Are There Disparities in Surgical Treatment for Breast Cancer Patients with Prior Physical Disability A Path Analysis.

INTRODUCTION: Cancer care for patients with prior physical disability has hardly been researched in clinical research, health services research, or special education. This article aims to compare the severity of disease and the surgical treatment of diagnosed breast cancer patients with and without prior physical disability. METHODS: A total of 4,194 patients with primary breast cancer who underwent surgery in a breast cancer center in North Rhine-Westphalia, Germany, participated in an annual postoperative postal survey, which was complemented by clinical data. Latent class analysis and logit path models were applied to study (1) differences in terms of UICC staging and local cancer treatment between patients with and without prior physical disability and (2) respective differences by disability severity. RESULTS: Patients with physical disability (n = 780; 18.7%) had a higher chance of receiving mastectomy compared to breast-conserving therapy, even after controlling for socioeconomic status and UICC staging. Disability severity is directly and indirectly associated with receiving a mastectomy. CONCLUSION: In light of the research gap on disability and cancer, this work indicates disparities in care for breast cancer patients with prior physical disability. Inequalities might be attributable to (1) unequal access to care, (2) individual preferences and difficulties, or (3) medical difficulties.

Development of xMAP assay for detection of six protein toxins.

xMAP technology was used for simultaneous identification of six protein toxins (staphylococcal enterotoxins A and B, cholera toxin, ricin, botulinum toxin A, and heat labile toxin of E. coli). Monoclonal antibody-conjugated xMAP microspheres and biotinilated monoclonal antibodies were used to detect the toxins in a sandwich immunoassay format. The detection limits were found to be 0.01 ng/mL for staphylococcal enterotoxin A, cholera toxin, botulinum toxin A, and ricin in model buffer (PBS-BSA) and 0.1 ng/mL for staphylococcal enterotoxin B and LT. In a complex matrix, such as cow milk, the limits of detection for staphylococcal enterotoxins A and B, cholera toxin, botulinum toxin A, and ricin increased 2- to 5-fold, while for LT the detection limit increased 30-fold in comparison with the same analysis in PBS-BSA. In the both PBS-BSA and milk samples, the xMAP test system was 3-200 times (depending on the toxin) more sensitive than ELISA systems with the same pairs of monoclonal antibodies used. The time required for a simultaneous analysis of six toxins using the xMAP system did not exceed the time required for ELISA to analyze one toxin. In the future, the assay may be used in clinical diagnostics and for food and environmental monitoring.

Our experience in endoscopic treatment of vesico-ureteral reflux in children.

AIM OF THE STUDY: To define the guidelines of endoscopic treatment of vesico-ureteral reflux (VUR) in children in relation to grade of VUR, of the location of the ureteral orifice, of the stage of reflux nephropathy and of the association with other urinary tract malformations. MATERIALS AND METHODS: 498 children with vesico-ureteral reflux (VUR) were observed in 702 ureters. All the patients were submitted to a complete urological evaluation and to endoscopic treatment (ET) of the VUR with the implant of a stable polyacrylamid gel (DAM+). RESULTS: The reflux was degree I in 53 ureters, II in 174, III in 301, IV in 165 and V in 9 ureters. VUR was primary in 149 children, secondary to a neurogenic dysfunction of the bladder in 271 patients, complex in the remaining cases. An overall 90.5% success rate of endoscopic treatment with "DAM+" implantation was observed. Success of VUR endoscopic treatment was obtained in 80% of cases with- orifice lateralisation, in 60% of cases with high and low intravesical orifice ectopy, and in 10% of cases with extravesical orifice. In 151 ureters (21.5%) endoscopical treatment of VUR had to be repeated, while a third procedure was necessary in 42 ureters (5.9% of cases). In total 895 endoscopic procedures were performed. Open surgical ureteral reimplantation was performed in the cases with persisting VUR after the third attempt of endoscopic procedure. CONCLUSION: These results of the endoscopic treatment of VUR in children confirm the high efficacy and safety of this method. In any case, before choosing the method of VUR correction, it is necessary to inform the parents of the child about the potential rate of success of the endoscopic treatment in function of the peculiarity of the individual patient.