Extended-duration thromboprophylaxis following major abdominopelvic surgery - For everyone or selected cases only?

Major abdominopelvic surgery is an important risk factor for postoperative venous thromboembolism (VTE). VTE is the leading cause of 30-day postoperative mortality in patients with cancer undergoing major abdominopelvic surgery. Randomized controlled trials have shown that extended duration thromboprophylaxis using a low molecular weight heparin or a direct oral anticoagulant significantly decreases the risk of overall VTE (symptomatic events and asymptomatic deep vein thrombosis). Hence, several clinical practice guidelines suggest the use of extended duration thromboprophylaxis for all high-risk patients undergoing major abdominopelvic surgery. Despite these recommendations by clinical practice guidelines, adoption of extended duration thromboprophylaxis in clinical practice remains low and clinical equipoise seems to persist. In this narrative review, we aim is to highlight and summarize the reasons that may explain discrepancy between clinical guideline recommendations and current practice regarding extended duration thromboprophylaxis in this patient population. We also aim to review different personalized approaches based on patients' individualized risk of VTE that may foster shared decision making and improve patient outcomes by reducing decisional conflict, increasing patient knowledge, and increasing risk perception accuracy.

Oral delivery of water-soluble compounds to the phytoseiid mite Neoseiulus californicus (Acari: Phytoseiidae).

Phytoseiids are predatory mites that prey on other mites and small arthropods, and several species are used in commercial agriculture for biological control of pests. To optimize phytoseiid mites' use in biocontrol, an efficient method for oral delivery of test compounds is required to assess their sensitivities to pesticides, RNAi for gene functional analysis and artificial diets. Here we developed four methods for oral delivery of a solution of xenobiotics to different life stages of the commercially available generalist predatory mite Neoseiulus californicus: (i) soaking mites in the solution, or allowing them to feed on (ii) spider mites soaked in the solution, (iii) a solution droplet, or (iv) solution-saturated filter paper. As measured by ingestion of a tracer dye, the droplet-based feeding system was most efficient; the dye was observed in the alimentary canal of >90% test mites of all life stages, with no mortality. The droplet-based feeding system was also effective for the commercially available specialist predatory mite Phytoseiulus persimilis, with >80% delivery efficiency. This study paves the way for development of methods for high-throughput RNAi and for toxicological or nutritional assays in phytoseiid mites.

Epidemiology of breast cancer patients at a tertiary care center in the Eastern Province of Saudi Arabia.

BACKGROUND: Breast cancer is the most common cancer in Saudi Arabia. However, detailed published epidemiologic data are scarce. In this study, breast cancer patients at a tertiary care hospital were characterized and compared with data from the United States. METHODS: Medical records were retrospectively reviewed of female patients with confirmed diagnosis of invasive breast cancer who consulted with Saad Specialist Hospital between 2004 and 2011. Descriptive statistics were calculated and compared with published data. RESULTS: Two-hundred and sixty-two female patients with cytologically or histologically confirmed diagnosis of invasive breast cancer were identified and analyzed. Compared to published American data derived from the SEER database, patients were diagnosed at a markedly younger age (<50 years: 57.5% versus 12.5%) and more advanced disease (localized disease: 28.6% versus 61.2%). The difference of the age at diagnosis could not be fully explained by the different age structures of the Saudi Arabian and American population in our analysis. Although the overall mastectomy rate was higher (58.2% versus 38.5%), no relevant difference in the mastectomy rates was found if analyzed by stage. CONCLUSION: Our data suggest that breast cancer in this part of Saudi Arabia is diagnosed at a much higher stage compared to the United States. More effort in awareness campaigns, easier access to screening and treatment are needed to improve the prognosis and to reduce the currently relatively high mastectomy rate.