Total skin electron beam therapy for primary cutaneous T-cell lymphomas: clinical characteristics and outcomes in a Mexican reference center.

AIM: The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT). BACKGROUND: Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative. MATERIALS AND METHODS: This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality. RESULTS: Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6-8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months. CONCLUSION: This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.

Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit, oncologic outcomes and incidence of gastrointestinal and urinary toxicities.

AIM: The purpose of this study was to review genitourinary (GU) and gastrointestinal (GI) toxicity associated with high-dose radiotherapy (RT) delivered with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) or volumetric arc therapy (VMAT) following radical prostatectomy (RP). BACKGROUND: RP is a therapeutic option for the management of prostate cancer (PrCa). When assessing postoperative RT techniques for PrCa, the published literature focuses on patients treated with 2-dimensional conventional methods without reflecting the implementation of 3D-CRT, IMRT, or VMAT. MATERIALS AND METHODS: A total of 83 patients were included in this analysis; 30 patients received 3D-CRT, and 53 patients received IMRT/VMAT. Acute and late symptoms of the GU and lower GI tract were retrospectively graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer radiation toxicity grading systems. The relapse failure-free rate and overall survival were also evaluated. RESULTS: The rate of acute GU toxicity was 9.4% vs. 13.3% for the IMRT/VMAT and 3D-CRT groups (p = 0.583). The 5-year actuarial rates of late GI toxicity for IMRT/VMAT and 3D-CRT treatments were 1.9% and 6.7%, respectively. The rate of late GU toxicity for the IMRT/VMAT and 3D-CRT treatment groups was 7.5% and 16.6%, respectively (p = 0.199). We found no association between acute or late toxicity and the RT technique in univariate and multivariate analyses. CONCLUSION: Postprostatectomy IMRT/VMAT and 3D-CRT achieved similar morbidity and cancer control outcomes. The clinical benefit of highly conformal techniques in this setting is unclear although formal analysis is needed.

Identification of Interleukin-27 (IL-27)/IL-27 Receptor Subunit Alpha as a Critical Immune Axis for In Vivo HIV Control.

Intact and broad immune cell effector functions and specific individual cytokines have been linked to HIV disease outcome, but their relative contribution to HIV control remains unclear. We asked whether the proteome of secreted cytokines and signaling factors in peripheral blood can be used to discover specific pathways critical for host viral control. A custom glass-based microarray, able to measure >600 plasma proteins involved in cell-to-cell communication, was used to measure plasma protein profiles in 96 HIV-infected, treatment-naive individuals with high (>50,000) or low (<10,000 HIV RNA copies/ml) viral loads. Univariate and regression model analysis demonstrate that plasma levels of soluble interleukin-27 (IL-27) are significantly elevated in individuals with high plasma viremia (P < 0.0001) and are positively correlated with proviral HIV-DNA copy numbers in peripheral blood mononuclear cells (PBMC) (Rho = 0.4011; P = 0.0027). Moreover, soluble IL-27 plasma levels are negatively associated with the breadth and magnitude of the total virus-specific T-cell responses and directly with plasma levels of molecules involved in Wnt/ß-catenin signaling. In addition to IL-27, gene expression levels of the specific IL-27 receptor (IL27RA) in PBMC correlated directly with both plasma viral load (Rho = 0.3531; P = 0.0218) and the proviral copy number in the peripheral blood as an indirect measure of partial viral reservoir (Rho = 0.4580; P = 0.0030). These results were validated in unrelated cohorts of early infected subjects as well as subjects before and after initiation of antiretroviral treatment, and they identify IL-27 and its specific receptor as a critical immune axis for the antiviral immune response and as robust correlates of viral load and proviral reservoir size in PBMC.IMPORTANCE The detailed knowledge of immune mechanisms that contribute to HIV control is a prerequisite for the design of effective treatment strategies to achieve HIV cure. Cells communicate with each other by secreting signaling proteins, and the blood is a key conduit for transporting such factors. Investigating the communication factors promoting effective immune responses and having potentially antiviral functions against HIV using a novel focused omics approach ("communicome") has the potential to significantly improve our knowledge of effective host immunity and accelerate the HIV cure agenda. Including 140 subjects with variable viral loads and measuring the plasma levels of >600 soluble proteins, our data highlight the importance of Th17 cells and Wnt/ß-catenin signaling in HIV control and especially identify the IL-27/IL-27 receptor subunit alpha (IL-27RA) axis as a predictor of plasma viral load and proviral copy number in the peripheral blood. These data may provide important guidance to therapeutic approaches in the HIV cure agenda.

Superoxide dismutases: a physiopharmacological update.

Reactive oxygen species (ROS) are known participants in several cellular processes. Superoxide anion radical, one example of ROS, forms as a result of normal cellular respiration and is usually cleared successfully by superoxide dismutase (SOD) and other radical scavengers. However, when superoxide exceeds the clearance capacity of SOD and other ROS scavengers, superoxide initiates a number of pathologic processes. This review examines pathologies involving superoxide, including: cancer, neurodegenerative diseases, ischemia/reperfusion injury, and inflammation. We will also explore the basic science principles of superoxide and SOD, including: SOD evolution, SOD mutations, biochemistry, physiology, and pathophysiology. In reviewing the basic science, clinical pathology, and therapeutic research, we hope to clearly demonstrate plausible pharmacologic targets of action. We have revised data about basic science, clinical pathology and therapeutic research in an effort to propose plausible pharmacological targets of action. The understanding of these aspects is critical in the accomplishment of a successful clinical intervention.

Superoxide dismutases: a physiopharmacological update

Reactive oxygen species (ROS) are known participants in several cellular processes.Superoxide anion radical, one example of ROS, forms as a result of normal cellularrespiration and is usually cleared successfully by superoxide dismutase (SOD) andother radical scavengers. However, when superoxide exceeds the clearance capacityof SOD and other ROS scavengers, superoxide initiates a number of pathologicprocesses. This review examines pathologies involving superoxide, including: cancer,neurodegenerative diseases, ischemia/reperfusion injury, and inflammation. Wewill also explore the basic science principles of superoxide and SOD, including: SODevolution, SOD mutations, biochemistry, physiology, and pathophysiology. Inreviewing the basic science, clinical pathology, and therapeutic research, we hope toclearly demonstrate plausible pharmacologic targets of action. We have revised dataabout basic science, clinical pathology and therapeutic research in an effort to proposeplausible pharmacological targets of action. The understanding of these aspectsis critical in the accomplishment of a successful clinical intervention(AU)

Calidad de vida en pacientes trasplantados de corazón / Quality of life in heart transplanted patients

Se ha realizado un estudio prospectivo de calidad de vida en 62 pacientes que recibieron un trasplante de corazón en nuestro Centro analizando los parámetros objetivos (vuelta al trabajo, actividad física, actividad sexual y patología discapacitante asociada) así como los parámetros subjetivos (percepción del estado físico y psíquico, depresión, cambios en las relaciones personales, actividad de ocio y capacidad subjetiva para trabajar). El 71 por ciento de los trasplantados tuvieron una percepción buena de su estado de salud, tanto física como psicológica, un 38,7 por ciento se consideraron aptos para trabajar, pero sólo lo hicieron un 26,6 por ciento, porcentaje muy inferior al de otras series. Asimismo el 91,9 por ciento presentó alguna patología asociada y percibida por ellos como discapacitante en mayor o menor grado, especialmente del aparato locomotor (debilidad muscular, mialgias, artralgias y dolor de espalda), patología que con frecuencia fue la responsable de la sensación de incapacidad laboral y que fue tratada solamente en el 56,5 por ciento y únicamente fue evaluada por un Médico Rehabilitador en el 26,6 por ciento. (AU)

Patología post-trasplante cardíaco / Post-transplantation cardiac pathology

Se han estudiado 250 pacientes trasplantados de corazón entre agosto del año 1988 y mayo de 1998 en nuestro Centro, de los que 212 fueron hombres (85 por ciento) y 38 mujeres (15 por ciento). La edad media era 52 ñ 10 años y la supervivencia al año de la recepción llegó al 64 por ciento mientras que a los cinco años bajó al 31 por ciento.La patología post-trasplante más frecuentemente observada correspondió a la de los receptores con factores de riesgo cardiovascular (hipertensión arterial, hipercolesterolemia, diabetes mellitus y obesidad), donde la diabetes mellitus tuvo una prevalencia máxima en los mayores de 50 años de edad. Siguió en frecuencia de aparición la clínica del sistema músculo-esquelético (alteraciones musculares, dolor de espalda, artralgias, fracturas vertebrales y osteoporosis), donde así mismo las lumbalgias y la osteoporosis prevalecieron en los mayores de 60 años de edad.Ante estos cuadros sintomáticos post-trasplante pensamos que los programas de Rehabilitación Cardíaca en los trasplantados de corazón deben y tienen que incluir protocolos para su temprana detección y para su adecuado tratamiento rehabilitador. (AU)

Vuelta al trabajo tras el trasplante de corazón / Return to work after heart transplantation

La reincorporación laboral postrasplante cardiaco está tomando mayor importancia a medida que los resultados médicos mejoran. El propósito de este estudio es determinar la tasa de reempleo postrasplante cardiaco y estudiar qué factores influyen en este sentido. Hemos entrevistado a sesenta y dos enfermos trasplantados de nuestro hospital. Todos habían recibido un trasplante de corazón al menos seis meses antes. Encontramos una tasa de vuelta al trabajo del 24 por ciento, pese a que el 38,7 por ciento se sentía capaz (o quería) trabajar. Coincidimos con otras publicaciones en la influencia positiva de factores como una breve discapacidad previa al trasplante, sensación subjetiva del paciente de poder trabajar,edad menor, satisfacción con sus trabajo previo y un alto nivel educativo. Los pacientes no se ven influenciados por una mala situación económica al buscar empleo. Hay un importante número de pacientes que trabajan y cobran pensión por incapacidad simultáneamente. El 61 por ciento (38 pacientes) no se sentían físicamente capaces de trabajar, alegando 27 debilidad física y 10 algún tipo de patología osteomuscular. Subrayamos la necesidad de una rehabilitación cardíaca integral postrasplante cardiaco para conseguir que estos enfermos disfruten de mejor calidad de vida y sean miembros producticos de nuestra sociedad. (AU)

Pronóstico funcional en la hemiplejia de origen vascular / Functional prognosis in the vascular caused hemiplegia

Introducción: Los accidentes cerebrovasculares representan una causa muy frecuente de morbilidad y mortalidad, y por ello suponen un problema socioeconómico muy importante, por lo que es necesario conocer desde el principio el pronóstico de cada paciente. El objetivo de este estudio es encontrar instrumentos que nos sirvan como predictores funcionales desde el momento del ingreso de los pacientes. Se analiza especialmente la influencia de las escalas de actividades de la vida diaria. Material y métodos: La muestra se constituye por 57 pacientes que sufrieron un accidente cerebrovascular entre agosto y octubre de 1996, a los que se valoró mediante un protocolo que incluía factores de riesgo, manifestaciones clínicas y otras variables consideradas como predictores funcionales, así como las escalas de Barthel y FIM, que se les aplicaba al ser remitidos a Rehabilitación, a los tres y a los seis meses. Para evaluar los resultados funcionales se tuvo en cuenta el destino al alta de los pacientes, dependiendo de si volvían a su domicilio realizando una vida similar a la previa al ictus, si precisaban ingreso en centros para completar su tratamiento rehabilitador o si quedaban con una dependencia total (cuidados de enfermería).Resultados y conclusiones: Los factores que se asocian con un peor pronóstico son el deterioro cognitivo y los trastornos del lenguaje. El FIM se muestra como mejor predictor funcional que el índice de Barthel, y ambos constituyen buenos instrumentos a la hora de establecer un pronóstico en el hemipléjico de origen vascular (AU)