Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study.

Background: Pancreatic Stereotactic Body Radiotherapy (SBRT) allows for the administration of a higher biologically effective doses (BED), that would be essential to achieve durable tumor control. Escalating treatment doses need a very accurate tumor positioning and motion control during radiotherapy.The aim of this study to assess the feasibility and safety of a Simultaneous Integrated Boost (SIB) dose-escalated protocol at 45 Gy, 50 Gy and 55 Gy in 5 consecutive daily fractions, in Border Line Resectable Pancreatic Cancer (BRCP) /Locally Advanced Pancreatic Cancer (LAPC) by means of a standard LINAC platform. Methods: Patients diagnosed of BRPC/LAPC, candidates for neoadjuvant chemotherapy and SBRT, in four university hospitals of the province of Las Palmas (Canary Islands, Spain) were included in this prospective study. Radiotherapy was administered using standard technology (LINACS) with advanced positioning (Lipiodol® and metallic stent used as fiducial markers) and tumor motion control (4D, DBH, Calypso®). There were 3 planned dose-escalated SIB groups, 45 Gy/5f (9 patients) 50 Gy/5f (9 + 9 patients) and 55 Gy/5f (9 patients). The defined primary end points of the study were the safety and feasibility of the proposed treatment protocol. Secondary endpoints included radiological tumor response after SBRT, local control and survival. Results: From June 2017 to December 2022, sixty-two patients were initially assessed for eligibility in the study in the four participating centers, and 49 were candidates for chemotherapy (CHT). Forty-one were referred to radiotherapy after CHT and 33 finally were treated by escalated-dose SIB, 45 Gy (9 patients) 50 Gy (16 patients), 55 Gy(8 patients). All patients completed the scheduled treatment and no acute or late severe (≥grade3) gastrointestinal toxicity was observed.Local response was analyzed by CT/MRI two months after the end of SBRT. Ten patients (31,25 %) achieved objective response (2/9:45 Gy, 5/15:50 Gy, 3/8:55 Gy). Follow-up was closed as July 2023. Freedom from local progression at 1-2y were 89,3% (95 %CI:83,4-95,2%) and 66 % (95 %CI:54,6-77,4%) respectively. The 1-2y survival rates were 95,7% (95 %CI:91,4-100 % and 48,6% (95 %CI:37,7-59,5%) respectively. Conclusion: These promising results should be confirmed by further studies with larger sample size and extended follow-up period.

Carbohydrate metabolism and gene expression of sirtuin 1 in healthy subjects after Sacha inchi oil supplementation: a randomized trial.

BACKGROUND: The postprandial stage is related to cardiovascular risk and it depends on the type of meal consumed. We study the effects of Sacha inchi oil on the postprandial glycemic state caused by meals rich in saturated fat. METHODS AND RESULTS: A double blind randomized trial in which 42 adult men ingested two breakfasts rich in saturated fat, one of them containing additionally 15 mL of Sacha inchi oil. Blood samples were obtained before or after 1 and 4 hours post-ingestion to quantify glucose, insulin and lipid profile in serum. The insulinogenic and sensitivity indices were calculated and the expression of sirtuin-1 in circulating mononuclear cells by qPCR was determined. RESULTS: Oil addition attenuated the increase of glucose in 16 (38.1%) participants. This group showed a higher concentration of fasting triacylglycerides and sirtuin-1 expression at 4 hours post-Sacha inchi oil correlated with glucose at the same time (r = -0.724; p = 0.012), and with postprandial insulin sensitivity (r = 0.636; p = 0.035). CONCLUSIONS: The addition of Sacha inchi oil to a highly fatty meal improves insulin sensitivity in people with higher basal triglyceridemia and higher glycemic responses after a fat load. Under these conditions, sirtuin-1 expression correlates with postprandial insulin sensitivity.

[Neuro-ultrasonographic evaluation of ischemic stroke]. / Valoración neurosonológica del ictus isquémico.

INTRODUCTION AND DEVELOPMENT: The development of new management strategies for acute stroke demands better understanding of the ischemic mechanism, cerebrovascular anatomy, and cerebral hemodynamics for individual patients. The use of carotid duplex sonography, transcranial Doppler sonography, and echocardiography allows evaluation of the key areas of interest in a prompt, safe, accurate, and cost effective manner. CONCLUSIONS: Knowledge of these methods is essential for neurologist caring for patients with stroke.

Effect of ursodeoxycholic acid administration on bile acid composition in hamster bile.

The modification in the composition of bile acids in hamster by the administration of high dose of ursodeoxycholic acid (UDCA) was investigated. Male Golden Syrian hamsters were divided into five groups: a control group, two groups that received 0.5 g of UDCA per 100 g of standard diet during 30 and 60 days and another two groups that received 1 g of UDCA per 100 g of standard diet during 30 and 60 days. After ether anaesthesia the gallbladder was removed and bile was immediately aspirated. Bile acids were determined by high performance liquid chromatography (HPLC). Taurolithocholic (TLCA) and glycolithocholic acids (GLCA) increased significantly in all treated groups. The glyco/tauro ratio of 0.69 in controls became more than 1 in treated animals except in the case of lithocholic acid (LCA) conjugates which remained less than 1. UDCA derivatives increased proportionally to the administered dose and the cholic/cheno ratio diminished significantly. A moderate increase of 3- and 7-keto derivatives of chenodeoxycholic acid (CDCA) was observed in all treated groups but the above mentioned increment was especially evident in 3-keto derivatives. A high percentage of UDCA administered in the hamster was likely transformed to CDCA and the glyco conjugates of the bile acids were the predominant species except for the LCA derivatives.

Leucodermia por paraterbutilfenol.Padecimiento profesional generalizado? / Leukoderma due to paratertiarybutylphenol. A generalized professional disease?

Se informan 12 casos de leucodermia en bajadores dedicados a la sintesis de paraterbutilfenol. Se estudian macroscopicamente y ultramicroscopicamente las lesiones dermicas y se investigan, en detalle, las posibles repercusiones generales. Se comparan con hallazgos similares en otros paises y se proponen algunas hipotesis sobre el mecanismo patogenico para basar las medidas terapeuticas y profilacticas idoneas

Dermatitis de contacto alergica por colorantes en calcetines. / Alergic contact dermatitis to dyes in socks

La dermatitis de contacto alergica por colorantes en calcetines, constituye un problema cronico e incapacitante, su diagnostico no siempre es sencillo y a menudo se confunde con otras dermatosis que afectan los pies.Los agentes etiologicos principales son los colorantes azoicos derivados del aminoazobenceno y otros colorantes de tipo antraquinonico que pueden jugar tambien un papel importante. El diagnostico preciso puede efectuarse unicamente por medio de pruebas epicutaneas con los colorantes utilizados en la tincion de acetato, nylon y poliester, asi como con fragmentos de las prendas sospechosas, lo cual permite identificarlas, facilitando las alternativas adecuadas para el uso de calcetines que pueden ser tolerados por el paciente. Es importante completar el estudio inmunologico con otras substancias que pueden originar dermatitis de contacto en los pies como son materiales del calzado y medicamentos topicos

Occupational pigmented contact dermatitis from Naphthol AS.

Hyper-pigmentation as a manifestation of contact sensitivity to optical brighteners has previously been reported. In 1973 we observed an epidemic of pigmented contact dermatitis occurring in a textile mill in connection with the manufacture of drill fabrics impregnated with a recently introduced azo dye coupling component Naphthol AS. Of the 53 workers included in the study, 12 presented a spotted pattern of hyperpigmentation mainly affecting the exposed areas, but without pruritus, 18 were pigmented to a lesser degree, and in 21 it was not possible to discern any well-defined discoloration; some of the patients in the last group, however, complained of slight pruritus. The last two patients who were fair-skinned showed a reddish-brown pigmentation and a well pronounced pruritus. Hyper-pigmentation was most pronounced in individuals with dark complexions, whereas fair-skinned patient also showed "classical" eczematous symptoms including pruritus. A field study demonstrated direct exposure to the chemical. All 53 patients were patch-tested with Naphthol AS 5% in water, and 24 were found to be positive. Histological features were melanocyte proliferation, incontinence of pigment, and various degrees of damage to the basal layer.

Occupational koilonychia from organic solvents.

Occupational koilonychia of the finger-nails among cabinet makers is reported. Six cases occurred in workers in close contact with a mixture of organic solvents (thinners). The deformity involved particularly the thumb, index and middle finger-nails, due to a particular way of cleaning metal accessories in finished furniture. The possible mechanism is discussed.