Ultrahypofractionation in postoperative radiotherapy for breast cancer: A single-institution retrospective cohort series.

BACKGROUND: The 'FAST-forward', study published in April 2020, demonstrated the effectiveness of an extremely hypofractionated radiotherapy schedule, delivering the total radiation dose in five sessions over the course of 1 week. We share our department's experience regarding patients treated with this regimen in real-world clinical settings, detailing outcomes related to short-term toxicity and efficacy. METHODS: A descriptive observational study was conducted on 160 patients diagnosed with breast cancer. Between July 2020 and December 2021, patients underwent conservative surgery followed by a regimen of 26 Gy administered in five daily fractions. RESULTS: The median age was 64 years (range: 43-83), with 82 patients (51.3%) treated for left-sided breast cancer, 77 patients (48.1%) for right-sided breast cancer, and 1 instance (0.6%) of bilateral breast cancer. Of these, 66 patients had pT1c (41.3%), 70.6% were infiltrative ductal carcinomas, and 11.3% were ductal carcinoma in situ. Most tumours exhibited intermediate grade (41.9%), were hormone receptor positive (81.3%), had low Ki-67 (Ki-67 < 20%; 51.9%) and were Her 2 negative (85%). The majority of surgical margins were negative (99.4%). Among the patients, 72.5% received hormonotherapy, and 23.8% received chemotherapy. Additionally, 26 patients (16.3%) received an additional tumour boost following whole breast irradiation (WHBI) of 10 Gy administered in five sessions of 2 Gy over a week. The median planning target volume (PTV) was 899 cm3 (range: 110-2509 cm3). Early toxicity was primarily grade I radiodermatitis, affecting 117 patients (73.1%). During a median follow-up of 15 months (range: 3.9-28.77), only one patient experienced a local relapse, which required mastectomy. CONCLUSIONS: The implementation of this highly hypofractionated regimen in early-stage breast cancer appears feasible and demonstrates minimal early toxicity. However, a more extended follow-up duration would be required to evaluate long-term toxicity and efficacy accurately.

Ácaro Sarcoptes scabiei en movimiento / Sarcoptes scabiei mite moving

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Caliber-persistent labial artery: report of 3 cases

Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

Caliber-persistent labial artery: report of 3 cases.

The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

The decolorization and degradation of azo dyes by two Stenotrophomonas strains isolated from textile effluent (Tepetitla, Mexico).

Stenotrophomonas' metabolic versatility plays important roles in the remediation of contaminated environment and plant growth promotion. We investigated two Stenotrophomonas strains isolated from textile polluted sewage for their ability to decolorize and degrade azo dyes. Two Stenotrophomonas strains (TepeL and TepeS) were isolated from textile effluents (Tepetitla, Mexico) using the selective agar Stenotrophomonas vancomycin, imipenem, amphotericin B agar (SVIA). Isolates' identity was determined by the sequencing of their partial 16S rRNA fragments. Their abilities to decolorize dyes were tested in a Luria broth supplemented with varying concentrations (50 mg/L-1 g/L) of textile dyes (acidic red, methyl orange, reactive green, acidic yellow, and reactive black). Fourier-transform infrared (FTIR) spectroscopy and ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) metabolite analyses were used to determine the effect of the isolates' growth on the dyes (acidic red, methyl orange). We also identified the enzymes that may be involved in the degradation process. Phylogenetic analysis based on the 16S rDNA sequences showed that the isolates belong to the genus Stenotrophomonas. Stenotrophomonas sp. TepeL and TepeS respectively decolorize all the azo dyes at the tested concentration except at 1 g/L and degraded the azo dyes. The degradation resulted in the formation of N, N-dimethyl p-phenylenediamine, and sodium 4-amino-1-naphthalenesulfonate from methyl orange and acid red. TepeL and TepeS rapidly decolorized and degraded the azo dyes tested. This result showed that the two isolates have a good potential for the decontamination of textile effluents.

Flexural comedones and scar formation caused by inflammatory Tinea corporis.

Childhood flexural comedones are a recently described entity defined as comedones characterized by double orifices connected by a thin layer of epidermis showing the contents beneath. We present a case of flexural comedones and scar formation caused by inflammatory tinea corporis.

Assessment of Fennel Oil Microfluidized Nanoemulsions Stabilization by Advanced Performance Xanthan Gum.

In this work, nanoemulsion-based delivery system was developed by encapsulation of fennel essential oil. A response surface methodology was used to study the influence of the processing conditions in order to obtain monomodal nanoemulsions of fennel essential oil using the microchannel homogenization technique. Results showed that it was possible to obtain nanoemulsions with very narrow monomodal distributions that were homogeneous over the whole observation period (three months) when the appropriate mechanical energy was supplied by microfluidization at 14 MPa and 12 passes. Once the optimal processing condition was established, nanoemulsions were formulated with advanced performance xanthan gum, which was used as both viscosity modifier and emulsion stabilizer. As a result, more desirable results with enhanced physical stability and rheological properties were obtained. From the study of mechanical spectra as a function of aging time, the stability of the nanoemulsions weak gels was confirmed. The mechanical spectra as a function of hydrocolloid concentration revealed that the rheological properties are marked by the biopolymer network and could be modulated depending on the amount of added gum. Therefore, this research supports the role of advanced performance xanthan gum as a stabilizer of microfluidized fennel oil-in-water nanoemulsions. In addition, the results of this research could be useful to design and formulate functional oil-in-water nanoemulsions with potential application in the food industry for the delivery of nutraceuticals and antimicrobials.

Advances in the treatment of prostate cancer with radiotherapy.

INTRODUCTION: Prognosis of prostate cancer has improved as a result of the combination with androgen deprivation therapy and the increase of radiation dose. However, a high number of prostate cancer patients will develop biochemical recurrence; therefore a research effort to increase the control of the tumour in these patients is necessary. METHODS: To increase the therapeutic ratio (the index between cytotoxic effects and normal tissue complications with a certain dose of radiation), different new strategies described in the literature have been reviewed. RESULTS: There are several strategies that may increase the efficacy of radiotherapy to treat prostate cancer. First is based on physics and technology, and second based on biology. DISCUSSION: Technical advances in radiotherapy allow intensification of radiation through escalation of the dose or in combination with chemotherapy. Furthermore, targeting specific molecular dysregulated pathways in the tumour will increase the effects of radiation specifically in tumour cells. Hopefully, these strategies will result in increased rates of tumour control in all prognostic groups, especially in high risk tumours and a subgroup of patients with intermediate risk tumours, minimizing treatment morbidity and increasing the therapeutic ratio of radiotherapy.

Long-term effects of varying consumption of ω3 fatty acids in ear, nose and throat cancer patients: assessment 1 year after radiotherapy.

A prospective 1-year follow-up study in ear, nose, and throat (ENT) cancer patients was carried out one year after radiotherapy to assess the effect of varying consumption of ω3 fatty acid according to whether they consumed more or less than the 50th percentile of ω3 fatty acids. Clinical, analytical, inflammatory (CRP and IL-6), and oxidative variables (TAC, GPx, GST, and SOD) were evaluated. The study comprised 31 patients (87.1% men), with a mean age of 61.3 ± 9.1 years. Hematological variables showed significant differences in the patients with a lower consumption of ω3 fatty acids. A lower mortality and longer survival were found in the group with ω3 fatty acid consumption ≥50th percentile but the differences were not significant. No significant difference was reached in toxicity, inflammation, and oxidative stress markers. The group with ω3 fatty acid consumption <50th percentile significantly experienced more hematological and immune changes.

Current status of IMRT in head and neck cancer.

BACKGROUND: IMRT provides highly conformal dose distributions creating non uniform spatial intensity using different segments in the beam. MATERIAL & METHODS AND RESULTS: Different retrospective studies have shown a high capability of IMRT to treat tumours close to the base of skull. Prospective studies have shown a decrease in xerostomia compared with conventional 3D conformal treatment (3DCRT). Modulation of intensity is performed by the movement of the multileaf collimator (MLC) that can deliver the radiation in different ways, such as static field segments, dynamic field segments and rotational delivery (arc therapy and tomotherapy). There are slight differences among the different techniques in terms of homogeneity, dose conformity and treatment delivery time. CONCLUSIONS: The best method to deliver IMRT will depend on multiple factors such as deliverability, practicality, user training and plan quality.

Secondary prevention of arterial disease in very elderly people: results from a prospective registry (FRENA).

There is little information on the effectiveness of secondary prevention interventions in very elderly patients. In this article, the incidence of major cardiovascular events during a 12-month follow-up period in a series of consecutive patients with coronary, cerebrovascular, or peripheral artery disease is analyzed. As of October 2006, 1264 patients had been enrolled. Of these, 324 (26%) were >or=75 years of age. Their incidence rate of 22 events per 100 patient-years (95% CI, 17-28) was over 2-fold the 7.9 (95% CI, 6.2-10) found in those <75 years of age. Among them, only chronic heart failure and diabetes were independently associated with an increased risk for major events, whereas the use of angiotensin II antagonists was associated with a lower risk. Patients >or=75 years of age had an over 2-fold higher incidence of major cardiovascular events. The use of angiotensin II antagonists was associated with a lower risk.

Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant.

Leakage and fistula are feared complications after gastro-intestinal anastomosis. A 36-year-old female underwent an one-anastomosis gastric bypass. The 24-h routine radiological study before oral intake showed a tiny leak, which was treated by NPO and I.V. fluids. After 5 days, despite output reduction, total parenteral nutrition was commenced. After 8 days, the leak remained with reduced output. It was then occluded endoscopically by fibrin glue. To our surprise, we found the drain that we had left behind the anastomosis, inside the gastric pouch. We began withdrawing the drain and occluded the defect with 4 ml Tissucol. After 48-h of no output, a repeat radiological study showed persistence of the leak. 6 days later, a radiological study demonstrated total closure of the leak.

One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients.

BACKGROUND: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz. METHODS: The results of our first 209 OAGB patients operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight 66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery (18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation had been performed previously. RESULTS: 2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3 patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%), 1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only 2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80% at 2 years. CONCLUSION: OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric bypass, quicker return to normal activities, and better quality of life.

Guías para la reposición de las pérdidas sanguíneas en cirugía abdominal de urgencia / Guidelines for blood loss replacement in emergency abdominal surgery

La reposición de la pérdidas sanguíneas en cirugía abdominal urgente desempeña un papel clave para la supervivencia, sobre todo en los pacientes que presentan una pérdida de sangre masiva provocada por la rotura del hígado, el bazo y los vasos mesentéricos, así como en el hemoperitoneo masivo secundario a un embarazo ectópico. Para manejar con éxito a estos pacientes debe seguirse un algoritmo claro previamente consensuado y aceptado por los miembros del servicio, tanto para el rápido diagnóstico y utilización de maniobras quirúrgicas precisas para el control de la fuente de hemorragia como, sobre todo, para el control de la alteración de los factores de la coagulación y la consecuente necesidad de una precisa pauta de uso de los distintos componentes sanguíneos que deben utilizarse en su reposición. El uso de estas guías reduce la mortalidad de forma significativa. En este contexto, el uso de la autotransfusión intraoperatoria ha demostrado ser un procedimiento seguro y con un buena relación coste-efectividad que se puede utilizar incluso por vía laparoscópica. Sin embargo, su utilización está poco extendida, sistematizada y mal organizada, a tenor de los datos publicados en la bibliografía (AU)