Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis.

STUDY QUESTION: Is it safe to perform controlled ovarian stimulation (COS) for fertility preservation before starting anticancer therapies or ART after treatments in young breast cancer patients? SUMMARY ANSWER: Performing COS before, or ART following anticancer treatment in young women with breast cancer does not seem to be associated with detrimental prognostic effect in terms of breast cancer recurrence, mortality or event-free survival (EFS). WHAT IS KNOWN ALREADY: COS for oocyte/embryo cryopreservation before starting chemotherapy is standard of care for young women with breast cancer wishing to preserve fertility. However, some oncologists remain concerned on the safety of COS, particularly in patients with hormone-sensitive tumors, even when associated with aromatase inhibitors. Moreover, limited evidence exists on the safety of ART in breast cancer survivors for achieving pregnancy after the completion of anticancer treatments. STUDY DESIGN, SIZE, DURATION: The present systematic review and meta-analysis was carried out by three blinded investigators using the keywords 'breast cancer' and 'fertility preservation'; keywords were combined with Boolean operators. Eligible studies were identified by a systematic literature search of Medline, Web of Science, Embase and Cochrane library with no language or date restriction up to 30 June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: To be included in this meta-analysis, eligible studies had to be case-control or cohort studies comparing survival outcomes of women who underwent COS or ART before or after breast cancer treatments compared to breast cancer patients not exposed to these strategies. Survival outcomes of interest were cancer recurrence rate, relapse rate, overall survival and number of deaths. Adjusted relative risk (RR) and hazard ratio (HR) with 95% CI were extracted. When the number of events for each group were available but the above measures were not reported, HRs were estimated using the Watkins and Bennett method. We excluded case reports or case series with <10 patients and studies without a control group of breast cancer patients who did not pursue COS or ART. Quality of data and risk of bias were assessed using the Newcastle-Ottawa Assessment Scale. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 1835 records were retrieved. After excluding ineligible publications, 15 studies were finally included in the present meta-analysis (n = 4643). Among them, 11 reported the outcomes of breast cancer patients who underwent COS for fertility preservation before starting chemotherapy, and 4 the safety of ART following anticancer treatment completion. Compared to women who did not receive fertility preservation at diagnosis (n = 2386), those who underwent COS (n = 1594) had reduced risk of recurrence (RR 0.58, 95% CI 0.46-0.73) and mortality (RR 0.54, 95% CI 0.38-0.76). No detrimental effect of COS on EFS was observed (HR 0.76, 95% CI 0.55-1.06). A similar trend of better outcomes in terms of EFS was observed in women with hormone-receptor-positive disease who underwent COS (HR 0.36, 95% CI 0.20-0.65). A reduced risk of recurrence was also observed in patients undergoing COS before neoadjuvant chemotherapy (RR 0.22, 95% CI 0.06-0.80). Compared to women not exposed to ART following completion of anticancer treatments (n = 540), those exposed to ART (n = 123) showed a tendency for better outcomes in terms of recurrence ratio (RR 0.34, 95% CI 0.17-0.70) and EFS (HR 0.43, 95% CI 0.17-1.11). LIMITATIONS, REASONS FOR CAUTION: This meta-analysis is based on abstracted data and most of the studies included are retrospective cohort studies. Not all studies had matching criteria between the study population and the controls, and these criteria often differed between the studies. Moreover, rate of recurrence is reported as a punctual event and it is not possible to establish when recurrences occurred and whether follow-up, which was shorter than 5 years in some of the included studies, is adequate to capture late recurrences. WIDER IMPLICATIONS OF THE FINDINGS: Our results demonstrate that performing COS at diagnosis or ART following treatment completion does not seem to be associated with detrimental prognostic effect in young women with breast cancer, including among patients with hormone receptor-positive disease and those receiving neoadjuvant chemotherapy. STUDY FUNDING/COMPETING INTEREST(S): Partially supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC; grant number MFAG 2020 ID 24698) and the Italian Ministry of Health-5 × 1000 funds 2017 (no grant number). M.L. acted as consultant for Roche, Pfizer, Novartis, Lilly, AstraZeneca, MSD, Exact Sciences, Gilead, Seagen and received speaker honoraria from Roche, Pfizer, Novartis, Lilly, Ipsen, Takeda, Libbs, Knight, Sandoz outside the submitted work. F.S. acted as consultant for Novartis, MSD, Sun Pharma, Philogen and Pierre Fabre and received speaker honoraria from Roche, Novartis, BMS, MSD, Merck, Sun Pharma, Sanofi and Pierre Fabre outside the submitted work. I.D. has acted as a consultant for Roche, has received research grants from Roche and Ferring, has received reagents for academic clinical trial from Roche diagnostics, speaker's fees from Novartis, and support for congresses from Theramex and Ferring outside the submitted work. L.D.M. reported honoraria from Roche, Novartis, Eli Lilly, MSD, Pfizer, Ipsen, Novartis and had an advisory role for Roche, Eli Lilly, Novartis, MSD, Genomic Health, Pierre Fabre, Daiichi Sankyo, Seagen, AstraZeneca, Eisai outside the submitted work. The other authors declare no conflict of interest. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. REGISTRATION NUMBER: N/A.

Características das lesões em acidentes motociclísticos: uma revisãointegrativa da literatura / Types of injuries in motorcycle accidents: an integrative review of literature

Objetivo: conhecer as lesões ocorridas em acidentes motociclísticos no Brasil. Métodos: revisãointegrativa cujas buscas foram realizadas em novembro de 2016 com os descritores motocicletas;acidente de trânsito; ferimentos e lesões. Resultados: 13 publicações foram encontradas naLiteratura Latino-Americana e do Caribe em Ciências da Saúde e 337 na Medical Literature Analysisand Retrieval System Online, e após serem usados os critérios de seleção, restaram seis artigos. Podese perceber que as lesões predominam em membros superiores e inferiores, em homens jovens,durante o período da tarde e noite, sendo mais evidenciados na sexta-feira e no sábado.Considerações finais: o público mais acometido, as características das lesões mais frequentes einformações importantes relacionadas, foram identificadas neste estudo, as quais podem auxiliar noplanejamento e desenvolvimento de estratégias a fim de diminuir esses altos índices de ocorrências.

Objective: to determine the types of injuries caused by motorcycle accidents in Brazil. Methods: anintegrative review study carried out in November of 2016 with the descriptors motorcycles; trafficaccidents; wounds and injuries. Results: 13 publications were found in Latin American and CaribbeanHealth Sciences Literature and 337 in Medical Literature Analysis and Retrieval System Online, andafter applying the selection criteria, six articles remained. It can be seen that the lesionspredominate in upper and lower limbs in young men during the afternoon and evening, being moreevident on Friday and Saturday. Final considerations: the most affected patients, thecharacteristics of the most frequent lesions and important related information were identified inthis study, which can help in the planning and development of strategies in order to reduce thesehigh incidence rates.

A participação da família na reabilitação psicossocial do sujeito emsofrimento psíquico / Family involvement in psychosocial rehabilitation of individuals under psychological suffering

Objetivo: conhecer a participação da família na reabilitação psicossocial do sujeito em sofrimento psíquico. Métodos: trata-se de uma pesquisa qualitativa, exploratória e descritiva, realizada em 2012. Os sujeitos do estudo foram seis familiares de usuários de um Centro de Atenção Psicossocial (CAPS). Foi utilizada a análise temática conforme Minayo, que tem como foco encontrar núcleos de sentido na comunicação apresentada pelo material estudado. Resultados: emergiram desse estudo dois eixos temáticos: A inserção do sujeito em sofrimento psíquico na sociedade sob a ótica da família e A participação da família na reabilitação psicossocial do sujeito em sofrimento psíquico. Conclusão: há um certo isolamento do usuário no serviço substitutivo. É importante que os profissionais de saúde invistam na autonomia dos sujeitos, contribuindo para o conhecimento do usuário e sua família acerca dos seus direitos e da proposta da reforma psiquiátrica. Colaborando com o aumento do compromisso da família neste processo.

Objective: to now the family's participation in psychosocial rehabilitation of the individual underpsychological distress. Methods: this is a qualitative, exploratory and descriptive study, held in2012. The study subjects were relatives of individuals with psychological distress, users of aPsychosocial Care Center (CAPS). The thematic analysis according to Minayo was used, whose focusis to find nuclei of meaning in the communication presented by material studied. Results: this studyemerged the themes: The insertion of the subject in psychological distress in society from theperspective of the family and the family's participation in psychosocial rehabilitation of the subject in psychological distress. Conclusions: there’s a certain isolation used in substitute service. It isunderstood that it is important for health professionals bet on education, increasing the user'sknowledge and his family about their rights and psychiatric reform proposal. This may collaboratewith the commitment of the family in this process.

Production of haemolytic factor by clinical isolates of Candida tropicalis.

Although haemolytic factor is known to be a putative virulence factor contributing to pathogenicity in Candida species, its production by Candida tropicalis is poorly understood. In this study, we analysed the culture conditions under which C. tropicalis can display haemolytic factor on plate assay and the secretion of haemolytic factor in liquid medium by clinical isolates obtained from different specimens. All the tested isolates exhibited an internal translucent ring, resembling beta-haemolysis, surrounding by a peripheral greenish-grey halo on sheep blood agar medium. Similar haemolytic pattern was observed on human blood enriched medium. Furthermore, incubation either under normal atmosphere or under increased CO(2) had no effect on haemolysis. Overall, no differences were observed on beta-haemolytic activities (P > 0.05) among tested isolates of C. tropicalis. In glucose-limited medium (RPMI 1640 with 0.2% glucose), none of the isolates induced haemolysis on red blood cells. Similarly to found on plate assays, there were no significant differences (P > 0.05) in the activity of secreted haemolytic factor in liquid medium among C. tropicalis isolates. However, after growth, the number of yeast cells varied among isolates revealing different efficiencies of haemolytic factor production. Haemolytic activity was neither inhibited by heat treatment (100 °C) nor by the addition of pepstatin A. The obtained results extend our knowledge about haemolytic factor production by Candida species.

Haemolytic and proteinase activities in clinical isolates of Candida parapsilosis and Candida tropicalis with reference to the isolation anatomic site.

The aim of this study was to determine in vitro haemolytic and protease activities of Candida parapsilosis and Candida tropicalis isolates, obtained from anatomically distinct sites. Analysis of haemolytic activity of C. parapsilosis and C. tropicalis isolates obtained from the same anatomic site revealed that C. tropicalis isolates from blood had statistically higher activity (P < 0.05) than C. parapsilosis. On comparison of haemolytic activities of Candida isolates obtained from different anatomic sites, C. parapsilosis isolates from tracheal secretion were found to have higher activity than blood isolates. Protease activity was detected in the majority of the isolates analysed. Analysis of proteinase activity of C. parapsilosis and C. tropicalis isolates obtained from the same anatomic site revealed that C. parapsilosis isolates from tracheal secretion had statistically higher activity than C. tropicalis isolates. On comparison of proteinase activities of Candida isolates obtained from different anatomic sites, C. parapsilosis isolates from tracheal secretion were found to have higher activity than blood and superficial lesions isolates. Furthermore, C. tropicalis isolates from superficial lesions had higher activity than tracheal secretion isolates. Our results show the potential of C. parapsilosis and C. tropicalis isolates, obtained from distinct anatomic sites, to produce haemolytic factor and proteinases. Anatomic sites of isolation seem to be correlated with these activities, particularly for C. parapsilosis isolates.

Photodegradation of halobenzenes in water ice.

Results from the photolysis of o, p-dichlorobenzene, bromobenzene, and p-dibromobenzene in water ice are reported. All phototransformations appeared to be based on dehalogenation, coupling, and rearrangement reactions in ice cavities. No photosolvolysis products, i.e. products from intermolecular reactions between organic and water molecules, were found. Many of the products were very toxic substances of a high environmental risk, such as PCBs. The results support our model, in which secondary, very toxic, pollutants can be formed in ice, snow, and atmospheric ice particles from primary pollutants through the action of solar irradiation. The photoproducts may be released to the environment by ice melting and evaporation.