Neoadjuvant chemotherapy with or without radiotherapy versus upfront surgery for resectable pancreatic adenocarcinoma: a meta-analysis of randomized clinical trials.

BACKGROUND: The role of neoadjuvant chemotherapy (NC) in resectable pancreatic cancer (RPC) has yet to be defined. This review aims to analyze the benefit of NC in RPC compared with upfront surgery (US) in terms of overall survival (OS) and disease-free survival (DFS). PATIENTS AND METHODS: PubMed, CENTRAL (The Cochrane Library), and Embase were systematically reviewed until 3 November 2021. Abstract proceedings and virtual meeting presentations from the American Society of Clinical Oncology and the European Society of Medical Oncology conferences, reference articles of published clinical trials, and review articles were considered. Only randomized clinical trials (RCTs) comparing NC administration with or without radiotherapy previous with surgery (experimental arm) versus US followed by adjuvant chemotherapy with or without radiotherapy (control arm) for RPC were included. RESULTS: A total of 1135 studies were screened. Of these, 1117 studies were primarily excluded. Of the remaining 18 studies, 5 were excluded because of no adequate trial design for this work and 7 others had no available results. Finally, 6 trials with 469 patients with pancreatic cancer randomized to NC (n = 212) or US (n = 257) were selected. Compared with US, NC significantly improved OS [hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.58-0.98; P = 0.033] and DFS (HR 0.73; 95% CI 0.59-0.89; P = 0.002). While the NC approach was not significantly associated with lower resection rate [relative risk (RR) 0.92; 95% CI 0.84-1.01; P = 0.069], the R0 resection rate was significantly higher for NC than for US (RR 1.31; 95% CI 1.13-1.52; P = 0.0004). CONCLUSION: This is the first meta-analysis of RCTs showing that NC improves OS for RPC compared with US followed by adjuvant therapy. Ongoing RCTs should confirm these findings with FOLFIRINOX to generalize the indication of NC.

[Microalbuminuria, lipid changes and coronary heart disease in non-insulin-dependent diabetics]. / Microalbuminuria, alteraciones lipídicas y cardiopatía coronaria en diabéticos no insulino dependientes.

BACKGROUND: Microalbuminuria could be a possible coronary risk factor: AIM: To study the association between microalbuminuria, serum lipid levels and coronary heart disease in non-insulin-dependent diabetics. PATIENTS AND METHODS: We studied 104 non-insulin-dependent diabetics, who were separated in four groups according to the presence of microalbuminuria, defined as a 24 h albumin excretion of 30-300 mg/24 h and according the history of coronary artery disease. Total, HDL and LDL cholesterol, triglycerides, alpha, beta, prebeta lipoproteins, lipoprotein (a), apoproteins A and B were measured in all. RESULTS: Twenty patients with and 32 without coronary artery disease had normal albumin excretion and the same number of patients had a urinary albumin 30-300 mg/24 h. All four groups were comparable in terms of metabolic control, nutritional status, blood pressure and creatinine levels. Patients with coronary artery disease had higher urinary albumin excretion than patients without the disease 91 (32-173) and 34 (5-97) mg/24 h respectively p < 0.01. Patients with coronary artery disease and microalbuminuria had higher triglycerides, beta, pre beta lipoproteins, Apo B, Lp(a) and lower Apo B and alpha lipoproteins. This group also had a higher frequency of abnormal pre beta and alpha lipoprotein levels, when compared with coronary patients with normal albumin excretion. In coronary patients there was a positive association between urinary albumin levels and triglycerides (r = 0.24), pre beta lipoproteins (r = 0.27) and Apo B (r = 0.3); there was also a negative association with HDL cholesterol (r = 0.25) and alpha lipoproteins (r = -0.41). CONCLUSIONS: In this group of non-insulin-dependent diabetics, an association among microalbuminuria, abnormal serum lipid levels and coronary artery disease was detected.

[Cryoglobulins in rheumatoid arthritis: exhaustive detection, immunochemical findings and clinical expression]. / Crioglobulinas en artritis reumatoide: detección exhaustiva, hallazgos inmunoquímicos y expresion clínica.

Cryoglobulins were measured in 29 patients (24 female, age 53.8 +/- 9.8 years) with rheumatoid arthritis (70% active). The cryoprecipitate was isolated, characterized and quantified. Cryoglobulinemia, always polyclonal or type III, was found in 83% of patients. The most frequent immunochemical isotypes found were IgG and A. Acrocyanosis was found in 50% and Raynaud phenomenon in 32% of patients with cryoglobulinemia. It is concluded that exhaustive detection of cryoglobulinemia in rheumatoid arthritis demonstrated a higher frequency than previously reported an is important for understanding pathogenesis of the disease.

[Acipimox in primary hyperlipidemias: safety and efficacy evaluated in six months]. / Acipimox en hiperlipidemias primarias: seguridad y eficacia evaluada a 6 meses.

The efficacy and tolerance of 750 mg of Acipimox was tested in 38 pts with primary dyslipidemias: 20 type IIa, 12 type IIb, and 6 type IV. All pts had been poor responders to a 2 month diet according to the recommendations of the National Cholesterol Education Program. Clinical examination, eye fundus, and the following laboratory tests: total cholesterol (TC), HDL, triglycerides (TG), total bilirubin, alkaline phosphatase, oxalacetic and pyruvic transaminases, uric acid, plasmatic creatinine, albumin, postprandial glucose test, hematocrit, white blood and platelet count were performed 60 days before drug initiation, 60 and 180 days after treatment had been started. No side effects were observed (myositis, visual gastrointestinal). 50% of the pts had slight to moderate flushing which appeared the first 3 days and lasted 14 +/- 7 days after treatment had been started. Plasmatic creatinine increased from 0.89 to 1.86 mg/dl in pt with one kidney, returning to normal levels 30 days after Acipimox interruption. After 180 days of therapy in the IIa group TC was -27% (p < 0.001), HDL + 15% (p < 0.001); in the IIb group: TC-23% (p < 0.001), HDL +9% (NS), TG -48% (p < 0.001); and in the IV group: TC-10% (p < 0.05), HDL +20% (p < 0.001), TG-53% (p < 0.001). Acipimox is well tolerated and is useful as a lipid-lowering drug in type IIa, IIb and IV dyslipidemias. Further studies are necessary to clear effects of the drug on renal metabolism and on long term survival of coronary pts.

[The determination of immunological parameters in splenectomized patients]. / Determinación de parámetros inmunológicos en pacientes esplenectomizados.

We studied 15 patients submitted to splenectomy. Humoral immunity was studied with protein electrophoresis and quantification of immunoglobulins; cellular immunity was studied by total and subpopulation lymphocyte counts and evaluation of phagocytosis. Increased levels of IgG, IgM and IgA, a decrease in circulating T-lymphocytes and an increased phagocytosis was seen after operation. These findings correlated to the presence of viral and parasitic infections postoperatively. Preoperative antipneumococcal vaccination prevented infections by this agent. Thus, appropriate preventive measures must be taken to deal with altered immunological responses after splenectomy.

Gammapatias monoclonales. / Monoclonal gammapathies

Se analizan 112 casos de inmunoglobulinas monoclonales pesquisadas en un periodo de cuatro anos, en el Laboratorio de Inmunologia de la Universidad de Fisiopatologia Occidente, Facultad de Medicina, Universidad de Chile, en pacientes del Area de Salud Metropolitana Occidente. El estudio consiste en una evaluacion inmunologica, clinica, radiologica y de laboratorio bioquimico general. Se determina la distribucion diagnostica de las inmunoglobulinas monoclonales detectadas clasificandolas en gammapatias monoclonales de significado indeterminado y gammapatias monoclonales malignas. Se analiza la distribucion por sexo y edad en cada grupo. Por ultimo, se establece una relacion entre la clasificacion diagnostica y los niveles sericos de las inmunoglobulinas monoclonales

Complemento serico: actividad hemolitica en adultos sanos. / Serum complement: hemolytic activity in healthy adults

Se estudia la actividad hemolitica total del complemento serico "CH50" en adultos sanos. Se establece el intervalo de referencia, agrupando ambos sexos, ya que el analisis estadistico no mostro una diferencia significativa entre ambos grupos.Se discute la importancia de realizar este examen conjuntamente con las dosificaciones de componentes individuales del complemento en la evaluacion de algunos estados patologicos

Determinacion de niveles normales de proteinemia y perfil electroforetico de proteinas en adultos del area occidente de Santiago. / Determination of serum protein and protein electrophoresis in adults of the occidental area of Santiago

Se determina la proteinemia total con el metodo de Biuret y las fracciones electroforeticas en la sangre de 358 adultos aparentemente sanos. Los resultados se analizan estadisticamente y se establecen los valores promedios asi como el rango normal tanto para la proteinemia total como para las diversas fracciones electroforeticas. Se insiste en la necesidad que cada laboratorio establezca sus propios valores segun el equipamiento disponible y las tecnicas empleadas