FR - Prevención farmacológica del cáncer cutáneo no-melanoma en pacientes de alto riesgo / RF - Pharmacological Prevention of Nonmelanoma Skin Cancer in High-Risk Patients

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Vitamin B3 impairs reverse cholesterol transport in Apolipoprotein E-deficient mice / La vitamina B3 altera el transporte reverso del colesterol en ratones con deficiencia en apolipoproteína E

Introduction: High Density Lipoproteins (HDL) are dysfunctional in hypercholesterolemia patients. The hypothesis was tested that nicotinamide (NAM) administration will influence HDL metabolism and reverse cholesterol transport from macrophages to the liver and feces in vivo (m-RCT) in a murine model of hypercholesterolemia. Methods: Apolipoprotein E-deficient (KOE) mice were challenged with a high-fat diet for 4 weeks. The effect of different doses of NAM on cholesterol metabolism, and the ability of HDL to promote m-RCT was assessed. Results: The administration of NAM to KOE mice produced an increase (∼1.5-fold; P < 0.05) in the plasma levels of cholesterol, which was mainly accounted for by the non-HDL fraction. NAM produced a [3H]-cholesterol plasma accumulation (∼1.5-fold) in the m-RCT setting. As revealed by kinetic analysis, the latter was mainly explained by an impaired clearance of circulating non-HDL (∼0.8-fold). The relative content of [3H]-tracer was lowered in the livers (∼0.6-fold) and feces (> 0.5-fold) of NAM-treated mice. This finding was accompanied by a significant (or trend close to significance) up-regulation of the relative gene expression of Abcg5 and Abcg8 in the liver (Abcg5: 2.9-fold; P < 0.05; Abcg8: 2.4-fold; P = 0.06) and small intestine (Abcg5: 2.1-fold; P = 0.15; Abcg8: 1.9-fold; P < 0.05) of high-dose, NAM-treated mice. Conclusion: The data from this study show that the administration of NAM to KOE mice impaired m-RCT in vivo. This finding was partly due to a defective hepatic clearance of plasma non-HDL

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Pel·lagra en una adolescent afectada d'anorèxia nerviosa / Pelagra en una adolescente afecta de anorexia nerviosa / Pellagra in an adolescent with anorexia nerviosa

Introducció: la pel•lagra, o malaltia de les 3D (dermatitis, diarrea, demència), es produeix per un dèficit de niacina (vitamina B3). És freqüent en països subdesenvolupats amb elevada prevalença de desnutrició, però és infreqüent en països desenvolupats, i en aquests afecta pacients amb malalties de base, fonamentalment alcohòlics amb desnutrició. Cas clínic: adolescent de 13 anys afectada d'anorèxia ner-viosa molt restrictiva que presentava una dermatitis fotosensible a la zona de l'escot (collar de Casal), produïda per un dèficit greu de niacina. Comentaris: hi ha pocs casos descrits de pel•lagra en relació amb trastorns de la conducta alimentària (anorèxia ner-viosa) i no s'ha trobat publicat cap cas en l'edat pediàtrica per aquest motiu. És interessant la presentació del cas, ja que pot tenir un desenllaç mortal si no rep tractament amb niacina

Introducción. La pelagra, o enfermedad de las 3D (dermatitis, diarrea, demencia), se produce por un déficit de niacina (vitamina B3). Es frecuente en países subdesarrollados con altas tasas de malnutrición, pero es infrecuente en países desarrollados, y en estos afecta a pacientes con patología de base, fundamentalmente a alcohólicos con malnutrición. Caso clínico. Adolescente de 13 años afecta de anorexia nerviosa muy restrictiva que presentaba una dermatitis fotosensible a nivel del escote (collar de Casal), producida por déficit grave de niacina. Comentarios. Se han descrito pocos casos de pelagra en relación con trastornos de conducta alimentaria (anorexia nerviosa) y no se ha encontrado publicado ningún caso en la edad pediátrica por dicho motivo. Es interesante la presentación del caso, que puede tener un desenlace mortal de no recibir tratamiento con niacina (AU)

Introduction. Pellagra, also known as the 3D disease, presents with diarrhea, dermatitis and dementia, and it is due to a deficit of niacin (vitamin B3). It is frequently seen in underdeveloped countries with high malnutrition rates, and it commonly affects people with chronic diseases, usually malnourished alcoholics. Case report. We describe the case of a 13 years old adolescent female with very restrictive anorexia nervosa who presented with a photosensitive dermatitis in the neck area (Casal necklace) due to a very severe niacin deficit. Comments. Reports of pellagra due to an eating disorder such anorexia nervosa are very rare in the literature, with no pediatric cases reported. If undiagnosed and treated, this disease can have a fatal outcome (AU)

FR - Nuevas indicaciones de nicotinamida en dermatología / Nicotinamide: new Indications in dermatology

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Dietary flaxseed oil and fish oil ameliorates renal oxidative stress, protein glycation, and inflammation in streptozotocin-nicotinamide-induced diabetic rats

Protective and prophylactic effects of omega-3 fatty acids on oxidative stress and inflammation are well known. We assessed beneficial effects of flaxseed oil and fish oil on streptozotocin (65 mg/kg; i.p.)-nicotinamide (110 mg/kg; i.p.) induced diabetic rats by studying renal expression of antioxidant and inflammatory genes. Diabetic rats given 10 % flaxseed oil or 10 % fish oil diet for 35 days showed significant decrease in renal lipid peroxidation. Flaxseed oil diet resulted in up-regulation of renal superoxide dismutase-1 (SOD-1) (activity and expression) and glutathione peroxidase-1 (GPx-1) expression. Furthermore, both diets up-regulated catalase (CAT) (activity and expression) and down-regulated heme oxygenase-1 (HO-1) expression. Both diets were able to limit the renal advanced glycation end products (AGEs) formation and reduced receptor of AGE (RAGE) protein expression significantly. Expressions of interleukin-6 (IL-6) and NF-κB p65 subunit were down-regulated significantly by flaxseed oil or fish oil diet. The histological tubular injuries were also lowered by both diets. These results suggest that dietary ω-3 fatty acids may slow the progression of diabetic nephropathy (DN) associated with oxidative stress, glycation, and inflammation in the kidney (AU)

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A signature of microRNA-155 in the pathogenesis of diabetic complications

The current study was designed to explore the potential involvement of miR-155 in the pathogenesis of diabetes complications. Male rats were divided into control and diabetic groups (n = 6). Type 2 diabetes was induced by a single-dose injection of nicotinamide (110 mg/kg; intraperitoneal (i.p.)), 15 min before injection of streptozotocin (STZ; 50 mg/kg; i.p.) in 12-h fasted rats. Two months after induction of diabetes, the rats were sacrificed for subsequent measurements. The nuclear factor kappa B (NF-κB) activity was higher in diabetic peripheral blood mononuclear cells (PBMCs), aorta, heart, kidney, liver, and sciatic nerve, than the control counterparts. Also, apoptosis rate was increased in these tissues, except the aorta. NF-κB messenger RNA (mRNA) expression level was higher in the kidney, heart, PBMCs, and sciatic nerve of diabetic rats than their control counterparts. Except the liver, the miR-155 expression level was significantly decreased in diabetic kidney, heart, aorta, PBMCs, and sciatic nerve versus the controls. Moreover, the expression of miR-155 was negatively correlated with NF-κB activity and apoptosis rate. These results suggest that changes in the expression of miR-155 may participate in the pathogenesis of diabetes-related complications, but causal relationship between miR-155 dysregulation and diabetic complications is unknown

Sorafenib for non-selected patient population with advanced hepatocellular carcinoma: efficacy and safety data according to liver function

OBJECTIVE: Sorafenib is the standard treatment of patients with advanced hepatocellular carcinoma, regardless of the liver functional reserve. We present a single institutional series of Child-Pugh A and Child-Pugh B patients treated with sorafenib with the aim to establish the efficacy and safety of sorafenib in patients of daily clinical conditions and to compare these results between Child-Pugh A and Child-Pugh B patients. MATERIALS AND METHODS: A total of 51 patients were treated with sorafenib 400 mg/12 h until disease progression or unacceptable toxicity. RESULTS: The median progression-free survival and overall survival for the overall population were 3.5 and 8.2 months, respectively, with a 1-year survival rate of 27 %. Overall survival was significantly longer for patients Child-Pugh A compared with those with Child-Pugh B liver function (8.7 vs. 4.7 months, respectively). The most common adverse events were fatigue (62.7 %), diarrhea (58 %), hypertension (31.3 %), and hand-foot syndrome (31.3 %), and in most cases grade 1 or 2 according to the NCI-CTC 3.0. Grade 4 liver-related events occurred mainly in Child-Pugh B patients with decompensated cirrhosis at the time of sorafenib initiation (54.5 % of that group). DISCUSSION: The benefit of sorafenib in Child-Pugh B patients, if exist, may be limited by frequent liver-related events, especially in decompensated patients, and then, toxicity and impact in quality of life should be carefully monitored (AU)

Antihyperglycemic and antioxidant effects of a flavanone, naringenin, in streptozotocin-nicotinamide-induced experimental diabetic rats

In the present study, the putative antihyperglycemic and antioxidant effects of a flavanone, naringenin, were evaluated in comparison with those of glyclazide, a standard drug for therapy of diabetes mellitus. Diabetes was induced experimentally in 12-h-fasted rats by intraperitoneal injections of first streptozotocin (50 mg/kg b.w.) and then of nicotinamide (110 mg/kg b.w.) after a 15-min interval. Untreated diabetic rats revealed the following in comparison with normal rats: significantly higher mean levels of blood glucose and glycosylated hemoglobin, significantly lower mean levels of serum insulin, significantly lower mean activities of pancreatic antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, glutathione-S-transferase), significantly lower mean levels of plasma non-enzymatic antioxidants (reduced glutathione, vitamin C , vitamin E), significantly elevated mean levels of pancreatic malondialdehyde (MDA) and significantly elevated mean activities of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). Following oral administration of naringenin (50 mg/kg b.w./day) to diabetic rats for 21 days, the following observations were made in comparison with (..) (AU)

N-Methyl-2-pyridone-5-carboxamide is 1-methylnicotinamide metabolite of low cyclooxygenase-dependent vasodilating activity

1-Methylnicotinamide (MNA) is a primary metabolite of nicotinamide recently proven to cause systemic increase in PGI2 plasma levels in an unknown mechanism. Our present study was aimed at verifying whether the increased production of PGI2, a vasodilating prostanoid, in response to MNA, its metabolite N-methyl-2-pyridone-5-carboxamide (Met2PY), and nicotinamide may be reproduced under in vitro conditions. Since prostacyclin is a vasodilating prostanoid, we also performed the functional tests in the ex vivo model of coronary vascular bed perfusion to evaluate the vasoactive properties of those compounds. We did not observe any significant effect of the tested drugs on either PGI2 or PGE2 secretion in our in vitro model. Nicotinamide at the concentrations of 10 and 100 ìmol/l and 100 ìmol/l Met2PY slightly but significantly increased coronary flow in rat heart. These increases, however, remained very low when compared to that induced by the reference compound, bradykinin (100 nmol/l). Perfusion of rat hearts with Met2PY in the presence of 50 ìmol/l indomethacin resulted in decreased coronary flow, which proves that the effect is cyclooxygenase dependent. We conclude that MNA metabolites should be more carefully addressed in reference to pro-prostacyclin activity and that systemic mechanism of MNA-induced PGI2 production needs further clarification (AU)

Novel antiangiogenic therapies against advanced hepatocellular carcinoma (HCC)

Angiogenesis is a cornerstone in the process of hepatocarcinogenesis. In the sorafenib era, other antiangiogenic targeted drugs, such as monoclonal antibodies and a new generation of tyrosine kinase inhibitors, have been shown in phase II trials to be safe and effective in the treatment of advanced hepatocellular carcinoma. Several currently active phase III trials are testing these drugs, both in first- and second-line settings. Strategies to overcome primary and acquired resistance to antiangiogenic therapy are urgently needed. Novel biomarkers may help in improving the efficacy of drugs targeting angiogenesis (AU)

Oral nicotinamide reduces serum phosphorus,increases HDL, and induces thrombocytopenia in hemodialysis patients: a double-blind randomized clinical trial

Background: Recently, nicotinamide has been suggested as an effective drug for hyperphosphatemia in hemodialysispatients. The authors assessed the efficacy and safety ofnicotinamide in these patients with lower doses and longer duration than other studies. Methods: Forty eight patients with fasting serum phosphorus >5 mg/dl enrolled in this randomized clinical trial study and were randomly assigned to two equal-sized groups of nicotinamide or placebo. The study lasted 8 weeks. In the first four weeks, nicotinamide was administered at 500 mg/day, and in the second four weeks at 1,000 mg/day. Blood samples were tested at baseline, week 4, and week 8. Results: In nicotinamide group, the mean phosphorus level decreased from5.9 ± 0.58 mg/dl to 4.77 ± 1.43 mg/dl in week 4 (P = 0.002)and to 4.66 ± 1.06 mg/dl in week 8 (P = 0.000). The mean calcium-phosphorus product decreased significantly with the same pattern as phosphorus. High-density lipoprotein level increased from 42.46 ± 8.01 mg/dl to 55.71 ± 11.88mg/dl in week 4 (P = 0.000) and to 65.25 ± 20.18 mg/dl in week 8 (P = 0.000). Levels of serum calcium, uric acid, SGOT, SGPT, and iPTH didn’t change significantly. Compared to baseline, the platelet counts were decreased in both week 4 and week 8. No significant changes were observed in placebo group. Conclusions: In our patients, nicotinamide effectively decreased phosphorus, increased high-density lipoprotein, and caused thrombocytopenia. Since nicotinamide lowered platelet counts and caused thrombocytopenia in lower doses than other studies in these patients, it is necessary to plan other studies for assessing the safety of the drug especially in different populations (AU)

Antecedentes: Recientemente, se ha sugerido que la nicotinamida es un fármaco eficaz para la hiperfosfatemia en pacientes en hemodiálisis. Los autores evaluaron la eficacia y la seguridad de la nicotinamida en estos pacientes con dosis más bajas y mayor duración que en otros estudios. Métodos: Cuarenta y ocho pacientes con fósforo sé-rico en ayunas >5 mg/dl participaron en este estudio clínico aleatorio y fueron asignados al azar a dos grupos de igual tamaño uno de los cuales recibiría nicotinamida y el otro, placebo. El estudio duró 8 semanas. En las primeras4 semanas, se les administraron 500 mg de nicotinamida al día, y en el segundo período de 4 semanas se aumentó la dosis a 1.000 mg/día. Se tomaron muestras de sangre en la primera, quinta y novena semanas. Resultados: En el grupo de la nicotinamida, el nivel de fósforo se redujo de 5,9± 0,58 a 4,77 ± 1,43 mg/dl en la quinta semana (p = 0,002) y a 4,66 ± 1,06 mg/dl en la novena semana (p = 0.000). El producto calcio-fósforo se redujo significativamente siguiendo el mismo patrón que el fósforo. El nivel de HDL aumentó de 42,46 ± 8,01 a 55,71 ± 11,88 mg/dl en la quinta semana (p = 0,000) y a 65,25 ± 20,18 mg/dl en la novena semana (p = 0,000). Los niveles de calcio sérico, ácido úrico, TGO, TGP e iPTH no cambiaron de manera significativa. En comparación con la primera semana, el recuento de plaquetas en la quinta y novena semana disminuyó. No se observaron cambios significativos en el grupo placebo. Conclusiones: En nuestros pacientes, la nicotinamida disminuyó de forma efectiva el fósforo, aumentó el HDL, y causó trombocitopenia. Como la nicotinamida redujo el recuento de plaquetas y causó trombocitopenia en dosis más bajas que en otros estudios con estos pacientes, es necesario planificar más estudios para evaluar la seguridad del fármaco, especialmente en diferentes poblaciones (AU)

Impact of the incorporation of tyrosine kinase inhibitor agents on the treatment of patients with a diagnosis of advanced renal cell carcinoma: study based on experience at the Hospital Universitario Central de Asturias

INTRODUCTION: For nearly the past two decades, cytokines (CKs) have been the only systemic treatment option available for advanced renal cell carcinoma (RCC). In recent years, tyrosine kinase inhibitors (TKIs) have demonstrated clinical activity on this tumour. Our purpose is to describe one centre's experience with the use of CKs and TKIs in the treatment of patients with advanced RCC. MATERIALS AND METHODS: This study was designed as a retrospective chart review of RCC patients who were treated with CKs and/or TKIs in our department between July 1996 and June 2008. Efficacy and toxicity were assessed using World Health Organization (WHO) criteria. The Kaplan-Meier method was used to estimate progression-free (PFS) and overall (OS) survival. RESULTS: Ninety-four patients were classified into three groups depending on the modality of treatment administered: 46 were treated with CKs alone and/or chemotherapy (27 with immunotherapy, one with chemotherapy and 18 with both), 28 with TKIs alone (25 with sunitinib and 13 with sorafenib) and 20 with TKIs in second-line treatment following failure with CKs (17 with sunitinib, eight with sorafenib, four with bevacizumab and one with lapatinib). The median age was 60 years in the CK group and 65 and 62, respectively, in TKI in first and second-line treatment groups. Eighty-five percent of patients treated with CKs and 75% in the TKI group in first-line treatment and 80% in second-line treatment were men. Overall, 89% of patients had favourable risk, and 11% had intermediate risk. All patients were considered evaluable for toxicity. The main grade 3-4 (%) toxicity was asthenia for both groups, (ten in TKIs and 15 in CKs). Other grade 1-2 toxicities were mucositis (39), bleeding (8), hypertension (19), skin toxicity (33) and hypothyroidism (12.5) associated with TKIs; and anaemia (33), cough (29), asthenia (39) and emesis (14) associated with CKs. The objective response rate among 80 patients evaluable for activity was 10.6% with CKs and 46.5% and 35%, respectively, with TKIs in first- and second-line treatments. Disease stabilisation with CKs was recorded at 59% of patients and with TKIs 25% and 50% in first- and second-line treatment groups, respectively. The median progression-free survival (PFS) with CKs was 122 days [95% confidence interval (CI) 82-162] and with TKIs 201 days (65-337) in the first and 346 days (256-436) in second-line treatment groups. The median overall survival (OS) was 229 days (142-316) and 2,074 days (1,152-2,996) for patients treated with CKs and TKIs. CONCLUSIONS: Our results are in line with the activity and survival rates previously reported in the literature regarding the use of TKIs for patients with advanced RCC in first- and second-line treatment, which has demonstrated an acceptable toxicity level (AU)

A phase II trial of first-line sorafenib in patients with metastatic renal cell carcinoma unwilling to receive or with early intolerance to immunotherapy: SOGUG Study 06-01

AIMS: Our aim was to evaluate first-line treatment of metastatic renal cell carcinoma (mRCC) with sorafenib in patients unwilling to receive immunotherapy or with early in

The role of antiangiogenesis therapy: bevacizumab and beyond

The importance of angiogenesis in tumour growth and development is well known. Overexpression of vascular endothelial growth factor (VEGF), the key mediator of angiogenesis, is associated with poor prognosis in cancer. As a result, several therapeutic agents that inhibit the actions of VEGF or its receptors are currently in development for use in advanced solid tumours, such breast, colorectal, lung and renal cancer. Clinical data from trials of anti-VEGF agents in this group of tumours are discussed, with a particular focus on the efficacy and safety of bevacizumab, the anti-VEGF agent at the most advanced stage of development in those tumour types. Future potential uses of bevacizumab in cancer therapy will be discussed (AU)

Generalised erythematous skin eruptions induced by sorafenib: cutaneous toxicity and treatment outcome

A woman diagnosed of a renal cell carcinoma in 1989 had a metastatic kidney cancer localised in subcutaneous nodules, gut and lung in 2007. Sorafenib treatment was initiated a 400 mg orally twice a day. The patient developed generalised erythematous skin eruptions and two weeks later a widespread erythematous maculopapular eruption located exclusively on the legs and arms, along with an objective response. The most likely cause of the generalised erythematous skin eruptions was considered to be sorafenib because of the close temporal relationship between exposure to the drug and onset of symptoms. Furthermore, a relationship between sorafenib skin toxicity and treatment efficacy was observed. This therapeutic efficacy of EGFR inhibitors and cutaneous side effects should be better assessed in large cohorts or trials to determine whether the skin toxicity of patients can be linked to an objective antitumour response (AU)

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Estudio clínico para evaluar el efecto de dos cremas humectantes con protector solar en la piel de pacientes que utilizan tretinoína0, 025% para el tratamiento del fotodaño / Clinical study to evaluate the effect of two facial moisturizer test products

Introducción: La exposición a la radiación ultravioleta (RUV) produce un deterioro en la piel denominado fotodaño, que puede mejorarse con la aplicaciónde tretinoína. Este tratamiento, sin embargo, puede causar efectos colaterales.El objetivo es comparar las diferencias en la eficacia, tolerancia y preferencias al utilizar tretinoína al 0,025%, junto con dos productos hidratantes diferentes.Materiales y métodos: Estudio abierto, prospectivo, doble ciego, randomizado. Cincuenta y siete mujeres de 35 a 55 años, con daño solar, se aplicaronen el período de pre-condicionamiento, una crema humectante en cada hemicara: una con niacinamida y otra sólo con componentes hidratantes.Luego, se agregó tretinoína tópica al 0,025%. Se evaluó fotodaño, tolerancia y preferencias.Resultados: En el período de precondicionamiento no se hallaron diferencias significativas en la tolerancia. La pérdida trans epidérmica de agua(PTEA) fue significativamente peor para el humectante B. La textura de la piel mejoró significativamente para ambos humectantes. En el período detratamiento la tolerancia disminuyó más para el humectante B en las semanas 2 y 4, mejorando al final del estudio. Los parámetros relacionados confoto daño mejoraron, más para el humectante A.La PTEA aumentó en las semanas 2 y 4, más para el humectante B; para luego disminuir.Comentario: La tretinoína tópica es bien tolerada, cuando se la utiliza en combinación con cremas humectantes. La niacinamida agrega beneficios ala acción hidratante de un producto, ya que cumple un rol en la prevención de efectos adversos y en la potenciación de los efectos beneficiosos delretinoide (AU)

Introduction: Ultraviolet radiation exposure cause a deleterious effect in the skin called photodamage. Tretinoin application can improve this damage,however it can also cause adverse effects. The objective of this paper is to compare the differences in tolerance and patient preference when usingtretinoin 0.025% along with two different moisturizers.Material and methods: It was and open, prospective, randomized, double blinded study. Fifty sevenwomen, 35 to 55 year old with photodamagedskin, applied during a preconditioning period a different moisturizer in each side of the face. One of them contained niacinamide and the other onlyhydrating components. After 15 days topical tretinoin 0,025% was added. Efficacy, tolerance and preferences were evaluated.Results: We didn’t find significative differences in tolerance during the preconditioning period. Transepidermal water loss (TEWL) was significativelyworse for moisturizer B. Skin texture improved for both used products. During the treatment period, tolerance was worse for moisturizer B in weeks 2 and 4. There was a more important improvement in photodamage related items for moisturizer A. TEWL were high for both products in weeks 2 and4, diminishing afterwards. This elevation was higher for moisturizer B.Comment: topical tretinoin is well tolerated when used in combination with moisturizer creams. Niacinamide adds benefits because it helps preventingadverse events and promote desirable anti age effects of the retinoid (AU)

Sorafenib TARGET trial results in Spanish patients

INTRODUCTION: Sorafenib improves progression-free survival in advanced clear-cell renal-cell carcinoma patients progressing to first-line therapy, as has been shown in the placebo-controlled international TARGET trial. The aim of this study is to report the results of the patients included in the Spanish centres in this trial. PATIENTS AND METHODS: The records of the patients in the database of the TARGET trial have been reviewed. Data about progression-free survival, overall survival and toxicity have been collected in order to do this subpopulation analysis. RESULTS: A total of 15 patients have been included (sorafenib arm 7, placebo arm 8). A trend to an improved progression-free survival in the sorafenib arm has been observed period Toxicity in the sorafenib arm has been manageable. CONCLUSION: The analysis of these 15 patients has shown efficacy and toxicity results that follow the trend observed for the overall international population (AU)

Molecular biology of renal cell carcinoma

Recent developments in molecular biology have lead to an increased understanding of the events involved in renal cell carcinoma (RCC) carcinogenesis. In this field, basic molecular pathways important to oncogenic transformation secondary to Von Hippel-Lindau (VHL) tumor suppression gene inactivation, associated to clear-cell RCC, have been elucidated. Loss of function of VHL results in the high-expression of pro-angiogenic growth factors, such as vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF). New therapies against specific targets in RCC have demonstrated significant clinical activity in patients. These therapeutic approaches are based on the VEGF inhibition by using anti-VEGF monoclonal antibodies (bevacizumab) or multi-kinase inhibitors, that also target PDGF and c-kit tyrosine kinases (sorafenib, sunitinib); or by the inhibition of the mammalian target of rapamycin (mTOR) pathway (temsirolimus). This article reviews current knowledge of molecular pathogenesis of inherited and sporadic RCC (AU)

Treatment of pemphigus vulgaris. An overview in Mexico / Tratamiento del pénfigo vulgar. Estado actual en méxico

Pemphigus is an autoimmune skin disease that can present in a variety of forms and can prove challenging to manage and treat. An overview of the condition in Mexico is presented. Emphasis is placed on management of the condition, with description of the most commonly used treatments (glucocorticoids, azathioprine), the second line therapies (cyclosporine and mycophenolate mofetil), and additional alternative treatments (cyclophosphamide and dapsone)

El pénfigo es una enfermedad autoinmune de la piel que se presenta en una variedad de formas y puede ser un reto para manejar y tratar. Se presenta un panorama de la enfermedad. Se hace énfasis en lo terapéutico. Están incluidas las opciones de tratamiento más comúnmente usadas (glucocorticoides y azatioprina), algunas alternativas (ciclosporina y mofetil micofenolato) y alternativas adicionales (ciclofosfamida y dapsona)

Tratamiento de la hiperfosforemia del enfermo dializado con nicotinamida / No disponible

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