Brief inductions in episodic past or future thinking: effects on episodic detail and problem-solving.

Episodic specificity inductions, involving brief training in recollecting episodic details, have been shown to improve subsequent performance on tasks involving remembering the past, imagining the future and problem solving. The current study examined if specificity inductions targeting self-referential past or future episodic thinking would have dissociable effects on generating past and future episodic detail and problem solving. Sixty-three participants were randomised to either a past self-referential or future self-referential episodic induction. All participants also completed a control task. Participants randomised to the self-referential future thinking induction generated more episodic details on past and future narrative tasks compared to a control task, whereas participants randomised to a self-referential past thinking induction showed similar performance to the control task. When examining within-group performance of participants randomised to the past or future induction, we found some evidence of dissociable effects of inductions on narrative generation tasks, but not on problem solving outcomes. Our findings suggest that self-referential inductions may be useful for increasing episodic specificity, but that the temporal distance and direction of the induction matters. We discuss our results in the context of the potential clinical utility of this approach for populations vulnerable to autobiographical memory disruption.

Innovations for the future of breast surgery.

BACKGROUND: Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. METHODS: Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. RESULTS: Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. CONCLUSION: Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.

This article describes how future innovations in science and technology influence the management of breast cancer from a surgical perspective. This work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England.

Severity of polymorphic light eruption in pre- and post-menopausal women: a comparative study.

BACKGROUND: Polymorphic light eruption (PLE) is approximately four times more common in women than in men and often begins in young adult life. It is hypothesized that patients with PLE have an inherent resistance to UVL-induced immunosuppression, which is a physiological phenomenon in normal healthy individuals. Consequently, in PLE there is a delayed-type hypersensitivity reaction to a UVL-modified skin antigen, which results in an inflammatory reaction and a variable rash. The female hormone, 17ß-oestradiol, has been shown to inhibit UVL-induced physiological suppression of contact hypersensitivity responses. This has been postulated to account for the female preponderance of PLE. If 17ß-oestradiol plays a significant part in the disease, one might hypothesize that the severity of PLE might reduce in women after menopause. OBJECTIVES: To compare the severity of PLE in pre-menopausal women with that in post-menopausal women. METHODS: Eighteen pre-menopausal and 18 post-menopausal women with PLE had their Polymorphic Light Eruption Severity Index (PLESI) scored by a single investigator. RESULTS: Pre-menopausal women (mean age 40 years; range 25-50) had a mean PLESI of 54.8 (range 0-86, SD 20.2). Post-menopausal women (mean age 63 years; range 53-78) had a mean PLESI of 36.8 (range 0-74, SD 18.2). A significant difference in mean PLESI values between pre- and post-menopausal women was noted (18.0; 95% CI 4.9-31.0; P = 0.008). At the time of the study, three subjects in the pre-menopausal group and one subject in the post-menopausal group were on oestrogen preparations. Even after excluding the four patients on oral oestrogens, there remained a statistically significant difference in the mean PLESI scores between the pre-menopausal and post-menopausal groups (55.10 vs. 36.64; difference of 18.46, 95% CI: 4.0-32.91; P = 0.014). CONCLUSIONS: The severity of PLE was significantly less in post-menopausal women as compared with pre-menopausal women.

Outcome of surgically treated octogenarians with breast cancer.

CONTEXT: Breast cancer is the commonest cancer in women worldwide and its incidence increases with increasing age. In an era of evidence-based practice, there is a paucity of evidence relating to the management of breast cancer in an oncogeriatric population. The authors define oncogeriatrics as cancer in patients aged 80 years or more. AIM: The study aimed to evaluate the survival benefit of surgically managed octogenarians with breast cancer. MATERIALS AND METHODS: This was a retrospective study of octogenarians diagnosed with breast cancer over a 5-year period and who were treated surgically. Kaplan-Meier survival analysis was used to determine the overall survival. The differences in survival were tested using the logrank (Mantel-Cox) test. A P-value of <0.05 was considered to be statistically significant. RESULTS: One hundred patients were included (median age- 84 years, median follow up 3.3 years). A validated adult comorbidity evaluation-27 (ACE-27) index score system was used to characterize patient comorbidities. Fourteen percent of patients had severe comorbidities, 55% nonsevere, 11% no comorbidities, and 20% with unknown comorbidities. The estrogen receptor was positive in 67% of tumors. Eighty-four percent had mastectomy and 15% had wide local excision. Sixty-eight percent had axillary lymph node dissection, 10% had sentinel lymph node biopsy, and 5% had no axillary surgery. The majority (72%) of the tumors were pathologically T1 or T2 tumor. The Nottingham Prognostic Index (NPI) mean score was 4.4. The Kaplan-Meier survival analysis showed a median survival of 5 years. Forty-eight percent died during the observation period, with 54.2% of this group dying of causes unrelated to breast cancer. CONCLUSION: The surgically treated octogenarians in our sample had an acceptable survival outcome.

New mutation identified in two sisters with adult-onset erythropoietic protoporphyria.

BACKGROUND: Erythropoietic protoporphyria (EPP; OMIM #177000) is a rare disease that usually presents in infancy or early childhood. The uncommon adult-onset EPP is often associated with acquired somatic mutations of the FECH gene, secondary to blood dyscracias. METHODS: We investigated two sisters with adult-onset EPP. RESULTS: We found a novel germline mutation in the FECH gene, in trans with the common hypomorphic IVS3-48C allele. CONCLUSIONS: The adult presentation and identical genotypes of the two sisters suggests that the late development of the condition is to an extent a function of the mutation. The exact mechanism for this delayed penetrance is not clear, although these atypical cases raise the possibility of other genetic or nongenetic disease-modifying factors.

Reasons for not drinking among young adults with simultaneous alcohol and cannabis use: A latent class analysis applied to daily diary data.

Simultaneous alcohol and cannabis use (i.e., simultaneous use) is prevalent among young adults and often associated with negative consequences. Understanding reasons for not drinking (RND) may provide insight into a key intervention target for reducing negative consequences associated with simultaneous use. RND may vary on a day-to-day level, and multiple RND may be endorsed on a given day. Latent class analysis (LCA) of daily diary data is a nuanced approach that can identify complex patterns of daily RND as well as its day- and person-level covariates. The current study was a secondary data analysis of daily diary data from young adults who engaged in heavy drinking and recent simultaneous use (n = 154). We aimed to: (1) characterize daily RND, (2) use LCA to classify day-level patterns of RND, and (3) compare latent classes on same-day variables (i.e., positive and negative affect, day of the week), previous-day variables (i.e., substance use, intoxication level, consequences), and person-level characteristics (i.e., age, sex, baseline substance use frequency, simultaneous use motives). Participants completed up to 14 consecutive diaries. Multilevel LCA identified four classes of heterogeneous daily RND profiles. Daily RND classes significantly differed in terms of day of the week, previous day quantity of cannabis use, and several baseline variables (age, typical substance use, simultaneous use motives). Study findings offer preliminary support for heterogeneous RND classes among young adults engaging in simultaneous use and suggest multiple avenues for future research.

'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps.

BACKGROUND: Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS: STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS: Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS: This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.

A prospective evaluation of the American College of Surgeons Surgical Risk Calculator as a predictor of complications for breast surgery.

BACKGROUND: The infection rates for operative management of breast cancer are often unpredictable and higher than average for a clean surgical procedure (0.8% and 28%). We aimed to assess the effectiveness of the American College of Surgeons (ACS) Surgical Risk Calculator (SRC), a preoperative scoring system to calculate the risk of surgical site infection (SSI) and serious complications following breast surgery. METHODS: Prospective risk scoring using the SRC on 213 patients in the preoperative clinic and the incidence of SSI and serious complications within 30 days postoperatively was prospectively collected. RESULTS: The overall SSI rate in our sample was 5% (n=11/210 patients). For a one-unit increase in SRC score, the odds of having SSI increased by a factor of 1.88 (95% CI 1.33 to 2.74). Odds of developing SSI were higher in patients with high Body Mass Index (OR 1.25; 95% 1.13 to 1.40) and American Society of Anesthesiologists score 3 (OR 11.54; 95% CI 2.98 to 43.65). The odds of developing an SSI were ∼19 times higher if a patient had an SRC score >3.0 versus those with an SRC score <3.0. Only 3% (n=4) of patients who had an SRC score of <3.0 experienced SSI, compared with 33% (n=7) for those with a risk score of >3.0. Out of 210 patients, 9 had serious complications (4.2%). CONCLUSIONS: ACS SRC Score of more than 3 was associated with a higher likelihood of SSI. SRC was able to predict the risk of SSI and serious complications and can be used preoperatively for identification and risk minimisation.

Daily Exercise and Alcohol Use Among Young Adult College Students.

The present study examined associations between exercise and alcohol use at the between- and within-person levels, including temporal sequencing and the impact of gender. Participants were 221 college students that completed an online survey and 14 daily surveys assessing their daily exercise and alcohol use. Individuals who reported higher exercise scores also consumed more alcohol, on average. On days when individuals reported consuming fewer drinks than usual, they also reported greater exercise scores. Individuals reported lower exercise scores following a day with heavier alcohol use than usual or a day with heavy episodic drinking. Exercise was unassociated with next-day alcohol use. There were mixed findings on the impact of gender. Exercise may have a more proximal influence on drinking. Exercise interventions for alcohol use could target days with higher probabilities of drinking to reduce levels of alcohol use among college students.

Observational studies on the efficacy of carbamazepine and ascorbyl palmitate in managing trigeminal neuralgia.

OBJECTIVE: Ascorbyl palmitate is a fat-soluble ester of vitamin C and is used as an antioxidant food additive. While literature reports that ascorbyl palmitate can prevent exacerbation of pain and improve the quality of life of patients suffering from pain, this is not yet supported by clinical trial data. Our study aimed to investigate the effectiveness of ascorbyl palmitate in managing trigeminal neuralgia. PATIENTS AND METHODS: This study was carried out in a single-centre clinical trial in which subjects suffering from trigeminal neuralgia (N=11) were included. All patients were on carbamazepine when first included and, after washout period, received Ascorbyl palmitate. Eligible patients had the most severe trigeminal neuralgia pain in the oral cavity or pain on touching trigger zones, aged 20 years or older, were capable of proper assessment of the severity of pain and their condition, and had experienced multiple episodes of intraoral pain for at least 3 months with a pain intensity of more than 4 points on the numerical rating scale. The Brief Pain Questionnaire was used to evaluate patient's quality of life. RESULTS: A total of 11 patients were included with a mean age 55.36±10.67 years (7 males, 4 females). Most patients had compression by the superior cerebellar artery and vascular loops upon magnetic resonance examination. The mean numerical rating scale score for carbamazepine after one month was 7.9±0.56 (95% CI 7.49, 8.30). Similarly, for ascorbyl palmitate was 5.5±1.50 (95% CI 4.42, 6.57) (p<0.001). CONCLUSIONS: Ascorbyl palmitate can be used as an adjunct intervention in managing trigeminal neuralgia pain. According to the results, ascorbyl palmitate prevents frequent exacerbation of pain and improves patient quality of life.

Quantitative analysis of the human immunodeficiency virus type 1 (HIV-1)-specific cytotoxic T lymphocyte (CTL) response at different stages of HIV-1 infection: differential CTL responses to HIV-1 and Epstein-Barr virus in late disease.

Major histocompatibility complex (MHC)-restricted cytotoxic T lymphocytes (CTL) are part of the cellular immune response to human persistent virus infections. Measurements of the frequency and specificity of human immunodeficiency virus type 1 (HIV-1)-specific CTL and their variation with time may indicate their relative importance in modulating the progression of HIV-1 infection. We have used limiting dilution analysis (LDA) to derive quantitative estimates of the frequency of HIV-1-specific CTL precursors in a cross-sectional study of 23 patients at different clinical stages of HIV-1 infection and to compare these with the frequency of CTL precursors specific for another persistent virus (Epstein-Barr virus [EBV]) in the same patients. Peripheral blood mononuclear cells (PBMC) were stimulated in vitro with autologous HIV-1-infected lymphoblasts and assayed for cytotoxicity in 51Cr release assays against autologous and MHC-mismatched lymphoblastoid B cells infected with recombinant vaccinia viruses expressing the three HIV-1 structural gene products. The frequency of MHC-restricted precursors was high in asymptomatic HIV-1-infected patients (env-specific CTL precursors up to 73/10(6) PBMC; gag-specific CTL precursors up to 488/10(6) PBMC), although the relative frequency against the different structural gene products varied from patient to patient. The HIV-1-specific CTL precursor frequency was reduced in patients who had more severe (< 400/microliters) CD4+ lymphocyte depletion, while in the majority of such patients the frequency of CTL precursors against EBV was maintained at levels observed in healthy controls. Direct CTL activity in unstimulated PBMC was observed in three of nine patients but no correlation was found between the presence of an activated CTL response and the magnitude of the CTL response detected after stimulation in LDA. Thus, CTL precursors were detected against all three HIV-1 structural gene products in patients with CD4+ lymphocyte counts > 400/microliters, at frequencies that are high compared with those reported for other persistent viruses. A CTL response directed against multiple protein antigens of HIV-1 may protect the patient against epitope variation. The fact that the EBV-specific CTL precursor frequencies were maintained in advanced HIV-1 infection suggests that there may be selective impairment of the HIV-1-specific CTL response associated with disease progression.