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Background: this is an exploratory study to evaluate calprotectin serum levels in patients with rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitor (ICI) treatment. Methods: this is a retrospective observational study including patients with irAEs rheumatic syndromes. We compared the calprotectin levels to those in a control group of patients with RA and with a control group of healthy individuals. Additionally, we included a control group of patients treated with ICI but without irAEs to check calprotectin levels. We also analysed the performance of calprotectin for the identification of active rheumatic disease using receiver operating characteristic curves (ROC). Results: 18 patients with rheumatic irAEs were compared to a control group of 128 RA patients and another group of 29 healthy donors. The mean calprotectin level in the irAE group was 5.15 μg/mL, which was higher than the levels in both the RA group (3.19 μg/mL) and the healthy group (3.81 μg/mL) (cut-off 2 μg/mL). Additionally, 8 oncology patients without irAEs were included. In this group, calprotectin levels were similar to those of the healthy controls. In patients with active inflammation, the calprotectin levels in the irAE group were significantly higher (8.43 μg/mL) compared to the RA group (3.94 μg/mL). ROC curve analysis showed that calprotectin had a very good discriminatory capacity to identify inflammatory activity in patients with rheumatic irAEs (AUC of 0.864). Conclusions: the results suggest that calprotectin may serve as a marker of inflammatory activity in patients with rheumatic irAEs induced by treatment with ICIs.

Prostate-specific antigen (PSA) is the tumor marker most widely used in conjunction with digital rectal examination (DRE) for the early detection of prostate cancer (PCa). Due to its limitations, especially the high rate of false positive (FP) results, PSA screening of transplant candidates is a controversial issue. Moreover, obtaining a FP result in the PCa screening of heart transplant candidates may lead to potentially harmful effects. Although most of the factors that may cause PSA FP results are well known, FP results related to cardiogenic shock, a common indication for heart transplant, are less known. We studied retrospectively four patients who suffered cardiogenic shock during their hospital stay and became heart transplant candidates. Their PSA serum levels were very high suggesting the presence of PCa. Our findings have shown that elevated PSA serum levels in these patients were not related to PCa and they might be associated with cardiogenic shock. This clinical case study adds evidences to the fact that cardiogenic shock is an important cause of PSA FP results, therefore it cannot be used as a reliable marker of PCa in this clinical condition and positive results should be properly interpreted.

Prior studies have described distinct patterns of brain gray matter and white matter alterations in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), as well as differences in their cerebrospinal fluid (CSF) biomarkers profiles. We aim to investigate the relationship between early‐onset AD (EOAD) and FTLD structural alterations and CSF biomarker levels. We included 138 subjects (64 EOAD, 26 FTLD, and 48 controls), all of them with a 3T MRI brain scan and CSF biomarkers available (the 42 amino acid‐long form of the amyloid‐beta protein [Aβ42], total‐tau protein [T‐tau], neurofilament light chain [NfL], neurogranin [Ng], and 14‐3‐3 levels). We used FreeSurfer and FSL to obtain cortical thickness (CTh) and fraction anisotropy (FA) maps. We studied group differences in CTh and FA and described the “AD signature” and “FTLD signature.” We tested multiple regression models to find which CSF‐biomarkers better explained each disease neuroimaging signature. CTh and FA maps corresponding to the AD and FTLD signatures were in accordance with previous literature. Multiple regression analyses showed that the biomarkers that better explained CTh values within the AD signature were Aβ and 14‐3‐3; whereas NfL and 14‐3‐3 levels explained CTh values within the FTLD signature. Similarly, NfL levels explained FA values in the FTLD signature. Ng levels were not predictive in any of the models. Biochemical markers contribute differently to structural (CTh and FA) changes typical of AD and FTLD.

Introduction Synaptic damage, axonal neurodegeneration, and neuroinflammation are common features in Alzheimer's disease (AD), frontotemporal dementia (FTD), and Creutzfeldt-Jakob disease (CJD). Methods Unicentric cohort of 353 participants included healthy control (HC) subjects, AD continuum stages, genetic AD and FTD, and FTD and CJD. We measured cerebrospinal fluid neurofilament light (NF-L), neurogranin (Ng), 14-3-3, and YKL-40 proteins. Results Biomarkers showed differences in HC subjects versus AD, FTD, and CJD. Disease groups differed between them except AD versus FTD for YKL-40. Only NF-L differed between all stages within the AD continuum. AD and FTD symptomatic mutation carriers presented differences with respect to HC subjects. Applying the AT(N) system, 96% subjects were positive for neurodegeneration if 14-3-3 was used, 94% if NF-L was used, 62% if Ng was used, and 53% if YKL-40 was used. Discussion Biomarkers of synapse and neurodegeneration differentiate HC subjects from neurodegenerative dementias and between AD, FTD, and CJD. NF-L and 14-3-3 performed similar to total tau when AT(N) system was applied.

BACKGROUND Due to insufficient scientific evidence, panels of tumour markers (TMs) are currently not recommended for use in suspected cancer. However, recent well-designed studies have revealed a potential clinical value in lung cancer. We analysed the diagnostic accuracy of a panel of 11 circulating TMs with clinically controlled thresholds in the differentiation of cancer from nonmalignant diseases. METHODS We prospectively recruited 4776 consecutive patients presenting with focal or nonspecific symptoms suggestive of cancer who underwent testing for 11 serum TMs before diagnosis was known. The study abided by 2015 STARD guidelines. Tumour markers included, among others, carbohydrate antigen 19-9, carcinoembryonic antigen, alpha-fetoprotein, squamous cell carcinoma-associated antigen, prostate-specific antigen (males), neuron-specific enolase, progastrin-releasing peptide and carbohydrate antigen 125. Thresholds were adjusted for the presence of kidney failure, liver disease, effusions and dermatological disorders. Results showing ≥1 TMs with concentrations above threshold were considered positive. RESULTS Benign diseases were diagnosed in 3281 (68.7%) patients and cancer in 1495 (31.3%), with epithelial cancers in 1214 (77% at stage IV). When applying criteria for controlled thresholds, overall specificity was 98%. Overall sensitivity of the panel in epithelial cancers was 72.2%, positive predictive value 93% and negative predictive value 90.5%. The area under the receiver operating characteristic curve was 0.920 (95% confidence interval, 0.902-0.924). CONCLUSIONS By using clinically controlled cut-offs, the combined panel demonstrated an excellent ability to discriminate epithelial cancers from nonmalignant diseases. However, its use in clinical practice would need formal validation through a multicentre controlled trial assessing a panel-guided strategy vs. standard diagnosis.

Resumen Introducción El estradiol en suero (E2) se emplea para el diagnóstico y/o seguimiento de una amplia variedad de patologías. El objeto del presente estudio es evaluar el ensayo enhanced estradiol (eE2) de Siemens en el sistema Atellica IM 1600 (Siemens Healthineers) y llevar a cabo una comparación de muestras con el analizador Advia Centaur XP (Siemens Healthineers). Métodos Los coeficientes de variación (CV) intradía e interdía se evaluaron utilizando pools de muestras séricas y materiales de control de calidad. El límite de cuantificación se determinó mediante el empleo de seis muestras de suero con concentraciones decrecientes de E2. La linealidad fue evaluada a través del análisis de dos muestras diferentes de suero. La exactitud se determinó midiendo tres materiales de referencia certificados. Comparamos los sistemas Atellica y Centaur XP con el método de regresión de Passing–Bablok y el gráfico de Bland–Altman utilizando 119 muestras de suero con concentraciones de entre 45 y 10.059 pmol/L. Resultados La imprecisión intradía e interdía fue Conclusiones Este estudio indica que el ensayo eE2 tiene una imprecisión y una exactitud aceptables, mostrando una buena correlación con el sistema Centaur XP.

Background: An evaluation of SENTiFIT® 270 (Sentinel Diagnostics, Italy; Sysmex, Spain) analyser for the quantitation of faecal haemoglobin (f-Hb) was performed. Methods: The analytical imprecision, linearity, carry over and f-Hb stability were determined. Evaluation of the diagnostic accuracy was performed on 487 patients. Results: Within-run and between-run imprecision ranged 1.7%–5.1% and 3.8%–6.2%, respectively. Linearity studies revealed a mean recovery of 101.1% (standard deviation, 6.7%) for all dilutions. No carry over was detected below 7650 μg Hb/g faeces. Decay of f-Hb in refrigerated samples ranged 0.2%–0.5% per day. f-Hb in patients with advanced colorectal neoplasia (ACRN) (colorectal cancer [CRC] plus advanced adenoma [AA]) were significantly higher than from those with a normal colonoscopy. Sensitivity for ACRN at f-Hb cutoffs from 10 to 60 μg Hb/g faeces ranged from 28.9% (95% confidence interval [CI], 21.7%–37.2%) to 46.5% (95% CI, 38.1%–55%), the specificity ranged from 85% (95% CI, 82.3%–87.3%) to 93.2% (95% CI, 91.2%–94.8%), positive predictive values for detecting CRC and AA ranged from 11.6% (95% CI, 7.6%–17.2%) to 20.6% (95% CI, 13.3%–30.3%) and from 34.7% (95% CI, 28.1%–42%) to 42.3% (95% CI, 32.4%–52.7%), respectively, and the negative predictive value for ACRN ranged from 90.2% (95% CI, 87.9%–92.2%) to 88.4% (95% CI, 86%–90.4%). Using two samples per patient sensitivity increased with a slight decrease in specificity. Conclusions: The analytical and clinical performances of SENTiFIT assay demonstrate a specific and accurate test for detecting ACRN in symptomatic patients and those undergoing surveillance.

Background Serum estradiol (E2) levels may be used in the diagnostic and/or monitoring of a broad variety of clinical conditions. The aims of this study were to evaluate the Siemens enhanced estradiol assay (eE2) on Atellica IM 1600 (Siemens Healthineers) and to perform a sample comparison with the Siemens ADVIA Centaur XP (Siemens Healthineers). Methods Within-day and between-day coefficient of variation (CV) were determined using serum sample pools and quality control materials. Six serum samples with decreasing concentrations of E2 were used to assess the limit of quantification. Linearity was evaluated using two different serum samples. Accuracy was evaluated by measuring three certified reference materials. Passing–Bablok regression and Bland–Altman plot were used for comparing Atellica and Centaur XP in 119 serum samples ranging from 45 to 10,059 pmol/L. Results Within-day and between-day imprecision was R = 0.99), with recoveries ranging from 77 to 93%. Comparison study showed good agreement and no significant bias. Conclusions The study shows that Atellica eE2 assay presents acceptable imprecision and accuracy and correlates well with Centaur XP.

Background & Aims Screening for colorectal cancer (CRC) is effective in the population at average risk. The most extended strategy in organized programs involves the fecal immunochemical test, which is limited by low sensitivity for the detection of advanced adenomas (AAs). We aimed to identify microRNA (miRNA) signatures in fecal samples that identify patients with AAs or CRC and might be used in noninvasive screening. Methods Our study comprised 4 stages. In the discovery phase, we performed genome-wide miRNA expression profiling of 124 fresh, paired colorectal tumor and nontumor samples (30 CRC; 32 AAs) from patients in Spain. In the technical validation stage, miRNAs with altered expression levels in tumor vs nontumor tissues were quantified by reverse-transcription polymerase chain reaction in fecal samples from a subset of patients included in the discovery phase (n = 39) and individuals without colorectal neoplasms (controls, n = 39). In the clinical validation stage, the miRNAs found to be most significantly up-regulated by quantitative reverse transcription polymerase chain reaction analysis were measured in an independent set of fecal samples (n = 767) from patients with positive results from fecal immunochemical tests in a CRC screening program. Finally, we developed a model to identify patients with advanced neoplasms (CRCs or AAs) based on their miRNA profiles, using findings from colonoscopy as the reference standard. Results Among 200 and 324 miRNAs significantly deregulated in CRC and AA tissues, respectively, 7 and 5 of these miRNAs were also found to be deregulated in feces (technical validation). Of them, MIR421, MIR130b-3p, and MIR27a-3p were confirmed to be upregulated in fecal samples from patients with advanced neoplasms. In our model, the combination of fecal level of MIR421, MIR27a-3p, and hemoglobin identified patients with CRC with an area under the curve (AUC) of 0.93, compared with an AUC of 0.67 for fecal hemoglobin concentration alone. Conclusions We found that increased levels of 2 miRNAs and hemoglobin in feces can identify patients with AAs or CRC more accurately than fecal hemoglobin concentration alone. Assays for these miRNAs might be added to fecal tests for the detection of CRC or AAs.

Background & Aims An algorithm based on fecal levels of 2 microRNAs (miR-421 and miR-27a-3p), fecal hemoglobin concentration, and patient age and sex can identify patients with advanced colorectal neoplasia. We investigated whether this algorithm, called miRFec, could increase effectiveness and efficiency of fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening programs. Methods We obtained data and fecal samples from 767 persons with a positive result from the FIT who then underwent colonoscopy examination while participating a population-based CRC screening program, from March 2011 through May 2017 in Barcelona, Spain. Fecal miRNAs were isolated from the buffer contained in the original FIT collection device and analyzed by quantitative reverse transcription PCR. Aims were to evaluate the usefulness of the miRFec algorithm in identifying persons at greatest risk for CRC who should be prioritized for colonoscopy examination and individuals at low risk for whom colonoscopy could be avoided. Results Of the 767 study subjects, 414 (54.0%) were found by colonoscopy to have advanced colorectal neoplasia (67 with CRC and 347 with advanced adenomas) and 353 (46.0%) were found to have either non-advanced adenomas (n = 136) or a normal examination (n = 217). MiRFec algorithm scores (1–4) were independently associated with the presence of advanced colorectal neoplasia (P Conclusions An algorithm based on fecal levels of 2 miRNAs and hemoglobin, patient age and sex (miRFec) differentiated patients with CRC from those with non-advanced adenomas or normal colonoscopy with an area under the receiver operating characteristic curve value of 90% and avoided 34% of colonoscopies. Inclusion of this algorithm in FIT-based CRC screening programs could increase their effectiveness and efficiency.

Background and study aims Serrated polyposis syndrome (SPS) is a high risk condition for colorectal cancer (CRC). Surveillance strategies for patients with serrated lesions remain controversial. We aimed to evaluate a diagnostic strategy to detect SPS consistently during reassessment colonoscopy in patients with proximal serrated lesions. Methods This was a retrospective study of all individuals from a fecal immunochemical test (FIT)-based CRC screening program (2010 – 2013) with one or more serrated lesions of ≥ 5 mm proximal to the sigmoid colon on baseline colonoscopy. We analyzed all individuals empirically scheduled for a reassessment colonoscopy aimed at diagnosing SPS within 1 year. Reassessment colonoscopy was performed with standard white-light or chromoendoscopy ± high definition endoscopy depending on availability. SPS diagnosis was based on the cumulative number of polyps in both the baseline and reassessment colonoscopies. Factors associated with SPS diagnosis were analyzed. Results From 3444 screening colonoscopies, 196 patients met the study entry criteria, of whom 11 patients (0.32 %) met the criteria for SPS on baseline colonoscopy. Reassessment colonoscopies were performed in 71 patients at 11.9 ± 1.7 months and detected 20 additional patients with SPS, a tripling of the rate of SPS up to 0.90 %. Independent factors associated with SPS diagnosis were: having five or more proximal serrated lesions (odds ratio [OR] 4.01 [95 % confidence interval 1.20 – 13.45]; P = 0.02) or two or more sessile serrated polyps ≥ 10 mm (OR 6.35 [1.40 – 28.81]; P = 0.02) on baseline colonoscopy and the use of chromoendoscopy ± high definition endoscopy during reassessment colonoscopy (OR 4.99 [1.11 – 22.36]; P = 0.04). Conclusions A 1-year reassessment colonoscopy using chromoendoscopy and high definition endoscopes substantially improves SPS detection in individuals from a FIT-based screening program with proximal serrated lesions. Five or more proximal serrated lesions or two or more sessile serrated polyps ≥ 10 mm could be thresholds for requiring a reassessment colonoscopy. Prospective studies are required to validate these results and adjust surveillance recommendations in patients with serrated lesions.

We have previously identified six serum tumor markers (TMs) (carcinoembryonic antigen, carbohydrate antigen 15.3, squamous cell carcinoma-associated antigen, cytokeratin-19 fragment, neuron-specific enolase, and pro-gastrin-releasing peptide) related to the presence of lung cancer (LC).To validate their individual performance in an independent cohort, and to explore if their combined assessment (≥1 abnormal TM value) is a more accurate marker for LC presence.We determined these six TMs in 3,144 consecutive individuals referred to our institution by their primary care physician because of the clinical suspicion of LC.LC was excluded in 1,316 individuals and confirmed in 1,828 patients (1,563 with non-small cell LC and 265 with small cell LC). This study validated the previously reported performance of each individual TM. We also showed that their combined assessment (≥1 abnormal TM) had a better sensitivity, specificity, negative predictive value, and positive predictive value (88.5, 82, 83.7, and 87.3%, respectively) than each TM considered individually and that it increased the diagnostic performance (area under the curve) of a clinical model that included tumor size, age, and smoking status. In patients with radiographic nodules less than 3 cm, the negative predictive value of the TM panel was 71.8%, hence providing some support for a more conservative diagnostic approach. Finally we identified two TMs (neuron-specific enolase and pro-gastrin-releasing peptide) that differentiate the risk of non-small cell LC from that of small cell LC.The combined assessment of a panel of six serum TMs is a more accurate marker for LC presence than these same TMs considered individually. The potential of these TMs in the diagnostic and screening settings deserves further research.

BACKGROUND AND PURPOSE Several diagnostic biomarkers are currently available for clinical use in early-onset cognitive impairment. The decision on which biomarker is used in each patient depends on several factors such as its predictive value or tolerability. METHODS There were a total of 40 subjects with early-onset cognitive complaints (

Introduction Increased values in the fecal immunochemical test (FIT) are correlated with increasingly severe colorectal neoplasia, but little attention has been given to FIT values below the cut-off point (negative FIT, nFIT). We analysed the relationship between the concentrations of two consecutive nFIT and the risk of following screen-detected advanced neoplasia and interval cancer (IC) in a population-based colorectal cancer screening program. Methods FIT results were categorised into non-detectable nFIT (0–3.8 μg haemoglobin/g feces), low nFIT (3.9–9.9) and high nFIT (10.0–19.9). Multivariable adjusted logistic regression was used to estimate the odds ratios (OR) of advanced neoplasia and IC with the nFIT results in the first two screens. Results More than 90% of the 42,524 persons had non-detectable nFIT in the first and second screen; 4.5% and 5.8% had a low nFIT, respectively, and 2.2% and 2.9% had a high nFIT. The probability of testing positive and being diagnosed of advanced neoplasia or IC rose with increasing values of nFIT. Compared with those with two non-detectable nFIT results, the highest OR were found among those who had two high nFIT results (OR 21.75; 95% confidence interval: 12.44, 38.04) and those with one low nFIT and one high nFIT (ORs around 20). Conclusions Participants with nFIT results above the detection limit of the test had an increased risk of advanced neoplasia and IC in subsequent participations. This information could be used in the design of personalised screening strategies.

Background and objective The Colorectal Cancer Screening Program of Barcelona was implemented in December 2009 and involves pharmacies for the distribution and collection of screening tests. The aim of this article is to describe the main indicators of the first round of the Program (2010–2011), based on the ones suggested by the European Union. Material and methods The target population of the Colorectal Cancer Screening Program of Barcelona includes men and women aged 50–69 years who live in the catchment areas of Hospital Clinic and Hospital del Mar . Screening consists of biennial immunochemical fecal occult blood testing, with colonoscopy as confirmatory procedure. Results Target population comprised 197,795 persons. Participation rate was 43.6%, was higher among women and among those aged 60 and older. 2.1% of the eligible population stated to have been already screened for colorectal cancer. Overall positivity rate was 6.2%, higher among men and with a broad variability among health care areas. The detection rates of low- and high-risk adenoma, and of invasive cancer were 9.1‰, 21.7‰ and 3.1‰, respectively. 48.2% of tumors were stage I. Conclusions These results are considered satisfactory and consistent with those obtained in other programs and with European standards. Nevertheless, some areas for improvement have been identified. The high participation rate can be attributed, at least in part, to the type of test and to the involvement of community pharmacies.

The variability of total PSA (tPSA) and free PSA (fPSA) results among commercial assays has been suggested to be decreased by calibration to World Health Organization (WHO) reference materials. To characterize the current situation, it is necessary to know its impact in the critical cutoffs used in clinical practice. In the present study, we tested 167 samples with tPSA concentrations of 0 to 20 μg/L using seven PSA and six fPSA commercial assays, including Access, ARCHITECT i2000, ADVIA Centaur XP, IMMULITE 2000, Elecsys, and Lumipulse G1200, in which we only measured tPSA. tPSA and fPSA were measured in Access using the Hybritech and WHO calibrators. Passing-Bablok analysis was performed for PSA, and percentage of fPSA with the Hybritech-calibrated access comparison assay. For tPSA, relative differences were more than 10 % at 0.2 μg/L for ARCHITECT i2000, and at a critical concentration of 3, 4, and 10 μg/L, the relative difference was exceeded by ADVIA Centaur XP and WHO-calibrated Access. For percent fPSA, at a critical concentration of 10 %, the 10 % relative difference limit was exceeded by IMMULITE 2000 assay. At a critical concentration of 20 and 25 %, ADVIA Centaur XP, ARCHITECT i2000, and IMMULITE 2000 assays exceeded the 10 % relative difference limit. We have shown significant discordances between assays included in this study despite advances in standardization conducted in the last years. Further harmonization efforts are required in order to obtain a complete clinical concordance.

Background:Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor caused by a malignant transformation in the parafollicular C-cells of the thyroid, where calcitonin (CT) is released. Nowadays the main tumor markers (TM) used in the diagnosis and follow-up of MTC patients are CT and carcinoembryonic antigen (CEA). Nonetheless, progastrin releasing peptide (proGRP) has been recently proposed as a TM useful in the MTC. Our aims were to investigate the release of proGRP in thyroid tumors, its role in the assessment of advanced MTC and its utility in the differential diagnosis between MTC and non-MTC thyroid tumors.Methods:Serum samples from 22 patients with MTC and 16 with non-MTC were collected. Patients were classified into advanced cancer or no evidence of disease (NED). ProGRP was performed by Architect (Abbot Diagnostics), CT by Liaison (Diasorin) and CEA by Cobas E601(Roche Diagnostics).Results:ProGRP median concentration in advanced MTC was significantly higher (1398.4 pg/mL) when compared with non-MTC, either in advanced disease (24.9 pg/mL) or NED (14.6 pg/mL). In non-MTC patients, proGRP median concentration was below its cutoff level (50 pg/mL). Similar to CT, proGRP was able to detect 88.9% of MTC patients, but with a slightly lower specificity of 76.9%. Using proGRP together with CT the sensitivity increased to 100%.Conclusions:The low prevalence of this malignancy strongly recommends further collaborative studies, mainly focused on monitoring proGRP during tyrosine kinase inhibitors treatment for early detection of resistance and assessing its usefulness to avoid the observed false positive fluctuations that occur with CT and CEA.

Matrix metalloproteinase 7 (MMP-7) is involved in invasion, metastasis, growth, and angiogenesis. The aim of this study is to assess the prognostic role of serum MMP-7 in curatively resected colorectal cancer (CRC).Patients undergoing resection for CRC (n = 175) were recruited from July 2003 to December 2004. MMP-7 was determined using a quantitative solid phase sandwich ELISA. Cox analysis was used to assess the role of MMP-7 in predicting overall survival (OS) and disease-free survival (DFS).The median length of follow-up was 45 months (range 1 to 59). Levels of MMP-7 are predictors of DFS (hazard ratio [HR] 1.119, 95% confidence interval [95% CI] 1.038-1.207) and of OS (HR 1.113, 95% CI 1.025-1.209). Patients with MMP-7 higher than the median (4.3 ng/ml) are more likely to relapse (29.5% vs 18.4%, P = .084); median time to progression in relapsed patients is 8 months if MMP-7 isor =4.3 ng/ml and 18 months if MMP-7 is4.3 ng/ml. Node-negative patients with low MMP-7 have a predicted probability of relapse-free survival at 4 years of 88% (95% CI 83-92%); if the MMP-7 is higher than the median value; this probability is 77% (95% CI 73-81%).MMP-7 predicts recurrence in curatively resected CRC patients.

Insulin-like growth factor-I (IGF-I) is thought to have antiapoptotic and mitogenic properties in colorectal cancer, whereas IGF-binding protein-3 (IGFBP-3) seems to exert a pro-apoptotic effect. Additionally, matrix metalloproteinase-7 (MMP-7), an enzyme with in vitro ability to degrade IGFBP-3, has been shown to be a prognostic factor in advanced colorectal cancer (ACRC). We studied whether chemotherapy treatment for ACRC modulates IGF-I, IGFBP-3, and MMP-7 serum levels. In 41 patients undergoing first-line therapy for ACRC, serum levels of IGF-I, IGFBP-3, and MMP-7 were measured with immunoassays at baseline and every 3 months until progressive disease, or a maximum of five determinations, during a chemotherapy regimen of either FOLFOX or FOLFIRI therapies. Associations were assessed for paired samples, using t-test or Wilcoxon ranks test depending on normality of the variable, verified with Shapiro-Wilk test. An average of four extractions (range 3–5) were done, for a total of 157 determinations. Mean pretreatment values of IGF-I, IGFBP-3, and MMP-7 were 83 (95% CI, 73–92) ng/ml, 2372 (95% CI, 2121–2623) ng/ml, and 10.6 (95% CI, 7.21–13.98) ng/ml respectively. No significant changes in IGF-I were found, but a significant increase in IGFBP-3 serum concentrations was observed during or after chemotherapy treatment without progressive disease, compared with basal levels (PP

Background: There is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT). Objectives: To evaluate the performance of this test at distinct positivity cut-offs in a population -based colorectal cancer (CRC) screening program. Methods: CRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40 tig Hb/g) respect to a reference value (15 tig Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013). Results: At the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women 60 years increasing cut-off at 25-30 tig Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40 tig Hb/g (CRC miss rate 25%). Conclusions: To improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Metalloproteinase 7 (MMP-7) plays an important role in tumor growth, invasion and dissemination, and is secreted to the media. Because of the close implication of MMP-7 in cancer biology, we sought to define the prognostic significance of serum levels of MMP-7 in metastatic colorectal cancer (CRC) and explore its possible impact in the daily clinical practice. MMP-7 expression was determined by enzyme-linked immunoabsorbent assay. We assessed serum MMP-7 levels in 87 healthy controls, 96 patients with nonmetastatic CRC and 120 patients with advanced CRC. Clinical information was gathered from patient files. Cox proportional hazards model was used to assess survival. MMP-7 and the variables associated with prognosis were entered and a backward elimination method was employed to adjust the model. Inclusion criteria was p/= 0.05 and exclusion criteria was p/= 0.10. Advanced CRC patients have a significant higher mean serum MMP-7 levels (13.4 ng/ml) than those in nonmetastatic CRC (5.5 ng/ml; p0.001) and healthy controls (4.2 ng/ml; p0.001). In metastatic patients, after adjusting for other prognostic variables, MMP-7 (entered as a continuous variable) is associated with decreased survival (HR 1.016, IC 95% 1.002-1.031). Serum MMP-7 levels are significantly elevated in patients with advanced CRC. In conclusion, MMP-7 is an independent prognostic factor for survival in advanced CRC. In our sample, the risk of death associated to MMP-7 increase is much higher than the risk of death associated to lactate dehydrogenase elevation.

It was the aim of this study to analyze the clinical value of the determination of serum S-100beta protein in high-risk melanoma patients.Patients were tested for serum S-100beta protein by luminoimmunometric assay after melanoma surgical excision, before starting interferon-alpha2b and every 3 months thereafter, until treatment was completed.Ninety-seven patients were included in the study. Median follow-up was 62.9 months (range 32.7-87.4). High baseline S-100beta levels were associated with positive lymph node status (p = 0.02). High S-100beta levels (during therapy) showed a relation with positive lymph node status (p = 0.014), number of positive lymph nodes (p = 0.01), macroscopic lymph node involvement (p = 0.002) and second melanoma diagnosis at study entry (p = 0.001). By univariate analysis, high baseline S-100beta levels were associated with disease-free survival (p = 0.004) and overall survival (p = 0.0007). Similarly, high S-100beta levels during therapy were associated with disease-free survival (p0.0001) and overall survival (p0.0001). In the multivariate analysis, high S-100beta levels during therapy (hazard ratio 1.017, 95% CI 1.008-1.026; p0.0001) and high baseline S-100beta levels (hazard ratio 3.31, 95% CI 1.10-9.89; p = 0.032) were independent prognostic factors for overall survival when compared with low levels while on therapy and low baseline S-100beta levels, respectively.These results provide evidence of the clinical usefulness of serum S-100beta level determination in high-risk melanoma patients. S-100beta serum determination should be considered to be included in clinical trials that test adjuvant therapies in melanoma patients.

The utility of faecal immunochemical tests (FIT) in assessment of symptomatic patients with lower gastrointestinal symptoms has not been well explored. The aims of this study were to evaluate the diagnostic yield for advanced colorectal neoplasia (ACRN) in symptomatic patients using the first of two FIT samples (FIT/1) and the higher concentration of two FIT samples (FIT/max).Samples from two consecutive bowel motions from 208 symptomatic patients who required colonoscopy were analysed using the HM-JACKarc analyser (Kyowa Medex Co., Ltd., Tokyo, Japan). Patients were categorised into two groups: patients with any ACRN and individuals with other diagnoses or normal colonoscopy.Colonoscopy detected ACRN in 29 patients. In these patients, FIT/1 and FIT/max were significantly higher than in patients with low-risk adenoma (p=0.006 and p=0.024), other findings (p=0.002 and p=0.002) and normal colonoscopy (pUndetectable FIT is a good strategy to rule-out ACRN in symptomatic patients. The diagnostic yield of collecting two samples for FIT can be achieved with one sample, but a lower faecal haemoglobin concentrations (f-Hb) cut-off is required.

Introduction and objectives Intravascular ultrasound (IVUS) studies in conventional stent angioplasty with predilatation have demonstrated that late luminal narrowing is caused by neointimal proliferation. In the present study, we analyzed the degree and distribution of in-stent neointimal proliferation after direct stent implantation and aimed to identify variables that predict a proliferative response. Material and method We studied 45 patients who underwent successful stent implantation without predilatation and 23 patients with similar clinical and angiographic characteristics who underwent conventional stent angioplasty with predilatation. IVUS imaging was performed at 7.85±2.81 months. The cross-sectional area was measured at five predetermined points in the stented coronary segment. The inflation pressure used in patients who underwent direct stent implantation was higher than that employed in those who underwent conventional angioplasty with predilatation (13±3 atm vs 10±2 atm; P = .005). Results Luminal and stent cross-sectional areas were greater in the group that did not undergo predilatation than in the group that did. Neointimal proliferation in the 5 sections analyzed along the axis of the stent was similar in the 2 groups. There was a weak linear relationship between the amount of plaque outside the stent and neointimal proliferation in both the group that underwent predilatation ( r = 0.37; P = .005) and the group that did not ( r = 0.33; P = .005). Conclusions As with conventional angioplasty, the neointimal proliferation that occurred after direct stent implantation showed a diffuse homogeneous pattern along the length of the stent. There was a weak correlation between this proliferative response and the amount of plaque outside the stent.

Introduccion y objetivos En la implantacion de stent con predilatacion la ecografia intracoronaria ha demostrado que la reduccion luminal tardia se debe a la proliferacion neointimal. En la presente serie analizamos el grado y la distribucion de la proliferacion neointimal intra-stent despues de la implantacion sin predilatacion, asi como las variables implicadas en esta respuesta proliferativa. Material y metodo Se analizo a 45 pacientes despues de la implantacion exitosa de un stent sin predilatacion y 23 pacientes con lesiones de caracteristicas clinicas y angiograficas similares despues de la implantacion de un stent con predilatacion. La ecografia intracoronaria en el seguimiento se realizo a los 7,85 ± 2,81 meses. Se midieron las areas transversales (AT) en 5 segmentos predeterminados del segmento con stent. En el grupo de stent directo se empleo una presion de hinchado mayor que en el grupo con predilatacion (13 ± 3 atm frente a 10 ± 2 atm; p = 0,005). Resultados Los AT luminal y del stent fueron mayores en el grupo sin predilatacion que en el grupo con predilatacion. La proliferacion neointimal en los 5 segmentos a lo largo del eje axial del stent fue similar en los dos grupos. Se observo una ligera relacion lineal entre la placa fuera del stent y la proliferacion neointimal en el grupo con predilatacion (r = 0,37; p = 0,005) y sin predilatacion (r = 0,33; p = 0,005). Conclusiones De forma similar a la angioplastia convencional, en el stent directo la respuesta neointimal presenta un patron difuso y homogeneo a lo largo del eje longitudinal del stent. Esta respuesta proliferativa se correlaciono ligeramente con la placa excluida por el stent.

Introduccion y objetivos Se desconoce como son tratados y como evolucionan los pacientes ancianos con infarto agudo de miocardio atendidos en hospitales espanoles que realizan angioplastia primaria (AP). Pacientes y metodo Registro prospectivo de pacientes ≥75 anos ingresados por infarto agudo de miocardio con elevacion del segmento ST en hospitales espanoles que tienen un programa activo de AP (abril-julio de 2002). Resultados Se estudio a 410 pacientes consecutivos con un seguimiento de 1 mes. La edad media fue de 80 ± 4,3 anos y un 46% era mujer. La mediana de retraso desde el inicio de los sintomas a la llegada al hospital fue de 190 min. El 42% de los pacientes no recibio tratamiento de reperfusion, el 35% fue tratado con trombolisis y el 22% con angioplastia primaria. Los pacientes que recibieron tratamiento de reperfusion eran mas jovenes, con mas frecuencia varones, llegaron con menor retraso desde el inicio de los sintomas al hospital, tenian una situacion hemodinamica inicial (clase Killip) mas favorable, pero se trataba con mayor frecuencia de infartos anteriores y mas extensos. La mortalidad a los 30 dias fue de 24,9%; fueron predictores independientes de ella la edad, la presion arterial sistolica y la clase de Killip > 1, pero no el uso de fibrinoliticos ni de AP. Conclusiones El 42% de los ancianos con infarto agudo de miocardio que ingresan en hospitales espanoles con programa de AP no recibe tratamiento de reperfusion. La fibrinolisis fue el tratamiento de reperfusion mas empleado. La fibrinolisis y la AP no se asociaron con mejoria del pronostico de mortalidad a los 30 dias.

Introduction and objectives The nature and outcome of treatment for acute myocardial infarction in elderly patients admitted to Spanish hospitals with primary angioplasty facilities are not well documented. Patients and method Prospective analysis of registry data on patients ≥75 years old with ST-segment-elevation acute myocardial infarction admitted between April and July 2002 to Spanish hospitals with an active primary angioplasty program. Results We followed up 410 consecutive patients for 1 month. Their mean age was 80 (4.3) years and 46% were female. The median delay between symptom onset and arrival at hospital was 190 minutes. Around 42% of patients received no reperfusion therapy, 35% were treated by thrombolysis, and 22% by primary angioplasty. Patients who underwent reperfusion therapy were younger, were more frequently male, had a shorter delay from symptom onset to hospital arrival, and had a better initial hemodynamic status (Killip Class). However, they were more likely to have extensive anterior infarctions. Overall, 30-day mortality was 24.9%. Independent predictors of death were age, systolic blood pressure, and Killip class >1, but not use of thrombolysis or primary angioplasty. Conclusions Over 42% of elderly patients with myocardial infarction admitted to Spanish hospitals with angioplasty facilities did not receive reperfusion therapy. Thrombolysis was the most frequently used reperfusion therapy. However, neither thrombolysis nor primary angioplasty improved 30-day mortality.

Introduccion y objetivos. El numero de pacientes de edad avanzada que presenta un infarto agudo de miocardio (IAM) se incrementara en los proximos anos, sin que se conozca en la actualidad cual es la mejor forma de reperfusion. Pacientes y metodo. El Registro TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) se diseno para analizar la factibilidad de efectuar un estudio aleatorizado en Espana para comparar la eficacia del intervencionismo coronario percutaneo (ICP) con la trombolisis en el tratamiento del IAM en pacientes de edad avanzada (= 75 anos). El subregistro TRIANA 1 evaluo a todos los pacientes consecutivos, con independencia de la edad, en los que se efectuaba un procedimiento de ICP en IAM con ST elevado (= 12 h de evolucion) en una serie de hospitales seleccionados. Resultados. En el subregistro TRIANA 1 se incluyo a 459 pacientes en 25 hospitales en un periodo de 3 meses. Un 11% de los pacientes se presentaron en shock cardiogenico. En un 15% la indicacion del ICP fue por contraindicacion a la trombolisis y en un 24%, por rescate. Se obtuvo un flujo TIMI 3 sin estenosis residual significativa post-ICP en el 83% de los pacientes. La mortalidad al mes fue del 10,8%. El analisis multivariado identifico la presencia de shock cardiogenico en el ingreso (odds ratio [OR] = 7,2; IC del 95%, 2,2-23,3), la edad (OR = 1,05 por ano; IC del 95%, 1,005-1,100), el valor maximo de CK-MB (OR = 1,01; IC del 95%, 1,004-1,270) y el flujo TIMI < 3 post-ICP en la arteria causante (OR = 2,8; IC del 95%; 1,0-8,3) como factores predictivos independientes de la mortalidad. De los 104 pacientes incluidos con una edad = 75 anos (mortalidad del 24%), 58 pacientes (55,7%) cumplian criterios potenciales para ser incluidos en un estudio aleatorizado. Conclusiones. 1) El Registro TRIANA 1 traduce posiblemente la realidad del ICP en el IAM en Espana y sugiere una seleccion en los pacientes tratados. 2) La mortalidad se asocio a factores predictivos clasicos. 3) La mitad de los pacientes = 75 anos expuestos a ICP primario serian potencialmente incluibles en un estudio aleatorizado. Estos datos apoyan la viabilidad de la realizacion de un estudio para determinar la mejor estrategia de reperfusion en pacientes ancianos con IAM.

Introduction and objectives Non-invasive coronary artery angiography by 16 multidetector-row spiral computed tomography is a novel diagnostic tool whose reliability is still unclear. The aim of our study was to compare this technique with invasive coronary angiography. Patients and method A total of 31 selected patients were examined with both angiographic methods. Non-invasive studies were performed with a helical computed tomography system (Toshiba Aquilion 16). A contrast agent was injected into a peripheral vein, and cross-sectional images were reconstructed with a slice thickness of 0.5 mm or 1.0 mm. Findings from both techniques were analyzed according to a predetermined segmented anatomical model of the coronary artery. The detection and relevance of coronary artery lesions were evaluated, and lesions with a reduction in diameter of more than 50% were considered significant. Results Non-invasive coronary angiography yielded an appropriate assessment in 88.4% of the coronary artery segments. The reasons that prevented correct segment evaluation were extensive coronary calcifications, inappropriate breath-hold, motion artifacts and small vessel size. Sensitivity and specificity for the detection of significant coronary lesions with the non-invasive method were 75% and 91%, respectively. Sensitivity and specificity for individual coronary artery segments were as follows: proximal, 89% and 93%; medial, 87% and 90%; distal, 50% and 90%; and main branches, 62% and 92%. Conclusions Non-invasive coronary artery angiography with 16 multidetector-row computed tomography is a powerful diagnostic tool, especially for the evaluation of the proximal and medial segments of the major coronary arteries.

Introduccion y objetivos La coronariografia no invasiva mediante tomografia computarizada con 16 detectores es una herramienta diagnostica de reciente aparicion cuya fiabilidad esta por determinar. El objetivo del presente estudio es la comparacion entre esta tecnica y la coronariografia invasiva. Pacientes y metodo Se estudio a 31 pacientes por ambas tecnicas. El estudio no invasivo se realizo con un equipo Toshiba Aquilion 16. Se realizo una toma helicoidal del volumen cardiaco durante una apnea, inyectandose contraste en una vena periferica y reconstruyendo posteriormente las imagenes con cortes de 0,5 o 1 mm. Ambas coronariografias fueron evaluadas segun un modelo anatomico predefinido de segmentacion del arbol coronario. Se analizaron la presencia y la magnitud de las lesiones coronarias, considerando significativas las estenosis > 50%. Resultados La coronariografia no invasiva permitio evaluar el 88,4% de los segmentos analizados por coronariografia convencional. Las causas de no evaluacion de un segmento fueron: presencia extensa de calcio parietal coronario, apnea incorrecta, artefacto de movimiento y reducido calibre del segmento estudiado. La sensibilidad y la especificidad global de la coronariografia no invasiva para la deteccion de lesiones coronarias significativas fueron del 75 y del 91%, respectivamente. Los valores de sensibilidad y especificidad para los distintos segmentos coronarios considerados independientemente fueron: proximales, 89 y 93%; medios, 87 y 90%; distales, 50 y 90%, y ramas secundarias, 62 y 92%. Conclusiones La coronariografia no invasiva mediante tomografia computarizada con 16 detectores muestra un elevado poder diagnostico, en especial en las lesiones proximales y medias de los principales troncos coronarios.

Introduccion y objetivos La cirugia de derivacion aortocoronaria ha sido considerada el tratamiento de eleccion de la estenosis del tronco comun. Diversos estudios multicentricos sugieren la posibilidad de la angioplastia con stent. El objetivo del presente estudio fue analizar los resultados inmediatos y a largo plazo de la angioplastia con stent en el tronco comun, asi como identificar los factores predictores de mortalidad. Pacientes y metodo Se incluyo a 38 pacientes no consecutivos de 69 ± 8 anos de edad con una lesion severa del tronco comun a los que se implanto un stent entre noviembre de 1997 y marzo del 2003. La indicacion de la angioplastia fue «electiva» en 27 pacientes y «urgente » en los 11 restantes. El tronco comun no estaba protegido en 23 pacientes (60,5%). En todos los pacientes se realizo el seguimiento clinico a los 25 ± 20 meses. Resultados En todos los pacientes, el procedimiento angiografico se realizo con exito. Un paciente presento una oclusion aguda 1 h despues. En 4 pacientes (10%) se produjo un infarto de miocardio no transmural. La mortalidad hospitalaria fue del 15,8%. En el grupo con indicacion urgente, 5 de 11 pacientes (45,4%) fallecieron por fallo cardiaco severo (clase Killip III-IV) en el contexto de un infarto agudo de miorcadio. En cambio, solo fallecio 1 de los 27 pacientes (3,7%) del grupo electivo (p = 0,007). Durante el seguimiento se produjeron eventos clinicos mayores en 5 pacientes (13%): 3 fallecieron y los 2 restantes presentaron recurrencia de la angina. Todos los pacientes que fallecieron tenian el tronco comun desprotegido. La probabilidad acumulada de supervivencia para el grupo electivo fue del 92 ± 0,5, 88 ± 0,6 y 86 ± 0,7% a los 6 meses, 1 y 3 anos, respectivamente. En cambio, para el grupo urgente fue del 54 ± 0,2% a partir del sexto mes (p Conclusiones La angioplastia con stent del tronco comun en pacientes seleccionados se asocia con una elevada tasa de exito inmediato. En la angioplastia electiva, la incidencia de eventos cardiacos durante el seguimiento es relativamente baja. La angioplastia urgente y la presencia de signos de disfuncion ventricular izquierda son los principales predictores de mortalidad.

CEA, CA 125, SCC, CYFRA 21-1 and NSE were prospectively studied in 211 patients with non-small cell lung cancer and compared with clinical parameters (age, sex, Karnofsky Index, symptoms and smoking status), histopathological parameters (stage, histology, tumor size and nodal involvement), biological parameters (LDH and albumin) and the therapy used (surgery, chemotherapy or radiotherapy). Tumor marker sensitivity was CYFRA 21-1: 76%, CA 125: 55%, CEA: 52%, SCC: 33% and NSE: 22%. One of the tumor markers was abnormally high in 87% of the patients with locoregional disease and in 100% of the patients with metastases. Except for NSE, all tumor markers showed a clear relationship with tumor stage and histology and therefore enabled a better histological diagnosis. Abnormal CEA serum levels were mainly found in adenocarcinomas, CA 125 in large-cell lung cancers (LCLC) and adenocarcinomas and SCC in squamous tumors. Eighty-five percent of the patients with SCC levels >2 ng/ml had squamous tumors. Likewise, CA 125 levels

Impairment of endothelium-dependent vasodilatation in response to acetylcholine reflects an abnormal endothelial function. Labelled indium-111 monoclonal antimyosin antibodies enable detection of myocardial cell damage. We analysed whether endothelial dysfunction correlates with myocardial antimyosin uptake in a selected group of patients with idiopathic dilated cardiomyopathy. Methods: Twenty-two consecutive patients with chronic stable idiopathic dilated cardiomyopathy (18 males and four females) were included. The duration of heart failure symptoms was 46±34 months. At inclusion, the functional class of New York Heart Association was 2.1±0.7. Endothelial function was evaluated using intracoronary graded concentrations of acetylcholine. Vasomotor responses of the left anterior descending coronary artery were measured by quantitative coronary analysis. Myocardial uptake of antimyosin antibodies was quantified by means of a heart-to-lung ratio (HLR). Results: Eighteen patients showed endothelial dysfunction (82%) and the remaining four patients showed a normal endothelial function. There were no statistically significant differences between patients with and without endothelial dysfunction in relation to clinical, echocardiographic and hemodynamic parameters. In addition, these variables did not correlate with the magnitude of the vasomotor response to acetylcholine. Eighteen patients (82%) showed abnormal antimyosin uptake; 15 of them (83%) showed endothelial dysfunction. The global mean HLR of antimyosin uptake was 1.73±0.24. The coronary vasomotor response to acetylcholine correlated with the intensity of uptake of antimyosin antibodies ( r =−0.45, P Conclusions: Coronary endothelial dysfunction and myocardial antimyosin uptake was found in a high percentage of patients with chronic stable idiopathic dilated cardiomyopathy. The abnormal vasomotor response seems to be related to the degree of myocardial damage.

Prostate health index (phi), a measure calculated as p2PSA/fPSA × √tPSA, has shown valuable results in the detection of prostate cancer (PCa), improving the prediction of the aggressiveness of the tumor. The aim of our study was to test whether prostate volume influences phi performance using univariate and multivariate models. 220 patients with PSA10 μg/L (102 with negative biopsy and 118 with PCa) were included in the study. Serum concentrations of tPSA, fPSA and p2PSA were measured on Access2 analyzer. The higher accuracy was found for phi, obtaining an AUC of 0.748. Bigger AUCs were obtained for phi, %p2PSA, %fPSA and tPSA in patients with small prostate volume (≤35 cc); meanwhile, the lowest AUCs were found in patients with large prostate volume (50 cc). Including phi and %p2PSA in a multivariable analysis based on patient age, prostate volume, tPSA, and %fPSA accuracy increased from 0.762 to 0.802 (logistic regression model) or 0.815 (artificial neural network). Accuracy excluding prostate volume in these models was 0.762 and 0.775, respectively. The inclusion of phi and %p2PSA in a multivariate model identifies better men with PCa. Prostate volume remains a key factor in the interpretation of biomarkers used to detect PCa.

The Colorectal Cancer Screening Program of Barcelona was implemented in December 2009 and involves pharmacies for the distribution and collection of screening tests. The aim of this article is to describe the main indicators of the first round of the Program (2010-2011), based on the ones suggested by the European Union.The target population of the Colorectal Cancer Screening Program of Barcelona includes men and women aged 50-69 years who live in the catchment areas of Hospital Clínic and Hospital del Mar. Screening consists of biennial immunochemical fecal occult blood testing, with colonoscopy as confirmatory procedure.Target population comprised 197,795 persons. Participation rate was 43.6%, was higher among women and among those aged 60 and older. 2.1% of the eligible population stated to have been already screened for colorectal cancer. Overall positivity rate was 6.2%, higher among men and with a broad variability among health care areas. The detection rates of low- and high-risk adenoma, and of invasive cancer were 9.1 ‰, 21.7 ‰ and 3.1 ‰, respectively. 48.2% of tumors were stage i.These results are considered satisfactory and consistent with those obtained in other programs and with European standards. Nevertheless, some areas for improvement have been identified. The high participation rate can be attributed, at least in part, to the type of test and to the involvement of community pharmacies.

The cutting balloon is a new device for coronary angioplasty, which, by the combination of incision and dilatation of the plaque, is believed to minimize arterial wall trauma, the neoproliferative response, and subsequent restenosis. In this study, we sought to determine predictors of the restenosis using this technique. Seventy-seven patients underwent successful coronary angioplasty with cutting balloon alone. In 67 of these patients (87%), we performed a control angiogram at 6-month follow-up. Pre-, post-, and late angiographic results were evaluated by quantitative coronary analysis. Clinical and angiographic variables were correlated with restenosis as a binary variable and a continuous variable (late loss and late minimum luminal diameter). Univariate analysis showed that the immediate postprocedure minimum luminal diameter (MLD) was smaller in the restenotic group (defined as MLD > 50% by quantitative coronary angiography) than in the nonrestenotic group (1.90 +/- 0.47 mm vs. 2.19 +/- 0.56 mm, P < 0.05). In addition, the immediate percentage of stenosis was higher in the restenotic group than in the nonrestenotic group (37% +/- 10% vs. 27% +/- 11%, P < 0. 003). Multivariate analysis identified the immediate postcutting balloon percentage of stenosis as an independent determinant of binary restenosis (P < 0.008). When restenosis was defined as a continuous variable, the immediate postprocedure MLD was an independent predictor of late loss (P < 0.02) and of late MLD (P < 0. 0002). No clinical, preprocedure angiographic, or technical variables tested were associated with restenosis. The degree of postprocedural residual stenosis after cutting balloon angioplasty is predictive of late restenosis.

Introduccion y objetivos El stentintracoronario Multi-Link es un cilindro de acero inoxidable compuesto de anillos con multiples enlaces que proporcionan flexibilidad y adaptabilidad conservando la fuerza radial. Presentamos los resultados de nuestra experiencia inicial con la utilizacion de este stent. Pacientes y metodos Entre mayo de 1996 y abril de 1997 se implantaron 124 stentsMulti-Link consecutivos con el sistema monorrail en 97 pacientes. La edad media fue de 62,2 ± 11 anos. Todos los pacientes incluidos tenian un diametro de arteria superior a 2,7 mm. La clinica que motivo su implantacion fue angina estable en 20 pacientes, inestable en 72 e infarto de miocardio en 5. Segun la clasificacion de la ACC/AHA las lesiones eran tipo A en 6 pacientes, tipo B en 72 y tipo C en 19. La indicacion de la implantacion fue en lesiones arteriales «de novo» en 85 pacientes y en lesiones reestenoticas en 12. El tratamiento despues del procedimiento fue ticlopidina y acido acetilsalicilico en todos los pacientes excepto en 6 que recibieron acenocumarol y acido acetilsalicilico. Dieciseis enfermos fueron tratados concomitantemente con Abciximab. El grado de estenosis se determino mediante angiografia cuantitativa. Resultados La colocacion del stentfue se realizo con exito en todos los pacientes. El porcentaje de estenosis antes del procedimiento, del 79,6 ± 13,1%, disminuyo despues de la implantacion del stental 17,7 ± 11,4%. Las complicaciones fueron infarto de miocardio sin onda Q en tres pacientes. Dos enfermos presentaron una trombosis subaguda del stent, falleciendo uno de ellos por insuficiencia cardiaca. Durante el seguimiento clinico de 4,7 ± 2,6 meses, cinco enfermos reingresaron por recurrencia de la angina (4 por reestenosis y 1 por oclusion del vaso) y un paciente con insuficiencia cardiaca postinfarto agudo de miocardio presento una muerte subita a las tres semanas del procedimiento. Conclusiones El stentMulti-Link se implanto con exito en todos los pacientes con una baja incidencia de complicaciones, presentando en el seguimiento una reducida tasa de reestenosis clinica.

The latest generation of fecal immunochemical tests (FIT) allows for quantitation of hemoglobin in feces, allowing for selection of optimal cut-off concentrations. We investigated whether individuals with positive results from quantitative FITs, in combination with other factors, could be identified as being at greatest risk for advanced colorectal neoplasia.In a retrospective study, we analyzed data from a consecutive series of 3109 participants with positive results from FITs (≥20 μg/g of feces) included in the first round of the Barcelona colorectal cancer screening program, from December 2009 through February 2012. All participants underwent colonoscopy and were assigned to groups with any advanced colorectal neoplasia or with nonadvanced colorectal neoplasia (but with another diagnosis or normal examination findings).Median fecal hemoglobin concentrations were significantly higher in participants with advanced colorectal neoplasia (105 μg/g; interquartile range, 38-288 μg/g) compared with participants with nonadvanced colorectal neoplasia (47 μg/g; interquartile range, 23-119 μg/g) (P.001). Positive predictive values for advanced colorectal neoplasia, determined using arbitrary fecal hemoglobin concentrations, differed with sex and age. Multivariate logistic regression analysis identified sex (men: odds ratio [OR], 2.07; 95% confidence interval, 1.78-2.41), age (60-69 y: OR, 1.24; 95% confidence interval, 1.07-1.44), and fecal hemoglobin concentration (177 μg/g: OR, 3.80; 95% confidence interval, 3.07-4.71) as independent predictive factors for advanced colorectal neoplasia. Combining these factors, we identified 16 risk categories associated with different probabilities of identifying advanced colorectal neoplasia. Risk for advanced colorectal neoplasia increased 11.46-fold among individuals in the highest category compared with the lowest category; positive predictive values ranged from 21.3% to 75.6%.Fecal hemoglobin concentration, in addition to sex and age, in individuals with positive results from FITs can be used to stratify probability for the detection of advanced colorectal neoplasia. These factors should be used to prioritize individuals for colonoscopy examination.

BACKGROUND %p2PSA and prostate health index (phi) has shown valuable results in the detection of prostate cancer (PCa), improving the prediction of the aggressiveness of the tumor. The goal of the present study was to evaluate %p2PSA and phi in the detection of PCa, estimating their relationship with the aggressiveness of PCa. METHODS A total of 354 patients with positive or negative prostatic biopsy were included. Prospectively, 150 were enrolled and 204 were enrolled retrospectively proceeding from our serum bank. RESULTS The best performance was observed for %p2PSA and phi, obtaining an AUC of 0.723 and 0.732, respectively. The highest specificity at sensitivity around 90% was obtained for phi (27.4%). Using the cut-off of 31.94 for phi, a reduction of 19% biopsies could be obtained, while 17 PCa would have been missed, including only four patients with a Gleason score ≥7. Similarly, using a cut-off of 1.21 for %p2PSA, a reduction of 12.7% biopsies could be obtained, while 16 PCa would have been missed, including only four patients with a Gleason score ≥7. Moreover, among patients with PCa, phi (median: 69.75 vs. 48.04) and %p2PSA (median: 2.60 vs. 1.98) values are significantly higher (p

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perforation in a distal branch of the right coronary artery caused by the coronary guidewire tip, and complicated by acute cardiac tamponade. Blood extravasation to the pericardium was stopped by releasing two metallic coils into the distal vessel, thereby avoiding the need for emergent cardiac surgery.

La perforacion coronaria con la guia de angioplastia es una complicacion rara que puede ocasionar taponamiento cardiaco, infarto, arritmias e incluso la muerte. La utilizacion de farmacos inhibidores de los receptores glucoproteicos IIb/IIIa de las plaquetas aumenta considerablemente el riesgo de complicaciones agudas y dificulta el manejo terapeutico. Describimos el caso de un paciente tratado con abciximab que durante la angioplastia presento una perforacion en una rama distal de la arteria coronaria derecha producida con la punta de la guia, que se complico con taponamiento cardiaco agudo. El sangrado al pericardio se resolvio mediante la liberacion de 2 coils o espirales metalicas en la luz distal del vaso perforado, y se evito la cirugia emergente

Although widely used, the value of prostate-specific antigen (PSA) in the detection of prostate cancer is controversial. The percentage of free PSA increases the specificity of PSA, but results are not enough. Prostate cancer gene 3 (PCA3) has been proposed as an option that may complement these markers in the detection and management of early prostate cancer. Our aim has been to review the value of PCA3 as tumor marker. The available results suggest that PCA3 is particularly useful to select in which patients the biopsy should be repeated when the first biopsy was negative. However, some points should be specified with further studies, including the most appropriate PCA3 cutoff level and the significance of a high PCA3 score in patients with negative biopsy. False-negative results are also a conflictive point in the use of PCA3, because prostate cancer, including aggressive tumors, may be present in patients with a low PCA3 score. Probably, a proper interpretation of this test requires its management together with other tests, through multivariate models for the detection of prostate cancer. On the other hand, several studies showed the relation between PCA3 score and Gleason score, and also the utility of PCA3 to select patients for active surveillance. To summarize, the available studies show the utility of PCA3 in the detection and management of early prostate cancer, although some aspects referred to its use need to be retested after further studies to confirm the actual value and the limitations of this test.