Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, ...frailty, or sarcopenia, which can negatively affect the patient’s quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis.
PROSARC is a national (Spain) prospective observational study (May-2022–May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up.
A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012).
In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.
El carcinoma prostático (CP) es una neoplasia frecuente en pacientes de edad avanzada. La privación androgénica, con beneficio en supervivencia, se relaciona con efectos adversos tales como osteoporosis, fragilidad o sarcopenia, que pueden impactar negativamente en la calidad de vida del paciente. Este estudio pretende cuantificar y evaluar el estado de osteoporosis, fragilidad o sarcopenia en pacientes con CP de edad avanzada antes y después de la privación androgénica. Presentamos datos de un análisis intermedio.
Estudio nacional (España) observacional prospectivo, PROSARC, aún en marcha (mayo del 2022-mayo del 2025) en 2 hospitales. Incluye a pacientes con CP de alto riesgo, ≥ 70 años, no candidatos a tratamiento local e inicio programado de privación androgénica. Se analizan las siguientes variables: comorbilidad, fragilidad (criterios de Fried), osteoporosis, sarcopenia (EWGSOP2), masa grasa y masa muscular, antes del tratamiento y tras 6 meses de seguimiento.
Completaron un seguimiento de 6 meses 12/25 pacientes incluidos (edad media, 84 años), con una elevada prevalencia basal de prefragilidad/fragilidad (67,7%), sarcopenia (66,7%) y osteoporosis (25%). El tratamiento no varió significativamente estas variables ni la comorbilidad. Se observaron cambios en el índice de masa corporal (p=0,666), reducción del valor medio de la masa muscular apendicular (p=0,01) e incremento del porcentaje de masa grasa (p=0,012).
La privación androgénica (6 meses) en pacientes con CP de alto riesgo, edad avanzada y una prevalencia considerable de osteoporosis, fragilidad y sarcopenia, produce disminución de masa muscular sin que ello repercuta en la incidencia de los efectos adversos de la privación androgénica estudiados.
Abstract
Background/Introduction
Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left ...atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS.
Purpose
To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls.
Methods
46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating).
Results
LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls.
MFS vs controls
MFS patients (n=40)
Controls (n=20)
p
MFS patients (n=40)
Controls (n=20)
p
Age
33.8±12.4
34.4±8.3
0.846
Septal e' (cm/s)
9.7±2.5
11.7±2.3
0.006
Male (%)
24 (60%)
12 (60%)
1.000
Average E/e' ratio
6.8±1.5
5.5±1.1
0.002
SBP (mmHg)
120.3±12.4
120.1±9.4
0.969
TR velocity (cm/s)
208.6±21.4
201.6±22.9
0.390
DBP (mmHg)
72.0±10.1
67.1±6.2
0.069
LAVi (ml/m2)
23.5±7.1
25.5±4.8
0.260
Aortic root (mm)
40.3±4.6
31.7±3.7
<0.001
LASr (%)
32.6±8.8
43.0±8.3
<0.001
LVEF (%)
60.9±5.6
64.2±4.2
0.022
LAScd (%)
−20.1±8.0
−29.4±5.5
<0.001
E-wave (cm/s)
74.6±16.5
76.7±16.5
0.651
LASct (%)
−12.8±6.1
−13.6±5.2
0.622
A-wave (cm/s)
55.2±10.9
52.0±12.8
0.327
LASRr
2.02±0.49
2.31±0.43
0.030
E/A ratio
1.4±0.4
1.5±0.4
0.287
LASRcd
−2.22±0.61
−3.07±0.68
<0.001
Lateral e' (cm/s)
13.0±3.6
16.3±3.3
0.002
LASRct
−2.24±0.90
−2.35±0.75
0.600
SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction.
Example of LA strain and strain rate
Conclusion
MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients.
Acknowledgement/Funding
Programa de Actividades de I+D de la Comunidad de Madrid
Abstract
Background
Left Ventricular systolic disfunction has already been described in Marfan Syndrome (MS) in patients without valvular dysfunction using 2D and 3D speckle tracking echocardiography ...(STE). This dysfunction has been related to a more severe causal genetic mutation, which suggest the presence of a primary cardiomiopathy in these patients. Right ventricular function has been less studied so far. We sought to evaluate biventricular function in our cohort of MS patients with 2D-STE.
Methods
95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. Patients with more than mild mitral or aortic regurgitation were excluded. Using STE we obtanied left ventricular global longitudinal strain (LVGLS) from the average of 16 segments from 4,2 and 3-chamber views and RVGLS values were obtained from the average of 6 segments from the apical 4-chamber view. We also measured classic parameters of systolic biventricular function (LVEF and TAPSE).
Results
Compared to controls, patients with MFS had significantly lower LVGLS and RVGLS (table 1). Values obtanied for LVGLS in MS patients were at the lower limit of normality stablished in the latest cuantification guidelines, while RVGLS and RV free wall LS were slightly above the limit of normality. LVEF and TAPSE were also slightly diminished in MS patients, though the differences found were clinically not relevant.
Results of statistical analysis
MS (n=93)
Controls (n=32)
p
Age (years)
32.84±12.4
32.41±7.98
0.85
Aortic Root Diameter Valsalva Sinuses (mm)
38.82±5.35
30.91±5.3
<0.001
LVGLS (%)
−18.93±2.62
−21.52±2.26
<0.001
RVGLS (%)
−21.25±3.54
−24.68±3.08
<0.001
RV free wall LS (%)
−22.09±3.92
−25.56±3.63
<0.001
LVEF (%)
59.5±5.34
63.27±4.19
0.001
TAPSE (mm)
23.97±4.57
25.82±3.32
0.03
MS = Marfan Syndrome; LVGLS = Left ventricular global longitudinal strain; RVGLS = right ventricular global longitudinal strain.
Conclusions
Our study suggests that patients with MFS show lower biventricular strain compared with healthy controls. 2D-STE imaging may be useful to detect subclinical changes in cardiac function in patients with MFS and should be added to routine ecocardiographic evaluation in order to improve the follow-up and treatment of these patients.
Abstract
Background
Evolution of left and right ventricular (LV and RV) function after heart transplantation (HT) has not been well described. Our objective was to evaluate the normal evolution of ...echocardiographic parameters of both ventricles and to explore if there is a link between the decrease of strain values and acute rejection (AR) or coronary allograft vasculopathy (CAV)
Methods
We followed 29 HT recipients with serial echocardiograms performed between 2011 and 2018, with a median follow-up of 5 years. LV global longitudinal strain (LV GLS) was analyzed by speckle tracking in 12 LV segments in 4 and 2 chamber views, and RV free wall longitudinal strain (RV free Wall LS) was measured in 4 chamber view. Acute rejection was diagnosed by EMB following our HT protocol. We take into consideration only moderate or severe rejection episodes (grade ≥2R).The presence of CAV was studied by coronariography or IVUS one year post-HT.
Results
As shown in the table below, LVEF was preserved from the begining of the follow up while LV GLS reached the normality in the 6th month, and both remained in normal ranges untill the 5th year. Regarding RV function, TAPSE was impaired in the early post-HT period and increased progressively and reached normality 1 year after HT. RV lateral wall LS rose during follow-up as well, reaching normal values 6 months after HT. Nevertheless, we noticed an impairment in this parameter at 5 years (−20.1±2.7, p=0.001), although it remained within normal ranges compared to guidelines reference parameters. We did not find any correlation between any parameter evaluated and the presence of AR or CAV at five years of follow-up.
LV and RV function parameters
LVEF
LV GLS
TAPSE
FAC
RV free wall LS
Basal (14 days)
63.0±7.9
−17.2±3.6
12.1±2.9*
43.7±9.8
−19.3±4.2
3 months
65.0±8.6
−17.7±2.8
14.8±3.4*
45.3±8.2
−22.0±4.6
6 months
65.8±9.6
−18.7±3.4
16.1±3.6
44.6±9.6
−24.6±4.9*
1 year
63.5±8.1
−18.1±2.2
17.1±4.1
44.0±8.1
−26.7±7.1*
2 years
63.8±6.8
−18.3±9.0
19.4±3.7
45.3±7.9
−27.6±6.3*
5 years
64.4±7.3
−18.1±3.3
17.9±3.9
46.6±12.1
−20.1±2.8
P (Anova)
0.85
0.85
<0.001
0.82
<0.001
Conclusion
As we show in this series of HT recipients with uneventful postoperative course, all LV and RV function parameters showed normal values 1 year after HT and manteined them during long-term follow-up. The presence of AR or CAV did not have any influence in ventricular function.
Abstract
Background
Elastic properties of the thoracic aorta in patients with Marfan Syndrome (MS) have already been evaluated with classic echocardiographic parameters. In the latest years the use ...of Speckle-Tracking (STE) ecocardiography has been widely extended. Our aim is to describe and provide new parameters of aortic deformation measured by STE in patients with MS.
Methods
95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. We measured classic parameters of the aortic root using 2D echocardiography. We calculated the posterior aortic wall systolic excursion at the sinuses of Valsalva and ascending aorta using M Mode in TDI colour; with ST 2D ecocardiography we measured the aortic strain at the sinuses of Valsalva (SV) and the anterior and posterior aortic wall displacement at the SV. Aortic distensibility was calculated using the formula: 1000 * (Ds − Dd)/Dd * 1/(Ps − Pd) in mmHg–1 (Ds: systolic and Dd: diastolic diameters, Ps systolic and Pd diastolic blood pressure). Aortic stiffness index was calculated as Ln((Ps/Pd)/(Ds-Dd)/Dd)).
Results
As shown in the table bellow, patients with MS had lower aortic strain, aortic anterior and posterior wall displacement and impaired aortic distensibility and stiffness index compared to healthy controls. We found a strong negative linear correlation between aortic root diameter at the SV and aortic root strain (r=−0.56, figure 1).
Results of statistical analysis
MS (n=95)
Controls (n=32)
p
Age (years)
32.84±12.35
32.41±7.98
0.85
Aortic root diameter at the sinuses of Valsalva (mm)
38.82±5.35
30.92±3.65
<0.001
Aortic root strain (%)
4.66±2.45
9.19±2.49
<0.001
Anterior aortic wall displacement STE (mm)
10.39±3.64
13.10±2.26
<0.001
Posterior aortic wall displacement STE (mm)
9.02±2.87
11.04±1.82
<0.001
Aortic distensibility
0.98±0.46
1.37±0.72
0.01
Aortic stiffness index
3.74±0.43
3.47±0.51
0.01
MS = Marfan Syndrome; STE = Speckle Tracking Ecocardiography.
Figure 1. Dispersion plot
Conclusions
Our results suggest that aortic deformation and displacement obtained by STE echocardiography is impaired in MS, showing a reduced distensibility and an increased stiffness of the aortic wall, with a strong negative correlation between aortic root dilation and aortic strain. All these parameters may be useful as additional tools for the diagnosis and follow-up of Marfan patients, and could be useful to to improve the echocardiographic evaluation of the aortic root.
Abstract
Background/Introduction
Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). ...Certain speckle-tracking echocardiography (STE) derived parameters have shown good correlation with invasive measurements of LV relaxation.
Purpose
To evaluate diastolic function in Marfan patients using STE-derived parameters along with traditional diastolic measurements and compare them with healthy controls.
Methods
We consecutively included 127 MFS patients with normal LV ejection fraction and no previous cardiovascular surgery or significant valvular regurgitation. We also studied 38 healthy controls (age and sex-matched). We performed LV and LA strain analysis using 2D STE (QLAB 10, Philips). Echocardiographic parameters recommended to assess diastolic function (according to ASE/EACVI 2016 guidelines) were also considered.
Results
Reported use of BB/ARB was 28/39% in MFS patients. According to current guidelines, all participants had normal diastolic function. MFS patients showed lower TDI e' velocities (septal and lateral) and higher average E/e' ratio compared to controls, but still within normal range. Regarding STE-derived measurements, LVGLS, EDLSR and PALS were significantly reduced in MFS. E/EDLSR ratio was higher among MFS patients, reflecting impaired LV relaxation. Interestingly, E/LVGLS was not different between both groups.
Conclusion
STE-derived parameters showed impaired LV relaxation in MFS patients compared to controls. Our results suggest that STE derived parameters can be markers of early diastolic dysfunction and provide a better insight into Marfan-related cardiomyopathy.
STE derived parameters
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Programa de Actividades de I+D de la Comunidad de Madrid
Dengue is an acute febrile illness caused by any of four dengue virus types (DENV-1-4). DENVs are transmitted by mosquitos of the genus Aedes (1) and are endemic throughout the tropics (2). In 2010, ...an estimated 390 million DENV infections occurred worldwide (2). During 2007-2013, a total of three to 10 dengue cases were reported annually in Arizona and all were travel-associated. During September-December 2014, coincident with a dengue outbreak in Sonora, Mexico, 93 travel-associated dengue cases were reported in Arizona residents; 70 (75%) cases were among residents of Yuma County, which borders San Luis Río Colorado, Sonora, Mexico. San Luis Río Colorado reported its first case of locally acquired dengue in September 2014. To investigate the temporal relationship of the dengue outbreaks in Yuma County and San Luis Río Colorado and compare patient characteristics and signs and symptoms, passive surveillance data from both locations were analyzed. In addition, household-based cluster investigations were conducted near the residences of reported dengue cases in Yuma County to identify unreported cases and assess risk for local transmission. Surveillance data identified 52 locally acquired cases (21% hospitalized) in San Luis Río Colorado and 70 travel-associated cases (66% hospitalized) in Yuma County with illness onset during September-December 2014. Among 194 persons who participated in the cluster investigations in Yuma County, 152 (78%) traveled to Mexico at least monthly during the preceding 3 months. Four (2%) of 161 Yuma County residents who provided serum samples for diagnostic testing during cluster investigations had detectable DENV immunoglobulin M (IgM); one reported a recent febrile illness, and all four had traveled to Mexico during the preceding 3 months. Entomologic assessments among 105 households revealed 24 water containers per 100 houses colonized by Ae. aegypti. Frequent travel to Mexico and Ae. aegypti colonization indicate risk for local transmission of DENV in Yuma County. Public health officials in Sonora and Arizona should continue to collaborate on dengue surveillance and educate the public regarding mosquito abatement and avoidance practices. Clinicians evaluating patients from the U.S.-Mexico border region should consider dengue in patients with acute febrile illness and report suspected cases to public health authorities.
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•Energy supplied by the ball-mill tune the physicochemical properties of starch.•Three stages of transformation of potato starch through energy supplied can be.•identified.•Above ...4.5 J/g of energy supplied, potato starch loses every characteristic property.•High-energy ball-milling not only modified but also destroy potato starch.
Pure potato starch has been modified by high-energy-ball-milling as a function of energy supplied, aiming to obtain products for different possibilities of industrial application. Burgios's equation has been used to calculate the energy supplied. The effect of the milling has been followed by a characterization of the starch morphology, crystallinity, solubility, swelling, retrogradation, viscosity, apparent viscosity, functional groups, and reducing sugar concentration. The high-energy-ball-milling not only changes the physical properties but also induces the mechanolysis of potato starch, breaking the glycosidic linkages of the starch molecules. A representation of the possible mechanism of starch mechanolysis is proposed. Three stages of the transformation of potato starch through high-energy ball-milling can be identified. Each of these stages generates starch with properties that can be used in different industrial applications.