20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials

Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5–14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4–8·6]; rate ratio 1·37 [95% CI 1·17–1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92–1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95–1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94–1·15]; p=0·45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered—eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy

El veneno del materialismo: Juan Ignacio Gorriti, crítico de D`Holbach

This paper aims to offer a contribution to the reconstruction of the Ibero-American reception itinerary of the Radical Enlightenment. In particular, of the ideas of one of the philosophes most reviled by Catholic orthodoxy: the Baron d’Holbach, whose texts were not only known and translated in Spain, but also in South America. Indeed, La morale universelle (1776) was established as an official study text in schools of Bolivia in 1827, provoking the reaction of the Argentine priest Juan Ignacio Gorriti. In order to clarify this episode, the text is organized into three sections. First, the figure and the main ideas of d’Holbach are presented; second, a brief reconstruction of the dissemination of his texts in Spain and South America is offered; finally, the arguments that Gorriti exposed against materialism in his Reflexiones (1836) are analysed. A book through which he tried to prevent American youth from being infected by «the poison of materialism»El objetivo de este artículo es el de contribuir a la reconstrucción del itinerario de recepción hispanoamericana de la Ilustración radical. En particular, de las ideas de uno de los philosophes más denostados por la ortodoxia católica: el barón d’Holbach, cuyos textos no solo fueron conocidos y traducidos en España, sino también en Sudamérica. En efecto, La morale universelle (1776) fue establecida como texto de estudio oficial en las escuelas de Bolivia en 1827, lo que provocó la reacción del sacerdote argentino Juan Ignacio Gorriti. Con el fin de esclarecer este episodio, el texto se organiza en tres secciones. Primero, se presentan la figura y las principales ideas de d’Holbach; segundo, se ofrece una breve reconstrucción de la difusión de sus textos en España y Sudamérica; finalmente, se analizan los argumentos que Gorriti esgrimió contra el materialismo en sus Reflexiones (1836). Un libro a través del cual intentó impedir que los jóvenes americanos fueran infectados por «el veneno del materialismo

La formación transdisciplinaria en el grado universitario: una experiencia de la asignatura de Análisis de la Sustentabilidad Ambiental de Proyectos

Frente a la crisis ambiental contemporánea es necesario contribuir a la construcción de una "Nueva Sociedad". Para que esto se logre, es necesario generar cambios en los patrones de comportamiento de los sujetos que diariamente conviven en ella. Frente a esta situación y como motores de producción de conocimiento, las universidades no pueden estar excluidas sino que, por el contrario, deben ser unpilar fundamental para lograrlo.Formar profesionales para un funcionamiento diferente de la sociedad es un gran desafío. Desde esta perspectiva, se trabaja desde la asignatura Análisis de la Sustentabilidad Ambiental de Proyectos de la carrera de Ingeniería Ambiental de la UNL en pos de generar nuevas herramientas para la sociedad actual. La asignatura está incluida como práctica de Extensión Experiencial de la UNL, y dentro de este marco se propone una metodología transdisciplinaria que pretende generar un acercamiento a las problemáticas actuales de la sociedad y buscar las vías y actores más acordes para resolverlas