Purpose
To report oncologic outcomes of patients undergoing salvage cryotherapy (SCT) for local recurrence of prostate cancer (PCa) and to establish a nadir PSA (nPSA) value that best defines ...long-term oncologic success.
Methods
Retrospective study of men who underwent SCT for local recurrence of PCa between 2008 and 2020. SCT was performed in men with biochemical recurrence (BCR), after primary treatment and with biopsy-proven PCa local recurrence. Survival analysis with Kaplan–Meier and Cox models was performed. We determined the optimal cutoff nPSA value after SCT that best classifies patients depending on prognosis.
Results
Seventy-seven men who underwent SCT were included. Survival analysis showed a 5-year biochemical recurrence-free survival (BRFS), androgen deprivation therapy-free survival (AFS), and metastasis-free survival (MFS) after SCT of 48.4%, 62% and 81.3% respectively. On multivariable analysis for perioperative variables associated with BCR, initial ISUP, pre-SCT PSA, pre-SCT prostate volume and post-SCT nPSA emerged as variables associated with BCR. The cutoff analysis revealed an nPSA < 0.5 ng/ml to be the optimal threshold that best defines success after SCT. 5-year BRFS for patients achieving an nPSA < 0.5 vs nPSA ≥ 0.5 was 64% and 9.5% respectively (
p
< 0.001). 5-year AFS for men with nPSA < 0.5 vs ≥ 0.5 was 81.2% and 12.2% (
p
< 0.001). Improved 5-year MFS for patients who achieved nPSA < 0.5 was also obtained (89.6% vs 60%,
p
= 0.003).
Conclusion
SCT is a feasible rescue alternative for the local recurrence of PCa. Achieving an nPSA < 0.5 ng/ml after SCT is associated with higher long-term BRFS, AFS and MFS rates.
We studied the association of mitochondrial DNA (mtDNA) haplogroups with weight and body mass index (BMI) gain at 96 weeks in 1,019 treatment-naïve persons with HIV (PWH) who initiated first-line ...antiretroviral therapy (ART) since 2014. The mean increase in weight and BMI over the study period was 2.90 Kg and 0.98 Kg/m2, respectively. We found a significant adjusted association between the major UK mtDNA haplogroup and lower weight and BMI increase at 96 weeks after ART initiation. Our findings reveal a potential role for mitochondrial genetics in the complex phenomenon of weight gain after initial ART in PWH.
Abstract
Background
The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in ...the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH.
Methods
We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS).
Discussion
The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented.
Trial registration
ClinicalTrials.gov
NCT04735445. Registered on 25 June 2019
Background
Recent and reliable estimates on the prevalence of coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in Europe are lacking.
Aim
Leveraged on a study designed ...to assess HIV/HCV coinfection prevalence, we assessed the prevalence of HIV/HBV coinfection in Spain in 2018 and compared the results with five similar studies performed since 2002.
Methods
This cross-sectional prevalence study was carried out in 43 centres, and patients were selected using simple random sampling. The reference population comprised 40,322 patients and the sample size were 1,690 patients.
Results
The prevalence of HIV/HBV coinfection in Spain at the end of 2018 was 3.2%. The prevalence in 2002, 2009, 2015, 2016 and 2017 was 4.9%, 3.4%, 3%, 3.9% and 3%, respectively. Among the HIV/HBV-coinfected patients identified in 2018, 16.7% had cirrhosis according to transient elastography and 26.3% tested positive for antibodies against hepatitis D virus. All HIV/HBV-coinfected patients were receiving drugs with activity against HBV, and 97% of those tested for HBV DNA had an HBV DNA load < 80 IU/mL.
Conclusions
The prevalence of HIV/HBV coinfection in Spain remained stable at around 3% for a decade. Our data could facilitate the design of national programmes to control HBV infection and help identify areas of patient management that need improvement.
This study focused on using electromagnetically generated impulses to correct dimensional errors resulting from springback on two different geometric features. Modification or correction of a corner ...feature is considered first. A simple linear actuator is used to correct springback on a simply bent high strength aluminum alloy (AA 5754) and a high strength steel alloy (DP 600). It is shown to be possible to fully correct for springback using a net-shape die with both materials with higher electromagnetic discharge energies being required for the steel. The second geometric feature considered is a sidewall curl ‘defect’ that is the result of bending and unbending U-Channel drawing. A serpentine actuator and net-shape die were shown effective at correcting for this defect in both DP 600 and TRIP 700 high strength steels. A somewhat higher forming energy is required for effective shape correction in the higher strength TRIP 700 alloy. A detailed mechanistic understanding of springback correction remains elusive, but these results are consistent with several other studies in the literature that show this is an effective means to control springback.
•This OPF approach solves VSC-HVDC grids based on shift factors.•Needs one global equality constraint plus those related to the VSC power set points.•This alternative OPF formulation reduces the ...complexity computational burden.•Errors inferior to 5% are obtained for the generation dispatch and nodal prices.•This novel approach reduces the computational time by more than 70% on average.
This paper introduces a novel approach for optimal power flows (OPF) in VSC-HVDC power grids based on shift factors. The optimum solution is calculated using a global equality constraint (generation minus losses equals system load) plus those related to the power set points of the VSC units. Indeed, the shift factors enable the enforcement of the VSC power flow constraints. This is the hallmark of this method which features a considerable reduction of the model complexity and the computational burden because the system nodal equations are not explicitly represented. This lies in sharp contrast with existing OPF approaches whose model complexity is inevitably increased as is the computing requirements to its solution.
Three variants of the proposed OPF model are described: (i) quadratic generation cost curves with quadratic AC/DC transmission losses; (ii) quadratic generation cost curves with power losses considered by piecewise linear equations; (iii) generation cost curves and transmission losses approximated by piecewise linear functions. The effectiveness of the developed approach is assessed using three AC/DC test systems formed by three, four and six VSC stations, respectively. The results are compared against those calculated by a conventional Sequential Quadratic Programming formulation using a full, nonlinear power grid model. It is demonstrated that the optimal solutions concur very well between each other since errors inferior to 5% are obtained for the generation dispatch and nodal energy prices. Equally important is the fact that this novel approach reduces the computational time by more than 70% on average.
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