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Introducción La quimioterapia neoadyuvante (QTn) es una herramienta de uso cada vez más frecuente en el tratamiento del cáncer de mama. su repercusión es objetivada a partir de parámetros clínicos (examen físico y estudios por imagen) y parámetros anatomo-patológicos sobre la pieza quirúrgica. Existe variabilidad en el impacto de la Qt según el subtipo molecular. Este estudio evalúa el grado de respuesta (clínica y patológica) a la QTn de las pacientes con cáncer de mama subtipo luminal y la tasa de cirugías conservadoras en este subgrupo. Objetivo Describir la tasa de respuesta clínica y patológica obtenida en el subgrupo de pacientes luminales y evaluar la tasa de conversión a cirugía conservadora luego del tratamiento neoadyuvante. Material y método Se analizaron 220 historias clínicas pertenecientes a pacientes que realizaron neoadyuvancia en el periodo 2014-2017 en el Servicio de Patología Mamaria del Hospital Oncológico Marie Curie. Se incluyeron 78 pacientes con diagnóstico de carcinoma invasor subtipo luminal A y B, Her 2 negativas. Se evaluó la tasa de respuesta clínica, patológica y la tasa de cirugía conservadora. Resultados Se clasificaron como Luminal A el 26.9% (n=21) de las 78 pacientes, y Luminal B el 73.1% (n=57). La distribución por tamaño tumoral fue: T1 en el 1.25% (n= 1); T2 en 46.1% (n= 36); T3 en 37.2% (n=29) y T4 en el 15.4% (n=12) de los casos. No presentaban compromiso axilar (N0) el 24.3% de las pacientes (n=19), y se vio afectación ganglionar el 75.5 % (n= 59). El Estadio clínico más frecuente fue el III A (32% = 25 pacientes). El 60.3% (47 pacientes) de los casos tenía indicación de mastectomía de inicio y el 39.7% (41 pacientes) eran candidatas a cirugía conservadora. Posterior a la quimioterapia, se indicaron cirugías conservadoras en el 52.6 % (n=41) y mastectomía en el 47.4% (n=37), con una tasa de conversión a cirugía conservadora del 24.4%. La respuesta clínica completa fue del 28.2% (n=22) y la respuesta patológica completa del 16.6%. Conclusión Se observó una respuesta clínica y patológica acorde a la experiencia de otros centros, sobre todo en el subtipo luminal B, con una alta tasa de conversión a cirugía conservadora del 24.4%. Esto nos permite considerar la quimioterapia neoadyuvante como una opción de tratamiento válida para aquellas pacientes con cáncer de mama subtipo luminal B- Her 2 negativa.
Introduction Neoadjuvant chemotherapy (QTn) is a tool that is increasingly used in the treatment of breast cancer. its repercussion is objectified based on clinical parameters (physical examination and imaging studies) and anatomo-pathological parameters on the surgical specimen. There is variability in the impact of Qt according to the molecular subtype. This study evaluates the degree of response (clinical and pathological) to the QTn of patients with luminal subtype breast cancer and the rate of conservative surgeries in this subgroup. Objective To describe the clinical and pathological response rate in the subgroup of luminous patients and to evaluate the conversion rate in a conservative surgery after neoadjuvant treatment. Material and method We will analyze 220 clinical records belonging to patients that developed during the 2014-2017 period in the Breast Pathology Service of the Marie Curie Oncology Hospital. We included 78 patients with a diagnosis of invasive carcinoma luminal subtype A and B, their 2 negative. The clinical and pathological response rate and the rate of conservative surgery in each group were evaluated. Results Luminal A was classified as 26.9% (n = 21) of the 78 patients, and Luminal B was 73.1% (n = 57). The distribution by tumor size was: T1 at 1.25% (n = 1); T2 at 46.1% (n = 36); T3 in 37.2% (n = 29) and T4 in 15.4% (n = 12) of the cases. There is no axillary involvement (N0) in 24.3% of the patients (n = 19), and the ganglion was affected 75.5% (n = 59). The most frequent clinical stage was III A (32% = 25 patients). Sixty-three percent (47 patients) of the cases had an initial mastectomy indication and 39.7% (41 patients) were candidates for conservative surgery. After chemotherapy, conservative surgeries were indicated in 52.6% (n = 41) and mastectomy in 47.4% (n = 37), with a conversion rate to conservative surgery of 24.4%. The complete clinical response was 28.2% (n = 22) and the complete pathological response was 16.6%. Conclusion A clinical and pathological response was observed according to the experience of other centers, especially in luminal subtype B, with a high conversion rate to conservative surgery of 24.4%. This allows us to consider neoadjuvant chemotherapy as a valid treatment option for those patients with luminal B-Her 2 negative breast cancer.
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Humans , Female , Breast Neoplasms , Neoadjuvant Therapy , Drug TherapyABSTRACT
Objective:To evaluate the antibacterial activity and neuroprotective capacity of the ethanolic and aqueous extracts of Tarenaya spinosa (T.spinosa) as well as to determine and quantify some of its polyphenols by high performance liquid chromatography with diode-array detection (HPLC-DAD).Methods:The bacterial Escherichia coli,Staphylococcus aureus and Pseudomonas anuginosa strains,grown in Heart Agar Infusion,were tested.The drugs gentamicin,norfloxacin and imipenem were used to evaluate the modulating or antagonistic capacity of the T.spinosa extracts.The extract was analysed by HPLC-DAD to determine the main phenolic compounds.For the cell viability tests.individual heads of the Nauphoeta cinerea arthropod model were removed,homogenized in Trifluoromethyl ketone and centrifuged afterwards.Subsequently,20 μL of NaNO2 were added to the biological material,except in the control group,to evaluate the protection capacity of the extracts.The homogenate of the insect heads was incubated for 2 h in tubes containing tetrazolium bromide.Results:HPLC-DAD demonstrated that the ethanolic extract of T.spinosa presented caffeic acid as the major compound.The ethanolic extract also showed neuroprotective effects at concentrations ≥ 10 μg/mL,while aqueous extract was shown to have a protective effect only at the concentration of 100 μg/ mL.The aqueous extract demonstrated a clinically relevant antibacterial activity against the Staphylococcus aureus multidrug resistant strain-MDR,with MIC 512 μg/mL.However,when the extracts were associated with gentamicin and imipenem,a synergism was detected against Staphylococcus aureus and Escherichia coli MDR strains.Conclusions:Although it does not present an antibacterial action,the extracts of T.spinosa can be used in the pharmaceutical industries since its extracts show modulating action of drugs.Besides,these natural products have neuroprotective capacity.
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Myeloperoxidase (MPO) is released from activated neutrophils.The inflammation in preeclampsia was found to be associated with endothelial dysfunction.We hypothesized that cardiac and circulating MPO levels are elevated in hypertensive pregnancy.Systolic and diastolic blood pressure and heart rate were measured on pregnancy days 14,16,18 and 20 in normal pregnant and hypertensive pregnant rats.Left and right ventricle weights,the number of viable fetuses,litter size,fetal and placenta weights were recorded on gestational day 21.Circulating and cardiac MPO activities,soluble fms-like tyrosine kinase-1 (sFlt-1) and vascular endothelial growth factor (VEGF) and nitric oxide (NO) were detected.The results showed increases in cardiac (left,but not right ventricle) and circulating MPO activities,and concomitantly lower number of viable fetuses,litter size,and fetal and placenta weights,and decreases in NO in hypertensive pregnant rats.Also,the increases in circulating sFlt-1 and VEGF were found in hypertensive pregnant group.In conclusion,maternal and fetal detrimental changes along with increases in circulating sFlt-1 and VEGF in hypertensive pregnancy may be associated with increases in cardiac and circulating MPO activities,confirming the causative role of inflammatory response in preeclampsia.