Biological Basis of Breast Cancer-Related Disparities in Precision Oncology Era.

Precision oncology is based on deep knowledge of the molecular profile of tumors, allowing for more accurate and personalized therapy for specific groups of patients who are different in disease susceptibility as well as treatment response. Thus, onco-breastomics is able to discover novel biomarkers that have been found to have racial and ethnic differences, among other types of disparities such as chronological or biological age-, sex/gender- or environmental-related ones. Usually, evidence suggests that breast cancer (BC) disparities are due to ethnicity, aging rate, socioeconomic position, environmental or chemical exposures, psycho-social stressors, comorbidities, Western lifestyle, poverty and rurality, or organizational and health care system factors or access. The aim of this review was to deepen the understanding of BC-related disparities, mainly from a biomedical perspective, which includes genomic-based differences, disparities in breast tumor biology and developmental biology, differences in breast tumors' immune and metabolic landscapes, ecological factors involved in these disparities as well as microbiomics- and metagenomics-based disparities in BC. We can conclude that onco-breastomics, in principle, based on genomics, proteomics, epigenomics, hormonomics, metabolomics and exposomics data, is able to characterize the multiple biological processes and molecular pathways involved in BC disparities, clarifying the differences in incidence, mortality and treatment response for different groups of BC patients.

The effect of spinal anesthesia that is performed in sitting or right lateral position on post-spinal headache and intraocular pressure during elective cesarean section.

Background: Although spinal anesthesia can be applied in different patient positions, the most frequently used positions are sitting and lateral positions. It is known that different patient positions during spinal anesthesia have effects on hemodynamic parameters, postdural puncture headache, and intraocular pressure. Aim: The study aimed to determine the effect of spinal anesthesia performed in either sitting or right lateral position on postspinal headache and intraocular pressure during elective cesarean section. Patients and Methods: The study was a randomized controlled study of 104 eligible pregnant women scheduled to undergo elective cesarean section. The women were randomized into two groups. Spinal anesthesia was performed either in the sitting (Group S, n = 53) or the right lateral position (Group L, n = 51). Heart rate and blood pressure were recorded throughout the operation. The participants were informed and monitored for postspinal headaches. Intraocular pressure before and after the operation was measured with Icare PRO. The obtained data were statistically compared between the two groups. Results: There was no difference between the groups in terms of demographic data. Postdural puncture headache was observed in five patients in Group S and one patient in Group L (P =0.04). There was no difference between the groups in terms of intraocular pressure (P >.05). Heart rate was not significantly different between the groups; however, there was a significant difference in average blood pressure in 1, 5, 30, and 40 minutes (P <.05). The number of trials administered to patients for spinal anesthesia was significantly higher in Group L (P =0.01). Conclusion: Spinal anesthesia performed in the sitting position for cesarean section caused a higher postspinal headache than in the right lateral position, but the position did not affect intraocular pressure.

The effect on mental well-being, life attitude and depression levels of positive psychology program applied to patients diagnosed with depression.

Positive psychology (PP) interventions are treatment methods or intentional activities aiming to develop positive feelings, behaviors or cognitions. This study was conducted to determine the effect on mental well-being, life attitude and depression levels of PP program applied to patients diagnosed with depression. The pre, post and follow-up test were conducted as a quasi-experimental study. Patients who diagnosis of depression for at least 6 months constituted the population of the study, and a total of 53 patients, 26 were in the experimental and 27 in the control group. Data were collected using Personal Information Form,Beck Depression Inventory,Warwick-Edinburgh Mental Well-Being Scale and Life Attitude Profile Scale. After the analysis,it has been determined that the online PP program is effective in reducing the level of depression, increasing mental well-being and developing a positive life attitude. It is recommended that the PP program be used by psychiatric nurses in the treatment of depression and the execution of studies comparing online positive psychology practices with face-to-face positive psychology practices are recommended.

Design, implementation, and evaluation of a mobile application for patient empowerment and management of long-term follow-up after childhood cancer.

In Germany, about 1,800 new cases of childhood cancer are diagnosed every year. The chances of survival have increased significantly over the last 40 years due to the continuous improvement of treatment strategies. The number of childhood cancer survivors in Germany thus ranges around 30,000 nowadays. But their treatment with surgery, chemotherapy, and radiation has certain side-effects. In addition to the acute effects during the treatment phase, the disease- and treatment-related late effects can occur even decades after the end of therapy. These late effects draw attention as the survival rate constantly increases. Two-thirds of the former patients retain long-term consequences, nearly a fifth with a resulting diminished quality of life. Early detection of these late effects can help to reduce or even to prevent serious health damage. Therefore, the study group LESS supplies long-term follow-up recommendations for former patients. The project described in this paper was to design and implement a mobile application to increase the compliance for this aftercare program. This application provides information about the patient's individual aftercare plan and supports appointment management as well as a reminding functionality. A prototype for former osteosarcoma patients was tested and evaluated in two university hospitals. First results show the application's very high potential for patient empowerment.

Minimally invasive anterior contralateral approach for the treatment of cervical disc herniation.

BACKGROUND: During the practice of ipsilateral approach to the offending lesion in anterior simple discectomy, the authors realized that it achieves better surgical exposure of the opposite foraminal area. In addition, it was also realized that routine procedures for better visualization of the foraminal area, such as stripping longus colli muscles, further excising of the anterior longitudinal ligament, or using a spreader, which cause more invasive surgery during the standard anterior approach, are not necessary because the contralateral approach already achieves sufficient exposure of the target foraminal area. OBJECTIVE: Evaluation of the results and effectiveness of this minimal invasive technique in patients with either soft or hard disc herniations. METHODS: Between January 1994 and April 2002, 216 patients underwent anterior contralateral microdiscectomy without fusion for cervical disc herniation at 1 or 2 adjacent levels. Anterior contralateral microdiscectomy is a less invasive technique than standard anterior simple discectomy in which longus colli muscles are not stripped, and the lateral part of annulus fibrosis at the side of intervention and ventrolateral part of it at the opposite side are not removed. In addition, a mini Zenker handheld retractor is used for retraction of paravertebral soft tissues and a spreader is not used during the discectomy procedure. There were 182 patients diagnosed with radiculopathy and 34 patients with myelopathy. Assessments of the neurological status of patients with radiculopathy were done by physical examinations, and of those with myelopathy according to the modified Japanese Orthopaedic Association cervical spine functional assessment scale. These neurological assessments were repeated in the 18th month after surgery. In the follow-up period, the outcomes of surgery were also assessed for all patients in 4 categories, from failure to excellent. RESULTS: Surgery outcomes generally have been good to excellent and none of the patients were made worse by the procedure. The outcomes were significantly better in the radiculopathy and soft disc herniation groups. Other positive outcome factors were short duration and sudden onset of symptoms, normal cervical curvature, and single-level disease. Follow-up radiological studies revealed fibrous healing with normal or slight loss of disc height in 199 (92.1%) patients and total obliteration of the involved disc space representing radiological fusion signs in 13 (6%) patients. The overall complications observed in this study were 2 spontaneous and 2 postinfection collapses of disc level, 1 excessive fibrosis of disc level, and 2 adjacent-level diseases. CONCLUSION: Anterior contralateral microdiscectomy without fusion achieves better exposure for resection of the offending foraminal or far lateral lesions, ventral osteophytes, or a disc fragment under direct microscopic visualization. Collapse and instability of the involved disc level can also be avoided via this less invasive technique.

Removal of an anterior spinal dermoid cyst with fenestra corpectomy in Klippel-Feil syndrome: technical case report.

OBJECTIVE AND IMPORTANCE: A spinal cord tumor occurring in association with Klippel-Feil syndrome is quite rare. The removal of an anteriorly located spinal cord tumor at the level of block vertebrae creates a surgical challenge. CLINICAL PRESENTATION: A case of an intradural extramedullary dermoid cyst located anterior to the spinal cord and a syringomyelic cavity at the level of block vertebrae in a 43-year-old woman with Klippel-Feil syndrome is presented. She experienced pain and numbness in both shoulders and in her neck, and she had a slight weakness in both arms before the operation. Her weakness and the clinical symptoms completely disappeared after the operation, and the resolution of the syringomyelic cavity was observed at control magnetic resonance imaging. INTERVENTION: An anterior approach creating a fenestra corpectomy to the block vertebrae was performed, and the tumor was removed totally. No fusion or fixation was performed. CONCLUSION: To our knowledge, this is the first report of an anteriorly located intradural extramedullary cervical spine tumor in association with Klippel-Feil syndrome treated with this surgical technique. A three-dimensional computed tomographic control scan obtained 1 year after the operation did not show any instability.

The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvian transinsular approach.

OBJECTIVE: Hypertensive putaminal hematoma (HPH) is a devastating type of stroke that mostly results in death or severe neurologic deficit. There seems to be no general agreement on the selection of treatment modality for individual patients. In this study a comparison has been made between conservative treatment and the results of surgical treatment through the transsylvian transinsular approach of HPH with 30 cc or more. METHODS: Sixty-six patients with 30 cc volume or over of HPH, who were admitted within 36 hours after ictus, have been included in this study. Selection of the patients was made primarily according to the computerized tomography scan (CT) findings on admission. Out of the 66 patients, 47 were operated for hematoma evacuation through transsylvian transinsular approach, and the remaining 19 were accepted as a control group to be treated conservatively after their relatives declined authorization for surgery. All patients' neurologic grades and CT findings on admission were classified according to the hypertensive intracerebral hemorrhage grading system, as proposed by the cooperative study in Japan. After 6 months the outcomes of both groups were assessed according to the Glasgow outcome scale (GOS). RESULTS: The statistical difference between the mortality rates was considerable (p < 0.05) with ratios of 34% and 63.1% in the surgically and conservatively treated groups, respectively. Good recovery, that is GOS score 5, was not observed in either group. In the group of surgically treated patients, 27.7% was eventually moderately disabled (GOS score 4); whereas this ratio was 5.3% among the conservatively treated group, giving a statistically significant difference (p < 0.05). Our results indicate that neurologic grades and CT findings on admission are good predictors of outcome, as the grades increase the outcome worsens. Furthermore, ventricular spread of hematoma is not a good prognostic factor. CONCLUSIONS: Surgical treatment via transsylvian transinsular approach of HPH with a volume of 30 cc or more results in improved outcome as compared to conservative treatment. Operation time within the first 36 hours after ictus did not affect the outcome.

Intramedullary spinal cord metastasis: a rare and devastating complication of cancer--two case reports.

Two cases of very rare intramedullary spinal cord metastasis from colon carcinoma and renal carcinoma were treated primarily by microsurgical excision. A 44-year-old female presented with colon carcinoma metastasis manifesting as complete neurological deficit. She had undergone colon resection 2 years previously for colon carcinoma. The tumor was excised by microsurgery with megadose steroid therapy but she remained paraplegic. A 43-year-old man presented with renal carcinoma metastasis manifesting as incomplete neurological deficits. He had undergone nephrectomy one year previously for renal carcinoma. The tumor was removed by microsurgery. He made a remarkable neurological recovery and became ambulatory after physical therapy.

Proliferating activity in differential diagnosis of benign phyllodes tumor and cellular fibroadenomas: is it helpful?

Benign phyllodes tumors and fibroadenomas are two types of fibroepithelial tumors of breast that are usually difficult to differentiate. The purpose of this study is to evaluate the proliferative activity of these tumors and to find out if it helps in differential diagnosis. Thirty-one benign phyllodes tumors and twelve cellular fibroadenomas were retrieved from the archives of Pathology Department of Akdeniz University, School of Medicine. Proliferating activity of epithelial and stromal cells were evaluated by using labeling index (LI) of proliferating cell nuclear antigen (PCNA) and Ki-67 antigen by immunohistochemistry. The results were compared with other clinicopathologic findings. There was not any significant difference between the proliferating activity of phyllodes tumor and cellular fibroadenomas. Mean LI of PCNA was 28.01 (+/-22.85) in stromal cells and 56.57 (+/-30.98) in epithelial cells of phyllodes tumor where it was 28.92 (+/-24.02) and 62.53 (+/-32.56) in fibroadenomas. Ki-67 indices were 0.05 (+/-0.19) in stromal cells, 2.65 (+/-12.53) in epithelial cells of phyllodes tumors and 0.0 (+/-0) in stromal cells, 0.43 (+/-0.63) in epithelial cells of fibroadenomas. There was no correlation between the diameter of tumors and proliferating activity in both groups. Proliferating activity, determined by immunohistochemistry with PCNA and Ki-67 antibodies did not reveal significant difference between phyllodes tumor and fibroadenoma.

Immunohistochemical staining properties of PCNA, Ki-67, p53, beta-hCG and HPL in trophoblastic disease.

OBJECTIVE: In this study proliferating markers PCNA (proliferating cell nuclear antigen) Ki-67 and mutation of supressor gene p53 were investigated in gestational trophoblastic disease (GTL). These markers were tested by using immunostaining with beta subunits of human chorionic gonadotropin (hCG) and human placental lactogen (HPL). MATERIAL AND METHODS: Twenty curetting samples, 20 spontaneous abortions, 16 hydatidiform moles and two choriocarcinomas were studied and compared. Hydatidiform moles were subdivided into 10 complete and six partial moles by using flow cytometry analysis. All slides were stained with PCNA, Ki-67, p53, hCG, and HPL immunohistochemically. PCNA and Ki-67 stained slides were studied quantitatively to determine the PCNA and Ki-67 index. Other slides that were stained with p53, hCG, HPL were evaluated according to staining percentage and intensity. Staining properties of all groups were compared with each other. Variance analysis and the Mann Whitney U test were used for statistical analysis. Choriocarcinomas were not included in the statistical analysis. Ki-67 and the PCNA index in two choriocarcinoma cases found 81.4% and 41%, and 44% and 64%, respectively. One case was stained in 70% with (++) intensity by p53. While both were stained in 80% with (++) intensity by hCG, one was stained in 30% field (+) intensity by HPL. RESULTS: The four groups of complete and incomplete diagnosed hydatiform moles, spontaneous abortions and retention curettage were matched in pairs and evaluated according to the PCNA index. This index showed significant differences among the groups. The differences among the Ki-67 index, p53, hCG and HPL staining properties were not statistically significant. CONCLUSION: Our findings showed that PCNA is a significant and useful marker for trophoblastic diseases and can be used as a prognostic factor.

Intravenous immunoglobulin in the treatment of Salmonella typhimurium infections in preterm neonates.

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. typhimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 (P < .05); complications developed in 81.8% in group 1 and 16% in group 2 (P < 0.01); mortality was 40.9% in group 1 and 12% in group 2 (P < .05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 (P < .01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.