Hospital Real de Granada

Parkinson's disease (PD) is a progressive neurodegenerative disorder marked by motor and non-motor dysfunctions that severely compromise patients' quality of life. While pharmacological treatments provide symptomatic relief in the early stages, advanced PD often requires neurosurgical interventions, such as deep brain stimulation (DBS) and focused ultrasound (FUS), for effective symptom management. A significant challenge in optimizing these therapeutic strategies is the early identification and recruitment of suitable candidates for clinical trials. This review explores the role of artificial intelligence (AI) in advancing neurosurgical and neuroscience interventions for PD, highlighting the ways in which AI-driven platforms are transforming clinical trial design and patient selection. Machine learning (ML) algorithms and big data analytics enable precise patient stratification, risk assessment, and outcome prediction, accelerating the development of novel therapeutic approaches. These innovations improve trial efficiency, broaden treatment options, and enhance patient outcomes. However, integrating AI into clinical trial frameworks presents challenges such as data standardization, regulatory hurdles, and the need for extensive validation. Addressing these obstacles will require collaboration among neurosurgeons, neuroscientists, AI specialists, and regulatory bodies to establish ethical and effective guidelines for AI-driven technologies in PD neurosurgical research. This paper emphasizes the transformative potential of AI and technological innovation in shaping the future of PD neurosurgery, ultimately enhancing therapeutic efficacy and patient care.

Background: Disparities in neuro-oncological care between high-income and low- and middle-income countries (LMICs) are well documented, yet region-specific data from Latin America remain limited. This review evaluates epidemiologic trends, access to care, and systemic challenges in brain tumor management across Latin American LMICs, using Argentina as a case study. Methods: A systematic review of peer-reviewed literature was conducted focusing on brain tumor incidence, mortality, risk factors, and availability of diagnostics and treatments in Latin America. Socioeconomic, cultural, and systemic barriers were also analyzed. Results: Latin America exhibits some of the highest global brain tumor mortality rates, with Brazil reporting age-standardized rates exceeding 4.5 per 100,000. Glioblastomas are frequently diagnosed at younger ages, often in the fifth decade of life, compared to the global average. Meningioma incidence has increased by 15–20% over the last decade, yet region-wide data remain fragmented. Access to neuroimaging, neurosurgery, radiotherapy, and chemotherapy is limited, with up to 60% of patients relying solely on under-resourced public health systems. Less than 30% of hospitals in rural areas have MRI availability, and continuous professional training is infrequent. Innovative adaptations, such as awake craniotomy, are used in some LMIC centers in response to equipment scarcity. Conclusions: Brain tumor care in Latin America is hindered by limited epidemiological data, restricted access to diagnostics and treatment, and insufficient workforce training. Targeted investments in healthcare infrastructure, international educational collaborations, and policy-level reforms are critical to reducing disparities and improving outcomes in neuro-oncology across the region.

<h3>Background and Importance</h3> Basal cell carcinoma (BCC) is the most common skin cancer, with advanced cases often difficult to treat using traditional methods like surgery and radiotherapy. The Hedgehog signalling pathway plays a key role in BCC, leading to treatments like vismodegib and sonidegib. This study evaluates their effectiveness and safety in real clinical settings. <h3>Aim and Objectives</h3> The study aims to evaluate the effectiveness and safety of Hedgehog pathway inhibitors in patients with locally advanced or metastatic basal cell carcinoma. It focuses on treatment response, tumour recurrence, and adverse events, while comparing outcomes between vismodegib and sonidegib, two commonly used inhibitors in clinical practice. <h3>Material and Methods</h3> A retrospective observational study was conducted on patients with locally advanced or metastatic basal cell carcinoma between December 2020 and March 2024. Data on demographics, tumour location, treatment details, and adverse events were collected. Patients received vismodegib or sonidegib, with treatment effectiveness assessed by disease recurrence. Quality of life was measured using the ECOG scale. Adverse events, dose modifications, and reasons for treatment discontinuation were also recorded. In some cases, neoadjuvant treatments were used to facilitate subsequent surgeries. <h3>Results</h3> The study included 14 patients, of whom 64.29% were male and the mean age was 76.21 years. Most of the patients (57.14%) received off-label neoadjuvant treatment, and the rest were cases of inoperable locally advanced BCC. The tumours were predominantly located on the face (64.29% of cases). All patients treated with sonidegib had adverse events (ADRs), including haematologic toxicity and muscle damage, leading to discontinuation or dose adjustment in some cases. Adverse events were also experienced by 77.78% of vismodegib-treated patients. There was tumour recurrence in 25% of neoadjuvant-treated patients. Three patients treated with vismodegib were able to maintain response after more than 12 months, and four other patients with inoperable BCCla remain on treatment with significant tumour regression. <h3>Conclusion and Relevance</h3> Hedgehog pathway inhibitors, vismodegib and sonidegib, effectively treat locally advanced and metastatic BCC, offering an alternative to surgery or radiotherapy. Despite frequent adverse effects, they control disease and enable salvage surgeries. Further research is needed to compare effectiveness, manage side effects, and improve treatment adherence. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest

Abstract Introduction Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein -cholesterol (LDL-c) levels, increasing early cardiovascular risk. Many patients do not reach LDL-c targets despite treatment. Physical activity and exercise may help by improving cardiorespiratory fitness (CRF), reducing inflammation, and modulating metabolic pathways. This study aims 1) to cross-sectionally evaluate the association of physical activity and CRF with markers of sub-clinical atherosclerosis and a nuclear magnetic resonance-derived metabolomic profile in patients with FH, and 2) to assess the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on CRF (primary outcome), markers of subclinical atherosclerosis, serum biomarkers and metabolomic profiles (secondary outcomes), and to unravel the underlying mechanisms. Methods and analysis For aim 1, a cross-sectional study will be conducted in approximately 200 patients with FH from Granada and Almería (Spain). Assessments will include accelerometer-measured physical activity, CRF, markers of subclinical atherosclerosis and metabolomic profiles. For aim 2, a 16-week, parallel-group randomized controlled trial will be conducted with 75 participants assigned to one of three groups: HIIT (4 intervals of 4 minutes at 85–95% of maximal heart rate, 3 days/week), MICT (34 minutes at 69–76% of maximal heart rate, 3 days/week) or usual care. CRF will be assessed using the modified Bruce test. Markers of subclinical atherosclerosis will include vascular inflammation (PET/CT scan), arterial stiffness (Mobil-O-Graph® 24h pulse wave monitor), carotid intima-media thickness, and carotid plaque presence (carotid Doppler ultrasound). Metabolomic profiles will be analyzed using nuclear magnetic resonance spectroscopy. Analyses will include correlation and regression models for cross-sectional associations, and linear mixed-effects models for RCT outcomes, following an intention-to-treat approach with additional sensitivity analyses. Ethics and dissemination The study was approved by the Ethics Committee for Biomedical Research of Granada (ref. 1417-N-23), and findings will be disseminated through peer-reviewed publications, conference presentations, and outreach activities aimed at patients and healthcare professionals. Trial registration number ClinicalTrials.gov ID NCT06833944 . Strengths and limitations of this study This is the first study to evaluate the effects of structured exercise in patients with familial hypercholesterolemia, comparing two exercise modalities (high-intensity interval training and moderate-intensity continuous training) and assessing multiple clinically relevant health outcomes (cardiorespiratory fitness, subclinical atherosclerosis, and metabolomic profiles). The study integrates objective measures of physical activity (accelerometry), cardiorespiratory fitness (VO□max), vascular imaging (PET/CT, carotid ultrasound, arterial stiffness), and metabolomics, providing a comprehensive assessment of both functional and mechanistic outcomes. The interventions are supervised, individualized, and follow established exercise reporting guidelines (CERT), which enhances safety, adherence, and reproducibility. The intervention duration (16 weeks) and the specific clinical population (aged 18– 70 years, clinically stable, without cardiovascular disease) may limit assessment of long-term effects and generalizability to all patients with familial hypercholesterolemia. Although some outcomes are directly applicable to clinical or exercise practice, other mechanistic outcomes (PET/CT, metabolomics, and vascular imaging) provide rigorous scientific insight but have lower direct applicability.