Sentinel lymph node biopsy before and after neoadjuvant chemotherapy in cN0 breast cancer patients: impact on axillary morbidity and survival-a propensity score cohort study.

PURPOSE: In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies. METHODS: We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI). RESULTS: The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985). CONCLUSION: Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.

Axillary lymph node dissection versus radiotherapy in breast cancer with positive sentinel nodes after neoadjuvant therapy (ADARNAT trial).

Introduction: Breast cancer surgery currently focuses on de-escalating treatment without compromising patient survival. Axillary radiotherapy (ART) now replaces axillary lymph node dissection (ALND) in patients with limited sentinel lymph node (SLN) involvement during the primary surgery, and this has significantly reduced the incidence of lymphedema without worsening the prognosis. However, patients treated with neoadjuvant systemic treatment (NST) cannot benefit from this option despite the low incidence of residual disease in the armpit in most cases. Data regarding the use of radiotherapy instead of ALND in this population are lacking. This study will assess whether ART is non-inferior to ALND in terms of recurrence and overall survival in patients with positive SLN after NST, including whether it reduces surgery-related adverse effects. Methods and analyses: This multicenter, randomized, open-label, phase 3 trial will enroll 1660 patients with breast cancer and positive SLNs following NST in approximately 50 Spanish centers over 3 years. Patients will be stratified by NST regimen and nodal involvement (isolated tumoral cells or micrometastasis versus macrometastasis) and randomly assigned 1:1 to ART without ALND (study arm) or ALND alone (control arm). Level 3 and supraclavicular radiotherapy will be added in both arms. The primary outcome is the 5-year axillary recurrence determined by clinical and radiological examination. The secondary outcomes include lymphedema or arm dysfunction, quality of life based (EORTC QLQ-C30 and QLQ-BR23 questionnaires), disease-free survival, and overall survival. Discussion: This study aims to provide data to confirm the efficacy and safety of ART over ALND in patients with a positive SLN after NST, together with the impact on morbidity. Ethics and dissemination: The Research Ethics Committee of Bellvitge University Hospital approved this trial (Protocol Record PR148/21, version 3, 1/2/2022) and all patients must provide written informed consent. The involvement of around 50 centers across Spain will facilitate the dissemination of our results. Trial registration: ClinicalTrials.gov, identifier number NCT04889924.

Management of the axilla in postmenopausal patients with cN0 hormone receptor-positive/HER2-negative breast cancer treated with neoadjuvant endocrine therapy and its prognostic impact.

PURPOSE: To evaluate the differences in nodal positivity if the sentinel lymph node biopsy (SLNB) is performed before or after neoadjuvant endocrine therapy (NET) in breast cancer patients, and its impact on prognosis. METHODS: A retrospective cohort study was performed in a single center including 91 postmenopausal cases with clinically node-negative and hormone receptor-positive/HER2-negative (HR + /HER2-) breast cancer, treated with NET and SLNB. SLNB was done pre-NET until 2014, and post-NET thereafter. Axillary lymph node dissection (ALND) was indicated only in SLNB macrometastasis, although in selected elderly patients, it was omitted. Kaplan-Meier survival curves were estimated in relation to the status of the axilla, and the differences assessed using the log-rank test. RESULTS: Between December 2006 and March 2022, SLNB was performed pre-NET in 14 cases and post-NET in 77. Both groups were similar in baseline tumor and patient characteristics. SLNB positivity was similar regardless of whether SLNB was performed before (5/14, 35.7%) or after NET (27/77, 37%), with 2/14 SLN macrometastases in the pre-NET cohort and 17/77 in the post-NET cohort. Only three patients (18.7%) with SLN macrometastasis had > 3 positive nodes following ALND. The 5-year overall survival and distant disease-free survival were 92.4% and 94.8%, respectively, with no significant differences according to SLNB status (p 0.5 and 0.8, respectively). CONCLUSION: SLN positivity did not differ according to its timing (before or after NET). Therefore, NET has no effect on lymph node clearance. Furthermore, the prognosis is good regardless of the axillary involvement. Therefore, factors other than axillary involvement may affect the prognosis in these patients.

Characteristics of the bachelor thesis in dentistry, satisfaction and motivations of the students / Características de las tesis de licenciatura en odontología, satisfacción y motivaciones de los tesistas

Objective: To describe the characteristics of under-graduate theses, satisfaction and reasons for choosing a topic of study. Materials and Methods: Cross-sectional study that included two populations, theses and thesis students who were able to support their work from 2015 to 2021 in the Faculty of Dentistry of the Universidad Nacional Mayor de San Marcos (Lima, Peru). Documentary analysis was used at first to record bibliometric data. The survey was used in a second stage to collect information related to the reasons why the thesis students chose their topic and the degree of satisfaction. Results: A total of 269 theses were examined. The theses corresponded to more women (n=142; 52.8%). All had a quantitative approach. The cross-sectional/descriptive design was the most frequent (n=207; 77%). Of the 114 respondents, the majority of them indicated that their thesis topic decision was influenced by a faculty member outside of their advisor (n= 26; 22.8%). A total of 49.1% of thesis students were in complete agreement about what they had learned about research at the end of their thesis. Conclusions: The undergraduate theses evidenced to be developed mainly by women, most of the thesis students were satisfied with the elaboration and execution of their academic work; it was evidenced that the thesis topics are mainly influenced by a teacher different from the thesis advisor, this indicates that the advisors should be more conscious when guiding the student and influencing the thematic, methodological and writing decisions together with the advised.

Objetivo: Describir las características de las tesis de licenciatura, satisfacción y motivos para la elección de un tema de estudio. Materiales y Métodos: Estudio transversal que incluyó a dos poblaciones, las tesis y a los tesistas que lograron sustentar sus trabajos desde el año 2015 al 2021 en la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos (Lima, Perú). Se utilizó el análisis documental en un primer momento para registrar datos bibliométricos. La encuesta se utilizó en un segundo momento para recabar información relacionada a los motivos por los cuales escogieron su tema los tesistas y el grado de satisfacción. Resultados: Se examinaron 269 tesis. La mayoría de ellas fueron realizadas por mujeres (n=142; 52,8%). Todas tuvieron un enfoque cuantitativo. El diseño transversal/descriptivo fue el más frecuente (n=207; 77%). De los 114 encuestados, la mayoría de ellos indicó que la decisión de su tema de tesis fue influida por un docente ajeno a su asesor (n= 26; 22,8%). El 49,1% de tesistas estuvo totalmente de acuerdo respecto a lo aprendido sobre investigación al culminar su tesis. Conclusión: Las tesis de licenciatura evidenciaron ser desarrolladas principalmente por mujeres, la mayoría estuvo satisfecho con la elaboración y ejecución de su trabajo académico; se evidenció que los temas de tesis son influenciados principalmente por un docente diferente al asesor de tesis, esto indica que los asesores deben ser más conscientes al momento de guiar al estudiante e influir en las decisiones temáticas, metodológicas y de redacción junto con el asesorado

Effects of technosols based on organic amendments addition for the recovery of the functionality of degraded quarry soils under semiarid Mediterranean climate: A field study.

This study aims to evaluate the effects of technosols made with different organic amendments to restore degraded soils in a semiarid limestone quarry. The effects on soil quality, functionality and organic matter dynamics of the technosols amended with waste of gardening, greenhouse horticultural, stabilized sewage sludge and two mixtures of sludge with both vegetable composts were assessed. Several physical and chemical properties, humus fractions, soil respiration and molecular composition was performed after 6 and 18 months. Un-amended soils, and nearby natural undegraded soils served as reference. Amended technosols increased water retention capacity, electrical conductivity, total organic carbon and nitrogen, respect to not amended and natural soils. Humus fraction composition was not altered over time. Un-amended soils, very poor in organic matter, did not show any pyrolyzable compounds or labile soil organic matter by thermogravimetry. In contrast, the pyrochromatograms of natural soils showed lignocellulosic materials, polypeptides and a noticeable presence of alkylic compounds. In technosols with both types vegetable compost, the organic matter structure was more complex, showing compounds from lignin-derived and long-chain alkyl, polysaccharides, chlorophyll isoprenoids and nitrogen. In sludge technosol, a set of sterols was outstanding. The mixtures showed a molecular fingerprint of materials derived from the decomposition of the organic amendments that formed them. These signs of the contribution of different organic matter forms derived from the amendments were also reported by the series exothermic peaks found in the calorimetry. This short-term study indicates a clear effect of the amendments on the recovery of soil organic matter and presumably of its functionality. After the amendments application, microbial activity and soil respiration rates increased rapidly but ceased 18 months later. The molecular composition of the organic matter of the soils amended with plant compost was very similar to that of natural, non-degraded soils in nearby areas.

Perspectivas de los graduados de Odontología sobre la supervisión (asesoría) de la tesis de licenciatura

Resumen Se identificó las perspectivas que tienen los graduados sobre los procesos de supervisión que tuvieron con sus asesores de tesis. Estudio cualitativo cuya población fueron graduados del pregrado de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos (Lima. Perú), a través de entrevistas semiestructuradas. Las categorías de estudio estuvieron relacionadas con la planificación de las actividades con el supervisor, decisiones del supervisor y percepciones generales sobre el supervisor. De los 20 entrevistados, 12 (60%) fueron mujeres. La planificación fue indicada como uno de los elementos que poco se discutió con el asesor, la mayoría indicó que nunca tuvieron una primera reunión para coordinar cómo serían las sesiones de asesoría. La percepción que se tiene de los supervisores de tesis no es adecuada por parte de los estudiantes de Odontología. Los principales aspectos negativos estuvieron relacionados a la falta de planificación de las actividades y reuniones.

Resumo Foram identificadas as perspectivas que os egressos têm sobre os processos de supervisão que tiveram com seus orientadores de tese. Estudo qualitativo cuja população foram graduandos da Faculdade de Odontologia da Universidad Nacional Mayor de San Marcos (Lima, Peru), por meio de entrevistas semiestruturadas. As categorias do estudo foram relacionadas ao planejamento das atividades com o supervisor, decisões do supervisor e percepções gerais sobre o supervisor. Dos 20 entrevistados, 12 (60%) eram mulheres. O planejamento foi apontado como um dos elementos pouco discutidos com a assessoria, a maioria indicou que nunca teve uma primeira reunião para coordenar como seriam as sessões de assessoria. A percepção dos orientadores de tese não é adequada por parte dos alunos de Odontologia. Os principais aspectos negativos foram relacionados à falta de planejamento das atividades e reuniões.

Abstract We identified graduates' views on their thesis supervision process as led by their thesis advisors. A qualitative study of graduates of the School of Dentistry of Universidad Nacional Mayor de San Marcos (Lima, Peru) included semi-structured interviews. The study categories were planning activities with the advisor, the advisor's decisions, and general views on the advisor. Of the 20 interviewees, 12 (60%) were women. Planning was insufficiently discussed with the advisor; most interviewees said that they never had a first meeting to coordinate what the advisory sessions would be like. Dental students do not have a favorable view of thesis advisors. The main negative aspects were the lack of planning of activities and meetings.

Comparación del módulo de elasticidad y resistencia de la resina acrílica de termocurado y la resina flexible superpoliamida. Estudio in vitro / Comparison of the module of elasticity and resistance of thermal curing acrylic resin and flexible superpolyamide resin. An in vitro study

Objetivo: Comparar el módulo de elasticidad y resistencia de la resina acrílica de termocurado y la resina flexible superpoliamida. Métodos: Se diseñó un estudio experimental que empleó dos tipos de resinas acrílicas preparadas en cera para obtener una forma rectangular de 64 mm de largo, 10 mm de ancho y 2,5 mm de grosor, pasadas a acrílico de termocurado y resina flexible superpoliamida. Se emplearon 10 bloques de resina acrílica de cada tipo sometidas a compresión por la máquina de ensayos universal, que generó una fuerza de aproximación de 0,001 N sobre los bloques con un avance de 0,01 mm/min. El módulo de resistencia y el módulo de elasticidad se analizaron mediante la prueba de flexión de tres puntos. Resultados: El módulo de elasticidad de la resina acrílica de termocurado fue de 2501,83 ± 139,42, mientras que el módulo de resistencia fue de 78,36 ± 11,69 MPa. Por otro lado, el módulo de elasticidad de la resina flexible superpoliamida fue de 1020,59 ± 92,95, mientras que el módulo de resistencia fue de 36,04 ± 2,71 MPa. El módulo de elasticidad de la resina acrílica de termocurado fue mayor al de la resina flexible superpoliamida, esta diferencia fue de 1481,24 MPa. El módulo de resistencia de la resina acrílica de termocurado fue mayor al de la resina flexible superpoliamida. Conclusiones: Se concluyó que el módulo de elasticidad (rigidez) y resistencia fue mayor en la resina acrílica de termocurado en comparación a la resina flexible superpoliamida(AU)

Objective: Compare the module of elasticity and resistance of thermal curing acrylic resin and flexible superpolyamide resin. Methods: An experimental study was conducted of two types of acrylic resins molded in wax to obtain a 64 mm long, 10 mm wide and 2.5 mm thick rectangular shape, and then transferred to thermal curing acrylic resin and flexible superpolyamide resin. Ten acrylic resin blocks of each type were used. The blocks were compressed by the universal testing machine, which generated an approximation force of 0.001 N on the blocks at a forward speed of 0.01 mm/min. The resistance module and the elasticity module were analyzed with the three point flexural test. Results: The elasticity module of the thermal curing acrylic resin was 2501.83 ± 139.42, whereas the resistance module was 78.36 ± 11.69 MPa. The elasticity module of the flexible superpolyamide resin was 1020.59 ± 92,95, whereas the resistance module was 36.04 ± 2.71 MPa. The elasticity module of the thermal curing acrylic resin was greater than that of the flexible superpolyamide resin, the difference being 1481.24 MPa. The resistance module of the thermal curing acrylic resin was greater than that of the flexible superpolyamide resin. Conclusions: The elasticity (rigidity) and resistance module was greater in the thermal curing acrylic resin than in the flexible superpolyamide resin(AU)

Producción científica relacionada a las Sociedades Científicas de Estudiantes en las ciencias de la salud / Scientific production about health sciences published by students scientific societies

Objetivo: Describir la producción científica mundial relacionada a las Sociedades Científicas Estudiantiles en los programas de las ciencias de la salud. Métodos: Se realizó un estudio descriptivo que incluyó a los artículos científicos publicados en las bases de datos Scopus, MedLine, ScienceDirect, SciELO, Redalyc y el buscador Google académico en el periodo 2010 a 2020. Los términos incluyeron: Sociedad Científica de Estudiantes, Sociedad Estudiantil, Sociedad Científica Estudiantil y Asociación estudiantil. De los artículos seleccionados se recolectó las categorías de: tipo de publicación, año, nombre de la revista, país de origen, colaboración internacional, programa de estudios y autoría. Los datos fueron analizados de forma descriptiva a través de frecuencias. Resultados: Se encontraron 51 publicaciones, el país que más publicaciones tuvo fue Perú (37,3 por ciento). Los principales tipos de artículos fueron las cartas al editor (41,2 por ciento) y los artículos originales (29,4 por ciento). Los investigadores Cvetkovic Vega y Mejia constituyeron los autores con mayor número de artículos. La revista con mayor cantidad de publicaciones fue Ciencia e Investigación Médica Estudiantil Latinoamericana (11,8 por ciento), mientras que la mayoría de artículos estuvieron en el programa de Medicina humana (90,2 por ciento). Conclusiones: La producción científica relacionada a las Sociedades Científicas de Estudiantes en las ciencias de la salud tiene como principal temática a la producción que realizan sus integrantes; Perú es el país con más artículos que ha publicado sobre el tema y la mayoría de fuentes de información son artículos del tipo carta al editor(AU)

Objective: Describe the scientific production published in health sciences programs by students scientific societies worldwide. Methods: A descriptive study was conducted of scientific articles published in the databases Scopus, MEDLINE, ScienceDirect, SciELO and Redalyc, and the search engine Google Scholar in the period 2010-2020. The search terms used were students scientific society, student society student scientific society and students association. The following data were collected from the articles retrieved: publication type, year, journal name, country of origin, international collaboration, syllabus and authorship. Descriptive data analysis was based on frequency estimation. Results: A total 51 publications were retrieved. The most productive country was Peru (37.3 percent). The main article types were letters to the editor (41.2 percent) and original articles (29.4 percent). Researchers Cvetkovic Vega and Mejia were the most productive authors. The journal with the largest number of publications was Ciencia e Investigación Médica Estudiantil Latinoamericana (11.8 percent), whereas most articles were related to the Human Medicine program (90.2 percent). Conclusions: Scientific production about health sciences published by students scientific societies is mainly concerned with production generated by their members. Peru is the country with the most articles published about the subject. Most information sources are articles of the letter to the editor type(AU)

Highly Discriminative Physiological Parameters for Thermal Pattern Classification.

Infrared Thermography (IRT) is a non-contact, non-intrusive, and non-ionizing radiation tool used for detecting breast lesions. This paper analyzes the surface temperature distribution (STD) on an optimal Region of Interest (RoI) for extraction of suitable internal heat source parameters. The physiological parameters are estimated through the inverse solution of the bio-heat equation and the STD of suspicious areas related to the hottest spots of the RoI. To reach these values, the STD is analyzed by means: the Depth-Intensity-Radius (D-I-R) measurement model and the fitting method of Lorentz curve. A highly discriminative pattern vector composed of the extracted physiological parameters is proposed to classify normal and abnormal breast thermograms. A well-defined RoI is delimited at a radial distance, determined by the Support Vector Machines (SVM). Nevertheless, this distance is less than or equal to 1.8 cm due to the maximum temperature location close to the boundary image. The methodology is applied to 87 breast thermograms that belong to the Database for Mastology Research with Infrared Image (DMR-IR). This methodology does not apply any image enhancements or normalization of input data. At an optimal position, the three-dimensional scattergrams show a correct separation between normal and abnormal thermograms. In other cases, the feature vectors are highly correlated. According to our experimental results, the proposed pattern vector extracted at optimal position a=1.6 cm reaches the highest sensitivity, specificity, and accuracy. Even more, the proposed technique utilizes a reduced number of physiological parameters to obtain a Correct Rate Classification (CRC) of 100%. The precision assessment confirms the performance superiority of the proposed method compared with other techniques for the breast thermogram classification of the DMR-IR.

The effect of omitting axillary dissection and the impact of radiotherapy on patients with breast cancer sentinel node macrometastases: a cohort study following the ACOSOG Z0011 and AMAROS trials.

PURPOSE: To report the outcomes of implementing the ACOSOG Z0011 and AMAROS trials relevant to clinical practice, and to define target groups in whom to avoid or recommend axillary radiotherapy (ART). We also aimed to analyse the reduction in morbidity when axillary lymph node dissection (ALND) was omitted. METHODS: A retrospective cohort study of T1-T2 patients with macrometastases at sentinel lymph node (SLN) who were treated between 2011 and 2020. Breast surgery included either lumpectomy or mastectomy. Patients with ≤ 2 positive SLN were divided into two cohorts by whether they received ART or not. Survival outcomes and morbidity were analysed by Kaplan-Meyer curves and Cox-regression, respectively. RESULTS: 260 pN1a patients were included and ALND was avoided in 167 (64.2%). According the Z0011 results, 72 (43.1%) received no further ART; and based on AMAROS criteria 95 (56.9%) received ART. Median follow-up was 54 months. The 5-year overall survival was 96.8% in the non-RT cohort and 93.4% in the RT cohort (p = 0.19), while the respective 5-year disease-free survivals were 100% and 92.3% (p = 1.06). Lymphedema developed in 3.6% of patients after SLNB versus 43% after ALND (OR 20.25; 95%CI 8.13-50.43). Decreased upper-extremity range of motion appeared in 8.4% of patients after SLNB versus 31.2% after ALND (OR 4.95; 95%CI 2.45-9.98%). CONCLUSIONS: Our study confirms that omitting ALND is safe and has high survival rates in patients with T1-T2 tumours and ≤ 2 positive SLNs. Adding ART could be a treatment option for patients who present other risk factors. Avoiding ALND with or without ART was associated with significantly less arm morbidity.

Diseño de un programa educativo sobre interacciones entre alimentos y medicamentos en ancianos con enfermedades cardiovasculares

RESUMEN Introducción: Las interacciones entre alimentos y fármacos pueden ser provocadas por alteraciones en los mecanismos farmacocinéticos. La mayoría de los problemas ocurren durante la absorción del fármaco. Su resultado puede ser una variación en la biodisponibilidad, lo que puede tener repercusiones clínicas. Es importante que los profesionales sanitarios reciban educación continuada para optimizar el tratamiento. Objetivo: Identificar posibles interacciones entre fármacos y alimentos en pacientes con enfermedades cardiovasculares, y elaborar un programa educativo para aumentar el nivel de información. Método: Se realizó un estudio descriptivo sobre las características de la administración de fármacos y alimentos en el anciano, se analizaron las historias clínicas de 35 pacientes con enfermedades cardiovasculares de un Hogar de Ancianos; se realizó entrevista individual con pacientes y trabajadores de la salud. Se analizaron los fármacos y los alimentos que ingieren, así como el horario de administración de ambos, y se diseñó un programa educativo. Resultados: La enfermedad cardiovascular más frecuente fue la hipertensión arterial (77,2%), por lo que los fármacos más prescriptos son los antihipertensivos; y, en la mayoría de los casos, son administrados juntos con los alimentos (80,0%). Se diseñó un programa educativo a partir de las deficiencias encontradas, donde se conformó un plegable y se impartieron charlas educativas a los pacientes sobre aspectos generales de tema. Además, se impartió un curso de postgrado, para el personal de salud, sobre farmacocinética y los alimentos que la modifican, así como los horarios de administración. Conclusiones: Existe administración conjunta de fármacos y alimentos, el programa educativo diseñado estuvo basado en estos aspectos dirigido a pacientes y personal de salud.

ABSTRACT Introduction: Food-drug interactions may be caused by alterations in pharmacokinetic mechanisms. Most problems occur during drug absorption. The result may be a variation in bioavailability and could have clinical repercussions. Healthcare professionals should receive ongoing education to optimize treatment. Objective: To identify possible drug-food interactions in patients with cardiovascular diseases and develop an educational program to increase the level of information. Methods: We conducted a descriptive study on the characteristics of drug and food administration in the elderly. We analyzed the medical records of 35 patients with cardiovascular disease from a Nursing Home and conducted an individual interview with patients and healthcare workers. We also analyzed the drugs and food prescribed, as well as their respective administration schedules. Finally, an educational program was designed. Results: High blood pressure was the most frequent cardiovascular disease (77.2%), which is why antihypertensive drugs are the most frequently prescribed. In most cases, they are administered together with food (80.0%). Based on the deficiencies found, we began the design of an educational program. We created a poster and agreed to hold educational talks for the patients on general aspects of the subject. Moreover, we offered a postgraduate course for the healthcare staff on pharmacokinetics, foods that modify it, and administration schedules. Conclusions: We were able to ascertain the co-administration of drugs and food. Both patients and healthcare personnel received an educational program based on this aspect.

Can we avoid axillary lymph node dissection in N2 breast cancer patients with chemo-sensitive tumours such as HER2 and TNBC?

PURPOSE: To find a group of cN2 patients or patients with high axillary burden who become ypN0 after neoadjuvant chemotherapy (NACT) and who may benefit from avoiding a lymphadenectomy. METHODS: A retrospective observational cohort study was conducted with 221 clinically staged N2 patients or patients with at least 3 suspicious lymph nodes found by ultrasound at diagnosis. The predictive factors for ypN0 analysed were age, MRI-determined tumour size, histological subtype, the Nottingham histologic grade, surrogate molecular subtype, ki-67 and vascular invasion when present. Clinical and radiological responses after NACT were also evaluated. Univariate and multivariate analyses by logistic regression were performed. Distant disease-free survival (DDFS) was calculated in relation to the status of the axillary lymph nodes after NACT. RESULTS: After NACT, 89 patients (40.3%) had axillary pathologic complete response (pCR) (ypN0) and 132 (59.7%) had residual axillary disease (ypN+). Molecular surrogate subtype, Ki-67 expression, and the clinical and radiological responses to NACT were the only independent factors associated with ypN0. Axillary pCR was observed more often in HER2-positive and triple-negative tumours than in luminal ones (OR 7.5 and 3.6, respectively). DDFS was 88.7% (95% CI 80.7-96.7%) for ypN0 and 56.2% (95% CI 32.1-80.3%) for ypN+ (p = 0.09). CONCLUSIONS: In HER2-positive and triple-negative breast cancer patients staged as cN2 or with high axillary burden before NACT, a sentinel lymph node biopsy after NACT could be recommended if there is a clinical and radiological response.

Tesis sustentadas y publicadas por estudiantes de las ciencias de la salud en Perú / Theses supported and published by health sciences students in Peru

RESUMEN Fundamento: la tesis universitaria culmina los estudios de pregrado y/o posgrado, es inédita y original, consolida la formación académica y permite obtener un título profesional. Objetivo: cuantificar la cantidad de tesis universitarias publicadas como artículo científico en las ciencias de la salud: Medicina Humana, Odontología, Farmacia y Bioquímica, Medicina Veterinaria y Psicología, de la Universidad Nacional Mayor de San Marcos; Lima, Perú. Métodos: se realizó un estudio con enfoque cuantitativo, básico, observacional, de nivel descriptivo y diseño retrospectivo que evaluó 1954 tesis realizadas por estudiantes de pregrado registradas en el portal web Cybertesis, entre 2010-2018. Se analizaron las variables: productividad por facultad/escuela profesional, tiempo y lugar de publicación, experiencia del asesor y género de los tesistas. Resultados: fueron publicadas 134 (6,9 %) tesis en revistas científicas. El promedio del tiempo que demoró publicar una tesis en formato de artículo científico fue de 1,72 ± 1,05 años. 124 (92,5 %) tesis publicadas presentaron asesores que incursionaban en publicaciones científicas. En 133 artículos (99,3 %) los estudiantes fueron los autores principales. 123 tesis (91,8 %) aparecieron en revistas científicas peruanas. El 6,9 % de tesis sustentadas fueron publicadas en formato artículo original; la Facultad de Medicina Veterinaria fue la de mayor producción científica. Conclusiones: el estudio realizado permitió diagnosticar el porciento de tesis publicadas con respecto a las sustentadas, lo que aporta una herramienta para su incremento a partir de estudios donde se delimiten las causas que inciden en los porcientos encontrados.

ABSTRACT Background: the university thesis culminates undergraduate and / or postgraduate studies, it´s unpublished and original, it consolidates academic training and allows obtaining a professional degree. Objective: to quantify the amount of university thesis published as a scientific article in health sciences: Human Medicine, Dentistry, Pharmacy and Biochemistry, Veterinary Medicine and Psychology, of the National University of San Marcos; Lima Peru. Methods: a study was carried out with a quantitative, basic, observational, descriptive level and retrospective design approach that evaluated 1954 theses carried out by undergraduate students registered on the Cybertesis web portal, from 2010 to 2018. The variables were analyzed: productivity by faculty / professional school, time and place of publication, experience of the advisor and gender of the thesis students. Results: theses were published in scientific journals 134 (6.9%). The average time it took to publish a thesis in scientific article format was 1.72 ± 1.05 years. 124 (92.5%) published theses presented consultants who participated in scientific publications. In 133 articles (99.3%) the students were the main authors. 123 theses (91.8%) appeared in Peruvian scientific journals. 6.9% of theses supported were published in original article format; the Faculty of Veterinary Medicine was the one with the greatest scientific production. Conclusions: the study carried out allowed diagnosing the percentage of published theses with respect to the sustained ones, which provides a tool for its increase from studies where the causes that affect the found percentages are delimited.

Correction: Lymphangioleiomyomatosis Biomarkers Linked to Lung Metastatic Potential and Cell Stemness.

[This corrects the article DOI: 10.1371/journal.pone.0132546.].

The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results, and the Advantages and Disadvantages of Both Procedures.

BACKGROUND: In patients with breast cancer who are candidates for neoadjuvant therapy (NAT), the timing of when to perform sentinel lymph node biopsy (SLNB) remains under discussion. The aim of this study was to compare the advantages and disadvantages of SLNB performed before and after NAT. PATIENTS AND METHODS: One hundred seventy-two patients, T1c to T3 and N0 (clinically and according to ultrasound) candidates for NAT were included. We compared the outcomes of 2 groups: (1) 122 patients of whom SLNB was performed before NAT (pre-NAT) from December 2006 to April 2014; and (2) 50 patients with SLNB performed after NAT (post-NAT) from May 2014 to July 2016. RESULTS: Both groups were homogeneous in baseline patient characteristics. The SLNB was positive in 50 patients [41.7%] (33 macrometastases [66%] and 17 micrometastases [34%]) versus 6 patients [12%] (5 macrometastases [83.3%] and 1 micrometastases [16.7%]) in pre- and post-NAT groups, respectively. The lymphadenectomy was performed in 34 patients [28.3%] versus 4 patients [8%], with an odds ratio of 3.48 (95% confidence interval, 1.3-9.3). The recurrences in the pre-NAT group after a median follow-up of 62 months were 12 systemic, 2 local and systemic, and none axillary. In the post-NAT group were no recurrences after a median follow-up of 16 months. Finally, SLNB after NAT reduces the delay in starting NAT from 24 to 14 days (medians; P < .001) and the identification of the SLNB was in 122 patients [100%] versus 49 patients [98%]. CONCLUSION: SLNB performed after NAT significantly reduces the rate of lymphadenectomies without any increase in recurrences at early follow-up. Furthermore, it allows systemic treatment to be started earlier without interfering in the SLNB identification rate.

Feasibility, accuracy and prognosis of sentinel lymph node biopsy before neoadjuvant therapy in breast cancer. A prospective study.

BACKGROUND AND OBJECTIVE: It remains controversial whether sentinel lymph node biopsy (SLNB) should be performed before or after neoadjuvant therapy (NAT). We aimed to evaluate the feasibility and accuracy of SLNB before NAT at a single institution, and to determine its relation to patient prognosis. METHODS: A prospective study of T1c-T2-T3 N0 breast cancer patients, after ultrasound examination, who underwent SLNB prior to NAT. Overall, disease-specific and disease-free survival were calculated by Kaplan-Meier curves. RESULTS: SLNB before NAT was performed in 123 patients from December 2006 to May 2014. The identification rate was 100%. SLNB was positive in 42.3% of cases (27.6% macrometastases). NAT was chemotherapy in 88.6% of cases and endocrine-therapy in 11.4%. Lymphadenectomy was avoided in 72.4% of cases. Median follow-up was 40 months (range 8-100). Overall and disease-free survival was 90.2% and 88.6% respectively.SLN involvement was not related to patient outcome (p 0.72); however there were significant differences in survival according to molecular-like subtypes (p < 0.025) and NAT response (p < 0.0001). CONCLUSIONS: SLNB prior to NAT is an accurate method of axillary staging associated with a high identification rate. It avoided lymphadenectomy in more than 70% of patients. SLN involvement did not worsen the prognosis in our cohort.

Study of breast cancer incidence in patients of lymphangioleiomyomatosis.

Molecular evidence has linked the pathophysiology of lymphangioleiomyomatosis (LAM) to that of metastatic breast cancer. Following on this observation, we assessed the association between LAM and subsequent breast cancer. An epidemiological study was carried out using three LAM country cohorts, from Japan, Spain, and the United Kingdom. The number of incident breast cancer cases observed in these cohorts was compared with the number expected on the basis of the country-specific incidence rates for the period 2000-2014. Immunohistochemical studies and exome sequence analysis were performed in two and one tumors, respectively. All cohorts revealed breast cancer standardized incidence ratios (SIRs) ≥ 2.25. The combined analysis of all cases or restricted to pre-menopausal age groups revealed significantly higher incidence of breast cancer: SIR = 2.81, 95 % confidence interval (CI) = 1.32-5.57, P = 0.009; and SIR = 4.88, 95 % CI = 2.29-9.99, P = 0.0007, respectively. Immunohistochemical analyses showed positivity for known markers of lung metastatic potential. This study suggests the existence of increased breast cancer risk among LAM patients. Prospective studies may be warranted to corroborate this result, which may be particularly relevant for pre-menopausal women with LAM.

Lymphangioleiomyomatosis Biomarkers Linked to Lung Metastatic Potential and Cell Stemness.

Lymphangioleiomyomatosis (LAM) is a rare lung-metastasizing neoplasm caused by the proliferation of smooth muscle-like cells that commonly carry loss-of-function mutations in either the tuberous sclerosis complex 1 or 2 (TSC1 or TSC2) genes. While allosteric inhibition of the mechanistic target of rapamycin (mTOR) has shown substantial clinical benefit, complementary therapies are required to improve response and/or to treat specific patients. However, there is a lack of LAM biomarkers that could potentially be used to monitor the disease and to develop other targeted therapies. We hypothesized that the mediators of cancer metastasis to lung, particularly in breast cancer, also play a relevant role in LAM. Analyses across independent breast cancer datasets revealed associations between low TSC1/2 expression, altered mTOR complex 1 (mTORC1) pathway signaling, and metastasis to lung. Subsequently, immunohistochemical analyses of 23 LAM lesions revealed positivity in all cases for the lung metastasis mediators fascin 1 (FSCN1) and inhibitor of DNA binding 1 (ID1). Moreover, assessment of breast cancer stem or luminal progenitor cell biomarkers showed positivity in most LAM tissue for the aldehyde dehydrogenase 1 (ALDH1), integrin-ß3 (ITGB3/CD61), and/or the sex-determining region Y-box 9 (SOX9) proteins. The immunohistochemical analyses also provided evidence of heterogeneity between and within LAM cases. The analysis of Tsc2-deficient cells revealed relative over-expression of FSCN1 and ID1; however, Tsc2-deficient cells did not show higher sensitivity to ID1-based cancer inhibitors. Collectively, the results of this study reveal novel LAM biomarkers linked to breast cancer metastasis to lung and to cell stemness, which in turn might guide the assessment of additional or complementary therapeutic opportunities for LAM.

[Diagnosis of acute heart failure and relevance of biomarkers in elderly patients]. / Diagnóstico de la insuficiencia cardíaca aguda y relevancia de los biomarcadores en pacientes de edad avanzada.

Diagnosis of acute heart failure (HF) is difficult in elderly patients with multiple comorbidities. Risk scales and classification criteria based exclusively on clinical manifestations, such as the Framingham scales, lack sufficient specificity. In addition to clinical manifestations, diagnosis should be based on two key factors: natriuretic peptides and echocardiographic study. When there is clinical suspicion of acute HF, a normal natriuretic peptide level will rule out this process. When a consistent clinical suspicion is present, an echocardiographic study should also be performed. Diagnosis of HF with preserved ejection fraction (HF/pEF) requires detection of an enlarged left atrium or the presence of parameters of diastolic dysfunction. Elevation of cardiac biomarkers seems to be due to myocardial injury and the compensatory mechanisms of the body against this injury (hormone and inflammatory response and repair mechanisms). Elevation of markers of cardiac damage (troponins and natriuretic peptides) have been shown to be useful both in the diagnosis of acute HF and in prediction of outcome. MMP-2 could be useful in the diagnosis of HF/pEF. In addition to biomarkers with diagnostic value, other biomarkers are helpful in prognosis in the acute phase of HF, such as biomarkers of renal failure (eGFR, cystatin and urea), inflammation (cytokines and CRP), and the cell regeneration marker, galectin-3. A promising idea that is under investigation is the use of panels of biomarkers, which could allow more accurate diagnosis and prognosis of acute HF.

[Cystic renal papillary carcinoma. Apropos of a case]. / Carcinoma papilar renal quístico. A propósito de un caso.

OBJECTIVES: Papillary renal cell carcinoma is a malignant neoplasia which represents 5-10% of all renal cell carcinomas. We perform a bibliographic review, and detail the clinical, diagnostic and therapeutic aspects of the case, as well as its postoperative outcome. METHODS: 55-year-old patient who was admitted in the urology department from the emergency room. On physical examination we detected a mass in the left flank and left upper abdominal quadrant, painful on flank percussion, and gross hematuria also. It was a patient who debuted with left lumbar-abdominal pain and hematuria with clots after a physical effort. Blood tests, ultrasound, x-rays and surgical treatment were performed. RESULTS AND CONCLUSIONS: On evaluation of the ultrasound and x-ray films it was concluded that it was a significant renal tumor. Left radical nephrectomy was performed and pathology reported papillary renal cell carcinoma. Postoperative outcome was satisfactory after three months.