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Hormonal factors predictive of fertility in patients with breast cancer interrupting adjuvant endocrine therapy to attempt pregnancy in POSITIVE trial
Full text linkAssisted reproductive technology; Breast cancer; PregnancyTecnologia de reproducció assistida; Càncer de mama; EmbaràsTecnología de reproducción asistida; Cáncer de mama; EmbarazoPurpose
The POSITIVE trial showed that premenopausal women with breast cancer (BC) can safely pause adjuvant endocrine treatment (ET) to attempt conception. 74 % of patients conceived spontaneously or through assisted reproductive technology (ART); Investigating hormonal factors that predict fertility was a key secondary endpoint.
Methods
Hormonal factors were assessed in non-pregnant women at months 3, 6, and 12 after ET interruption. The frequency of low ovarian reserve, defined as anti-Mullerian hormone (AMH) 25 IU/L at month 12, were primary measures. Secondary analyses to predict pregnancy included AMH, FSH, thyroid stimulating hormone (TSH), prolactin and ovulatory status (defined as progesterone >3 ng/mL at month 6), considering covariates such as age, treatment, and ART use.
Results
Of 518 women enrolled in POSITIVE, 438 were eligible for low ovarian reserve analysis. Low ovarian reserve was observed in 209 women (47.7 %), more frequently among older women and those with prior chemotherapy, but not in relation to ET type or duration. Overall, low ovarian reserve was associated with reduced odds of pregnancy (OR:0.52; 95 % CI:0.31–0.87). Of 142 patients evaluated for POI, 16.7 % of those who received prior chemotherapy experienced POI. FSH at month 3 was associated with POI, but only modestly with spontaneous pregnancy (OR:0.96; 95 %CI: 0.93–1.00); other factors were not predictive of pregnancy.
Conclusion
Hormonal factors are associated with pregnancy in BC patients pausing adjuvant ET to conceive, and their assessment may help to optimize fertility counseling.
Trial registration
ClinicalTrials.gov number NCT02308085
Biomarkers of palbociclib response in hormone receptor-positive advanced breast cancer from the PARSIFAL trial
Full text linkBiomarkers; Hormone receptor-positive; Advanced breast cancerBiomarcadores; Cáncer de mama avanzado; Receptor hormonal positivoBiomarcadors; Càncer de mama avançat; Receptor hormonal positiuCurrently, there are no clinically actionable biomarkers to predict patient to cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i) plus endocrine therapy for hormone receptor (HR)[+]/ human epidermal growth factor receptor 2 (HER2)[-] advanced breast cancer (ABC). Herein, we report an exploratory biomarker substudy (transFAL) from a subset of patients included in PARSIFAL, a phase II randomized clinical trial that evaluated first-line palbociclib plus fulvestrant or letrozole for HR[+]/HER2[−] ABC. No definitive biomarkers were discovered, however, worse outcomes were found with CDK6 postivity (p = 0.008), ER negativity (p = 0.008), high Ki67 (p = 0.04), and TP53 mutation (p = 0.04). ctDNA density (p = 0.036) and number of mutations (p = 0.033) at baseline were significantly higher for resistant patients. Our study reveals future directions to explore in the goal to determine biomarkers of response to CDK4/6i
Mapatge sistemàtic de la literatura científica sobre la cirurgia robòtica en patologia benigna i maligna
Full text linkCirurgia robòtica; Patologia benigna; Patologia malignaRobotic surgery; Benign pathology; Malignant pathologyCirugía robótica; Patología benigna; Patología malignaSíntesi dels principals resultats de l'informe elaborat per avaluar l'evidència disponible sobre l'ús de la cirurgia robòtica en patologies benignes i malignes.Síntesis de los principales resultados del informe elaborado para evaluar la evidencia disponible sobre el uso de la cirugía robótica en patologías benignas y malignas.Summary of the main results of the report prepared to evaluate the available evidence on the use of robotic surgery in benign and malignant pathologies
Analytical Interference of Exemestane With Androstenedione Immunoassays
No full textExemestane; Immunoassay; Liquid chromatography-mass spectrometryExemestano; Inmunoensayo; Cromatografía líquida-espectrometría de masasExemestà; Immunoassaig; Cromatografia líquida-espectrometria de massesBackground: Exemestane, an aromatase inhibitor commonly used for breast cancer treatment, shares structural similarities with sex steroids analyzed in clinical laboratories. We aimed to investigate the influence of exemestane cross-reactivity in the measurement of sex steroids across various immunoassays.
Methods: We conducted a multicenter study involving measurements of androstenedione, testosterone, estradiol, progesterone, and 17-hydroxyprogesterone in serum samples from women undergoing exemestane therapy (N=15; 25 mg/day). Measurements were performed using liquid chromatography-mass spectrometry (LC-MS) and various commercially available chemiluminescence immunoassays, ELISA, and radioimmunoassay. In-vitro cross-reactivity was assessed by adding exemestane and 17-hydroexemestane to serum samples.
Results: Patients undergoing exemestane therapy had markedly falsely elevated androstenedione results in all immunoassays evaluated (N=4), which correlated with serum exemestane levels. In-vitro experiments confirmed this interference to be caused by cross-reactivity with exemestane. Additionally, one immunoassay yielded falsely elevated estradiol results in 20% of patients. However, in-vitro experiments did not confirm this to be caused by cross-reactivity with exemestane or 17-hydroexemestane.
Conclusions: Exemestane cross-reacts with androstenedione immunoassays, causing falsely elevated results in treated patients. This analytical interference may raise unnecessary concerns, leading to expensive diagnostic workups
Estimating the impact of displacement from Ukraine on HBV and HCV prevalence among migrants in the European Union, 2024: a modeling study
Full text linkEpidemiology; European Union; Hepatitis BEpidemiologia; Unió Europea; Hepatitis BEpidemiología; Unión Europea; Hepatitis BBackground: In countries with low baseline burdens of hepatitis B and C viruses (HBV, HCV), high levels of migration can impact the burden of viral hepatitis. The screening and treatment of migrants requires different methods and sensitivities than broad-based programs. We aimed to estimate the prevalence of HBV and HCV among migrants in EU-27 countries in 2024. The Ukrainian Refugee Crisis was also quantified.
Methods: Using the United Nations 2024 migrant stock data, we estimated the migrant population for each EU-27 country by five-year age and sex cohorts by country of birth. These distributions were multiplied by five-year age and sex prevalence estimates in the country-of-birth models maintained by the Polaris Observatory. The difference between the 2024 and 2020 Ukrainian migrant stock was quantified to estimate the impact of the Ukrainian Refugee Crisis.
Findings: In 2024, there were an estimated 1.73 million (UI: 1.04-2.66 million) migrants living with HBV and 1.03 million (UI: 757,000-1,559,000) living with anti-HCV in the EU-27, corresponding to migrant prevalences of 2.73% (UI: 1.6-4.2%) and 1.53% (UI: 1.2-2.5%) respectively. The Ukrainian Refugee Crisis is estimated to have resulted in an additional 43,000 (UI: 28,700-60,900) migrants living with HBV, and 154,000 (UI: 12,500-202,000) with HCV in the EU-27.
Interpretation: The burden of HBV and HCV among migrants and which communities are most affected in the EU-27 at the national level are vastly heterogeneous. These data provide evidence for policy makers to better understand the burden their community faces so that they can be better poised to develop culturally appropriate materials and outreach. While there is a great deal of uncertainty regarding the number of migrants by country, as well as the prevalence among these groups, this work provides direction towards which groups are most likely impacted at the EU-27 and national level.John C Martin Foundation
Regional sepsis care in Catalonia: comparative insights from a secondary analysis of the European Sepsis Care Survey
Full text linkRegional care; SepsisAtenció regional; SèpsiaAtención regional; SepsisTheEuropean Sepsis Care Survey was funded by the European Sepsis Alliance and an educational grant by Becton Dickinson S.A. (BD). BD was neither involved in the study design and recruitment nor in writing or reviewing or submission of the manuscript. This article represents the views of the named authors only
Platelet inhibition strategies in rescue stenting after failed thrombectomy: a large retrospective multicenter registry
Full text linkIntracranial arteriosclerosis; Ischemic stroke; Platelet aggregation inhibitorsArteriosclerosi intracranial; Ictus isquèmic; Inhibidors de l'agregació plaquetàriaArteriosclerosis intracraneal; Ictus isquémico; Inhibidores de la agregación plaquetariaBackground:
Rescue stenting (RS) is a bailout strategy for failed thrombectomy. Optimal platelet inhibition strategy after RS remains unclear.
Objectives:
We aimed to describe and compare different platelet inhibition strategies during/after RS.
Design:
Retrospective cohort study across 34 international centers.
Methods:
Patients with large vessel occlusion and RS after failed thrombectomy (2019–2023) were included. Periprocedural and postprocedural platelet inhibition strategies were described and compared, focusing on glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors, single antiplatelet therapy (SAPT), and dual antiplatelet therapy (DAPT). We assessed the effects of platelet inhibition strategy and potentially covariates on the primary outcome of 90-day modified Rankin Scale (mRS) using ordinal shift analysis with proportional odds models.
Results:
RS was performed in 589 patients (mean age 67.9 years, 60.8% male). Numerous combinations of platelet inhibitors were administered. Periprocedural GPIIb/IIIa inhibitors were used in 61.5% of patients. Postprocedural DAPT was administered to 80.5% and SAPT to 13.3%. Functional independence (mRS 0–2) was achieved in 40.7%, while 26.3% died within 90 days. Stent occlusion occurred in 20.5%, with 67.6% of these occlusions within 24 h. Postprocedural stent-occlusion was independently associated with worse functional outcome at 90 days (OR 4.1, 95% CI 2.3–7.2, p < 0.001). No significant association between periprocedural GPIIb/IIIa inhibitors, and 90-day mRS or stent occlusion was found. Postprocedural SAPT was associated with worse functional outcomes (adjusted odds ratio (aOR) 2.4, 95% CI 1.1–5.0, p = 0.02), higher mortality (aOR 2.1, 95% CI 1.05–4.0, p = 0.03), and increased stent occlusion rates (aOR 4.8, 95% CI 2.3–9.7, p < 0.001) compared to postprocedural DAPT. Symptomatic intracranial hemorrhage occurred in 6.8% of patients, with no significant difference between antiplatelet regimens.
Conclusion:
Extensive heterogeneity exists in platelet inhibition strategies following RS. Stent occlusion is associated with worse clinical outcomes, and the first 24 h post-RS are critical for stent patency. Compared to SAPT, DAPT was associated with better functional outcome, lower mortality, and lower stent occlusion rates.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: No project-specific funding was received for this study. V.S.-Z. is recipient of a research grants from Basel University, Bangerter-Rhyner-Foundation Basel and Freiwillige Akademische Gesellschaft Basel, Basel, Switzerland
Impacto de una intervención formativa sobre el conocimiento y experiencias de los profesionales como segundas víctimas
Full text linkErrors mèdics; Emocions; Segona víctima; Professionals de la salutMedical errors; Emotions; Second victim; Health professionalsErrores médicos; Emociones; Segunda víctima; Profesionales de la saludAnalizar el grado de conocimiento previo y posterior a la intervención sobre el concepto de segunda víctima y el reconocimiento de las experiencias relacionadas.
Metodología: Estudio observacional, descriptivo, transversal con medición pre y post intervención. Se realizó una encuesta basal en mayo de 2023 y, posteriormente, 8 sesiones formativas. En mayo de 2024 se repitió la encuesta.
Resultados: Se recogieron 199 respuestas antes y 134 después de la intervención, sin diferencias significativas entre las características sociodemográficas de ambas muestras. El conocimiento del concepto de segunda víctima incrementó un 18,5% (PRE: 48,7%, POST: 67,2%; p=0,001). No aumentó el número de profesionales que conocieran casos de compañeros afectados emocionalmente por un incidente o evento adverso en los últimos 5 años (40,2% vs. 44%; p=0,470).
Conclusiones: El grado de conocimiento sobre el concepto de segunda víctima aumentó tras la formación, así como el número de profesionales que reconocieron haber vivido sentimientos compatibles con ser una segunda víctima
Two-stage surgical management of septic pseudoarthrosis of the clavicle using a tricortical iliac crest autograft: a report of two cases
Full text linkClavicle; Iliac crest autograft; MasqueletClavícula; Autoempelt de cresta ilíaca; MasqueletClavícula; Autoinjerto de cresta ilíaca; Masquele
The Growing Burden of Obesity: Addressing a Global Public Health Challenge
Full text linkModifiable risk factors; Noncommunicable diseases; ObesityFactores de riesgo modificables; Enfermedades no transmisibles; ObesidadFactors de risc modificables; Malalties no transmissibles; Obesita