Five-Fraction Proton Therapy for the Treatment of Skull Base Chordomas and Chondrosarcomas: Early Results of a Prospective Series and Description of a Clinical Trial.

(1) Background: Our purpose is to describe the design of a phase II clinical trial on 5-fraction proton therapy for chordomas and chondrosarcomas of the skull base and to present early results in terms of local control and clinical tolerance of the first prospective series. (2) Methods: A dose of 37.5 GyRBE in five fractions was proposed for chordomas and 35 GyRBE in five fractions for chondrosarcomas. The established inclusion criteria are age ≥ 18 years, Karnofsky Performance Status ≥ 70%, clinical target volume up to 50 cc, and compliance with dose restrictions to the critical organs. Pencil beam scanning was used for treatment planning, employing four to six beams. (3) Results: A total of 11 patients (6 chordomas and 5 chondrosarcomas) were included. The median follow-up was 12 months (9-15 months) with 100% local control. Acute grade I-II headache (64%), grade I asthenia and alopecia (45%), grade I nausea (27%), and grade I dysphagia (18%) were described. Late toxicity was present in two patients with grade 3 temporal lobe necrosis. (4) Conclusions: Hypofractionated proton therapy is showing encouraging preliminary results. However, to fully assess the efficacy of this therapeutic approach, future trials with adequate sample sizes and extended follow-ups are necessary.

A concept for integrated care pathways for atopic dermatitis-A GA2 LEN ADCARE initiative.

INTRODUCTION: The integrated care pathways for atopic dermatitis (AD-ICPs) aim to bridge the gap between existing AD treatment evidence-based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co-ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. METHODS: The GA2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD-ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2 EN ADCARE centres. RESULTS: The AD-ICPs outline the diagnostic procedures, possible co-morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. CONCLUSION: The AD-ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD.

Phenolic Profile, Antioxidant Capacities and Enzymatic Inhibitory Activities of Propolis from Different Geographical Areas: Needs for Analytical Harmonization.

Propolis is a resinous vegetal exudate modified by bees, and is interesting as a preservative and potentially functional product. This work dealt with studying the common phenolic profiles and antioxidant capacities of 13 bee propolis from different geographical areas. Both hyaluronidase and angiotensin converting enzyme (ACE) inhibitory activities were also assessed and related when possible with particular phenolic compounds. High performance liquid chromatography-ultraviolet detection (HPLC-UV) analysis showed that every propolis contained p-coumaric acid (1.2-12.2 mg/g) and ferulic acid (0.3-11.0 mg/g). Pinocembrin, catechin, and caffeic acid phenethyl ester (CAPE) plus galangin were the main flavonoids. Antioxidant activities were higher than 280 µmol trolox/g for trolox equivalent antioxidant capacity (TEAC), 0.099 mmol uric acid/g for radical-scavenging effect on hydroxyl radicals, and 0.19 mg/mL for half maximal inhibitory concentration (IC50) of antioxidant activity against superoxide anion radical. Working with solutions of 10 mg/mL propolis, hyaluronidase inhibitory activity ranged between 0% and 68.20%, being correlated to ferulic acid content. ACE inhibitory effect determined by HPLC was higher than 78%, being correlated with catechin and p-coumaric acid. Therefore, propolis could be useful for food, pharmaceutical, and cosmetic companies, also helping to reduce risk factors for diseases related to oxidative damage, inflammatory processes, and hypertension. This research also highlights the necessity for harmonized analysis methods and the expression of results for propolis.

Manejo clínico y paliativo del sufrimiento en la COVID-19 / Clinical and palliative management of suffering in COVID-19

La COVID-19 ha representado un desastre humanitario que ha conmovido a nuestros sistemas sanitarios y a la economía global. Se revisa su presentación clínica, evaluación y triaje de los pacientes estables o inestables, la toma de decisiones, las ayudas respiratorias, comorbilidades asociadas, el control de síntomas, el papel de los cuidados paliativos en esta pandemia, y la necesidad de promover un cambio en la visión y organización del mundo y la necesidad de una gobernanza mundial sanitaria a cargo de la OMS.

COVID-19 has represented an humanitarian disaster that has shaken our healthcare systems and the global economy. We review the clinic presentation, assessment and triage of stable or unstable patients, decision making, respiratory aids, intubation, associated comorbidities, symptom control, the role of palliative care and family in this pandemic, and the need to promote a change in the vision and organization of the world and the need for a global health gobernance by WHO.

Modification of carbon nanotubes for gene delivery vectors.

The surface modification of carbon nanotubes (CNTs) can be tailored to allow the formation of a complex between these potential carriers with DNA. In this chapter, protocols developed in our lab to prepare transfection vectors through the modification of MWCNTs are described. The protocol includes sections focused on the reduction of CNTs length, protocols to increase the dispersability of CNTs and finally, protocols for surface modification to attach through electrostatic interactions DNA to the CNTs.