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1.

Background

Radium 223 was introduced for metastatic castration-resistant prostate cancer based on the results of a randomized controlled trial showing risk reduction for death and skeletal events. Our aim was to evaluate the outcome of patients receiving radium 223 in a real-world setting.

Patients and Methods

We conducted a multicenter retrospective analysis in the Triveneto region of Italy.

Results

One hundred fifty-eight patients received radium 223 in our region. After a median follow-up of 9.5 months, 75 patients died. The median overall survival (OS) was 14.2 months, and the median progression-free survival (PFS) was 6.2 months. Seventy-one (45%) patients achieved progression as best response. Thirty-seven (23%) patients stopped the treatment early because of progression. Eastern Cooperative Oncology Group performance status was prognostic for OS (18.4 vs. 12.3 vs. 7.5 months; 0 vs. 1, P = .0062; 0 vs. 2, P = .0002), whereas previous prostatectomy or docetaxel exposure were not. A neutrophil to lymphocytes ratio ≥ 3 significantly impacted OS (18.1 vs. 9.7 months; P < .001) and slightly impacted PFS (6.6 vs. 5.6 months; P = .05). Patients with a baseline alkaline phosphatase (ALP) value ≥ 220 U/L had worse OS and PFS (24.1 vs. 10.5 months; 7.2 vs. 5.5 months; P < .001). Patients with changes in ALP value achieved better OS (P = .029) and PFS (P = .002). There was no difference according to the line of therapy (0 vs. ≥ 1; P = .490). The main grade 3/4 toxicities were anemia, asthenia, and thrombocytopenia.

Conclusion

This large real-world report confirms comparable OS and PFS data when compared with the pivotal study, as well as the predictive role of ALP and neutrophil to lymphocytes ratio. The definition of the optimal position of radium 223 in the treatment of metastatic castration-resistant prostate cancer has still to be defined.  相似文献   
2.
This study evaluated the effect of Er:YAG laser irradiation of enamel and dentin on the shear bond strength of resin-modified glass ionomer cements (RMGIC). Twenty molars were selected and the roots removed. The crowns were bisected, embedded in polyester resin and ground to plane the enamel or expose the dentin. The bonding site was delimited, and samples were randomly assigned according to the cavity preparation device: I--Er.YAG laser (350mJ/2Hz); II--Carbide bur (control group). They were subdivided according to the restorative material employed: A) Fuji II LC (GC); B) Vitremer (3M). Samples were then fixed to a metallic device where ionomer cylinders were prepared. Sequentially, the molars were stored for 24 hours and subjected to a shear bond strength test (50Kgf at 0.5 mm/minute). Means in MPa were: Enamel--IA) 4.77 (+/- 1.12); IB) 4.36 (+/- 1.50); IIA) 7.70 (+/- 1.53); IIB) 7.34 (+/- 1.52) and Dentin--IA) 3.13 (+/- 1.15); IB) 2.67 (+/- 0.74); IIA) 6.38 (+/- 1.44); IIB) 5.58 (+/-2.09). Data were submitted to statistical analysis by ANOVA. Adhesion for enamel was more efficient than for dentin (p < 0.01). The cavities prepared with a conventional bur (control group) presented higher bond strength values than those recorded for Er:YAG laser (p < 0.01). No significant differences were observed between the restorative materials. Based on these results, it was concluded that Er:YAG laser adversely affected the shear bond strength of RMGIC for both enamel and dentin.  相似文献   
3.
PURPOSE: To assess in vitro the effect of Er:YAG laser irradiation distance on dentin surface morphology, by SEM. METHODS: 60 sound human third molars were employed to obtain discs (approximately equal to 1mm thick), that were polished to standardize the smear layer. Discs were randomly assigned to six groups (n=10) and sequentially bisected. Five groups (including both disc halves of each sample) received Er:YAG laser irradiation (80mJ/2Hz) for 20s, according to the irradiation distance (11, 12, 14, 16 or 17mm) and one was the control group. In the lased-groups, one disc half was separated for superficial analysis without subsequent acid-etching and the other half received phosphoric acid for 15 seconds. In the control group, one disc half was treated with phosphoric acid and no superficial treatment was done in the other half. Specimens were prepared for SEM. RESULTS: Er:YAG laser-irradiated specimens, regardless of the irradiation distance, showed an irregular and scaly surface, with intense ablation of the intertubular dentin, mainly when the irradiation was performed in the focused mode (12 mm). The smear layer was removed and dentin tubules were opened, however, no tubule enlargement was found, unlike the group that only received acid application. The irradiation with 17 mm resulted in a surface appearance more homogeneous than those presented with other distances closer to the focus. The subsequent acid-etching on the lased surfaces decreased the superficial irregularities with partial exposure and enlargement of dentin tubules, in all the tested irradiation distances.  相似文献   
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Neurological Sciences - The coronavirus pandemic became the hard challenge for the modern global health system. To date, vaccination is the best strategy against Sars-Cov-2-related illness. About 3...  相似文献   
7.
OBJECTIVES: Prevalence of single quinolone-resistance determining region (QRDR) mutations in Streptococcus pneumoniae was studied from nine institutions over 5 years to track the incidence of single QRDR mutations. METHODS: All 1106 levofloxacin-susceptible pneumococci (MICs < or = 2.0 mg/L) identified from 1112 total isolates (99.5% susceptibility) in TRUST 3 (1999), TRUST 5 (2001) and TRUST 7 (2003) surveillance studies from the same nine hospitals in nine states were screened for QRDR mutations. Using pyrosequencing, the strains were screened for mutations corresponding to hot spots Asp-78, Ser-79 and Asp-83 in ParC; Asp-80, Ser-81 and Glu-85 in GyrA; Asp-435 in ParE and Asp-435 in GyrB. DNA sequencing of QRDRs was performed to confirm mutations. RESULTS: No QRDR mutations were found in any of the isolates with levofloxacin MICs < or = 0.5 mg/L and no gyrA or gyrB QRDR mutations were found in any of the screened isolates (MICs < or = 2 mg/L). Four single-step QRDR mutants with the following amino acid substitutions were found: ParE Asp-435 to Asn (isolated in 1999 in Colorado); ParC Asp-83 to Asn (isolated in 2001 in Kentucky); ParC Ser-79 to Phe (isolated in 2003 in Indiana) and ParC Ser-79 to Tyr (isolated in 2003 in California). These non-clonal strains had levofloxacin MICs of 1 mg/L and were non-susceptible to ciprofloxacin (MIC 2-4 mg/L). CONCLUSIONS: Overall prevalence of single QRDR mutations in levofloxacin-susceptible S. pneumoniae with MICs of < or = 2 mg/L was 0.4% (4/1106) and has remained <1% within nine institutions over 5 years (1999-2003).  相似文献   
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9.
This study aimed to identify risk factors for the incidence of peri‐implant pathology. One‐thousand, two‐hundred and seventy‐fifty patients (255 cases and 1020 controls), rehabilitated with dental implants, were included. Peri‐implant pathology was defined as the presence of peri‐implant pockets ≥ 5 mm, bleeding on probing, vertical bone loss, and loss of attachment ≥2 mm. Cases and controls were matched for age, gender, and duration of follow‐up. A logistic regression model was used, with estimation of the OR for each variable and interaction, with a level of significance of 5%. The risk factors for peri‐implant pathology were: history of periodontitis (OR = 19), bacterial plaque (OR = 3.6), bleeding (OR = 2.9), bone level on the medium third of the implant (OR = 13.9), lack of prosthetic fit or non‐optimal screw joint (OR = 5.9), metal–ceramic restorations (OR = 3.9), and the interaction between bacterial plaque and the proximity of other teeth or implants (PROXI) (OR = 4.3). PROXI (OR = 0.44) exerted a protective effect when independent. Based on the results, peri‐implant pathology represents a group of multifactorial situations with interaction of biological and biomechanical components in its pathogenesis. It was possible to model the condition and to assess, with high precision, the risk profile of each patient.  相似文献   
10.
The aim of the present study was to assess the feasibility of a portable gamma camera (PGC) for guiding surgical treatment in locally advanced breast cancer (LABC) after neoadjuvant therapy (NT). Since January 2012, a PGC (Sentinella 102, ONCOVISION) has been available in our center. We planned to perform a feasibility monocentric prospective study involving 15–20 patients with LABC for assessing the diagnostic performance of this PGC after NT (Breast Cancer Surgery-S102). Before the surgical treatment and at the end of NT an injection of 99mTc-Sestamibi (100–150 MBq) was made. Conventional scintimmamography (SMM) and Sentinella 102 images were obtained from 18 patients. 10 (55.5 %) patients showed a focal uptake of tracer in the breast or lymph nodes before or after the surgical excision (on histological specimen), while 8 did not. The histological specimen concluded for a complete response to NT in 4 (22.2 %) patients and for a partial or no response to treatment in the remnant 14 subjects. The specificity and false-negative rate of the Sentinella 102 compared to SMM were 100 % for both and 38 % vs. 60 %, respectively. The global diagnostic accuracy of Sentinella 102 was: 66.7 % (95 % confidence interval: 44.88–88.44 %). The present feasibility study shows how a new nuclear imaging device can be useful in the operating theatre for guiding a radical surgery approach in patients with LABC after NT.  相似文献   
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