Real world evidence of adjuvant trastuzumab in HER2 positive early breast cancer.

Adjuvant trastuzumab in HER2+ breast cancer reduces recurrence and mortality, and has been the standard treatment since 2006. The objective was to analyze health outcomes in the real world. Observational, retrospective study of patients with HER2+ breast cancer, stages I-III, treated with adjuvant trastuzumab in the past 15 years in only one center and for the first time in Spain. Survival was analyzed according to the number of cycles and cardiotoxicity. Two hundred and seventy-five HER2positive patients (18.60%) out of 1479 received adjuvant (73%) or neoadjuvant/adjuvant (26%) trastuzumab, concomitantly (90%) or sequentially (10%) with chemotherapy. The probability of overall and disease-free survival (OS and DFS) at 5 years was 0.93 (95% CI 0.89-0.96), and 0.88 (95% CI 0.83-0.92). The number of cases with a significant and asymptomatic decrease in ventricular ejection fraction and heart failure were 54 (19.64%) and 12 (4.36%), respectively. Sixty-eight patients (24.70%) received 16 or fewer cycles, especially those older than 65 (OR 0.371, 95% CI 0.152-0.903; p = 0.029) and with cardiotoxicity (OR 15.02, 95% CI 7.437-30.335; p < 0.001). The risk of cardiotoxicity was associated with having received radiotherapy (OR 0.0362, 95% CI 0.139-0.938; p = 0.037). Arterial hypertension (HR 0.361, 95% CI 0.151-0.863, p = 0.022), neoadjuvant treatment (HR 0.314, 95% CI 0.132-0.750, p = 0.009) and cardiotoxicity (HR 2.755, 95% CI 1.235-6.143, p = 0.013) maintained significant association with OS. Only neoadjuvant treatment maintained a significant association with DFS (HR 0.437, 95% CI 0.213-0.899, p = 0.024). The effectiveness of neoadjuvant and adjuvant trastuzumab can be considered comparable to those of clinical trials. In the real world, factors such as age, hypertension, radiotherapy, neoadjuvant treatment, and cardiotoxicity should be taken into consideration to optimize outcomes.

Bursting strength in CO2 laser-assisted microvascular anastomoses.

Iliac artery end-to-end anastomoses were performed in 42 Sprague-Dawley rats, divided into seven groups, to determine the welding effects of CO2 laser radiation in microvascular anastomoses. Conventional suture techniques were performed on right iliac arteries, and left iliac arteries were anastomosed with a laser-assisted technique. Bursting strength and diameters of the anastomotic sites were measured at different intervals (from one day to five weeks) post surgery. The anastomotic patency rate was 100 percent in both groups, and the aneurysm rate was only 2 percent in the laser group. Bursting strength was low at one and three days post surgery in both groups; then, it increased gradually until both groups could withstand higher than physiologic pressures. Results of high patency rates, low aneurysm formation, and the ability to withstand pressures higher than physiologic, suggest that the laser-assisted anastomotic technique can play an important role in microvascular surgery.

Hemodynamic and morphologic features of arteriovenous angioaccess loop grafts.

Bilateral femoral A-VLG (5 acute, 5 chronic) were implanted in 10 dogs (e-PTFE, 6 mm ID, 25 cm length). Acute studies included measurements of cardiac output (CO) and systemic vascular resistance (SVR). Blood pressure and pressure waveforms in the graft were obtained by retrograde catheterization and pull-back readings. Chronic dogs were sacrificed 8 wks postimplant; samples were obtained following a standardized protocol and studied by light microscopy (LM) and scanning electron microscopy (SEM). Hemodynamic data show a rise in CO, a decline in SVR and a high flow through each graft. Pull-back readings show a gradual drop in pressure and loss of pulsatility from the arterial to the venous side of the graft. LM studies show IH primarily in the proximal vein. SEM showed limited pannus ingrowth endothelium close to the anastomoses and otherwise a thrombus layer throughout the lumen. A-VLG are associated with high flow, pressure drop and loss of pulsatility. Proximal vein IH is a reproducible lesion. We conclude there is severe hemodynamic stress from disturbed flow and high flow velocity and it plays a critical role in the development of venous intimal hyperplasia in AV loop grafts.