Breast cancer patient-reported outcomes on level 1 and level 2 oncoplastic procedures using BREAST-Q®

PURPOSE

In breast cancer management not only mortality and surgical morbidity measurements are important but also patient satisfaction indexes. The authors evaluated the satisfaction and health-related quality of life (HRQOL) using the breast-conserving therapy (BCT) and breast reduction (BR) modules of BREAST-Q^®.

METHODS

This is a cross-sectional study that analyzed breast cancer patients consecutively submitted to breast surgery between January 2011 and April 2018 using two modules of BREAST-Q^®. 968 patients were contacted and 232 answers were gathered: 171 patients submitted to oncoplastic level 1 surgery answered the BCT module and 61 submitted to oncoplastic level 2 surgery answered the BR module. Clinical data were retrieved from patients' medical records.

RESULTS

Among the 232 questionnaires received, the median scores for psychosocial well-being, sexual well-being and (postoperative) satisfaction with breasts for BCT and BR modules were, respectively, 77.0 and 73.5 (p = 0.17); 62.0 and 53.0 (p = 0.14); 72.0 and 66.0 (p = 0.66). The median of adverse effects of radiation in the BCT module was 87.0. The median satisfaction with outcome in the BR module was 86.0. Both groups of patients revealed high scores of satisfaction with care. For the BCT patients, satisfaction with breasts strongly correlated with sexual well-being and was moderately correlated with psychosocial and physical well-being. For the BR patients, the satisfaction with outcome strongly correlated with satisfaction with medical team and moderately correlated with the remaining scales.

CONCLUSION

Both oncoplastic surgery levels yielded similar satisfaction outcomes when assessed using BCT and BR modules of BREAST-Q^®.

Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients

Background

Targeted axillary dissection (TAD) combines sentinel node biopsy (SNB) with the removal of the previously marked metastatic node. TAD is a promising concept for axillary restaging in node-positive breast cancer patients with pathological complete response (pCR) to neoadjuvant therapy (NAT). We aimed to evaluate TAD feasibility in this context.

Methods

A prospective observational study was conducted in biopsy-confirmed cN1 patients. The removal of the clipped node (CN) was guided by intraoperative ultrasound. SNB used indocyanine green and patent blue V dye. If the CN or sentinel lymph nodes (SLN) had any metastatic foci, or the TAD procedure was unsuccessful, the patient underwent axillary lymph node dissection (ALND).

Results

Thirty-seven patients were included. TAD and SNB identification rates were 97.3%. Every retrieved CN was also a SLN. At the individual level, SNB identification rate was 89.2% with indocyanine green and 85.5% with patent blue V dye. The CN identification rate was 81.1%, being higher when the CN was localized on the intraoperative ultrasound (84.4% vs 60.0%). Nodal pCR was achieved by 54.1% of our patients and was more frequent in HER2-positive and triple-negative tumors (p = 0.039). Nineteen patients were spared from ALND.

Conclusion

TAD with intraoperative ultrasound-guided excision of the CN and SNB with indocyanine green and patent blue V dye is a feasible concept to identify patients without axillary residual disease after NAT, that can be spared from ALND, although the need for marking the biopsied node should be further investigated.

Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district

Background

Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.

Results

In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).

Conclusions

Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.

Key messages

Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Perovskite-type titanate zirconate as photocatalyst for textile wastewater treatment

Calcium titanate zirconate, Ca(Ti_(1-x)Zr_x)O₃ (CZT), powders have been synthesised by the polymeric precursor method. The structural analysis of the CZT powders was monitored by X-ray diffraction (XRD), photoacoustic spectroscopy (PAS) and textural analysis. The photocatalytic properties were evaluated by methylene blue (MB) decomposition and real textile wastewater (RTW) combined treatment (coagulation/flocculation/photocatalysis). Chemical oxygen demand (COD) of RTW was successfully reduced from 6195 mg L^-1 (untreated) to 662 mg L^-1 after coagulation/flocculation with a tannin-based coagulant (Tanfloc®) and finally to 471 mg L^-1 after combined treatment (coagulation/flocculation/photocatalysis) applying ultraviolet radiation and CaTiO₃ as photocatalyst.

The zebrafish goosepimples/myosin Vb mutant exhibits cellular attributes of human microvillus inclusion disease

Microvillus inclusion disease (MVID) is a life-threatening enteropathy characterised by malabsorption and incapacitating fluid loss due to chronic diarrhoea. Histological analysis has revealed that enterocytes in MVID patients exhibit reduction of microvilli, presence of microvillus inclusion bodies and intestinal villus atrophy, whereas genetic linkage analysis has identified mutations in myosin Vb gene as the main cause of MVID. In order to understand the cellular basis of MVID and the associated formation of inclusion bodies, an animal model that develops ex utero and is tractable genetically as well as by microscopy would be highly useful. Here we report that the intestine of the zebrafish goosepimples (gsp)/myosin Vb (myoVb) mutant shows severe reduction in intestinal folds - structures similar to mammalian villi. The loss of folds is further correlated with changes in the shape of enterocytes. In striking similarity with MVID patients, zebrafish gsp/myoVb mutant larvae exhibit microvillus atrophy, microvillus inclusions and accumulation of secretory material in enterocytes. We propose that the zebrafish gsp/myoVb mutant is a valuable model to study the pathophysiology of MVID. Furthermore, owing to the advantages of zebrafish in screening libraries of small molecules, the gsp mutant will be an ideal tool to identify compounds having therapeutic value against MVID.

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myosin Vb is expressed in the zebrafish intestine.

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goosepimples/myosin Vb function is essential for epithelial morphogenesis in the zebrafish intestine.

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The goosepimples mutant recapitulates pathognomonic features of microvillus inclusion disease.

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The function of myosin Vb in the intestine is conserved between fish and mammals.

[Therapeutic implication of the azygos vein lobe in patients with pulmonary adenocarcinoma]

The azygos vein lobe is an anatomic variant reported in 0.1 to 8% of the population and results from an anomalous development of the right lung upper lobe. In the majority of the cases, clinical implications are lacking. Since the original description of a tumor of the azygos vein lobe, in 1969, only two more cases have been reported in the literature. Behind its rarity, a tumor with such location may pose some management implications. The authors report the clinical case of a 56 years old smoker man, in whom a chest x-rays revealed a poorly defined image in the upper lobe of the right lung. Complementary studies and evaluation allowed the diagnosis of pulmonary adenocarcinoma, adherent to the azygos vein, in a patient with azygos vein lobe. The authors emphasize the fact that despite the origin of the tumor being the lung, the presence of this anatomic variant of the azygos vein played a determinant role in the surgical approach.

Pharmacokinetics of ingested fluoride: lack of effect of chemical compound

Fluoride in drinking water may be present from natural sources or added as sodium fluoride (NaF), sodium silicofluoride (Na(2)SiF(6)) or fluorosilicic acid (H(2)SiF(6)). Results from an early study with rats suggested that, when ingested as Na(2)SiF(6), the absorption and excretion of fluoride were greater than when ingested as NaF.

OBJECTIVE

The present single-blind, crossover study with 10 adults was done to determine three key pharmacokinetic parameters: the maximum plasma fluoride concentrations (C(max)), the elapsed time to reach the maximum concentrations (T(max)) and the 6-h areas under the time-plasma concentration curves (AUCs) after ingestion of 500 mL of water containing 0.67 or 5.45 mg F/L present naturally or added as NaF or H(2)SiF(6).

DESIGN

Blood was collected prior to and at nine time points during 6h after ingestion of the test solutions. Plasma was analysed by electrode after HMDS-facilitated diffusion and the data were analysed for statistically significant differences using repeated measures ANOVA.

RESULTS

The C(max), T(max) and AUC values after ingestion of the solutions containing natural fluoride, NaF or H(2)SiF(6) did not differ significantly at either dose level. Further, the T(max) values associated with the 0.67 and 5.45 mg/L solutions did not differ significantly indicating that the absorption, distribution and elimination rates were not affected by the dose size.

CONCLUSIONS

Considered together with published reports, the present findings support the conclusion that the major features of fluoride metabolism are not affected differently by the chemical compounds commonly used to fluoridate water nor are they affected by whether the fluoride is present naturally or added artificially.

Aborto induzido em mulheres de baixa renda: dimensão de um problema

Este artigo enfoca a prática de aborto, principalmente aborto induzido entre mulheres de baixa renda. A análise é baseada em dados de pesquisa coletados entre 1984 e 1985 em sete favelas localizadas na área metropolitana do Rio de Janeiro, Brasil (<a href="#rodape1">¹</a>). Apesar da legislação severa existente, a prática do abono induzido é muito freqüente. Entre as mulheres casadas, 21,4 por cento declararam terem praticado aborto induzido. Embora grande parte dos abortos terem sido feitos por médicos, a qualidade dos cuidados nestes procedimentos é questionável, devido ao fato de que, sendo ilegal, na maioria dos casos não há possibilidade de supervisão por parte das autoridades de saúde. A incidência de complicações pós-aborto é muito alta, principalmente nos casos em que é praticado por curiosas ou pela própria mulher. Mais de 60 por cento das mulheres não faziam uso de métodos contraceptivos ao engravidar. Cerca de 21 por cento declararam que estavam usando pílula anticoncepcional. Claro está que uma taxa de falha tão elevada é inaceitável e deve-se ao seu uso incorreto. Tudo isto revela a necessidade urgente de um melhor acesso ao planejamento familiar, oferecido pelos serviços de saúde dentro da concepção de atenção integral. São discutidas, também, as conseqüências das leis restritivas em matéria de abono no Brasil, restrições que, na prática, provam ser ineficazes para prevenir a prática do aborto induzido, mas podem ser muito efetivas para ampliar ainda mais as desigualdades sociais já existentes.