Dramatic photoluminescence quenching in carbon dots induced by cyclic voltammetry.

This study focuses on the structural rearrangements and the photoluminescent behavior of pyrolytically derived carbon dots when subjected to a series of cyclic voltammetry sweeps. Although the electrical signals involved are not pronounced, multiple electrochemical cycling results in a progressive suppression of the photoluminescence, so that after 42 sweeps the intensity is reduced by one order of magnitude. At the same time, the fluorescence component stemming from the organic fluorophores is blue-shifted, while the contribution of the carbogenic cores is red-shifted. XPS and FTIR spectra reveal that the voltammetric field induces an extensive formation of C-O and C[double bond, length as m-dash]O at the expense of the C[double bond, length as m-dash]C bonds. Our findings indicate a close relationship between the electrochemical response and the structure of C-dots and, thus, have direct implications on the development of C-dot based electroluminescent materials, electrochemical sensors and solar cells.

Relación de la presencia de polimorfismos de CFH, HTRA1, ARMS2,VEGF-A y VEGF-R con la aparición de los subtipos de degeneración macular asociada a la edad / The presence of CFH, HTRA1, ARMS2, VEGF-A and VEGF-R and the appearance of age-related macular degeneration sub-types

OBJETIVO: Demostrar la influencia genética en el desarrollo de los distintos tipos de degeneración macular asociada a la edad (DMAE) analizando las distribuciones genotípicas de polimorfismos de CFH,ARMS2, HTRA1, VEGF-A y VEGF-R en pacientes con DMAE exudativa y DMAE atrófica. MÉTODO: Se toman 101 pacientes diagnosticados de DMAE (74 exudativa y 27 atrófica) según las normas del sistema internacional de clasificación Wisconsin. Analizamos los polimorfismos rs1410996 del genCFH, rs10940923 de ARMA2, rs833061 y rs699947 de VEGF-A y rs2071559 de VEGF-R mediante PCR a tiempo real con sondas Taqman y el HTRA1 rs112000638 mediante digestión con endonucleasas de restricción. Analizamos la distribución genotípica de los distintos polimorfismos en nuestro grupo de pacientes con DMAE exudativa y los que presentan DMAE atrófica y comparamos los resultados para cada uno de los genes a estudio. RESULTADOS: No encontramos diferencias estadísticamente significativas (p > 0,05) en la distribución genotípica de los distintos polimorfismos entre pacientes con DMAE atrófica y pacientes con DMAE exudativa en nuestra población, si bien los genotipos considerados «de riesgo» por otros estudios tienden a aparecer de forma más frecuente en la DMAE exudativa, a pesar de no obtener diferencias significativas. CONCLUSIONES: Las variantes alélicas de los genes CFH, ARMS2, HTRA1, VEGF-A o VEGF-R no se asocian con los diferentes subtipos de DMAE, lo que indica que, aunque parece que están implicados en la susceptibilidad a padecer la enfermedad, no están implicados en el desarrollo de las variantes clínicas en nuestra población. Son necesarios nuevos estudios en diferentes poblaciones y con un mayor tamaño muestral para confirmar estos resultados

OBJECTIVE: To demonstrate the genetic influence in the onset of the different age-related macular disease (AMD) subtypes by analysing the genotype distribution of CFH, ARMS2, HTRA1, VEGF-A and VEGF-Rpolymorphisms in patients with neovascular and atrophic AMD. MATERIALS AND METHODS: The study was conducted on 101 consecutive patients with AMD diagnosis (74 exudative, 27 atrophic) following Wisconsin international classification criteria. The CFH rs1410996, ARMS2 rs10940923,VEGF-A rs833061, rs699947, and VEGF-R rs2071559 polymorphisms were analysed using real time PCR with taqman probes, and HTRA1 rs112000638 using restriction endonucleases digestion. A study was made of the genotype distribution of the different polymorphisms in our group of patients with neovascular AMD and those with the atrophic type, and a comparison was made of the results for each one of the genes studied. RESULTS: No statistically significant differences (P>.05) were found in the genotype distribution of the different polymorphisms between patients with neovascular AMD and patients with atrophic AMD in our population, although the 'risk' genotypes tended to appear more frequently in patients with neovascular AMD, despite the lack of statistical significance. CONCLUSIONS: Allelic variants of CFH, ARMS2, HTRA1, VEGF-A or VEGF-R genes are not associated with the different AMD subtypes. This suggests that, although the polymorphisms seem to be associated with the disease susceptibility, they are not involved in the onset of the different clinical variants of AMD. Further studies in different populations, and with a larger cohort of patients, are needed to confirm these results

The presence of CFH, HTRA1, ARMS2, VEGF-A and VEGF-R and the appearance of age-related macular degeneration sub-types.

OBJECTIVE: To demonstrate the genetic influence in the onset of the different age-related macular disease (AMD) subtypes by analysing the genotype distribution of CFH, ARMS2, HTRA1, VEGF-A and VEGF-R polymorphisms in patients with neovascular and atrophic AMD. MATERIALS AND METHODS: The study was conducted on 101 consecutive patients with AMD diagnosis (74 exudative, 27 atrophic) following Wisconsin international classification criteria. The CFH rs1410996, ARMS2 rs10940923, VEGF-A rs833061, rs699947, and VEGF-R rs2071559 polymorphisms were analysed using real time PCR with taqman probes, and HTRA1 rs112000638 using restriction endonucleases digestion. A study was made of the genotype distribution of the different polymorphisms in our group of patients with neovascular AMD and those with the atrophic type, and a comparison was made of the results for each one of the genes studied. RESULTS: No statistically significant differences (P>.05) were found in the genotype distribution of the different polymorphisms between patients with neovascular AMD and patients with atrophic AMD in our population, although the "risk" genotypes tended to appear more frequently in patients with neovascular AMD, despite the lack of statistical significance. CONCLUSIONS: Allelic variants of CFH, ARMS2, HTRA1, VEGF-A or VEGF-R genes are not associated with the different AMD subtypes. This suggests that, although the polymorphisms seem to be associated with the disease susceptibility, they are not involved in the onset of the different clinical variants of AMD. Further studies in different populations, and with a larger cohort of patients, are needed to confirm these results.

Inhibiting the PI3K signaling pathway: buparlisib as a new targeted option in breast carcinoma.

Aberrations in the PI3K signaling pathway are frequently observed in patients with breast cancer. Because of that, PI3K inhibitors are attractive options for the treatment of breast cancer because PI3K is the most proximal component of the pathway other than receptor tyrosine kinases. Buparlisib is a potent and highly specific oral pan-class I PI3K inhibitor, which is currently under investigation in patients with breast cancer. In this article, we describe the PI3K signaling pathway, the prognostic value of PI3K pathway mutations, as well as the mechanism of action of buparlisib. Lastly, we discuss preliminary results of preclinical and clinical studies showing the efficacy and safety profile of this agent in breast cancer patients.

SEOM clinical guidelines in early-stage breast cancer 2015.

Breast cancer is a major public health problem. Despite remarkable advances in early diagnosis and treatment, one in three women may have metastases since diagnosis. Better understanding of prognostic and predictive factors allows us to select the most appropriate adjuvant therapy in each patient. In these guidelines, we summarize current evidence for the medical management of early-stage breast cancer.

[Questionnaire to evaluate the importance of the family in nursing care. Validation of the Spanish version (FINC-NA)]. / Cuestionario para evaluar la importancia de la familia en los cuidados de enfermería. Validación de la versión española (FINC-NA).

BACKGROUND: The nursing profession is focused on patient care, without forgetting that patients are part of a social group, the family. The aim of this study was the adaptation of the "Families' Importance in Nursing Care-Nurses' Attitudes" (FINC-NA) scale to the Spanish language and its validation. METHODS: A descriptive cross-sectional study was carried out, using the bidirectional translation method for linguistic-cultural adaptation. It was applied to the nursing staff in the Paediatric Department of a University Hospital in Madrid. To evaluate the psychometric properties of the Spanish version, reliability, internal consistence and construct validity were calculated. RESULTS: The sample consisted of 274 professionals. Cronbach´s Alpha coefficient for the total scale was 0.864, oscillating between 0.888 and 0.769 in the subscales. The principal components factor analysis identified 4 factors, which explained 54.22% of total variance. CONCLUSIONS: The new instrument makes it possible to determine the importance nurses give to participation by family members and their attitude to involving the latter in patient care, and the possibility of involving them in planning. It has been adapted to the Spanish population with good psychometrics results and enough evidence for its use in this context.

Cuestionario para evaluar la importancia de la familia en los cuidados de enfermería. Validación de la versión española (FINC-NA) / Questionnaire to evaluate the importance of the family in nursing care. Validation of the Spanish version (FINC-NA)

Fundamento: La profesión de enfermería se centra en el cuidado del paciente, sin olvidar que éste forma parte de un grupo social, la familia. El objetivo del presente estudio es adaptar la escala "Families' Importance in Nursing Care-Nurses' Attitudes" (FINC-NA) al español. Material y métodos: Se realizó un estudio transversal descriptivo utilizando el método de traducción directa e inversa para obtener la adaptación lingüístico-cultural. Los participantes fueron los profesionales de enfermería del Departamento Materno-Infantil del H.G.U. Gregorio Marañón de Madrid. Para evaluar las propiedades psicométricas de la versión española, se valoró la fiabilidad, analizando la consistencia interna y la validez por medio del análisis de la estructura factorial. Resultados: Con una muestra de 274 profesionales se obtuvo un coeficiente alfa de Cronbach para el cuestionario total de 0,864 para la escala total, oscilando entre 0,888 y 0,769 en las subescalas. El análisis factorial identificó 4 factores que explicaron el 54,22% de la varianza total. Conclusiones: Se ha obtenido un instrumento que permite conocer la importancia que dan los profesionales de enfermería a la participación de las familias y su actitud con la implicación de estos en los cuidados de los pacientes y la posibilidad de involucrarles en su planificación, adaptado a la población española, con buenas características psicométricas y suficiente evidencia para su utilización en población española (AU)

Background: The nursing profession is focused on patient care, without forgetting that patients are part of a social group, the family. The aim of this study was the adaptation of the "Families' Importance in Nursing Care-Nurses' Attitudes" (FINC-NA) scale to the Spanish language and its validation. Methods: A descriptive cross-sectional study was carried out, using the bidirectional translation method for linguistic-cultural adaptation. It was applied to the nursing staff in the Paediatric Department of a University Hospital in Madrid. To evaluate the psychometric properties of the Spanish version, reliability, internal consistence and construct validity were calculated. Results: The sample consisted of 274 professionals. Cronbach's Alpha coefficient for the total scale was 0.864, oscillating between 0.888 and 0.769 in the subscales. The principal components factor analysis identified 4 factors, which explained 54.22% of total variance. Conclusions: The new instrument makes it possible to determine the importance nurses give to participation by family members and their attitude to involving the latter in patient care, and the possibility of involving them in planning. It has been adapted to the Spanish population with good psychometrics results and enough evidence for its use in this contex (AU)

Impact of chemotherapy on telomere length in sporadic and familial breast cancer patients.

Recently, we observed that telomeres of BRCA1/2 mutation carriers were shorter than those of controls or sporadic breast cancer patients, suggesting that mutations in these genes might be responsible for this event. Given the contradictory results reported in the literature, we tested whether other parameters, such as chemotherapy, could be modifying telomere length (TL). We performed a cross-sectional study measuring leukocyte TL of 266 sporadic breasts cancer patients treated with first-line chemotherapy, with a median follow-up of 240 days. Additionally, we performed both cross-sectional and longitudinal studies in a series of 236 familial breast cancer patients that included affected and non-affected BRCA1/2 mutation carriers. We have measured in leukocytes from peripheral blood: the TL, percentage of short telomeres (<3 kb), telomerase activity levels and the annual telomere shortening speed. In sporadic cases we found that chemotherapy exerts a transient telomere shortening effect (around 2 years) that varies depending on the drug combination. In familial cases, only patients receiving treatment were associated with telomere shortening but they recovered normal TL after a period of 2 years. Chemotherapy affects TL and should be considered in the studies that correlate TL with disease susceptibility.

Breast cancer management in the elderly

The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment (AU)

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Síndrome de pseudo-duane paraneoplásico secundario a tumor de mama / Pseudo-duane's paraneoplasic syndrome secondary to breast tumor

Se describe el caso clínico de una mujer de 50 años con antecedentes personales de cáncer de mama, que refiere alteraciones de los movimientos oculares. En la exploración se observa una limitación de la abducción y estrechamiento de la hendidura palpebral en aducción en ambos ojos. RMN craneal y orbitaria normales. Marcadores tumorales con títulos bajos. Se realiza el diagnóstico de Síndrome de pseudo- Duane, ya que se trata de un síndrome restricitivo adquirido. En este caso, su presentación clínica es similar al síndrome Duane tipo I, siendo contradictorio a lo descrito en publicaciones previas. Por otra parte, este síndrome está relacionado en el tiempo con su patología oncológica y la RMN es normal, por lo que lo consideramos un síndrome paraneoplásico. Destacamos la originalidad del caso debido a su inusual etiología, y clínica (AU)

We report the case of a 50 years-old woman with history of breast tumor and anormal ocular motility. An examination of ocular motility revealed limited abduction and narrowing of the palpebral fissure on adduction. Orbital and cranial nuclear magnetic resonance were normal. Tumor markers had low levels. We think about her oncologic history because of the beginning of the sintomatology in this period of time. The diagnosis was Pseudo-Duane syndrome, wich is a restrictive acquired syndrome. Despite clinical presentation was similar to Duane I syndrome, it is enterely different from it. We highlight the originality of the case due to its inusual ethiology(only one case published previously) and its clinical presentation (AU)

Breast cancer management in the elderly.

The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment.

Perforación corneal como primera manifestación de síndorme de Sjören secundario a artritis reumatoide / Corneal melts as the initial manifestation of sjögren syndrome secondary to rheumatoid arthritis

La artritis reumatoide es una enfermedad sistémica inflamatoria crónica frecuente, de etiología desconocida. El síndrome de Sjögren puede ir asociado a dicha patología. El curso clínico de la artritis reumatoide a nivel ocular es muy variable y el diagnóstico temprano es determinante para prevenir graves complicaciones. Presentamos el caso de una mujer de 64 años de edad que acudió al Servicio de Urgencias por presentar ojo rojo bilateral con fotofobia, lagrimeo continuo, dolor y disminución de la agudeza visual. En la exploración se objetivó importante adelgazamiento del estroma corneal en OD y perforación corneal OI, que requirió recubrimiento tectónico con membrana amniótica. Los análisis serológicos mostraron los siguientes resultados: Factor Reumatoide+, ANA+, ENA Anti-Ro/SSA+, ENA Anti-La/SSB+. La paciente fue diagnosticada de Artritis Reumatoide y Síndrome de Sjögren secundario. Desde entonces, sigue un tratamiento sistémico con corticoides y azatioprina. Aproximadamente, el 25% de los pacientes desarrollan enfermedad oftalmológica, esencialmente queratoconjuntivitis seca (25%), epiescleritis, escleritis y queratitis. Estas manifestaciones son en general poco severas, pero hay un pequeño porcentaje de pacientes, como el caso que aquí presentamos, que sufren una inflamación ocular grave y que sin tratamiento inmunosupresor precozmente instaurado, pueden desarrollar úlceras corneales estériles, centrales o periféricas, que les puede llevar incluso a la perforación y destrucción del globo (AU)

Rheumatoid arthritis(RA) is a common chronic inflammatory autoinmune disease, with unknown etiology. Approximately 11-31% of RA patients have secondary Sjögren´s syndrome. Ophthalmologic manifestations of these diseases can cause corneal scarring, ulceration, infection, and even perforation; thus, although the prognosis is good for most patients with Sjögren syndrome and ophthalmologic features, individuals with complications have much guarded prognosis. We report the case of a 65 years old woman with photophobia, pain, tearing and blurred vision in both eyes. Slit lamp exam showed an important corneal melting right eye, and corneal perforation left eye, which required amniotic membrane transplantation. The diagnosis was: Rheumatoid Arthritis and secondary Sjögren´s Syndrome. Azathioprine treatment was started in combination with oral steroids. Approximately 25% of patients have ocular involvement, and keratoconjunctivitis sicca is the most frequent ocular complication. Although the prognosis is good in most cases, an early diagnosis is necessary to avoid several complications (AU)

Cambios morfométricos de las células del endotelio corneal en el síndrome pseudoexfoliativo y glaucoma pseudoexfoliativo / Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Objetivo: Analizar el patrón morfométrico de las células endoteliales de la córnea y el espesor corneal central (ECC) en los ojos con pseudoexfoliativo (PEX) con y sin glaucoma, y compararlos con ojos normales y con glaucoma primario de ángulo abierto (GPAA). Método: Se incluyeron 166 pacientes en el estudio: 36 sujetos con síndrome seudoexfoliativo, 30 con glaucoma seudoexfoliativo (GPEX), 40 con GPAA y 60 pacientes normales. Los parámetros evaluados con el microscopio especular de no contacto fueron la densidad de células endoteliales (DCE), el coeficiente de variación ( CV ) del tamaño celular y el porcentaje de hexagonalidad. El ECC se midió con paquimetría de contacto. Resultados: La DCE y el porcentaje de hexagonalidad celular fueron menores en los sujetos con PEX y GPAA respecto al grupo control, mientras que el CV del tamaño celular fue mayor. Considerando los 2 grupos de ojos con PEX, se observó una tendencia hacia una mayor pérdida de células endoteliales y de modificaciones en los parámetros morfométricos en los ojos con GPEX. Las alteraciones en el patrón especular aumentaron progresivamente con la edad. No hubo diferencias significativas en el valor medio de ECC entre los 4 grupos. Conclusión: La densidad de células endoteliales está significativamente disminuida y el pleomorfismo y polimegatismo celular incrementado en los ojos con PEX, especialmente cuando la presión intraocular es alta (AU)

Objetive: To evaluate the corneal endothelial morphometry and central corneal thickness (CCT) in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma (POAG).Method: A total of 166 patients were included in this study: 36 eyes with pseudoexfoliation syndrome (PXS), 30 eyes with pseudoexfoliation glaucoma (PXG), 40 eyes with POAG, and 60normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, and percentage of hexagonal cells, were measured using a non-contact specular microscope, whereas CCT was measured with an ultrasonic pachymeter. Results: ECD and percentage of hexagonal cells were lower in PEX groups and in the POAG group compared with normal eyes, while the CV in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG eyes compared to PXS eyes, when all pseudoexfoliative eyes were analyzed together. Changes in endothelial cells increased with age. There were no significant differences in mean CCT between the four groups. Conclusion: Endothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high (AU)

[Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma]. / Cambios morfométricos de las células del endotelio corneal en el síndrome pseudoexfoliativo y glaucoma pseudoexfoliativo.

OBJECTIVE: To evaluate the corneal endothelial morphometry and central corneal thickness (CCT) in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma (POAG). METHOD: A total of 166 patients were included in this study: 36 eyes with pseudoexfoliation syndrome (PXS), 30 eyes with pseudoexfoliation glaucoma (PXG), 40 eyes with POAG, and 60 normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, and percentage of hexagonal cells, were measured using a non-contact specular microscope, whereas CCT was measured with an ultrasonic pachymeter. RESULTS: ECD and percentage of hexagonal cells were lower in PEX groups and in the POAG group compared with normal eyes, while the CV in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG eyes compared to PXS eyes, when all pseudoexfoliative eyes were analyzed together. Changes in endothelial cells increased with age. There were no significant differences in mean CCT between the four groups. CONCLUSION: Endothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high.

Farmacogénetica y degeneración macular asociada a la edad, hacia un tratamiento individualizado de la enfermedad / Pharmacogenetics and Age-related Macular Degeneration, towards an individualized treatment of the disease

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VEGF A (rs699947 and rs833061) and VEGFR2 (rs2071559) gene polymorphisms are not associated with AMD susceptibility in a Spanish population.

PURPOSE: Age-related macular degeneration (AMD) is a multifactorial disease due to interaction between genetic and environmental factors. Increased angiogenesis plays a central role in AMD development. Previous studies on the potential link between AMD and vascular endothelial growth factor (VEGFA) and vascular endothelial growth factor receptor (VEGFR) have yielded conflicting results. We have analysed if polymorphisms in genes coding for VEGFA and VEGFR are associated to susceptibility to suffer AMD in a cohort of Spanish subjects. PATIENTS AND METHODS: We obtained peripheral blood samples from 151 patients with diagnosis of exudative AMD. We also studied 91 healthy subjects matched by age. We studied VEGFA rs699947 and rs833061, and VEGFR2 rs2071559 polymorphisms using real-time PCR with TaqMan probes. RESULTS: We did not find statistically significant differences in genotypic distribution of VEGF rs699947 and rs833061 polymorphisms between patients and controls. However, analysis of VEGFR2 rs2071559 polymorphism shows that carriers of GG genotype are more frequent in subjects with AMD (p: 0.032; Odds Ratio(OR): 1.933; confidence interval (CI): 1.053-3.549), but, when corrected by Bonferroni testing, the result was found to be not significant. CONCLUSION: Our study shows that VEGFA rs699947 and rs833061 and VEGFR2 rs2071559 polymorphisms do not modify the risk of suffering AMD in a Spanish population.

Retrospective study assessing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features.

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI.

Finding the right dose of fulvestrant in breast cancer.

Fulvestrant is a selective estrogen receptor downregulator, behaving as a complete antagonist. It was initially approved, at a dose of 250 mg, to treat hormone dependant breast cancer in second line setting. However, a series of pharmacological and pre-clinical studies have suggested that a higher dose of 500 mg may be more effective. The present work summarizes and discusses clinical trials that have aimed to test the benefits of administering fulvestrant at a higher dose. The data support the use of a higher, and more possibly, effective dose of the agent.

A randomized phase II trial of platinum salts in basal-like breast cancer patients in the neoadjuvant setting. Results from the GEICAM/2006-03, multicenter study.

Chemotherapy remains as the only systemic treatment option available for basal-like breast cancer (BC) patients. Preclinical models and several phase II studies suggested that platinum salts are active drugs in this BC subtype though there is no randomized study supporting this hypothesis. This study investigates if the addition of carboplatin to a combination of an alkylating agent together with anthracyclines and taxanes is able to increase the efficacy in the neoadjuvant treatment context. Patients with operable breast cancer and immunophenotypically defined basal-like disease (ER-/PR-/HER2- and cytokeratin 5/6+ or EGFR+) were recruited. Patients were randomized to receive EC (epirubicin 90 mg/m(2) plus cyclophosphamide 600 mg/m(2) for 4 cycles) followed either by D (docetaxel 100 mg/m(2) × 4 cycles; EC-D) or DCb (docetaxel 75 mg/m(2) plus carboplatin AUC 6 × 4 cycles; EC-DCb). The primary end point was pathological complete response (pCR) in the breast following the Miller and Payne criteria. Ninety-four patients were randomized (46 EC-D, 48 EC-DCb). pCR rate in the breast was seen in 16 patients (35 %) with EC-D and 14 patients (30 %) with EC-DCb (P value = 0.61). pCR in the breast and axilla was seen in 30 % of patients in both arms. The overall clinical response rate was 70 % (95 % CI 56-83) in the EC-D arm and 77 % (95 % CI 65-87) in the EC-DCb arm. Grade 3/4 toxicity was similar in both arms. The addition of carboplatin to conventional chemotherapy with EC-D in basal-like breast cancer patients did not improve the efficacy probably because they had already received an alkylating agent. These findings should be taken into consideration when developing new agents for this disease.