Prognostic models for locally advanced cervical cancer: external validation of the published models

David Lora,Agustín Gómez de la Cámara,Sara Pedraza Fernández,Rafael Enríquez de Salamanca,José Fermín Pérez-Regadera Gómez 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.5

Objective: To externally validate the prognostic models for predicting the time-dependentoutcome in patients with locally advanced cervical cancer (LACC) who were treated withconcurrent chemoradiotherapy in an independient cohort. Methods: A historical cohort of 297 women with LACC who were treated with radicalconcurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital(H12O), Madrid, Spain. The external validity of prognostic models was quantified regardingdiscrimination, calibration, measures of overall performance, and decision curve analyses. Results: The review identified 8 studies containing 13 prognostic models. Different(International Federation of Gynecology and Obstetrics [FIGO] stages, parametriuminvolvement, hydronephrosis, location of positive nodes, and race) but related cohorts withvalidation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%;average age of 50; and over 79% squamous cell) were evaluated. The following models exhibitedgood external validity in terms of discrimination and calibration but limited clinical utility: theOS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristiccurve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models ofDFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 yearsfrom Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrencemodel at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%). Conclusion: The external validation revealed the statistical and clinical usefulness of 4prognostic models published in the literature.

Diagnostic Yield and Therapeutic Impact of Rectal Retroflexion: A Prospective, Single-Blind Study Conducted in Three Centers

Félix Téllez-Ávila,Josué Barahona-Garrido,Sandra García-Osogobio,Gustavo López-Arce,Jesús Camacho-Escobedo,Angela Saúl,Salvador Herrera-Gómez,Javier Elizondo-Rivera,Rafael Barreto-Zúñiga 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.1

Background/Aims: No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination. Methods: A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. Results: A total of 934 patients (542 women [58%]) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. Conclusions: Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

Evaluation of the effect of D-002, a mixture of beeswax alcohols, on osteoarthritis symptoms

Roberto Puente,José Illnait,Rosa Mas,Daisy Carbajal,Sarahí Mendoza,Julio César Fernández,Meilis Mesa,Rafael Gámez,Pablo Reyes 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.2

Background/Aims: Nonsteroidal anti-inflammatory drugs relieve osteoarthritis(OA) symptoms but cause adverse effects. D-002, a mixture of beeswax alcohols,is effective against experimental OA. A pilot study found that D-002 (50 mg/day)for 8 weeks improves OA symptoms. The aim of this study was to investigate theeffects of D-002 (50 to 100 mg/day) administered for 6 weeks on OA symptoms. Methods: Patients with OA symptoms were double-blindly randomized to D-002(50 mg) or placebo for 6 weeks. Symptoms were assessed by the Western Ontarioand McMaster Individual Osteoarthritis Index (WOMAC) and the visual analogscale (VAS) scores. Patients without symptom improvement at week 3 were titratedto two daily tablets. The primary outcome was the total WOMAC score. WOMACpain, joint stiffness and physical function scores, VAS score, and use of rescuemedications were secondary outcomes. Results: All randomized patients (n = 60) completed the study, and 23 experienceddose titration (two in the D-002 and 21 in the placebo groups). At study completion,D-002 reduced total WOMAC (65.4%), pain (54.9%), joint stiffness (76.8%), andphysical function (66.9%) WOMAC scores, and the VAS score (46.8%) versusplacebo. These reductions were significant beginning in the second week, andbecame enhanced during the trial. The use of rescue medication by the D-002(6/30) group was lower than that in the placebo (17/30) group. The treatment waswell tolerated. Seven patients (two in the D-002 and five in the placebo group)reported adverse events. Conclusions: These results indicate that D-002 (50 to 100 mg/day) for 6 weeksameliorated arthritic symptoms and was well tolerated.

Molecular detection and phylogenetic analyses of Arsenophonus endosymbiont in wild specimens of phlebotomine sand flies from Colombia

Duque Granda Daniela,Ximena Moreno Herrera Claudia,Ester Cadavid-Restrepo Gloria,José Vivero-Gómez Rafael 한국응용곤충학회 2023 Journal of Asia-Pacific Entomology Vol.26 No.1

Endosymbionts have gained prominence as a potential tool for biological control strategies in reducing vectorborne diseases. This study aimed to evaluate the presence of Arsenophonus, Spiroplasma, and Rickettsia endo symbionts in wild specimens of phlebotomine sand flies, as well as in culicids collected in different regions of Colombia. Analyses were conducted through conventional PCR, Sanger sequencing of the 16S rRNA gene, and phylogenetic analyses. Individuals from among 946 phlebotomine sand flies and 143 mosquitoes were selected for taxonomic identification confirmed through the analysis of the cytochrome oxidase subunit I gene sequences. Results showed the presence of Arsenophonus bacteria in samples of Lutzomyia longipalpis, Psychodopygus pan amensis, and Pintomyia evansi. Arsenophonus sequences associated with Lu. longipalpis and Ps. panamensis are phylogenetically located near to sequences of louse flies, with K2P genetic distances of 0.006. In contrast, se quences obtained from Pi. evansi are phylogenetically located near Arsenophonus nasoniae (K2P 0.001–0.014). Other sequences of endosymbionts similar to Arsenophonus with high K2P genetic distances (0.056–0.097), when compared to different reference strains of this endosymbiont, were also found in other samples of Lu. longipalpis and Ae. aegypti. To the best of our knowledge, this is the first successful attempt to detect and elucidate the phylogenetic relationship of Arsenophonus in phlebotomine sand flies, yet its role within these insect vectors remains to be fully determined; therefore, the importance of entomological surveys that help better understand its behavior and potential use as a control agent is required to enable the proactive reduction of sand fly populations.

Effects of D-002, a mixture of high molecular weight beeswax alcohols, on patients with nonalcoholic fatty liver disease

José Illnait,Iván Rodríguez,Sarahí Mendoza,Yolanda Fernández,Rosa Mas,Mirtha Miranda,Jesús Piñera,Julio César Fernández,Meilis Mesa,Lilia Fernández,Daisy Carbajal,Rafael Gámez 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.4

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is intimately related to insulin resistance and ranges from a benign course to liver fibrosis and cirrhosis. NAFLD management mainly involves dietary modification and weight loss. Although no fully successful pharmacological intervention is available, alternative therapies to treat NAFLD have shown promising results. Experimental studies have shown that D-002, a mixture of beeswax alcohols with antioxidant effects, is hepatoprotective. The aim of this study was to investigate the efficacy and safety of D-002 in patients with NALFD. Methods: Fifty patients with NAFLD were randomized to receive a placebo or D-002 (100 mg/day) for 24 weeks. The primary endpoint was a significant ultrasonography-detected reduction of liver fat infiltration versus a placebo. Secondary endpoints were decreases in the homeostatic model assessment (HOMA) index,insulin levels, serum liver enzymes, increases in plasma total antioxidant status (TAS) and improved clinical symptoms versus the placebo recipients. Results: At randomization, all indicators were comparable in both groups. At study completion, seven (28.0%) D-002-patients, but none of the placebo recipients,exhibited a normal liver echo pattern on ultrasonography (p < 0.01). Also,D-002 significantly reduced (p < 0.01 vs. baseline and placebo) the HOMA index and insulin levels and increased the TAS, but did not affect other parameters. The proportion of D-002-patients (12/25, 48.0%) showing symptom improvement was higher (p < 0.001) than that of the placebo group (1/25, 4.0%). The treatment was safe and well tolerated. Three patients in each group withdrew from the study. Conclusions: D-002 (100 mg/day) improved ultrasonographic findings, indicators of insulin resistance, plasma TAS and clinical evolution on NAFLD patients. Further studies, however, are needed to confirm these results.