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Introducción: El objetivo del presente estudio fue evaluar las características clínicas, patológicas e histológicas tumorales y su asociación con la recurrencia, metástasis y pronóstico en términos de supervivencia global y libre de enfermedad, de las pacientes que padecen sobrepeso u obesidad al momento del diagnóstico de cáncer de mama. Materiales y métodos: Se condujo un estudio descriptivo, longitudinal, retrospectivo, en un centro oncológico de referencia de Medellín. Se recolectó información de pacientes mayores de 18 años, con cáncer de mama infiltrante temprano y avanzado, entre los años 2012 – 2017, quienes presentaran IMC > 25 kg/m 2 al momento del diagnóstico. Las medianas de supervivencia se calcularon a través de curvas de Kaplan Meier y las diferencias mediante Log Rank Test. Resultados: Se analizó información de 1.349 pacientes. La mortalidad por todas las causas fue de 13.6% y aumentó proporcionalmente con el IMC (HR = 1.03, IC 1.0-1.05). Se identificaron 12.6% de recurrencias y el riesgo con el aumento de IMC no fue estadísticamente significativo (HR =1.02, IC 0.99 - 1.05). Características como mala diferenciación tumoral, invasión linfovascular y estadio tumoral se asociaron de forma univariada con mayor mortalidad. Conclusión: Se demostró una asociación positiva e independiente entre el IMC elevado, la mortalidad y el riesgo de recurrencia en pacientes con cáncer de mama. Así como una asociación con fenotipos tumorales agresivos y características de peor pronóstico. Se sugiere considerar modificaciones en el estilo de vida y un manejo multidisciplinario, como estrategias que posiblemente impacten en estos desenlaces.

Abstract Introduction Infant lumbar puncture (LP) is such a common procedure performed by pediatric house staff that the ACGME states it is a required essential pediatric residency skill. However, as new learners enter a clinical setting, they may be asked to perform an LP without having had any experience on a live infant. The purpose of the materials in this mastery learning module is to provide a comprehensive simulation-based training and assessment package related to the infant LP procedure. Methods This multimodal package will use simulation as a formative assessment medium to review LP training on a simulator prior to performing an LP on a live infant patient. The simulated environment provides a means for trainees to achieve a specific competency level via practice without affecting live patients. In the context of the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) phases of training (i.e., learn, see, practice, prove, do, maintain), this simulation addresses the first four of these phases: (1) initial instruction about the procedure, (2) faculty-led demonstration, (3) hands-on simulation-based training, and (4) assessment on a simulator. Materials provided in this resource include an instruction guide, session outline/rating checklist, and a train-the-trainer video. Results Our work has demonstrated that under the right conditions participation in a simulation-based mastery learning with deliberate practice intervention improves infant LP skills. Fifty-one residents reported 32 clinical encounters. Sixteen of 17 subjects (94%) who received this module and performed a clinical infant LP obtained cerebrospinal fluid compared with 7 of 15 subjects (47%) in the control group. Discussion The use of this formative assessment in LP training has potentially broad implications in terms of resident education and improved clinical outcomes. If errors are identified and resolved in a simulated situation, not only will the trainee feel more confident, but also could lead to an improved clinical outcome on a live patient.

The objective of this research is to find the effectiveness factor of the catalyst particles for the most favorable conditions of the phthalic anhydride production in a fixed bed reactor, with the aim of achieving the highest rate of phthalic anhydride production compared to other secondary products and analyzing the areas of lower effectiveness for the modification of the reactor design. Initially, the material and the energy balances in the catalytic bed are solved to obtain the concentration and temperature profiles based on the radius and length of the reactor, using polymath software(Polymath® v6.2 Software Minitab 19 Matlab 2019) with the data from literature. Once the profiles reproducibility was verified using the initial data (inlet temperature, pressure in the reactor, reactor wall temperature, reactor radius and mass flow rate) the experimental design 35 carry out, which generates 243 “experiments”, whose response variable (phthalic anhydride concentration) was obtained using Matlab. Subsequently, the variables were analyzed using the Minitab 18® that, through the response surface analysis method, allowed us to obtain the optimal values of the tested variables. Then, Subsequently, material and energy balances coupled with Fourier and Fick’s laws, along with the effectiveness factor equation, were applied, resulting in the generation of 9 coupled differential equations. Upon implementing the finite difference method, this yielded 90 nonlinear algebraic equations, which were solved using the Polymath software. A total of 78 particles were preselected based on their radial and axial positions to determine the effectiveness factor profile, with values ranging from 0.83 to near unity. The lower values correspond to the points with higher temperature, as evidenced by the calculations performed.

Response to neoadjuvant chemotherapy in breast cancer patients is of prognostic value in determining short- and mid-term outcomes. Inflammatory biomarkers, such as platelet-to-lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR), have been proposed as predictive factors of response to neoadjuvant chemotherapy. Currently, there are no studies in Colombian patients reporting the role of inflammatory biomarkers as response predictors in patients receiving neoadjuvant chemotherapy. Therefore, in this study we performed a cross-sectional study and analyzed the association between inflammatory biomarkers and pCR (pathological complete response) in patients diagnosed with breast cancer-of different molecular subtypes- and treated with neoadjuvant chemotherapy. A total of 288 patients were included in the study, with a median age of 51 years old. Disease was locally advanced in 83% of the participants, and 77.7% had compromised lymph nodes. In our cohort, the most frequent tumor molecular subtype was luminal B/Her2- (27.8%) followed by triple negative [TN] (21.5%), luminal B/Her2+ (19.8%), Her2-enriched (16%) and luminal A (13.5%). PLR was not associated with age, menopausal status, baseline tumor size, histologic grade, axillary lymph node involvement, disease stage, estrogen receptor status, or Ki67; however, complete pathological response was significantly higher in the low PLR group (PLR

Introduction. Obesity is an established risk factor for cancer and cancer-related deaths, including that of the breast. While the prevalence of female obesity has accelerated over the past decade in many developing countries, such as Colombia, the prevalence of overweight and obesity specifically in breast cancer populations has not been fully described. Methods. A cross-sectional study including 849 women diagnosed with breast cancer between 2009 and 2014. Based on body mass index, prevalence of overweight (BMI ≥ 25 < 30) and obesity (BMI ≥ 30) and associations of BMI with clinical and tumor histopathological features were analyzed. Results. Colombian breast cancer patients had a prevalence of overweight of 34.28% and obesity of 28.15%. Mean BMI was comparable between premenopausal and postmenopausal women (27.2 versus 27.7, resp.). Among premenopausal women, higher BMI was significantly positively associated with hormone receptor negative tumors, as well as with greater lymphovascular invasion. Conclusions. Colombian breast cancer patients exhibit a significant prevalence of overweight and obesity. Associations of high BMI and poor prognosis variables in the premenopausal population suggest risk of aggressive disease in this population. Future studies to further validate our observations are warranted in order to implement multidisciplinary clinical guidelines.