Radioterapia preoperatoria del ciclo corto en el cancer de recto.

381 p.El objetivo es presentar los resultados en cuanto a supervivencia y control local de una serie consecutiva de pacientes de cáncer de recto en los que utilizó el esquema secuencial con RTCC 5 x 5 Gy = 25 Gy asociada a cirugía radical con escisión mesorrectal total y compararla dentro del contexto del estado del arte actual con los datos de la literatura referidos a los esquemas que utilizan QT-RT convencional.Todos (100%) recibieron RTCC, 25 Gy en 5 fracciones. El tiempo de tratamiento tuvo una media de 5,64 días, rango de 4 a 9 días. El intervalo RT ¿ cirugía en días tuvo una media de 11,52 con un rango entre 3 y 35 días. El intervalo entre cirugía y QT en días, fue de 53, con una media de 18 a 170 días. El tratamiento RTCC se efectuó en 5 días en 101 p (68,24%) y en más de 5 en 47 p (31,76%). La técnica de RT se aplicó con dosimetría en dos dimensiones (2D ) Cobalto en 33 p (22,3%) y tres dimensionas (3D) . acelerador lineal (ALI) en 115 p (77,7%). Hubo 28 p. con complicaciones específicas (18,92%) y sin complicaciones 120 p. (81,08%), todas ellas < G III.Todos fueron intervenidos, con CI, practicándose resección anterior en 110 p (74,3%), amputación abdómino-perineal 29 p. (19,6%), Hartman 4 p. (2,7%), exenteración pélvica 2 p. (1,3%), resección local 3 p (2,1%). La vía de abordaje fue laparotomía en 77 p (52%) y laparoscópica en 68 p (45,9%), otras 3 p. (2,1%). Se realizaron 54 ileostomías temporales (36,5%), no ileostomía temporal 60 p (40,5%) y colostomía definitiva 34 p. (23%). Las complicaciones al procedimiento quirúrgico fueron: infección o absceso 27 p. (18,2%), oclusión no quirúrgica 19 p. (12,8%), dehiscencia de sutura anastomótica 10 p. (6,7%), dehiscencia de herida perineal 8 p. (5,41%), fístula 5 p.(3,4%), hemorragia leve 7 P (4,7%), hemorragia grave 5 P (3,4%), dolor pélvico 7 p. (4,7%), urológicas 28 p. (18,9%). Cualquier tipo de complicación se registró en 81 p. (54,73%) y no hubo complicaciones en 67 p. (45,27%). La mortalidad quirúrgica a 30 días fue de 4 p. (2,7%) y la global a un año 8 p (5,41%).Estos datos confirman que el esquema RTCC en monoterapia obtiene resultados equiparables a los que utilizan QT¿Rt convencional y no es más toxico

Effect of LHRH analogs on lower urinary tract symptoms associated with advanced prostate cancer in real clinical practice: ANALUTS study

Androgen deprivation; Hormonal therapy; RadiotherapyPrivación de andrógenos; Terapia hormonal; RadioterapiaPrivació d'andrògens; Teràpia hormonal; RadioteràpiaAims To estimate the prevalence of lower urinary tract symptoms (LUTS) in patients with prostate cancer scheduled to receive LHRH analogs, and to assess the effectiveness of LHRH analogs on LUTS in patients presenting moderate/severe symptoms. Methods Prospective, noninterventional, multicenter study conducted at 28 centers in Spain and Portugal. LUTS were evaluated using the International Prostate Symptom Score (IPSS) at baseline, 24 and 48 weeks after initiation of treatment. Subanalyses were performed according to age and concomitant treatment (radiotherapy, alpha-blockers, and antiandrogens). Results A total of 354 patients were treated with LHRH analogs for 48 weeks. The percentage of patients with moderate/severe LUTS (IPSS > 7) decreased from 60.2% (n = 213/354) at baseline to 52.8% (n = 187/354) at Week 48. Among patients with moderate/severe LUTS at baseline: 73.7% (n = 157/213) still had moderate/severe LUTS at Week 48; percentage reductions of patients with LUTS at Week 48 were statistically significant (p < 0.05) overall and by age or concomitant treatment, except for alpha-blockers (84.2% patients receiving them still had moderate/severe LUTS at Week 48). All IPSS items, including quality of life for urinary symptoms, improved throughout the study. The only predictor of response to treatment with LHRH analogs that improved IPSS by 3 points after 48 weeks was baseline testosterone levels. Lower baseline testosterone levels were associated with greater improvement in IPSS after treatment with LHRH analogs (odds ratio 0.998, 95% confidence interval 0.996–1.000, p = 0.0277). Conclusion LHRH analogs have a positive effect in patients with locally advanced or metastatic prostate cancer presenting moderate/severe LUTS regardless of age or concomitant treatment received (radiotherapy, antiandrogens, or alpha-blockers).The study was funded by Ipsen Pharma S.A.U

Impact of long-term viral suppression in CD4+ recovery of HIV-children on Highly Active Antiretroviral Therapy

BACKGROUND: The effects of HAART may differ between children and adults because children have a developing immune system, and the long-term immunological outcome in HIV-infected children on HAART is not well-known. A major aim of our study was to determine CD4+ evolution associated with long-term VL control during 4 years of observation on HAART. METHODS: We carried out a retrospective study on a cohort of 160 vertically HIV-infected children. It was carried out from 1996 to 2004 in six large Spanish pediatric referral hospitals. We compared 33 children who had long-term VL suppression (VL ≤400 copies/ml) in the first 12 months of follow-up and maintained that level throughout follow-up (Responders-group), and 127 children with persistently detectable VL in spite of ART switches (Non-Responders-group). RESULTS: We observed a quick initial and significant increase in CD4(+ )counts from the baseline to 12 months on HAART in both groups (p < 0.01). The Non-Responders group sustained CD4+ increases and most of these children maintained high CD4(+ )level counts (≥25%). The Non-Responders group reached a plateau between 26% and 27% CD4(+ )at the first 12 months of follow-up that remained stable during the following 3 years. However, the Responders group reached a plateau between 30% and 32% CD4(+ )at 24, 36 and 48 months of follow-up. We found that the Responders group had higher CD4(+ )count values and higher percentages of children with CD4(+ )≥25% than the Non-Responders group (p < 0.05) after month 12. CONCLUSION: Long-term VL suppression in turn induces large beneficial effects in immunological responses. However, it is not indispensable to recover CD4(+ )levels

Pasados y presente. Estudios para el profesor Ricardo García Cárcel

Ricardo García Cárcel (Requena, 1948) estudió Historia en Valencia bajo el magisterio de Joan Reglà, con quien formó parte del primer profesorado de historia moderna en la Universidad Autónoma de Barcelona. En esta universidad, desde hace prácticamente cincuenta años, ha desarrollado una extraordinaria labor docente y de investigación marcada por un sagaz instinto histórico, que le ha convertido en pionero de casi todo lo que ha estudiado: las Germanías, la historia de la Cataluña moderna, la Inquisición, las culturas del Siglo de Oro, la Leyenda Negra, Felipe II, Felipe V, Austrias y Borbones, la guerra de la Independencia, la historia cultural, los mitos de la historia de España... Muy pocos tienen su capacidad para reflexionar, ordenar, analizar, conceptualizar y proponer una visión amplia y llena de matices sobre el pasado y las interpretaciones historiográficas. A su laboriosidad inimitable se añade una dedicación sin límites en el asesoramiento de alumnos e investigadores e impulsando revistas, dosieres, seminarios o publicaciones colectivas. Una mínima correspondencia a su generosidad lo constituye este volumen a manera de ineludible agradecimiento

Radioterapia preoperatoria del ciclo corto en el cancer de recto.

381 p.El objetivo es presentar los resultados en cuanto a supervivencia y control local de una serie consecutiva de pacientes de cáncer de recto en los que utilizó el esquema secuencial con RTCC 5 x 5 Gy = 25 Gy asociada a cirugía radical con escisión mesorrectal total y compararla dentro del contexto del estado del arte actual con los datos de la literatura referidos a los esquemas que utilizan QT-RT convencional.Todos (100%) recibieron RTCC, 25 Gy en 5 fracciones. El tiempo de tratamiento tuvo una media de 5,64 días, rango de 4 a 9 días. El intervalo RT ¿ cirugía en días tuvo una media de 11,52 con un rango entre 3 y 35 días. El intervalo entre cirugía y QT en días, fue de 53, con una media de 18 a 170 días. El tratamiento RTCC se efectuó en 5 días en 101 p (68,24%) y en más de 5 en 47 p (31,76%). La técnica de RT se aplicó con dosimetría en dos dimensiones (2D ) Cobalto en 33 p (22,3%) y tres dimensionas (3D) . acelerador lineal (ALI) en 115 p (77,7%). Hubo 28 p. con complicaciones específicas (18,92%) y sin complicaciones 120 p. (81,08%), todas ellas < G III.Todos fueron intervenidos, con CI, practicándose resección anterior en 110 p (74,3%), amputación abdómino-perineal 29 p. (19,6%), Hartman 4 p. (2,7%), exenteración pélvica 2 p. (1,3%), resección local 3 p (2,1%). La vía de abordaje fue laparotomía en 77 p (52%) y laparoscópica en 68 p (45,9%), otras 3 p. (2,1%). Se realizaron 54 ileostomías temporales (36,5%), no ileostomía temporal 60 p (40,5%) y colostomía definitiva 34 p. (23%). Las complicaciones al procedimiento quirúrgico fueron: infección o absceso 27 p. (18,2%), oclusión no quirúrgica 19 p. (12,8%), dehiscencia de sutura anastomótica 10 p. (6,7%), dehiscencia de herida perineal 8 p. (5,41%), fístula 5 p.(3,4%), hemorragia leve 7 P (4,7%), hemorragia grave 5 P (3,4%), dolor pélvico 7 p. (4,7%), urológicas 28 p. (18,9%). Cualquier tipo de complicación se registró en 81 p. (54,73%) y no hubo complicaciones en 67 p. (45,27%). La mortalidad quirúrgica a 30 días fue de 4 p. (2,7%) y la global a un año 8 p (5,41%).Estos datos confirman que el esquema RTCC en monoterapia obtiene resultados equiparables a los que utilizan QT¿Rt convencional y no es más toxico

Current treatment of rectal cancer adapted to the individual patient

Preoperative radiochemotherapy and total mesorectal excision surgery is a recommended standard therapy for patients with locally advanced rectal cancer. However, some subgroups of patients benefit more than others from this approach. In order to avoid long-term complications of radiation and chemotherapy, efforts are being made to subdivide T3N0 stage using advanced imaging techniques, and to analyze prognostic factors that help to define subgroup risk patients. Long-course radiochemotherapy has the potential of downsizing the tumor before surgery and may increase the chance of sphincter preservation in some patients. Short-course radiotherapy (SCRT), on the other hand, is a practical schedule that better suits patients with intermediated risk tumors, located far from the anal margin. SCRT is also increasingly being used among patients with disseminated disease, before resection of the rectal tumor. Improvements in radiation technique, such as keeping the irradiation target below S2/S3 junction, and the use of IMRT, can reduce the toxicity associated with radiation, specially long-term small bowel toxicity

Could preoperative short-course radiotherapy be the treatment of choice for localized advanced rectal carcinoma?

Short-course preoperative radiotherapy (RT) is widely used in northern Europe for locally advanced resectable rectal cancer, but its role in the era of advanced imaging techniques is uncertain. Here, we reviewed articles and abstracts on SCRT published from 1974 through 2013 with the goal of identifying patients who might be best suited for short-course RT. We included relevant articles comparing surgery with or without preoperative radiation published before and after the advent of total mesorectal excision. We also analyzed two randomized trials directly comparing short-course RT with conventionally fractionated chemoradiation (the Polish Colorectal Study Group and the Trans-Tasman Radiation Oncology Group) that compared short-course RT with conventional chemoradiotherapy. We conclude from our review that short-course RT can be generally applied for operable rectal cancer and produces high rates of pelvic control with acceptable toxicity; it reduces local recurrence rates but does not increase overall survival. SCRT seems to be best used for tumors considered “low risk,” i.e., those that are >5[[ce:hsp sp="0.25"/]]cm from the anal margin, without circumferential margin involvement, and involvement of fewer than 4 lymph nodes. Whether sequential chemotherapy can further improve outcomes remains to be seen, as does the best time for surgery (immediately or 6–8 weeks after RT). We further recommend that selection of patients for short-course RT should be based on findings from magnetic resonance imaging or transrectal ultrasonography

Wheat Transformation with <i>ScTPS1-TPS2</i> Bifunctional Enzyme for Trehalose Biosynthesis Protects Photosynthesis during Drought Stress

Wheat cultivation makes an important contribution to human nutrition. Trehalose synthesis plays a role in the tolerance to drought stress. A bifunctional TPS-TPP enzyme gene from yeast was used to obtain transgenic wheat plants to increase trehalose synthesis. Mature wheat embryos were transformed using pGreen rd29A::TPS1-TPS2 or pGreen 35S::TPS1-TPS2 constructs. The transgene presence in mature leaves of T3 plants was confirmed by sequencing a PCR fragment of the inserted transgene. Transgenic and NT plants were submitted to drought stress for eight days. Transformed wheat lines retained a higher relative water content than NT plants during drought stress, and the Rubisco activity was unaffected. Plants transformed with the 35S construct showed a lower photosynthetic rate and lower fructose 1–6-bisphosphatase (FBPase) activity during drought, suggesting that constitutive trehalose and sucrose synthesis caused a reduced ribulose 1,5-bisphosphate (RuBP) regeneration. Lines transformed with the rd29A promoter showed a higher photosynthetic rate after eight days of drought, as the RuBP regeneration was unaffected. Transgenic wheat plants had higher biomass and grain weight than NT plants after drought. These results suggest that trehalose synthesis improves photosynthesis during stress and induces changes in the activity of some Calvin-cycle enzymes, reflected in plant metabolism and growth

Quorum sensing network in clinical strains of A. baumannii : AidA is a new quorum quenching enzyme

Acinetobacter baumannii is an important pathogen that causes nosocomial infections generally associated with high mortality and morbidity in Intensive Care Units (ICUs). Currently, little is known about the Quorum Sensing (QS)/Quorum Quenching (QQ) systems of this pathogen. We analyzed these mechanisms in seven clinical isolates of A. baumannii. Microarray analysis of one of these clinical isolates, Ab1 (A. baumannii ST-2-clon-2010), previously cultured in the presence of 3-oxo-C12-HSL (a QS signalling molecule) revealed a putative QQ enzyme (α/β hydrolase gene, AidA). This QQ enzyme was present in all nonmotile clinical isolates (67% of which were isolated from the respiratory tract) cultured in nutrient depleted LB medium. Interestingly, this gene was not located in the genome of the only motile clinical strain growing in this medium (A. baumannii strain Ab421-GEIH-2010 [Ab7], isolated from a blood sample). The AidA protein expressed in E. coli showed QQ activity. Finally, we observed downregulation of the AidA protein (QQ system attenuation) in the presence of HO (ROS stress). In conclusion, most of the A. baumannii clinical strains were not surface motile (84%) and were of respiratory origin (67%). Only the pilT gene was involved in surface motility and related to the QS system. Finally, a new QQ enzyme (α/β hydrolase gene, AidA protein) was detected in these strains