7 research outputs found
Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism
Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous
and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial
and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent
systemic embolism has not been previously reported.
In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis
and a peripheral embolism. He had no history of thrombotic events. Transthoracic
echocardiography showed a large, polypoid and mobile mass (4.0 Ă— 1.2 cm) attached to the
apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently
underwent open heart surgery. The histological examination showed an older thrombus and
a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming
the primary APS diagnosis. The patient initiated treatment with oral anticoagulation
(INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac
mass recurrence on two-dimensional echocardiography was seen.
Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular
mass mimicking primary cardiac tumor with recurrent systemic embolism has not
been previously reported. Pre-operative investigations could not distinguish such a thrombus
from a cardiac tumor and the diagnosis was made post-operatively
Immuno-priming durvalumab with bevacizumab in HER2-negative advanced breast cancer : a pilot clinical trial
Preclinical research suggests that the efficacy of immune checkpoint inhibitors in breast cancer can be enhanced by combining them with antiangiogenics, particularly in a sequential fashion. We sought to explore the efficacy and biomarkers of combining the anti-PD-L1 durvalumab plus the antiangiogenic bevacizumab after bevacizumab monotherapy for advanced HER2-negative breast cancer. Patients had advanced HER2-negative disease that progressed while receiving single-agent bevacizumab maintenance as a part of a previous chemotherapy plus bevacizumab regimen. Treatment consisted of bi-weekly durvalumab plus bevacizumab (10 mg/kg each i.v.). Peripheral-blood mononuclear cells (PBMCs) were obtained before the first durvalumab dose and every 4 weeks and immunophenotyped by flow-cytometry. A fresh pre-durvalumab tumor biopsy was obtained; gene-expression studies and immunohistochemical staining to assess vascular normalization and characterize the immune infiltrate were conducted. Patients were classified as "non-progressors" if they had clinical benefit (SD/PR/CR) at 4 months. The co-primary endpoints were the changes in the percentage T cell subpopulations in PBMCs in progressors versus non-progressors, and PFS/OS time. Twenty-six patients were accrued. Median PFS and OS were 3.5 and 11 months; a trend for a longer OS was detected for the hormone-positive subset (19.8 versus 7.4 months in triple-negatives; P = 0.11). Clinical benefit rate at 2 and 4 months was 60% and 44%, respectively, without significant differences between hormone-positive and triple-negative (P = 0.73). Non-progressors' tumors displayed vascular normalization features as a result of previous bevacizumab, compared with generally abnormal patterns observed in progressors. Non-progressors also showed increased T-effector and T-memory signatures and decreased T signatures in gene expression studies in baseline-post-bevacizumab-tumors compared with progressors. Notably, analysis of PBMC populations before durvalumab treatment was concordant with the findings in tumor samples and showed a decreased percentage of circulating T in non-progressors. This study reporting on sequential bevacizumab+durvalumab in breast cancer showed encouraging activity in a heavily pre-treated cohort. The correlative studies agree with the preclinical rationale supporting an immunopriming effect exerted by antiangiogenic treatment, probably by reducing T cells both systemically and in tumor tissue. The magnitude of this benefit should be addressed in a randomized setting. (www.clinicaltrials.gov):. Registered on June 16, 202
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Biodiversity recovery of Neotropical secondary forests.
Old-growth tropical forests harbor an immense diversity of tree species but are rapidly being cleared, while secondary forests that regrow on abandoned agricultural lands increase in extent. We assess how tree species richness and composition recover during secondary succession across gradients in environmental conditions and anthropogenic disturbance in an unprecedented multisite analysis for the Neotropics. Secondary forests recover remarkably fast in species richness but slowly in species composition. Secondary forests take a median time of five decades to recover the species richness of old-growth forest (80% recovery after 20 years) based on rarefaction analysis. Full recovery of species composition takes centuries (only 34% recovery after 20 years). A dual strategy that maintains both old-growth forests and species-rich secondary forests is therefore crucial for biodiversity conservation in human-modified tropical landscapes
TRATAMIENTO SINDROMICO DE FLUJO VAGINAL EN GESTANTES ATENDIDAS EN EL CENTRO DE SALUD CHACAPUNCO ENERO A JUNIO 2017
TesisObjetivo: Determinar las caracterĂsticas del tratamiento sindrĂłmico de flujo vaginal. MetodologĂa: El tipo de investigaciĂłn es sustantiva, nivel descriptivo y diseño descriptivo simple. Se trabajĂł con una muestra censal de 30 gestantes que desarrollaron sĂndrome de flujo vaginal resultados: Las caracterĂsticas encontradas en la edad fue edad mĂnima 17 años y la máxima 40 años, la mayorĂa presentĂł 23 años., el 53% son convivientes. SegĂşn el grado de instrucciĂłn, el 60% de las gestantes tienen primaria, el 47% son amas de casa, el 87% procede del área rural. Dentro de las caracterĂsticas clĂnicas el 67% de las gestantes tienen abundante secreciĂłn, las caracterĂsticas de las secreciones vaginales son el 67% presentan aspecto leche cortada, el 33% mal olor. Y los sĂntomas identificados fueron 60% disuria y prurito vulvar. Se encontrĂł que el 60% de las gestantes atendidas tienen como diagnostico presuntivo trichomona y cándida. Las complicaciones encontradas fueron: amenaza de parto prematuro 60%, amenaza de aborto 27%. La respuesta al tratamiento sindrĂłmico de flujo vaginal en gestantes el 73% de las gestantes se suministrĂł el Metronidazol y al 87% con Clotrimazol. ConclusiĂłn: El tratamiento sindrĂłmico de flujo vaginal con medicamentos resulto que el 83% de las gestantes fue efectivo y el 17% de las gestantes no fue efectivo.
Palabras claves: SĂndrome de flujo vaginal, tratamiento y gestantes
Above-ground biomass of Neotropical secondary forests database
This database is the product of the 2ndFOR collaborative research network on secondary forests. The database contains aboveground biomass data (in Mg/ha) for 1334 secondary forest plots differing in time since abandonment. The plots belong to different chonosequence studies in the Neotropics. For a description of the database, see Poorter et al. 2016. Biomass resilience of Neotropical secondary forests. Nature doi:10.1038/nature16512
Identification of four novel susceptibility loci for oestrogen receptor negative breast cancer
Common variants in 94 loci have been associated with breast cancer including 15 loci with genome-wide significant associations (P<5 x 10(-8)) with oestrogen receptor (ER)-negative breast cancer and BRCA1-associated breast cancer risk. In this study, to identify new ER-negative susceptibility loci, we performed a meta-analysis of 11 genome-wide association studies (GWAS) consisting of 4,939 ER-negative cases and 14,352 controls, combined with 7,333 ER-negative cases and 42,468 controls and 15,252 BRCA1 mutation carriers genotyped on the iCOGS array. We identify four previously unidentified loci including two loci at 13q22 near KLF5, a 2p23.2 locus near WDR43 and a 2q33 locus near PPIL3 that display genome-wide significant associations with ER-negative breast cancer. In addition, 19 known breast cancer risk loci have genome-wide significant associations and 40 had moderate associations (P<0.05) with ER-negative disease. Using functional and eQTL studies we implicate TRMT61B and WDR43 at 2p23.2 and PPIL3 at 2q33 in ER-negative breast cancer aetiology. All ER-negative loci combined account for similar to 11% of familial relative risk for ER-negative disease and may contribute to improved ER-negative and BRCA1 breast cancer risk prediction