Early regression index (ERI) on MR images as response predictor in esophageal cancer treated with neoadjuvant chemo-radiotherapy: Interim analysis of the prospective ESCAPE trial.

PURPOSE: The early regression index (ERI) predicts treatment response in rectal cancer patients. Aim of current study was to prospectively assess tumor response to neoadjuvant chemo-radiotherapy (nCRT) of locally advanced esophageal cancer using ERI, based on MRI. MATERIAL AND METHODS: From January 2020 to May 2023, 30 patients with esophageal cancer were enrolled in a prospective study (ESCAPE). PET-MRI was performed: i) before nCRT (tpre); ii) at mid-radiotherapy, tmid; iii) after nCRT, 2-6 weeks before surgery (tpost); nCRT delivered 41.4 Gy/23fr with concurrent carboplatin and paclitaxel. For patients that skipped surgery, complete clinical response (cCR) was assessed if patients showed no local relapse after 18 months; patients with pathological complete response (pCR) or with cCR were considered as complete responders (pCR + cCR). GTV volumes were delineated by two observers (Vpre, Vmid, Vpost) on T2w MRI: ERI and other volume regression parameters at tmid and tpost were tested as predictors of pCR + cCR. RESULTS: Complete data of 25 patients were available at the time of the analysis: 3/25 with complete response at imaging refused surgery and 2/3 were cCR; in total, 10/25 patients showed pCR + cCR (pCR = 8/22). Both ERImid and ERIpost classified pCR + cCR patients, with ERImid showing better performance (AUC:0.78, p = 0.014): A two-variable logistic model combining ERImid and Vpre improved performances (AUC:0.93, p < 0.0001). Inter-observer variability in contouring GTV did not affect the results. CONCLUSIONS: Despite the limited numbers, interim analysis of ESCAPE study suggests ERI as a potential predictor of complete response after nCRT for esophageal cancer. Further validation on larger populations is warranted.

Polifenoles, capacidad antioxidante y factor de protección solar de Borago officinalis L. "borraja" dispensada en las farmacias naturales de EsSalud / Polyphenols, antioxidant capacity and sun protection factor of Borago officinalis L. "borraja" dispensed in the Natural Pharmacies of EsSalud

Objetivos. Cuantificar los polifenoles, la capacidad antioxidante y el factor de protección solar de las hojas y flores de Borago officinalis L. dispensadas en las farmacias naturales de EsSalud. Materiales y métodos. Se prepararon tres extractos fluidos en etanol (96%, 70% y 40%) y dos extractos acuosos (decocto e infuso), se concentraron bajo vacío hasta obtener extractos secos (ES). Los polifenoles fueron cuantificados utilizando el método analítico de Folin-Ciocalteu, dichos valores fueron expresados como equivalentes de ácido gálico (EAG), la capacidad antioxidante fue determinada por el método de DPPH (1,1-difenil-2- picrilhidracilo), expresada en equivalentes de ácido ascórbico (EAA), del mismo modo como equivalentes de butilhidroxitolueno (EBHT). El factor de protección solar (FPS) se evaluó por el método espectrofotométrico en el rango de 290 a 320 nm. Resultados. Se cuantificaron polifenoles en el rango de 157,487 ± 3,628 y 66,777 ± 0,734 mg EAG/g ES del extracto fluido de 70 y 96%, respectivamente; la capacidad antioxidante entre 198,631 ± 5,636 y 73,699 ± 5,946 mg EAA/g ES del infuso y decocto, respectivamente, así como 388,694 ± 10,591 y 153,919 ± 11,174 mg EBHT/g ES del infuso y decocto; el FPS en el rango de 8,91 ± 0,07 y 5,53 ± 0,02 para el extracto fluido de 40% e infuso, respectivamente. Conclusiones. El infuso de Borago officinalis L. dispensada en las farmacias naturales de EsSalud, reportó polifenoles con la mayor capacidad antioxidante, y el extracto fluido de 40% presentó el mayor valor de FPS.

Objectives. Quantitation of polyphenols, antioxidant capacity and the sun protection factor of the leaves and flowers of Borago officinalis L. dispensed in Natural Pharmacies of EsSalud. Materials and methods. Three extracts were prepared with ethanol (96%, 70% and 40%) and two aqueous extracts (decoction and infusion), were removed volatile solvents under vacuum until obtaining dry extract (DE). Polyphenols were quantified by using analytic method referred as Folin-Ciocalteu, such values were expressed as gallic acid equivalents (GAE). On the other hand, the antioxidant capacity was determined by DPPH (1,1-diphenyl- 2-picrylhydracil) method, as well as values expressed in ascorbic acid equivalents (AAE) and butylated hydroxytoluene equivalents (BHTE). The sun protection factor values (SPF) were evaluated by using spectrophotometric method which values were in the range 290 to 320 nm. Results. Polyphenols were quantified in the range of 157.487 ± 3.628 and 66.777 ± 0.734 mg GAE/g DE of the redissolved and dilute extract of 70% and 96%, respectively. The antioxidant capacity was found between 198.631 ± 5.636 and 73.699 ± 5.946 mg AAE/g DE of the infusion and decoction, respectively, as well as 388.694 ± 10.591 and 153.919 ± 11.174 mg BHTE/g DE of the infusion and decoction; the SPF in the range 8.91 ± 0.07 and 5.53 ± 0.02 for the fluid extract of 40% and infusion, respectively. Conclusions. Infusion extract of Borago officinalis L. dispensed at the Natural Pharmacies of EsSalud, reported high concentration of polyphenols with the highest antioxidant activity. And the 40% redissolved and dilute extract was found a high SPF value.

Hemodynamic effects of transdermal estradiol alone and combined with norethisterone acetate.

A 24 weeks, randomized, two-period, placebo controlled study was conducted to compare the effects of continuous transdermal 17 beta-estradiol replacement therapy (0.05 mg/day once a week) with placebo on systemic hemodynamics and blood pressure in postmenopausal women. Twenty-nine postmenopausal women (47-62 years) free of hormone replacement therapy were randomized in two groups; group 1 received estradiol patches for the first 12 weeks and placebo patches for the second, and group 2 received the same treatments in the reverse order. The effect of combined estradiol plus oral norethisterone acetate (NETA) 1 mg was also evaluated in the subset of women with intact uteri (n = 24). Crossover analysis showed that stroke volume and cardiac output were significantly higher (P < 0.05) and blood pressure was significantly lower (P < 0.05) with estradiol, irrespective of the order in which the treatments were administered. Although correlations between plasma estradiol levels during active treatment and hemodynamic changes were not significant, hemodynamic changes were significantly greater above 63 pg/ml than below this level (P < 0.05). Oral norethisterone acetate administration either during transdermal placebo or estradiol arms tended to modify systemic hemodynamics in the same direction than estradiol but the changes did not attained statistical significance. In summary compared with placebo, transdermal 17 beta-estradiol, replacement to postmenopausal women, increased cardiac output and decreased blood pressure. Although the average magnitude of changes was small, the results suggest that plasma estradiol levels could be a source of individual variability in the hemodynamic response. Oral NETA administration tended to enhance rather than reverse the estradiol-induced changes.

[The current status of the perendoscopic treatment of biliary lithiasis]. / Lo stato attuale del trattamento perendoscopico della litiasi biliare.

The role of therapeutic biliary endoscopy, for management of bile duct stones, continues to be defined. Actually the endoscopic management should be considered the procedure of choice for treatment of retained or recurrent stones of the main bile duct, gallstone pancreatitis an acute cholangitis. It's role in the era of laparoscopic cholecystectomy is evolving. Actually new techniques and accessories continue to be developed for treatment of bile duct stones. The problem of the difficult bile duct stones has essentially been solved by the development of a variety of lithotripsy techniques. This work focuses on new developments in the therapeutic biliary endoscopy for treatment of main bile duct stones.

[Results of endoscopic Nd-Yag laser treatment of inoperable colorectal carcinoma]. / Risultati del trattamento perendoscopico con Nd-YAG laser del carcinoma del colon-retto non operabile.

Between November 1986 and December 1993, 94 patients underwent endoscopic laser therapy for inoperable colo-rectal cancers. According to the main clinical symptoms, tumors were divided into obstructing and bleeding; A Nd-YAG non contact laser was used at power setting of 70 to 100 watt. In 28 cases laser therapy was carried out after electrorection of the tumor and in 22 cases after dilation; in 41 cases it was associated with radiation therapy. In 90% of bleeding tumors and in 70% of obstructing tumors we achieved a good result in the short term. In 50% of bleeding tumors and in 65% of obstructing tumors the symptoms recurred after an interval of 8.2 and 6.1 weeks. The main survival period was 11.2 months for bleeding tumors and 7.4 months for obstructing tumors. Two patients with a small rectal cancer are free to neoplasia at 19 and 26 months after laser therapy.