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2.
Clin Transl Oncol ; 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34585316

RESUMO

BACKGROUND: Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included. MATERIALS AND METHODS: Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5-1 Gy on every other day up to a total dose of 3-6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course. RESULTS: With a median follow-up of 10.5 months (range 7.55-12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9-14). The mean VAS score before treatment was 8 (range 3-10). After treatment, it was 5 (range 1-10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0-9), 3 (range 0-9) and 3.5 (range 0-9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed. CONCLUSION: LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.

3.
Micron ; 149: 103124, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34314943

RESUMO

The current work presents the complex dielectric function and the opto-electronic properties of lead-free Ba0.8Ca0.2Ti0.9Zr0.1O3 (BCZT) electro-ceramic, derived from valence electron energy loss spectroscopy, in transmission electron microscopy (VEELS-TEM). A single tetragonal perovskite phase, with P4mm space group, was determined by Rietveld refinement of the x-ray diffraction pattern. The VEELS-TEM experiment scanned the energy interval from 0-50 eV. The spectroscopic analysis started with the chemical identification of the atoms that conforms the BCZT solid-solution. Bulk and surface plasmons were located at 27.2 eV and 12.9 eV, respectively in the energy loss function. Complex dielectric function was obtained using Kramers-Kronig analysis from the Gatan Microscopy Suite software. Dielectric constant was calculated from the real part of the complex dielectric function, while the inter-band transitions were identified in the joint density of states function. The refraction index n and the extinction coefficient k, as a function of energy, were obtained from the complex dielectric function. The bandgap energy was determined using a polynomial fit in the optical absorption coefficient plot with an Eg = 3.2 eV.

4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34243960

RESUMO

Neuropathic pain is an important and disabling clinical problem, its management constitutes a challenge for healthcare professionals. Vortioxetine is a new antidepressant drug with multimodal action, which gives it a unique profile. Tricyclic antidepressants, in particular amitriptyline, and serotonin and norepinephrine reuptake inhibitors venlafaxine and duloxetine are first-line drugs in the treatment of neuropathic pain. The interaction between the pain and depression binomial is very frequent, being the most frequent psychological complication in patients with chronic pain. This comprehensive and descriptive review summarizes the most relevant pharmacological data on vortioxetine, as well as the specific literature on vortioxetine in neuropathic pain and chronic pain.

5.
Strahlenther Onkol ; 197(11): 1010-1020, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34230996

RESUMO

PURPOSE: To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Inclusion criteria comprised patients with COVID-19-related moderate-severe pneumonia warranting hospitalization with supplemental O2 and not candidates for admission to the intensive care unit because of comorbidities or general status. All patients received single lung dose of 0.5 Gy. Respiratory and systemic inflammatory parameters were evaluated before irradiation, at 24 h and 1 week after LD-RT. Primary endpoint was increased in the ratio of arterial oxygen partial pressure (PaO2) or the pulse oximetry saturation (SpO2) to fractional inspired oxygen (FiO2) ratio of at least 20% at 24 h with respect to the preirradiation value. RESULTS: Between June and November 2020, 36 patients with COVID-19 pneumonia and a mean age of 84 years were enrolled. Seventeen were women and 19 were men and all of them had comorbidities. All patients had bilateral pulmonary infiltrates on chest X­ray. All patients received dexamethasone treatment. Mean SpO2 pretreatment value was 94.28% and the SpO2/FiO2 ratio varied from 255 mm Hg to 283 mm Hg at 24 h and to 381 mm Hg at 1 week, respectively. In those who survived (23/36, 64%), a significant improvement was observed in the percentage of lung involvement in the CT scan at 1 week after LD-RT. No adverse effects related to radiation treatment have been reported. CONCLUSIONS: LD-RT appears to be a feasible and safe option in a population with COVID-19 bilateral interstitial pneumonia in the presence of significant comorbidities.


Assuntos
COVID-19/radioterapia , Radioterapia Conformacional/métodos , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/uso terapêutico , Proteína C-Reativa/análise , COVID-19/diagnóstico por imagem , COVID-19/mortalidade , COVID-19/terapia , Causas de Morte , Terapia Combinada , Comorbidade , Dexametasona/uso terapêutico , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mortalidade Hospitalar , Humanos , Interleucina-6/sangue , L-Lactato Desidrogenase/sangue , Pulmão/diagnóstico por imagem , Pulmão/efeitos da radiação , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/radioterapia , Doenças Pulmonares Intersticiais/terapia , Masculino , Oxigênio/sangue , Oxigênio/uso terapêutico , Oxigenoterapia , Pressão Parcial , Estudos Prospectivos , Dosagem Radioterapêutica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Clin Transl Oncol ; 23(11): 2344-2349, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34013493

RESUMO

BACKGROUND: The use of low dose radiotherapy (LD-RT) for the treatment of COVID-19 pneumonia is supported by biological rationale for its immunomodulatory effect. Some institutions have started to treat these patients showing encouraging results. To shorten procedure times is crucial for the comfort of symptomatic patients receiving respiratory support and to optimize institutional facilities. PATIENTS AND METHODS: At our institution, LD-RT is offered to hospitalized patients with COVID-19 pneumonia and signs of early cytokine-released syndrome on behalf of a multicenter study. We designed a coordinated process flow starting from the patient transfer to the simulation CT-scan (first-step), to the end of the LD-RT treatment (last step). The times spent on each step of the process flow were evaluated. RESULTS: Mean age of treated patients was 83 (72-91) years-old. The timing parameters of the first 10 consecutive patients were analyzed. Except for the first (dummy run), patients were managed from the first to the last step in a median of 38 min (25-58, SD 10.67). The most time-consuming sub-process was the contouring of the treatment volumes and dosimetry. CONCLUSIONS: LD-RT is not only an encouraging option for COVID-19 pneumonia patients, but a convenient and feasible procedure if performed in a coordinated way by reducing procedure times.


Assuntos
COVID-19/radioterapia , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Humanos , Fatores de Tempo
7.
Clin Transl Oncol ; 23(11): 2358-2367, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34043153

RESUMO

PURPOSE: To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer. MATERIAL AND METHODS: Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. A CT scan for planning was acquired at free breathing. The treatment was planned and DVH were assessed according to international recommendations. Prescription dose was 30 Gy in five consecutive fractions of 6 Gy. A 6MV monoenergetic LINAC (linear accelerator) that combines stereoscopic X-ray imaging system and ExacTrac Adaptive Gating technique was used. PTV (planning target volume) intrafraction motion was controlled and PTV was irradiated in a selected gated area of the respiratory cycle. Shifts for a correct, gated set-up were calculated and automatically applied. RESULTS: Between April 2013 and October 2015, a total of 23 patients were included. The median tumor size was 12 mm. The mean PTV volume was 114 cc. The mean ipsilateral lung V9 Gy was 2.2% and for left-sided breast cancers, the volume of the heart receiving 1.5 Gy was 11.5%. Maximum skin dose was 30.8 Gy. Acute toxicity was grade1 in all the patients and 100% experienced excellent/good breast cosmesis outcomes. With a median follow-up of 66 months (range 8-99 months) local-relapse-free-survival reaches 100%. One patient developed a second breast cancer outside the treated quadrant after 25.1 months. CONCLUSION: APBI with SBRT and ExacTrac Adaptive Gating System was feasible. The acute and late toxicities were almost null and cosmesis was excellent. We also found that the margins of 5 mm applied from CTV to PTV were sufficient to compensate for geometric uncertainties.

10.
Comput Biol Med ; 131: 104269, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33639352

RESUMO

In radiation therapy, a CT image is used to manually delineate the organs and plan the treatment. During the treatment, a cone beam CT (CBCT) is often acquired to monitor the anatomical modifications. For this purpose, automatic organ segmentation on CBCT is a crucial step. However, manual segmentations on CBCT are scarce, and models trained with CT data do not generalize well to CBCT images. We investigate adversarial networks and intensity-based data augmentation, two strategies leveraging large databases of annotated CTs to train neural networks for segmentation on CBCT. Adversarial networks consist of a 3D U-Net segmenter and a domain classifier. The proposed framework is aimed at encouraging the learning of filters producing more accurate segmentations on CBCT. Intensity-based data augmentation consists in modifying the training CT images to reduce the gap between CT and CBCT distributions. The proposed adversarial networks reach DSCs of 0.787, 0.447, and 0.660 for the bladder, rectum, and prostate respectively, which is an improvement over the DSCs of 0.749, 0.179, and 0.629 for "source only" training. Our brightness-based data augmentation reaches DSCs of 0.837, 0.701, and 0.734, which outperforms the morphons registration algorithms for the bladder (0.813) and rectum (0.653), while performing similarly on the prostate (0.731). The proposed adversarial training framework can be used for any segmentation application where training and test distributions differ. Our intensity-based data augmentation can be used for CBCT segmentation to help achieve the prescribed dose on target and lower the dose delivered to healthy organs.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Processamento de Imagem Assistida por Computador , Algoritmos , Humanos , Masculino , Pelve , Próstata , Planejamento da Radioterapia Assistida por Computador
13.
Clin Transl Oncol ; 23(7): 1452-1462, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33433839

RESUMO

PURPOSE: Conventional post-prostatectomy radiation therapy comprises 6.5-8 weeks of treatment, therefore, hypofractionated and shortened schemes arouse increasing interest. We describe our experience regarding feasibility and clinical outcome of a post-prostatectomy moderate hypofractionated image-guided radiotherapy schedule MATERIALS AND METHODS: From Oct 2015-Mar 2020, 113 patients, median age of 62 years-old (range 45-76) and prostate adenocarcinoma of low risk (30%), intermediate risk (49%) and high risk (21%) were included for adjuvant (34%) or salvage radiation therapy (66%) after radical prostatectomy (RP). All patients underwent radiotherapy with image-guided IMRT/VMAT to a total dose of 62.5 Gy in 2.5 Gy/fraction in 25 fractions. Sixteen patients (14%) received concomitant androgen deprivation therapy. RESULTS: With a median follow-up of 29 months (range 3-60 months) all patients but three are alive. Eleven patients (10%) developed exclusive biochemical relapse while 19 patients (17%) presented macroscopically visible relapse: prostatectomy bed in two patients (2%), pelvic lymph nodes in 13 patients (11.5%) and distant metastases in four patients (4%). The 3 years actuarial rates for OS, bFRS, and DMFS were 99.1, 91.1 and 91.2%, respectively. Acute and late tolerance was satisfactory. Maximal acute genitourinary (AGU) toxicity was G2 in 8% of patients; maximal acute gastrointestinal (AGI) toxicity was G2 in 3.5% of patients; maximal late genitourinary (LGU) toxicity was G3 in 1% of patients and maximal late gastrointestinal (LGI) toxicity was G2 in 2% of patients. There were no cases of severe acute or late toxicity. No relationship was found between acute or late GI/GU adverse effects and dosimetric parameters, age, presence of comorbidities or concomitant treatments. CONCLUSIONS: Hypofractionated radiotherapy (62.5 Gy in 25 2.5 Gy fractions) is feasible and well tolerated with low complication rates allowing for a moderate dose-escalation that offers encouraging clinical results for biochemical control and survival in patients with prostate cancer after radical prostatectomy.

18.
Arch. Soc. Esp. Oftalmol ; 95(11): 559-564, nov. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197748

RESUMO

Las endoftalmitis asociadas a la ampolla de filtración tras cirugía filtrante de glaucoma son poco frecuentes, de inicio tardío y la mayoría están asociadas a una blebitis. Los agentes causales suelen ser estreptococos o bacterias gramnegativas. Existen pocos casos descritos en la literatura de endoftalmitis causada por Moraxella nonliquefaciens y la mayoría están asociados a una blebitis tras cirugía filtrante de glaucoma. Presentamos el caso de una paciente de 90 años con endoftalmitis en ojo derecho por Moraxella nonliquefaciens asociada a blebitis 10 años después de la cirugía de glaucoma. Tras el tratamiento, se observó la desaparición de la blebitis 2 semanas después y resolución de la vitritis 29 días después, con recuperación de la visión a valores previos (20/200). La endoftalmitis por Moraxella nonliquefaciens es rara y está asociada a blebitis de inicio tardío tras una cirugía filtrante de glaucoma. A pesar de la virulencia del cuadro, el pronóstico visual suele ser favorable


Bleb-related endophthalmitis is rare and appears months or years after surgery. The causative agents are usually streptococci or gram-negative bacteria. There are few cases in the literature of endophthalmitis caused by Moraxella nonliquefaciens, and most are delayed-onset associated with blebitis after glaucoma filtration surgery. The case is presented of a 90-year-old patient with endophthalmitis in the right eye due to Moraxella nonliquefaciens associated with blebitis 10 years after glaucoma surgery. After treatment, disappearance of blebitis is observed 2 weeks later and resolution of vitritis 29 days later, with recovery of vision to previous values (20/200). Endophthalmitis due to Moraxella nonliquefaciens is rare, and is associated with late onset blebitis after glaucoma filtration surgery. Despite the virulence of the clinical symptoms, the visual prognosis is usually favourable


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Endoftalmite/microbiologia , Endoftalmite/patologia , Infecções por Moraxellaceae/patologia , Vesícula/patologia , Endoftalmite/tratamento farmacológico , Vancomicina/administração & dosagem , Antibacterianos/administração & dosagem , Ceftazidima/administração & dosagem , Injeções Intravítreas , Acuidade Visual , Infecções por Moraxellaceae/tratamento farmacológico , Moraxella/isolamento & purificação
20.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(7): 487-496, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-201256

RESUMO

La nocturia es la interrupción del sueño principal, una o más veces, por la necesidad de micción. Se asocia a una disminución de la calidad de vida y a un aumento de la mortalidad. Se trata de un síntoma complejo y multifactorial en el que intervienen 2 mecanismos fisiopatológicos causales principalmente, que ocurren solos o en combinación: poliuria nocturna o disminución de la capacidad vesical. La poliuria nocturna es la más frecuente. La elaboración de un diario miccional es la clave para el diagnóstico. El tratamiento suele combinar cambios en el estilo de vida y terapia farmacológica. La desmopresina ha demostrado ser un tratamiento eficaz y bien tolerado en pacientes con poliuria nocturna. Se debe controlar el riesgo de hiponatremia en pacientes tratados con desmopresina


Nocturia is the interruption of the main sleep, one or more times, due to the need for urination. It is associated with a decrease in the quality of life and an increase in mortality. It is a complex and multifactorial symptom in which two pathophysiological mechanisms are mainly involved. These occur alone or in combination as nocturnal polyuria or decreased bladder capacity. Nocturnal polyuria is the most frequent. The preparation of a bladder diary is the key to diagnosis. Treatment usually combines lifestyle changes and drug therapy. Desmopressin has proven to be an effective and well-tolerated treatment in patients with nocturnal polyuria. The risk of hyponatraemia should be controlled in patients treated with desmopressin


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde , Noctúria/diagnóstico , Noctúria/terapia , Fatores de Risco , Comorbidade
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