Phyllodes tumor of the breast. Experience and clinical-pathological characteristics of patients treated in a third level oncologic referral center / Tumor phyllodes de la mama. Experiencia y características clínico-patológicas de los pacientes tratados en un centro oncológico de referencia de tercer nivel

Introduction: Phyllodes tumors are rare fibroepithelial lesions, with an incidence of 2.1 cases per million. They represent 0.2-2% of all breast tumors. The breast tumor department treats the largest number of patients per year at the Oncology Hospital, National Medical Center Siglo XXI, Mexican Social Security Institute, representing 17.4% of all patients treated in this centre. Material and methods: Retrospective, descriptive study. We assessed clinical and pathological characteristics, recurrences and overall survival at 5 years in patients with phyllodes tumor of the breast treated at the Oncology Hospital, Siglo XXI National Medical Center, from January 2000 to December 2017. Results: Thirty-two patients were included in the analysis. Mean age was 43.5 years, presentation was in the right breast in 66% of the patients and pain was present in 19%. 66% presented in the right breast, presented pain 19%. A total of 41% were benign phyllodes tumors, 41% were borderline and 18% malignant. In all, 18% of the cases were treated with wide resection, 65% with simple total mastectomy and 15% with modified radical mastectomy. Recurrence at 5 years was observed in 12%. Overall survival at 5 years was 94%, 100% for patients with benign histology, 100% for patients with borderline histology, and 66% for those with malignant histology (p=0.09). Conclusions: In our population, phyllodes tumors show a tendency towards size greater than 5cm, which is reflected in the greater number of mastectomies in contrast to other reports

Introducción: Los tumores phyllodes son lesiones fibroepiteliales raras, con una incidencia de 2,1 casos por millón, representando del 0,2 al 2% de todos los tumores de mama. El departamento de tumores de mama del Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, ocupa el primer lugar en la atención, por el número de pacientes al año, lo que representa el 17,4% de todos los pacientes tratados en este centro. Material y métodos: Estudio retrospectivo, descriptivo. Se analizaron las características clínico-patológicas, la recurrencia y la supervivencia general a los 5 años en pacientes con tumor phyllodes de la mama, tratados en el Hospital de Oncología, Centro Médico Nacional Siglo XXI, desde enero de 2000 hasta diciembre de 2017. Resultados: Incluimos 32 pacientes. La edad media fue 43,5 años. El 66% se localizó en la mama derecha y el 19% presentó dolor. El 41% correspondió a tumor phyllodes benigno, 41% límítrofe y el 18% maligno. El 18% se trató con resección amplia, 65% con mastectomía total simple y 15% con mastectomía radical modificada. La recurrencia a 5 años se observó en el 12%. La supervivencia global a 5 años fue del 94%; para la histología benigna del 100%, limítrofe 100% y maligna 66% (p = 0,09). Conclusiones: En nuestra población el tumor phyllodes presentó una tendencia hacia un tamaño mayor a 5 cm, lo cual se refleja en el mayor número de mastectomías que contrasta con otros estudios

The Role of Central Blood Pressure Monitoring in the Management of Hypertension.

PURPOSE OF REVIEW: Central blood pressure is a novel predictor of cardiovascular risk that can be measured in the clinical setting using currently available technology. This paper will review current available methods of central blood pressure monitoring as well as its impact in cardiac and renal disease. RECENT FINDINGS: Both aortic and carotid systolic blood pressure are independently associated with cardiovascular mortality and serious cardiac events. Furthermore, studies show that systolic aortic blood pressure has been shown to be superior predictor of cardiovascular as compared to brachial blood pressure. Inhibitors of the renin angiotensin axis may have a beneficial effect on central blood pressure; however, long term studies evaluating the impact of lowering central blood pressure on clinical outcomes are lacking. Central blood pressure is a good predictor of cardiovascular risk. As more studies emerge demonstrating the value of central blood pressure as a therapeutic target, it is possible that targeting central blood pressure may become an important part of the armamentarium to lower cardiovascular risk.

Glucose and insulin induction of bile acid synthesis: mechanisms and implication in diabetes and obesity.

Bile acids facilitate postprandial absorption of nutrients. Bile acids also activate the farnesoid X receptor (FXR) and the G protein-coupled receptor TGR5 and play a major role in regulating lipid, glucose, and energy metabolism. Transgenic expression of cholesterol 7α-hydroxylase (CYP7A1) prevented high fat diet-induced diabetes and obesity in mice. In this study, we investigated the nutrient effects on bile acid synthesis. Refeeding of a chow diet to fasted mice increased CYP7A1 expression, bile acid pool size, and serum bile acids in wild type and humanized CYP7A1-transgenic mice. Chromatin immunoprecipitation assays showed that glucose increased histone acetylation and decreased histone methylation on the CYP7A1 gene promoter. Refeeding also induced CYP7A1 in fxr-deficient mice, indicating that FXR signaling did not play a role in postprandial regulation of bile acid synthesis. In streptozocin-induced type I diabetic mice and genetically obese type II diabetic ob/ob mice, hyperglycemia increased histone acetylation status on the CYP7A1 gene promoter, leading to elevated basal Cyp7a1 expression and an enlarged bile acid pool with altered bile acid composition. However, refeeding did not further increase CYP7A1 expression in diabetic mice. In summary, this study demonstrates that glucose and insulin are major postprandial factors that induce CYP7A1 gene expression and bile acid synthesis. Glucose induces CYP7A1 gene expression mainly by epigenetic mechanisms. In diabetic mice, CYP7A1 chromatin is hyperacetylated, and fasting to refeeding response is impaired and may exacerbate metabolic disorders in diabetes.

Synthesis of chiral amino epoxyaziridines: useful intermediates for the preparation of chiral trisubstituted piperidines.

Chiral aminoalkyl epoxyaziridine 1 is synthesized in high yield and diastereoselectivity from L-serine. Ring opening of epoxyaziridine 1 with primary amines is carried out with total chemo- and regioselectivity, affording chiral polyfunctionalized piperidines 8. The structure of these trisubstituted piperidines is established by NMR studies.