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ImportanceEvidence is lacking from randomized clinical trials to guide the optimal approach for stereotactic ablative body radiotherapy (SABR) in patients with pulmonary oligometastases.ObjectiveTo assess whether single-fraction or multifraction SABR is more effective for the treatment of patients with pulmonary oligometastases.Design, setting, and participantsThis multicenter, unblinded, phase 2 randomized clinical trial of 90 patients across 13 centers in Australia and New Zealand enrolled patients with 1 to 3 lung oligometastases less than or equal to 5 cm from any nonhematologic malignant tumors located away from the central airways, Eastern Cooperative Oncology Group performance status 0 or 1, and all primary and extrathoracic disease controlled with local therapy. Enrollment was from January 1, 2015, to December 31, 2018, with a minimum patient follow-up of 2 years.InterventionsSingle fraction of 28 Gy (single-fraction arm) or 4 fractions of 12 Gy (multifraction arm) to each oligometastasis.Main outcomes and measuresThe main outcome was grade 3 or higher treatment-related adverse events (AEs) occurring within 1 year of SABR. Secondary outcomes were freedom from local failure, overall survival, disease-free survival, and patient-reported outcomes (MD Anderson Symptom Inventory-Lung Cancer and EuroQol 5-dimension visual analog scale).ResultsNinety participants were randomized, of whom 87 were treated for 133 pulmonary oligometastases. The mean (SD) age was 66.6 [11.6] years; 58 (64%) were male. Median follow-up was 36.5 months (interquartile range, 24.8-43.9 months). The numbers of grade 3 or higher AEs related to treatment at 1 year were 2 (5%; 80% CI, 1%-13%) in the single-fraction arm and 1 (3%; 80% CI, 0%-10%) in the multifraction arm, with no significant difference observed between arms. One grade 5 AE occurred in the multifraction arm. No significant differences were found between the multifraction arm and single-fraction arm for freedom from local failure (hazard ratio [HR], 0.5; 95% CI, 0.2-1.3; P = .13), overall survival (HR, 1.5; 95% CI, 0.6-3.7; P = .44), or disease-free survival (HR, 1.0; 95% CI, 0.6-1.6; P > .99). There were no significant differences observed in patient-reported outcomes.Conclusions and relevanceIn this randomized clinical trial, neither arm demonstrated evidence of superior safety, efficacy, or symptom burden; however, single-fraction SABR is more efficient to deliver. Therefore, single-fraction SABR, as assessed by the most acceptable outcome profile from all end points, could be chosen to escalate to future studies.Trial registrationClinicalTrials.gov Identifier: NCT01965223.

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including: psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Trabajo presentado en la 16th NanoSpain Conference (NanoSpain2019), celebrada en Barcelona (España), del 28 al 31 de mayo de 2019

International audience; The TCAD infrastructure developed within the DOTFIVE project is described. The hierarchical TCAD platform includes different Boltzmann equation solvers as well as simulators based on the widely used drift-diffusion and hydrodynamic transport models. In the latter case, accurate physical models were generated. The TCAD platform is used to explore the physics of extremely scaled devices and investigate new device concepts and architectures.

En experimentos con siete cultivares de cebolla de diferente longitud de ciclo, realizados en el sudeste de la provincia de Buenos Aires (Argentina) bajo restricción hídrica, se observó además del esperable tamaño reducido de los bulbos, una llamativa desmejora en su conservación, en relación con ensayos sin limitaciones de agua. La marcada aceleración de la brotación y el incremento en la tasa de pérdida de peso de los bulbos en almacenamiento como consecuencia de las restricciones hídricas durante el llenado fueron confirmadas en un ensayo independiente con el cv. Valcatorce INTA. Estos resultados sugieren la necesidad de replantear el manejo del agua en cebolla al menos cuando se pretende su conservación a largo plazo, como es el caso de los cultivos para exportación., In experiments with seven onion cultivars of different cycle length in the S.E. of Buenos Aires province (Argentina) under restricted water supply, an expected reduction in bulb size but also an unexpected decline in bulb postharvest life were observed, relative to essays with non-limiting irrigation. The remarkable acceleration of sprouting together with an increased weight loss rate, as a consequence of water deficit during bulb filling, was confirmed in an independent experiment with cv. Valcatorce INTA. These results suggest the need of reevaluating water management of the onion crop, especially when destined to long-term storage as required for export., Facultad de Ciencias Agrarias y Forestales