Cáncer de mama Her2-positivo: Terapias sistémicas actuales y experiencia local

El cáncer de mama (CM) es la primera causa de muerte por cáncer en mujeres tanto a nivel mundial como en Chile. Basados en características clínicas, histológicas y moleculares, múltiples estudios han identificado cuatro subtipos básicos de CM, los cuales están asociados a estrategias de tratamiento específicas y diferenciadas. El CM HER2-positivo representa un 15%-25% de todas las neoplasias mamarias y se caracteriza por su agresividad, recurrencia temprana y mayor tendencia a presentar compromiso del sistema nervioso central. En las últimas décadas, nuevas terapias dirigidas se han posicionado como el estándar de tratamiento y han cambiado la historia natural de esta enfermedad, transformándola en una enfermedad potencialmente curable incluso en etapas avanzadas. Esta revisión busca entregar un resumen de las bases biológicas de esta enfermedad. Por otro lado, dada la aparición de un creciente número de nuevas estrategias de manejo sistémico, nos proponemos revisar sus mecanismos de acción analizando reportes de datos clínicos publicados y la experiencia de nuestro grupo.

Breast cancer (BC) is the leading cause of cancer death for women both worldwide and in Chile. Based on clinical, histological, and molecular features, studies have identified four BC subtypes that correlate with treatment sensitivity. Human Epidermal growth factor Receptor type 2-positive (HER2+) BC represents 15%-25% of newly diagnosed breast neoplasms; HER2+ BC is characterized by its aggressive behavior, early recurrence, and higher risk of brain metastasis. In recent years, HER2-targeted therapies have become the mainstay of treatment and have redefined the natural history of this subtype, reducing relapse rates for early-stage patients and increasing survival in advanced-stage patients. Herein we review novel treatment strategies and their mechanisms of action, along with clinical and real-world data. We also provide a summary of currently available treatments for this subtype and our local experience regarding the management of this disease.

Evaluation of the Thermophysical, Sensory, and Microstructural Properties of Colombian Coastal Carimañola Obtained by Atmospheric and Vacuum Frying.

The quality of fried products affects consumer purchase decisions, and frying is an important stage in the production process. The objective of this research was to evaluate the thermophysical properties, the sensory quality, and microstructure of Colombian coastal Carimañola traditionally manufactured, in atmospheric frying and vacuum frying conditions. Lower moisture and fat content were reported in samples fried under vacuum compared to samples fried under atmospheric conditions, which is associated with the vacuum pressure during the process. Thermophysical properties, related to heat transfer in the samples, showed a correlation between thermal conductivity and moisture content. The micrographs visualized the changes in the porous structure of the coastal Carimañola. A greater effect was evidenced in the samples obtained by atmospheric frying because higher temperatures were used. The sensory evaluation reflected a preference for Carimañolas made with conventional frying. This research provides a basis for consumer purchases of traditionally fried products made with vacuum frying.

Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study.

BACKGROUND: As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. METHODS: In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. RESULTS: Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively). CONCLUSIONS: Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.

Cáncer de mama triple negativo: terapias sistémicas actuales y experiencia local / Triple negative breast cancer: current systemic therapy and local experience

Resumen El cáncer de mama (CM) es la principal causa de muerte por cáncer en mujeres chilenas. Es una enfermedad heterogénea, en la cual se han identificado cuatro subtipos básicos, determinados según características clínicas, histológicas y moleculares, los que se relacionan a estrategias terapéuticas. El CM triple negativo (CMTN) se caracteriza por su agresividad, recaída temprana y mayor tendencia a presentarse en etapas avanzadas. Frecuentemente afecta a mujeres jóvenes o con antecedentes familiares de CM u ovario. La única terapia sistémica aprobada para el CMTN es la quimioterapia; sin embargo, recientemente terapias moleculares con inhibidores de puntos de control inmune e inhibidores de la poli-adenosina difosfato ribosa polimerasa, han mostrado eficacia en pacientes seleccionados, y se han agregado al arsenal terapéutico para CMTN. Dada la aparición de estas nuevas estrategias, parece relevante entender la heterogeneidad de esta enfermedad, los mecanismos de acción de las nuevas terapias, resultados clínicos y criterios de selección de pacientes para terapias moleculares. Presentamos una revisión de la terapia sistémica actual del CMTN.

Breast cancer is the leading cause of cancer death in Chilean women and worldwide. It is a heterogeneous disease and four different subtypes have been identified based on clinical, histological and molecular features, which correlate with different treatment tumor sensitivity. Triple negative breast cancer is characterized by its aggressiveness, early relapse, and a greater tendency to present in advanced stages. It frequently affects young women, with cancer family history, especially breast or ovarian cancer. The approved systemic therapy for triple negative breast cancer is chemotherapy; however, recently, targeted therapies with checkpoint inhibitors and polyadenosine diphosphate ribose polymerase inhibitors have been shown to be effective in selected patients and have been added to the therapeutic arsenal for triple negative breast cancer. Given the appearance of these new strategies, it seems relevant to understand the heterogeneity of this disease, the mechanisms of action behind new therapies, clinical results, and the criteria to select patients for molecular therapies. We present a review of the current systemic therapy of this breast cancer subtype.

Mass Transfer and Colour Analysis during Vacuum Frying of Colombian Coastal Carimañola.

This study is aimed at analysing the effect of vacuum frying on the kinetic parameters of mass transfer, the CIE L ∗ a ∗ b ∗ colour parameters of the Carimañola. For the kinetic analysis, the moisture and oil content were measured by means of an experimental design consisting of two factors: frying time with seven levels (60, 120, 180, 240, 300, 420, and 540 s) and frying temperature with three levels (120, 130, and 140°C). The diffusivity coefficient, the moisture transfer rate, and the oil adsorption rate, with their respective activation energies, were calculated. For the colour analysis, the reflectance technique was used to determine the colour coordinates of the CIE L ∗ a ∗ b ∗ space, and the general colour change was calculated (ΔE). Concerning the kinetics, the increase in temperature and frying time reduced the moisture content, while the oil content decreased with the increase in temperature and increases with frying time. The diffusivity ranged from 1, 238 × 10-6 m2/s at 120°C to 2, 84 × 10-6 m2/s at 140°C. The mass transfer coefficients for moisture ranged from 2 × 10-4 m/s at 120°C to 4 × 10-4 m/s at 140°C. The values of the oil uptake rate were from 0.0022 s-1 at 120°C to 0.0018 s-1 at 140°C. Finally, the luminosity parameter shows a decrease with the increase in temperature, although the first 240 s shows a rise and then begins to decrease. Vacuum frying allowed Carimañolas to be obtained with a lower oil and moisture content, with an appropriate colouring, eye-catching and visually attractive to consumers.

Experiencia del Policlínico De Medicina Complementaria Hospital-CRS El Pino, USACH / Experience of the Complementary Medicine Polyclinic Hospital-CRS El Pino, USACH

Durante el año 2013 comienza a funcionar el Policlínico de Medicina Complementaria en el Campus Hospital y CRS El Pino - USACH con la implementación de la terapia de SP.

Interacciones neuroinmunológicas en el ictus / Neuroimmunological interactions in stroke

Introducción: El ictus es una de las principales causas de mortalidad en el mundo y debido al incremento en la expectativa de vida su incidencia va en aumento; sin embargo, el desarrollo de nuevos medicamentos con utilidad clínica ha sido prácticamente nulo, por lo que hasta la fecha el tratamiento de estos pacientes es muy limitado. Desarrollo: La evidencia básica y clínica en el área señala que tras un infarto cerebral se producen una serie de cambios neuroquímicos, entre los que se encuentran: la depleción energética, la producción de radicales libres, la acumulación de calcio, la desregulación de neurotransmisores, la excitotoxicidad, y de manera tardía, la activación del sistema inmune caracterizada como inflamación. Esta respuesta del sistema inmunológico ha mostrado ser un evento central en la progresión de la patología, en el que destaca la participación de las citocinas proinflamatorias como TNF, que aumentan el daño por excitotoxicidad y por acumulación de calcio, favorecen la formación de radicales libres y en general promueven la muerte celular. Por otro lado, algunas citocinas antiinflamatorias como IL-10 e IL-4 han mostrado tener efectos neuroprotectores e incluso favorecen la recuperación de sinapsis y la neurogénesis, haciendo de la modulación de la respuesta inmunológica un área con mucho potencial terapéutico. Conclusiones: El entendimiento de las relaciones entre el sistema inmunológico y el sistema nervioso no solo nos permite entender con mayor profundidad el fenómeno del ictus, sino que también nos ofrece un nuevo arsenal de estrategias diagnósticas, pronósticas y terapéuticas que podrían mejorar la calidad de vida de las personas aquejadas por esta terrible enfermedad

Introduction: Stroke is one of the leading causes of death in the world; its incidence is increasing due to increased life expectancy. However, treatment options for these patients are limited since no clinically effective drugs have been developed to date. Development: According to clinical evidence, a number of neurochemical changes take place after stroke, including energy depletion, increased free radical synthesis, calcium accumulation, neurotransmitter imbalance, excitotoxicity, and, at a later stage, immune system activation leading to inflammation. Immune response has been shown to be a major factor in disease progression. The release of proinflammatory cytokines such as TNF increase brain damage secondary to excitotoxicity and calcium accumulation, and promote free radical synthesis and cell death through various mechanisms. On the other hand, certain anti-inflammatory cytokines, such as IL-10 and IL-4, have been shown to have a neuroprotective effect and even promote neurogenesis and synapse remodeling, which makes immune modulation a promising treatment approach. Conclusions: Understanding the relationship between the immune system and the nervous system not only deepens our knowledge of stroke but also provides new diagnostic, prognostic, and therapeutic strategies that may increase the quality of life of stroke patients

Neuroimmunological interactions in stroke. / Interacciones neuroinmunológicas en el ictus.

INTRODUCTION: Stroke is one of the leading causes of death in the world; its incidence is increasing due to increased life expectancy. However, treatment options for these patients are limited since no clinically effective drugs have been developed to date. DEVELOPMENT: According to clinical evidence, a number of neurochemical changes take place after stroke, including energy depletion, increased free radical synthesis, calcium accumulation, neurotransmitter imbalance, excitotoxicity, and, at a later stage, immune system activation leading to inflammation. Immune response has been shown to be a major factor in disease progression. The release of proinflammatory cytokines such as TNF increase brain damage secondary to excitotoxicity and calcium accumulation, and promote free radical synthesis and cell death through various mechanisms. On the other hand, certain anti-inflammatory cytokines, such as IL-10 and IL-4, have been shown to have a neuroprotective effect and even promote neurogenesis and synapse remodeling, which makes immune modulation a promising treatment approach. CONCLUSIONS: Understanding the relationship between the immune system and the nervous system not only deepens our knowledge of stroke but also provides new diagnostic, prognostic, and therapeutic strategies that may increase the quality of life of stroke patients.

Fabrication of Silver Nanoparticles Using a Gas Phase Nanocluster Device and Preliminary Biological Uses.

Nanoparticles can be used in a large variety of applications, including magnetic sensing, biological, superconductivity, tissue engineering, and other fields. In this study, we explore the fabrication of gas phase silver nanoparticles using a sputtering evaporation source. This setup composed of a dual magnetron cluster source holds several advantages over other techniques. The system has independent control over the cluster concentration and a wide range of cluster size and materials that can be used for the clusters and for the matrix where it can be embedded. Characterization of these silver nanoparticles was done using transmission electron microscopy (TEM). We obtain a lateral width of 10.6 nm with a dispersion of 0.24 nm. With atomic force microscopy (AFM) a Gaussian fit of this distribution yields and average height of 6.3 nm with a standard deviation of 1.4 nm. We confirm that the deposited silver nanoparticles have a homogenous area distribution, that they have a defined shape and size distribution, and that they are single standing nanoparticles. Given that the scientific literature is not precise regarding the toxic concentration of the nanoparticles, devices such as ours can help clarify these questions. In order to explore further biological applications, we have done preliminary experiments of cell spreading (myoblast adhesion), obtaining interesting morphological changes correlated with the silver concentration on the surface. With a deposited silver concentration ranging from 100⁻620 ng/cm², the cells showed morphological changes in a short time of 2 h. We conclude that this high precision nanoparticle fabrication technique is adequate for further biological research.

Diferencias en el diagnóstico de cáncer de mama en menores de 40 años en tres sectores del sistema de salud / Difference at the time of diagnosis of breast cancer under age 40 between three sectors of the health system

Introducción El cáncer de mama en mujeres menores de 40 años es una patología que, aunque poco frecuente ­alrededor del 5 al 7% de los cánceres­, presenta una mortalidad del 47%. Se diagnostica en estadios más avanzados y es de peor pronóstico, siendo la edad el principal factor pronóstico desfavorable. El programa nacional de detección de cáncer de mama del Instituto Nacional del Cáncer (inc) recomienda solicitar la primera mamografía de screening a los 35 años y con una perioricidad anual a partir de los 40 años. Objetivo Con este estudio, se pretende identificar si existe diferencias al momento del diagnóstico de cáncer de mama en menores de 40 años entre tres sectores del sistema de salud en nuestro país. Material y método Se trata de un estudio descriptivo, de corte transversal. Se enfoca el estudio desde tres áreas: el sector público (Hospital Parmenio Piñero), el sector de obras sociales (Obra Social de Empleados de Comercio ­osecac­) y el sector privado (consultorio del Dr. Gerardo Müller Perrier). Se realizó una revisión de historias clínicas de las pacientes que fueron atendidas entre los años 2005 y 2015 en los tres sectores mencionados. La población abarcó a 1.761 pacientes, y la muestra final quedó conformada por 89 pacientes: 29 del sector público, 31 del sector de obras sociales y 29 de consultorio privado. Bases de datos utilizadas: Pubmed, md Consult, rima. Años de búsqueda: 2005-2015. Resultados La incidencia hallada fue del 5%, siendo la más alta la del sector de la obra social: 7,2%. La franja etaria más frecuente fue la comprendida entre los 36 y 39 años, con el 51%. El 67% de las pacientes no tenían antecedentes familiares. El motivo de consulta más frecuente ­69%­ fue el nódulo palpable. En el sector privado, el 42% consultó por control. Habia realizado mamografía de screening solo el 24% en la serie general pero el 42% en el sector privado. El 21% tenía ecografía de screening pero complementaria a la mamografía. El tipo histológico más frecuente ­78%­ fue¨el Carcinoma Ductal Invasor (cdi). El Carcinoma Ductal In Situ (cdis ) fue del 24% en el sector privado y de menos del 10% en los otros dos sectores. El Triple Negativo (tn) se presentó en el 32% de la serie general, seguido del Luminal A (la) en el 30%. En cuanto a estadios avanzados al diagnóstico, el resultado fue del 50% entre EIIB-IIIA, mientras que el Estadio O fue más frecuente en el sector privado: 17%. Encontramos una sobrevida global de 104 meses (ic 95% 89-119); y comparando los tres grupos, el tiempo de sobrevida fue mayor para el sector privado (p < 0,001). Pero cuando analizamos la sobrevida según el método de screening, no encontramos diferencias. Conclusiones Los distintos estilos de vida en los diferentes sectores de nuestro estudio generan conductas diferentes en cuanto a participar de estudios de screening y de prevención secundaria para el cáncer de mama, circunstancia que atribuimos a la disparidad en la información y en el conocimiento respecto del tema. Recomendamos que el examen clínico y el autoexamen sean impulsados por los profesionales de la salud a partir de edades precoces como herramientas útiles en la detección temprana, especialmente en esta población.

Introduction The breast cancer in women under 40 years old is a rare pathology, about 5 to 7%, with a mortality rate of 47%. It is diagnosed at more advanced stages and it´s of worse prognosis. The age is main factor unfavorable prognosis. The national breast cancer screening program recommends to request the first screening mammogram at age 35 and annually starting at age 40. Objectives This study aims to identify if there is difference at the time of diagnosis of breast cancer under age 40 between three sectors of the health system. Materials and method This is a descriptive, cross-sectional study. This study focuses in three areas: public sector (Hospital Parmenio Piñero), social security sector (osecac) and the private sector (clinic of Dr. Gerardo Müller Perrier). By reviewing the medical records of patients who were treated between 2005-2015 in the three sectors mentioned, the population was formed by 1.761 and the final sample was conformed by 89 patients: 29 of public sector, 31 of social security sector and 29 of private clinics. Results The incidence found was of 5%, the more high in the sector of the work social: 7.2%. Strip age more common were 36 to 39 years with 51%. 67% of the patients did not have a family history of cancer. Frequently the reason of medical visit was nodule palpable (69%); in the private sector, 42% looked for control. Only 24% had mammography in screening in the series general, but 42% in the sector private. 21% had ultrasound for screening but always with the mammography. cdi was the commonest histological type: 78%; dcis was 24% in private sector and less than 10% in the other two sectors. tn was present in 32% of the overall series, followed by la with the 30%. Advanced stage to the diagnostics was 50% between EIIB-IIIA, while Stage O was 17% more frequent in the private sector. We found a global survival of 104 months (95% ci 89-119); comparing the three groups, the survival time was higher for the private sector (p < 0.001). But when we analyzed the survival according to the screening method, we found no differences. Conclusions The different lifestyles in the different sectors of our study generate a different way to participate in studies of screening and secondary prevention of breast cancer; we attribute this to the disparity between the information and the knowledge in this regard. We recommend that clinical examination and self-examination shut driven for professionals in health, from the early ages, as an useful early detection tools, particularly in this population.

Cáncer de mama avanzado receptor de estrógeno positivo: manejo sistémico actual / Systemic therapy for estrogen receptor positive advanced breast cancer

El cáncer de mama es la primera causa de muerte por cáncer en mujeres chilenas. Mientras la mayoría de las personas logra curarse de esta enfermedad, un 5% de los casos se presenta inicialmente con enfermedad avanzada y hasta un 20-30% de pacientes con enfermedad localizada pueden sufrir recurrencias sistémicas. La mayoría de las neoplasias mamarias son dependientes del estímulo estrogénico, de allí que la deprivación de estrógenos es la principal estrategia terapéutica. Recientemente, el uso de terapias molecularmente dirigidas en combinación con la terapia endocrina ha logrado mejorar los resultados de sobrevida del cáncer de mama avanzado, con menos efectos colaterales que aquellos producidos por la quimioterapia convencional. El conocimiento de los mecanismos de acción de estas nuevas terapias, sus toxicidades, vías de resistencia y selección de pacientes para lograr los mejores beneficios terapéuticos son aspectos relevantes en el manejo de la enfermedad. Presentamos una revisión del estado actual del manejo del cáncer de mama metastásico hormonodependiente con enfásis en el uso de terapias endocrinas combinadas con terapias moleculares.

Breast cancer is the leading cause of cancer death in Chilean women. While most patientes are cured, five percent of cases present with advanced disease initially and up to 20-30% of patients with localized disease may suffer systemic recurrences. The majority of breast neoplasms are dependent on the estrogenic stimulus, hence the deprivation of estrogen is the main therapeutic strategy. Recently, the use of molecular targeted therapies in combination with endocrine therapy has been successful in improving the survival outcomes of advanced breast cancer, with fewer side effects than those produced by conventional chemotherapy. Knowledge of the mechanisms of action of these new therapies, their toxicities, resistance pathways and patient selection to achieve the best therapeutic benefits are relevant aspects in the management of the disease. We present a review of the current state of management of hormone-dependent metastatic breast cancer with emphasis on the use of endocrine therapies combined with molecular therapies.

Aplicación de tres modelos pronósticos en cáncer de mama precoz / Application of three prognostic models in T1N0M0 breast cancer

Resumen Objetivo Aplicar tres modelos pronósticos "online" (índice pronóstico de Nothingham (NPI), Adjuvantonline! (AO) y PREDICT utilizados en la práctica oncológica para estratificar a pacientes y definir el uso de terapias adyuvantes en pacientes con cáncer de mama (CM) precoz, para evaluar su correlación y predicción de sobrevida en nuestra población. Métodos Obtuvimos datos clínicos de pacientes con CM invasor T1N0M0, tratados en el Centro de Cáncer de la Pontificia Universidad Católica de Chile, Santiago, Chile, desde enero de 1997 hasta diciembre de 2003. Resultados Analizamos datos de 125 pacientes. Edad mediana fue 55 años (35-80). La mayoría de los tumores fueron carcinomas ductales infiltrantes (72,8%), receptor de estrógeno (RE) positivos (88,8%), 80% recibieron terapia endocrina (TE). El beneficio estimado de la TE y la quimioterapia (QT) en la sobrevida global (SG), determinadas según AO y PREDICT, no fueron significativamente diferentes (1,3% y 1% para QT, p = 0,13; 0,9% y 1% para TE, p = 0,8; respectivamente). El modelo NPI estimó una mediana de SG superior (96%) a la calculada por AO (90,9%) y PREDICT (92,5%). La mortalidad específica por CM fue de 3%, similar a lo observado (3,2%). La mediana de SG estimada por todos los modelos en el grupo de pacientes fallecidos no fue estadísticamente diferente al grupo de sobrevivientes (p = 0,85). Conclusión Los modelos pronósticos predicen apropiadamente la SG en pacientes con CM precoz; sin embargo, en esta serie, no discriminaron pacientes de mal pronóstico.

Objective Apply three prognostic models "online" (Nothingham index (NPI), Adjuvantonline! (AO) and PREDICT used in routine oncology practice in order to stratify patients and define the use of adjuvant therapies in patients with stage I breast cancer (BC) to evaluate its correlation and overall survival (OS) in our population. Methods We obtained patients' medical records data with invasive BC T1N0M0, treated at the Cancer Center of the Pontificia Universidad Católica de Chile, Santiago, Chile, from January 1997 to December 2003. Results We analyzed data from 125 patients. Median age was 55 years (35 80). Most tumors were infiltrating ductal carcinoma (72.8%), estrogen receptor positive (88.8%), 80% received endocrine therapy (ET). The estimated ET and chemotherapy benefit was not significantly different according to the AO and PREDICT models (1.3% and 1% for CT, p = 0.13, 0.9% and 1% for ET p = 0.8, respectively). The estimated median OS on NPI (96%) was higher than calculated by AO (90.9%) and PREDICT (92.5%). Interestingly disease specific mortality estimated was 3%, similar to that observed (3.2%). While the estimated median OS by all models in the group of deceased patients was lower than in surviving, this difference did not reach statistical significance (p = 0.85). Conclusion The prognostic models applied effectively predict OS in Chilean patients with T1N0M0 BC, but in this series, they do not sufficiently discriminate patients with poor prognosis. The addition of co -morbidities to AO does not alter the results.

Pruebas estadísticas utilizadas en revistas odontológicas de la red SciELO / Statistical methods used in dental journals of SciELO networks

Introducción: El objetivo de este estudio fue analizar las revistas odontológicas de la red SciELO y evaluar los métodos estadísticos utilizados en artículos originales de investigación. Material y método: Se realizó una revisión bibliométrica descriptiva. Fueron incluidos todos los artículos originales publicados en revistas odontológicas indexadas en la red SciELO entre los años 2013 y 2014. La evaluación abarcó 4.262 artículos, y a través de un muestreo aleatorio estratificado por asignación proporcional se seleccionaron 309 artículos. Se evaluó el número y tipos de métodos estadísticos empleados. Resultados: Los métodos paramétricos fuero los análisis estadísticos principalmente empleados. Los más frecuentes correspondieron a las pruebas post-hoc (n= 110) (prueba de Tukey), seguido del modelo lineal (n= 84) y de la prueba t para muestras independientes (n= 29). En cuanto a los métodos no paramétricos, la prueba chi cuadrado de Pearson fue la más frecuentemente utilizada (n= 46), seguida de la prueba KruskalWallis (n= 42) y la prueba U Mann-Whitney (n= 27). La estadística descriptiva se observó en 112 de los artículos analizados. Conclusiones: Los métodos estadísticos más comúnmente utilizados en revistas SciELO del área odontológica fueron las pruebas de estadística inferencial, como post hoc, ANOVA, prueba t para muestras independientes, pruebas de Pearson Chi-cuadrado, Kruskal-Wallis y Mann-Whitney. Esta investigación proporciona una evidencia objetiva de lo que debe ser enseñado para mejorar la comprensión de la literatura dental desde una perspectiva bioestadística. Con esto, además de comprender claramente la información de los trabajos científicos, podríamos tomar mejores decisiones clínicas (AU)

Introduction: The aim of this study was to analyze the SciELO dental journals and evaluate what statistical methods were being used in their original research articles. Material and method: A descriptive bibliometric review was performed. All original articles published in the dental journals indexed in the SciELO database between 2013 and 2014 were included. The evaluation covered 4262 articles, and through a stratified random sampling by proportional allocation 309 articles were selected. The number and types of statistical methods employed were evaluated. Results: Parametric methods were the mainly statistical analyzes employed. The most frequent were the PostHoc tests (n= 110) (Tukey test), followed by one-way ANOVA (n= 84) and the independent-samples t-test (n= 29). Regarding the non-parametric methods, Pearson Chi-Square test was the most frequent (n= 46), followed by the Kruskal-Wallis test (n= 42) and Mann-Whitney U test (n= 27). Descriptive statistics was observed in 112 of the articles. Conclusions: The statistical methods most commonly used in SciELO dental journals were inferential statistics such as Post Hoc tests, ANOVA, t-test for independent samples, Pearson chi-square, Kruskal-Wallis, and MannWhitney U tests. This research provides an objective evidence of what ought to be taught to improve understanding of the dental literature from a biostatistics perspective. With this, in addition to clearly understand what give us the scientific papers, we could take better clinical decisions (AU)

[Impact of secondary prophylaxis in the management of patients with high recurrence risk of urolithiasis]. / Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva.

UNLABELLED: In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. AIM: To report the evolution of these patients after 5 years of follow-up. PATIENTS AND METHODS: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. RESULTS: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. CONCLUSIONS: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up.

Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva / Impact of secondary prophylaxis in the management of patients with high recurrence risk of urolithiasis

In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. Aim: To report the evolution of these patients after 5 years of follow-up. Patients and Methods: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. Results: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. Conclusions: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up.

Reproducibilidad de la valoración cualitativa de la atrofia del lóbulo temporal por RM / Reproducibility of qualitative assessments of temporal lobe atrophy in MRI studies

Objetivo: Determinar la reproducibilidad de la escala visual de Scheltens para establecer la atrofia del lóbulo temporal medial. Material y métodos: Reunimos 25 pacientes con diagnóstico clínico de enfermedad de Alzheimer leve o deterioro cognitivo leve (DCL) y 25 sujetos sin deterioro cognitivo. Todos fueron estudiados con RM 1,5 Tesla utilizando secuencias de inversión recuperación ponderadas en T1 en el plano coronal. Cinco neurorradiólogos fueron entrenados para aplicar la escala de Scheltens y analizaron las imágenes. Se utilizó el coeficiente de correlación intraclase para valorar el grado de acuerdo inter e intraobservadores. Resultados: El 80% de los pacientes con deterioro cognitivo leve o enfermedad de Alzheimer obtuvieron puntuaciones entre 2 a 4, mientras que 21 de los 25 controles sanos (84%) fueron puntuados entre 0-1. La concordancia entre observadores fue consistentemente mayor de 0,82, con un intervalo de confianza del 95% (0,7-0,9). La concordancia intraobservador varió entre 0,82 y 0,87, con un intervalo de confianza del 95% (0,56-0,93). Conclusión: La clasificación de Scheltens es un método reproducible entre observadores, lo que apoya su uso en la práctica clínica (AU)

Objective: To determine the reproducibility of the Scheltens visual rating scale in establishing atrophy of the medial temporal lobe. Material and methods: We used coronal T1-weighted inversion recovery sequences on a 1.5 Tesla MRI scanner to study 25 patients with clinically diagnosed Alzheimer's disease or mild cognitive decline and 25 subjects without cognitive decline. Five neuroradiologists trained to apply the Scheltens visual rating scale analyzed the images. We used the interclass correlation coefficient to evaluate interrater and intrarater agreement. Results: Raters scored 20 (80%) of the 25 patients with mild cognitive decline or Alzheimer's disease between 2 and 4; by contrast, they scored 21 (84%) of the 25 subjects without cognitive decline between 0 and 1. The interrater agreement was consistently greater than 0.82, with a 95% confidence interval of (0.7-0.9). The intrarater agreement ranged from 0.82 to 0.87, with a 95% confidence interval of (0.56-0.93). Conclusion: The Scheltens visual rating scale is reproducible among observers, and this finding supports its use in clinical practice (AU)

Reproducibility of qualitative assessments of temporal lobe atrophy in MRI studies.

OBJECTIVE: To determine the reproducibility of the Scheltens visual rating scale in establishing atrophy of the medial temporal lobe. MATERIAL AND METHODS: We used coronal T1-weighted inversion recovery sequences on a 1.5 Tesla MRI scanner to study 25 patients with clinically diagnosed Alzheimer's disease or mild cognitive decline and 25 subjects without cognitive decline. Five neuroradiologists trained to apply the Scheltens visual rating scale analyzed the images. We used the interclass correlation coefficient to evaluate interrater and intrarater agreement. RESULTS: Raters scored 20 (80%) of the 25 patients with mild cognitive decline or Alzheimer's disease between 2 and 4; by contrast, they scored 21 (84%) of the 25 subjects without cognitive decline between 0 and 1. The interrater agreement was consistently greater than 0.82, with a 95% confidence interval of (0.7-0.9). The intrarater agreement ranged from 0.82 to 0.87, with a 95% confidence interval of (0.56-0.93). CONCLUSION: The Scheltens visual rating scale is reproducible among observers, and this finding supports its use in clinical practice.

Clinicopathologic subtypes and compromise of lymph nodes in patients with breast cancer.

UNLABELLED: Breast cancer (BC) is currently a heterogeneous disease with variations in clinical behaviour. Classification according to subtypes has allowed progress in the individualisation of treatment. The objective of this study is to evaluate the risk of axillary node compromise in patients with BC, according to clinicopathologic subtypes. Materials and methods are a retrospective, descriptive-analytical study. All patients that had undergone surgery for invasive BC were included, with the study of sentinel lymph nodes (SLNs) at Hospital Clínico de la Pontificia Universidad Católica, between May 1999 and December 2012. The results showed 632 patients fulfilled the inclusion criteria, with the median age being 55 years (range: 28-95), and 559 (88.4%) patients presented with estrogen receptor and/or progesterone receptor positive tumours. Luminal A: 246 patients (38.9%), luminal B: 243 (38.4%), luminal not otherwise specified: 70 (11.1%) triple negative (TN): 60 (9.5%) and over expression of epidermal growth factor type 2 receptor (HER2 positive): 13 (2.1%). Luminal tumours displayed a greater risk of metastasis in the SLNs, but this difference was not statistically significant (p = 0.67). TN and HER2 positive tumours presented the greatest proportion of metastatic compromise in non-sentinel lymph nodes (non-SLNs) (57.1% and 50%, respectively). The presence of macrometastasis (MAM) in the SLN was associated with a greater risk of compromise of the non-SLN. CONCLUSIONS: Luminal tumours are the most frequent and present a greater proportion of axillary lymph node compromise, without being statistically significant. TN and HER2 positive tumours tend to have a higher axillary compromise; however, this was not statistically significant in either. Only the presence of MAM in SLNs displayed a statistically significantly association in the compromise of non-SLNs.

[Survival of patients with metastatic breast cancer according to pathological types of tumors]. / Cáncer de mama metastásico: Caracterización de una cohorte según subtipos.

BACKGROUND: The prognosis of breast cancer (BC) is in part determined by the stage at diagnosis and its pathological characteristics. AIM: To evaluate the association between survival of women with metastatic breast cancer and pathological features of the tumor. PATIENTS AND METHODS: We obtained clinical and pathological data from patients diagnosed with a metastatic BC between 1999 and 2013. The expression of estrogen (ER) and progesterone (PR) receptors and human epidermal growth factor receptor 2 (HER2) was determined by immunohistochemistry. Clinicopathological subtypes were defined as: Luminal A: ER or PR positive, HER2 negative, histological grade (HG) 1 or 2; Luminal B: ER or PR positive, HER2 negative or positive or HG 3; triple negative (TN): ER, PR and HER2 negative, independent of the HG, positive HER2: ER, PR negative and HER2 positive, independent of HG. We analyzed survival based on these subtypes. RESULTS: We identified 54 patients aged 24 to 85 years, with metastatic BC at diagnosis. Seventy five percent had luminal tumors; 19.6% HER2 positive and 7.8% were TN. In 61% of evaluable tumors, HG was classified as 3. The frequency of HER2 positive and high HG tumors was greater in these patients with metastatic BC than in a non-metastatic local BC cohort. Survival was higher among patients with Luminal tumors than in women with non-Luminal cancer (56.4 and 11.4 months, respectively, p = 0.04). CONCLUSIONS: Patients with metastatic BC at diagnosis often had HER2 positive tumors and high HG. As in other studies, ER positive tumors had a better survival.