Clearance of ctDNA in triple-negative and HER2-positive breast cancer patients during neoadjuvant treatment is correlated with pathologic complete response.

Background: Although the standard of care is to perform surgery of primary breast cancer (BC) after neoadjuvant chemotherapy (NAC), for certain patients achieving clinical complete response (cCR) and pathologic complete response (pCR), omission of surgical treatment may be an option. Levels of circulating tumor DNA (ctDNA) during and after therapy could identify patients achieving minimal residual disease. In this study, we evaluated whether ctDNA clearance during NAC could be a correlate to effective response in human epidermal growth factor receptor 2 positive (HER2+) and triple-negative (TN) BC patients. Methods: A prospective study was conducted to identify patient-specific PIK3CA and TP53 mutations in tissue using next-generation sequencing, which could then be used to track the presence/absence of mutations prior to, during, and following NAC using Sysmex SafeSEQ technology. All patients underwent a surgical excision after NAC, and pCR was assessed. Results: A total of 29 TN and HER2+ BC patients were examined and 20 that carried mutations in the PIK3CA and/or TP53 genes were recruited. Overall, 19 of these 20 patients harbored at least one tumor-specific mutation in their plasma at baseline. After NAC, 15 patients (75.0%) achieved pCR according to the histopathologic evaluation of the surgical specimen, and 15 patients (75.0%) had a cCR; 18 of 20 patients (90.0%) had concordant pCR and cCR. The status of 'no mutation detected' (NMD) following NAC in cCR patients correctly identified the pCR in 14 of 15 patients (93.33%), as well as correctly ruled out pCR in three patients, with an accuracy of 89.47%. During the 12-month follow-up after surgery, 40 plasma samples collected from 15 patients all showed no detectable ctDNA (NMD), and no patient recurred. Conclusion: These findings prompt further research of the value of ctDNA for non-invasive prediction of clinical/pathological response, raising the possibility of sparing surgery following NAC in selected BC patients.

Tumor-infiltrating regulatory T cells, CD8/Treg ratio, and cancer stem cells are correlated with lymph node metastasis in patients with early breast cancer.

BACKGROUND: Tumor-infiltrating lymphocytes are an important component of the tumor microenvironment (TME) in breast cancer. They have been linked with tumor pathogenesis in advanced stages. However, little is known about their contribution in early phases. In this study, we analyzed the infiltration of leukocytes and cancer stem cells (CSC) in tumors from patients with early breast cancer. METHODS: Samples of blood and tumor tissue from 30 patients with breast cancer were collected, and the number of dendritic cells (DC), T cells, and CSC were analyzed by flow cytometry. RESULTS: Tumor-infiltrating CD4 and CD8 T cells expressed higher levels of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) compared with peripheral T cells. Regulatory T cells (Treg) were enriched in tumors and overexpressed glucocorticoid-induced TNFR-related protein and CTLA-4. Tumor Treg had a positive correlation with the amount of myeloid DC (mDC) and disease progression. The CD8/Treg ratio was associated with lymph node metastasis and tumor stages. The main subset of DC in early breast tumors was mDC, while plasmacytoid DC were almost absent. CSC were present in most tumors with higher frequencies in patients with lymph node metastasis. CSC were also associated with the amount of tumor-infiltrating Treg. CONCLUSION: Early breast cancer has an inflammatory milieu characterized by mDC, Treg, and CSC infiltration. The frequencies of Treg, CSC and CD8/Treg ratio were associated with disease progression. The composition of leukocytes and the presence of CSC in early breast tumors should be considered for the development of new therapeutic approaches.

Proceso de atención a donantes de sangre con pruebas reactivas al tamizaje en un hospital de Lambayeque / Process of attention to blood donors with reactive screening tests in a hospital in Lambayeque

Objetivo: Describir el resultado del proceso de atención en donantes con pruebas reactivas al tamizaje realizado en el banco de sangre del Hospital Nacional Almanzor Aguinaga Asenjo, primer semestre del 2015. Material y Métodos: Estudio descriptivo transversal, realizado en 363 donantes con resultado reactivo, durante el primer semestre del año 2015. Se incluyó a todos los donantes. Durante estos meses fueron llamados telefónicamente para citarlos a una prueba confirmatoria; y durante los meses de julio a octubre del 2015, se les realizó seguimiento basado en el tiempo que demoraron en realizarse la prueba confirmatoria, cita con el especialista y estado de tratamiento. Resultados: De 3969 donantes, 363 tuvieron un resultado reactivo. Se logró contactar vía telefónica a 221 donantes (60,9%); de los cuales acudieron 98 (44,3%) y de ellos, 29 obtuvieron resultado positivo en la prueba confirmatoria. De éstos 9 fueron informados del resultado de la prueba confirmatoria, 7 acudieron a consulta con médico especialista, y 5 han recibido o se encuentran recibiendo tratamiento según la infección que presentaron. Conclusiones: La mayor prevalencia de reactividad fue en varones, siendo el marcador serológico Anti HBc total con 4,2%. Se obtuvo gran cantidad de falsos positivos. Además, la mayoría de donantes no acude realizarse la prueba confirmatoria a pesar de haber sido informado.

Objetive: describe the outcome of the donor care process with reactive screening tests performed at the blood bank of the Almanzor Aguinaga Asenjo National Hospital, first semester of 2015. Material and Methods: Cross-sectional descriptive study, carried out on 363 donors with reactive results, during the first semester of 2015. All donors were included. During these months they were called by telephone to summon them to a confirmatory test; and during the months of July to October 2015, they were followed up based on the time it took to perform the confirmatory test, appointment with the specialist and treatment status. Results: Of 3969 donors, 363 had a reactive result. Telephone contact was made to 221 donors (60.9%); of which 98 (44.3%) attended and of them, 29 obtained positive results in the confirmatory test. Of these, 9 were informed of the result of the confirmatory test, 7 attended a specialist consultation, and 5 received or are receiving treatment according to the infection they presented. Conclusions: The highest prevalence of reactivity was in males, with a total anti - HBc serological marker of 4.2%. A large number of false positives was obtained. In addition, most donors do not attend the confirmatory test despite having been informed.

Calidad del sueño en una facultad de medicina de Lambayeque / Sleep quality in a LambayequeÆs faculty of medicine

Introducción: Una buena calidad de sueño es importante para que los estudiantes universitarios tengan un rendimiento académico satisfactorio. No se cuenta con datos locales en relación a la frecuencia de mala calidad de sueño en universitarios de ciencias de la salud. Objetivos: Determinar la frecuencia de mala calidad de sueño en una facultad de medicina de la Universidad Católica Santo Toribio de Mogrovejo (USAT). Diseño: Estudio descriptivo transversal. Institución: Facultad de Medicina, Universidad Católica Santo Toribio de Mogrovejo (USAT), Chiclayo, Lambayeque, Perú. Participantes: Alumnos de la Facultad de Medicina. Intervenciones: Durante el mes de octubre de 2011 se aplicó el índice de calidad de sueño de Pittsburgh (ICSP), validado en español, a alumnos de las escuelas de Medicina, Enfermería, Psicología y Odontología. Principales medidas de resultados: Frecuencia de mala calidad de sueño en alumnos de la facultad, por escuela, y descripción de los componentes del índice de Pittsburgh. Resultados: Se encuestó 247 estudiantes: 194 mujeres (78,5 por ciento) y 53 varones (21,5 por ciento). La edad media fue de 20,04 ± 2,5 años. Hubo 210 æmalos dormidoresÆ (85 por ciento). La frecuencia de mala calidad de sueño según escuelas fue: medicina (89,5 por ciento), enfermería (86,4 por ciento), odontología (84,4 por ciento) y psicología (78,2 por ciento). El mayor uso de hipnóticos se encontró en psicología: 21,8 por ciento. Conclusiones: En la Facultad de Medicina de la USAT existe alta frecuencia de mala calidad de sueño; la escuela con mayor uso de hipnóticos fue Psicología.

Background: Good sleep quality is important for university students to accomplish satisfactory academic performance. There is lack of local data on poor sleep quality frequency among faculty of medicine students. Objectives: To determine the frequency of poor sleep quality in students from a Faculty of Medicine. Design: Cross-sectional, descriptive study. Setting: Faculty of Medicine, Universidad Santo Toribio de Mogrovejo (USAT), Chiclayo, Lambayeque, Peru. Participants: University students. Interventions: To students from all four university schools -medicine, psychology, nursery and dentistry- the Pittsburg quality index scale validated in Spanish and in Peru was applied. Main outcome measures: Frequency of poor sleeping quality by school and description of Pittsburg scale components. Results: Two hundred and forty-seven students were interviewed: 194 women (78.5 per cent) and 53 men (21.5 per cent). Median age was 20.04 ± 2.53 years; there were 210 æpoor sleepersÆ (85 per cent); the frequency of poor quality of sleepiness was as follows: medicine (89.5 per cent), nursery (86.4 per cent), dentistry (84.4 per cent) and psychology (78.2 per cent). Psychology students reported the highest use of hypnotics: 21.8 per cent. Conclusions: At USAT Faculty of Medicine there was high frequency of poor sleep quality; the school of psychology reported the highest use of hypnotics.