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Alba E.,Hospital Universitario Virgen Of La Victoria | Albanell J.,H. del Mar | De la Haba J.R.,Hospital Reina Sofia | Arcusa Lanza A.,Consorci Sanitari de Terrassa | And 6 more authors.
Annals of Oncology | Year: 2012

Background: Luminal breast cancer is a highly endocrine responsive disease. However, the therapeutic benefit of chemotherapy (CT) in this population is not fully characterized. This study investigates the value of CT and hormone therapy (HT) in luminal breast cancer patients in the neoadjuvant setting. Patients and Methods: Patients with operable breast cancer and immunophenotypically defined luminal disease (ER+/PR+/HER2-/cytokeratin 8/18+) were recruited. Patients were randomized to CT (epirubicin 90 mg/m. 2 plus cyclophosphamide 600 mg/m. 2 × 4 cycles followed by docetaxel 100 mg/m. 2× 4 cycles [EC-T]) or HT (exemestane 25 mg daily × 24 weeks [combined with goserelin in premenopausal patients]). The primary end point was the clinical response measured by magnetic resonance imaging. Results: Ninety-five patients were randomized (47 CT, 48 HT). The clinical response rate was 66% for CT and 48% for HT (P = 0.075). We performed an unplanned analysis based on Ki67 levels (cut-off of 10%). Similar clinical response was seen between arms in patients with low Ki67 (CT: 63%, HT: 58%; P = 0.74); patients with high Ki67 had a better response with CT (67 versus 42%; P = 0.075). Grade 3/4 toxicity was more frequent with CT. Conclusions: Luminal immunophenotype is not enough to identify patients who do not benefit from neoadjuvant CT. Luminal patients with low proliferation index could potentially avoid CT. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Alvarez P.,Center Forum | Urretavizcaya M.,Hospital de Bellvitge | Benlloch L.,Consorci Sanitari de Terrassa | Vallejo J.,Hospital de Bellvitge | Menchon J.M.,Hospital de Bellvitge
International Journal of Geriatric Psychiatry | Year: 2011

Objective Several studies have reported clinical and biological differences between early- and late-onset (EO and LO) depression, which suggest different underlying aetiological processes. The aim of the present study is to examine whether there are differences between EO and LO depressed patients with melancholy, controlling for current age, with regard to clinical variables, vascular risk factors and family history of affective disorders or suicide. Methods One hundred and twenty-one melancholic patients were divided into three groups: patients with current age and onset earlier than 60 (N = 60), patients aged 60 or over and with onset at 60 or later (N = 30) and patients aged 60 or over and with onset before the age of 60 (N = 31). Systematic clinical data were collected with the structured interview 'The Schedule for Affective Disorders and Schizophrenia'. Symptom ratings at admission and at discharge were assessed by means of the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Widlöcher Depression Retardation Scale. Family history of affective disorders or suicide was obtained using the Family History Research Diagnostic Criteria. Vascular risk factors were also recorded. Results The only symptoms that differed across the groups were feelings of anger and irritability, which scored lower in the LO older group. No other significant differences were found in the variables studied. Conclusion According to this study, LO depression with melancholia should not be considered as a distinct entity. Further studies on EO and LO-depression should consider this diagnostic subtype, among others, as a key variable. Copyright © 2010 John Wiley & Sons, Ltd. Source

Hotouras A.,Academic Surgical Unit | Ribas Y.,Consorci Sanitari de Terrassa | Zakeri S.,Whittington Hospital NHS Trust | Bhan C.,Whittington Hospital NHS Trust | And 3 more authors.
Colorectal Disease | Year: 2015

Aim: There are no available guidelines to support surgical decision-making in recurrent rectal prolapse. This systematic review evaluated the results of abdominal or perineal surgery for recurrent rectal prolapse, with the aim of developing an evidence-based treatment algorithm. Method: PubMed and MEDLINE databases were searched for all clinical studies involving patients who underwent surgery for recurrent rectal prolapse between 1950 and 2014. The primary outcome measure was the recurrence rate after abdominal or perineal surgery for recurrent rectal prolapse. Secondary outcomes included morbidity, mortality and quality of life data where available. Results: There were no randomized controlled studies comparing the success rates of abdominal or perineal surgery for recurrent rectal prolapse. Most studies were heterogeneous, of low quality (level IV) and involved small numbers of patients. The follow-up of 144 patients included in the studies undergoing perineal surgery ranged from 8.8 to 81 months, with recurrence rates varying from 0% to 50%. Morbidity ranged from 0% to 17% with no mortality reported. Limited data on quality of life following the Altemeier procedure were available. The follow-up for 158 patients included in the studies who underwent abdominal surgery ranged from 0 to 23 years, during which recurrence rates varied from 0% to 15%. Morbidity rates ranged from 0% to 32% with 4% mortality. No quality of life data were available for patients undergoing abdominal surgery. Conclusion: This systematic review was unable to develop a treatment algorithm for recurrent rectal prolapse due to the variety of surgical techniques described and the low level of evidence within heterogeneous studies. Larger high-quality studies are necessary to guide practice in this difficult area. © 2015 The Association of Coloproctology of Great Britain and Ireland. Source

Dapelo M.M.,Kings College London | Bodas S.,Consorci Sanitari de Terrassa | Morris R.,Kings College London | Tchanturia K.,Kings College London | Tchanturia K.,Ilia State University
Journal of Affective Disorders | Year: 2016

Background People with eating disorders have difficulties in socio emotional functioning that could contribute to maintaining the functional consequences of the disorder. This study aimed to explore the ability to deliberately generate (i.e., pose) and imitate facial expressions of emotions in women with anorexia (AN) and bulimia nervosa (BN), compared to healthy controls (HC). Methods One hundred and three participants (36 AN, 25 BN, and 42 HC) were asked to pose and imitate facial expressions of anger, disgust, fear, happiness, and sadness. Their facial expressions were recorded and coded. Results Participants with eating disorders (both AN and BN) were less accurate than HC when posing facial expressions of emotions. Participants with AN were less accurate compared to HC imitating facial expressions, whilst BN participants had a middle range performance. All results remained significant after controlling for anxiety, depression and autistic features. Limitations The relatively small number of BN participants recruited for this study. Conclusions The study findings suggest that people with eating disorders, particularly those with AN, have difficulties posing and imitating facial expressions of emotions. These difficulties could have an impact in social communication and social functioning. This is the first study to investigate the ability to pose and imitate facial expressions of emotions in people with eating disorders, and the findings suggest this area should be further explored in future studies. © 2015 Published by Elsevier B.V. Source

Agency: Cordis | Branch: H2020 | Program: IA | Phase: PHC-20-2014 | Award Amount: 4.36M | Year: 2015

As Europes population is ageing, long-term care for elderly citizens will become an increasing cost for society. To manage this transition healthcare policies in the EU and individual Member States are heavily focussed on extending the independent life of the elderly, with the dual aim of increasing their quality of life and reducing the costs of care. Dementia affects more than 6% of people aged 60\ and has a devastating effect on their independence to date, there is no proven intervention to help dementia patients live a fulfilling life for longer. In this project we will build on an innovative patient support tool to develop a mHealth application that is specifically targeted to patients with mild dementia. The tool will help patients to adhere to their treatment and share data with their carers and doctors; carers will use the same application to monitor patients more easily and share their own well-being with doctors. This will slow the patients cognitive and functional decline, avoid carers getting exhausted and reduce costs of emergency care. Our project will comprise two phases: first we will use digital accessibility tools to re-design the existing application for dementia patients. The development will be steered by patients, carers and doctors, through user-centric design: we will collect feedback on each new version of the application until the design is perfectly adapted to the users needs. In the second phase we will pilot the optimised application with 1,100 users (patients \ carers) and 1,100 controls. This will show the clinical and social benefits for patients and carers, as well as financial benefits for the healthcare system. Successful delivery of the pilot will increase patients adherence to treatment (10 %-points), while improving the quality of life of carers and patients. It will save healthcare providers 1,818 / patient / year in care costs and will generate revenue of over 18 million / year for the consortium (Year 5).

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