in older men and women. Participants were old adults, aged≥60years (61 women and 34 men) who were all capable of performing basic daily activities by themselves and lived on their own. To describe physical activity we used objective data measured by accelerometers which record active and sedentary periods during everyday life for five days. Determination of oxidative stress was conducted from three perspectives: determination plasma total antioxidant status (TAS), plasma antioxidant enzyme activities, i.e., glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD), and membrane lipid peroxidation (TBARS). In the group of women, those who met physical activity recommendations (WR) had lower level of TAS. In addition, the moderate to vigorous physical activity (MVPA) was negatively correlated with TAS. Simultaneously, MVPA was correlated with increase in the GPx antioxidant enzyme activity, and the counts per minute were positively correlated with CAT activity. In the group of men, the cpm and the MVPA were negatively correlated with lipid peroxidation while lifestyle physical activity was positively correlated with CAT activity. These findings suggest that MVPA in the elderly although it is related to a decrease in the TAS in women, induces adaptive increase in antioxidant enzyme activity and decreases lipid peroxidation in both women and men. These results suggest that at this time of life, it is not only the amount of physical activity performed that is important but also its intensity.

Effects of muscle injury severity on localized bioimpedance measurements.

Muscle injuries in the lower limb are common among professional football players. Classification is made according to severity and is diagnosed with radiological assessment as: grade I (minor strain or minor injury), grade II (partial rupture, moderate injury) and grade III (complete rupture, severe injury). Tetrapolar localized bioimpedance analysis (BIA) at 50 kHz made with a phase-sensitive analyzer was used to assess damage to the integrity of muscle structures and the fluid accumulation 24 h after injury in 21 injuries in the quadriceps, hamstring and calf, and was diagnosed with magnetic resonance imaging (MRI). The aim of this study was to identify the pattern of change in BIA variables as indicators of fluid [resistance (R)] and cell structure integrity [reactance (Xc) and phase angle (PA)] according to the severity of the MRI-defined injury. The % difference compared to the non-injured contralateral muscle also measured 24-h after injury of R, Xc and PA were respectively: grade I (n = 11; -10.4, -17.5 and -9.0%), grade II (n = 8; -18.4, -32.9 and -16.6%) and grade III (n = 2; -14.1, -52.9 and -43.1%), showing a greater significant decrease in Xc (p < 0.001). The greatest relative changes were in grade III injuries. However, decreases in R, that indicate fluid distribution, were not proportional to the severity of the injury. Disruption of the muscle structure, demonstrated by the localized determination of Xc, increased with the severity of muscle injury. The most significant changes 24 h after injury was the sizeable decrease in Xc that indicates a pattern of disrupted soft tissue structure, proportional to the severity of the injury.

Localized BIA identifies structural and pathophysiological changes in soft tissue after post-traumatic injuries in soccer players.

Localized bioimpedance (BIA) was measured with a single frequency phase-sensitive analyzer at 50 kHz in three post-traumatic types of injuries on four professional soccer players: (1) myositis ossificans, (2) intramuscular seroma and (3) trochanteric (hip) bursitis. Normal reference value (no injury) was obtained from the contra lateral not injured limb at a mirror-like location of the injury. The relative variations resistance (R) and reactance (Xc) at the time of injury was confronted with the not injured values. Relative variations between acute measurements and post medication ones on intramuscular seroma and bursitis have been computed. In intramuscular seroma and trochanteric bursitis we have obtained a percent of change between injury data and after medical intervention. On myositis ossificans, localized BIA showed a 7-8 % decrease in Xc whereas the percent of change of R was negligible (1 %). These percent of changes are in concordance with histological evidence. In the case of a presence of seroma or the lower thigh and trochanteric bursitis, the soft tissue cavity accumulates fluid. Post-injury localized BIA, relative with respect to non-injured side, confirmed sizeable soft tissue destruction evidenced by 50 % decrease of Xc and 24-31 % decrease of R due to interstitial fluid accumulation. Once the seroma and the blood in the bursitis was removed the localized the immediate post-injury BIA parameters increased as follows: a) intramuscular seroma + 10 % on R and + 74 % of Xc; b) trochanteric bursitis + 20 % of R and +24 % of Xc. Localized BIA other than classifying soft tissue injuries, can be useful to understand the pathophysiology and structural impairments of other kind of injuries and to understand their behavior.

Localized bioimpedance to assess muscle injury.

Injuries to lower limb muscles are common among football players. Localized bioimpedance analysis (BIA) utilizes electrical measurements to assess soft tissue hydration and cell membrane integrity non-invasively. This study reports the effects of the severity of muscle injury and recovery on BIA variables. We made serial tetra-polar, phase-sensitive 50 kHz localized BIA measurements of quadriceps, hamstring and calf muscles of three male football players before and after injury and during recovery until return-to-play, to determine changes in BIA variables (resistance (R), reactance (Xc) and phase angle (PA)) in different degrees of muscle injury. Compared to non-injury values, R, Xc and PA decreased with increasing muscle injury severity: grade III (23.1%, 45.1% and 27.6%), grade II (20.6%, 31.6% and 13.3%) and grade I (11.9%, 23.5% and 12.1%). These findings indicate that decreases in R reflect localized fluid accumulation, and reductions in Xc and PA highlight disruption of cellular membrane integrity and injury. Localized BIA measurements of muscle groups enable the practical detection of soft tissue injury and its severity.

Assessment and follow-up of muscle injuries in athletes by bioimpedance: preliminary results.

Mono-frequency (50 kHz) whole-body and segmental bioimpedance is measured before sport training in 14 high performance athletes. The athletes are classified in two groups according to the team sport: football and basketball. Bioelectrical impedance vector analysis (BIVA) method is used to obtain the individual whole-body impedance and 6 segmental impedance vectors in the main muscular groups in the lower-limbs. The whole-body vector is analyzed in the tolerance ellipses of the reference population. Individual impedance vector components are standardized by the height H of the subject, (R/H and Xc/H) to obtain the impedance vector (Z/H) of each segment. The hypotheses of the study are: 1) Not all the sports have the same pattern of bioimpedance vector by muscle group. 2) In elite well trained athletes their muscle groups are symmetrical (right and left sides), thus each athlete is its own reference for future comparisons. 3) We expect a change in the two components of bioimpedance vector (R/H and Xc/H) in front of a muscle injury. In order to compare the differences between the complex Z/H vector (R/H, Xc/H) we use Hotelling's T2 test. Preliminary results show a significant difference (P < 0.05) in bioimpedance vectors between groups according to the team sport, and also between normal muscle condition and after muscle injury producing hyper-hydration.

Genes related to iron metabolism and susceptibility to Alzheimer's disease in Basque population.

Alzheimer's disease (AD) is the most common dementing disorder and presents with a progressive and irreversible cognitive decline of gradual onset. To date, several reports have involved iron in AD physiopathology. In this study, we have analysed TFC2 variant and HFE mutations (H63D and C282Y) in 211 AD patients and 167 controls recruited from an area of the Basque Country. Furthermore, we have studied APOE genotype as it is a well-known risk factor for AD. APOE epsilon 4 allele was associated with an increased risk of AD and an earlier age at onset, whereas no association was found between TFC2 or HFE C282Y mutation and disease susceptibility. The frequency of H63D mutation was higher in control population (29.9%) than in AD patients (18%), suggesting a protective role of this allele on AD either due to the presence of the mutation itself or through the effect of other related genes in the ancestral haplotype in which it is included.

[Extracorporeal lithofragmentation and of direct contact. Development of mathematical models for calculating the energy and predicting the fragmentation]. / Litofragmentación extracorpórea y de contacto directo. Desarrollo de modelos matemáticos para el cálculo de la energía y la predicción de la fragmentación.

The present experimental 'in vitro' study pursues the development of mathematical equations which, prior to lithofragmentation, would allow to estimate the amount of energy required and to predict the degree of fragmentation for each of the different sources of energy. A total of 114 calculi with 6 different compositions were analyzed by conventional X-rays (Rx), computerized axial tomography (CT) and dual X-ray densitometry (DO). Calculi were then fragmented using 4 different types of energy: electrohydraulic (LEH), piezoelectric (LEP), ultrasounds (US) and pulse laser (LAS). The correlation between imaging techniques parameters on the one side, and the amount of energy used and degree of fragmentation obtained on the other one, allow with a multiple linear regression analysis, both to develop mathematical equations to estimate the amount of energy required, and to predict the fragmentation rate.

[Comparative analysis of lithiasic fragmentation induced by extracorporeal and direct contact sources]. / Análisis comparativo de la fragmentación litiásica inducida por las fuentes extracorpóreas y de contacto directo.

An in vitro experimental study on stone fragmentation was conducted on 114 calculi analyzed by infrared spectrophotometry. Four energy sources were utilized: electrohydraulic, piezoelectric, ultrasound and pulsed laser. We analyzed stone susceptibility to fragmentation (particles < 3 mm), pulverization (particles < 1 mm) and stone fragility (amount of energy/mg of calculus fragmented into particles < 3 mm) for each type of energy source of each of the following 6 stone compositions: calcium oxalate monohydrate, calcium oxalate dihydrate, magnesium ammonium phosphate, phosphate carbonate, uric acid and phosphate oxalate. The calcium oxalate dihydrate calculi were the most susceptible to fragmentation and the infective calculi (magnesium ammonium phosphate and phosphate carbonate) were the most susceptible to pulverization. The piezoelectric energy showed the highest capacity for fragmentation and pulverization of calculi. Stone fragility depended on each stone type and the energy source utilized.

[Efficacy and limitations of piezoelectric extracorporeal lithotripsy in kidneys with anatomical abnormalities]. / Eficacia y limitaciones de la litofragmentación extracorpórea piezoeléctrica (LEP) en riñones con anaomalías anatómicas.

We analyze the results achieved by extracorporeal piezoelectric lithotripsy (EPL) in 40 renal units with the following anatomic anomalies: solitary kidney (10), chronic pyelonephritis (8), medulospongiosis (6), caliceal diverticula (5), intrarenal cysts (5), pyeloureteric duplicity (3), megacaliosis (1), horseshoe kidney (1), and ureterocele (1). Adequate stone fragmentation was achieved in 80% of the patients with solitary kidney; 20% developed obstructive complications (1 patient with a 15 mm.-stone and 1 patient with obstruction of double-J catheter). At 6 months, stone remnants persist in 71.4% (5/7) after stone fragmentation in those cases with pyelonephrosis. The rates for fragmentation, elimination of remaining stone fragments, and disappearance of pain are 80%, 50% and 100% for diverticular caliceal calculi, and 67%, 50% and 100% for those in kidney with medulospongiosis. We can conclude that placement of a double-J catheter is useful before EPL in patients with solitary kidney and calculi greater than 10 mm. EPL is the first therapeutic approach in symptomatic lithiasis in caliceal diverticula or precaliceal cystic dilatation (medulospongiosis).