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Barcelona, Spain

Munoz-Garzon V.,Hospital Meixoeiro CHUVI | Rovirosa A.,Hospital Clinic iversitari | Ramos A.,Hospital Ramon y Cajal
Reports of Practical Oncology and Radiotherapy | Year: 2013

Background/aim: Radiation oncology covers many different fields of knowledge and skills. Indeed, this medical specialty links physics, biology, research, and formation as well as surgical and clinical procedures and even rehabilitation and aesthetics. The current socio-economic situation and professional competences affect the development and future or this specialty. The aim of this article was to analyze and highlight the underlying pillars and foundations of radiation oncology, indicating the steps implicated in the future developments or competences of each. Methods: This study has collected data from the literature and includes highlights from discussions carried out during the XVII Congress of the Spanish Society of Radiation Oncology (SEOR) held in Vigo in June, 2013. Most of the aspects and domains of radiation oncology were analyzed, achieving recommendations for the many skills and knowledge related to physics, biology, research, and formation as well as surgical and clinical procedures and even supportive care and management. Results: Considering the data from the literature and the discussions of the XVII SEOR Meeting, the "waybill" for the forthcoming years has been described in this article including all the aspects related to the needs of radiation oncology. Conclusions: Professional competences affect the development and future of this specialty. All the types of radio-modulation are competences of radiation oncologists. On the other hand, the pillars of Radiation Oncology are based on experience and research in every area of Radiation Oncology. © 2013 Greater Poland Cancer Centre.

Molinuevo Guix J.L.,Hospital Clinic iversitari
Revista de Neurologia | Year: 2011

The symptomatic treatment of Alzheimer's disease is currently carried out using a twofold therapeutic approach involving acetylcholinesterase inhibitors, whose mechanism of action is based on the selective inhibition of this enzyme, and memantine, which acts by blocking the pathological tonic activation of NMDA receptors. Both drugs have been approved for the treatment of Alzheimer's disease and present a therapeutic indication spectrum that is shared in the moderate phase (MMSE: 10-20). Since both therapeutic approaches offer the same complementary mechanisms of action and share the same therapeutic indication over a wide symptomatic disease spectrum, the aim of this article is to review the existing evidence on the effectiveness of combined therapy so as to be able to discern its usefulness from the moment treatment begins. © 2011 Revista de Neurología.

Molinuevo J.L.,Hospital Clinic iversitari | Frolich L.,University of Heidelberg | Grossberg G.T.,Washington University in St. Louis | Galvin J.E.,New York University | And 3 more authors.
Alzheimer's Research and Therapy | Year: 2015

Introduction: OPtimizing Transdermal Exelon In Mild-to-moderate Alzheimer's disease (OPTIMA) was a randomized, double-blind comparison of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch in patients with mild-to-moderate Alzheimer's disease who declined despite open-label treatment with 9.5 mg/24 h patch. Over 48 weeks of double-blind treatment, high-dose patch produced greater functional and cognitive benefits compared with 9.5 mg/24 h patch. Methods: Using OPTIMA data, a post-hoc responder analysis was performed to firstly, compare the proportion of patients demonstrating improvement or absence of decline with 13.3 mg/24 h versus 9.5 mg/24 h patch; and secondly, identify predictors of improvement or absence of decline. 'Improvers' were patients who improved on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) by ≥4 points from baseline, and did not decline on the instrumental domain of the Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-IADL). 'Non-decliners' were patients who did not decline on either scale. Results: Overall, 265 patients randomized to 13.3 mg/24 h and 271 to 9.5 mg/24 h patch met the criteria for inclusion in the intention-to-treat population and were included in the analyses. Significantly more patients were 'improvers' with 13.3 mg/24 h compared with 9.5 mg/24 h patch at Weeks 24 (44 (16.6%) versus 19 (7.0%); P < 0.001) and 48 (21 (7.9%) versus 10 (3.7%); P = 0.023). A significantly greater proportion of patients were 'non-decliners' with 13.3 mg/24 h compared with 9.5 mg/24 h patch at Week 24 (71 (26.8%) versus 44 (16.2%); P = 0.002). At Week 48, there was a trend in favor of 13.3 mg/24 h patch. Functional and cognitive assessment scores at double-blind baseline did not consistently predict effects at Weeks 24 or 48. Conclusion: More patients with mild-to-moderate Alzheimer's disease who are titrated to 13.3 mg/24 h rivastigmine patch at time of decline are 'improvers' or 'non-decliners' i.e. show responses on cognition and activities of daily living compared with patients remaining on 9.5 mg/24 h patch. Trial registration: Clinicaltrials.gov identifier: NCT00506415; registered July 20, 2007 © 2015 Molinuevo et al.; licensee BioMed Central.

Lleo A.,Biomedical Research Institute Sant Pau | Cavedo E.,Irccs Istituto Centro San Giovanni Of Dio Fatebenefratelli | Parnetti L.,University of Perugia | Vanderstichele H.,ADxNeurosciences | And 15 more authors.
Nature Reviews Neurology | Year: 2015

Alzheimer disease (AD) and Parkinson disease (PD) are the most common neurodegenerative disorders. For both diseases, early intervention is thought to be essential to the success of disease-modifying treatments. Cerebrospinal fluid (CSF) can reflect some of the pathophysiological changes that occur in the brain, and the number of CSF biomarkers under investigation in neurodegenerative conditions has grown rapidly in the past 20 years. In AD, CSF biomarkers are increasingly being used in clinical practice, and have been incorporated into the majority of clinical trials to demonstrate target engagement, to enrich or stratify patient groups, and to find evidence of disease modification. In PD, CSF biomarkers have not yet reached the clinic, but are being studied in patients with parkinsonism, and are being used in clinical trials either to monitor progression or to demonstrate target engagement and downstream effects of drugs. CSF biomarkers might also serve as surrogate markers of clinical benefit after a specific therapeutic intervention, although additional data are required. It is anticipated that CSF biomarkers will have an important role in trials aimed at disease modification in the near future. In this Review, we provide an overview of CSF biomarkers in AD and PD, and discuss their role in clinical trials.

Holman R.R.,University of Oxford | Zinman B.,Samuel Lunenfeld Research Institute | Yusuf S.,Hamilton Health Sciences | Sheridan P.M.,McMaster University | And 9 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To examine the impact of withdrawing rosiglitazone and ramipril medication on diabetes incidence after closeout of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial. RESEARCH DESIGN AND METHODS - The 3,366 DREAM subjects at trial end who had not developed diabetes while taking double-blind study medication were transferred to single-blind placebo for 2 to 3months before undergoing an oral glucose tolerance test. Glycemic status was analyzed for the trial plus washout period and for the washout period alone. RESULTS - Following median (interquartile range) 71 (63-86) days drug withdrawal, overall glycemic status remained modestly improved in those allocated ramipril during the trial with an 11% increase in regression to normoglycemia, compared with placebo. In those previously allocated rosiglitazone, glycemic status remained substantially improved with a 49% reduction of new-onset diabetes or death and a 22% increase in regression to normoglycemia, compared with placebo. However, during the washout phase alone the incidence of diabetes or death was identical for those allocated previously to ramipril or placebo, or to rosiglitazone or placebo. CONCLUSIONS - In people allocated to ramipril comparedwith those not allocated ramipril during the trial, the postwashout normoglycemia incidence was higher. In people allocated to rosiglitazone compared with those not allocated rosiglitazone during the trial, the postwashout incidence of diabetes was significantly lower and the incidence of normoglycemia was higher. During the washout period, diabetes incidence was the same for ramipril versus placebo and for rosiglitazone versus placebo. Rosiglitazone delays disease progression during treatment but the process resumes at the placebo rate when the drug is stopped. © 2011 by the American Diabetes Association.

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