Deciphering the Clinical Behaviour of Invasive Lobular Carcinoma of the Breast Defines an Aggressive Subtype

Background: Invasive lobular carcinoma (ILC), the most common special type of breast cancer (BC), has unique clinical behaviour and is different from invasive ductal carcinoma of no special type (IDC-NST). However, ILC further comprises a diverse group of tumours with distinct features. This study aims to examine the clinicopathological and prognostic features of different variants of ILC, with a particular focus on characterising aggressive subtypes. Methods: A large (n = 7140) well-characterised and histologically reviewed BC cohort with treatment and long-term follow-up data was investigated. The cohort was classified based on the WHO classification of tumours into main histological subtypes, including ILC and IDC-NST. ILCs were further classified into variants. Clinicopathological parameters and patient outcomes in terms of BC-specific survival (BCSS) and disease-free survival (DFS) were evaluated. Results: ILC constituted 11% of the cohort. The most common non-classic ILC variants were pleomorphic (pILC) and solid (sILC), constituting 19% of ILC. Compared to classic and related variants (alveolar, trabecular, papillary, and tubulolobular; cILC), pILC and sILC variants were associated with aggressive tumour characteristics. The histologic grade of ILC was an important prognostic variable. The survival patterns identified an aggressive ILC subtype encompassing pILC and high-grade sILC. These tumours, which comprised 14% of the cases, were associated with clinicopathological characteristics of poor prognosis and had high BC-specific death and recurrence rates compared not only to cILC (p < 0.001) but also to IDC-NST (p = 0.02) patients. Contrasting this, cILC patients had significantly longer BCSS and DFS than IDC-NST patients in the first 10 to 15 years of follow-up. Adjuvant chemotherapy did not improve the outcome of patients with aggressive ILC subtypes. Conclusions: pILC and high-grade sILC variants comprise an aggressive ILC subtype associated with poor prognostic characteristics and a poor response to chemotherapy. These results warrant confirmation in randomised clinical trials

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

Background and Objectives: In the last years, prepectoral breast reconstruction has increased its popularity, becoming a standard reconstructive technique by preserving pectoralis major anatomy and functionality. Nevertheless, the lack of solid and extensive data negatively impacts on surgeons\u2019 correct information about postoperative complication rates and proper patient selection. This study aims to collect the largest evidence on this procedure. Methods: A multicentre retrospective audit, promoted by the Barcelona Hospital, collected the experience of 30 centers on prepectoral breast reconstruction with Braxon ADM. The study had the scientific support of INPECS and IIB societies which provided the online database Clinapsis. Results: A total of 1450 procedures were retrospectively collected in a 6-year period. Mean age 52.4 years, BMI 23.9, follow-up 22.7 months. Reconstruction was carried out after a tumor in 77.1% of the cases, 20.1% had prophylactic surgery, 2.8% had revisions. Diabetes, smoke, and immunosuppression had an influence on complications occurrence, as well as implant weight. Capsular contracture was associated with postoperative radiotherapy, but the overall rate was low (2.1%). Complications led to implant loss in 6.5% of the cases. Conclusions: The international Braxon Audit Group multicentre data collection represents a milestone in the field of breast reconstruction, extensively improving the knowledge of this procedure

Argumentación jurídica y trasfondo ideológico. Análisis del debate legislativo sobre prórroga de alquileres en Argentina a priincipios del siglo xx

Resumen: El presente trabajo aborda el debate parlamentario de las leyes 11.152 y 11.157, que intentaron brindar una solución legislativa al problema habitacional que en ese momento atravesaba nuestro país. La hipótesis de nuestra investigación plantea que lejos de buscar en las discusiones conceptos cerrados o rígidos, las referencias a nociones como código, derecho, propiedad, libertad de contratar, derecho extranjero, nos remiten a lugares de discusión desde donde se argumentan las disímiles posturas suscitadas frente a las medidas proyectadas. Creemos que una fuente privilegiada donde es posible rescatar las múltiples significaciones de nuestras instituciones jurídicas y sus trasfondos ideológicos, lo constituyen los debates parlamentarios. En efecto, se ha visto en los parlamentos, una «asamblea de los representantes de los principales puntos de vista en conflicto en la sociedad», conduciendo sus «deliberaciones y toma de sus decisiones en el marco del conflicto y la controversia sobre losmismos» y creando derecho «sobre la base de las convicciones y los votos explícitamente partidistas de sus miembros». En este contexto, el derecho ya no sería entidad abstracta y aséptica, lógica en sus consecuencias, sino más bien tópico, argumentación jurídica de un cierto posicionamiento ideológico, frente a las circunstancias fácticas de una determinada sociedad. Una arista peculiar de nuestro análisis es el derecho extranjero como tópico. Nuestra mirada, más que simplificar, intentará acercarse a la complejidad de los procesos de circulación de ideas jurídicas y seguimiento de modelos jurídicos europeos que gravitaron sobre las élites argentinas durante la primera mitad del siglo XX.Abstract: This article pretends to deal with the parliamentary discussion of the laws 11.152 and 11.157 that intended to bring a legislative solution to the habitual problem that Argentina was going through at that moment. The hypothesis of our investigation is that, far from trying to find closed or rigid concepts in those debates, the reference to notions such as code, right, property, freedom to hire, foreign law, takes us to areas of discussion from which different opinions on the measures taken can be formed. We think that a privileged source from which it is possible to rescue the multiple meanings of our juridical institutions and their ideological backgrounds are the parliamentary debates.Therefore, parliaments are seen as an »assembly of the representatives of the main points of view which are found in society«, taking their »deliberations and decisions to the frame of the conflict and the controversy on those views« and creating law »on the basis of convictions and votes explicitly partisan«. In this context, the law is no longer an abstract and neutral entity, logical in its consequences, but a topic, a juridical argumentation of a certain ideological position, dealing with the factual circumstances of a certain society. A particular aspect of this analysis is Foreign Law as a topic. Our point of view stresses that rather than seek to simplify, we should try to understand the complexity of the circulation processes of juridical ideas and the adoption of European juridical models that were in the mind of the Argentinian elites during the first half of the 20th century

Hacia una nueva experiencia del Derecho: el debate en torno a la enseñanza práctica del derecho en la Universidad de Buenos Aires a comienzos del siglo XX

El comienzo del siglo XX se presta a la vista del historiador del derecho como un momento rico en debates y cuestionamientos que llevaron a una nueva visión y experiencia del derecho. En este trabajo se aborda el examen de la discusión académica mantenida en la Facultad de Derecho y Ciencias Sociales de la Universidad de Buenos Aires en torno a la enseñanza práctica del derecho, asunto que lejos de reducirse a un problema meramente pedagógico, se erigió como una propuesta destinada a quebrar la visión jurídica decimonónica comprimida en los estrechos limites de los códigos. Fruto de esa polémica fue la creación en 1922 del Instituto de Enseñanza Práctica del Derecho, cuyo fundador y primer director, Héctor Lafaille, plasmó buena parte de los ideales discutidos

La argentinidad de la constitución: Nuevos enfoques para el estudio de nuestra carta magna a principios del siglo XX (1901-1930)

At the end of the 19th century and the beginning of the 20th, the scientific Argentinean panorama receives the influence of new orientations and perspectives that were brought by the "Social Science" or Sociology, together with a "National point of view", which was seeking the search, through them, of an "Argentinean soul" and was the eco of a Nationalist affirmation that was influencing both the political and intellectual life of Argentina since 1880. In the sphere of the Law, the sociological influence brought a crisis in the exegetic method by putting into evidence "the huge abysm between the socio-juridical phenomena and the Law as a science". That is why most of our jurists insisted on tracking what "might be of our own in our Constitution or our laws". From this perspective, the object of this investigation is to analyse those speeches which, in the sphere of the Constitutional Law, were built up considering the identity of our National Constitution and moving away from those speeches that considered it as a copy of the American Constitution. They set out an interpretation of its rules, basing this interpretation, mainly, in the national facts and precedents.A fines del siglo XIX y principios del XX la realidad científica argentina recibe la influencia de las nuevas orientaciones y perspectivas que traían la "ciencia social" o sociología, acompañadas también de un "enfoque nacional", que perseguía, la búsqueda, a través de ellas del "alma argentina", y que era el eco de la afirmación nacionalista que agitaba el mundo político e intelectual de la Argentina desde 1880. En el ámbito del derecho, el embate sociológico puso en crisis el método exegético poniendo en evidencia el "enorme abismo entre el fenómeno socio-jurídico y la ciencia del derecho". Es así que la mayoría de nuestros juristas se empeñaron en rastrear lo que "podía haber de propio en nuestra constitución o en nuestras leyes". Desde esta perspectiva, el objeto del presente trabajo es el análisis de aquellos discursos, que en el ámbito del derecho constitucional, se construyeron en torno a la identidad de nuestra constitución nacional, y que apartándose de aquéllos que la consideraban como una copia de la norteamericana, planteaban una interpretación de sus normas fundamentada, principalmente, en los factores y antecedentes nacionales

One-Step Prepectoral Breast Reconstruction With Dermal Matrix–Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation

The aim of this study was to compare the functional and economical outcomes of the prepectoral breast reconstruction (PPBR) versus the subectoral one. PPBR entailed significantly lower postoperative pain and faster upper limb functional recovery than subpectoral procedure. Moreover, PPBR largely reduced the need for symmetrization. Therefore, PPBR was also economically advantageous over traditional implant reconstruction. Background: The breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. Patients and Methods: From February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix–wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. Results: Compared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. Conclusion: Immediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix–wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness

A PCR-Based Strategy for Dombrock Screening in Brazilian Blood Donors Reveals a Novel Allele: The DO*A-WL

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Background: Determination of the molecular basis underlying the antigens in the Dombrock blood group system has shown various rearrangements between the alleles associated with DO*A and DO*B. Based on this, we employed a PCR-based strategy to screen DO alleles (DO*A, DO*B, HY*1, HY*2 and JO) in Brazilians. Methods: We tested DNA of 278 Brazilian blood donors by PCR-RFLP on plates of 96 wells to determine the 793A/G (DO*A/DO*B), 323G/T (HY), 350C/T (JO) and 898C/G (HY*1/HY*2) single nucletide polymorphisms. In order to confirm the results sequence analysis was also performed. Results: When samples of these donors were analyzed, a novel allele combination, the DO*A allele (793A and 323G) associated with 898G was identified and designated as DO*A-WL allele. This new allele encoding 300Val is the same as HY*1 at nucleotide 898 on the molecular background of DO*A. Among the 556 alleles analyzed by PCR-RFLP, 3 were DO*A-WL and 78 were DO*B-WL. This represents an overall frequency of 0.5% for DO*A-WL and 14% for DO*B-WL across the population studied. Conclusion: Molecular screening of Brazilians revealed one novel allele, the DO*A-WL. Our data highlight the importance of testing a cohort of different populations to determine DO haplotypes and to establish reliable genotyping tests for predicting Do(a)/Do(b) status. J. Clin. Lab. Anal. 25:79-82, 2011. (C) 2011 Wiley-Liss, Inc.2527982Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [07/59546-1