Restore C19 national practice survey: The position of UK delayed breast reconstruction services

Introduction: The offer of immediate breast reconstruction (IBR) was temporarily withdrawn for women requiring mastectomy during the COVID-19 pandemic to allow prioritisation of emergency care. Many women are now awaiting delayed breast reconstruction (DBR) surgery. This survey aimed to explore the current provision of DBR in the UK and how this had been impacted by COVID-19. Method(s): An online survey was distributed to UK breast units via the ABS/Mammary Fold newsletters and social media feeds between 10/2021 and 04/2022. Simple descriptive statistics were used to summarise the results. Result(s): Of the 42 UK breast units that completed the survey, most units reported that COVID-19 had led to increased waits for DBR. Before the pandemic over three quarters of units reported waits of less than 1 year (29% <6 months, 45% 6-12 months) whereas currently waits of 12-24 months are common with a third of units reporting waits of 24-36 months. A small number of units reported waits of >3 years or that DBR had not yet restarted (14%). Key identified challenges for DBR services included limited availability of theatre time and consultant and/or theatre/nursing staff, and a lack of in-patient capacity for post-operative recovery. Conclusion(s): Waiting times for DBR have been negatively impacted by COVID-19. As reconstruction is an integral part of women's breast cancer treatment, there is an urgent need to develop a recovery plan to address this issue, support patients and allow women to access reconstructive surgery in a timely manner.Copyright © 2023

Summer Meeting of the Anatomical Society

The proceedings contain 71 papers. The topics discussed include: experience of learning human anatomy and histology during COVID-19 pandemic in Kharkiv National Medical University;using musculoskeletal modelling to investigate the functional significance of craniofacial form variation within the genus homo;a morphometric analysis of the cranial fossae in patients with scaphocephaly;exploring the thalamus in young adolescents with psychotic experiences;to replace or not replace that is the question: addressing fate decisions during minipig tooth replacement;anatomy of termination of popliteal artery: a multidetector CT angiographic study;anatomical variation between populations of British red squirrels: the potential impact of supplementary feeding;revealing the biomechanics of the masticatory muscles in the eastern grey squirrel (Sciurus carolinensis) using multibody dynamics analysis;and myoepithelial and immune cell dynamics in the ovine mammary gland during postnatal development.

Effect of Soybean Isoflavones on Proliferation and Related Gene Expression of Sow Mammary Gland Cells In Vitro.

The present study was conducted to investigate the effects of synthetic soybean isoflavones (ISO) on the proliferation and related gene expression of sow mammary gland cells. Cells were cultured with 0 (control), 10, 20, or 30 µM of ISO under incubation conditions. After a 48 h incubation, these ISO-incubated cells proliferated more (p < 0.05) than the control cells. Cyclin E expression was higher (p < 0.05) in the 10 µM ISO and 20 µM ISO treatment groups than in the control group. Cyclin D1 and p21 expressions decreased (p < 0.05) with the 10 µM ISO treatment for 48 h. The relative mRNA abundances of the cells' IG-1R (Insulin-like growth factor-1R), EGFR (Epidermal growth factor receptor), STAT3 (Signal transducer and activator of transcription 3) and AKT (protein kinase B) were enhanced (p < 0.05) by the 20 µM ISO treatment for 24 h and 48 h in the medium. The relative mRNA abundances of κ-casein at 48 h of incubation and ß-casein at 24 h and 48 h of incubation were increased (p < 0.05) by 10 µM of ISO supplementation. It was concluded that ISO improved the proliferation of sow mammary gland cells, possibly by regulating cyclins and function genes expression in the cell proliferation signaling pathway.

Colostrum ingredients, its nutritional and health benefits - an overview

This review focused on compiling, summarizing, updating the information available on the colostrum and its health benefits. Colostrum is the first milk secreted by the mammary gland of female mammals immediately after birth during the first few days, and its composition differs from the mature milk. It ensures immune support for newborns in the early stages of life. It is a divine immune gift from the Creator. Mammalian colostrum contains unique components rich in nutritional macronutrients (proteins, fat, carbohydrates) and micronutrients (vitamins, minerals, antioxidants) and many bioactive substances like antimicrobial factors (Igs, LF, LP, LZ, cytokines) and growth factors (EGF, TGFalpha and beta, IGF-1 and 2, FGF, PDGF, GH), which are necessary to stimulate the immune systems that newborns need for health and survival life. Physicochemical composition changes dramatically in the first few days that distinguish it from mature milk. This reverses an essential difference in their biological function as fractional sources or for health-promotion. So it is considered one of the best natural food supplements consumed within various life stages. Colostrum is used to treat cancer, AIDS, polio, heart disease, and rheumatoid arthritis. Hyper-immune colostrum or milk collected from cows immunized by SARS-CoV-2, it can grant protection short-term from infection in humans and can be used as an alternative way to produce specific antibodies against CoVID-19 until effective excess vaccines against new mutations can be available. Likewise, colostrum and its components contribute as a non-drug alternative to the clinical management of CoVID-19. Also, lactoferrin and its supplements are effective in preventing and treating people with coronavirus infection. Therefore, due to these previous multiple functions, colostrum is considered as a natural food, called miracle immune milk, and used as a medicine.Copyright © 2022 The Author

Host Factors Affecting Generation of Immunity Against Porcine Epidemic Diarrhea Virus in Pregnant and Lactating Swine and Passive Protection of Neonates.

Porcine epidemic diarrhea virus (PEDV) is a highly virulent re-emerging enteric coronavirus that causes acute diarrhea, dehydration, and up to 100% mortality in neonatal suckling piglets. Despite this, a safe and effective PEDV vaccine against highly virulent strains is unavailable, making PEDV prevention and control challenging. Lactogenic immunity induced via the gut-mammary gland-secretory IgA (sIgA) axis, remains the most promising and effective way to protect suckling piglets from PEDV. Therefore, a successful PEDV vaccine must induce protective maternal IgA antibodies that passively transfer into colostrum and milk. Identifying variables that influence lymphocyte migration and IgA secretion during gestation and lactation is imperative for designing maternal immunization strategies that generate the highest amount of lactogenic immune protection against PEDV in suckling piglets. Because pregnancy-associated immune alterations influence viral pathogenesis and adaptive immune responses in many different species, a better understanding of host immune responses to PEDV in pregnant swine may translate into improved maternal immunization strategies against enteric pathogens for multiple species. In this review, we discuss the role of host factors during pregnancy on antiviral immunity and their implications for generating protective lactogenic immunity in suckling neonates.

Thirteenth Annual ENBDC Workshop: Methods in Mammary Gland Biology and Breast Cancer.

The thirteenth annual workshop of the European Network for Breast Development and Cancer (ENBDC) Laboratories Annual Workshop took place on the 28-30 April 2022 in Weggis, Switzerland and focused on methods in mammary gland biology and breast cancer. Sixty scientists participated in the ENBDC annual workshop which had not been held in person since 2019 due to the global COVID-19 pandemic. Topics spanned the mammary gland biology field, ranging from lactation biology and embryonic development, single cell sequencing of the human breast, and stunning cutting-edge imaging of the mouse mammary gland and human breast as well as breast cancer research topics including invasive progression of the pre-invasive DCIS stage, metabolic determinants of endocrine therapy resistance, models for lobular breast cancer, and how mutational landscapes of normal breast during age and pregnancy determine cancer risk. The latest findings from participating researchers were presented through oral presentations and poster sessions and included plenty of unpublished work.

Social isolation promotes mammary cancer recurrence, increases IL6/JAK/STAT3 signaling and causes mitochondrial dysfunction in tamoxifen treated rats, and a traditional herbal mixture reverses all these changes

Social isolation is associated with increased risk and mortality from many diseases, such as breast cancer. Socially isolated breast cancer survivors have a 43% higher risk of recurrence and a 64% higher risk of breast cancer-specific mortality than socially integrated survivors. Since Covid-19 has dramatically increased the incidence of social isolation, it is important to determine if social isolation affects the response to endocrine therapy and/or recurrence after the therapy is completed. Since previous studies indicate that social isolation increases circulating inflammatory cytokines, we investigated if an anti-inflammatory herbal mixture Jaeumkanghwa-tang (JGT) prevents the adverse effects of social isolation on breast cancer mortality. Estrogen receptor positive mammary tumors were initiated with 7,12-dimethylbenz[a]anthracene. When a rat developed a palpable mammary tumor, it was either socially isolated (SI) by housing it singly or a rat was allowed to remain group-housed (GH). Tamoxifen (340ppm via diet) or tamoxifen + JGT (500ppm via drinking water) started when the first mammary tumor reached a size of 11 mm in diameter. Tamoxifen administration ended when a complete response to this therapy had lasted for 9 weeks (corresponds to 5 years in women). During tamoxifen therapy, social isolation non-significantly reduced the rate of complete responses to 21%, from 31% in GH group (p>0.05). After the therapy was completed, SI significantly increased local mammary tumor recurrence (p<0.001;45% GH vs 75% SI). RNAseq analysis was performed in the mammary glands. Gene set enrichment analysis (GSEA) of transcriptome showed that the increased recurrence risk in socially isolated rats was associated with an enrichment of IL6/JAK/STAT3 signaling: this result was confirmed in the tumors. In addition, oxidative phosphorylation (OXPHOS) pathway was suppressed: the suppressed genes included those involved in mitochondrial pyruvate transport and conversion of pyruvate to acetyl CoA as well as genes in the TCA cycle and mediating electron transport in mitochondrial complexes I-IV. Social isolation also increased the expression of inflammatory receptor for advanced glycation end-products (RAGE) (p≤0.05). Consumption of an anti-inflammatory JGT inhibited IL6/JAK/STAT3 signaling, upregulated OXPHOS signaling and prevented the increased risk of mammary cancer recurrence in socially isolated animals. The percentage of recurrences in the SI rats dropped from 75% without JGT to 22% with JGT (p<0.001). Breast cancer mortality among socially isolated survivors may be most effectively prevented by focusing on the period following endocrine therapy using tools that inhibit IL6/JAK/STAT3 inflammatory cytokine signaling and correct disrupted OXPHOS and mitochondrial dysfunction.

The Endocrine Adipose Organ: A System Playing a Central Role in COVID-19.

In the last 30 years the adipose cell has been object of several studies, turning its reputation from an inert cell into the main character involved in the pathophysiology of multiple diseases, including the ongoing COVID-19 pandemic, which has changed the clinical scenario of the last two years. Composed by two types of tissue (white and brown), with opposite roles, the adipose organ is now classified as a real endocrine organ whose dysfunction is involved in different diseases, mainly obesity and type 2 diabetes. In this mini-review we aim to retrace the adipose organ history from physiology to physiopathology, to provide therapeutic perspectives for the prevention and treatment of its two main related diseases (obesity and type 2 diabetes) and to summarize the most recent discoveries linking adipose tissue to COVID-19.

Scars of a long battle - A rare case of post covid vanishing lung

Introduction: Vanishing lung syndrome , a primary bullous disease of the lung is defined as a large bulla occupying at least one third of a hemithorax. Usually it associated with riskfactors of smoking, marijuana abuse, alpha 1 antitrypsin deficiency. Here we present a rare case of vanishing lung syndrome developed in a post covid patient without any comorbidities making it a rare presentation. History: A 35year,male with no significant cigaratte smoking presented with acute onset dyspnoea along with dry cough and right sided chest pain for 1 week duration .no history of any recent trauma Past history of COVID 19 one month back, he was hospitilized was put on NIV and HFNC and was discharged on domicillary oxygen and other medications. Clinical Findings: On examination there was hyperresont note in right side along with diminished air entry in all areas in right side along with left side mammary, infraaxillary, infrascapular areas. Diagnosis and Management: Diagnosis was made with the help of contrast enchanced computed tomography aided by other serological and microbilogical workup. Patient was managed conservatively antibiotics ,analgesics and other supportive measures. Learning Points: We are well aware of lung fibrosis post covid , our intention was to throw light into the new entity of bullous lung disease Bullous lung disease (with or without pneumothorax) should be part of differential diagnosis in a patient returning with chest pain and dyspnoea after SARS-Cov-2 infection.CT imaging essential to differentiate radiographically presumed complex pneumothoraces from large bullae to prevent erroneous chest drain insertion into a bulla.

Impact of COVID-19 on the relapse and reawakening of dormant tumor cells in breast cancer

Worldwide, the study shows that breast cancer is one of the major cancer responsible for women death. All the effective therapies - immune-modulator therapy, chemo-radiation and cell targeted therapies can worsen the body immune system which majorly affects the lungs and these women with weak immune system and bronchi problems are more susceptible to major complications if they are exposed to COVID-19. In start of pandemic, it was difficult for healthcare system to manage the surgeries, scans and therapies of cancer patients without let them exposed to SARCoV-2, leads to delay in their treatment which can even more worsen condition for the patient. SARCoV-2 triggers the IL-6 release by the formation of neutrophil extracellular trap which can increase the complications in the breast cancer patient as well as it can also reactivate the relapsed dormant breast cancer cells. So, after seeing the condition of patients doctors decided that they can treat the patients by taking all measuring safety precautions during the admission to the hospital and found Anti-IL-6 receptor (tocilizumab) neutrophils inhibitor (alvestat) and JAK1/JAK2 inhibitors (baricitinib) effective and vaccines are also available in international market considering them safe and efficient for patient with breast cancer history or maybe undergoing in treatment.

Risk factor modeled microenvironment effects lymphatics activity and IBC invasiveness and progression

Background. Lymphovascular invasion (LVI) and breast tumor emboli within dermal and breast lymphatic vessels are prognostic for metastatic spread and poor outcomes, and are abundant in Inflammatory breast cancer (IBC). IBC is an aggressive breast cancer that presents suddenly with breast swelling and redness due to tumor emboli in lymphatics. Lack of breast-feeding and obesity are IBC risk factors. We sought to demonstrate the combinatorial effects of a high-fat diet and nursing on lymphatic function and compare these to IBC tumor induced changes in lymphatic function. We hypothesize that risk factors for aggressive breast cancer may alter lymphatic function in the normal gland prior to tumor initiation. Methods. Following two rounds of pregnancy in 20 multiparous SCID Beige immunocompromised mice, half of the mice were force weaned while half nursed pups. Prior to forced weaning, half of each of these groups were fed a high fat diet (HFD: 60 Kcal %, N = 10) while the other half received a low-fat diet (LFD: 10 Kcal %, N = 10). Consecutive dynamic near-infrared fluorescence (NIRF) lymphatic imaging was performed at 6-7 months (covid interruption) and 14 months after initiating the diet by injecting a near-IR fluorophore into the mammary fatpad and recording lymphatic pulsing over 8 minutes using V++. Matlab and ImageJ were used to quantify pulsing rates on the ventral lymphatics in each animal. Fatpads were Ssubsequently inoculated with SUM149 IBC cells and imaging was repeated 16 months post diet initiation. Lymphatic imaging over time by HFD vs LFD was further studied in nulliparous animals. Tissues were collected for further analyses. ResultsData analysis prior to tumor injection, demonstrated lymphatic pulsing (pulses/4 minutes) increased over time in HFD force weaned (HFFW) and HFD nursing (HFN) animals only (65.5 vs 72.6, P=0.059;60.1 vs 76.6, P=0.0099, respectively). Comparing HFFW and HFN to matched LFD groups (LFFW and LFN), at 14 weeks HFD was associated with increased pumping after forced weaning (62.3 vs. 72.6, P=0.074), and nursing (62.5 vs 76.6, P=0.0023). There was an increase in pulsing after tumor initiation (16 months after initiation of diet) in all groups (80.1, 84.1, 83.2, 82.4, P > 0.05 all comparisons to initial timepoint). In a separate experiment examining HFD (N=5) vs LFD (N=5) in nulliparous mice, lymphatic contractile activity increased in all animals over. time, average ventral lymphatic contractile frequency for LFD and HFD at week 8, 11 and 14 weeks after diet initiation were 5, 8.64, 15.9 pumps/4 mins vs 11.8, 18.5, 28.2 pumps/4 mins, (P = 0.01, 0.05, and 0.0005 respectively). ConclusionsHFD increased lymphatic pulsing rate over time to a significantly greater extent than LFD continuing over 14 months independent of reproductive and nursing status. Tumor initiation prompted further increased pulsing rates beyond that observed after HFD across all groups. The magnitude of the effect of HFD on lymphatic pulsing approached the rate after tumor initiation, while reproductive variables did not impact lymphatic pulsing. Further studies are warranted to demonstrate the relationship if any between lymphatic pumping pre-initiation and LVI after tumor initiation and examine the role of intervention on reducing LVI.

64th Annual Meeting of the Pathology Section of the German Veterinary Medical Association

These proceedings contain 25 papers from the 64th Annual Meeting of the Pathology Section of the German Veterinary Medical Association. Topics include tumour infiltrating lymphocytes in mammary carcinomas in domestic rabbits;what decides good or bad? - global gene expression analysis of the adenoma of the hepatoid perianal glands and adenocarcinoma the canine apocrine anal sac glands;the canine cutaneous histiocytoma - boring or perspective in immuno-oncology?;impact of antibiotic pretreatment on ventilator-induced lung injury: contradiction between histology and transcriptome analysis?;characterization of murine satellite glial cells of the dorsal root ganglia - a unique cell population with potential regenerative capacities;impact of antibiotic pretreatment on ventilator-induced lung injury: contradiction between histology and transcriptome analysis?;primary diffuse leptomeningeals oligodendrogliomatosis in a cat;pathomorphological studies of fibroadnexal dysplasia in dogs;pyogranulomatous inflammation in multiple Organs of a dog with evidence of Corynebacterium tuberculostearicum;ovary tumors in cats - overview of the examination material from 2009-2020 and case report of a recurrent dysgerminoma;atherosclerosis in the dog;spinal neuroenteric cyst in one Saint Bernard;MENX - an endogenous model for pseudohypoxic pheochromocytomas;molecular Level Evolution II: similarities of CLCA2 in sauropsids and mammals;in vivo detection of double-stranded Ribonucleic acid (RNA) as an early detection marker unclear viral infections using the example of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in experimental infected hamsters;the role of different mast cell subtypes in the context of intestinal carcinogenesis - a species-comparative approach;an underestimated treasure in paraffin - establishment of a global transcriptome analysis canine tumors from FFPE material based on QuantSeq 3' technology;well researched? - an approximation of the role of CLCA1 in joints through usage molecular databases;integration of digitized historical and cytopathology into an open source DICOM database and viewer system;3R 3D: skin model for the study of viral infections;CARD9 signaling promotes hippocampal neurogenesis and cytokine balance in a mouse model of virus-induced encephalitis;neuropathological changes after intranasal infection with Rift Valley fever virus - a murine model for human encephalitis;a T-cell a day keeps Theiler away - the influence non-reactive T-cells on the course of a Theiler virus infection in mice with C57BL/6 background;digitization in pathology - new opportunities and their obstacles;and specific features of satellite glial cells of dog and pig.

Implementation of breast cancer and cervical cancer screening programmes in Poland during the first period of restrictions introduced due to COVID -19 pandemic

Introduction and objective: Prophylactic examinations allow the reduction in morbidity from breast cancer and cervical cancer. The aim of the study was to estimate the impact of COVID-19 pandemic and the first months of restrictions in public life, introduced due to the risk of its outbreak, on the provision of services within cancer prevention programmes in Poland. Material and methods: The analysis was performed based on information concerning the number of mammography and cytology tests carried out as part of the breast cancer screening programme and cervical cancer screening programme. The study was conducted during January - May in 2020, and the same period in 2019 - as a basis for comparison. The data relate to three (out of sixteen) Polish Provinces: Katowice, Warsaw and Olsztyn.

COVID 19 Vaccine and Cancer: A Prospective Study of 186 Cases

Introduction: Vaccination against SARS-CoV-2 is currently recommended. Cancer patients are considered a priority. In Tunisia, these patients were included on the vaccination platform as priorities. The only contraindication to this vaccine is neutropenia. Objectives: The objective of this work was to study the acceptability and adherence of the COVID 19 vaccine in cancer patients. Methods: This is a prospective study including cancer patients undergoing chemotherapy. The study was carried out at the medical department of oncology at Habib Bourguiba hospital in Sfax between March 2021 and June 2021. Results: 186 patients were included including 38 men and 148 women. The average age was 52 years old [24-72 years old]. The site of the tumor was mammary in 61.3% of cases, recto-colic in 11.3%, and at the cavum in 3.8%. The tumor was localized in 52.7% and metastatic in 47.3% of cases. The chemotherapy was neoadjuvant in 9.1% of cases, adjuvant in 44.1% of cases and palliative in 46.2%. Administration of targeted therapies was observed in 25.3% of patients. Ten patients (5.3%) have a COVID infection during their treatment. Ninety-nine patients (53.2%) accepted the vaccine. Sixty-nine patients (37.1%) refused and eighteen patients (9.7%) were hesitant. Thirty patients (16.1%) were enrolled at the vaccine registration site. Twenty patients (10.7%) had the SARS-CoV-2 vaccine. The tolerance of the vaccination was good. Conclusion: It is important to vaccinate all cancer patients under chemotherapy given the severity of the COVID-19 infection and this after checking the blood count. In our series, 53.2% of patients agreed to have the COVID19 vaccine. This rate was higher than that described in the literature which is 37.4%. This can be explained by the awareness of patients through the vaccination brochures.

CoViD-19 and complications: pectoral hematoma, a rare condition

Background: Patients with CoViD-19 pneumonia have hyperactive coagulation status and one of the main causes of death is pulmonary embolism. They also suffer from hypoxia, so they need respiratory support and prone positioning. Description of the case: A 59-year old woman (weight 100 Kg, BMI 32) came to our hospital reporting fever and dyspnea. Chest X-ray: extensive parenchymal thickenings in the subpleural regions of both lungs. Analysis: hemoglobin 14.7 g/dl, creatinine 1.18 mg/dl, D-Dimer >10000 ng/dl, pO2/FiO2 124. Treatment: antibiotics, hydroxychloroquine, tocilizumab, high flow oxygen alternating with NIV, dexamethasone, enoxaparin 8000 U bid and alternating supine and prone position. Eighteen days after admission we noticed a swelling in her breast. A thoracic CT scan showed a leveled hematoma (16x10cm) below the left pectoralis major muscle, an arterial spread from the lateral thoracic artery, a thromboembolic image in a subsegmentary branch of the pulmonary artery and extended bilateral ground glass. The patient underwent blood transfusions for acute anemia (hemoglobin 6.9 g/dl) and multiple arterial embolizations. Conclusions:We hypothesized that the pro-inflammatory endovascular condition, in a severe CoViD-19, and the anticoagulant treatment have determined fragility of the vascular wall. In addition, the continuous changes of posture have probably led to a repeated traumatism and rupture of blood vessels. Therefore in obese women, whose lateral thoracic artery is large and emits mammary branches, pronosupination should be personalized taking into account enoxaparin dosage.

Twelfth Annual ENBDC Workshop: Methods in Mammary Gland Biology and Breast Cancer.

The twelfth annual workshop of the European Network for Breast Development and Cancer focused on methods in mammary gland biology and breast cancer, was scheduled to take place on March 26-28, 2020, in Weggis, Switzerland. Due to the COVID-19 pandemic, the meeting was rescheduled twice and eventually happened as a virtual meeting on April 22 and 23, 2021. The main topics of the meeting were branching and development of the mammary gland, tumor microenvironment, circulating tumor cells, tumor dormancy and breast cancer metastasis. Novel and unpublished findings related to these topics were presented, with a particular focus on the methods used to obtain them. Virtual poster sessions were a success, with many constructive and fruitful interactions between researchers and covered many areas of mammary gland biology and breast cancer.