Effect of combined treatment with prednisone and methotrexate versus prednisone alone over laboratory parameters in giant cell arteritis / Efecto del tratamiento combinado con prednisona y metotrexato versus prednisona sola sobre los parámetros de laboratorio en arteritis de células gigantes

Objective: To compare the effect of combined treatment with prednisone and methotrexate (MTX) versus prednisone alone over laboratory parameters in giant cell arteritis (GCA). Patients and methods: We performed a double-blind, placebo-controlled, randomized clinical trial about usefulness of treatment with prednisone and MTX versus prednisone and placebo in GCA (Ann Intern Med 2001;134:106–114). As a part of follow-up of patients (n=42), we performed laboratory analysis in 20 time points during the two-year period of follow-up. To analyze differences, we calculated the area under the curve (AUC) for erythrocyte sedimentation rate (ESR), hemoglobin, and platelets, and compared the results in both groups adjusting by time of follow-up, existence of relapses and dose of prednisone. Results: A total of 724 laboratory measurements were done. Median value of ESR was 33 [18–56] in patients with placebo and 26 [15–44] in patients with MTX (P=0.0002). No significant differences were observed in ESR during relapses. The mean ESR value followed a parallel course in both groups, but was lower in the group with MTX than in the group with placebo in 18 of 20 time points of follow-up. The AUC of ESR by time of follow-up was 28,461.7±12,326 in the group with placebo and 19,598.4±8,117 in the group with MTX (mean difference 8,863, 95% CI 1.542–16.184; P=0.019). The course of other laboratory parameters paralleled, without statistical significance, those observed for ESR. Conclusions: These data, along with clinical data, suggest that MTX might play a role as a disease-modifying agent in the treatment of GCA.(AU)

Objetivo: Comparar el efecto del tratamiento combinado con prednisona y metotrexato (MTX) versus prednisona sola sobre parámetros de laboratorio en arteritis de células gigantes (ACG). Pacientes y métodos: Realizamos un ensayo clínico aleatorizado, doble ciego, controlado con placebo sobre la utilidad del tratamiento con prednisona y MTX frente a prednisona y placebo en la ACG (Ann Intern Med. 2001;134:106-114). Como parte del seguimiento de los pacientes (n=42), realizamos análisis de laboratorio en 20 puntos temporales durante el período de seguimiento de 2 años. Para analizar diferencias calculamos el área bajo la curva (AUC) de VSG, hemoglobina y plaquetas, y comparamos los resultados en ambos grupos ajustando por tiempo de seguimiento, existencia de recaídas y dosis de prednisona. Resultados: Se realizaron un total de 724 mediciones de laboratorio. El valor medio de la VSG fue de 33 (18-56) en pacientes con placebo y de 26 (15-44) en pacientes con MTX (p=0,0002). No se observaron diferencias significativas en la VSG durante las recaídas. El valor medio de la VSG siguió un curso paralelo en ambos grupos, pero fue menor en el grupo con MTX que en el grupo con placebo en 18 de 20 puntos temporales de seguimiento. El AUC de la VSG por tiempo de seguimiento fue de 28.461,7±12.326 en el grupo con placebo y de 19.598,4±8.117 en el grupo con MTX (diferencia de medias 8.863; IC 95%: 1.542-16.184; p=0,019). La evolución de los demás parámetros de laboratorio fue paralela, sin significación estadística, a la observada para la VSG. Conclusiones: Estos datos, junto con los datos clínicos, sugieren que el MTX podría desempeñar un papel como agente modificador de la enfermedad en el tratamiento de la ACG.(AU)

Predictors of trimodality therapy in patients with muscle-invasive bladder cancer and effect on survival

Background Due to its unique advantages over radical cystectomy (RC), trimodality therapy (TMT) is increasingly being utilized by patients diagnosed with muscle-invasive bladder cancer (MIBC) who are not suitable for or refuse RC. However, achieving a satisfactory oncological outcome with TMT requires strict patient selection criteria, and the comparative oncological outcomes of TMT versus RC remain controversial. Methods Patients diagnosed with non-metastatic MIBC who underwent TMT or RC were identified from the SEER database during 2004–2015. Before one-to-one propensity score matching (PSM), logistic regression was utilized to identify predictors of TMT. After matching, K-M curves were generated to estimate cancer-specific survival (CSS) and overall survival (OS) with log-rank to test the significance. Finally, we conducted univariate and multivariate Cox analyses to identify independent prognostic factors for CSS and OS. Results The RC and TMT groups included 5812 and 1260 patients, respectively, and the TMT patients were significantly older than the RC patients. Patients with advanced age, separated, divorced, or widowed (SDW) or unmarried marital status (married as reference), and larger tumor size (< 40 mm as reference) were more likely to be treated with TMT. After PSM, TMT was found to be associated with worse CSS and OS, and it was identified as an independent risk factor for both CSS and OS. Conclusion MIBC patients may not be carefully evaluated prior to TMT, and some non-ideal candidates underwent TMT. TMT resulted in worse CSS and OS in the contemporary era, but these results may be biased. Strict TMT candidate criteria and TMT treatment modality should be required (AU)

Ortoqueratología vs ortoqueratología combinada con atropina para el control de miopía en niños: revisión sistemática / Orthokeratology vs. orthokeratology combined with atropine for the control of myopia in children: Systematic review

El propósito de esta investigación es determinar la eficacia de la ortoqueratología (OK) en comparación con la ortoqueratología combinada con atropina (AOK) para el control de la miopía en niños. Se realizó una revisión sistemática que incluyó revisiones sistemáticas con metaanálisis, además de ensayos clínicos aleatorizados y controlados, en las bases de datos PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct, y de una búsqueda manual de las revistas Q1-Q4 del Scimago Journal & Country Rank, publicadas en últimos 5 años en idioma inglés y español. Se tomaron en cuenta 18 estudios que cumplieron con los criterios de elegibilidad. Los artículos seleccionados incluyeron 6.866 pacientes para el análisis, en donde se encontró mayor eficacia de la AOK al 0,01% debido a su capacidad de reducir la progresión de miopía y alargamiento axial. En nuestra investigación se determinó que podría existir un efecto aditivo en la combinación de atropina al 0,01% con OK en un periodo de 1 a 2 años de tratamiento en pacientes con miopía leve, sin embargo, se deben realizar más estudios multiétnicos, en donde se considere una correcta evaluación de la progresión de miopía, factores genéticos y ambientales que puedan influir en los resultados (AU)

The purpose of this investigation is to determine the efficacy of orthokeratology (OK) compared to orthokeratology combined with atropine (AOK) for the control of myopia in children. A systematic review that included systematic reviews with meta-analyses, as well as randomized and controlled clinical trials, was carried out in the PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct databases, as well as a manual search of the Q1-Q4 journals of the Scimago Journal & Country Rank, published in the last 5 years in English and Spanish. Eighteen studies that met the eligibility criteria were considered. The articles selected included 6866 patients for analysis, where orthokeratology combined with 0.01% atropine was found to be more effective due to its ability to reduce the progression of myopia and axial elongation. In our investigation, it was determined that there could be an additive effect in the combination of 0.01% atropine with orthokeratology in a period of 1–2 years of treatment in patients with mild myopia; however, more multiethnic studies should be carried out, in where a correct evaluation of the progression of myopia, genetic and environmental factors that may influence the results is considered (AU)

Effect of Terazosin Hydrochloride Combined with Interventional Embolisation on Prostate Volume and Quality of Life of Elderly Patients with Prostatic Hyperplasia

Objective: This study aimed to explore the effect of terazosin hydrochloride combined with interventional embolisation on prostate volume and quality of life (QOL) of elderly patients with prostatic hyperplasia (PH). Methods: The clinical data of 175 elderly patients with PH admitted to Central Hospital Affiliated to Shandong First Medical University from July 2020 to July 2022 were selected for retrospective analysis. Based on different treatment regimens, 89 patients who received interventional embolisation alone were included in the control group (CG), and 86 patients undergoing interventional embolisation combined with terazosin hydrochloride were included in the study group (SG). The prostate volume, serum indicators, adverse reactions and QOL of the two groups before and after treatment were compared between the two groups. Results: Before treatment, no significant difference in 36-item short-form health survey (SF-36) scores, serum tumour necrosis factor-α (TNF-α) and prostate-specific antigen (PSA) was observed in both groups (p > 0.05). After treatment, the SF-36 score in the SG was 78.20 ± 6.84 points, which was significantly higher than that in the CG (72.67 ± 5.94 points). In addition, the SG had remarkably lower residual urine volume and prostate volume, higher maximum flow rate and lower TNF-α and PSA levels compared with the CG (p < 0.05). The adverse reaction rate of the SG was only 4.65%, which was significantly lower than that of the CG (14.61%, p < 0.05). Conclusions: Terazosin hydrochloride combined with interventional embolisation overtly reduces the prostate volume and improves the clinical symptoms of patients with fewer side effects, which has a certain clinical application value (AU)

Observation of Serological Index and Efficacy of Abiraterone Hydrochloride Tablets Combined with Endocrine Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer

Purpose: This study reviewed and analysed the serological indexes, clinical efficacy and common clinical indexes of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with combination of abiraterone hydrochloride tablets and endocrine therapy. Method: This study is a retrospective analysis. A total of 133 mCRPC patients who were admitted to our hospital from January 2019 to December 2021 were selected as the study subjects. The patients were categorised into the experimental group (n = 51) and control group (n = 82) according to their treatment method. The control group was treated with docetaxel combined with endocrine therapy, whilst the experimental group was treated with combination therapy with abiraterone hydrochloride tablets. Subsequently, the clinical data of the two groups, including serum insulin-like growth factor-1 (IGF-1), human glandular kallikrein 2 (hK2), prostate specific antigen (PSA), vascular endothelial growth factor (VEGF) and serum carcinoembryonic antigen (CEA), were analysed. Result: The overall response rate of the experimental group (84.3%) was higher than that of the control group (72.0%). The serum levels of CEA, total prostate specific antigen, free prostate specific antigen, testosterone and androgen receptor splice variant 7 in both groups were lower than those of before treatment, and the values obtained by the experimental group were lower than those of the control group (p < 0.05). After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in both groups were higher than those before treatment, and the levels of CD8+, IGF-1, hK2, PSA and VEGF in the two groups decreased after treatment (p < 0.05). Conclusions: The use of abiraterone hydrochloride tablet combined with endocrine therapy for patients with mCRPC is effective and can improve clinical symptoms and serum cytokine levels (AU)

Tumor fibroso pleural ¿son realmente benignos? ¿Cuándo deben operarse? / Pleural fibrous tumor, are they really benign? When should they have operation?

El tumor fibroso pleural es un tumor habitualmente asintomático, benigno y de lento crecimiento, que en un pequeño porcentaje de los casos tiene un comportamiento más agresivo. Para definir los criterios de malignidad es necesario un análisis inmunohistoquímico. El tratamiento de elección es la resección quirúrgica completa con márgenes de seguridad ya sea por toracotomía o por videotoracoscopia en función del tamaño. Se encuentra en estudio la utilización de terapia adyuvante radioterápica o quimioterápica que en el momento actual no cuenta con resultados significativos. Presentamos dos casos que fueron tratados de forma quirúrgica, con extirpación completa siendo el primero definido como maligno según los criterios histológicos y el segundo benigno, pero de alto riesgo. Solo uno de ellos recibió terapia adyuvante. (AU)

Solitary fibrous pleural tumor is a usually asymptomatic, benign and slow-growing tumor, which in a small percentage of cases has a more aggressive behavior. To define the malignancy criteria, an immunohistochemical analysis is necessary. The gold standard treatment is a complete surgical resection with safety margins either by thoracotomy or by videothoracoscopy depending on the size. The use of radiotherapy or chemotherapy as an adjuvant therapy is under study, which at the present time does not have significant results. We present two cases that were treated surgically, with complete removal, one being classified as malignant according to histological criteria and the other benign but high risk. Only one of them received adjuvant therapy. (AU)

Morbimortality after 1321 consecutive CRS+HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy

Purpose Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). Methods Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. Results A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6–144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. Conclusions Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%) (AU)

Terapia de privación de andrógenos en el cáncer de próstata localizado. Situación actual y tendencias futuras / Androgen deprivation therapy in localized prostate cancer. Current status and future trends

Introducción El cáncer de próstata (CaP) se ha reconocido como una enfermedad sensible a los andrógenos desde las investigaciones de Huggins y Hodges en 1941, quienes, gracias a estos hallazgos, recibieron el Premio Nobel en 1966. Aquí se originó el desarrollo de la terapia de privación de andrógenos (TPA) como tratamiento para los pacientes con CaP. Objetivo Resumir las indicaciones actuales de la TPA en el CaP localizado. Adquisición de la evidencia Hemos realizado una investigación bibliográfica exhaustiva en inglés y español, centrada en las principales indicaciones de la TPA en el CaP localizado. Síntesis de la evidencia En la actualidad, las indicaciones de la TPA como monoterapia en el CaP localizado se han limitado a situaciones específicas, a pacientes que no desean o no pueden recibir ninguna forma de tratamiento local y que tienen un PSA-DT<12 meses y un PSA>50 ng/mL, un tumor poco diferenciado o síntomas locales molestos relacionados con la enfermedad. La TPA puede utilizarse en combinación con tratamiento local en diferentes escenarios. Aunque el tratamiento neoadyuvante con TPA antes de la cirugía con intención curativa no tiene un impacto oncológico claro, el CaP es una enfermedad heterogénea y en el futuro podría haber un grupo de pacientes con enfermedad localizada de alto riesgo que se beneficiaran de este tratamiento. Conclusiones Necesitamos optimizar el tratamiento con TPA en el CaP localizado, seleccionando a los pacientes en función de las características de su enfermedad. Dado que el arsenal terapéutico evoluciona día a día, es necesario el desarrollo de nuevos ensayos clínicos, así como el estudio molecular en los pacientes, para identificar a aquellos que podrían beneficiarse de un tratamiento multimodal temprano (AU)

Introduction Prostate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa. Objective To summarize the current indications of ADT in localized PCa. Evidence acquisition We conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa. Evidence synthesis Nowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT<12 months, and either a PSA>50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit. Conclusions We need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment (AU)

Multimodal home care intervention for dependent older people “Live better at home”: Protocol of a randomized clinical trial / Intervención multimodal en domicilios para gente mayor dependiente «Vivir mejor en casa»: Protocolo de un ensayo clínico aleatorizado

Background The intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence. Objective To evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH. Methods A randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention. Discussion A multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home (AU)

Introducción La intensidad de las intervenciones del servicio de atención domiciliaria (SAD) para personas mayores en situación de dependencia que se ofrece en España puede no ser suficiente para ayudarles a permanecer viviendo en su domicilio, siendo la institucionalización en una residencia geriátrica una consecuencia inevitable. Objetivo Evaluar el efecto de una intensificación en las intervenciones del SAD en personas con grado de dependencia II o III, así como una formación de sus personas cuidadoras no profesionales para retrasar o evitar su institucionalización en una residencia geriátrica. Métodos Se realizará un ensayo clínico aleatorizado con dos brazos paralelos y evaluación ciega a nivel comunitario en dos municipios de Cataluña (España). El estudio incluirá a aquellas personas mayores (de 65 años o más) que vivan en la comunidad, con grado II o III de dependencia, usuarias del SAD público, sin voluntad de institucionalización y con una persona cuidadora no profesional principal a cargo, quien participará en el estudio. Las valoraciones se realizarán mensualmente hasta los 15 meses, cuando finalizará la intervención. La variable principal será el tiempo transcurrido hasta la voluntad de ingreso en una residencia geriátrica. Las variables secundarias se diferenciarán entre sociodemográficas, de salud, psicosociales, de uso de recursos y de seguimiento. Para estimar la eficacia de la intervención se realizará un modelo de regresión de Cox multivariante. Discusión Una intervención multimodal podría mejorar el estado de salud y psicosocial de las personas dependientes y sus personas cuidadoras no profesionales y facilitar su permanencia en el hogar (AU)

Immunotherapy combined with radiotherapy to reverse immunosuppression in microsatellite stable colorectal cancer

In recent years, the exploration of immune checkpoint inhibitors (ICIs) has resulted in substantial progress and has changed the pattern of cancer treatment. ICIs have revolutionized the treatment landscape of microsatellite instable colorectal cancer while the efficacy is very limited in patients with microsatellite stable colorectal cancer. Therefore, sensitizing MSS CRC to immunotherapy is a major challenge in the field of CRC immunotherapy. Immunotherapy-based combination therapy is an effective strategy. This review of radiotherapy (RT) as a local treatment has dramatically changed in recent years, and it is now widely accepted that RT can deeply reshape the tumor environment by modulating the immune response. Such evidence gives a strong rationale for the synergism of radiotherapy and immunotherapy, introducing the era of ‘immunoradiotherapy’. How to give full play to the synergistic effect of radiotherapy and immunotherapy to improve the therapeutic effect of MSS CRC and bring good prognosis is a hot problem to be solved in the field of cancer treatment.This article reviews the development of CRC immunotherapy, the immune resistance mechanism of MSS CRC, and the impact and potential value of immunotherapy combined with radiotherapy on the immune environment of CRC (AU)

Educación, ejercicio terapéutico y terapia manual en el dolor orofacial. Estudio de casos / Education, therapeutic exercise, and manual therapy approaches in orofacial pain. Case reports

Introducción Los trastornos temporomandibulares son la causa más común de dolor crónico orofacial. Intervenciones pasivas como la terapia manual (TM) es de las herramientas más utilizadas. Sin embargo, este tipo de abordajes puede resultar insuficiente. La investigación de nuevas estrategias, ahora de naturaleza activa, como son el ejercicio o la educación, es necesaria para generar un cambio en la práctica clínica de los profesionales sanitarios y brindar una atención completa al paciente con dolor crónico. Objetivos Analizar el efecto de tres abordajes principales de forma combinada sobre el dolor, factores psicosociales, variables funcionales y biomecánicas. Métodos Se siguió un diseño de estudio de casos compuesto por tres sujetos divididos en tres modelos de intervención: educación para el dolor y terapia manual (PEdu+TM), ejercicio terapéutico y terapia manual (PEjerc+TM) y terapia manual cervical y orofacial (PTM). El periodo de intervención duró 3-4 semanas; las medidas fueron tomadas en tres momentos: preintervención, postintervención inmediata y 45 días postintervención. Dolor, características psicosociales y funcionalidad del paciente fueron evaluadas con diferentes herramientas validadas. Resultados Los resultados mostraron a corto plazo una mejora en todas las variables analizadas en el PEdu+TM y en el PEjerc+TM, pero no en el PTM. A medio plazo (45 días postintervención), el PEdu+TM mostró beneficios en todas las variables estudiadas mientras que el PEjerc+TM generó cambios positivos en las mismas variables excluyendo el dolor. Conclusión El tratamiento combinado podría ser una intervención más eficaz que la terapia manual a solas, siendo necesarios ensayos clínicos aleatorizados que corroboren dichos hallazgos (AU)

Introduction Temporomandibular disorders are the most common cause of chronic orofacial pain. Passive interventions such us manual therapy (MT) is being one of the most used tools. However, this type of approach may be insufficient. The investigation of new strategies, now of an active nature such as exercise or education, it is necessary to generate a change in the clinical practice of health professionals and provide comprehensive care to patients with chronic pain. Objectives To analyze the effect of three main approaches in combination on pain, psychosocial factors, functional and biomechanical variables. Methods A case study design was followed consisting of three subjects divided into three intervention models: pain education and manual therapy (PEdu+TM), therapeutic exercise and manual therapy (PExer+TM), and cervical and orofacial manual therapy (PTM). The intervention period lasted 3-4 weeks, the measurements were taken at three moments: pre-intervention, immediate post-intervention and 45 days post-intervention. Pain, psychosocial characteristics and functionality of the patient were evaluated with different validated tools. Results The results showed in the short-term an improvement in all the variables analyzed in the PEdu+TM and in the PExer+TM, but not in the PTM. In the medium term (45 days post-intervention), the PEdu+TM showed benefits in all the variables studied, while the PExer+TM generated positive changes in the same variables, excluding pain. Conclusion Combined treatment could be a more effective intervention than manual therapy alone, requiring randomized clinical trials to corroborate these findings (AU)

Primary central nervous system Hodgkin lymphoma: A case report and review of the literature / Linfoma de Hodgkin primario del sistema nervioso central. Presentación de un caso y revisión de la literatura

Central nervous system (CNS) involvement in the context of relapsed/refractory Hodgkin lymphoma (HL) is a quite rare, but well-known complication. Nevertheless, primary CNS–HL is an exceedingly rare condition, which diagnosis is based on well-defined morphological and immunohistochemical features, in addition to isolated involvement of the CNS. In spite of limited casuistry (just over twenty cases reported in the literature), available data agree that primary and isolated CNS–HL, when treated with a combination of surgery followed by some form of adjuvant therapy (radiotherapy±chemotherapy), carries a better prognosis than those cases with CNS involvement in the context of relapsed/refractory HL or those with CNS non-Hodgkin lymphoma. We herein report a case of a 55-year-old female patient who was diagnosed with primary CNS–HL. The patient was treated with complete surgical resection followed by intrathecal chemotherapy and whole brain radiotherapy (WBRT), showing fourteen months of disease-free survival at the time of this case report. A review of the available literature is also presented (AU)

La afectación del sistema nervioso central (SNC) en pacientes con diagnóstico de linfoma de Hodgkin (LH) sistémico es una complicación muy poco frecuente, aunque bien definida. Sin embargo, el LH primario del SNC es una entidad extremadamente rara, cuyo diagnóstico precisa la identificación de un patrón morfológico e inmunohistoquímico específico, así como la afectación aislada del SNC. Pese a contar con una casuística muy limitada (apenas una veintena de casos publicados en la literatura) la bibliografía disponible coincide en que el LH con afectación primaria y aislada del SNC, cuando es tratado con cirugía y tratamiento adyuvante (radioterapia±quimioterapia), parece tener un mejor pronóstico que aquellos casos en los que la afectación del SNC se produce en el contexto de un LH sistémico o en el contexto de un linfoma no Hodgkin. En este artículo se presenta el caso de una mujer de 55 años con diagnóstico histopatológico de LH primario del SNC. La paciente fue sometida a una exéresis completa de la lesión y a tratamiento adyuvante con quimioterapia intratecal y radioterapia holocraneal, con una supervivencia libre de enfermedad hasta la fecha de 14 meses. Se presenta asimismo, la revisión de la literatura disponible (AU)

Nanoformulaciones avanzadas contra la infección bacteriana / Advanced nanoformulations against bacterial infection

En la actualidad, los antibióticos constituyen la piedra angular en el tratamiento de las infecciones bacterianas. Sin embargo, en las últimas décadas, las bacterias han desarrollado mecanismos de defensa que las hace altamente resistentes a los antibióticos existentes, lo que nos deja vulnerables frente a las infecciones. La Organización Mundial de la Salud alerta de que las resistencias bacterianas constituyen una grave amenaza para la toda la humanidad y que necesitamos urgentemente el desarrollo de nuevos antibacterianos. La nanotecnología ha irrumpido en este escenario proporcionando herramientas novedosas para el diagnóstico, prevención y tratamiento de numerosas patologías, principalmente el cáncer. De este modo, la nanomedicina permite abordar diferentes enfermedades utilizando nanotransportadores de fármacos capaces de dirigirse de forma selectiva a la diana terapéutica, aumentando así la eficacia del tratamiento y disminuyendo los efectos secundarios. Este discurso se centra en las nanopartículas mesoporosas de sílice (MSNs), cuyas propiedades únicas y enorme versatilidad permiten diseñar múltiples nanosistemas para tratar infecciones bacterianas. Su capacidad para dirigirse específicamente a las bacterias y/o al biofilm, liberar distintos fármacos de manera controlada y/o inteligente en respuesta a determinados estímulos, e incorporar cationes terapéuticos en terapias combinadas, auguran el desarrollo de nanoformulaciones avanzadas que podrían revolucionar la lucha contra la infección bacteriana. (AU)

Nowadays, antibiotics remain the cornerstone in the treatment of bacterial infections. However, in recent decades, bacteria have developed defense mechanisms that make them highly resistant to the existing antibiotics, leaving us vulnerable to infection. The World Health Organization warns that bacterial resistance constitutes a serious threat to humanity at global level and that there is an urgent need of developing new antibacterial agents. Nanotechnology has entered into this scenario by providing novel tools for the treatment of numerous pathologies, highlighting cancer. Nanomedicine brings up the opportunity to address different diseases using drug nanocarriers that can be specifically directed to the therapeutic target, increasing the efficacy of the treatment and reducing the side effects. This entrance speech focuses on mesoporous silica nanoparticles, whose unique properties and enormous versatility allow the design of multiple nanosystems to treat bacterial infections. Its ability to specifically target bacteria and/or biofilm, release different drugs in a controlled manner and/or in a smart fashion, i.e. in response to certain stimuli, and incorporate therapeutic cations for combined therapies, envision the development of advanced nanoformulations that could revolutionize the fight against bacterial infection. (AU)

Synergistic effects of radiotherapy and targeted immunotherapy in improving tumor treatment efficacy: a review

Radiotherapy (RT), unlike chemotherapy, is one of the most routinely used and effective genotoxic and immune response inducing cancer therapies with an advantage of reduced side effects. However, cancer can relapse after RT owing to multiple factors, including acquired tumor resistance, immune suppressive microenvironment buildup, increased DNA repair, thus favoring tumor metastasis. Efforts to mitigate these undesirable effects have drawn interest in combining RT with immunotherapy, particularly the use of immune checkpoint inhibitors, to tilt the pre-existing tumor stromal microenvironment into long-lasting therapy-induced antitumor immunity at multiple metastatic sites (abscopal effects). This multimodal therapeutic strategy can alleviate the increased T cell priming and decrease tumor growth and metastasis, thus emerging as a significant approach to sustain as long-term antitumor immunity. To understand more about this synergism, a detailed cellular mechanism underlying the dynamic interaction between tumor and immune cells within the irradiated tumor microenvironment needs to be explored. Hence, in the present review, we have attempted to evaluate various RT-inducible immune factors, which can be targeted by immunotherapy and provide detailed explanation to optimally maximize their synergy with immunotherapy for long-lasting antitumor immunity. Moreover, we have critically assessed various combinatorial approaches along with their challenges and described strategies to modify them in addition to providing approaches for optimal synergistic effects of the combination (AU)