Mieloma múltiple. Experiencia de 9 años en el Hospital Naval Almirante Nef / Multiple myeloma. Nine years' experience at the Hospital Naval Almirante Nef

Introducción: el mieloma múltiple (MM) continúa siendo una enfermedad incurable sin embargo, el trasplante autólogo de médula ósea (TAH), y las drogas antineoplásicas han permitido mejorar la sobrevida global (SG) de los pacientes. Materiales y métodos: estudio de cohorte retrospectivo de 50 pacientes con diagnóstico de MM en el hospital Naval Almirante Nef, desde 2005 a 2013. Los pacientes se dividieron en dos cohortes, según la eligibilidad a trasplante, y analizados acordes a la primera línea de tratamiento y la sobrevida global (SG) hasta abril de 2019. Resultados: mediana de edad 73 años (47-88 años), SG 49 meses, y 50% en etapa-II del Sistema de Etapificación Internacional. La SG de los 39 no candidatos a TAH fue 46 meses; con un mayor número de respuestas completas y sobrevida, con el esquema melfalán-prednisona-talidomida. La SG de los 11 candidatos a TAH fue 66 meses, siendo el esquema bortezomib-ciclofosfamida-dexame-tasona el que concentró un mayor número de respuestas completas libres de progresión. Se trasplantó el 45% de los candidatos, con una mediana de sobrevida de 79 meses versus a los 51 meses de aquellos no trasplantados. Tres casos de neuropatía asociada a talidomida y uno a bortezomib. La SG a los seis meses y a los cinco años de todos los pacientes fue 86% y 44%, respectivamente. Conclusión: la incorpo-ración de nuevos fármacos permitió obtener mejores resultados de sobrevida lo que se condice con estudios nacionales e internacionales.

Introduction: Multiple myeloma (MM) is still an incurable disease however, autologous stem cell transplantation (ASCT), and antineo-plastic drugs have allowed improving the overall survival (OS) of patients. Materials and methods: A retrospective cohort study of 50 patients diagnosed with MM at the Hospital Naval Almirante Nef, from 2005 to 2013. The patients were divided into two cohorts according to transplantation eligibility and analyzed about first-line treatment and overall survival (OS) up to April 2019. Results: Median age 73 years (47-88 years), OS 49 months, and 50% in stage-II International Staging System. OS of the 39 non-candidates for ASCT was 46 months: with a higher number of complete responses and survival, with the melphalan-prednisone-thalidomide scheme. The OS of the 11 candidates for ASCT was 66 months, with the bortezomib-cyclophosphamide-dexamethasone scheme being the one with the highest number of progression-free complete responses. Forty-five percent of the candidates were transplanted, with a median survival of 79 months versus 51 months for those not transplanted. Three cases of neuropathy were associated with thalidomide and one with bortezomib. OS at six months and five years for all patients was 86% and 44%, respectively. Conclusion: The incorporation of new drugs allowed to obtain better survival results, which is by national and international studies.

Centaurium cachanlahuen (Mol) Robinson, a Chilean native plant with a vasodilatory effect / Centaurium cachanlahuen (Mol) Robinson una planta nativa chilena con efecto vasodilatador

Centaurium cachanlahuen (Mol.) Robinson is a chilean native plant widely used in traditional medicine for the treatment of many diseases, including cardiovascular disorders. Studies carried out in normal and hypertensive rats suggested that extract of Centaurium cachanlahuen has antihypertensive effect. In this work, we aim to evaluate the effect of aqueous and hydroalcoholic extracts of Centaurium cachanlahuen on the vascular reactivity using rat aorta rings precontrated with phenylephrine (0.1 uM). Results showed that both aqueous (3 mg/mL) and hydroalcoholic extracts (3 mg/mL) produced rat aorta vasodilatation that was higher (P < 0.001) in the hydroalcoholic extract compared to the aqueous extract. This effect had an important endothelium-dependent component that was mediated by nitric oxide (NO), as supported by the inhibition of the response in the presence of N-nitro-L-arginine (L-NNA, 100 uM), a nitric oxide synthase (NOS) inhibitor. We suggest that xanthones present in the plant may play a key role in the vasodilator effect of Centaurium cachanlahuen extracts. The present study provides experimental evidence supporting the folkloric use of Centaurium cachanlahuen as hypotensive agent.

Centaurium cachanlahuen (Mol) Robinson es una planta nativa chilena ampliamente utilizada en medicina tradicional para el tratamiento de varias enfermedades, que incluyen alteraciones cardiovasculares. Estudios llevados a cabo en ratas normales e hipertensas sugieren que el extracto de Centaurium cachanlahuen tiene efecto antihipertensivo. El propósito de este trabajo fue evaluar el efecto de extractos acuosos e hidroalcohólicos de Centaurium cachanlahuen sobre la reactividad vascular de aorta de rata precontraída con fenilefrina (0.1 uM). Tanto el extracto acuoso (3 mg/mL) como el extracto hidroalcohólico (3 mg/mL) produjeron relajación de aorta de rata, la cual fue de mayor magnitud (P < 0.001) con el extracto hidroalcohólico respecto del extracto acuoso. El efecto observado tuvo un importante componente mediado por óxido nítrico (NO), tal como lo demuestra la inhibición de esta respuesta en presencia de N-nitro-L-arginina (L-NNA, 100 uM), un inhibidor de la óxido nítrico sintasa (NOS). Se sugiere que las xantonas presente en la planta pueden jugar un papel clave en el efecto vasodilatador observado por los extractos de Centaurium cachanlahuen. Este estudio constituye una evidencia experimental que apoya el uso popular de Centaurium cachanlahuen como agente hipotensor.

Nicotine-evoked cytosolic Ca2+ increase and cell depolarization in capillary endothelial cells of the bovine adrenal medulla

Endothelial cells are directly involved in many functions of the cardiovascular system by regulating blood flow and blood pressure through Ca2+ dependent exocitosis of vasoactive compounds. Using the Ca2+ indicator Fluo-3 and the patch-clamp technique, we show that bovine adrenal medulla capillary endothelial cells (B AMCECs) respond to acetylcholine (ACh) with a cytosolic Ca2+ increase and depolarization of the membrane potential (20.3±0.9 mV; n=23). The increase in cytosolic Ca2+ induced by 10µM ACh was mimicked by the same concentration of nicotine but not by muscarine and was blocked by 100 µM of hexamethonium. On the other hand, the increase in cytosolic Ca2+ could be depressed by nifedipine (0.01 -100 µM) or withdrawal of extracellular Ca2+. Taken together, these results give evidence for functional nicotinic receptors (nAChRs) in capillary endothelial cells of the adrenal medulla. It suggests that nAChRs in B AMCECs may be involved in the regulation of the adrenal gland's microcirculation by depolarizing the membrane potential, leading to the opening of voltage-activated Ca2+ channels, influx of external Ca2+ and liberation of vasoactive compounds.