The Relationship of Pre and Early Postnatal Risk Factors with Breast Cancer

Background: Breast cancer (BC) is the most prevalent cancer in Iranian women and the fifth most common cause of cancer-related death in Iran. Risk factors in the adult life may act during fetus life and after delivery. We conducted a case–control study to find out the relation of in utero and early life exposure and risk of BC. Methods: A structured questionnaire that covered demographic criteria and BC risk factors in utero was completed for case (732 cases) and control (584 subjects) groups, matched in terms of demographic variants, reproductive issues and socioeconomic status. Odds ratio (OR) and 95% confidence intervals (CI) were computed as measures of association from the logistic models. Results: Having been breast feed for more than 19-24 month (P<0.001, OR 0.03, CI 0.004-0.21) is protective and positive family history of mother (P-value= 0.009, OR 3.4) is a risk factor for BC in adult. Conclusion: There is increasing recognition that condition in utero is important for later risks in breast. Emerging evidence suggests an association between intrauterine status and women prenatal condition and their subsequent risk of developing breast cancer. this is the first Iranian study assessing prenatal factors and breast cancer risk in the EMR and it should be followed by the larger group of cases and controls in the future.     

The One Abutment–One Time Protocol: A Systematic Review and Meta‐Analysis

Background: The use of definitive abutments (DAs) at time of implant placement has been introduced to overcome limitations of dis/reconnection of healing/provisional abutments (PAs). With little and inconsistent information in the literature regarding the effectiveness of using DAs, the aim of this systematic review is to examine marginal bone and soft tissue level changes, technical and biologic complications, and implant failure rate associated with use of DAs and PAs. Methods: This systematic review was prepared according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and online trial registers were searched for studies comparing use of DAs and PAs. The Cochrane Collaboration risk of bias tool was used to assess selected studies, and meta‐analyses were performed using statistical software. Results: A total of 1,124 citations were identified. Of these, seven trials with 363 dental implants in 262 participants were included in the analysis. Pooled estimates for marginal bone level changes showed significant differences between the two prosthetic techniques in favor of using DAs. No significant differences were found in soft tissue level changes, technical and biologic complications, or implant failure rate. Conclusions: Within the limitations of this review, DAs appear to be a viable alternative to PAs at time of implant placement. However, favorable changes in peri‐implant marginal bone level associated with use of DAs should be viewed with caution as its clinical significance is still uncertain.     

Interaction between a variant of chromosome 9p21.3 locus and diet antioxidant capacity on metabolic syndrome in Tehrani adults

Background

Genome-wide association studies have shown that risk alleles on chromosome 9p21.3 locus, are associated with increasing the risk of cardiovascular diseases (CVDs). Several epidemiological studies have found that metabolic syndrome (MetS) is associated with CVDs. Dietary antioxidants also have shown to have potential favorable effects on MetS prevention. This study examined the interactions between rs1333048 genotypes on 9p21 genetic region and Total antioxidant capacity (TAC) on odds of MetS.

Methods

263 Tehrani adults were enrolled in this cross-sectional study. The MetS was defined according to the ATPIII. Dietary intake was assessed daily using a FFQ with 147 items. Dietary TAC was assessed according to United States Department of Agriculture database for oxygen radical absorbance capacity (ORAC). Bioelectrical impedance analysis method was used for body analysis and rs1333048 were genotyped by restriction fragment length polymorphism method. Participants were categorized into three groups based on rs1333048 genotypes.

Results

The results demonstrate that, prevalence of C allele was 52.85% and A allele was 47.15%. After adjustment for confunder variable, this study demonstrated an interaction between AA genotype and high Lyophilic oxygen radical absorbance capacity (L-ORAC) and high Hydrophilic oxygen radical absorbance capacity (H-ORAC) intake on low odds of MetS (OR?=?0.24, 95% CI?=?0.06–0.94, P for interaction?=?0.04, OR?=?0.26, 95% CI?=?0.06–0.99, P for interaction?=?0.04). Also, our result indicated, there was no interaction between AA genotype and high total oxygen radical absorbance capacity (T-ORAC) and total phenolic intakes on reduce odds of MetS (OR?=?0.07, 95% CI?=?0.07–1.10, P for interaction?=?0.07, OR?=?0.58, 95% CI?=?0.16–2.07, P for interaction?=?0.40) respectively.

Conclusion

The results of the present study indicate that high L-ORAC and high H-ORAC intake may modify the elevated odds of MetS in AA genotype of rs1333048 on the 9p21 genetic locus.

     

Multilevel Influences on Patient-Oncologist Communication about Genomic Test Results: Oncologist Perspectives

Thousands of women with early-stage breast cancer receive gene-expression profile (GEP) tests to guide chemotherapy decisions. However, many patients report a poor understanding of how their test results inform treatment decision-making. We applied models of patient-centered communication and informed decision-making to assess which variables oncologists’ perceive as most influential to effective communication with their patients about GEP results and intervention modalities and approaches that could support more effective conversations about treatment decisions in routine clinical care. Medical oncologists who were part of a practice group in the mid-Atlantic US completed an online, cross-sectional survey in 2016. These data were merged with de-identified electronic patient and practice data. Of the 83 oncologists contacted, 29 completed the survey (35% response rate, representing 52% of the test-eligible patients in the practice network). There were no significant differences between survey responders and nonresponders. Oncologists reported patient-related variables as most influential, including performance status (65.5%), pretesting preferences for chemotherapy (55.2%), and comprehension of complex test results (55.2%). Oncologists endorsed their experience with testing (58.6%) and their own confidence in using the test results (48.3%) as influential as well. They indicated that a clinical decision support tool incorporating patient comorbidities, age, and potential benefits from chemotherapy would support their own practice and that they could share these results and other means of communication support using print materials (79.3%) with their patients in clinic (72.4%). These preferred intervention characteristics could be integrated into routine care, ultimately facilitating more effective communication about genomic testing (such as GEP) and its role in treatment selection.     

Impact of COVID-19 on cardiac surgical training: Our experience in the United Kingdom

The current evolving global pandemic caused by coronavirus disease-2019 (COVID-19) has dramatically impacted global health care systems, resulting in governments taking unprecedented measures to contain the spread of the infection, with adaptations by health care organizations. Research into understanding the pathophysiology behind this virus, to ascertain best medical management and treatment, has been accelerated to keep up with the rapidly evolving situation. There has been redeployment of medical and nursing staff to the frontlines and redistribution of health care resources. In addition, the cancellation of elective surgery and centralization of services to treat high-risk surgical cases will all, undeniably, have an impact on current surgical training with possible future implications. We aim to explore the impact COVID-19 is having on cardiac surgical training in the UK and what future implications this may have.     

Identification of intrathoracic lymph nodes by transesophageal echocardiography--a novel role of TEE

Transesophageal echocardiography (TEE) offers an excellent view of the heart and the descending aorta because of the close anatomic relationship between the esophagus and the heart and the absence of obstructing tissues common to the transthoracic approach. TEE is considered the procedure of choice in evaluating aortic diseases. As illustrated in this example, it may also be used to evaluate para-aortic pathology. We present a TEE example of large hilar lymphadenopathy that was directly compared with computed tomography (CT) scanning to provide additional clarification of this anatomic relationship for the echocardiographer. A brief review of the literature is also included.     

Human exposure to fipronil from dogs treated with frontline

This investigation determined fipronil residues on gloves worn while petting dogs after Frontline application. Frontline contains 9.8% fipronil, which controls fleas and ticks on dogs for at least 30 d. Frontline (1.34 ml) was applied topically on adult household dogs and gloves worn for 5 min during pettingwere collected 24 hr and 1, 2, 3, 4 and 5 w post-Frontline application for fipronil residue determinations using GC/MS. The highest concentration of fipronil (589.3 +/- 205.7ppm) was detected 24 h after Frontline application and was undetectable in the gloves collected at 5w. Repeated exposure to such contamination can pose human health risks.