Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review.

Background and Objective: De-escalation in breast cancer surgery has been a natural evolution since breast conserving surgery (BCS) was introduced in the early 1980s. From Halsted mastectomies to wide local excisions, we are facing nowadays the next trend in form of oncoplastic breast surgery. Oncoplastic breast surgery combines oncological principles with plastic surgery techniques to preserve the breast shape and appearance. The aim of this work is to review recent oncological and quality of live outcomes derived from oncoplastic techniques as well as offer a perspective about its implementation in breast cancer units. Methods: A literature review was conducted to explore the landscape of oncoplastic breast surgery. Key terms related to oncoplastic techniques and breast cancer were used in searches across databases such as PubMed, Embase and Cochrane Library. Inclusion criteria focused on recent articles discussing oncological and quality of life (QoL) outcomes, as well as perspectives on the role of oncoplastic surgery. Key Content and Findings: The research aims to contribute valuable insights into the efficacy and impact of oncoplastic surgery in the context of breast cancer treatment. In this new era of precision medicine, it is more than just healing patients; it is about improving their well-being. We ought to consider specific oncoplasty role in leading this paradigm shift. It is also relevant to define whether these new technical-demanding surgical options can be applied to all patients and if professional training performs adequately to current demands of personalized treatments. Conclusions: The global adoption of oncoplastic BCS is recommended due to its oncological safety and improvement in QoL compared to standard procedures. Emphasizing the need for skilled surgeons in complex cases, collaboration between breast surgeons and scientific societies is urged to certify ongoing educational training in oncoplastic techniques.

Impact of Continuous Estroprogestin Treatment on Circulating Microparticle Levels in Deep Endometriosis Patients.

There has been increasing interest in the study of new pathogenic mechanisms in endometriosis (END), including the coagulation/fibrinolysis system and its link with inflammation and tissue remodeling. It has been suggested that END patients, especially with deep-infiltrating (DE) forms, could present a hypercoagulable state revealing higher levels of proinflammatory and procoagulant markers, such as total circulating microparticles (cMPs) and cMP-TF (tissue factor), released by cells in response to damage, activation, or apoptosis. However, no previous study has assessed the effect of END hormonal treatments on cMP and cMP-TF levels. Therefore, the aim of this study was to evaluate the impact of these treatments on cMP and cMP-TF levels in DE patients. Three groups were compared: DE patients receiving a continuous combined oral contraceptive regimen (CCOCR) (n = 41), DE patients without CCOCR (n = 45), and a control group (n = 43). cMP and cMP-TF levels were evaluated in platelet-free plasma. A significant decrease in the total cMP levels was found in the DE group with CCOCR versus the group without CCOCR, reflecting a higher chronic inflammatory status in DE patients that decreased with the treatment. cMP-TF levels were higher in DE patients receiving CCOCR versus those not receiving CCOCR, suggesting that treatments containing estrogens play a predominant role in suppressing the inhibitory pathway of TF.

Analysis of Local Recurrence Risk in Ductal Carcinoma In Situ and External Validation of the Memorial Sloan Kettering Cancer Center Nomogram.

BACKGROUND: Adjuvant radiotherapy and hormonotherapy after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) have been shown to reduce the risk of local recurrence. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan Kettering Cancer Center (MSKCC) developed a nomogram to analyze local recurrence (LR) risk in our cohort and to assess its external validation. METHODS: A historical cohort study using data from 296 patients treated for DCIS at the Hospital Clínic of Barcelona was carried out. Patients who had had a mastectomy were excluded from the analysis. RESULTS: The mean age was 58 years (42-75), and the median follow-up time was 10.64 years. The overall local relapse rate was 13.04% (27 patients) during the study period. Actuarial 5- and 10-year IBTR rates were 5.8 and 12.9%, respectively. The external validation of the MSKCC nomogram was performed using a multivariate logistic regression analysis on a total of 207 patients, which did not reach statistical significance in the studied population for predicting LR (p = 0.10). The expression of estrogen receptors was significantly associated with a decreased risk of LR (OR: 0.25; p = 0.004). CONCLUSIONS: In our series, the LR rate was 13.4%, which was in accordance with the published series. The MSKCC nomogram did not accurately predict the IBTR in this Spanish cohort of patients treated for DCIS (p = 0.10).

Nonsentinel Axillary Lymph Node Status in Clinically Node-Negative Early Breast Cancer After Primary Systemic Therapy and Positive Sentinel Lymph Node: A Predictive Model Proposal.

BACKGROUND: In clinically node-negative (cN0) early stage breast cancer (EBC) undergoing primary systemic treatment (PST), post-treatment positive sentinel lymph node (SLN+) directs axillary lymph node dissection (ALND), with uncertain impacts on outcomes and increased morbidities. PATIENTS AND METHODS: We conducted an observational study on imaging-confirmed cN0 EBC, who underwent PST and breast surgery that resulted in SLN+ and underwent ALND. The association among baseline/postsurgical clinic-pathological factors and positive nonsentinel additional axillary lymph nodes (non-SLN+) was analyzed with logistic regression. LASSO regression (LR) identified variables to include in a predictive score of non-SLN+ (ALND-predict). The accuracy and calibration were assessed, an optimal cut-point was then identified, and in silico validation with bootstrap was undertaken. RESULTS: Non-SLN+ were detected in 22.2% cases after ALND. Only progesterone receptor (PR) levels and macrometastatic SLN+ were independently associated to non-SLN+. LR identified PR, Ki67, and type and number of SLN+ as the most efficient covariates. The ALND-predict score was built based on their LR coefficients, showing an area under the curve (AUC) of 0.83 and an optimal cut-off of 63, with a negative predictive value (NPV) of 0.925. Continuous and dichotomic scores had a good fit (p = 0.876 and p = 1.00, respectively) and were independently associated to non-SLN+ [adjusted odds ratio (aOR): 1.06, p = 0.002 and aOR: 23.77, p < 0.001, respectively]. After 5000 bootstrap-adjusted retesting, the estimated bias-corrected and accelerated 95%CI included the aOR. CONCLUSIONS: In cN0 EBC with post-PST SLN+, non-SLN+ at ALND are infrequent (~22%) and independently associated to PR levels and macrometastatic SLN. ALND-predict multiparametric score accurately predicted absence of non-SLN involvement, identifying most patients who could be safely spared unnecessary ALND. Prospective validation is required.

p53 and TAp63 participate in the recombination-dependent pachytene arrest in mouse spermatocytes.

To protect germ cells from genomic instability, surveillance mechanisms ensure meiosis occurs properly. In mammals, spermatocytes that display recombination defects experience a so-called recombination-dependent arrest at the pachytene stage, which relies on the MRE11 complex-ATM-CHK2 pathway responding to unrepaired DNA double-strand breaks (DSBs). Here, we asked if p53 family members-targets of ATM and CHK2-participate in this arrest. We bred double-mutant mice combining a mutation of a member of the p53 family (p53, TAp63, or p73) with a Trip13 mutation. Trip13 deficiency triggers a recombination-dependent response that arrests spermatocytes in pachynema before they have incorporated the testis-specific histone variant H1t into their chromatin. We find that deficiency for either p53 or TAp63, but not p73, allowed spermatocytes to progress further into meiotic prophase despite the presence of numerous unrepaired DSBs. Even so, the double mutant spermatocytes apoptosed at late pachynema because of sex body deficiency; thus p53 and TAp63 are dispensable for arrest caused by sex body defects. These data affirm that recombination-dependent and sex body-deficient arrests occur via genetically separable mechanisms.

Estresores psicosociales presentes según el instrumento prenatal Psychosocial Profile: Stress Scale en gestantes adultas con parto prematuro que acuden al Servicio de Obstetricia del Hospital Nacional Daniel Alcides Carrión, enero - mayo, 2015 - Callao / Psychosocial stressors present according to the prenatal instrument Psychosocial Profile: Stress Scale in adult pregnant women with preterm delivery who attend the Obstetrics Service at the National Hospital Daniel Alcides Carrion, January - May, 2015 - Callao

Objetivo: Identificar los estresores psicosociales presentes según el instrumento Prenatal Psychosocial Profile: Stress Scale en gestantes adultas con parto prematuro que acuden al servicio de Obstetricia del Hospital Nacional Daniel Alcides Carrión- Callao, enero - mayo, 2015. Metodología: Se realizó un estudio de tipo descriptivo, de corte transversal. Se aplicó el Test Prenatal Psychosocial Profile: Stress Scale que cuenta con 11 ítems que miden el nivel de estrés, cuya puntuación va del 1 al 4 para cada ítem, obteniendo un puntaje máximo de 44, cuyo corte para determinar la presencia de estrés en la gestante es una puntuación mayor o igual a 23 puntos. La muestra estuvo conformada por 40 gestantes adultas que acudieron al servicio de Obstetricia del Hospital Nacional Daniel Alcides Carrión durante el periodo de enero a mayo del 2015, las cuales cumplieron con los criterios de inclusión y exclusión. Resultados: El 100 por ciento de nuestra población pasó el corte determinado por el test, obteniendo un puntaje mayor a 23 puntos. El estresor psicosocial "Preocupaciones financieras: Alimentos, vivienda, salud, transporte" obtuvo un porcentaje mayor de 33 por ciento. "Sufrir de Violencia Psicológica, física o Sexual" 30 por ciento, "Problemas Familiares" 25 por ciento, "Otras preocupaciones por Dinero: Deudas" 23 por ciento. "Estado Actual emocional", "Problemas como el Trabajo" y "Sensación general de sobrecarga" 18 por ciento, por último, otros estresores como "Tener que mudarse, ya sea reciente o en el futuro" y "Distanciamiento o pérdida de un ser querido" obtuvieron un porcentaje mínimo del 5 por ciento y 3 por ciento respectivamente. Conclusión: Los estresores psicosociales presentes según el instrumento Prenatal Psychosocial Profile: Stress Scale en gestantes adultas con parto prematuro son: Preocupaciones financieras: Alimento, vivienda, salud, transporte, Sufrir de Violencia Psicológica, física o sexual, Problemas familiares y Otras Preocupaciones por...

Objective: Identify psychosocial stressors present as the Prenatal Psychosocial instrument Profile: Stress Scale in adult pregnant women with preterm labor who come to the Obstetrics of National Hospital Daniel Alcides Carrion-Callao, January to May, 2015. Methodology: It is a descriptive study, cross-section was performed. Stress Scale has 11 items that measure the level of stress, whose score ranges from 1 to 4 for each item, giving a maximum score of 44, whose court to determine the presence of stress in: Prenatal Test Psychosocial Profile applied expectant mother is greater than or equal to 23 points score. The sample consisted of 40 adult pregnant women who attended the service Obstetrics Daniel Alcides Carrion National Hospital during the period from January to May 2015, which met the inclusion and exclusion criteria. Results: 100 per cent of our population cutting step determined by the test, obtaining a score greater than 23 points. Psychosocial stressor ôFinancial concerns: food, housing, health, transportation" got a higher percentage of 33 per cent. "Suffering from psychological, physical or sexual violence "30 per cent ôFamily Problems" 25 per cent, "Other concerns for Money: Debt" 23 per cent.õEmotional Current Status", "Problems and Work" and "General feeling of overload" 18 per cent, finally other stressors as "Having to move, either recent or in the future" and ôAlienation or loss of a loved one" they obtained a minimum rate of 5 per cent and 3 per cent respectively. Conclusions: Psychosocial stressors present as the Prenatal instrument Psychosocial Profile: Stress Scale in adult pregnant women with preterm labor are: Financial worries: food, housing, health, transportation, suffer from psychological, physical or sexual violence, family problems and other concerns for Money: Debt.

Elemental 2D imaging of paintings with a mobile EDXRF system.

Imaging techniques are now used commonly and intensively in cultural heritage object analysis. Nowadays, many different techniques in nature as well as many applications exist, where they can be applied. X-ray radiography and infrared reflectography as well as UV photography are some of the most applied techniques. The study of works of art usually requires these techniques to be non-invasive. Furthermore, they are frequently required to perform in situ analysis. A few years ago, our laboratory developed a mobile energy-dispersive X-ray fluorescence and UV-vis-NIR coupled spectrometer, especially designed for fieldwork studies, where all three techniques can be applied strictly at the same site of analysis. Recent developments on a new positioning system have now allowed us to perform 2D elemental mappings with our equipment, which is especially well adapted to painting analysis. The system control is carried out entirely through a laptop computer running a dedicated homemade software. The positioning is achieved by means of a CCD camera embedded in the system and controlled via a Wi-Fi connection through the computer. The data acquisition system, which is made through a homemade multichannel pulse height analyzer, being also managed via the software mentioned above, goes through an Ethernet connection. We will present here the new developments of the system and an example of in situ 2D elemental mapping applied on an anonymous oil painting on wood panel. The discovery of a hidden painting under this oil painting makes it a good choice for a first example of 2D large scan with a mobile instrument.