Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Mobile Health Application Applying the Health Belief Model for Breast Cancer Awareness: What Is Missing?

@#Breast cancer (BC) is one of the most common cancer incidents among women and is estimated at around 24.2% worldwide and 32.1% in Malaysia. Accessibility to current breast promotion is limited to those who seek the information, suggesting consideration of an alternative approach using a mobile app. This study aimed to identify existing breast awareness mobile apps based on the Health Belief Model (HBM) components with a descriptive observation review. Fifty-two apps fulfilled the inclusion and exclusion criteria and were reviewed. Eligible apps (N=52) which are standalone (n=41) and non-standalone (n=11). The categories of the eligible apps are health & fitness (n=31), lifestyle (n=6), medical (n=11), entertainment (n=2), book & reference (n=1), education (n=3). The apps focused on perceived susceptibility (n=33/52, 63.5%), perceived severity (n=30/52, 57.7%), perceived threat (n=48/52, 92.3%), perceived benefit (n=46/52, 88.5%), perceived barriers (n=23/52, 44.2%), self-efficacy (n=25/52, 48.1%) and cues to action (n=27/52, 51.9%). Most of the apps focused on perceived threat and benefit but lacking on a perceived barrier. This review could provide information to develop appropriately tailored content supported by health theories to promote breast cancer awareness.

Thermal Profiling Analysis for Asymmetrically Embedded Tumour with Different Breast Densities

@#Introduction: Detecting breast cancer at earlier stage is crucial to increase the survival rate. Mammography as the golden screening tool has shown to be less effective for younger women due to denser breast tissue. Infrared Thermography has been touted as an adjunct modality to mammography. Further investigation of thermal distribution in breast cancer patient is important prior to its clinical interpretation. Therefore, thermal profiling using 3D computational simulation was carried out to understand the effect of changes in size and location of tumour embedded in breast to the surface temperature distribution at different breast densities. Methods: Extremely dense (ED) and predominantly fatty dense (PF) breast models were developed and simulated using finite element analysis (FEA). Pennes’ bioheat equation was adapted to show the heat transfer mechanism by providing appropriate thermophysical properties in each tissue layer. 20 case studies with various tumour size embedded at two asymmetrical positions in the breast models were analysed. Quantitative and qualitative analyses were performed by recording the temperature values along the arc of breast, calculating of temperature difference at the peaks and comparing multiple thermal images. Results: Bigger size of tumour demands a larger increase in breast surface temperatures. As tumour is located far from the centre of the breast or near to the edge, there was a greater shift of temperature peak. Conclusion: Size and location of tumour in various levels of breast density should be considered as a notable factor to thermal profile on breast when using thermography for early breast cancer detection.

Health-Related Quality of Life among Long Term and Short Term Breast Cancer Survivors

@#Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.

Factores asociados a depresión en pacientes con cáncer de mama / Factors associated with depression in patients with breast cancer

Objetivo: Sistematizar los hallazgos de los estudios sobre los factores asociados a depresión en pacientes con cáncer de mama. Métodos: Se realizó una revisión sistemática de la literatura médica en Medline, SciELO y Google Scholar con los términos descriptores del Medical Subject Headings: depression, breast cancer. Se seleccionaron 6 artículos con los criterios de exclusión de artículos con un periodo de publicación entre 2013-2018, escritos en español o inglés, que analizaban a pacientes con depresión asociado a cáncer de mama y estudios con una muestra mínima de 80 participantes. Resultados: En esta revisión se han incluido 6 estudios. Los factores asociados a depresión en pacientes con cáncer de mama tenemos está la edad donde se ve que la población entre 40 y 60 años, estar divorciada o soltera, grado de instrucción hasta primaria, estar desempleado, pertenecer a una clase social baja, el estadío clínico 4 y el tratamiento de quimioterapia aumenta el riesgo de tener depresión en pacientes con cáncer de mama. Conclusión: Se concluye en la presente revisión que hace falta más estudios a mayor escala respecto a los factores asociados a depresión en pacientes con cáncer de mama especialmente a nivel de Perú, ya que se encontró solo un artículo relacionado al tema de interés. Por otra parte hace falta sistematizar bien los factores asociados ya que se encuentran diversos factores relacionados a depresión y con diferentes resultados dependiendo del tipo de hospital y de país, para poder plantear un buen programa de apoyo psicológico y educación sobre la enfermedad.

Objective: Systematize the findings of the studies on the factors associated with depression in patients with breast cancer. Methods: A systematic review of the medical literature was made in Medline, SciELO and Google Scholar with the descriptive terms of the Medical Subject Headings: depression, breast cancer. Six articles were selected with the exclusion criteria of articles with a publication period between 2013-2018, written in Spanish or English, which analyzed patients with depression associated with breast cancer and studies with a minimum sample of 80 participants. Results: In this review, 6 studies have been included. The factors associated with depression in patients with breast cancer we have this age where it is seen that the population between 40 and 60 years, be divorced or single, education grade up to primary, be unemployed, belong to a low social class, the stadium clinical trial 4 and chemotherapy treatment increases the risk of depression in patients with breast cancer. Conclusion: It is concluded in the present review that more studies on a larger scale are needed regarding the factors associated with depression in patients with breast cancer, especially the level of Peru, since only one article related to the topic of interest was found. On the other hand, it is necessary to systematize the associated factors well since there are several factors related to depression and with different results depending on the type of hospital and country, in order to propose a good program of psychological support and education about the disease.

Profiling of Gene Expression Associated with Stemness and Aggressiveness of ALDH1A1- Expressing Human Breast Cancer Cells

@#Background: It has been widely reported that breast cancer aggressiveness may be driven by breast cancer stem cells (BCSCs). BCSCs display stemness properties that include self-renewal, tumourigenicity and pluripotency. The regulation of gene expression may have important roles in BCSC stemness and aggressiveness. Thus, the aim of this study was to examine the stemness and aggressiveness gene expression profile of BCSCs compared to MCF-7 and MDA-MB-231 breast cancer cells. Methods: Human ALDH1+ BCSCs were grown in serum-free Dulbecco’s Modified Eagle Medium (DMEM)/F12, while MCF-7 and MDA-MB-231 were cultured in DMEM supplemented with 10% foetal bovine serum under standard conditions. Total RNA was extracted using the Tripure Isolation Reagent. The relative mRNA expressions of OCT4, ALDH1A1 and CD44 associated with stemness as well as TGF-β1, TβR1, ERα1 and MnSOD associated with aggressiveness in BCSCs and MCF-7 cells were determined using the quantitative real-time PCR (qRT-PCR). Results: The mRNA expressions of OCT4 (5.19-fold ± 0.338; P = 0.001), ALDH1A1 (3.67- fold ± 0.523; P = 0.006), CD44 (2.65-fold ± 0.307; P = 0.006), TGF-β1 (22.89-fold ± 6.840; P = 0.015), TβR1 (3.74-fold ± 1.446; P = 0.045) and MnSOD (4.6-fold ± 1.096; P = 0.014) were higher in BCSCs than in MCF-7 but were almost similar to MDA-MB-231 cells. In contrast, the ERα1 expression of BCSCs (0.97-fold ± 0.080; P = 0.392) was similar to MCF-7 cells, indicating that BSCSs are oestrogen-dependent breast cancer cells. Conclusion: The oestrogen-dependent BCSCs express stemness and aggressiveness genes at a higher level compared to oestrogen-dependent MCF-7 but are almost similar to oestrogenindependent MDA-MB-231 cells.

Factors Associated with Breast-self Examination Practice and Mammogram Breast Density among Malaysian Women

@# Breast cancer is globally known to be the commonest cause of cancer-related deaths among women. Screening tools which include breast-self examination (BSE), clinical breast examination and mammography are well-recognised to aid the detection of breast cancer among high risk women. Thus, our study was aimed to evaluate breast cancer and BSE awareness and practice, and to perform mammography screening among women who attended community breast cancer awareness and screening programme. Methods: Data was collected cross-sectionally from 2,021 women during community services from September 2013 until December 2015. Results: Majority of the women had previously attended health education on breast cancer (56.3%) and had been taught BSE techniques (61.4%), but only 38.6% performed BSE monthly. Factors associated with regular BSE practice were older age, higher education level, being married, higher monthly income, had attended health education on breast cancer, and had been taught BSE techniques. A subset of 130 high-risk women had underwent mammography screening and majority had heterogenously dense and normal mammogram findings. Conclusion: These findings suggested that regular breast cancer awareness campaigns is needed to strengthen breast cancer knowledge and to emphasise BSE techniques. Such campaigns should target younger women and those with low socioeconomic status.

Endocrine disruptors and their influence in the origin of breast neoplasm and other breast pathologies / Disruptores endócrinos e o seu papel na gênese das neoplasias e de outras patologias das mamas

A higher occurrence of early breast cancer in women has created the need to identify possible etiologic agents characterized as direct co-responsible. The motivation for this review is the relevance of detecting potential endocrine disruptors responsible for harmful effects on breast tissue and, consequently, its damage

Uma maior ocorrência no surgimento precoce das neoplasias das mamas em mulheres tem gerado a necessidade da descoberta dos possíveis agentes etiológicos caracterizados como corresponsáveis diretos. A relevância da detecção dos possíveis disruptores endócrinos responsáveis por exercer efeitos danosos nos tecidos mamários e, consequentemente, o seu comprometimento é a motivação da presente revisão

RELATIONSHIP BETWEEN OBESITY AND BREAST CANCER / Relação entre obesidade e câncer de mama

Obesity is a growing clinical condition around the world, considered a risk factor for numerous diseases such as hypertension, myocardial infarction, diabetes, and cancer. Among the neoplasms related to overweight, breast cancer stands out. Therefore, the objective of this review is to elucidate the impact of obesity on the most prevalent cancer among women, either as a direct risk factor for its onset or as a determinant of survival

A obesidade aponta como condição clínica em ascensão pelo mundo, considerada fator de risco para inúmeras doenças como hipertensão, infarto, diabetes e câncer. Dentre as neoplasias relacionadas com o excesso de peso, destaca-se o câncer de mama. O objetivo desta revisão é, portanto, elucidar o impacto que a obesidade causa no câncer mais prevalente entre as mulheres, seja como fator de risco direto para seu aparecimento, seja como determinante na sobrevida

Clinical analysis of chemoradiation sequence for early breast cancer patients with conserving surgery / 中华放射医学与防护杂志

Objective To investigate the prognostic factors affecting early breast cancer patients with conserving surgery and discuss the influences of chemoradiation sequence on treatment efficacy.Methods We retrospectively analyzed 191 cases of early breast cancer after breast conservation surgery in the second hospital of Dalian medical university,from January 1,2006 to December 31,2015.According to the treatment order,they were divided into radiotherapy group,chemotherapy group and sandwich group.There were 32 patients in the radiotherapy group,107 patients in the chemotherapy group,and 52 patients in the sandwich group.The sandwich group was treated with chemotherapy-radiotherapy-chemotherapy.The factors were analyzed independently from the patients' age,menopausal status,pathology type,tumor size (T1,T2),axillary lymph node,molecular type of breast cancer,the interval between surgery and radiation,vascular tumor emboli.Regression model was used to find the risk factors of early stage breast cancer patients with conserving surgery.The 5-year LRR and 5-year OS was compared among radiotherapy-first group,chemotherapy-first group,the sandwich group in patients with high risk factors,and the factors associated with the prognosis of patients were analysed.Results The Multivariate Cox Regression model showed that tumor size,axillary lymph node,vascular tumor emboli,the interval between surgery and radiation were independent risk factors associated with 5-year OS.Among patients with T1 and T2 stage in radiotherapy-first group,chemotherapy-first group,sandwich group,there was no statistical difference in 5-year LRR or 5-year OS (P ＞ 0.05).Among patients with N0 stage in radiotherapy first group,chemotherapy first group,sandwich group,5-year LRR were not statistically different (P ＞ 0.05).For patients with N1 stage in chemotherapy-first group and the sandwich group 5-year LRR were with statistical difference(x2 =4.813,P =0.028).OS were without statistical difference (P ＞ 0.05).In patients with vascular tumor emboli in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (5.3％,9.2％,vs.18.1％,P ＞ 0.05),OS were statistically different (61.5％,90.1％ vs.87.2％,x2 =6.282,P =0.043).For patients without vascular tumor emboli,there was no statistical difference in 5-year LRR (P ＞ 0.05).For patients started radiation within 6 months after surgery in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (P ＞ 0.05).However,patients in chemotherapy-first group the time interval surgery and radiation ≤6 months vs.＞6 months 5-year LRR was 5.2％ and 14.1％ (x2 =4.886,P=0.027),5-year OS were 96.9％ and 85.7％ (x2 =5.758,P =0.038).Conclusions Clinical treatment is based on individualized options.For patients with negative axillary lymph nodes,but high risk factors for local recurrence,radiotherapy may be performed firstly.For high-risk patients with axillary lymph node metastasis or vascular tumor embolus,chemotherapy should be started early and radiotherapy may be followed,but not more than 6 months.

Aplicación actual de la clasificación Inmunohistoquímica de cáncer de mama / Current Applicaton of Immunohistochemistry in Breast Cancer

Introducción: El cáncer de mama es la primera causa de mortalidad en el mundo y en Guatemala ocupa el segundo lugar en frecuencia. Desde 1991 su clasifcación ha evolucionado a fn de mejorar el pronóstco y su tratamiento basado en la descripción del tpo y grado histológico. El objetvo de este estudio es conocer la aplicación actual de la inmunohistoquímica en cancer de mama. Metodología: Estudio observacional descriptvo retrospectvo, sobre cáncer de mama clasifcado por inmunohistoquímica en 281 pacientes en el Insttuto Guatemalteco de Seguridad Social (IGSS) de enero 2012 a enero del 2017. Resultados: El subtpo Luminal A se presentó en el 31% de los pacientes y su tratamiento fue principalmente hormonal; seguido por el Triple Negatvo en el 26% tratado mayoritariamente con quimioterapia. El HER2 Positvo en el 21%, el subtpo B-like 13% y en menor frecuencia el Luminal B en el 9% de los casos. El subtpo triple negatvo presento mayor recurrencia y mortalidad con mayor elevación del P53 (40%, OR 2.4) y Ki67 (37%, OR 1.4). La edad en la mayoría de pacientes incluidas fueron superiores a los 40 años y los estadios II y III se presentaron con mayor frecuencia. Conclusiones: El estudio de la inmunohistoquímica realizado en los tejidos obtenidos permitó mostrar que el subtpo luminal A fue el más frecuente, recibiendo en la mayoría de los casos tratamiento hormonal. El más agresivo en recurrencia, metástasis, mortalidad y con valor elevado del Gen p53 y Ki67, fue el Triple Negatvo, tratado con quimioterapia.

Background: Breast cancer is the leading cause of death in the world, and in Guatemala it is the second most common cause of death. Since 1991, its classifcaton has evolved in order to improve prognosis and treatment based on the descripton of type and histological grade. The purpose of this study is to learn the current applicaton of immunohistochemistry of breast cancer. Methods: This retrospectve descriptve observatonal study of breast cancer classifed by immunohistochemistry was performed on 281 patents at the Guatemalan Social Security Insttute (IGSS) between January 2012 and January 2017. Results: The subtype Luminal A was present in 31% of the patents and treatment was mainly hormonal; followed by Triple Negatve in 26% of patents treated mainly with chemotherapy. HER2 positve in 21% of patents, subtype B-like in 13% and lower frequency Luminal B in 9% of the patents. The triple negatve subtype presented higher recurrence and mortality with P53 elevaton (40%, OR 2.4) and Ki67 (37%, OR 1.4). Average age in the study was 40 years old and stages II and III were more frequent. Conclusions: The study of immunohistochemistry performed on tssue obtained, demonstrated that Luminal A subtype is the most frequent, in which the majority of patents received hormonal treatment. The most aggressive in recurrence, metastasis, mortality and with high values of gene p53 and Ki67, was the Triple Negatve, which were treated with chemotherapy.

IMPROVEMENT ASSESSMENT OF MASTOLOGIST IN THE BREAST ONCOPLASTIC AND RECONSTRUCTIVE SURGERY OF SANTA CASA DE BELO HORIZONTE, MG, BRAZIL / Avaliação do aprimoramento do mastologista em cirurgia oncoplástica e reconstrutiva da mama da Santa Casa de Belo Horizonte

Objective: This study aims to investigate the efficacy and improvement of knowledge acquired by breast cancer specialists in a postgraduate course of Oncoplastic Surgery conducted in Santa Casa de Belo Horizonte (SCBH). Method: For this evaluation, an exploratory qualitative study was carried out. It was supported by an online survey questionnaire sent to 36 breast cancer specialists, who had taken the course in the period from 2012 to 2014. The data were interpreted using statistical methods, as well as probabilistic sampling. Results: After the Oncoplastic Surgery course, almost all breast cancer specialists who had taken it demonstrated the ability to reconstruct the breasts of women who had undergone mastectomies with oncoplastic techniques. A large portion of the specialists was able to develop bilateral treatment with breast reduction, mastopexy and rebuild areolas and nipples, as well as immediately reconstruct the breast with expanders or prosthesis and contralateral symmetrization. A significant amount of professionals was able to perform breast reconstruction with autologous flaps. Conclusion: The course for the Professional Development of Breast Cancer Specialists sponsored by the Teaching and Research Institute of Santa Casa de Belo Horizonte was able to improve the skills of the professionals involved in the different breast remodeling and reconstruction techniques. This enables a paradigm shift in the treatment of cancer patients.

Objetivo: Este trabalho objetiva investigar a eficácia e aprimoramento dos conhecimentos adquiridos por mastologistas no Curso de Pós-graduação de Oncoplastia Mamária da Santa Casa de Belo Horizonte (SCBH). Método: Para essa avaliação, realizou-se um estudo exploratório de natureza qualitativa. Como suporte, a aplicação de questionário de pesquisa, enviado online aos trinta e seis mastologistas que fizeram o Curso, no período de 2012 a 2014. Os dados foram interpretados por intermédio de métodos estatísticos, bem como por uma amostragem probabilística. Resultados: Após o Curso, quase a totalidade dos Mastologistas que se aprimoraram se mostram capazes de reconstruir a mama das mulheres mastectomizadas com técnicas oncoplásticas. Uma grande parcela tem condições de desenvolver tratamento bilateral com redução mamária, mastopexia e reconstruir aréolas e mamilos, e reconstruir de maneira imediata a mama, com expansores ou próteses e simetrização contralateral. Uma quantidade significativa dos profissionais é capaz de efetuar a reconstrução da mama com retalhos autólogos. Conclusão: O Curso promovido por esse Instituto de Ensino e Pesquisa foi capaz de aprimorar os profissionais envolvidos, nas diferentes técnicas de remodelamento e reconstrução mamária. Isso possibilita uma mudança de paradigma no tratamento da paciente oncológica.

Guía práctica y resultados de la implementación de un programa de auditoría y calidad en imágenes mamarias / Practical Guide and Results of the Implementation of an Audit and Quality Program in Breast Imaging

Objetivo: Describir la experiencia del Centro de Diagnóstico para la Mujer, de la Fundación Santa Fe de Bogotá (FSFB), en la implementación de un sistema práctico de auditoría en imágenes mamarias y su utilidad en los procesos de calidad, basados en parámetros establecidos por el American College of Radiology (ACR). Métodos: Evaluación de los indicadores propuestos por el ACR mediante bases de datos y sistemas de información de imágenes de la FSFB (enero 2012-diciembre 2014). Se incluyeron todos los estudios mamográficos y biopsias de mama realizadas por ecografía y estereotaxia. Los resultados se compararon con los descritos en BIRADS ® 5ta. edición. Se realizó una búsqueda de la literatura en PubMed para definir el estado del arte de los procesos de auditoría en imágenes mamarias. Resultados: Incluimos 13 artículos originales y 4 guías internacionales de auditoría en imágenes mamarias. Se evaluaron 19.132 mamografías (6.060 en 2012, 6.568 en 2013 y 6.504 en 2014). El 95 % de las mamografías correspondieron a tamizaje de oportunidad. El rellamado global disminuyó 19,6 %, el VPP de las biopsias realizadas aumentó a 15,36 % y mejoró la detección de cáncer invasivo de menor tamaño con una diferencia significativa entre 2013 y 2014 (p=0,03). La detección del cáncer mínimo se encuentra en 54,23 %. Conclusión: Los programas de control de la calidad y auditoría en imágenes mamarias basados en recomendaciones internacionales permiten garantizar resultados clínicamente relevantes en pacientes que asisten a tamizaje mamográfico. Las recomendaciones de sociedades internacionales proveen un continuo mejoramiento en los indicadores.

Objective: To describe the experience of the Center of Diagnosis for Women, of the Fundación Santa Fe de Bogotá (FSFB) in the implementation of a practical system of auditing in mammary images and its utility in quality processes, based on parameters established by the American College of Radiology benchmarks. Methods: We evaluated the benchmarks proposed by the ACR's audit program, based on our imaging databases and FSFB imaging information between January 2012 and December 2014. We include all mammograms, ultrasound-guided and stereotacticguided breast biopsies. The results were compared with those described in BI-RADS 5 edition. A literature review was performed using PubMed to define the state of the art of the breast imaging audit process. Results: We included 13 original articles and 4 international guidelines of breast imaging audit. We included 19132 mammograms, 6060 from 2012, 6568 from 2013 and 6504 from 2014. 95% of the mammograms belong to opportunity screening program. Recall rate decreased in 19.6%, PPV of the biopsies increased to 15,36% and the detection of smaller invasive cancer increased with significant difference between 2013 and 2014 (p=0.03). Minimal breast cancer detection corresponds to 54.34%. Conclusion: Quality Control and Audit programs in breast imaging based on international recommendations allow assuring clinical results in patients from a screening program. The recommendations of international societies provide a medium to provide a continuous improvement in the indicators.

Clinical Observations on Moxibustion plus Acupoint Application for the Prevention and Treatment of Gastrointestinal ;Reactions During Chemotherapy for Breast Cancer / 上海针灸杂志

Objective To investigate the clinical efficacy of moxibustion plus acupoint application of Chinese herbal medicine in preventing and treating gastrointestinal reactions during chemotherapy for breast cancer. Method One hundred patients with breast cancer of stomach deficiency cold type were randomly allocated to two groups. The treatment group received moxibustion plus acupoint application of Chinese herbal medicine based on conventional treatment of western medicine and the control group, conventional treatment of Western medicine. Result Comparison of nausea and vomiting incidences and severities from the beginning day of chemotherapy to three days after it and constipation incidences and severities during three days after chemotherapy between the two groups of patients showed that the results were better in the treatment group than in the control group;there were statistically significant differences between the two groups (P<0.05). Conclusion Moxibustion plus acupoint application of Chinese herbal medicine can effectively prevent and treat gastrointestinal reactions during chemotherapy for breast cancer. The method is convenient.

Applications of Nanomedicine in Breast Cancer Therapy / 医药导报

Objective Nanomedicine is a branch of nanotechnology; it applies scientific principles and established methods of nanotechnology in healthcare. Small sized nanoparticles exhibit unique material properties. Nanoparticle therapeutic agents can be delivered with minimal invasiveness in vivo,and react more specifically to target tissues.Breast cancer is the most common cancer among women.Its incidence increases every year globally.Conventional therapeutic methods for breast cancer are effective,but have many limitations.In recent years the rapid development of nanotechnology medicine provides new solutions for those problems.There are many types of nanoengineered drug delivery systems (nDDS),each with distinguishing properties, including organic and inorganic materials, for example liposomes, polymers, antibodies, metals, magnets, carbons and ceramics. Nanomedicine may have passive and active targeting strategies. Both can enhance the accumulation of the drug in tumor sites. Specific nanoparticles can also kill or damage tumor cells.As its research advances fast,a wide application of nanomedicine in treating breast cancer is getting adopted.Many agents and formulations of nanomedicine are approved for clinical trials or approved for prescription.

ERCC1 and Ki67 Expression in Patients with Breast Cancer and Relationship Between Its Expression and Sensitivity of Platinum Chemotherapy / 医药导报

Objective To investigate the expressions of excision repair cross complementation group 1 ( ERCC1) and Ki67 in patients with breast cancer, and the relationships between their expressions and sensitivity of platinum-based chemotherapy. Methods Totally, 129 cases were pathologically diagnosed as breast cancer.Paclitaxel and carboplatin were used simultaneously. Chemotherapy regimen was as follows:Gemcitabine 1 000 mg??( m2 )-1 , IV drop on day 1 and 8;cisplatin 25 mg??( m2 )-1 , IV drop on day 1-3, for six cycles ( 21 days a cycle ) . ERCC1 and Ki67 expression in tumor tissue was observed by immunohistochemical analysis.Platinum-based chemotherapy sensitivity and survival of patients with different levels of ERCC1 and Ki67 expression were analyzed. Results In 129 patients, 18 cases were ERCC1 and Ki67 double-negative ( ERCC1-Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 88.89%and 83.33%, respectively.Twenty-four cases were ERCC1 positive but Ki67 negative ( ERCC1+Ki67-) , and the clinical effective rate and 3-year cumulative survival rate were 50. 00% and 62.50%, respectively.Thirty-three cases were ERCC1 negative but Ki67 positive (ERCC1-Ki67+), and the clinical effective rate and 3-year cumulative survival rate were 54. 55% and 60. 60%, respectively. Fifty-four patients were ERCC1 and Ki67 double-positive ( ERCC1+Ki67+) , and the clinical effective rate and 3-year cumulative survival rate were 22.78% and 31. 48%, respectively.Compared with ERCC1-Ki67- group, the clinical treatment efficiencies of cisplatin-based chemotherapy in ERCC1+Ki67- group, ERCC1-Ki67+ group, and ERCC1+Ki67+ group were significantly decreased ( P<0. 05 ) . The clinical treatment efficiency in patients of ERCC1+Ki67+ group with cisplatin-based chemotherapy was significantly decreased as compared with ERCC1+Ki67- group and ERCC1-Ki67+ group (P<0.05).Compared with ERCC1- Ki67- group, three-year cumulative survival rate in patients of ERCC1+ Ki67- group and ERCC1- Ki67+ group, ERCC1+Ki67+ group was significantly decreased ( P<0. 05 ) . Compared with ERCC1+Ki67-group and ERCC1-Ki67+group, three-year cumulative survival rate in patients of the ERCC1+Ki67+group was significantly decreased ( P<0.05) . Conclusion The expression levels of ERCC1 and Ki67 in breast cancer were high. Their expression levels are closely related with clinical efficiency of platinum-based chemotherapy.

Effect of Furin Inhibitor on Growth of Breast Cancer M CF￣7 Cell / 医药导报

Objective To investigate the role of Furin in breast cancer cell proliferation and provide a theoretical basis for in￣depth study of breast cancer. Methods Different concentrations of Furin inhibitor were added in MCF￣7 cell culture to test MCF￣7 cell proliferation by MTT essay.Hochest 33342 staining was used to detect the morphological change of apoptosic cells.Western blot analysis was applied to measure the level of cell apoptosis associated proteins,such as Caspase￣3,Caspase￣8 andCaspase￣9.The enzyme￣linked immunosorbent assay was used for detection the CAT and SOD levels in cell culture. ResultsMCF￣7 cell growth was inhibited by Furin inhibitor in a time and dose dependent manner.The results of Western blot and Hochest33342 staining indicated that MCF￣7 cells were apoptosis after Furin inhibitor treatment. The level of CAT was increasedsignificantly,associated with the level of SOD. Conclusion Furin inhibitor could induce MCF cell apoptosis, thereby inhibitcell proliferation by modulating MCF￣7 cell redox state.

Cáncer de mama embarazo: presentación de dos casos / Breast cancer pregnancy: presentation of two cases

La primera paciente de 46 años en la cual durante el primer trimestre de embarazo se identifica un carcinoma mamario derecho. No tenía antecedentes de cáncer mamario familiar ni hereditario. La punción biopsia por aguja fina reveló adenocarcinoma de alto grado nuclear. Fue estadificado como T3 NI M0 Estadio IIIa. A las 13 semanas de embarazo se realizó una histerectomía en bloque más salpingo ooferectomia bilateral. Se inicio 4 ciclos de quimioterapia neoadyuvante A la conclusión tratamiento se realizo mastectomia La segunda paciente de 37 años de edad que en su primera consulta prenatal a las 34 semanas, se diagnostica CA de mama derecha inflamatorio. Se estadifico T4 N2 M0 Estadio IIIb. Resultado de la PAAF concluyó positivo para células neoplásicas, compatible con adenocarcinoma. Se decide interrumpir el embarazo mediante cesárea mas ovariectomia bilateral a las 36 semanas. Posteriormente se realiza 4 ciclos de quimioterapia neoadyuvante, para finalmente realizar mastectomia simple.

Cancer of breast during the pregnancy is an infrequent clinic circumstance. This asociation raises questions with respect to the handling of the mother in special her condicin fisiolgic and the security of the fetus. We presented displayed two cases: The first patient of 46 ears in which during the first trimester a mamary carcinoma is identified straight. It Ins't antecedents of cancer mamary hereditary relative nor. Puncin biopsy by positive fine needle revel for adenocarcinom of high nuclear degree. That he was estadific like T3 NI M0 IIIa Stage. To the 13 weeks of realiz pregnancy one histerectomi in bilateral block whit salpingo ooferectomia. Beginning 4 cyles of neoadjuvant chemotherapy. To conclusin make mastectomia simple. The second patient of 37 ears of age that in his first prenatal consultation to the 34 weeks, diagnostic inflammatory CA of right breast. That estadific T4 N2 M0 IIIb Stage. Result of positive for cels neoplasic, the PAAF concluy with adenocarcinom. It is decided To interrupt the pregnaney by means of bilateral surgeri but oferectomia to the 36 weeks, later is made 4 cycles of neoadjuvant chemotherapy, finally to make mastectomia simple.

Effect of psychotherapy on depression,anxiety and gastrointestinal reactions in patients with lung or breast cancer undergoing chemotherapy / 中国康复理论与实践

@#ObjectiveTo investigate the effects of comprehensive psychotherapy on depression,anxiety and gastrointestinal reactions in patients with lung or breast cancer.Methods96 cases with lung or breast cancer were randomly divided into psychotherapy group(n=48) and control group(n=48) which were both treated with routine chemotherapy.Those in the psychotherapy group concomitantly received comprehensive psychotherapy for 2 weeks.Their characters of Symptom Checklist 90(SCL-90) were measured,while those of Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) were also measured before and after treatment.ResultsThe scores of SCL-90 in patients with lung or breast cancer were increased compared with Chinese norm in somatization,depression,anxiety,phobic anxiety(P<0.01).From the 3rd week,the scores of SDS(41.2±3.7) and SAS(34.6±5.8) in the psychotherapy group were significantly lower than those in the control group(P<0.01),as well as the gastrointestinal reactions.ConclusionPsychotherapy can obviously decease the severity of depressive and anxious emotions and the gastrointestinal reactions.

Radiologic findings of metastatic signet ring cell carcinoma to the breast from stomach

Two Korean women (41 and 23-years of age) presented with painful breast enlargement and redness. The involved breast was confirmed as metastatic signet ring cell carcinoma. Although metastatic signet ring cell carcinoma of the breast shows similar clinical symptoms to inflammatory breast cancer, the difference between the two is that this malignancy showed no microcalcifications or mass on radiographic findings (mammograms and US). Therefore, after the confirmation of signet ring cell carcinoma of the breast has been made, metastatic signet ring cell carcinoma should be considered if there are no microcalcifications or masses evident on radiographic findings.