Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs.

OBJECTIVE: Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD: 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS: The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129,696.89, € 82,654.34 in conservative surgeries (€ 3757.01 on average per patient) and € 47,042.55 in mastectomies (€ 6720.36 on average per patient). CONCLUSIONS: Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.

Rate of effect of surgical margins after breast conserving surgery and estimation of direct costs. / Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos.

OBJECTIVE: Assessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital. METHOD: 146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System. RESULTS: The rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient). CONCLUSIONS: Margin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.

Reduced circulating levels of TWEAK are associated with gestational diabetes mellitus.

BACKGROUND: To evaluate the inflammatory axis mediated by tumour necrosis factor-like weak inducer of apoptosis (TWEAK) and its scavenger receptor CD163 during pregnancy and their influence on insulin sensitivity in normal pregnancy and in gestational diabetes mellitus (GDM). MATERIALS AND METHODS: One hundred and thirty seven women with one singleton pregnancy, 71 with normal glucose tolerance (NGT) and 66 with GDM were studied. Glucose metabolism was assessed by oral glucose tolerance test. Serum concentrations of soluble TWEAK (sTWEAK) and CD163 (sCD163) and insulin resistance (HOMA-IR index) were determined in maternal blood drawn at recruitment, in the early third trimester. Offspring weight and height were assessed at birth. RESULTS: Women with GDM had lower circulating sTWEAK concentrations than control NGT group (237·8 (192·1-301·0) pg/mL vs. 277·2 (206·4-355·7) pg/mL; P = 0·013). sTWEAK was negatively associated with the presence of GDM (r = -0·212; P = 0·013), HOMA-IR index (r = -0·197; P = 0·021) and ponderal index of the newborn (r = -0·196; P = 0·025), but positively with HDL cholesterol (r = 0·283; P = 0·001). In multiple regression analysis, sTWEAK concentration emerged as one of the main predictors of insulin resistance, along with BMI, triglycerides and low concentrations of HDL cholesterol (R(2)  = 0·486; P < 0·001). No relationship was found between HOMA-IR index and sCD163 or sCD163/sTWEAK ratio. CONCLUSIONS: sTWEAK concentrations are lower in patients with GDM compared with healthy pregnant women, and low concentrations of sTWEAK are associated with insulin resistance. These findings suggest that insulin resistance during pregnancy is closely linked to inflammatory imbalance and sTWEAK may represent a new candidate associated with GDM.

Gender determines the actions of adiponectin multimers on fetal growth and adiposity.

OBJECTIVE: We sought to analyze the role of cord blood adiponectin and its multimeric forms in neonatal adiposity and fetal growth velocity (FGV) during the third trimester of pregnancy according to fetal gender. STUDY DESIGN: This was a prospective analytical observational study conducted at the Diabetes and Pregnancy Unit, University Hospital Joan XXIII, Tarragona, Spain. In all, 96 healthy pregnant women were included in the early third trimester and were followed up until delivery. Maternal blood was obtained upon recruitment, and cord blood was obtained at delivery. Serial fetal ultrasounds were performed during the third trimester to assess FGV. Skinfolds were measured after birth to assess neonatal adiposity. Adiponectin multimers were determined in maternal and cord blood. RESULTS: In female neonates, adiposity and FGV in the late third trimester were correlated positively with cord blood insulin (r = 0.343, P = .015 and r = 0.430, P = .002, respectively) and maternal pregravid body mass index (r = 597, P < .001 and r = 0.428, P = .002, respectively), and negatively with maternal high-molecular-weight (HMW)/total adiponectin ratio (r = -0.269, P = .035 and r = -0.387, P = .005, respectively), but in the stepwise multiple regression model, the main determinants were cord blood insulin, pregravid body mass index, and cord blood HMW adiponectin. Otherwise, in male neonates, adiposity and fetal growth were correlated with cord blood low-molecular-weight adiponectin (r = 0.486, P = .003 and r = 0.394, P = .020, respectively), and it was this multimeric form that emerged as an independent determinant in the stepwise regression model. CONCLUSION: Adiponectin seems to determine fetal growth and adipose tissue accretion, and low molecular weight is more specifically implicated in males, whereas the HMW isoform may be more important in females.