Abstract Background: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death in women in Latin America (LATAM). However, the region lacks a unified multinational initiative to investigate BC and to further understand regional disparities. Methods: LATINA (LACOG 0615/MO39485) is the first multinational prospective cohort study designed to describe clinicopathological characteristics, treatment patterns, and outcomes of patients with BC in LATAM. Patients aged ≥18 years diagnosed with primary or recurrent BC in the 12 months preceding site activation were included. Data were collected at enrollment and every 6 months for up to 5 years. We present here the results for clinicopathological and demographic characteristics at BC diagnosis. Multivariable logistic regression was performed to investigate characteristics associated with later diagnosis (stage II/III vs. stage I) and detection method (symptomatic vs. screening). Causal mediation analysis was performed to investigate the detection method as a mediator of the effect of health care provision (public or private) on stage at diagnosis. Results: Between February 2020 and August 2022, 3276 patients from 31 research sites in 10 LATAM countries were included. Most patients in this cohort (72.1%, N=2362) were treated in the public health system. Regarding ethnicity, most patients (91.8%, N=3008) self-identified as Latinos and were White (47.3%, N=1549), American Indian (21.0%, N=689), and Black or Brown (16.6%, N=544). The median age at diagnosis was 54 years (range 23–95), 41.8% (N=1368) were < 50 years of age at BC diagnosis, and 54.1% (N=375) of the American Indian patients were ≤50 years of age. BC subtype distribution was: 43.2% (N=1336) luminal A, 14.3% (N=433) luminal B, 22.9% (N=709) human epidermal growth factor receptor 2-positive (HER2+), and 15.4% (N=477) triple negative. In patients older than 50 years old, most cases were detected with symptoms, particularly in the public health system (63.2%, N=836) vs. 50.5% (N=232) in the private health system, p< 0.0001). This was also the case in Black/Brown (61.6%, N=178) and American Indian patients (89.5%, N=281) vs. White patients (45.6%, N=413) (p< 0.0001). In the public system, 37.7% (N=890) and 31.7% (N=748) of cases were diagnosed at stage II and III vs. 37.6% (N=343) and 26.6% (N=243) of cases in the private system, respectively (p< 0.0001). Users of the public health system had a significantly higher risk of being diagnosed with symptoms vs. screening (adjusted odds ratio [aOR] 3.54, 95% CI 2.17–5.76). Causal mediation analysis showed that the detection method (screening vs. symptomatic) mediated 21.8% (95% CI 1.7%–41.9%, p=0.034) of the effect of health care provision (public or private) on stage at diagnosis. Self-identifying as Black (aOR 2.11, 95% CI 1.29–3.45), age < 40 years (aOR 1.97, 95% CI 1.20–3.23), public health care provision (aOR 2.18, 95% CI 1.32–3.59), and a diagnosis of HER2+ (aOR 1.74, 95% CI 1.20–2.52) or triple-negative BC (aOR 2.34, 95% CI 1.47–3.71) were associated with an increased risk of being diagnosed at a later stage. Conclusions: A significant proportion of new BC diagnoses in LATAM is observed in patients < 50 years of age. Reflecting the low screening coverage throughout the region, most patients detect the disease with symptoms. Stage III BC accounted for 30.3% of new cases, being more common among users of the public health system. Differences in the stage at diagnosis related to health care provision (public or private), ethnicity, and country underscore significant disparities that need to be addressed. Further analyses of these data will help identify factors associated with late diagnosis and support the development of regional corrective health policies. Citation Format: Gustavo Werutsky, Cynthia Villarreal-Garza, Henry Gómez, Juan Manuel Donaire, José Bines, Luis Henrique Fein, Maria Clara Horsburgh, Paula Cabrera-Galeana, Heloísa Resende, Rosa Vasallo Veras, Miriam Raimondo, Ricardo Elías Brugés Maya, Vidal Maria Del Rosario, Yeni Nerón, Ana Maria Donoso, Fernanda B. Damian, José D'Oliveira, Couto Filho, Maria Isabel Alonso, Victoria Costanzo, Tomás Reinert, Adriana Elizabeth Borello, Eduardo Cronenberger, Luis Fein, Marcela Urrego, Enrique Alanya, Jorge Luis Soriano García, Saúl Campos-Gomez, Eduardo A. Richardet, Hugo Castro-Salguero, Felipe Cruz, Diego Gómez, Angel Hernández, Carlos Alberto Farfan Tello, Ronald Rodríguez, Rafaela Jesus, Gustavo Gössling, Carlos Barrios. Clinicopathological Characteristics and Factors Associated With Screening and Late-Stage Diagnosis in Patients With Breast Cancer in Latin America: The LATINA Study (LACOG 0615/MO39485) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-04.
El cáncer de mama es una enfermedad multifactorial, en la que existe la interacción de varios factores: hormonales, metabólicos, genéticos y ambientales. La mayoría se define como esporádicos 75-80%, que se producen en mujeres que no tienen antecedentes familiares de esta enfermedad. Una minoría de los casos, lo que representa alrededor del 10-15%, se denominan cánceres familiares, en la familia hay más de un miembro con cáncer. Alrededor del 5 -10% serían debido a la presencia de variaciones en el ADN constitutivo que confiere un riesgo mucho mayor a desarrollar cáncer que la población general y éstos son los llamados hereditarios. Estos datos son foráneos, Chile no tiene registro, por lo que solamente podemos extrapolar esas cifras. Breast cancer is a multifactorial disease in which a number of factors interact, namely hormonal, metabolic, genetic and environmental. The mayority of breast cancers are defined as sporadic, which means they are present in women with no family history of the disease. A small number, which represents about 15% are defined as Familial cancers in which more than one family member has cancer. About 5-10% are considered to be due to the presence of constitutive DNA variations which confer an elevated risk for the development of cancer in the general population and these are called hereditary cancers. This data is foreign; in Chile, we do not have a cancer registry so for now we can only extrapolate these numbers.
Abstract Background: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death in Latin American women, with an estimated age-standardized annual incidence of 38.3 and 56.8 and mortality rates of 10.1 and 13.4 cases per 100,000 females, in Central and South America respectively. However, BC incidence in Latin America (LATAM)is largely underestimated and lacks updated information. Furthermore, the shortage and quality of cancer registry data hinders a more reliable assessment of treatment and outcomes for these patients. The goals of LATINA Breast study is to build an electronic platform/database to allow a standardized collection of epidemiological data of BC in LATAMin addition to describe real world data on patients characteristics, treatment patterns and outcomes of this population. Methods: LATINA Breast (LACOG 0615) is a prospective, international, multicentre and non-interventional study of primary data collection designed to describe the diagnosis, oncologic treatment and outcomes of patients with BC in LATAM. Patients aged ≥ 18 years with stage I to IV newly diagnosed BC (i.e. <12 months since site activation) will be considered eligible for inclusion.Patient data will be collected from medical records at diagnosis and every 6 months for up to 5 years of follow-up. At baseline, data on socioeconomic, demographic, medical history and BC clinicopathological characteristics will be collected. Thereafter, information regarding treatment patterns, sequencing, response to treatment, adverse events, disease relapse/ progression and overall survival will be collected at each time-point. This study has a planned sample size of a minimum of 2.200 to a maximum of 4.500 patients accrued from approximately 30 sites in 10 LATAM countries: Argentina, Brazil, Cuba, Colombia, Chile, Dominican Republic, Ecuador, Mexico, Peru and Uruguay. The expected number of patients per country is based on age-standardize BC incidence rate by GLOBOCAN 2012 and not in a formal statistical estimation.Co-primary endpoints are (1) to describe patients’ characteristics, prevalence of BC subtypes at diagnosis, local and systemic treatment patterns and outcomes; (2) to build an electronic platform/database of epidemiological data of BC in LATAM. Secondary endpoints are to evaluate regional differences in treatment strategies, to describe treatment efficacy parameters such as locoregional relapse, invasive disease-free survival, progression-free survival, overall survival and to evaluate treatment safety. The trial is registered at clinicaltrials.gov NCT04158258.Results The first site was activated for patient accrual on February 13, 2020, in Argentina. As of July 6, 2020, a total of 243 patients have been included in Argentina (n=81), Brazil (n=123), Colombia (n=37), and Guatemala (n=2) within 19 active sites. Regulatory approval and activation are ongoing in the other countries. Recruitment is estimated to last until December 2021 to achieve the planned sample size. Patients will be followed-up for 5 years, therefore we estimate the last follow-up data collection in December 2026. ConclusionLATINA Breast is the first multinational, prospective cohort study of BC in Latin America that will generate detailed information on diagnosis, treatment and outcome in real-world clinical practice. It will address important gaps in BC management and will likely single out some of the main inequities in this large and diverse population of BC patients and consequently support strategies for the improvement of BC cancer care in LATAM. Citation Format: Gustavo Werutsky, Cynthia Villareal-Garza, Henry Gomez, Juan Manuel Donaire, José Bines, Luis Fein, Mariano Nicolas Carrizo, Facundo Zaffaroni, Paulo Ricardo Nunes Filho, Carlos H Barrios. A study to observe patients characteristics, treatment patterns and outcomes in patients with newly diagnosed breast cancer in Latin America - LATINA breast (LACOG 0615/ MO39485) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-10-01.
Abstract Introduction Cystic neutrophilic granulomatous mastitis (CNGM) is a form of breast lobulocentric granulomatous inflammation characterized by cystic spaces of dissolved lipid, surrounded by neutrophils. Corynebacterium is frequently the etiological agent, specially C kroppenstedtii. It is often painful and can simulate malignancy by clinical and imaging features. Clinical Case A 36-year-old woman, three pregnancies with puerperal mastitis in all. Consults by increase in left breast volume, painful, 1-month evolution, with erythema and not quantified fever. With antibiotherapy, erythema resolved, but the mass persisted. Ultrasound showed a 28-mm right nodule and extensive left architecture distortion, hypoechogenic, poorly delimited, which compromised superior quadrants, both BIRADS 4. Bilateral core biopsies had typical findings of CNGM, with bacteria inside cysts, identified with HE, which were Gram positive. The cultures gave Corynebacterium, typified as tuberculostearicum by MALDI-TOF methodology, with antibiotic multisensitivity. After 6 weeks of evolution, the last two with ciprofloxacin, on the left the mass had decreased, with 3-cm periareolar collection. Right lesion fistulized on the biopsy path. Conclusions We present a case of bilateral cystic neutrophilic granulomatous mastitis with clinical and imaging features suspected of malignancy. After 6 weeks of evolution, the last two with ciprofloxacin therapy, she had reduction of volume of the larger lesion and fistulization contralateral. She would probably require in its management, in addition to surgery to resolve the fistula, use of lipophilic antibiotics and corticosteroids.
Estudios recientes en pacientes con cáncer de mama irradiadas y reconstrucción mamaria (RM) con prótesis definitivas han reportado pérdida de la prótesis definitiva en porcentajes que alcanzan el 40,7%. Determinar si la preparación del tejido irradiado con lipotransferencia de protección en pacientes a las que se le realizó RM con expansor (previo a la RM definitiva con prótesis) o que sean portadoras de un implante definitivo irradiado, disminuye la frecuencia de pérdida de la prótesis. Estudio observacional, analítico, comparativo con cohorte histórica. Se estudiaron pacientes tratadas por cáncer de mama efectuándose mastectomía y RM con expansor más radioterapia postoperatoria y luego recambio a prótesis definitiva sin preparación previa con lipotransferencia (LPT) de protección comparándose con pacientes de igual diagnóstico tratadas con mastectomía y RM con expansor o portadoras de un implante definitivo irradiado a las que se le realizó LPT de protección previo recambio a prótesis, evaluando las complicaciones postoperatorias tempranas. Se estudiaron 33 pacientes de las cuales a 21 (63,6%) se le realizó LPT de protección previo recambio a prótesis. El grupo de LPT de protección no tuvo complicaciones comparado con el grupo sin LPT que presentó 2 casos de ulceración con pérdida de implante. La tasa de éxito global en pacientes irradiadas y con LPT fue del 100% en comparación con el 83,4% entre las pacientes irradiadas sin LPT. La LPT de protección contribuye a mejorar la calidad y el grosor del tejido disminuyendo a 0% las posibilidades de la pérdida del implante en esta casuística. Recent studies in breast cancer patients with postmastectomy radiation therapy and implant-based breast reconstruction (BR) have reported up to 40% of extrusion of the implant. To determine whether the preparation of the irradiated tissue with protective lipofilling in patients who underwent BR with expander (prior to implant BR) or patients with irradiated implant reconstruction, decreases the frequency of the extrusión of the implant. Observational, analytical, comparative study with an historical cohort. Patients treated for breast cancer with mastectomy and breast reconstruction with expander plus postoperative radiotherapy and who then underwent replacement to a definitive prosthesis without prior preparation with lipotransfer (LPT), were compared with those who underwent prior preparation with LPT, to evaluate the early postoperative complications. Thirty-three patients were studied, of whom 21 (63,6%) underwent protective lipofilling. The protective lipofilling group did not have complications compared with 2 cases in the group without protective lipofilling which presented withulceration with extrusion of the implant. The overall success rate in irradiated patients with protective lipofilling was 100% compared to 83,4% among irradiated patients without protective lipofilling. Protective lipofilling contributes to improve the quality and the thickness of the tissue diminishing to 0%, in our work, the possibilities of extrusion of the implant.
La incorporación de estudios genéticos en el manejo habitual del cáncer de mama ha tenido un impacto en la determinación del riesgo individual de desarrollar la enfermedad así como establecer modificaciones específicas en el tratamiento de un cáncer ya diagnosticado, que afecten su sobrevida. Actualmente se considera que 5 a 10% de los cánceres de mama son hereditarios portadores de mutaciones germinales. Existe una variabilidad en la penetrancia de estas mutaciones explicada hasta el momento por la presencia de genes modificadores, factores ambientales, estilos de vida y factores hormonales. Esto determina un amplio rango de incidencia para las portadoras de mutaciones. Sumado a esta variabilidad en el riesgo de desarrollar la enfermedad, en el caso de portadoras de una mutación diagnosticadas de cáncer de mama, se suman factores propios de su cáncer a considerar en la evaluación, lo que hace necesario ser prudente en las indicaciones de tratamiento considerando todos los factores que impactan en la toma de decisión. El objetivo de esta revisión es responder algunas inquietudes de la práctica diaria que influyen en el manejo de pacientes portadoras de mutaciones germinales diagnosticadas de cáncer de mama y que pueden dar espacio a cirugías más agresivas, de mayor morbilidad que no impactan en la sobrevida. The use of genetic studies in the management of breast cancer has had an impact on the determination of the individual risk of developing the disease as well as to establish specific changes in the treatment of an already diagnosed cancer that impact in the disease free survival and overall survival. It is now estimated that 5 to 10% of breast cancers are hereditary, carriers a germline mutations. There is a variability in the penetrance of these mutations explained so far by the presence of SNAPs, environmental factors, lifestyles and hormonal factors. This determine a wide range of risk for carriers of a specific mutation. In addition to this variability in risk, in the case of mutations diagnosed in patients with breast cancer, factors associated with their cancer must be considered in the evaluation, which impact on decision making. The objective of this review is to answer some concerns of daily practice that influence the management of patients and that can give space to more aggressive surgeries do not impact on survival.
Data were retrospectively collected from the registry of the High-Risk Breast and Ovarian Cancer Program at Clínica Las Condes, Santiago, Chile. Data captured included index case diagnosis, ancestry, family history, and genetic test results.
Abstract Background: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death in women in Latin America (LATAM). Studies have highlighted the importance of understanding contextual characteristics of each patient population to inform health policy-making. However, few data are available on women from LATAM, a region with marked inequalities. Methods: LATINA (LACOG 0615/MO39485) is a multicenter prospective cohort study designed to describe sociodemographic characteristics, diagnosis, treatment, and outcomes of patients with BC in LATAM. Female and male patients aged ≥18 years newly diagnosed (i.e., < 12 months from research site activation) histologically confirmed clinical stage I-IV BC were enrolled. Eligible patients provided informed consent and had data collected from medical records at diagnosis and every 6 months up to 5 years. Results: Between February 2020 and August 2022, 3276 patients with BC from 31 research sites in 10 LATAM countries were included. Median age was 54 years (range 23–95), 91.8% (N=3008) were Hispanic or Latinos, the majority (68%, N=2224) were diagnosed with stage II or III BC, and 73% (N=2362) were treated in the public health system. Age, stage and detection method stratified by education level, marital status and employment status are shown in Table 1. Overall, 38.8% (N=1149) of patients had not completed high school. These patients were more frequently diagnosed by symptoms and diagnosed at later stages than those who had completed high school or college. Half of the patients were married/in a civil partnership at BC diagnosis (50.5%, N=1497). Unmarried patients were more commonly diagnosed by symptoms (71.7%, N=835 vs. 64%, N=916, p< 0.001) and with stage II/III BC (71.4%, N=868 vs. 67.6%, N=1038, p< 0.001) than married patients. Most patients (54.1%, N=1603) were not employed at BC diagnosis. Patients not employed were more frequently diagnosed by symptoms (68.8%, N=1044) than employees/self-employed (61.6%, N=675). After adjusting for age, country, health care provision (public or private), stage, and BC subtype, being diagnosed by symptoms was associated with not being married (adjusted odds ratio [aOR] 1.41, 95% CI 1.11–1.82, p=0.004), being not employed (aOR 1.41, 95% CI 1.08–1.84, p=0.011), and not having completed high school (aOR 1.46, 95% CI 1.00–2.13, p=0.031). Conclusions: Patients with a lower level of education, unmarried and not employed, are more likely not to perform BC screening and to be diagnosed by symptoms. Socioeconomic characteristics impact the method of detection of BC in LATAM and are associated with diagnosis at later stages. Further analyses of the LATINA study will provide invaluable data for informing regional health policy-making in LATAM. Citation Format: Gustavo Werutsky, Cynthia Villarreal-Garza, Henry Gómez, Juan Manuel Donaire, José Bines, Luis Henrique Fein, Maria Clara Horsburgh, Paula Cabrera-Galeana, Heloísa Resende, Rosa Vasallo Veras, Miriam Raimondo, Ricardo Elías Brugés Maya, Vidal Maria Del Rosario, Yeni Nerón, Ana Maria Donoso, Fernanda B. Damian, José D'Oliveira, Couto Filho, Maria Isabel Alonso, Victoria Costanzo, Tomás Reinert, Adriana Elizabeth Borello, Eduardo Cronenberger, Luis Fein, Marcela Urrego, Enrique Alanya, Jorge Luis Soriano García, Saúl Campos-Gomez, Eduardo A. Richardet, Hugo Castro-Salguero, Felipe Cruz, Diego Gómez, Angel Hernández, Carlos Alberto Farfan Tello, Ronald Rodríguez, Rafaela Jesus, Gustavo Gössling, Carlos Barrios. The Impact of Socioeconomic Factors on Breast Cancer Diagnosis in Latin America: The LATINA study (LACOG 0615/MO39485) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-05.
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