Brachytherapy: An emblematic example of extreme hypofractionated regimen

In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.     

Role of arterial stiffness and endothelial dysfunction on lower limb performance in older adults with type 2 diabetes: A cross-sectional study

AimTo verify whether arterial stiffness and endothelial dysfunction influence lower limb muscle strength and gait speed in older adults with type 2 diabetes mellitus (T2DM).MethodsCross-sectional study including seventy-eight older adults with T2DM (aged 67 ± 6 years and 42 % male). Arterial stiffness was assessed using pulse wave velocity (PWV), while endothelial function was measured by flow-mediated dilation (FMD). Lower limb muscle strength and gait speed were assessed using the 30-second chair stand test (30s-CST) and 10-Meter Walk Test, respectively.ResultsBoth PWV (m/s) and FMD (%) were univariately associated with number of repetitions in 30s-CST and gait speed (P < 0.05). After control for age, sex and body mass index, PWV remained associated with repetitions in 30s-CST (95 % CI: ?0.494 to ?0.054; P = 0.015) and gait speed (95 % CI: ?0.039 to ?0.002; P = 0.031). After adjustments for control variables, T2DM duration and glycemic control, FMD was associated with repetitions in 30s-CST (95 % CI: 0.008 to 0.324; P = 0.039) and gait speed (95 % CI: 0.011 to 0.038; P = 0.001).ConclusionIn older adults with T2DM, both arterial stiffness and endothelial dysfunction are associated with decreased leg muscle strength and slower gait speed.     

Using Big Data for Cardiovascular Health Surveillance: Insights From 10.3 Million Individuals in the CANHEART Cohort

BackgroundThe increasing availability of large electronic population-based databases offers unique opportunities to conduct cardiovascular health surveillance traditionally done using surveys. We aimed to examine cardiovascular risk-factor burden, preventive care, and disease incidence among adults in Ontario, Canada—using routinely collected data—and compare estimates with health survey data.MethodsIn the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) initiative, multiple health administrative databases were linked to create a population-based cohort of 10.3 million adults without histories of cardiovascular disease. We examined cardiovascular risk-factor burden and screening and outcomes between 2016 and 2020. Risk- factor burden was also compared with cycles 3 to 5 (2012 to 2017) of the Canadian Health Measures Survey (CMHS), which included 9473 participants across Canada.ResultsMean age of our study cohort was 47.9 ± 17.0 years, and 52.0% were women. Lipid and diabetes assessment rates among individuals 40 to 79 years were 76.6% and 78.2%, respectively, and lowest among men 40 to 49 years of age. Total cholesterol levels and diabetes and hypertension rates among men and women 20 to 79 years were similar to Canadian Health Measures Survey (CHMS) findings (total cholesterol: 4.80/4.98 vs 4.94/5.25 mmol/L; diabetes: 8.2%/7.1% vs 8.1%/6.0%; hypertension: 21.4%/21.6% vs 23.9%/23.1%, respectively); however, patients in the CANHEART study had slightly higher mean glucose (men: 5.79 vs 5.44; women: 5.39 vs 5.09 mmol/L) and systolic blood pressures (men: 126.2 vs 118.3; women: 120.6 vs 115.7 mm Hg).ConclusionsCardiovascular health surveillance is possible through linkage of routinely collected electronic population-based datasets. However, further investigation is needed to understand differences between health administrative and survey measures cross-sectionally and over time.     

Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis

BackgroundProximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade.MethodsThis retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD).ResultA total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R² = 0.29.ConclusionA significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.