La mastectomía como medida de reducción de riesgo de cáncer de mama / Risk-reducing mastectomy in breast cancer

Objetivos: Evaluar las mastectomías reductoras de riesgo realizadas y analizar las indicaciones y resultados según las características individuales, oncológicas y quirúrgicas de nuestras pacientes.MétodosEstudio observacional retrospectivo de todas las mastectomías con reconstrucción inmediata en mamas sanas realizadas desde 2013 a 2019. Se dividieron las pacientes en tres grupos: I) riesgo genético de cáncer de mama, II) cáncer de mama diagnosticado y III) antecedente de cáncer de mama.ResultadosSe realizaron 56 mastectomías reductoras de riesgo a 46 pacientes, 15% grupo I, 50% grupo II y 35% grupo III, pero tras estudios diferidos, 20 pacientes (43%) presentaban mutación genética. La media de edad en este subgrupo fue de 40 años y con predominio de tumores HER2+ (40% frente al 12%, p=0,164). En el grupo III observamos más complicaciones inmediatas (31%, p=0,014) y tardías (69%, p=0,027) relacionadas con la reconstrucción protésica, y más evidente en mamas que tuvieron enfermedad (73% frente al 39% sanas, p=0,002). Se encontró relación entre contractura capsular y la radioterapia postoperatoria (p=0,008) y entre necrosis y radioterapia preoperatoria (p=0,001). Se reintervino al 7% por complicaciones en mastectomías profilácticas. No hemos tenido recidivas locales.ConclusionesConsideramos justificada la mastectomía reductora de riesgo realizada a mujeres jóvenes con mutación genética y a pacientes con cáncer precoz, HER2+ y riesgo familiar. En pacientes ya tratadas por cáncer, el riesgo de complicaciones supera el valor profiláctico de la técnica. La reconstrucción mamaria es la principal responsable de complicaciones postoperatorias y las pacientes deben ser plenamente conscientes de ello. (AU)

Objectives: To evaluate the risk-reducing mastectomies performed and to analyse the indications and results according to the individual, oncological and surgical characteristics of our patients.MethodsRetrospective observational study of all mastectomies with immediate reconstruction in healthy breasts performed from 2013 to 2019. The patients were divided into three groups: I) genetic risk of breast cancer, II) diagnosed breast cancer and III) history of cancer breast.ResultsA total of 56 risk-reducing mastectomies were performed in 46 patients, 15% in group I, 50% in group II and 35% in group III. After deferred studies, 20 (43%) patients had a genetic mutation. This subgroup had an average age of 40 years and a predominance of HER2+ tumours (40% versus 12%, p=0.164). In group III, we observed more immediate (31%, p=0.014) and late (69%, p=0.027) complications related to prosthetic reconstruction, which were more evident in breasts with disease (73% versus 39% healthy, p=0.002). A relationship was found between capsular contracture and postoperative radiotherapy (p=0.008) and between necrosis and preoperative radiotherapy (p=0.001). Reoperation was required in 7% for complications of prophylactic mastectomies. There were no local relapses.ConclusionsWe consider risk-reducing mastectomy to be justified in young women with a genetic mutation and in patients with early cancer, HER2+ and family risk. In patients already treated for cancer, the risk of complications exceeds the prophylactic value of the technique. Breast reconstruction is primarily responsible for postoperative complications and patients should be fully aware of this. (AU)

[Invasive neumococcal disease in Costa del Sol Hospital: replacement by non-vaccinable serotypes]. / Enfermedad neumocócica invasiva en el Hospital Costa del Sol: emergencia de serotipos no vacunables.

OBJECTIVE: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. METHODS: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. RESULTS: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. CONCLUSIONS: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients.

OBJETIVO: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. METODOS: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). RESULTADOS: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. CONCLUSIONES: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes.

Enfermedad neumocócica invasiva en el Hospital Costa del Sol: emergencia de serotipos no vacunables / Invasive neumococcal disease in Costa del Sol Hospital: emergency by non-vaccinable serotypes

Fundamentos: Streptococcus pneumoniae puede causar enfermedades invasivas y no invasivas. Bajo la denominación de enfermedad neumocócica invasiva, se incluyen aquellas infecciones que se localizan en tejidos, órganos y fluidos que normalmente son estériles y que se asocian con procesos clínicos generalmente severos. El objetivo de este estudio fue caracterizar los episodios de ENI (Enfermedad Neumocócica Invasiva) así como describir la sensibilidad antimicrobiana y distribución de los serotipos (vacunales y no vacunales) de cepas de S. pneumoniae aisladas en hemocultivos de pacientes atendidos en el Hospital Costa del Sol entre septiembre de 2012 y enero de 2017. Métodos: Estudio descriptivo a partir de cepas de S. pneumoniae aisladas en hemocultivos. Las variables de estudio fueron: edad, sexo, fallecimiento, tabaquismo, infección por VIH, diagnóstico clínico, serotipo y perfil de sensibilidad antimicrobiana. La fuente de información utilizada fue el programa de gestión clínica "Doctor ". El análisis estadístico se llevó a cabo mediante el software SPSS (SPSS, version 15,0; SPSS, Chicago Illinois, USA). Resultados: Se aislaron un total de 76 cepas de S. pneumoniae. Los serotipos más prevalentes fueron, en orden descendente 8, 3, 9N, 6C, 22F, 11A y 14. El 77,3% de las cepas fueron causantes de episodios de ENI con diagnóstico clínico de neumonía bacteriémica. Según el criterio del CLSI 2016 (Clinical & Laboratory Standards Institute), encontramos 2 cepas no sensibles a penicilina, 23 cepas no sensibles a eritromicina y 3 cepas no sensibles a levofloxacino. Conclusiones: Los resultados de este estudio muestran que los serotipos más frecuentes entre los pacientes con ENI atendidos en nuestro hospital no están cubiertos por las vacunas conjugadas, aunque sí por la VNP23. El serotipo 6C, no cubierto por ninguna vacuna, se situó entre los tres más frecuentemente aislados, causando exitus en un tercio de los pacientes

Background: Streptococcus pneumoniae can cause invasive and noninvasive diseases. Invasive pneumococcal disease causes infections in tissues, organs and fluids that are normally sterile and is associated with severe clinical processes generally. The aim of this study was to characterize ENI episodes as well as to describe the antimicrobial susceptibility and distribution of serotypes (vaccinal and non-vacunal) of S. pneumoniae strains isolated in blood cultures of patients treated at the Hospital Costa del Sol between September 2012 and January 2017. Methods: Descriptive study from S. pneumoniae strains isolated in blood cultures. The variables studied were: age, sex, death, smoking, HIV infection, clinical diagnosis, serotype and antibiotic susceptibility profile. The source of information used was the clinic management program called Doctor. Results: 76 S. pneumoniae strains were isolated. The most prevalent serotypes were 8, 3, 9N, 6C, 22F, 11A and 14. 77.3% of the strains were responsible for IPD (Invasive Pneumococcal Disease) episodes with clinical diagnosis of bacterial pneumonia. According to the CLSI 2016 (Clinical & Laboratory Standards Institute) criteria, 2 strains were non-susceptible to penicillin, 23 strains were non-susceptible to erythromycin and 3 were strains non-susceptible to levofloxacin. Conclusions: The results of this study show that the most frequent serotypes among ENI patients attended in our hospital are not covered by conjugate vaccines, although they do so by VNP23. Serotype 6C, not covered by any vaccine, was among the three most frequently isolated, causing death in one third of patients

Optical properties of graphene nanoribbons encapsulated in single-walled carbon nanotubes.

We report the photoluminescence (PL) from graphene nanoribbons (GNRs) encapsulated in single-walled carbon nanotubes (SWCNTs). New PL spectral features originating from GNRs have been detected in the visible spectral range. PL peaks from GNRs have resonant character, and their positions depend on the ribbon geometrical structure in accordance with the theoretical predictions. GNRs were synthesized using confined polymerization and fusion of coronene molecules. GNR@SWCNTs material demonstrates a bright photoluminescence both in infrared (IR) and visible regions. The photoluminescence excitation mapping in the near-IR spectral range has revealed the geometry-dependent shifts of the SWCNT peaks (up to 11 meV in excitation and emission) after the process of polymerization of coronene molecules inside the nanotubes. This behavior has been attributed to the strain of SWCNTs induced by insertion of the coronene molecules.

Oxazine-1 J-aggregates in polymer nanohybrids.

In a smart solution-processable luminescent poly(norbornene)/oxazine-1 (Ox1) intercalated fluoromica nanohybrid, the supramolecular organization of the Ox1 dyes can be tuned at the nanoscale level and a deep red emission band switched on by inducing a phase segregation of aligned molecules within the fluoromica layered scaffold. By combining low-temperature photoluminescence and ultrafast pump-probe spectroscopy we prove that the nanoconstrained Ox1 molecules are organized in a J-type packing and we highlight the critical factor that controls such a supramolecular dye arrangement.

Confocal ultrafast pump-probe spectroscopy: a new technique to explore nanoscale composites.

This article is devoted to the exploration of the benefits of a new ultrafast confocal pump-probe technique, able to study the photophysics of different structured materials with nanoscale resolution. This tool offers many advantages over standard stationary microscopy techniques because it directly interrogates excited state dynamics in molecules, providing access to both radiative and non-radiative deactivation processes at a local scale. In this paper we present a few different examples of its application to organic semiconductor systems. The first two are focussed on the study of the photophysics of phase-separated polymer blends: (i) a blue-emitting polyfluorene (PFO) in an inert matrix of PMMA and (ii) an electron donor polythiophene (P3HT) mixed with an electron acceptor fullerene derivative (PCBM). The experimental results on these samples demonstrate the capability of the technique to unveil peculiar interfacial dynamics at the border region between phase-segregated domains, which would be otherwise averaged out using conventional pump-probe spectroscopy. The third example is the study of the photophysics of isolated mesoscopic crystals of the PCBM molecule. Our ultrafast microscope could evidence the presence of two distinctive regions within the crystals. In particular, we could pinpoint for the first time areas within the crystals showing photobleaching/stimulated emission signals from a charge-transfer state.

Corneal transparency after cross-linking for keratoconus: 1-year follow-up.

PURPOSE: To evaluate the changes in corneal transparency and thickness measured objectively using Pentacam Scheimpflug (Oculus Optikgeräte GmbH) corneal tomography (densitometry) after corneal cross-linking (CXL). METHODS: Twenty-two eyes from 15 patients with keratoconus underwent CXL. Corneal thickness and curvature as well as lens and corneal densitometry were measured at baseline and 1, 3, 6, and 12 months after CXL with Pentacam. RESULTS: Immediately after CXL, central corneal thickness significantly decreased (-40 µm) and corneal densitometry increased significantly. At 6-month follow-up, densitometry values were reduced and seemed to stabilize at a higher value than baseline. No statistically significant differences were noted (mean difference at 12 months: +30%). Changes in corneal densitometry were detected with the Pentacam even when clinical haze did not increase beyond grade 1 during follow-up. CONCLUSIONS: Corneal CXL is associated with a transient reduction in central corneal thickness, which recovered to baseline after 12 months. During the same time period, corneal densitometry experienced a transient increase that recovered to baseline values after 3 months. Changes in compactness of the corneal tissue after CXL may have an impact in corneal power not due to curvature changes, but to refractive index changes as a result of hydration changes. Pentacam is a useful objective method to monitor corneal transparency after CXL.