In Mexico, the use of at least three lines of trastuzumab in combination with other therapies, but not with pertuzumab or TDM-1, represents the most cost-effective option for patients covered by the public healthcare system, and this sequence should be made available for all patients.
Stress is a cardiovascular disease risk factor, and resilience may serve as a buffer for stress. Little is known about stress and resilience among rural women. Objective:The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience. Design and sample:A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n = 354).Measures: Data were collected to measure perceived stress, social support, chronic stress, and resilience. Results:A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales. Conclusion:The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations. K E Y W O R D Sresilience, rural health, stress BACKGROUNDCardiovascular disease (CVD) remains a persistent international public health issue responsible for approximately 18 million deaths worldwide (Virani et al., 2021; WHO, 2019). Risk factors that increase the development of CVD include unhealthy diet, insufficient physical activity, overweight or obesity, smoking, high plasma cholesterol levels, and diabetes (Virani et al., 2021). However, stress is an underrecognized determinant of CVD-related comorbidities including coronary artery disease, stroke, metabolic syndrome, and diabetes (Janczura et al., 2015;O'Neill & O'Driscoll, 2015). Stress affects the amygdala of the brain, stimulates hormonal response, triggers arterial inflammation, and increases the likelihood of future cardiovascular adverse events
Cardiovascular disease is a global public health problem and leading cause of death. Stress is a modifiable cardiovascular disease risk factor. The objectives of this study were to examine whether stress was a predictor of resilience among rural younger women and to explore whether social support mediated the relationship between acute stress and resilience and between chronic stress and resilience. The study had a cross-sectional, descriptive design. A total of 354 women were randomly recruited in the rural, southeastern United States. Survey instruments were used to collect data about acute stress, chronic stress, social support, and resilience. A structural equation model was fit to test whether social support mediated the relationship between perceived stress and resilience and between chronic stress and resilience. Chronic stress predicted family and belongingness support and all the resilience subscales: adaptability, emotion regulation, optimism, self-efficacy, and social support. Acute stress predicted the self-efficacy subscale of resilience. Family support partially mediated the relationship between chronic stress and self-efficacy. Belongingness support partially mediated the relationships between chronic stress and the social support subscale of resilience.
s153 sensitivity analysis was done using a Montecarlo simulation with 1,000 iterations, furthermore, an univariate sensitivity analysis was estimated by a tornado diagram. Results: The effectiveness obtained after the adjustment (proportion of IAI cases successfully treated) was 89% for ertapenem, 73.6% for piperacilin/tazobactam, and 86% for ceftriaxone/metronidazole.
Background: Dysregulated signaling pathways occur in human cancers including breast cancer, making it a rational target for novel genome guided combinatorial personalized therapies. The aim of the present study was to investigate the different genetic mutation pattern between neoadjuvant and metastatic settings in breast cancer patients to guide research and clinical treatment. Material and Methods: 150 breast cancer patients were involved in this study. 38 patients were receiving neoadjuvant treatment and 112 patients were in the metastatic setting. Tumor specimens obtained from the 150 patients were subjected to genetic mutation testing by FoundationOne. Genetic alterations detected by FoundationOne test were collected and analyzed. Results: 96 and 149 different genes where reported by FoundationOne in neoadjuvant and metastatic setting respectively. The average number of non-synonymous mutation was five per case in the neoadjuvant setting and six per case in the metastatic setting. TP53 (58%), MYC (32%), PIK3CA (29%), PTEN (16%), CDH1 (13%), CCND1 (11%), EMSY (11%), LYN (11%) and ZNF703 (11%) were the most seen mutations in neoadjuvant setting. TP53 (40%), PIK3CA (39%), MYC (22%), CCND1 (21%), FGF19 (21%), FGF4 (21%), CDH1 (20%), FGF3 (19%), ERBB2 (17%), ESR1 (14%), FGFR1 (14%), ZNF703 (14%), GATA3 (13%), MYST3 (11%), PTEN (11%), EMSY (10%), NF1 (10%) and ZNF217 (10%) were the most seen mutations in metastatic setting. ESR1 and GATA3, which are seen in 14% and 13% of metastatic breast cancer patients, were not reported in neoadjuvant breast patients. Moreover, among the 16 metastatic breast cancer patients who has ESR1 mutation, 9 (56%) of them presented with PIK3CA or other genetic mutations which are directly involved in the phosphoinositide 3-kinase (PI3K)/AKT pathway. Conclusion: A significantly more mutation in Receptor Tyrosine Kinases (RTKs)/ Growth Factor Signaling ( especially ERBB and FGFR pathways) was reported in the metastatic setting compare to the neoadjuvant setting, suggesting a critical role of the RTKs in metastatic breast cancer patients. The coexisting of ESR1 and PI3K/AKT pathway alteration and the absence of ESR1 in neoadjuvant setting also suggested that in early stage breast cancer patients who have a PI3K pathway alterations; there is a higher chance to develop ESR1 mutation with disease progression. Citation Format: Xu B, Williams C, De P, Dey N, Klein J, Williams K, McMillan A, Leyland-Jones B. Differential mutation pattern between neoadjuvant and metastatic settings in breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-03-02.
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