Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial.

AIMS: Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. METHODS: A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. RESULTS: No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). CONCLUSION: Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium.

Fire management, climate change and their interacting effects on birds in complex Mediterranean landscapes: dynamic distribution modelling of an early-successional species - the near-threatened Dartford Warbler (Sylvia undata)

The current challenge in a context of major environmental changes is to anticipate the responses of species to future landscape and climate scenarios. In the Mediterranean basin, climate change is one the most powerful driving forces of fire dynamics, with fire frequency and impact having markedly increased in recent years. Species distribution modelling plays a fundamental role in this challenge, but better integration of available ecological knowledge is needed to adequately guide conservation efforts. Here, we quantified changes in habitat suitability of an early-succession bird in Catalonia, the Dartford Warbler (Sylvia undata) ― globally evaluated as Near Threatened in the IUCN Red List. We assessed potential changes in species distributions between 2000 and 2050 under different fire management and climate change scenarios and described landscape dynamics using a spatially-explicit fire-succession model that simulates fire impacts in the landscape and post-fire regeneration (MEDFIRE model). Dartford Warbler occurrence data were acquired at two different spatial scales from: 1) the Atlas of European Breeding Birds (EBCC) and 2) Catalan Breeding Bird Atlas (CBBA). Habitat suitability was modelled using five widely-used modelling techniques in an ensemble forecasting framework. Our results indicated considerable habitat suitability losses (ranging between 47% and 57% in baseline scenarios), which were modulated to a large extent by fire regime changes derived from fire management policies and climate changes. Such result highlighted the need for taking the spatial interaction between climate changes, fire-mediated landscape dynamics and fire management policies into account for coherently anticipating habitat suitability changes of early succession bird species. We conclude that fire management programs need to be integrated into conservation plans to effectively preserve sparsely forested and early succession habitats and their associated species in the face of global environmental change.

Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results.

PurposeThe purpose of this study was to report the 2-year outcome of an individually tailored 'observe-and-plan' treatment regimen for neovascular age-related macular degeneration (nAMD), and to investigate its clinical value in terms of functional outcome. This regimen aimed to reduce the clinical burden (visits) by employing individually fixed injection intervals, based on the predictability of an individual's need for retreatment.MethodsThis prospective case series included 104 patients (115 eyes) with nAMD. Following three loading doses of ranibizumab, the disease recurrence interval was determined in monthly observation visits. Retreatment was applied in a series of three injections with individually fixed intervals (2 weeks shorter than the recurrence interval), combined with periodic adjustment of the intervals. The allowed injection intervals in treatment plans ranged from 1 to 3 months. If there was no recurrence at 3 months, the patient could change to monitoring alone.ResultsMean visual acuity (VA) improved by 8.7, 9.7, and 9.2 letters at months 3, 12, and 24, respectively. The mean number of injections was 7.8 and 5.8 during years 1 and 2, respectively, whereas the mean number of ophthalmic examinations was 4.0 and 2.9, respectively. The mean treatment interval (after the loading doses) was 2.0 months during year 1, and 2.2 months during year 2.ConclusionThe observe-and-plan regimen significantly improved and maintained VA over the course of 2 years. This favourable functional outcome was achieved with fewer clinic visits compared with other regimens. Therefore, this observe-and-plan regimen has the potential to alleviate the clinical burden of nAMD treatment.

Evolutionary patchwork of an insecticidal toxin shared between plant-associated pseudomonads and the insect pathogens Photorhabdus and Xenorhabdus.

BACKGROUND: Root-colonizing fluorescent pseudomonads are known for their excellent abilities to protect plants against soil-borne fungal pathogens. Some of these bacteria produce an insecticidal toxin (Fit) suggesting that they may exploit insect hosts as a secondary niche. However, the ecological relevance of insect toxicity and the mechanisms driving the evolution of toxin production remain puzzling. RESULTS: Screening a large collection of plant-associated pseudomonads for insecticidal activity and presence of the Fit toxin revealed that Fit is highly indicative of insecticidal activity and predicts that Pseudomonas protegens and P. chlororaphis are exclusive Fit producers. A comparative evolutionary analysis of Fit toxin-producing Pseudomonas including the insect-pathogenic bacteria Photorhabdus and Xenorhadus, which produce the Fit related Mcf toxin, showed that fit genes are part of a dynamic genomic region with substantial presence/absence polymorphism and local variation in GC base composition. The patchy distribution and phylogenetic incongruence of fit genes indicate that the Fit cluster evolved via horizontal transfer, followed by functional integration of vertically transmitted genes, generating a unique Pseudomonas-specific insect toxin cluster. CONCLUSIONS: Our findings suggest that multiple independent evolutionary events led to formation of at least three versions of the Mcf/Fit toxin highlighting the dynamic nature of insect toxin evolution.

Significance of an isolated new right bundle branch block in a patient with chest pain.

Chest pain is a common presenting symptom in emergency departments, and a typical manifestation of acute myocardial infarction (AMI). Recognition of ECG changes in AMI is essential for timely diagnosis and treatment. Right bundle branch block (RBBB) may be an isolated sign of AMI, and was previously considered as a criterion for fibrinolytic therapy. Since the most recent European Society of Cardiology and American Heart Association guidelines in 2013, RBBB alone is no longer considered a diagnostic criterion of AMI, even if it occurs in the context of acute chest pain, as RBBB does not usually interfere with the interpretation of ST-segment alteration. Our case illustrates an acute septal myocardial infarction with an isolated RBBB, and thus the importance of recognising this pattern in order to permit timely diagnosis and treatment.

Neuro-mechanical determinants of repeated treadmill sprints - Usefulness of an "hypoxic to normoxic recovery" approach.

To improve our understanding of the limiting factors during repeated sprinting, we manipulated hypoxia severity during an initial set and examined the effects on performance and associated neuro-mechanical alterations during a subsequent set performed in normoxia. On separate days, 13 active males performed eight 5-s sprints (recovery = 25 s) on an instrumented treadmill in either normoxia near sea-level (SL; FiO2 = 20.9%), moderate (MH; FiO2 = 16.8%) or severe normobaric hypoxia (SH; FiO2 = 13.3%) followed, 6 min later, by four 5-s sprints (recovery = 25 s) in normoxia. Throughout the first set, along with distance covered [larger sprint decrement score in SH (-8.2%) compared to SL (-5.3%) and MH (-7.2%); P < 0.05], changes in contact time, step frequency and root mean square activity (surface electromyography) of the quadriceps (Rectus femoris muscle) in SH exceeded those in SL and MH (P < 0.05). During first sprint of the subsequent normoxic set, the distance covered (99.6, 96.4, and 98.3% of sprint 1 in SL, MH, and SH, respectively), the main kinetic (mean vertical, horizontal, and resultant forces) and kinematic (contact time and step frequency) variables as well as surface electromyogram of quadriceps and plantar flexor muscles were fully recovered, with no significant difference between conditions. Despite differing hypoxic severity levels during sprints 1-8, performance and neuro-mechanical patterns did not differ during the four sprints of the second set performed in normoxia. In summary, under the circumstances of this study (participant background, exercise-to-rest ratio, hypoxia exposure), sprint mechanical performance and neural alterations were largely influenced by the hypoxia severity in an initial set of repeated sprints. However, hypoxia had no residual effect during a subsequent set performed in normoxia. Hence, the recovery of performance and associated neuro-mechanical alterations was complete after resting for 6 min near sea level, with a similar fatigue pattern across conditions during subsequent repeated sprints in normoxia.

Interleukin-1- and type I interferon-dependent enhanced immunogenicity of an NYVAC-HIV-1 Env-Gag-Pol-Nef vaccine vector with dual deletions of type I and type II interferon-binding proteins.

UNLABELLED: NYVAC, a highly attenuated, replication-restricted poxvirus, is a safe and immunogenic vaccine vector. Deletion of immune evasion genes from the poxvirus genome is an attractive strategy for improving the immunogenic properties of poxviruses. Using systems biology approaches, we describe herein the enhanced immunological profile of NYVAC vectors expressing the HIV-1 clade C env, gag, pol, and nef genes (NYVAC-C) with single or double deletions of genes encoding type I (ΔB19R) or type II (ΔB8R) interferon (IFN)-binding proteins. Transcriptomic analyses of human monocytes infected with NYVAC-C, NYVAC-C with the B19R deletion (NYVAC-C-ΔB19R), or NYVAC-C with B8R and B19R deletions (NYVAC-C-ΔB8RB19R) revealed a concerted upregulation of innate immune pathways (IFN-stimulated genes [ISGs]) of increasing magnitude with NYVAC-C-ΔB19R and NYVAC-C-ΔB8RB19R than with NYVAC-C. Deletion of B8R and B19R resulted in an enhanced activation of IRF3, IRF7, and STAT1 and the robust production of type I IFNs and of ISGs, whose expression was inhibited by anti-type I IFN antibodies. Interestingly, NYVAC-C-ΔB8RB19R induced the production of much higher levels of proinflammatory cytokines (tumor necrosis factor [TNF], interleukin-6 [IL-6], and IL-8) than NYVAC-C or NYVAC-C-ΔB19R as well as a strong inflammasome response (caspase-1 and IL-1β) in infected monocytes. Top network analyses showed that this broad response mediated by the deletion of B8R and B19R was organized around two upregulated gene expression nodes (TNF and IRF7). Consistent with these findings, monocytes infected with NYVAC-C-ΔB8RB19R induced a stronger type I IFN-dependent and IL-1-dependent allogeneic CD4(+) T cell response than monocytes infected with NYVAC-C or NYVAC-C-ΔB19R. Dual deletion of type I and type II IFN immune evasion genes in NYVAC markedly enhanced its immunogenic properties via its induction of the increased expression of type I IFNs and IL-1β and make it an attractive candidate HIV vaccine vector. IMPORTANCE: NYVAC is a replication-deficient poxvirus developed as a vaccine vector against HIV. NYVAC expresses several genes known to impair the host immune defenses by interfering with innate immune receptors, cytokines, or interferons. Given the crucial role played by interferons against viruses, we postulated that targeting the type I and type II decoy receptors used by poxvirus to subvert the host innate immune response would be an attractive approach to improve the immunogenicity of NYVAC vectors. Using systems biology approaches, we report that deletion of type I and type II IFN immune evasion genes in NYVAC poxvirus resulted in the robust expression of type I IFNs and interferon-stimulated genes (ISGs), a strong activation of the inflammasome, and upregulated expression of IL-1β and proinflammatory cytokines. Dual deletion of type I and type II IFN immune evasion genes in NYVAC poxvirus improves its immunogenic profile and makes it an attractive candidate HIV vaccine vector.

Derivation of an observer model adapted to irregular signals based on convolution channels.

Anthropomorphic model observers are mathe- matical algorithms which are applied to images with the ultimate goal of predicting human signal detection and classification accuracy across varieties of backgrounds, image acquisitions and display conditions. A limitation of current channelized model observers is their inability to handle irregularly-shaped signals, which are common in clinical images, without a high number of directional channels. Here, we derive a new linear model observer based on convolution channels which we refer to as the "Filtered Channel observer" (FCO), as an extension of the channelized Hotelling observer (CHO) and the nonprewhitening with an eye filter (NPWE) observer. In analogy to the CHO, this linear model observer can take the form of a single template with an external noise term. To compare with human observers, we tested signals with irregular and asymmetrical shapes spanning the size of lesions down to those of microcalfications in 4-AFC breast tomosynthesis detection tasks, with three different contrasts for each case. Whereas humans uniformly outperformed conventional CHOs, the FCO observer outperformed humans for every signal with only one exception. Additive internal noise in the models allowed us to degrade model performance and match human performance. We could not match all the human performances with a model with a single internal noise component for all signal shape, size and contrast conditions. This suggests that either the internal noise might vary across signals or that the model cannot entirely capture the human detection strategy. However, the FCO model offers an efficient way to apprehend human observer performance for a non-symmetric signal.

Development of an enantioselective assay for simultaneous separation of venlafaxine and O-desmethylvenlafaxine by micellar electrokinetic chromatography-tandem mass spectrometry: Application to the analysis of drug-drug interaction.

To-date, there has been no effective chiral capillary electrophoresis-mass spectrometry (CE-MS) method reported for the simultaneous enantioseparation of the antidepressant drug, venlafaxine (VX) and its structurally-similar major metabolite, O-desmethylvenlafaxine (O-DVX). This is mainly due to the difficulty of identifying MS compatible chiral selector, which could provide both high enantioselectivity and sensitive MS detection. In this work, poly-sodium N-undecenoyl-L,L-leucylalaninate (poly-L,L-SULA) was employed as a chiral selector after screening several dipeptide polymeric chiral surfactants. Baseline separation of both O-DVX and VX enantiomers was achieved in 15min after optimizing the buffer pH, poly-L,L-SULA concentration, nebulizer pressure and separation voltage. Calibration curves in spiked plasma (recoveries higher than 80%) were linear over the concentration range 150-5000ng/mL for both VX and O-DVX. The limit of detection (LOD) was found to be as low as 30ng/mL and 21ng/mL for O-DVX and VX, respectively. This method was successfully applied to measure the plasma concentrations of human volunteers receiving VX or O-DVX orally when co-administered without and with indinivar therapy. The results suggest that micellar electrokinetic chromatography electrospray ionization-tandem mass spectrometry (MEKC-ESI-MS/MS) is an effective low cost alternative technique for the pharmacokinetics and pharmacodynamics studies of both O-DVX and VX enantiomers. The technique has potential to identify drug-drug interaction involving VX and O-DVX enantiomers while administering indinivar therapy.

Role of an LRR receptor-like kinase in the establishment of a functional root endodermal barrier

The endodermis is a highly conserved cell layer present in the root of all vascular plants, except Lycophytes. This tissue layer establishes a protective diffusion barrier surrounding the vasculature and is expected to prevent passive, uncontrolled flow of nutrients through the root. This barrier property is achieved by the production of Casparian strips (CS), a localized cell wall impregnation of lignin in the anticlinal walls of each endodermal cell, forming a belt-like structure sealing the extracellular space. The CS act as a selective barrier between the external cell layers and the vascular cylinder and are thought to be important in many aspects of root function. For instance, selective nutrient uptake and sequestration from the soil, resistance to different abiotic and biotic stresses are expected to involve functional CS. Although discovered 150 years ago, nothing was known about the genes involved in CS establishment until recently. The use of the model plant Arabidopsis thaliana together with both reverse and forward genetic approaches led to the discovery of an increasing number of genes involved in different steps of CS formation during the last few years. One of these genes encodes SCHENGEN3 (SGN3), a leucine-rich repeat receptor-like kinase (LRR-RLK). SGN3 was discovered first by reverse genetic due to its endodermis-enriched expression, and the corresponding mutant displays strong endodermal permeability of the apoplastic tracer Propidium Iodide (PI) indicative of defective CS. One aim of this thesis is to study the role of SGN3 at the molecular level in order to understand its involvement in establishing an impermeable CS. The endodermal permeability of sgn3 is shown to be the result of incorrect localization of key proteins involved in CS establishment (the "Casparian strip domain proteins", CASPs), leading to non-functional CS interrupted by discontinuities. CASPs localize in the plasma membrane domain subjacent to the CS, named the Casparian Strip membrane Domain (CSD). The CSD discontinuities in sgn3 together with SGN3 localization in close proximity to the CASPs lead to the assumption that SGN3 is involved in the formation of a continuous CSD. In addition, SGN3 might have a second role, acting as a kinase reporting CSD integrity leading to lignin and suberin production in CSD/CS defective plants. Up to now, sgn3 is the strongest and most specific CS mutant available, displaying tracer penetration along the whole length of the seedling root. For this reason, this mutant is well suited in order to characterize the physiological behaviour of CS affected plants. Due to the lack of such mutants in the past, it was not possible to test the presumed functions of CS by using plants lacking this structure. We decided to use sgn3 for this purpose. Surprisingly, sgn3 overall growth is only slightly affected. Nevertheless, processes expected to rely on functional CS, such as water transport through the root, nutrient homeostasis, salt tolerance and resistance to an excess of some nutrients are altered in this mutant. On the other hand, homeostasis for most elements and drought tolerance are not affected in sgn3. It is surprising to observe that homeostatic defects are specific, with a decrease in potassium and an increase in magnesium levels. It indicates a backup system, set up by the plant in order to counteract free diffusion of nutrients into the stele. For instance, potassium shortage in sgn3 upregulates the transcription of potassium influx transport proteins and genes known to be induced by potassium starvation. Moreover, sgn3 mutant is hypersensitive to low potassium conditions. Hopefully, these results about SGN3 will help our understanding of CS establishment at the molecular level. In addition, physiological experiments using sgn3 should give us a framework for future experiments and help us to understand the different roles of CS and their involvement during nutrient radial transport through the root. -- L'endoderme est un tissu présent dans les racines de toutes les plantes vasculaires à l'exception des Lycophytes. Ce tissu établit une barrière protectrice entourant les tissus vasculaires dans le but d'éviter la diffusion passive et incontrôlée des nutriments au travers de la racine. Cette propriété de barrière provient de la production des cadres de Caspary, une imprégnation localisée de lignine des parties anticlinales de la paroi de chaque cellule d'endoderme. Cela donne naissance à un anneau/cadre qui rend étanche l'espace extracellulaire. Les cadres de Caspary agissent comme une barrière sélective entre les couches externes de la racine et le cylindre central et sont supposés être importants dans beaucoup d'aspects du fonctionnement de la racine. Par exemple, l'absorption sélective de nutriments et leur séquestration à partir du sol ainsi que la résistance contre différents stress abiotiques et biotiques sont supposés impliquer des cadres de Caspary fonctionnels. Bien que découverts il y a 150 ans, rien n'était connu concernant les gènes impliqués dans Ja formation des cadres de Caspary jusqu'à récemment. Durant ces dernière années, l'utilisation de la plante modèle Arabidopsis thaliana ainsi que des approches de génétique inverse et classique ont permis la découverte d'un nombre croissant de gènes impliqués à différentes étapes de la formation de cette structure. Un des ces gènes code pour SCHENGEN3 (SGN3), un récepteur kinase "leucine-rich repeat receptor-like kinase" (LRR-RLK). SGN3 a été découvert en premier par génétique inverse grâce à son expression enrichie dans l'endoderme. Les cadres de Caspary ne sont pas fonctionnels dans le mutant correspondant, ce qui est visible à cause de la perméabilité de l'endoderme au traceur apoplastique Propidium Iodide (PI). Un des objectifs de cette thèse est d'étudier la fonction de SGN3 au niveau moléculaire dans le but de comprendre son rôle dans la formation des cadres de Caspary. J'ai pu démontrer que la perméabilité de l'endoderme du mutant sgn3 est le résultat de la localisation incorrecte de protéines impliquées dans la formation des cadres de Caspary, les "Casparian strip domain proteins" (CASPs). Cela induit des cadres de Caspary non fonctionnels, contenant de nombreuses interruptions. Les CASPs sont localisés à la membrane plasmique dans un domaine sous-jacent les cadres de Caspary appelé Casparian Strip membrane Domain (CSD). Les interruptions du CSD dans le mutant sgn3, ainsi que la localisation de SGN3 à proximité des CASPs nous font penser à un rôle de SGN3 dans l'élaboration d'un CSD ininterrompu. De plus, SGN3 pourrait avoir un second rôle, agissant en tant que kinase reportant l'intégrité du CSD et induisant la production de lignine et de subérine dans des plantes contenant des cadres de Caspary non fonctionnels. Jusqu'à ce jour, sgn3 est le mutant en notre possession le plus fort et le plus spécifique, ayant un endoderme perméable tout le long de la racine. Pour cette raison, ce mutant est adéquat dans le but de caractériser la physiologie de plantes ayant des cadres de Caspary affectés. De manière surprenante, la croissance de sgn3 est seulement peu affectée. Néanmoins, des processus censés nécessiter des cadres de Caspary fonctionnels, comme le transport de l'eau au travers de la racine, l'homéostasie des nutriments, la tolérance au sel et la résistance à l'excès de certains nutriments sont altérés dans ce mutant. Malgré tout, l'homéostasie de la plupart des nutriments ainsi que la résistance au stress hydrique ne sont pas affectés dans sgn3. De manière surprenante, les altérations de l'ionome de sgn3 sont spécifiques, avec une diminution de potassium et un excès de magnésium. Cela implique un système de compensation établi par la plante dans le but d'éviter la diffusion passive des nutriments en direction du cylindre central. Par exemple, le manque de potassium dans sgn3 augmente la transcription de transporteurs permettant l'absorption de cet élément. De plus, des gènes connus pour être induits en cas de carence en potassium sont surexprimés dans sgn3 et la croissance de ce mutant est sévèrement affectée dans un substrat pauvre en potassium. Ces résultats concernant SGN3 vont, espérons-le, aider à la compréhension du processus de formation des cadres de Caspary au niveau moléculaire. De plus, les expériences de physiologie utilisant sgn3 présentées dans cette thèse devraient nous donner une base pour des expériences futures et nous permettre de comprendre mieux le rôle des cadres de Caspary, et plus particulièrement leur implication dans le transport radial des nutriments au travers de la racine. -- Les plantes terrestres sont des organismes puisant l'eau et les nutriments dont elles ont besoin pour leur croissance dans le sol grâce à leurs racines. De par leur immobilité, elles doivent s'adapter à des sols contenant des quantités variables de nutriments et il leur est crucial de sélectionner ce dont elles ont besoin afin de ne pas s'intoxiquer. Cette sélection est faite grâce à un filtre formé d'un tissu racinaire interne appelé endoderme. L'endoderme fabrique une barrière imperméable entourant chaque cellule appelée "cadre de Caspary". Ces cadres de Caspary empêchent le libre passage des nutriments, permettant un contrôle précis de leur passage. De plus, ils sont censés permettre de résister contre différents stress environnementaux comme la sécheresse, la salinité du sol ou l'excès de nutriments. Bien que découverts il y a 150 ans, rien n'était connu concernant les gènes impliqués dans la formation des cadres de Caspary jusqu'à récemment. Durant ces dernière années, l'utilisation de la plante modèle Arabidopsis thaliana a permis la découverte d'un nombre croissant de gènes impliqués à différentes étapes de la formation de cette structure. Un de ces gènes code pour SCHENGEN3 (SGN3), un récepteur kinase "leucine-rich repeat receptor-like kinase" (LRR- RLK). Nous montrons dans cette étude que le gène SGN3 est impliqué dans la formation des cadres de Caspary, et que le mutant correspondant sgn3 a des cadres de Caspary interrompus. Ces interruptions rendent l'endoderme perméable, l'empêchant de bloquer le passage des molécules depuis le sol vers le centre de la racine. En utilisant ce mutant, nous avons pu caractériser la physiologie de plantes ayant des cadres de Caspary affectés. Cela a permis de découvrir que le transport de l'eau au travers de la racine était affecté dans le mutant sgn3. De plus, l'accumulation de certains éléments dans les feuilles de ce mutant est altérée. Nous avons également pu montrer une sensibilité de ce mutant à un excès de sel ou de certains nutriments comme le fer et le manganèse.

Gamma Knife Surgery versus Linac for Brain Metastasis: Which Technique for Which Patient? Analysis of an Historical Cohort of 63 Consecutive Patients Harboring 130 Lesions

Objectives: We present the retrospective analysis of a single-institution experience for radiosurgery (RS) in brain metastasis (BM) with Gamma Knife (GK) and Linac. Methods: From July 2010 to July 2012, 28 patients (with 83 lesions) had RS with GK and 35 patients (with 47 lesions) with Linac. The primary outcome was the local progression-free survival (LPFS). The secondary outcome was the overall survival (OS). Apart a standard statistical analysis, we included a Cox regression model with shared frailty, to modulate the within-patient correlation (preliminary evaluation showed a significant frailty effect, meaning that the correlation within patient could be ignored). Results: The mean follow-up period was 11.7 months (median 7.9, 1.7-22.7) for GK and 18.1 (median 17, 7.5-28.7) for Linac. The median number of lesions per patient was 2.5 (1-9) in GK compared with 1 (1-3) in Linac. There were more radioresistant lesions (melanoma) and more lesions located in functional areas for the GK group. The median dose was 24 Gy (GK) compared with 20 Gy (Linac). The LPFS actuarial rate was as follows: for GK at 3, 6, 9, 12, and 17 months: 96.96, 96.96, 96.96, 88.1, and 81.5%, and remained stable till 32 months; for Linac at 3, 6, 12, 17, 24, and 33 months, it was 91.5, 91.5, 91.5, 79.9, 55.5, and 17.1%, respectively (p = 0.03, chi-square test). After the Cox regression analysis with shared frailty, the p-value was not statistically significant between groups. The median overall survival was 9.7 months for GK and 23.6 months for Linac group. Uni- and multivariate analysis showed a lower GPA score and noncontrolled systemic status were associated with lower OS. Cox regression analysis adjusting for these two parameters showed comparable OS rate. Conclusions: In this comparative report between GK and Linac, preliminary analysis showed that more difficult cases are treated by GK, with patients harboring more lesions, radioresistant tumors, and highly functional located. The groups look, in this sense, very heterogeneous at baseline. After a Cox frailty model, the LPFS rates seemed very similar (p < 0.05). The OS was similar, after adjusting for systemic status and GPA score (p < 0.05). The technical reasons for choosing GK instead of Linac were the anatomical location related to highly functional areas, histology, technical limitations of Linac movements, especially lower posterior fossa locations, or closeness of multiple lesions to highly functional areas optimal dosimetry with Linac