Subtropical oceans contribute significantly to global primary production, but the fate of the picophytoplankton that dominate in these low-nutrient regions is poorly understood. Working in the subtropical Mediterranean, we demonstrate that subduction of water at ocean fronts generates 3D intrusions with uncharacteristically high carbon, chlorophyll, and oxygen that extend below the sunlit photic zone into the dark ocean. These contain fresh picophytoplankton assemblages that resemble the photic-zone regions where the water originated. Intrusions propagate depth-dependent seasonal variations in microbial assemblages into the ocean interior. Strikingly, the intrusions included dominant biomass contributions from nonphotosynthetic bacteria and enrichment of enigmatic heterotrophic bacterial lineages. Thus, the intrusions not only deliver material that differs in composition and nutritional character from sinking detrital particles, but also drive shifts in bacterial community composition, organic matter processing, and interactions between surface and deep communities. Modeling efforts paired with global observations demonstrate that subduction can flux similar magnitudes of particulate organic carbon as sinking export, but is not accounted for in current export estimates and carbon cycle models. Intrusions formed by subduction are a particularly important mechanism for enhancing connectivity between surface and upper mesopelagic ecosystems in stratified subtropical ocean environments that are expanding due to the warming climate.
Bacteria , Oceans and Seas , Seawater , Seawater/microbiology , Seawater/chemistry , Bacteria/metabolism , Carbon/metabolism , Carbon Cycle , Chlorophyll/metabolism , Ecosystem , Phytoplankton/metabolism , Seasons , Biomass , Microbiota/physiology , Oxygen/metabolism
BACKGROUND: Cardiovascular diseases (CVDs) prevalence has significantly increased in the last decade and atherosclerosis development is the main trigger. MicroRNAs (miRNAs) are non-coding RNAs that negatively regulate gene expression of their target and their levels are frequently altered in CVDs. METHODS: By RT-qPCR, we analysed miR-9-5p, miR-15a-5p, miR-16-5p and miR-199a-3p levels in aorta from apolipoprotein knockout (ApoE-/- ) mice, an experimental model of hyperlipidemia-induced atherosclerosis, and in human aortic and carotid atherosclerotic samples. By in silico studies, Western blot analysis and immunofluorescence studies, we detected the targets of the altered miRNAs. RESULTS: Our results show that miR-15a-5p and miR-199a-3p are significantly decreased in carotid and aortic samples from patients and mice with atherosclerosis. In addition, we found an increased expression in targets of both miRNAs that participate in the inflammatory pathway of nuclear factor kappa B (NF-κB), such as IKKα, IKKß and p65. In human vein endothelial cells (HUVECs) and vascular smooth muscle cells (VSMCs), the overexpression of miR-15a-5p or miR-199a-3p decreased IKKα, IKKß and p65 protein levels as well as NF-κB activation. On the other hand, miR-15a-5p and miR-199a-3p overexpression reduced ox-LDL uptake and the inflammation regulated by NF-κB in VSMCs. Moreover, although miR-15a-5p and miR-199a-3p were significantly increased in exosomes from patients with advanced carotid atherosclerosis, only in the ROC analyses for miR-15a-5p, the area under the curve was 0.8951 with a p value of .0028. CONCLUSIONS: Our results suggest that the decrease of miR-199a-3p and miR-15a-5p in vascular samples from human and experimental atherosclerosis could be involved in the NF-κB activation pathway, as well as in ox-LDL uptake by VSMCs, contributing to inflammation and progression atherosclerosis. Finally, miR-15a-5p could be used as a novel diagnostic biomarker for advanced atherosclerosis.
Atherosclerosis , Cardiovascular Diseases , MicroRNAs , Humans , Animals , Mice , I-kappa B Kinase , NF-kappa B/genetics , Endothelial Cells , MicroRNAs/genetics , Atherosclerosis/genetics , Protein Serine-Threonine Kinases
OBJECTIVE: Gout is prevalent in people with cardiovascular disease, although up to a third of the cases remain unregistered. We aimed to assess whether active gout screening in inpatients with cardiovascular events helps identify patients at higher risk of mortality after discharge. METHODS: This study included patients admitted for cardiovascular events. Gout was established by records review and clinical interview. After discharge, electronic medical records were reviewed for mortality and cause of death. The association between gout and subsequent mortality was tested using Cox regression models. RESULTS: Of 266 recruited patients, 17 were lost to follow-up, leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5%) were classified as having gout; 13 of these (36.1%) were identified through the interview. Mean follow-up was 19.9 (SD, 8.6) months. Gout significantly increased the risk of all-cause mortality in the overall sample (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.13-3.58) and in the subgroup with a prior diagnosis of gout (HR, 2.89; 95% CI, 1.54-5.41). The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI, 1.01-3.41). Patients with gout carried an increased risk of both cardiovascular and noncardiovascular deaths; age and chronic kidney disease were mortality predictors within the gout population. CONCLUSION: Gout was an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed the detection of a larger population at high risk of mortality and could help tailor patient management to minimize the cardiovascular impact.
Cardiovascular Diseases , Gout , Renal Insufficiency, Chronic , Humans , Gout/diagnosis , Gout/epidemiology , Gout/complications , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Proportional Hazards Models , Renal Insufficiency, Chronic/complications , Risk Factors
Resumen: Se presenta el caso de paciente masculino, de 60 años, programado para resección transuretral de próstata. Como antecedentes destacan enfermedad de Steinert e implantación de marcapasos. La enfermedad de Steinert es el antecedente principal que guiará nuestra práctica anestésica y, tras valorar el tipo de intervención prevista, se decide anestesia locorregional, dadas las potenciales complicaciones que pueden presentar estos pacientes con la anestesia general. La conducta anestésica de los pacientes con enfermedad de Steinert supone un reto para el anestesiólogo tanto por la gran cantidad de complicaciones que pueden aparecer en el intra- y en el postoperatorio, como por la baja frecuencia de esta enfermedad. Además, el estrés quirúrgico y las técnicas utilizadas pueden interferir en el curso de la enfermedad. Por todo ello, el abordaje y los cuidados intra- y postoperatorios se deben planificar y seleccionar con cuidado con el fin de obtener los mejores resultados y extremar la seguridad del paciente.
Abstract: A 60-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate. Steinert's disease and implantation of a pacemaker were his previous pathology. Being Steinert's disease the most relevant clinical characteristic and the type of intervention urologist has planned, we decide locoregional anesthesia technique, avoiding the potential complications that these patients may present with general anesthesia. The anesthetic management of Steinert's disease patients is a challenge for the anesthesiologist both due to the large number of complications that may appear during intra- and postoperative time as well as the low frequency of this pathology. In addition, surgical stress and the techniques we use can interfere with the course of the disease. Therefore, the approach and immediate intra-and postoperative care should be carefully planned and selected in order to obtain the best results and maximize patient safety.
Breast cancer is the most common tumor among women, representing the second cause of cancer deaths in women. Treatment with chemotherapy negatively interferes with nutritional status. The intake of vitamins before, during and after treatment in a pilot cohort of women with non-invasive breast cancer (type I, II) treated at the Valencian Institute of Oncology (IVO) is evaluated. A 3-day anthropometric and nutritional assessment was performed using the DIAL program. Nutritional intake is compared with the values of Estimated Average Requirements (EAR) and Dietary Reference Intake (DRI) provided by the United States Department of Agriculture (USDA) and the European Food Safety Authority (EFSA). There is an overall decrease in vitamin intake during treatment which worsens at the end of said treatment. The decrease is significant in the case of vitamins B2 (p = 0.006), B3 (p = 0.042), B5 (p = 0.001), and B8 (p = 0.021). The relative risk during and after treatment increases with respect to the reference timeframe, before treatment. Deficit risks are statistically significant in the case of vitamins B5 (p = 0.001), B8 (p = 0.001) and B12 (p = 0.001). Decreased vitamin intake during treatment suggests a negative change in the patients' dietary behaviors during this time. Nutritional intervention and support may be beneficial to optimize overall dietary intake and maintain compliance with EAR and DRI for patients during a time in which adequate nutrition is important.
Breast Neoplasms , Diet , Vitamins/administration & dosage , Adult , Breast Neoplasms/drug therapy , Cohort Studies , Female , Humans , Middle Aged , Nutritional Status , Pilot Projects , Spain , United States
The present study compared lab-based and web-based versions of cognitive individual difference measures widely used in second language research (working memory and declarative memory). Our objective was to validate web-based versions of these tests for future research and to make these measures available for the wider second language research community, thus contributing to the study of individual differences in language learning. The establishment of measurement equivalence of the two administration modes is important because web-based testing allows researchers to address methodological challenges such as restricted population sampling, low statistical power, and small sample sizes. Our results indicate that the lab-based and web-based versions of the tests were equivalent, i.e., scores of the two test modes correlated. The strength of the relationships, however, varied as a function of the kind of measure, with equivalence appearing to be stronger in both the working memory and the verbal declarative memory tests, and less so in the nonverbal declarative memory test. Overall, the study provides evidence that web-based testing of cognitive abilities can produce similar performance scores as in the lab.
Cognition/physiology , Memory and Learning Tests , Adult , Female , Humans , Internet , Linear Models , Male , Memory, Short-Term , Reproducibility of Results , Young Adult
Introducción: La amigdalectomía es un procedimiento quirúrgico cada vez más frecuente en pacientes adultos. El dolor postoperatorio puede ser intenso, y tiene una gran impronta sobre la calidad de vida de los enfermos. El paracetamol y los antinflamatorios no esteroideos (AINE) son, a menudo, insuficientes para tratar el dolor durante las primeras 48 horas postoperatorias. La analgesia controlada por el paciente (PCA) con cloruro mórfico es una alternativa eficaz y segura para el control del dolor agudo postoperatorio. Material y métodos: El objetivo principal fue comparar la calidad analgésica de una PCA con cloruro mórfico frente a la administración pautada de paracetamol y AINE para tratar el dolor postoperatorio de pacientes adultos intervenidos de amigdalectomía. Como objetivo secundario se estudió la frecuencia de efectos adversos y satisfacción en cada grupo. Se realizó un estudio de cohortes retrospectivo con los pacientes adultos intervenidos de amigdalectomía durante el año 2017. Se registró la escala verbal numérica (EVN) en las 24 horas y en las 48 horas del postoperatorio. Se recogió la aparición de efectos secundarios. Se realizó el estudio estadístico con el programa SPSS(R). Resultados: Se evaluaron un total de 46 pacientes, 20 del grupo de tratamiento de analgesia convencional y 26 tratados con PCA de cloruro mórfico. No hallamos diferencias significativas en las características demográficas de los grupos. El grupo de PCA tuvo una EVN menor que el grupo de analgesia convencional a las 24 horas y a las 48 horas. La diferencia fue estadísticamente significativa, tanto para el dolor en reposo como para el dolor en actividad. La incidencia de efectos secundarios fue mayor en el grupo PCA (46,15 %) frente al grupo de analgesia con paracetamol y AINE (15 %). Discusión: La analgesia con un PCA de cloruro mórfico es más eficaz que la administración de paracetamol y AINE para tratar el dolor postoperatorio de la amigdalectomía del paciente adulto. Los efectos adversos son más frecuentes con la PCA de morfina
Introduction: Tonsillectomy is surgical procedure which is being every time more often in adult patients. Postoperative pain may be very intense, and it has a very important mark in the quality of life of our patients. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may not be enough for pain management during the first 48 hours post-surgery. Morphine patient-controlled analgesia (PCA) is an effective and safe alternative for postoperative acute pain management. Material and methods: Our main goal was to compare the quality of analgesia between morphine PCA and acetaminophen and NSAIDs use for acute pain control in adult patients who had tonsillectomy surgery. Our secondary goal was to study the frequency of side effects and the satisfaction level on each group. A retrospective cohort study was performed with those adult patients who underwent tonsillectomy during the year 2017. Pain was evaluated during the first 24 and 48 hours post-surgery with the numerical rating scale (NRS). Secondary side effects were reported. The statistical study was performed with SPSS(R) programme. Results: a total of 46 patients were evaluated, 20 patients belonged to the group for conventional analgesia and 26 belonged to the group of morphine PCA. We did not find significative differences in the demographic characteristics in both groups. PCA group had a smaller NRS compared to the other conventional analgesia group during the first 24 and the 48 hours. The difference was statistically significant for pain control during activity and resting. The incidence of secondary effects was greater for the PCA group (46,15 %) than for the acetaminophen and NSAIDs group (15 %). Discussion: Analgesia with morphine PCA is more effective than the administration of acetaminophen and NSAIDs for postoperative pain control in tonsillectomy procedure in the adult patient. The adverse effects are more frequent with morphine PCA
Humans , Male , Female , Young Adult , Adult , Middle Aged , Pain, Postoperative/drug therapy , Tonsillectomy/statistics & numerical data , Tonsillitis/surgery , Analgesia, Patient-Controlled/methods , Morphine Derivatives/administration & dosage , Pain Management/methods , Analgesics/administration & dosage , Treatment Outcome , Case-Control Studies , Retrospective Studies , Pain Measurement/methods
This study examined the simultaneous acquisition of vocabulary and grammar by adult learners and the role of exposure condition and declarative memory. Most experimental studies investigating the acquisition of artificial or natural languages focus on either vocabulary or grammar, but not both. However, a systematic investigation of the simultaneous learning of multiple linguistic features is important given that it mirrors language learning outside the lab. Native English speakers were exposed to an artificial language under either incidental or intentional exposure conditions. Participants had to learn both novel pseudowords and word order patterns while also processing stimulus sentences for meaning. The results showed that adult learners are able to rapidly acquire basic syntactic information of a novel language while processing the input for meaning (plausibility judgments) and attempting to learn novel vocabulary at the same time. The results further indicated that exposure condition (incidental versus intentional) made no difference in terms of either vocabulary or grammar learning gains. Findings also revealed that learners developed explicit, not implicit, knowledge of lexis and syntax. Finally, the results indicated that individuals' declarative memory capacity was not related to vocabulary learning but only to grammar learning. Our study underscores the importance of studying the simultaneous acquisition of different language features and from different perspectives of comprehension versus production, incidental versus intentional learning conditions, implicit/explicit knowledge, and individual differences in cognitive abilities.
Purpose: This study aimed to identify biomarkers of resistance to endocrine therapy in estrogen receptor-positive (ER+) breast cancers treated with prolonged neoadjuvant letrozole.Experimental Design: We performed targeted DNA and RNA sequencing in 68 ER+ breast cancers from patients treated with preoperative letrozole (median, 7 months).Results: Twenty-four tumors (35%) exhibited a PEPI score ≥4 and/or recurred after a median of 58 months and were considered endocrine resistant. Integration of the 47 most upregulated genes (log FC > 1, FDR < 0.03) in letrozole-resistant tumors with transcription-binding data showed significant overlap with 20 E2F4-regulated genes (P = 2.56E-15). In patients treated with the CDK4/6 inhibitor palbociclib before surgery, treatment significantly decreased expression of 24 of the 47 most upregulated genes in letrozole-resistant tumors, including 18 of the 20 E2F4 target genes. In long-term estrogen-deprived ER+ breast cancer cells, palbociclib also downregulated all 20 E2F4 target genes and P-RB levels, whereas the ER downregulator fulvestrant or paclitaxel only partially suppressed expression of this set of genes and had no effect on P-RB. Finally, an E2F4 activation signature was strongly associated with resistance to aromatase inhibitors in the ACOSOG Z1031B neoadjuvant trial and with an increased risk of relapse in adjuvant-treated ER+ tumors in METABRIC.Conclusions: In tumors resistant to prolonged neoadjuvant letrozole, we identified a gene expression signature of E2F4 target activation. CDK4/6 inhibition suppressed E2F4 target gene expression in estrogen-deprived ER+ breast cancer cells and in patients' ER+ tumors, suggesting a potential benefit of adjuvant CDK4/6 inhibitors in patients with ER+ breast cancer who fail to respond to preoperative estrogen deprivation. Clin Cancer Res; 24(11); 2517-29. ©2018 AACR.
Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Drug Resistance, Neoplasm , E2F4 Transcription Factor/genetics , Protein Kinase Inhibitors/therapeutic use , Receptors, Estrogen/genetics , Aged , Aged, 80 and over , Aromatase Inhibitors/therapeutic use , Biomarkers, Tumor , Breast Neoplasms/metabolism , Cell Line, Tumor , Cell Proliferation , Computational Biology/methods , Drug Resistance, Neoplasm/drug effects , Drug Resistance, Neoplasm/genetics , E2F4 Transcription Factor/metabolism , Female , Gene Expression Profiling , Humans , Letrozole/therapeutic use , Middle Aged , Mutation , Protein Kinase Inhibitors/pharmacology , Receptors, Estrogen/metabolism , Retreatment , Transcriptome
INTRODUCTION: In locally and locally advanced triple-negative breast cancer (TNBC), neoadjuvant chemotherapy (NAC) only induces a pCR in 30-35% of patients. Clinical and pathological factors are not enough to distinguish the patients who have no chance of a pCR or not. The tumour microenvironment is critical for cancer and tumour-infiltrating lymphocytes (TIL). Moreover, the NAC scenario is the perfect setting to study possible changes in TIL levels. MATERIAL AND METHODS: Using our prospective maintained breast cancer (BC) database, we identified 164 TNBC patients treated with NAC between 1998 and 2015 with enough samples of diagnostic biopsy and after surgery. Evaluation of TILs before and after NAC followed a standardised methodology for visual assessment on haematoxylin-eosin sections and the amounts of TILs were quantitated in deciles. We categorised lymphocyte-predominant breast cancer cutoff according to a receiver operating characteristic (ROC) analysis. We categorised LPBC as involving > 40% lymphocytic infiltration tumour stroma. The primary end point was predictive value of TILs to NAC, and the secondary end point was disease-free survival (DFS). DFS was analysed using the Kaplan-Meier method and the groups were compared with a long-rank test. Univariate and multivariate Cox models were used to generate hazard ratios for determining associations between variables such as TIL after NAC and DFS. RESULTS: A total of 164 TNBC patients were treated with NAC and surgery. The main patients' characteristics are listed in Table 1. We identify different pathological complete response to anthracycline and taxane-based NAC; LPBC subgroup 51 from 58 patients (88%) pCR versus non- lymphocyte-predominant breast cancer (LPBC) subgroup 10 from 106 (9%) pCR, p = 0.001. At a median follow-up of 78 months, LPBC was associated with better DFS; the three-year Kaplan-Meier estimates for DFS were 2% and 30 % for patients with LPBC and non-LPBC, respectively, p = 0.01. Univariate and multivariate analysis confirmed TIL to be an independent prognostic marker of DFS. CONCLUSIONS: Tumour-infiltrating lymphocytes could be routinely used in locally advanced TNBC treated with anthracycline and taxane, such as biomarker, to be enabled the identification of different two subgroups: LPBC patients have a very high response to NAC pCR 88%, meanwhile non-LPBC patients only achieve 9%. Moreover, non-LPBC patients have a worse prognosis than LPBC patients. This data verified the predictive and prognostic value of TIL.
BACKGROUND: The appropriate selection criteria for breast-conserving surgery (BCS) or mastectomy after neoadjuvant chemotherapy (NAC) are poorly defined. The aim of this study is to analyse the incidence and prognostic factors for locoregional recurrence (LRR) in patients with breast cancer (BC) treated with NAC to develop a prognostic score to help with clinical decision-making. MATERIALS AND METHODS: Using our retrospective maintained BC database, we identified 730 patients treated with NAC (327 patients treated with BCS and 403 patients treated with mastectomy) between 1998 and 2014. To identify variables associated with an increased LRR rate, we performed firstly Kaplan-Meier curves, with comparisons among groups using log-rank test, and then, significant variables were included in a multivariate analysis using Cox proportional hazards. The prognostic index was developed by assigning score 0 (favourable) or score 1 (unfavourable) for each significant variable of multivariate analysis and was created separately for patients with BCS and mastectomy. RESULTS: At a median follow-up of 72 months, the 6-year cumulative incidence of LRR was 7.2% ( ± 3%) for BCS and 7.9% ( ± 3%) for mastectomy. By univariate analysis, variables associated with an increased LRR were for BCS: HER2 positive, grade III, ductal carcinoma in situ (DCIS), No-pCR (ypTis, ypN0), and age < 40 years; and for mastectomy, HER2-positive, DCIS, No-pCR, and LVI. By multivariate analysis, variables associated with an increased LRR were for BCS: HER2 positive (HR: 11.1, p = 0.001), DCIS (HR: 3.1, p = 0.005), and age < 40 years (HR: 2.8, p = 0.02); and for mastectomy: HER2 positive (HR: 9.5, p = 0.03), DCIS (HR: 2.7, p = 0.01), No-pCR (HR: 11.4, p = 0.01), and age < 40 years (HR: 2.8, p = 0.006). The score stratified patients into three subsets with statistically different levels of risk for LRR. For BCS, the six-year LRR rates were 3%, 13%, and 33% for the low (score 0, n = 120), intermediate (score 1, n = 95) and high (score 2-3, n = 27) risk groups, respectively (p = 0.001). For mastectomy, the six-year LRR rates were 0%, 8%, and 27% for the low (score 0, n = 20), intermediate (score 1-2, n 191), and high (score 3-4, n = 30) risk groups, respectively (p = 0.001). Of note, 21 patients that had a LRR event were HER2 positive, all of them had received trastuzumab. CONCLUSIONS: Patients with a score of 0, which made up to 19% of the study population, had very low risk of LRR. The score enabled the identification of a small group (7%) of patients with very high risk of LRR, and who may benefit from alternative treatment.
No disponible
Humans , Female , Adult , Breast Neoplasms/complications , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Neoplasm Metastasis/pathology , Neoplasm Metastasis , Paclitaxel/therapeutic use , /therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Diuretics/therapeutic use , Hormones/therapeutic use , Taxoids/therapeutic use , Bevacizumab/therapeutic use
PURPOSE: Capecitabine is an active drug in metastatic breast cancer (BC). GEICAM/2003-10 is an adjuvant trial to investigate the integration of capecitabine into a regimen of epirubicin and docetaxel for node-positive early BC. PATIENTS AND METHODS: Patients with operable node-positive BC (T1-3/N1-3) were eligible. After surgery, 1,384 patients were randomly assigned to receive epirubicin plus cyclophosphamide (EC; 90 and 600 mg/m(2), respectively, × four cycles), followed by docetaxel (100 mg/m(2) × four cycles; EC-T) or epirubicin plus docetaxel (ET; 90 and 75 mg/m(2), respectively, × four cycles), followed by capecitabine (1,250 mg/m(2) twice a day on days 1 to 14, × four cycles; ET-X); all regimens were given every 3 weeks. The primary end point was invasive disease-free survival. Secondary end points included safety (with an alopecia-specific study) and overall survival (OS). RESULTS: After a median follow-up of 6.6 years and 297 events, 86% of patients who received EC-T and 82% of those who received ET-X were invasive disease free at 5 years (hazard ratio, 1.30; 95% CI, 1.03 to 1.64; log-rank P = .03). The OS difference between arms was not statistically significant (hazard ratio, 1.13; 95% CI, 0.82 to 1.55; log-rank P = .46). The most frequent grade 3 to 4 adverse events in the EC-T versus ET-X arms were neutropenia (19% v 10%), with 7% febrile neutropenia across arms; fatigue (13% v 11%); diarrhea (3% v 11%); hand-foot syndrome (2% v 20%); mucositis (6% v 5%); vomiting (both, 5%); and myalgia (4.5% v 1%). Incomplete scalp hair recovery was more frequent in the EC-T than ET-X arm (30% v 14%), and patients who received EC-T wore wigs significantly longer than those who received ET-X (8.35 v 6.03 months). CONCLUSION: Invasive disease-free survival, but not OS, was significantly superior for patients with node-positive early BC who received the adjuvant standard schedule EC-T than for those who received the experimental ET-X regimen. Toxicity profiles differed substantially across arms.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Lymph Nodes/pathology , Adult , Aged , Breast Neoplasms/surgery , Capecitabine/administration & dosage , Capecitabine/adverse effects , Chemotherapy, Adjuvant , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Disease-Free Survival , Docetaxel , Drug Administration Schedule , Epirubicin/administration & dosage , Epirubicin/adverse effects , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Follow-Up Studies , Humans , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Odds Ratio , Taxoids/administration & dosage , Taxoids/adverse effects , Treatment Outcome
Patients with metastatic breast cancer should be offered comprehensive and personalized medical attention including, but not limited to, psychosocial, supportive and symptom-related interventions. A large number of treatment options are available and several prognostic and predictive factors are useful to identify the best therapeutic options individually (AU)
Humans , Female , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Breast Neoplasms/genetics , Central Nervous System Neoplasms/secondary , Central Nervous System Neoplasms/therapy , Chemotherapy, Adjuvant , Genes, erbB-2 , Neoadjuvant Therapy , Neoplasm Metastasis , Receptors, Estrogen/genetics , Recurrence
Patients with metastatic breast cancer should be offered comprehensive and personalized medical attention including, but not limited to, psychosocial, supportive and symptom-related interventions. A large number of treatment options are available and several prognostic and predictive factors are useful to identify the best therapeutic options individually.
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Breast Neoplasms/genetics , Central Nervous System Neoplasms/secondary , Central Nervous System Neoplasms/therapy , Chemotherapy, Adjuvant , Female , Genes, erbB-2 , Humans , Neoadjuvant Therapy , Neoplasm Metastasis , Postmenopause , Receptors, Estrogen/genetics , Recurrence
Patients with metastatic breast cancer have a wide number of treatment options, including medical, surgical, and supportive care measures. Treatment decisions are based in predictive and prognostic factors and the informed choice of the patients. SEOM has elaborated these guidelines with evidence-based recommendations for the diagnostic work-up, treatment (chemotherapy, endocrine therapy and targeted therapies) and supportive care for the management of these patient (AU)
Humans , Female , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Algorithms , Breast Neoplasms/diagnosis , Neoplasm Metastasis , Prognosis , Societies, Medical/trends , Societies, Medical , Spain/epidemiology
Patients with metastatic breast cancer have a wide number of treatment options, including medical, surgical, and supportive care measures. Treatment decisions are based in predictive and prognostic factors and the informed choice of the patients. SEOM has elaborated these guidelines with evidence-based recommendations for the diagnostic work-up, treatment (chemotherapy, endocrine therapy and targeted therapies) and supportive care for the management of these patients.
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Carcinoma/pathology , Carcinoma/therapy , Practice Guidelines as Topic , Algorithms , Breast Neoplasms/diagnosis , Carcinoma/diagnosis , Female , Humans , Neoplasm Metastasis , Prognosis , Societies, Medical , Spain
