A woman with reddish nodule on the skin of the breast.

A 54-year-old woman presented a peri-areolar nodule located in the skin of the right breast. Clinical examination showed a 6 x 5 cm exophytic, lobed, ulcerated, and bleeding nodule. The patient reported that the tumor had grown gradually over a period of 3 months. The patient had been diagnosed 8 years prior to presentation with infiltrating ductal carcinoma of the right breast (pT2NO). This tumor was treated with partial mastectomy (conservative surgery) and lymph node dissection, then subsequently received 30 tangent field radiotherapy sessions to the breast for a total dose of 45 Gy. The rest of her cutaneous exam was normal. There was no family history of any similar tumor.

MicroRNA-200 family modulation in distinct breast cancer phenotypes.

The epithelial to mesenchymal transition (EMT) contributes to tumor invasion and metastasis in a variety of cancer types. In human breast cancer, gene expression studies have determined that basal-B/claudin-low and metaplastic cancers exhibit EMT-related characteristics, but the molecular mechanisms underlying this observation are unknown. As the family of miR-200 microRNAs has been shown to regulate EMT in normal tissues and cancer, here we evaluated whether the expression of the miR-200 family (miR-200f) and their epigenetic state correlate with EMT features in human breast carcinomas. We analyzed by qRT-PCR the expression of miR-200f members and various EMT-transcriptional inducers in a series of 70 breast cancers comprising an array of phenotypic subtypes: estrogen receptor positive (ER+), HER2 positive (HER2+), and triple negative (TN), including a subset of metaplastic breast carcinomas (MBCs) with sarcomatous (homologous or heterologous) differentiation. No MBCs with squamous differentiation were included. The DNA methylation status of miR-200f loci in tumor samples were inspected using Sequenom MassArray® MALDI-TOF platform. We also used two non-tumorigenic breast basal cell lines that spontaneously undergo EMT to study the modulation of miR-200f expression during EMT in vitro. We demonstrate that miR-200f is strongly decreased in MBCs compared with other cancer types. TN and HER2+ breast cancers also exhibited lower miR-200f expression than ER+ tumors. Significantly, the decreased miR-200f expression found in MBCs is accompanied by an increase in the expression levels of EMT-transcriptional inducers, and hypermethylation of the miR-200c-141 locus. Similar to tumor samples, we demonstrated that downregulation of miR-200f and hypermethylation of the miR-200c-141 locus, together with upregulation of EMT-transcriptional inducers also occur in an in vitro cellular model of spontaneous EMT. Thus, the expression and methylation status of miR-200f could be used as hypothetical biomarkers to assess the occurrence of EMT in breast cancer.

Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis

BACKGROUND Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders. METHODS This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records. RESULTS The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001). CONCLUSIONS As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.

Bancos de leche, una apuesta por la promoción de la lactancia materna

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública, Inclusión y Calidad de Vida de la Consejería de Salud y Bienestar Social

Primer mes. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias.

Primer mes. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias.

Dos meses. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias

Dos meses. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias

4 a 6 meses. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias

4 a 6 meses. Información básica para la crianza

Información elaborada a partir de: Proyecto de Humanización de la Atención Perinatal en Andalucía; Plan para la Promoción de la Actividad Física y la Alimentación Equilibrada; Plan Integral de Obesidad Infantil de Andalucía; Programas de Promoción de Salud Bucodental "Sonrisitas" y "Aprende a sonreir"; Plan Integral de Atención a la Accidentabilidad de Andalucía; Plan Integral de Tabaquismo de Andalucía; Plan Integral de Oncología de Andalucía. Publicado en el Portal Web de Ventana Abierta a la familia: www.juntadeandalucia.es/salud/ventanafamilias

Styles de vie, besoins de santé et utilisation des services de soins des adolescents porteurs d'affections chroniques

Résumé Contexte et objectifs Le premier volet a comme objectif d'évaluer la prévalence de l'affection chronique (AC) parmi les adolescents en Suisse, de décrire leurs comportements (loisirs, sexualité, conduites à risque) et de les comparer aux adolescents non porteur d'AC afin d'évaluer l'impact de l'AC sur leur bien-être. Le second volet a comme objectif d'explorer leur réseau de soutien, leur mode d'adaptation et leur perception de la prise en charge dont ils bénéficient par les équipes soignantes. Chacun des objectifs est traité dans un article : - « Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland » Eur J Pediatr (2003) 162: 682-689 - « Adolescents porteurs d'affections chroniques: la parole aux patients » Med Hyg 2004 ; 62 : 2224-9. Méthode Première partie: les données ont été obtenues par analyse secondaire de l'enquête sur la santé des adolescents en Suisse, réalisée en 1993-1994 auprès d'un échantillon de 9268 jeunes de 15 à 20 ans (6% de la population visée), à l'aide d'un questionnaire auto administré de 100 questions environ. Le programme SPSS a été utilisé pour effectuer les analyses bi- et multi-variées. Seconde partie: la commission d'éthique de la Faculté de médecine de l'Université de Lausanne a donné son accord permettant la réalisation d'un focus group (discussion en petit groupe) de 12 jeunes. Ils ont participé à une discussion de 2 heures, conduite par un modérateur entraîné à cette méthode. Résultats Premier volet : 11.4% des filles et 9.6% des garçons se déclarent porteurs d'une AC. 25% des filles porteuses d'une AC (versus 13% de non porteur; p=0.007) et 38% des garçons porteurs d'une AC (versus 25% de non porteur; p=0.002) déclarent ne pas utiliser la ceinture de sécurité quand ils conduisent. 6.3% des filles (versus 2.7% ; p= 0.000) disent avoir conduit en étant ivres. 43% des filles (versus 36% ; p= 0.004) et 47% des garçons (versus 39% ; p=0.001) sent fumeurs de cigarettes. 32% des garçons (versus 27% p=0.02) rapportent avoir consommé du cannabis. 17% des filles (versus 13°h ; p=0.013) et 43% des garçons (versus 36% ; p= 0.002) disent boire de l'alcool. Le fait d'être porteur d'AC a aussi des conséquences psychologiques : 7.7% des filles (versus 3.4% ; p= 0.000) et 4.9% des garçons (versus 2% ; p=0.000) ont effectué un tentamen durant les 12 mois précédents. Deuxième volet: Sur oui peuvent-ils compter ? Avant tout sur eux-mêmes, puis sur leurs parents ou leurs amis. Les pairs, l'équipe soignante, les autres malades et les enseignants ont chacun des rôles à jouer à des moments précis de l'évolution de l'AC. Leurs modes d'adaptation: prendre du recul, faire preuve d'humour et demander de l'aide à leurs proches. Ils s'évadent dans l'écriture, les pensées ou la musique. Demande aux médecins une prise en charge globale qui permette une compréhension de l'ensemble de leurs besoins plutôt que focalisée seulement sur leur AC. Le respect, la possibilité d'un soutien et d'explications précises leur paraissent importants. Conclusions Les conduites dites à risque ne sont pas moins fréquentes chez les adolescents porteurs d'AC que chez leurs pairs Elles peuvent être expliquées par le besoin de tester leurs limites tant sur le plan des consommations que du comportement. Une prévention et une attention spécifiques des équipes soignantes sont nécessaires. Un réseau social diversifié paraît nécessaire aux jeunes souffrant d'AC. Les médecins devraient avoir une vision globale de leur patient, les aider à se situer dans le monde de l'adolescence, leur permettre de nommer leurs émotions et anticiper les questions difficiles à poser. Abstract The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; interval to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey Introduction on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P = 0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P= 0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. Conclusion: Experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

A phase I clinical and pharmacological study evaluating vinflunine in combination with doxorubicin as first line treatment in metastatic breast cancer.

Vinfunine (VFL) is a novel bifluorinated tubulin-targeted agent of the vinca alkaloids class active in advanced stage breast cancer. We conducted a phase I study combining VFL with doxorubicin (DXR) to define the recommended dose (RD), safety, pharmacokinetic (PK) interaction and efficacy. Two schedules (day 1 every 3 weeks; days 1 and 8 every 3 weeks) were investigated as first line chemotherapy in metastatic breast cancer patients. Thirty-two patients received a total of 162 cycles of the VFL-DXR combination (median 6). The RDs were VFL 250 mg/m(2)/DXR 40 mg/m(2) every 3 weeks for schedule 1 and VFL 120 mg/m(2)/DXR 25 mg/m(2) days 1 and 8 every 3 weeks for schedule 2. The main dose-limiting toxicity was neutropenia. The most frequent non-hematological adverse events were nausea, fatigue, constipation, vomiting, anorexia, stomatitis and dyspnea. Objective response rate was reached in 47.1% of the patients. No PK interaction was observed. VFL-DXR combination is feasible with manageable toxicity. The antitumor activity was promising and supports further evaluation.