[Gallbladder metastasis of clear cell renal carcinoma]. / Metástasis de carcinoma renal de células claras en la vesícula biliar.

Clear cell renal cell carcinoma (ccRCC) is an uncommon malignant neoplasm that accounts for 3% of all malignant tumors in adults. This tumor exhibits a high tendency to develop synchronous or metachronous metastases in different anatomical sites. Although gallbladder metastasis from ccRCC is extremely rare, sporadic cases have been reported in the medical literature. We present the case of a 78-year-old woman with a history of undifferentiated nasopharyngeal carcinoma, basal cell carcinoma, and ccRCC in the right kidney. She underwent radical nephrectomy. Histopathological analysis confirmed the diagnosis of ccRCC without vascular or ureteral invasion. Two years later, during follow-up, a nodular lesion was detected in the gallbladder through computed tomography. Despite the absence of symptoms, surgical resection was decided. Laparoscopic cholecystectomy was performed without complications. Histopathological examination confirmed the presence of ccRCC metastasis in the gallbladder. The patient had a favorable outcome and is currently under follow-up without recurrence. Gallbladder metastasis from ccRCC is extremely rare, but surgeons should consider this possibility in patients with a history of ccRCC. Preoperative differential diagnosis between primary gallbladder carcinoma and ccRCC metastasis can be challenging and is often confirmed through histopathological examination. Complete surgical resection is the best treatment option to achieve disease-free survival.

El carcinoma renal de células claras (CRCC) es una neoplasia maligna poco común que representa el 3% de todos los tumores malignos en adultos. Este tumor presenta una alta tendencia a desarrollar metástasis sincrónicas o metacrónicas en diferentes sitios anatómicos. Aunque la metástasis en la vesícula biliar por CRCC es extremadamente rara, se han reportado casos esporádicos en la literatura médica. Presentamos el caso de una mujer de 78 años con antecedentes de carcinoma indiferenciado de cavum, carcinoma basocelular y CRCC en riñón derecho. Se sometió a nefrectomía radical. El análisis histopatológico confirmó el diagnóstico de CRCC sin invasión vascular ni ureteral. Dos años después, durante el seguimiento, se detectó una lesión nodular en la vesícula biliar mediante tomografía computarizada. A pesar de la ausencia de síntomas, se decidió la resección quirúrgica. Se realizó colecistectomía laparoscópica sin complicaciones. El examen histopatológico confirmó la presencia de metástasis de CRCC en la vesícula biliar. La paciente evolucionó favorablemente encontrándose en seguimiento sin recurrencia. La metástasis vesicular por CRCC es extremadamente rara, pero los cirujanos deben considerarla en pacientes con antecedentes de CRCC. El diagnóstico diferencial prequirúrgico entre el carcinoma primario de vesícula biliar y la metástasis de CRCC puede ser desafiante y, a menudo, se confirma mediante el examen histopatológico. La resección quirúrgica completa parece ser la mejor opción de tratamiento para lograr una supervivencia libre de enfermedad.

Bystanders' reactions to animal abuse in relation to psychopathy, empathy with people and empathy with nature.

Social and academic interest in animal abuse has recently increased thanks to greater awareness of the importance of biodiversity in promoting sustainability. The redefinition of human-animal relationships, in the context of the fight against speciesism and the defense of veganism, has also contributed to this greater attention. Moreover, public awareness of animal rights has strengthened social reactions to violence against animals, though there are still some social sectors that are indifferent to these changes. Thus, better knowledge of the psychological mechanisms underlying reactions to animal abuse could contribute to better informal, social control of such abuse. The main aim of this study is to analyze the relationships between psychopathy, empathy with people, and empathy with nature arising from people's reactions to protected and domestic animal abuse and illegal dumping. Also, as previous studies have shown differences between men and women, both in animal abuse and in personality traits, thus gender is taken into account when analyzing these relationships. A total of 409 people, resident in a highly environmentally protected territory, participated in this study. They were aged between 18 and 82 years old and 49.9% women. Participants were asked about assigned punishments, as well as the probability of intervening personally and/or calling the police, in relation to ten scenarios, based on press releases, describing one of three types of transgression of environmental laws: abuse of protected animals, abuse of domestic animals or illegal dumping. They also responded to Spanish adaptations of the Inventory of Callous Unemotional Traits, the Basic Empathy Scale, the Dispositional Empathy with Nature Scale, and the Social Desirability Scale. Each participant was randomly given ten scenarios corresponding to just one transgression type but all the personality scales. Results show that people's reactions were greater for abuse of domestic than protected animals or for illegal dumping, irrespective of gender. Empathy with nature was related to the reaction against animal abuse more than empathy with people and psychopathy. Results are discussed highlighting the need for future research into similarities and differences between animal abuse and other types of environmental offences, which have many victims but no single being suffering.

Perception of task-irrelevant affective prosody by typically developed and diagnosed children with Autism Spectrum Disorder under attentional loads: electroencephalographic and behavioural data.

The relevance of affective information triggers cognitive prioritisation, dictated by both the attentional load of the relevant task, and socio-emotional abilities. This dataset provides electroencephalographic (EEG) signals related to implicit emotional speech perception under low, intermediate, and high attentional demands. Demographic and behavioural data are also provided. Specific social-emotional reciprocity and verbal communication characterise Autism Spectrum Disorder (ASD) and may influence the processing of affective prosodies. Therefore, 62 children and their parents or legal guardians participated in data collection, including 31 children with high autistic traits (x̄age=9.6-year-old, σage=1.5) who previously received a diagnosis of ASD by a medical specialist, and 31 typically developed children (x̄age=10.2-year-old, σage=1.2). Assessments of the scope of autistic behaviours using the Autism Spectrum Rating Scales (ASRS, parent report) are provided for every child. During the experiment, children listened to task-irrelevant affective prosodies (anger, disgust, fear, happiness, neutral and sadness) while answering three visual tasks: neutral image viewing (low attentional load), one-target 4-disc Multiple Object Tracking (MOT; intermediate), one-target 8-disc MOT (high). The EEG data recorded during all three tasks and the tracking capacity (behavioural data) from MOT conditions are included in the dataset. Particularly, the tracking capacity was computed as a standardised index of attentional abilities during MOT, corrected for guessing. Beforehand, children answered the Edinburgh Handedness Inventory, and resting-state EEG activity of children was recorded for 2 minutes with eyes open. Those data are also provided. The present dataset can be used to investigate the electrophysiological correlates of implicit emotion and speech perceptions and their interaction with attentional load and autistic traits. Besides, resting-state EEG data may be used to characterise inter-individual heterogeneity at rest and, in turn, associate it with attentional capacities during MOT and with autistic behavioural patterns. Finally, tracking capacity may be useful to explore dynamic and selective attentional mechanisms under emotional constraints.

Rotura espontánea de vena ilíaca: una causa infrecuente de abdomen agudo hemorrágico / Spontaneous rupture of the iliac vein: a rare cause of intra-abdominal hemorrhage

RESUMEN La rotura espontánea de la vena ilíaca es una causa poco frecuente de hemorragia retroperitoneal exanguinante. Generalmente está asociada con un traumatismo y las lesiones iatrogénicas durante la cirugía de hemiabdomen inferior o pelviana. Ocurre con frecuencia del lado izquierdo y afecta indistintamente a la vena ilíaca común como a la externa. Con el objetivo de destacar las características clínicas e imagenológicas de esta infrecuente entidad, presentamos un caso fatal de rotura espontánea de la vena ilíaca externa izquierda. El tratamiento se basa en la reparación quirúrgica abierta o, en casos seleccionados, en la colocación de prótesis por vía endovascular. Es necesario un alto índice de sospecha, ya que el diagnóstico y el tratamiento tempranos son fundamentales para mejorar las altas tasas de morbimortalidad que conlleva esta entidad.

ABSTRACT Spontaneous rupture of the iliac vein is a rare cause of fatal retroperitoneal hemorrhage that is generally associated with trauma and iatrogenic injury during lower abdominal or pelvic surgery. It usually occurs in the left common and external iliac veins. We report a fatal case of spontaneous rupture of the left external iliac vein to emphasize the clinical and imaging characteristics of this rare condition. Treatment is based on open surgical repair or endovascular stenting in selected cases. High level of suspicion is essential for early diagnosis and treatment to improve the associated morbidity and mortality.

Comparison of Two Tuberculosis Infection Tests in a South American Tertiary Hospital: STANDARD F TB-Feron FIA vs. QIAreachTM QuantiFERON-TB.

INTRODUCTION: Tuberculosis (TB) is one of the most prevalent respiratory diseases in the world. In 2020 there were at least 9.9 million new infections, with 1.5 million deaths. Approximately 10% of people infected with Mycobacterium tuberculosis develop the disease during the first 2 to 5 years after infection. In South America, the diagnosis of Latent Tuberculosis Infections (LTBI) continues to be performed through the Mantoux tuberculin skin test (TST). OBJECTIVE: The objective of our study was to compare the sensitivity of a new immunofluorescence IGRA test against a widely available IGRA kit on the market. MATERIAL AND METHOD: Close contact with infectious TB patients, HIV patients, or immunocompromised for another cause were recruited. Two interferon-gamma release assay (IGRA) diagnostic kits were used and compared with TST. RESULTS: 76 patients were recruited, 93.42% were Chilean nationality, and 98.68% of the patients did not have immunosuppression. The sensitivity of the new technique was 88.89%, and the specificity was 92.50% in the study population compared to the IGRA previously used. In the subgroup older than 36 years, the sensitivity was 95.65%, and the specificity was 89.47%. CONCLUSION: IGRA techniques are a new resource in clinical laboratories to make an accurate diagnosis of LTBI in the region of the Americas. In our population, the greatest benefit of this new IGRA would be observed in people over 36 years of age, where the sensitivity of the technique was like that of the currently available test.

Sociodemographic Factors Associated with Social Tolerance for Intimate Partner Violence in Peru: Evidence from the National Survey of Social Relations, 2019.

Our objective was to determine the factors associated with social tolerance for intimate partner violence (IPV) in the Peruvian population. A population-based cross-sectional study was conducted. Data from the 2019 National Survey of Social Relations (ENARES) of Peru were used. This survey collected data from a total of 1,026 Peruvians aged 18 years and older. Multilevel linear regression models were performed to evaluate the factors associated with a standardized index of social tolerance for IPV. Likewise, a stratified analysis was performed according to sex. Being older (ß = .01; 95% confidence interval [CI]: .01-.01) and living outside the capital (ß = 0.24; 95% CI: .07-0.41) were associated with greater social tolerance for IPV. On the other hand, being female (ß = -0.26; 95% CI: -0.36 to -0.17) and having a higher educational level were associated with lower tolerance. In the stratified analysis by sex, in both men and women, being older and having a higher level of education were associated with higher and lower tolerance for IPV, respectively. On the other hand, living outside the capital was associated with greater tolerance only in men. In Peru, older people and those living outside the capital showed greater acceptance of IPV, while women and those with higher levels of education expressed rejection of IPV.

Inteligencia emocional en residentes de Cirugía General: análisis de una encuesta nacional / Emotional intelligence among residents in general surgery: analysis of a national survey

RESUMEN Antecedentes: la inteligencia emocional (IE) es la capacidad de reconocer nuestros propios sentimientos y los de los demás, de motivarnos y de manejar adecuadamente las relaciones interpersonales. La IE se ha relacionado con muchas competencias no técnicas necesarias entre los médicos en formación. Objetivo: describir las características psicométricas de la IE en médicos residentes de Cirugía General de la Argentina y analizar los efectos que ejercen sobre ella la edad, el sexo, el ámbito de desempeño y el año de residencia. Material y métodos: estudio prospectivo, analítico de corte transversal; se utilizó la encuesta anónima y autogestionada Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF v1.5) respondida en línea durante el mes de marzo de 2020. Se aplicó la prueba de Kolmogorov-Smirnov para variables cuantitativas, pruebas T y la prueba ANOVA (IC 95%, p estadística α 0,05). Resultados: fueron respondidas 156 encuestas, de las cuales 105 (67,3%) corresponden a mujeres y 51 (32,7%) a hombres. Edad promedio: 29,02 ± 3,69 años. El promedio global de la prueba fue de 4,58 ± 0,89. El análisis ANOVA demostró que existen diferencias estadísticamente significativas de la dimensión bienestar entre los diferentes años de residencia (p = 0,002) así como en puntajes globales de IE (p = 0,0001). Conclusión: la IE es un modelo atractivo y eficaz para definir y capacitar a los futuros cirujanos generales en competencias no técnicas. Estos hallazgos son importantes para generar nuevas propuestas de formación.

ABSTRACT Background: Emotional intelligence (EI) is the ability to recognize our own feelings and those of others, to motivate us and properly manage relationships. EI encompasses many non-technical skills that are important for physicians in training. Objective: The aim of this study was to describe the psychometric characteristics of EI among residents in general surgery in Argentina and to analyze the effects of age, sex, scope of practice and postgraduate year level on it. Material and methods: We conducted a prospective, cross-sectional analytic study using the Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF v1.5), a self-report and anonymous survey that was answered on-line during March 2020. The statistical analysis was performed by using the Kolmogorov-Smirnov test for quantitative variables, Student's t-test and ANOVA (95% CI, p statistic α 0.05). Results: The survey was responded by 156 physicians; 105 (67.3%) were women and 51 (32.7%) were men (mean age: 29.02 ± 3.69 years). Mean global score was 4.58 ± 0.89. ANOVA showed statistically significant differences in the well-being dimension and global scores of EI across the different postgraduate year levels (p = 0.002 and p = 0.0001, respectively). Conclusion: EI is an attractive and effective model for defining and training future general surgeons in non-technical skills. These findings are important for generating new proposals for training.

Delayed B cell repopulation after rituximab treatment in multiple sclerosis patients with expanded adaptive natural killer cells.

BACKGROUND AND PURPOSE: The aim was to evaluate whether adaptive NKG2C+ natural killer (NK) cells, characterized by enhanced antibody-dependent cell cytotoxicity (ADCC), may influence time to B cell repopulation after rituximab treatment in multiple sclerosis (MS) patients. METHODS: This was a prospective observational study of MS patients treated with rituximab monitoring peripheral B cells for repeated doses. B cell repopulation was defined as CD19+ cells above 2% of total lymphocytes, classifying cases according to the median time of B cell repopulation as early or late (≤9 months, >9 months, respectively). Basal NK cell immunophenotype and in vitro ADCC responses induced by rituximab were assessed by flow cytometry. RESULTS: B cell repopulation in 38 patients (24 relapsing-remitting MS [RRMS]; 14 progressive MS) was classified as early (≤9 months, n = 19) or late (>9 months, n = 19). RRMS patients with late B cell repopulation had higher proportions of NKG2C+ NK cells compared to those with early repopulation (24.7% ± 16.2% vs. 11.3% ± 10.4%, p < 0.05), and a direct correlation between time to B cell repopulation and percentage of NKG2C+ NK cells (R 0.45, p < 0.05) was observed. RRMS cases with late repopulation compared with early repopulation had a higher secretion of tumor necrosis factor α and interferon γ by NK cells after rituximab-dependent NK cell activation. The NK cell immunophenotype appeared unrelated to B cell repopulation in progressive MS patients. CONCLUSIONS: Adaptive NKG2C+ NK cells in RRMS may be associated with delayed B cell repopulation after rituximab, a finding probably related to enhanced depletion of B cells exerted by NK-cell-mediated ADCC, pointing to the use of personalized regimens with anti-CD20 monoclonal antibody therapy in some patients.

Predicted functional genes for the biodegradation of xenobiotics in groundwater and sediment at two contaminated naval sites.

The goals of this study were to predict the genes associated with the biodegradation of organic contaminants and to examine microbial community structure in samples from two contaminated sites. The approach involved a predictive bioinformatics tool (PICRUSt2) targeting genes from twelve KEGG xenobiotic biodegradation pathways (benzoate, chloroalkane and chloroalkene, chlorocyclohexane and chlorobenzene, toluene, xylene, nitrotoluene, ethylbenzene, styrene, dioxin, naphthalene, polycyclic aromatic hydrocarbons, and metabolism of xenobiotics by cytochrome P450). Further, the predicted phylotypes associated with functional genes early in each pathway were determined. Phylogenetic analysis indicated a greater diversity in the sediment compared to the groundwater samples. The most abundant genera for sediments/microcosms included Pseudomonas, Methylotenera, Rhodococcus, Stenotrophomonas, and Brevundimonas, and the most abundant for the groundwater/microcosms included Pseudomonas, Cupriavidus, Azospira, Rhodococcus, and unclassified Burkholderiaceae. Genes from all twelve of the KEGG pathways were predicted to occur. Seven pathways contained less than twenty-five genes. The predicted genes were lowest for xenobiotics metabolism by cytochrome P450 and ethylbenzene biodegradation and highest for benzoate biodegradation. Notable trends include the occurrence of the first genes for trinitrotoluene and 2,4-dinitrotoluene degradation. Also, the complete path from toluene to benzoyl-CoA was predicted. Twenty-two of the dioxin pathway genes were predicted, including genes within the first steps. The following phylotypes were associated with the greatest number of pathways: unclassified Burkholderiaceae, Burkholderia-Caballeronia-Paraburkholderia, Pseudomonas, Rhodococcus, unclassified Betaproteobacteria, and Polaromonas. This work illustrates the value of PICRUSt2 for predicting biodegradation potential and suggests that a subset of phylotypes could be important for the breakdown of organic contaminants or their metabolites. KEY POINTS: • The approach is a low-cost alternative to shotgun sequencing. • The genes and phylotypes encoding for xenobiotic degradation were predicted. • A subset of phylotypes were associated with many pathways.

Effectiveness of the "Mente Sana [Healthy Mind]" Cognitive Training Program for Older Illiterate Adults with Mild Cognitive Impairment.

Aging can lead to functional and cognitive alterations, sometimes limiting older adults in their social development, especially illiterate groups of older adults who receive poor attention from healthcare systems. In this context, the present investigation proposes the cognitive training program "MENTE SANA [HEALTHY MIND]" to improve the cognitive functions of illiterate older adults in Arequipa (Peru). It is a type of quasi-experimental research with a pre-test/post-test design with a homogenous control group. The sample was made up of adults 60 years old and above and of female gender. The Montreal Cognitive Assessment (MoCA) test was used to detect the level of cognitive decline in illiterate older adults. The 50-sessions program was applied to all the older adults with mild cognitive impairment that were selected for the study, on a daily basis. It was found that the tested group improved their cognitive functions compared to the control group. These results help to propose adapted cognitive training programs for illiterate people.

Impact of cytomegalovirus infection on B cell differentiation and cytokine production in multiple sclerosis.

BACKGROUND: Human cytomegalovirus (HCMV) infection has been recently associated with a low risk of multiple sclerosis (MS), yet the basis behind this observation remains uncertain. In this study, we aimed to determine in MS patients whether HCMV induces modifications in the peripheral B cell compartment. METHODS: HCMV serostatus was determined in 73 MS patients (55 relapsing-remitting MS (RRMS); 18 progressive MS (PMS)) and 30 healthy controls, assessing their B cell immunophenotype and cytokine production (GM-CSF, IL-6, IL-10, and TNFα) by flow cytometry. RESULTS: HCMV seropositivity in untreated MS patients (n = 45) was associated with reduced switched memory B cells, contrasting with an opposite effect in PMS. Expansions of transitional B cells were observed in HCMV(+) IFNß-treated RRMS patients but not in HCMV(-) cases (p < 0.01), suggesting that HCMV may influence the distribution of B cell subsets modulating the effects of IFNß. Considering the B cell functional profile, HCMV(-) PMS displayed an increased secretion of proinflammatory cytokines (IL-6, TNFα) as compared to HCMV(+) PMS and RRMS cases (p < 0.001). CONCLUSIONS: Our study reveals an influence of HCMV infection on the phenotype and function of B cells, promoting early differentiation stages in RRMS and reducing the proinflammatory cytokine profile in advanced MS forms, which might be related with the putative protective role of this virus in MS.

Effects of In-Person Assistance vs Personalized Written Resources About Social Services on Household Social Risks and Child and Caregiver Health: A Randomized Clinical Trial.

Importance: Social and economic contexts shape children's short- and long-term health. Efforts to address contextual risk factors are increasingly incorporated into pediatric health care. Objective: To compare the effectiveness of 2 social risk-related interventions. Design, Setting, and Participants: This randomized clinical trial included English- and/or Spanish-speaking caregiver-child dyads recruited from a pediatric urgent care clinic nested in a large, urban, safety-net hospital. Study recruitment, enrollment, and follow-up were conducted from July 18, 2016, to March 8, 2019. Data analysis was conducted from January 1, 2019, to January 20, 2020. Interventions: Following standardized social risk assessment, caregivers were randomly assigned to receive either written information regarding relevant government and community social services resources or comparable written information plus in-person assistance and follow-up focused on service access. Main Outcomes and Measures: Caregiver-reported number of social risk factors and child health 6 months after enrollment. Results: Among 611 caregiver-child dyads enrolled in the study, 302 dyads were randomized to the written resources group and 309 dyads were randomized to the written resources plus in-person assistance group. The mean (SD) age of children was 6.1 (5.0) years; 483 children (79.1%) were Hispanic; and 315 children (51.6%) were girls. There were no significant differences between groups in the effects of the interventions. In post hoc secondary analyses, the number of reported social risks decreased from baseline to 6-month follow-up in both groups: caregivers who received written resources alone reported a mean (SE) of 1.28 (0.19) fewer risks at follow-up, while those receiving written resources plus in-person assistance reported 1.74 (0.21) fewer risks at follow-up (both P < .001). In both groups, there were small but statistically significant improvements from baseline to follow-up in child health (mean [SE] change: written resources, 0.37 [0.07]; written resources plus in-person assistance, 0.24 [0.07]; both P < .001). Conclusions and Relevance: This randomized clinical trial compared 2 approaches to addressing social risks in a pediatric urgent care setting and found no statistically significant differences in the social risk and child and caregiver health effects of providing written resources at the point of care with vs without in-person longitudinal navigation services. Caregivers in both groups reported fewer social risks and improved child and caregiver health 6 months after the intervention. These findings deepen understanding of effective doses of social risk-related interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT02746393.

Adaptive Features of Natural Killer Cells in Multiple Sclerosis.

Human cytomegalovirus (HCMV) has been recently related with a lower susceptibility to multiple sclerosis (MS). HCMV promotes an adaptive development of NK cells bearing the CD94/NKG2C receptor with a characteristic phenotypic and functional profile. NK cells are proposed to play an immunoregulatory role in MS, and expansion of the NKG2C(+) subset was recently associated with reduced disability progression. To further explore this issue, additional adaptive NK cell markers, i.e., downregulation of FcεRIγ chain (FcRγ) and PLZF transcription factor, as well as antibody-dependent NK cell activation were assessed in controls and MS patients considering HCMV serology and clinical features. In line with previous reports, increased proportions of NKG2C(+), FcRγ(-), and PLZF(-) CD56dim NK cells were found in HCMV(+) cases. However, PLZF(-) NK cells were detected uncoupled from other adaptive markers within the CD56bright subset from HCMV(+) cases and among CD56dim NK cells from HCMV(-) MS patients, suggesting an additional effect of HCMV-independent factors in PLZF downregulation. Interferon-ß therapy was associated with lower proportions of FcRγ(-) CD56dim NK cells in HCMV(+) and increased PLZF(-) CD56bright NK cells in HCMV(-) patients, pointing out to an influence of the cytokine on the expression of adaptive NK cell-associated markers. In addition, proportions of NKG2C(+) and FcRγ(-) NK cells differed in progressive MS patients as compared to controls and other clinical forms. Remarkably, an adaptive NK cell phenotype did not directly correlate with enhanced antibody-triggered degranulation and TNFα production in MS in contrast to controls. Altogether, our results provide novel insights into the putative influence of HCMV and adaptive NK cells in MS.

High Numbers of Circulating CD57+ NK Cells Associate with Resistance to HER2-Specific Therapeutic Antibodies in HER2+ Primary Breast Cancer.

Natural killer (NK) cells can orchestrate effective antitumor immunity. The presence of tumor-infiltrating NK cells in diagnostic biopsies predicts pathologic complete response (pCR) to HER2-specific therapeutic antibodies in patients with primary breast cancer. Here, we analyzed whether diversity in circulating NK cells might influence tumor infiltration and HER2-specific therapeutic antibody efficacy. We found that numbers of circulating CD57+ NK cells inversely correlated with pCR to HER2-specific antibody treatment in patients with primary breast cancer independently of age, traditional clinicopathologic factors, and CD16A 158F/V genotype. This association was uncoupled from the expression of other NK-cell receptors, the presence of adaptive NK cells, or changes in major T-cell subsets, reminiscent of cytomegalovirus-induced immunomodulation. NK-cell activation against trastuzumab-coated HER2+ breast cancer cells was comparable in patients with high and low proportions of CD57+ NK cells. However, circulating CD57+ NK cells displayed decreased CXCR3 expression and CD16A-induced IL2-dependent proliferation in vitro Presence of CD57+ NK cells was reduced in breast tumor-associated infiltrates as compared with paired peripheral blood samples, suggesting deficient homing, proliferation, and/or survival of NK cells in the tumor niche. Indeed, numbers of circulating CD57+ were inversely related to tumor-infiltrating NK-cell numbers. Our data reveal that NK-cell differentiation influences their antitumor potential and that CD57+ NK cells may be a biomarker useful for tailoring HER2 antibody-based therapeutic strategies in breast cancer.