EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience

PurposeEPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images.Methods15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, P_γ<1, and mean γ-values, γ_mean, using a local 3%–3 mm criteria, was adopted to check the treatment reproducibility. Tolerance levels of 5% for R ratio, P_γ<1 higher than 90% and γ_mean lower than 0.67 were adopted.ResultsA total of 160 EPID images, two images for each therapy session, were acquired during the treatment of the 15 patients. The overall mean of the R ratios was equal to 1.005 ± 0.014 (1 SD), with 96.9% of tests within ± 5%. The 2 D image γ-like analysis showed an overall γ_mean of 0.39 ± 0.12 with 96.1% of tests within the tolerance level, and an average P_γ<1 value equal to 96.4 ± 3.6% with 95.4% of tests with P_γ<1 > 90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified.ConclusionsThis procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation.     

Segmentation d’images de lésions cérébrales primitives en TEP FET : influence du volume de travail

Purpose(1) Evaluate the reproducibility of segmentation methods depending on the preselection region for tumour volume determination on ¹⁸F-fluoro-ethyl-tyrosine (FET) PET. (2) Evaluate the intra and inter-operator reproducibility of the manual delineation. (3) Compare this delineation with the segmentation methods.Materials and methodsEighteen FET PET of patients with glioblastoma were analysed. Preselection regions were determined prior to any segmentation. Two physicians delineated the tumour volume manually. The tumour volume was also delineated with a threshold method (40 and 70% of SUV_max), and a random walk based method. Pearson coefficient (r) (P < 0.05 for r > 0.468) and Jaccard indices (JI) were used to compare the volumes.ResultsManual delineation was reproducible with r = 0.97 and IJ = 0.65 for intra-operator, and r = 0.76 and IJ = 0.45 for inter-operator reproducibility. The preselection regions for a given lesion were different and the segmentation varied with the preselection region: r = 0.55 JI = 0.58; r = 0.85 JI = 0.83; r = 0.70 JI = 0.39 respectively for the threshold of 40%, 70% and the random walk. The segmentation differed form de manual delineation with r = 0.37 and JI = 0.16; r = 0.54 and JI = 0.42; r = 0.43 and JI = 0.37 respectively for the threshold of 40%, 70% and the random walk.ConclusionThe reproducibility of the segmentation methods depends extensively on the preselection region. The intra-operator reproducibility of cerebral lesion delineation on FET PET is satisfactory. The inter-operator reproducibility could be improved.     

Évaluation de l’exactitude de latéralisation du foyer épileptogène par la tomographie par émission de positons au 18f-fluorodésoxyglucose dans le bilan préopératoire de l’épilepsie temporale : analyse visuelle simple et par index d’asymétrie inter-hémisphérique par soustraction d’images,analyse quantitative par statistical parametric mapping

IntroductionInter-ictal 18F-2-fluoro-deoxy-D-glucose-positron emission tomography (FDG-PET) plays a key role for the preoperative evaluation of patients with pharmacoresistant temporal lobe epilepsy. PET images are usually analyzed visually, a way that is reported to provide a high diagnostic value but that remains subjective, depending on the expertise and experience of the observer. By contrast, the voxel-based quantitative analyses, such as statistical parametric mapping (SPM), are objective and therefore, observer independent methods of analyses. In this study, the accuracy of the analyses of brain FDG-PET images to lateralize the temporal lobe epileptogenic zone was compared between: (1) a conventional visual method, (2) a quantitative SPM analysis, and (3) a visual analysis of inter-hemispheric asymmetry (IHA) obtained after images substraction.Materials and methodsFDG-PET scans of 31 patients presenting a severe temporal epilepsy and whom the temporal foci had been accurately lateralized (successful subsequent surgical treatment) were retrospectively analysed by (1) a consensual visual analysis from two experienced observers; (2) SPM analysis with voxel-wise comparisons of FDG-PET images of patients with those of age-matched healthy controls, using various statistical threshold (P) and cluster (k) values; and (3) visual assessment by the two same observers of images obtained for assessing the IHA. For this purpose, a flipped image was initially obtained by reversing in the left-right direction the FDG-PET images, which had been previously spacially normalized with the SPM template. Then, flipped and non-flipped images were substracted.ResultsThe temporal hypometabolic area was accurately identified: (1) by the conventional visual analysis in 87 % of patients and with a satisfactory interobserver reproducibility (interobserver Cohen's coefficient = 0.79); (2) by SPM analysis, in 90 % of patients (when using optimal thresholds of 0.01 for P value and of 50 voxels (400 mm³) for k value); and (3) with the visual analysis of IHA in 97 % of patients with an excellent interobserver reproductibility (interobserver Cohen's coefficient = 1).ConclusionIn patients presenting severe temporal epilepsy, visual assessment of FDG-PET images from IHA seems more accurate for lateralizing the epileptogenic temporal areas when compared with either conventional visual or quantitative SPM analyses. Moreover, this method is very easy to use in clinical practice, contrary to the quantitative method using SPM     

Achievement of therapeutic targets in Mexican patients with diabetes mellitus

Background and aimComplications of diabetes comprise the leading cause of death in Mexico. We aimed to describe the characteristics of management and achievement of therapeutic targets in Mexican patients with diabetes mellitus.MethodsWe analyzed data from 2642 Mexican patients with type 1 (T1D, n = 203, 7.7%) and type 2 diabetes (T2D, n = 2439, 92.3%) included in the third wave of the International Diabetes Management Practices Study.ResultsOf T2D patients, 63% were on oral glucose-lowering drugs (OGLD) exclusively (mostly metformin), 11% on insulin, 22% on OGLD plus insulin, and 4% on diet and exercise exclusively. T2D patients on insulin were more likely to be trained on diabetes, but they were older, had worse control, longer disease duration and more chronic complications than patients on OGLD only. Glycated hemoglobin (HbA1c) < 7% was achieved by 21% and 37% of T1D and T2D patients, respectively. Only 5% of T1D and 3% of T2D attained the composite target of HbA1c < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl. T1D patients had less macrovascular but more microvascular complications, compared with T2D patients. Late complications increased with disease duration, so that about 80% of patients after 20 years of diagnosis have at least one late complication. Reaching the target HbA1c < 7% was associated with a reduced number of microvascular but not with less macrovascular complications.ConclusionA great proportion of these Mexican patients with diabetes did not reach therapeutic targets. Insulin was used mostly in complicated cases with advanced disease.     

Images pseudoplanaires issues des tomographies pulmonaires : étude de la reproductibilité de lecture et comparaison aux images planaires

PurposeDue to a long time of acquisition, performing during the same examination planar and pulmonary tomography is time expensive. Then, pseudoplanar images have been advocated to be used instead of planar images in the diagnosis of pulmonary embolism. We aim to compare both kinds of images in terms of probability and to assess intra- and inter-observer agreement.Materials and methodsThirty-four patients referred to our unit to diagnose or rule out pulmonary embolism, underwent a planar ventilation/perfusion (V/Q) lung scan and a V/Q lung SPECT. Using the SPECT projections, eight pseudoplanar images were created for each examination. Two experienced physicians read twice both sets of anonymous planar and pseudoplanar images. They checked the probability of pulmonary embolism using the modified PIOPED criteria but without the chest X-ray.ResultsFor both readers, intra-observer agreement for pseudoplanar images is good (κw = 0.69 and 0.78), and similar to the planar images agreement. Interobserver agreement (κw = 0.63) is also good. Both modalities show a good agreement in terms of probability of pulmonary embolism.ConclusionsWe showed that pseudoplanar pulmonary images have a good intra- and interobserver agreement. Furthermore, in our population, these images lead to the same results in terms of probability of pulmonary embolism as those obtained using the standard planar technique.     

Metabolic control and chronic complications during a 3-year follow-up period in a cohort of type 2 diabetic patients attended in primary care in the Community of Madrid (Spain)

BackgroundOur aim was to analyze both metabolic control and chronic complications of type 2 diabetes mellitus (T2D) patients regularly attended in primary care during a 3 years of follow-up in the Community of Madrid (Spain).MethodsFrom 2007 to 2010 we prospectively included 3268 patients with T2D attended by 153 primary care physicians from 51 family health centers. An prospective cohort study with annual evaluation over 3 years to the same population was performed. We measured the goals of control in diabetic patients and the incidence of chronic complications of diabetes during the study period.ResultsA significant decrease in serum glucose levels (143 ± 42 mg/dl vs 137 ± 43 mg/dl, p < 0.00), HbA1c (7.09 ± 1.2% vs 7.02 ± 1.2%, p < 0.00), total cholesterol (191.4 ± 38 mg/dl vs 181.5 ± 36 mg/dl, p < 0.00), LDL cholesterol (114.7 ± 31 mg/dl vs 105.5 ± 30 mg/dl, p < 0.00) and triglyceride levels (144.5 ± 93 mg/dl vs 138 ± 84 mg/dl, p < 0.00) during study period was documented. On the contrary, a significant elevation in HDL cholesterol levels was observed (49.2 ± 14 mg/dl vs 49.9 ± 16 mg/dl, p < 0.00). The incidence of diabetic complications throughout the study period was low, with a incidence of coronary heart disease of 6.2%, peripheral arterial disease 3%, ischemic stroke 2.8%, diabetic foot 11.2%, nephropathy 5.9%, retinopathy 4.5%, and neuropathy 3%.ConclusionMetabolic control in T2D patients attended in primary care in the Community of Madrid throughout 3 years is adequate and is accompanied by low percent of chronic diabetic complications during this period of follow-up.     

Placental antiangiogenic prolactin fragments are increased in human and rat maternal diabetes

Introduction/objectivesThe role of the placenta in diabetic mothers on fetal development and programming is unknown. Prolactin (PRL) produced by decidual endometrial cells may have an impact. Although full-length PRL is angiogenic, the processed form by bone morphogenetic protein-1 (BMP-1) and/or cathepsin D (CTSD) is antiangiogenic.The objectives were to investigate the involvement of decidual PRL and its antiangiogenic fragments in placentas from type-1 diabetic women (T1D) and from pregnant diabetic rats with lower offspring weights than controls.MethodsPRL, BMP-1, and CTSD gene expressions and PRL protein level were assessed in T1D placentas (n = 8) at delivery and compared to controls (n = 5). Wistar rats received, at day 7 of pregnancy, streptozotocin (STZ) (n = 5) or nicotinamide (NCT) plus STZ (n = 9) or vehicle (n = 9). Placental whole-genome gene expression and PRL western blots were performed at birth.ResultsIn human placentas, PRL (p < 0.05) and BMP-1 (p < 0.01) gene expressions were increased with a higher amount of cleaved PRL (p < 0.05) in T1D than controls. In rats, diabetes was more pronounced in STZ than in NCT–STZ group with intra-uterine growth restriction. Decidual prolactin-related protein (Dprp) (p < 0.01) and Bmp-1 (p < 0.001) genes were up-regulated in both diabetic groups, with an increased cleaved PRL amount in the STZ (p < 0.05) and NCT–STZ (p < 0.05) groups compared to controls. No difference in CTSD gene expression was observed in rats or women.ConclusionsAlterations in the levels of the PRL family are associated with maternal diabetes in both rats and T1D women suggesting that placental changes in these hormones impact on fetal development.     

Sacubitril/Valsartan is useful and safe in elderly people with heart failure and reduced ejection fraction. Data from a real-word cohort

BackgroundHF elderly patients are underrepresented in Sacubitril/Valsartan HF trials, and the effect of S/V in real-life patients with advanced age is unknown. The aim of this study was to evaluate the use and safety of S/V in a real-word cohort of elderly patients.MethodsWe performed a prospective registry of patients who started S/V in clinical practice. We compared baseline characteristics, adverse events during follow-up and causes of S/V withdrawal according to age.ResultsA total of 427 patients started treatment with S/V: 222 (52.0%) < 70 years old, 140 (32.8%) between 70 and 79 and 65 (15.2%) ≥ 80. During a mean follow-up of 7.0 ± 0.1 months S/V was well tolerated, with no age-related differences in adverse events (26.8%, 25.9%, 23.1% respectively; p = 0.83). Symptomatic hypotension tended to be more frequent in the elderly (19.8%, 25.6%, 33.3% respectively; p = 0.17). The withdrawal of S/V was more frequent in younger patients (14.4%, 10.0%, 4.6% respectively; p = 0.05) and related to poor prognosis (HR 13.51, 95% CI 3.22–56.13, p < 0.001).ConclusionsSacubitril/Valsartan is useful and safe in elderly people with HF-rEF in real-life clinical practice, and withdrawal is associated to poor prognosis. The doses achieved are lower in elderly people.     

Serum 25-Hydroxyvitamin D Deficiency; A Risk Factor for Chronic Kidney Disease in Ambulatory Indigent Patients

ObjectiveTo assess whether 25-hydroxyvitamin D (25[OH]D) deficiency is a risk factor for chronic kidney disease (CKD) in ambulatory indigent patients.MethodsData for all serum 25(OH)D concentrations measured during 2010 in our ambulatory nondialysis-dependent patients were analyzed along with CKD-related parameters. Patients were stratified into groups based on 25(OH)D levels of < 10, 10 to 19, 20 to 29, and ≥ 30 ng/mL. CKD was defined by estimated glomerular filtration rate (eGFR; Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI] equation) and abnormal urine protein to creatinine ratios. CKD-associated parameters included serum parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (1,25[OH]₂D), alkaline phosphatase, albumin, corrected calcium, and total CO₂ levels.ResultsA total of 2,811 patients had 25(OH)D levels measured. Patients with 25(OH)D levels < 10 ng/mL had significantly increased relative risk (RR) of an eGFR < 15 mL/min/1.73 m² (RR, 4.0), an eGFR of 15 to 29 mL/min/1.73 m² (RR, 2.6), urine protein to creatinine ratio > 3.5 g/g (RR, 5.6), and serum PTH > 100 pg/mL (RR, 2.8) compared to patients with a 25(OH)D level ≥ 30 ng/mL. Patients with 25(OH)D levels of 10 to19 ng/mL had significantly increased RR of a urine protein to creatinine ratio > 3.5 g/g (RR,4.8) and serum PTH > 100 pg/mL (RR, 1.5) compared to patients with 25(OH)D levels ≥ 30 ng/mL.Conclusion25(OH)D deficiency (< 10 ng/mL) was associated with reduced eGFR, nephrotic-range proteinuria, and increased PTH levels in our population of ambulatory urban indigent patients. (Endocr Pract. 2014;20:236-243)     

Hippocampal dose during Linac-based stereotactic radiotherapy for brain metastases: An observational study

IntroductionAim of the present study is to evaluate homolateral and contralateral hippocampus (H-H, C-H, respectively) dose during Fractionated Stereotactic Radiotherapy (FSRT) or Radiosurgery (SRS) for brain metastases (BM).Materials & methodsPatients with BM < 5, size ≤ 30 mm, KPS ≥ 80 and a life expectancy > 3 months, were considered for SRS/FSRT (total dose 15–30 Gy, 1–5 fractions). For each BM, a Flattening Filter Free (FFF) Volumetric Modulated Arc Therapy (VMAT) plan was generated with one or two arcs. Hippocampi were not considered during optimizations phase and were contoured and evaluated retrospectively in terms of dose: the Dmedian, Dmean, D0.1cc and the V1Gy, V2Gy, V5Gy and V10Gy were analyzed.ResultsFrom April 2014 to December 2015, 81 BM were treated with FFF-FSRT/SRS. For the H-H, the average values of Dmedian, Dmean and D0.1cc were 1.5Gy, 1.54Gy and 2.2Gy, respectively, while the V1Gy, V2Gy, V5Gy and V10Gy values were 25%, 8.9%, 8.9% and 2.1%, respectively. For the C–H, the average Dmedian, Dmean and D0.1 cc were 0.7Gy, 0.7Gy, 0.9Gy, respectively, while the average values of V1Gy, V2Gy, V5Gy and V10Gy were 18%, 10.2%, 2.8% and 1.4%, respectively. Tumor dimension, tumor cranial-caudal length and the distance between BM and H-H were correlated to Dmedian, Dmean and D0.1cc. For C-H, only the distance from PTV was correlated with a dose reduction.ConclusionDuring FFF-FSRT/SRS, hippocampus received a negligible dose. Despite its clinical significance is still under evaluation, in patients with a long life expectancy, H-H should be considered during Linac-based FSRT/SRS.     

Influencia del inmunoensayo empleado en la determinación de vitamina D sérica

IntroductionSerum 25-hydroxyvitamin D [25(OH)D] levels are the best indicator of vitamin D levels in the body. Precision, reproducibility, and lack of standardization are the main problems in such measurements. The aim of this study was to compare the 25(OH)D levels measured using Elecsys Vitamin D Total (Roche) and ADVIA Centaur Vitamin D Total (Siemens).Material and methods25(OH)D levels were tested in 166 patients using both methods. Patients were subsequently divided into two groups: a «supplemented group» consisting of patients receiving vitamin D supplements, and an «untreated group» consisting of the rest of patients.Results25(OH)D mean levels measured by the Roche and Siemens methods in the overall group were 33.6 ± 16.0 and 19.8 ± 12.4 ng/mL respectively. 54.2% of patients were receiving vitamin D supplements. In this group, mean 25(OH)D levels measured by the Roche and Siemens methods were 40.6 ± 14.5 and 25.4 ± 13.1 ng/mL respectively. In the untreated group, the respective values were 24.9 ± 13.2 and 12.8 ± 6.6 ng/mL. Prevalence of vitamin D deficiency (serum 25(OH)D levels less than 20 ng/mL) was higher in samples analyzed using the Siemens method (60.2%) as compared to those tested using the Roche method (23.5%).ConclusionThe assays evaluated are not comparable to each other. Laboratory specialists should inform clinicians of the features of the method used for measuring 25(OH)D because this will have a direct impact on interpretation of the results and medical decisions.     

Ethnicity,Clothing Style,and Body Mass Index are Significant Predictors of Vitamin D Insufficiency in Germany

ObjectiveTo analyze risk factors for vitamin D insufficiency in Germany with respect to ethnicity, sex, and clothing style.MethodsWe analyzed the routine diagnostic workups of 1,231 adult (45.9 ± 17.9 years old) German (n = 1,034) and Turk residents (n = 197) referred with nonspecific symptoms to the Thyroid Centers at St. Elisabeth-Hospital in Dorsten, Germany and Bottrop, Germany to assess for metabolic diseases. All subjects underwent a routine examination that consisted of a questionnaire, lab tests for 25-hydroxyvitamin-D (25OHD), and thyroid profile. Turk females with traditional clothing (headscarf and covered legs and arms) were considered to wear “covered clothing.” Logistic-regression was performed to identify factors that could predict vitamin D deficiency (< 20 ng/ mL) and insufficiency (20-30 ng/mL).ResultsVitamin D insufficiency was seen in 33% of Germans and 74.1% of Turks, and vitamin D deficiency was present in 11.3% and 44.2% of Germans and Turks, respectively (P < .001). The mean 25OHD value in Turk females with covered clothes was lower than that in Turk females with conventional clothing (16.3 ± 12.3 vs. 27.2 ± 15.8, P < .001). Vitamin D insufficiency was present in 86.0% of Turk females with covered clothing versus 62.8% with conventional clothing (odds ratio [OR] = 3.6, P = .002). Ethnicity, body mass index (BMI), and clothing style were significant predictors of vitamin D deficiency and insufficiency by logistic regression (P < .001).Conclusions(1) Vitamin D insufficiency among Turk residents in Germany is higher compared to Germans. The highest prevalence was present in Turk females with covered clothing. (2) Monitoring vitamin D in Turk residents in Germany is warranted. (3) Vitamin D supplements and access to facilities with sunlight exposure for females with covered clothing and all individuals with poor diets or limited access to sun exposure may prevent future health burden due to vitamin D insufficiency. (Endocr Pract. 2015; 21:122-127)     

Vitamin D Insufficiency is Associated With Reduced Parasympathetic Nerve Fiber Function in Type 2 Diabetes

ObjectiveVitamin D insufficiency is prevalent in subjects with type 2 diabetes mellitus (T2DM) and is associated with peripheral neuropathy. However, there are little data regarding vitamin D status in patients with cardiovascular autonomic neuropathy. Our objective was to evaluate the association of cardiovascular autonomic function, 25-hydroxyvitamin D (25[OH]D) insufficiency (i.e., levels < 30 ng/mL), and multiple metabolic parameters in subjects with T2DM.MethodsWe examined 50 individuals with T2DM. Cardiovascular autonomic function (i.e., parasympathetic function) was assessed by RR-variation during deep breathing (i.e., mean circular resultant [MCR] and expiration/inspiration [E/I] ratio). Metabolic parameters included measures of adiposity, glycemic control, insulin resistance, calcium metabolism, and 25(OH)D.ResultsParticipants with 25(OH)D insufficiency (n = 26) were younger (66 ± 9 vs. 60 ± 10 years, P < .05), more insulin resistant, had a higher body mass index (BMI) and lower adiponectin levels. The MCR (39.5 ± 26.3 vs. 27.6 ± 17.2, P < .01) and E/I ratio (1.21 ± 0.17 vs. 1.15 ± 0.09, P < .01) were lower for those with 25(OH)D insufficiency after controlling for age. A stepwise selection procedure regressing MCR and E/I ratio on a number of metabolic parameters resulted in a model identifying age and 25(OH)D insufficiency as significant determinants for both measures. The interaction of age × 25(OH)D insufficiency was also included (MCR model, R² = 0.491, P < .001; E/I ratio, R² = 0.455, P < .001). Neither glycemic control nor other metabolic parameters were selected.ConclusionOur results suggest that 25(OH)D insufficiency is associated with reduced parasympathetic function, with a stronger association in younger persons with T2DM. Studies are needed to determine if vitamin D supplementation into the sufficient range could prevent or delay the onset of cardiovascular autonomic dysfunction. (Endocr Pract. 2015;21:174-181)     

Rabbit preference for cages and pens with or without mirrors

Five-week-old Pannon White rabbits were housed in a closed climatized rabbitry and randomly assigned to either pens (56 rabbits) having a basic area of 1 m² with a stocking density of 16 and 12 rabbits/m² or to 18 individual cages (0.24 m²/cage). The pens and the cages were divided into two halves and animals could move freely between the two halves through swing doors. The walls of one half of the pens and cages were completely covered with mirrors while the other half was covered with white plastic panels. A 24 h video recording was made twice a week using infrared cameras and the number of rabbits in each pen and cage was counted every 15 min. The duration of the trial was 6 weeks. The lighting period was 16L/8D. In each half of the cage or pen, a feeder and nipple drinkers were available and feed intake was measured separately. Throughout the entire rearing period, 72% of the individually caged rabbits showed a preference for the cage half enriched with mirrors (P < 0.001). This preference decreased slightly with increasing age. Preference toward the cage half provided with mirror walls was independent of the time of day; in other words, during the active period (23:00–05:00) corresponding to the dark part of the day, rabbits continued to prefer the mirrored half even if the vision of the reflected image was reduced. The presence of conspecifics at different stocking densities (12 vs. 16 rabbits/m²) did not reduce this interest in mirrors: averaging the ages, 66% of animals living at 16 rabbits/m² stocking density and 63% of those living at 12 rabbits/m² density were found in the half pen with mirrors (P < 0.001). Group-penned rabbits showed a marked preference toward mirrors during the active period (73–76% for 12 and 16 rabbits/m² stocking densities, respectively; P < 0.001). The results suggest that the presence of mirrors offers advantages perhaps related to comfort and welfare, and therefore might be used as environmental enrichment for fattening rabbits and advised for rabbits caged individually for long periods.     

Utilización del POMA en nuestro medio para la valoración del equilibrio y la marcha en una población de personas mayors residentes en la comunidad

Objectivesto study the balance and the gait by the Performance Oriented Mobility Assessment (POMA) in the population of people ≥ 65 years in function of age, gender; relation with the capacity to develop the activities of daily living, physical exercise, perception of health and previous falls.Material and methodsWe study a cohort of 443 people, 262 women and 181 men, representative of the population ≥ 65 years, resident in the community and able to walk from the city of Mataró. The evaluation was made with the 22 items POMA. Basic and instrumental activities of the daily life (Katz Index and Lawton), physical activity, health perception (Iowa test) were also assessed.Results29.3% of subjects did not present abnormalities in any of the items, 22.6% presented one abnormality, 12.4% two, and 35.7% three or more. 35.9% and 50.2 of subjects did not present abnormalities in the static and dynamic components respectively. Women had greater number of abnormalities than men (42.0% vs 20.6%) for the global and also for each of the two components (static and dynamic) (p < 0.0001). The number of abnormalities increased significantly with age, specially on those 75 years and older (p < 0.0001). A greater number of errors was correlated with less independence on the basic and instrumental activities of daily living, with less physical activity, health perception and with antecedents of previous falls.     

Influence of the type of imaging on the delineation process during the treatment planning

AimThe aim of this study was to compare the intra- and interobserver contouring variability for structures with density of organ at risk in two types of tomography: kilovoltage computed tomography (KVCT) versus megavoltage computed tomography (MVCT). The intra- and interobserver differences were examined on both types of tomography for structures which simulate human tissue or organs.Materials and methodsSix structures with density of the liver, bone, trachea, lung, soft tissue and muscle were created and used. For the measurements, the special water phantom with all structures was designed. To evaluate interobserver variability, five observers delineated the structures in both types of computed tomography (CT).ResultsIntraobserver variability was in the range of 1–14% and was the largest for the liver. The observers segmented larger volumes on MVCT compared with KVCT for the trachea (79.56 ccm vs.74.91 ccm), lung (87.61 vs. 82.50), soft tissue (154.24 vs. 145.47) and muscle (164.01 vs. 157.89). For the liver (98.13 vs. 99.38) and bone (51.86 vs. 67.97), the volume on MVCT was smaller than KVCT. The statistically significant differences between observers were observed for structures with density of the liver, bone and soft tissue on KVCT and for the liver, lung and soft tissue on MVCT. For the structures with density of the trachea and muscles, there were no significant differences for both types of tomography.ConclusionsDuring the contouring process the interobserver and intraobserver contouring uncertainty was larger on MVCT, especially for structures with HU near 80, compared with KVCT.     

Retinopathy is a Strong Determinant of Atherosclerosis in Type 2 Diabetes: Correlation with Carotid Intima Media Thickness

ObjectiveWe investigated the correlation between the severity of diabetic retinopathy (DR) and carotid intima media thickness (IMT) as a marker of atherosclerosis in patients with type 2 diabetes.MethodsThe study group consisted of 140 normo-tensive Egyptian patients (68 males and 72 females) with type 2 diabetes and DR. Carotid IMT was evaluated using high-resolution B-mode ultrasonography. DR was assessed and graded using colored fundus photography and fundus fluorescein angiography, as either nonproliferative DR (NPDR) or proliferative DR (PDR).ResultsCarotid IMT was greater in patients with PDR compared to those with NPDR (1.094 ± 0.142 mm vs. 0.842 ± 0.134 mm; P < .001). Carotid IMT showed positive correlation with diabetes duration (P < .01), systolic blood pressure (P < .001), diastolic blood pressure (P < .01), fasting blood glucose (P < .01), postprandial blood glucose (PPBG) (P < .001), glycated hemoglobin (P < .01), total cholesterol (P < .01), triglycerides (TGs) (P < .001), and DR (P < .0001). No significant difference was found between males and females in any of the studied parameters. Multiple regression analysis revealed that the determinants of carotid IMT in the studied group were age (P < .01), PPBG (P < .01), TGs (P < .001), and DR (P < .0001).ConclusionOur study proves that both NPDR and PDR are strong determinants of carotid IMT and atherosclerosis in patients with type 2 diabetes. (Endocr Pract. 2015;21:226-230)     

Pretreatment hemoglobin level as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma

AimEvaluate pretreatment hemoglobin values as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy.BackgroundAnemia is one of the most prevalent laboratory abnormalities in oncological disease. It leads to a decrease in cellular oxygen supply, altering radiosensitivity of tumor cells and compromising therapeutic outcomes.Materials and MethodsRetrospective evaluation of patients with HNSCC treated with cCRT. Primary and secondary endpoint was to evaluate the correlation of Hb levels (≥12.5 g/dL or <12.5 g/dL) at the beginning of cCRT with overall survival (OS) and progression-free survival (PFS), respectively.ResultsA total of 108 patients were identified. With a median follow-up of 16.10 months median OS was 59.70 months for Hb ≥12.5 g/dL vs. 14.13 months for Hb <12.5 g/dL (p = 0.004). PFS was 12.29 months for Hb ≥12.5 g/dL and 1.68 months for Hb <12.5 g/dL (p = 0.016).ConclusionsIn this analysis, Hb ≥12.5 g/dL correlated with significantly better OS and PFS. Further studies are needed to validate these findings.     

Improvement in Pancreatic β-Cell Function with Vitamin D and Calcium Supplementation in Vitamin D-Deficient Nondiabetic Subjects

ObjectiveThere are varied reports on the effect of vitamin D supplementation on β-cell function and plasma glucose levels. The objective of this study was to examine the effect of vitamin D and calcium supplementation on β-cell function and plasma glucose levels in subjects with vitamin D deficiency.MethodsNondiabetic subjects (N = 48) were screened for their serum 25-hydroxyvitamin D (25-OHD), albumin, creatinine, calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (PTH) status. Subjects with 25-OHD deficiency underwent a 2-hour oral glucose tolerance test. Cholecalciferol (9,570 international units [IU]/day; tolerable upper intake level, 10,000 IU/day; according to the Endocrine Society guidelines for vitamin D supplementation) and calcium (1 g/day) were supplemented.ResultsThirty-seven patients with 25-OHD deficiency participated in the study. The baseline and postvitamin D/calcium supplementation and the difference (corrected) were: serum calcium, 9 ± 0.33 and 8.33 ± 1.09 mg/dL (− 0.66 ± 1.11 mg/dL); 25-OHD, 8.75 ± 4.75 and 36.83 ± 18.68 ng/mL (28.00 ± 18.33 ng/mL); PTH, 57.9 ± 29.3 and 36.33 ± 22.48 pg/mL (− 20.25 ± 22.45 pg/mL); fasting plasma glucose, 78.23 ± 7.60 and 73.47 ± 9.82 mg/dL (− 4.88 ± 10.65 mg/dL); and homeostasis model assessment-2–percent β-cell function C-peptide secretion (HOMA-2–%B C-PEP), 183.17 ± 88.74 and 194.67 ± 54.71 (11.38 ± 94.27). Significant differences were observed between baseline and post-vitamin D/calcium supplementation serum levels of corrected calcium (Z, − 3.751; P < .0001), 25-OHD (Z, − 4.9; P < .0001), intact PTH (Z, − 4.04; P < .0001), fasting plasma glucose (Z, − 2.7; P < .007), and HOMA-2–%B C-PEP (Z, − 1.923; P < .05) as determined by Wilcoxon signed rank test. Insulin resistance as measured by HOMA was unchanged.ConclusionOptimizing serum 25-OHD concentrations and supplementation with calcium improves fasting plasma glucose levels and β-cell secretory reserve. Larger randomized control studies are needed to determine if correction of 25-OHD deficiency will improve insulin secretion and prevent abnormalities of glucose homeostasis. (Endocr Pract. 2014;20:129-138)