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Management of lateral pelvic lymph nodes in rectal cancer:Is it time to reach an Agreement?

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World Journal of Clinical Oncology 2024年第4期15卷 472-477页

作者： Sigfredo E Romero-Zoghbi fernando lópez-campos Felipe Couñago Department of Radiation Oncology GenesisCareTalavera de la Reina 45600ToledoSpain Department of Radiation Oncology Hospital Universitario Ramón Y CajalMadrid 28034Spain Department of Radiation Oncology GenesisCare-Hospital Universitario Vithas Madrid La MilagrosaMadrid 28010Spain

In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mllN)in stage II/III rectal cancer patients below the peritoneal *** treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent *** dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern *** contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal *** the presence of high-risk nodal characteristics for mllN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient *** the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.

关键词： Rectal cancer lateral pelvic lymph node metastases Pelvic lymph node dissection Total neoadjuvant therapy Selective management of the lateral pelvic nodes Prophylactic management of the lateral pelvic nodes Chemoradiotherapy Total mesorectal excision

Watch and wait approach in rectal cancer:Current controversies and future directions

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World Journal of Gastroenterology 2020年第29期26卷 4218-4239页

作者： fernando lópez-campos Margarita Martín-Martín Roberto Fornell-Pérez Juan Carlos García-Pérez Javier Die-Trill Raquel Fuentes-Mateos Sergio lópez-Durán JoséDomínguez-Rullán Reyes Ferreiro AlejandroRiquelme-Oliveira Asunción Hervás-Morón Felipe Couñago Department of Radiation Oncology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Radiology Hospital Universitario de BasurtoBilbao 48013VizcayaSpain Department of Surgery Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Medical Oncology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Gastroenterology and Hepatology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Medical Oncology Hospital Infanta CristinaMadrid 28034Spain Department of Radiation Oncology Hospital Universitario QuirónsaludMadrid 28003Spain Department of Radiation Oncology Hospital La LuzMadrid 28003Spain Universidad Europea de Madrid(UEM) Madrid 28223Spain

According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by ***,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a *** resection is associated with significant morbidity and decreased quality of life(Qol),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, Qol in these patients, and thecontroversies surrounding this treatment approach.

关键词： Watch and wait Rectal cancer Clinical complete response Organ preservation Dose intensification

Neoadjuvant treatment of rectal cancer: Where we are and where we are going

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World Journal of Clinical Oncology 2024年第7期15卷 790-795页

作者： Elísabet González Del Portillo Felipe Couñago fernando lópez-campos Department of Radiation Oncología Hospital Universitario La PazMadrid 28046Spain Department of Radiation Oncology GenesisCare MadridMadrid 28010Spain Department of Radiation Oncology Hospital Universitario Ramón Y CajalMadrid 28034Spain

locally advanced rectal cancer requires a multidisciplinary approach based on total neoadjuvant treatment with radiotherapy(RT)and chemotherapy(ChT),followed by deferred ***,alternatives to the standard total neoadjuvant therapy(TNT)are being explored,such as new ChT regimens or the introduction of *** standard TNT,up to a third of patients may achieve a complete pathological response(CPR),potentially avoiding ***,as of now,we lack predictive markers of response that would allow us to define criteria for a conservative organ *** presence of muta-tions,genes,or new imaging tests is helping to define these *** example of this is the diffusion coefficient in the diffusion-weighted sequence of magnetic resonance imaging and the integration of this imaging technique into RT *** allows for the monitoring of the evolution of this coefficient over successive RT sessions,helping to determine which patients will achieve CPR or those who may require intensification of neoadjuvant therapy.

关键词： locally advanced rectal cancer Total neoadyuvant treatment Radiotherapy Biomarker Magnetic resonance imaging Conservative organ strategy Watch and wait

Metastatic hormone-sensitive prostate cancer:How should it be treated?

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World Journal of Clinical Oncology 2021年第2期12卷 43-49页

作者： fernando lópez-campos Carmen González-San Segundo Antonio JoséConde-Moreno Felipe Couñago Department of Radiation Oncology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Radiation Oncology HGU Gregorio MarañonComplutense UniversityMadrid 28007Spain Department of Radiation Oncology Hospital Universitario y Politécnico La Fe.CEU Cardenal Herrera UniversityValencia 46026Spain Department of Radiation Oncology Hospital Universitario Quirón Salud MadridHospital La LuzUniversidad Europea de Madrid(UEM)Madrid 28223Spain

The number of treatment options for metastatic hormone-sensitive prostate cancer has increased substantially in recent *** classic treatment approach for these patients—androgen-deprivation therapy alone—is now considered *** randomized phase III clinical trials have demonstrated significant clinical benefits—including significantly better overall survival and quality of life—for treatments that combine androgen-deprivation therapy with docetaxel,abiraterone acetate,enzalutamide,apalutamide,and/or radiotherapy to the primary *** a result,these approaches are now included in treatment guidelines and considered standard of ***,the different treatment strategies have not been directly compared,and thus treatment selection remains at the discretion of the individual physician or,ideally,a multidisciplinary *** the range of available treatment approaches with varying toxicity profiles,treatment selection should be individualized based on the patient’s clinical characteristics and preferences,which implies active patient participation in the decision-making *** the present document,we discuss the changing landscape of the management of patients with metastatic hormonesensitive prostate cancer in the context of several recently-published landmark randomized *** addition,we discuss several unresolved issues,including the optimal sequencing of systemic treatments and the incorporation of local treatment of the primary tumour and metastases.

关键词： Metastatic hormone-sensitive prostate cancer Androgen-receptor signaling inhibitors Abiraterone acetate Enzalutamide Apalutamide Docetaxel

Assessing radiation dose for postoperative radiotherapy in prostate cancer: Real world data

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World Journal of Clinical Oncology 2022年第7期13卷 652-662页

作者： Asunción Hervás-Morón Jose Domínguez-Rullán Victor Duque Santana Mireia Valero Carmen Vallejo Sonsoles Sancho Juan David García Fuentes Miguel Cámara Gallego fernando lópez-campos Department of Radiation Oncology Hospital Universitario Ramón Y CajalMadrid 28034Spain Department of Medical Physics Hospital Universitario Ramón Y CajalMadrid 28034Spain

BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical *** these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone ***,the optimal radiotherapy dose is unknown due to the limited data *** To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with *** Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July *** 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 *** were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 *** primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/*** endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer ***,we aimed to identify potential prognostic ***,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank *** and multivariate Cox regression models were performed to explore between-group differences in survival outcome *** A total of 301 consecutive patients were *** these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical *** this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage

关键词： Prostate cancer Postoperative radiotherapy Dose intensified Radiation dose Biochemical relapse free survival

Human health risks associated to trace elements and metals in commercial fish from the Brazilian Amazon

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Journal of Environmental Sciences 2025年第2期148卷 230-242页

作者： Andrea V.Waichman Gabriel Silva de Souza Nunes Rhaul de Oliveira Isabel lópez-Heras Andreu Rico Federal University of the Amazon Institute of Biological SciencesAv.Rodrigo Ramos 3000Manaus 69077-000Brazil Federal University of Pernambuco Department of ZoologyAv.Prof Moraes Rego 1235Cidade UniversitáriaRecife 50670-901Brazil University of Campinas School of TechnologyRua Paschoal Marmo 1888-Jd.Nova ItáliaLimeira 13484-332Brazil IMDEA Water Institute Science and Technology Campus of the University of AlcaláAv.Punto Com 2Alcaláde Henares 28805MadridSpain Cavanilles Institute of Biodiversity and Evolutionary Biology University of Valenciac/Catedrático JoséBeltrán 246980PaternaValenciaSpain

Fish constitutes the main protein source for the Amazonian ***,the impact of different anthropogenic activities on trace element and metal accumulation in fish and their risks for human health at a regional scale remain largely *** we assessed exposure levels of 10 trace elements andmetals(Cr,Mn,Fe,Ni,Cu,Zn,As,Cd,Pb,and Hg)in 56 samples belonging to 11 different species of fish from the Brazilian *** studied the relationship between exposure levels,fish origin,and fish feeding habits,and assessed toxicological and carcinogenic risks for the Amazonian *** significant correlation was found between sampling site and exposure levels to the studied elements,but a significant difference was found between the accumulation of some metals and the position of the fish species in the food *** concentrations of Cr and Hg in fish flesh were found to exceed the Brazilian limits for human *** study shows that current fish consumption patterns can lead to estimated daily intakes of Hg,As and Cr that exceed the oral reference dose,thus posing a toxicological ***,carcinogenic risks may be expected due to the continued exposure to Cr and *** results of this study show that the consumption of wild caught fish in the Amazon region should be ***,continued monitoring of trace element and metal contamination in fish and on the health of the Amazonian population is recommended,particularly for riverine and indigenous communities.

关键词： Metals Deforestation Mining Freshwater ecosystems Carcinogenic risks Amazon

Anti-amyloid antibodies in Alzheimer’s disease: what did clinical trials teach us?

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Neural Regeneration Research 2025年第4期20卷 1092-1093页

作者： Danko Jeremic lydia Jiménez-Díaz Juan D.Navarro-lópez NeuroPhysiology&Behavior lab University of Castilla-La ManchaBiomedical Research Center(CRIB)School of Medicine of Ciudad RealCiudad RealSpain

Although many causes of Alzheimer’s disease(AD)may exist,both the original amyloid cascade and tau hypotheses posit that abnormal misfolding and accumulation of amyloid-β(Aβ)and tau protein is the central event causing the ***,that conclusion could be only partly true,and there is conflicting evidence about the role of both proteins in AD,being able to precede and influence one *** researchers argue that these proteins are mere executors rather than primary causes of ***,there have been continuing refinements of both hypotheses,with alternative explanations proposed.Aβand tau proteins may be independently involved in specific neurotoxic pathways;yet there may be other crucial processes going on in early ***,accumulating evidence suggests that Aβand tau act synergistically,rather than additively in disease onset(Jeremic et al.,2021,2023a).

关键词： amyloid Alzheimer additive

Unveiling the brain’s symphony:exploring the necessity and sufficiency of neural networks in behavior control

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Neural Regeneration Research 2025年第1期20卷 186-187页

作者： fernando Jose Bustos Instituto de Ciencias Biomedicas Facultad de Medicina y Facultad de Ciencias de la VidaUniversidad Andres BelloSantiagoChile Millennium Nucleus of Neuroepigenetics and Plasticity(EpiNeuro) SantiagoChile

Since the pioneering work by Broca and Wernicke in the 19th century,who examined individuals with brain lesions to associate them with specific behaviors,it was evident that behaviors are complex and cannot be fully attributable to specific brain areas ***,they involve connectivity among brain areas,whether close or *** that time,this approach was considered the optimal way to dissect brain circuitry and *** pioneering efforts opened the field to explore the necessity or sufficiency of brain areas in controlling behavior and hence dissecting brain ***,the connectivity of the brain and the mechanisms through which various brain regions regulate specific behaviors,either individually or collaboratively,remain largely *** animal models,researchers have endeavored to unravel the necessity or sufficiency of specific brain areas in influencing behavior;however,no clear associations have been firmly established.

关键词： behavior connectivity neural

Prehospital critical care drug-therapy and 30-day mortality in patients with acute respiratory disease

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World Journal of Emergency Medicine 2025年第1期16卷 43-50页

作者： Jesús Jurado-Palomo Joséluis Martín-Conty Begoña Polonio-lópez Cristina Rivera Picón Raúl lópez-Izquierdo Carlos del Pozo Vegas Pedro Ángel de Santos Castro Ancor Sanz-García Francisco Martín-Rodríguez Technological Innovation Applied to Health Research Group(ITAS) Faculty of Health SciencesCastilla-La Mancha UniversityTalavera de la Reina 45600Spain Nuestra Señora del Prado General Hospital Talavera de la Reina 45600Spain Emergency Department Rio Hortega University HospitalValladolid 47012Spain CIBER of Respiratory Diseases(CIBERES) Institute of Health Carlos ⅢMadrid 28029Spain Faculty of Medicine University of ValladolidValladolid 470003Spain Emergency Department University Clinical HospitalValladolid 47003Spain Prehospital Emergency Medical Services(SACYl) Valladolid 47007Spain

BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory ***: A prospective, multicenter, emergency medical service(EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital ***: A total of 961 patients were included, with a mortality rate of 17.5%(168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation(IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve(AUC) of 0.857(95% confidence interval [95% CI] 0.827–0.888).CONClUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.

关键词： Drug-therapy Medication Prehospital Mortality Emergency medical services