The Impact of Neoadjuvant Chemotherapy on Axillary Surgical Management of Patients With Breast Cancer and Positive Axillary Lymph Nodes.

BACKGROUND/AIM: Sentinel lymph node biopsy (SLNB) is effective in patients with breast cancer (BC) and positive axillary lymph nodes undergoing neoadjuvant chemotherapy (NAC). However, the frequency with which axillary lymphadenectomy (ALND) can be avoided remains debated. This study aimed to identify patient populations that can benefit from this approach. PATIENTS AND METHODS: The data of 195 consecutive patients with BC and positive axillary lymph nodes at diagnosis who underwent NAC were retrospectively analyzed. In all cases, the positivity of the lymph nodes was confirmed by cytological examination. Patients converted to ycN0 after NAC were considered eligible for SLNB. Indications for ALND were failed mapping, fewer than three SLNs recovered, and positive SLNs. RESULTS: Of 195 cN1 patients potentially eligible for SLNB, 71 (36.4%) remained clinically ycN+ after NAC and underwent elective ALND, while 124 (83.7%) converted to ycN0 after NAC and SLNB. The lymph node identification rate was 95.9% (119/124 patients) with three or more SLNs recovered in 83 cases (89.8%). One or two lymph nodes were recovered in 36 cases (30.2%). Nodal pathologic complete response (pCR) was found in 34/83 (40.9%) patients with three or more SLNs recovered. Considering all 195 patients initially included in the study, 55 patients (28.2%) achieved lymph node pCR after NAC. Nodal pCR varied based on hormone receptor and HER2 status, with rates ranging from 20.7% for ER+/HER2- patients to 95.3% for ER-/HER2+ patients (p<0.001). CONCLUSION: More than 80% of cN1 patients in our study were eligible for SLNB after NAC. ALND could be avoided in approximately 30% of cases, supporting the role of NAC in reducing the need for ALND among patients with lymph node metastases.

Primary thromboprophylaxis to prevent thrombotic events in pediatric oncology patients with a malignant mediastinal mass.

Children with malignant mediastinal masses have increased thrombotic events (TE). Eligible subjects with malignant mediastinal masses between January 2000 and December 2017 were evaluated for TE, with 19 among 76 subjects receiving enoxaparin thromboprophylaxis. There were 13 TEs among 76 subjects for an incidence of 17.1%. Mediastinal compression directly led to TE in 9.2% of subjects who also had statistically significant superior vena cava compression at diagnosis. Primary thromboprophylaxis did not significantly affect TE occurrence; however, larger studies are warranted to consider strategic thromboprophylaxis guided by radiological monitoring of dynamic vascular compression to improve TE outcomes.

Validación del HAQ-UP-A (Health Assessment Questionnaire-Upper limbs Argentine version) en pacientes con artritis reumatoide / Validation of the HAQ-UP-A (Health Assessment Questionnaire-Upper Limbs-Argentine Version) in Patients With Rheumatoid Arthritis

El HAQ se considera el estándar de oro para la evaluación de la capacidad funcional en pacientes con artritis reumatoide (AR), ya que realiza una valoración global de la misma. Con el objetivo de evaluar la incapacidad funcional de la mano en pacientes ancianos con osteoartritis, Baron et al. utilizaron una versión modificada del HAQ al que llamaron «HAQ-UP». Este instrumento no ha sido validado en pacientes con AR. Objetivo: Validar la versión argentina del HAQ-UP en pacientes con AR. Métodos: Estudio de corte transversal. Se incluyeron pacientes consecutivos ≥18años con diagnóstico de AR (ACR/EULAR 2010). Se consignaron datos demográficos y características de la enfermedad. Se completaron los cuestionarios HAQ-A, HAQ-UP-A, FIHOA y Quick-DASH. Se estableció la reproducibilidad del cuestionario. Resultados: Se incluyeron 100 pacientes, 83% mujeres, edad media 57,9años (DE11,6). La prueba alfa de Cronbach fue de 0,94. La correlación intra-ítem no evidenció preguntas redundantes. El HAQ-UP-A mostró excelente correlación con HAQ-A (r=0,93), FIHOA (r=0,89) y Quick-DASH (r=0,91). También presentó buena correlación con DAS28-VSG (r=0,68) y otros índices compuestos de actividad, así como con otros parámetros de la enfermedad. No se evidenció correlación del HAQ-UP-A con tiempo de evolución de la AR. La reproducibilidad del cuestionario fue de 0,82. La regresión lineal múltiple ajustada por edad y sexo mostró como principales determinantes del HAQ-UP-A a la evaluación global de la enfermedad por parte del paciente seguido por la presencia de rigidez matinal. El HAQ-UP-A resultó ser confiable, válido y reproducible en pacientes con AR, constituyendo una herramienta útil en la evaluación de la capacidad funcional de los miembros superiores.(AU)

HAQ is considered the gold standard for the evaluation of functional capacity in patients with rheumatoid arthritis (RA), even though it does not focus on any particular anatomical region. With the objective of assessing functional disability of the hand in elderly patients with osteoarthritis, Baron et al. used a modified version of the HAQ which was calculated as the mean value for the categories mostly involving the upper extremities and named it ‘HAQ-UP’. This instrument has not been validated in patients with RA. Objective: To validate HAQ-UP-Argentine version in patients with RA. Methods: Cross-sectional study. Consecutive patients ≥18years with diagnosis of RA (ACR/EULAR 2010) were included. Socio-demographic data and RA characteristics were recorded. Questionnaires were administered: HAQ-A, HAQ-UP-A, FIHOA, Quick-DASH. The reproducibility of the questionnaire was assessed. Results: A total of 100 patients were included, 83% women, mean age 57.9years (SD 11.6). Cronbach's alpha test was 0.94. The intra-item correlation did not show redundant questions. HAQ-UP-A showed excellent correlation with HAQ-A (r=.93); FIHOA (r=.89) and Quick-DASH (r=.91). It also showed good correlation with DAS28-ESR (r=.68) and other composite disease activity indices as well as with other parameters of the disease. There was no correlation between HAQ-UP-A and disease duration. The reproducibility of the questionnaire was 0.82. Multiple linear regression adjusted for age and sex showed patient global VAS as the main determinant of HAQ-UP-A, followed by the presence of morning stiffness. Conclusion: HAQ-UP-A was found to be reliable, valid and reproducible in patients with RA, representing a useful tool for the evaluation of the functional capacity of the upper limbs in these patients.(AU)

Validation of the HAQ-UP-A (Health Assessment Questionnaire-Upper Limbs-Argentine Version) in Patients With Rheumatoid Arthritis. / Validación del HAQ-UP-A (Health Assessment Questionnaire-Upper limbs Argentine version) en pacientes con artritis reumatoide.

HAQ is considered the gold standard for the evaluation of functional capacity in patients with rheumatoid arthritis (RA), even though it does not focus on any particular anatomical region. With the objective of assessing functional disability of the hand in elderly patients with osteoarthritis, Baron et al. used a modified version of the HAQ which was calculated as the mean value for the categories mostly involving the upper extremities and named it 'HAQ-UP'. This instrument has not been validated in patients with RA. OBJECTIVE: To validate HAQ-UP-Argentine version in patients with RA. METHODS: Cross-sectional study. Consecutive patients ≥18years with diagnosis of RA (ACR/EULAR 2010) were included. Socio-demographic data and RA characteristics were recorded. Questionnaires were administered: HAQ-A, HAQ-UP-A, FIHOA, Quick-DASH. The reproducibility of the questionnaire was assessed. RESULTS: A total of 100 patients were included, 83% women, mean age 57.9years (SD 11.6). Cronbach's alpha test was 0.94. The intra-item correlation did not show redundant questions. HAQ-UP-A showed excellent correlation with HAQ-A (r=.93); FIHOA (r=.89) and Quick-DASH (r=.91). It also showed good correlation with DAS28-ESR (r=.68) and other composite disease activity indices as well as with other parameters of the disease. There was no correlation between HAQ-UP-A and disease duration. The reproducibility of the questionnaire was 0.82. Multiple linear regression adjusted for age and sex showed patient global VAS as the main determinant of HAQ-UP-A, followed by the presence of morning stiffness. CONCLUSION: HAQ-UP-A was found to be reliable, valid and reproducible in patients with RA, representing a useful tool for the evaluation of the functional capacity of the upper limbs in these patients.

Cannabinoids from Cannabis sativa L.: A New Tool Based on HPLC-DAD-MS/MS for a Rational Use in Medicinal Chemistry.

Cannabis sativa L. represents one of the most widely used source of drugs and drugs of abuse worldwide. Its biologically active compounds are mainly cannabinoids, including Δ9-tetrahydrocannabinol (THC), which is responsible for the psychoactive effects, tetrahydrocannabinolic acid (THCA), cannabinol (CBN), cannabidiol (CBD), and cannabidiolic acid (CBDA). Together with recreational and drug-type (or medicinal) Cannabis, some new products have been recently released into the market as fiber-type Cannabis variants (also known as hemp or industrial hemp) with low THC content and high content of nonpsychoactive CBD. In this research work, the aim was to characterize Cannabis recreational and drug-type samples by quantifying their active principles, after the development and validation of a suitable analytical method. In addition to the Cannabis samples described above, fiber-type plant varieties were also analyzed to monitor their content of nonpsychoactive compounds for both pharmaceutical and nutraceutical purposes. To do this, a highly efficient HPLC-DAD-MS/MS method, with an electrospray ionization (ESI) source and a triple-quadrupole mass analyzer acquiring in the multiple reaction monitoring (MRM) mode also coupled to a diode array detector (DAD), was developed and applied. Satisfactory validation results were obtained in terms of precision (RSD < 6.0% for all the analytes) and accuracy (>92.1% for all the compounds). The proposed methodology represents a versatile and reliable tool to assess both psychoactive and nonpsychoactive cannabinoid levels in Cannabis samples for a more rational use in both medicinal chemistry and nutraceutics.

Agenesis of the corpus callosum: clinical and genetic study in 63 young patients.

This study reports the clinical features of 63 patients with agenesis of the corpus callosum who received in-depth genetic, clinical, and laboratory testing with the aim to contribute to a better description of the large spectrum of associated malformations and to assist clinicians in the diagnosis. Thirty patients manifested complete agenesis and 33 patients displayed partial agenesis. Other associated nervous system malformations were detected in 14 patients with partial agenesis of the corpus callosum (mostly correlated to posterior fossa malformations) and in 10 patients with complete agenesis (more frequently associated with malformations of cortical development). Involvement of organs and apparatus other than the nervous system was present in 41 patients (ascribed to known syndromes in 21 cases). Cytogenetically detectable chromosomal abnormalities (7 patients) and subtelomeric rearrangements (3 patients) were found. Neuromotor skills were impaired in almost all cases (58/63). Mental retardation of different severity was present in 52 cases, whereas 2 patients were borderline and 9 patients had normal intelligence quotient. This study demonstrates that there is no unique prognosis for agenesis of the corpus callosum as this condition is associated with a broad range of clinical manifestations, oscillating between the limits of the norm and severe psychomotor delay.

Terapia de família centrada no sistema. Conectando a abordagem centrada na pessoa à teoria sistêmica de família: ampliando recursos e revigorando o processo

A presente dissertação tem como principal objetivo ampliar as alternativas e recursos no atendimento psicoterápico a famílias e casais. Para tanto, inicia-se com uma descrição de temas considerados como fundamentais no trabalho com famílias. São eles: filiação, questões de gênero, diferentes etapas da vida familiar e os diferentes formatos de grupos familiares nas mais variadas épocas e locais. Continua por especificar e definir o conceito de família a ser utilizado. Em seguida, descreve e Teoria da Abordagem Centrada na Pessoa e a Teoria Sistêmica para posterior demonstração de seus pontos de aproximação. Finaliza discutindo as contribuições enriquecedoras da utilização de recursos oriundos de outros campos de estudo, às atitudes básicas de consideração positiva incondicional, empatia e congruência (AU)

El mundo adolescente: cultura del trabajo y adicciones / The adolescent word =: culture of work and addictions

Se analiza la forma en que el trabajo incide psíquicamente en el adolescente teniendo en cuenta las profundas transformaciones económicas, políticas, sociales y culturales que se han producido a nivel a fines del siglo XX. Se aborda la caracterización psicológica del adolescente. En los grupos objeto de la investigación se define el perfil socio-familiar y socio-laboral, y sus puntos de vulnerabilidad en relación con el trabajo. Se revisan las preferencias, intereses y participación social. Se señala la falta de modelos identificatorios. Con estos datos se establece la relación con las adicciones. Como psicoprofilaxis se fijan pautas para ayudar al adolescente mediante fortaleciendo los vínculos sociales en un trabajo multidisciplinario...

El mundo adolescente: cultura del trabajo y adicciones / The adolescent word =: culture of work and addictions

Se analiza la forma en que el trabajo incide psíquicamente en el adolescente teniendo en cuenta las profundas transformaciones económicas, políticas, sociales y culturales que se han producido a nivel a fines del siglo XX. Se aborda la caracterización psicológica del adolescente. En los grupos objeto de la investigación se define el perfil socio-familiar y socio-laboral, y sus puntos de vulnerabilidad en relación con el trabajo. Se revisan las preferencias, intereses y participación social. Se señala la falta de modelos identificatorios. Con estos datos se establece la relación con las adicciones. Como psicoprofilaxis se fijan pautas para ayudar al adolescente mediante fortaleciendo los vínculos sociales en un trabajo multidisciplinario...(AU)