Consumer experiences of shame in clinical encounters for breast cancer treatment. "Who do you think you are- Angelina Jolie?"

BACKGROUND: Shame is a powerful negative emotion that has the potential to affect health. Due to the intimate nature of breast cancer treatment and its impact on body image, it is hypothesised that shame may be experienced during treatment. The aim of this study was to explore shame experiences related to clinical encounters for breast cancer treatment. METHODS: People with a lived experience of breast cancer were invited to anonymously share their stories of shame through an online survey. Using qualitative methodology, the stories were examined, and themes identified. PARTICIPANTS: Participants were members of the consumer organisation Breast Cancer Network Australia. RESULTS: Stories were contributed by 38 participants. Most (n = 28, 73.7 %) were >5 years post-diagnosis. Shame was experienced in a range of clinical settings (consulting rooms, wards, operating theatres, radiotherapy departments). They involved a different health professionals (oncologists, surgeons, nurses, radiation therapists, psychologists.) Five themes were identified: (1) Body shame (sub-themes: Naked/vulnerable and Weight), (2) Communication (subthemes: Lack of compassion/impersonal manner and Not listening), (3) Being blamed (subthemes: diagnosis and complications), (4) Feeling unworthy (subthemes: Burden to staff and Unworthy of care), (5) Judgement for treatment choices. CONCLUSIONS: Shame can be experienced in a range of situations, from scrutiny of the naked body to comments from health professionals. The impact of these experiences is profound, and the feelings of shame are carried for many years. These findings can inform strategies to support consumers and educate health professionals with the aim of reducing harm related to cancer treatment.

Hydrogen bonding of the dissociated histidine ligand is not required for formation of a proximal NO adduct in cytochrome c'.

Cytochromes c', that occur in methanotrophic, denitrifying and photosynthetic bacteria, form unusual proximal penta-coordinate NO complexes via a hexa-coordinate distal NO intermediate. Their NO binding properties are similar to those of the eukaryotic NO sensor, soluble guanylate cyclase, for which they provide a valuable structural model. Previous studies suggested that hydrogen bonding between the displaced proximal histidine (His120) ligand (following its dissociation from heme due to trans effects from the distally bound NO) and a conserved aspartate residue (Asp121) could play a key role in allowing proximal NO binding to occur. We have characterized three variants of Alcaligenes xylosoxidans cytochrome c' (AXCP) where Asp121 has been replaced by Ala, Ile and Gln, respectively. In all variants, hydrogen bonding between residue 121 and His120 is abolished yet 5-coordinate proximal NO species are still formed. Our data therefore demonstrate that the His120-Asp121 bond is not essential for proximal NO binding although it likely provides an energy minimum for the displaced His ligand. All variants have altered proximal pocket structure relative to native AXCP.

Can raisins ameliorate the hypercholesterolaemia-induced cardiac affection?

Raisins were investigated for their protective role on cardiac muscle both biochemically and histopathologically in high cholesterol diet (HCD)-fed rats. Wister male rats were randomly divided into four groups (n = 10): control, raisin-fed, HCD-fed and HCD-raisin fed group. Animals were anaesthetized after 13 weeks. Hearts were dissected and processed for histopathological examination. Raisins administration with HCD significantly decreased the animals' blood glucose, insulin, cholesterol, triglycerides, and low density lipoprotein levels; while increased their high density lipoprotein levels compared with rats fed HCD alone. They also decreased cardiomyocytes' degeneration, cellular infiltration, haemorrhages and blood vessels affection. Raisins reduced fibrosis by decreasing the immuno-expression of alpha smooth muscle actin marker, whereas they significantly increased the immuno-expression of endothelial nitric oxide synthase. Raisins showed a cardioprotective effect and were able to alleviate the biochemical and the histopathological changes induced by the HCD. Consumption of raisins or their pharmaceutical product should be recommended specially for those eating a high-fat diet.

Anatomical variations of the hand extensors.

This study was performed to investigate the anatomy and variations of the human extensor tendons of the fingers and their intertendinous connections. Ninetyfive upper limbs of adult cadavers were dissected. The variations in the extensor tendons of the fingers, both proximal and distal to the extensor retinaculum, and their mode of insertion were observed. Also, the intertendinous connections were explored and the obtained data were analysed. The extensor pollicis longus and brevis tendons were found to be single, doubled or, rarely, absent. Their insertion could be traced to either the proximal phalanx, or through the extensor expansion to both phalanges, or rarely to the distal phalanx of thumb. The extensor indicis had a single tendon in all specimens. In the majority of specimens, extensor digitorum had no independent slip to the little finger; it gave off a single tendon to the index, double tendons to the middle finger and triple tendons to the ring finger. Extensor digiti minimi muscle often had double or triple tendons distal to the extensor retinaculum. Three types of juncturae tendinum (JT) were identified between the tendons of extensor digitorum in the 2nd, 3rd and 4th intermetacarpal spaces (IMS) of hands. Types 1 and 2 JT were seen in the three IMS. Type 3 JT was the most frequently identified of all juncturae and was always absent in the 2nd IMS. The percentages of the present data were compared with other researchers'data.

Variations of the abductor pollicis longus tendon: an anatomic study.

This study was performed to investigate the variations, dimensions and attachment of the abductor pollicis longus (APL) tendon. Fifty upper limbs of adult cadavers were dissected in the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Variations of APL tendon and its way of insertion were observed;its length, width and thickness were also measured and statistically analysed. No single-tendon-APL was found in all the examined upper limbs. The APL exhibited 2-6 tendons in all the cases. Tendons of APL were classified into medial and lateral. The lateral was considered as the main APL tendon, which was inserted into the base of the first metacarpal bone. The medial tendons were regarded as accessory slips and were inserted most commonly into the base of the first metacarpalbone; 80% on its anterolateral surface vs. 20% on the lateral one. The rest of the medial slips extended to trapezium, abductor pollicis brevis, thenar fascia, capsule of first carpometacarpal joint and opponens pollicis, with a frequency of 80%,60%, 40%, 30% and 20%, respectively. Transverse tendinous fibres were noted connecting the various slips of the APL tendons. No significant difference was recorded between the length of the main APL tendon and its accessory tendons, however, a highly significant difference was found between their thicknesses as well as their widths. Thus it is verified that the lateral tendon of APL is the main,whereas the medial tendons are accessory. The observations regarding dimensions and variations of the APL and their accessory tendons may prove useful to surgeons as a source of grafting material.

Designing aligned inorganic nanotubes at the electrode interface: towards highly efficient photovoltaic wires.

Aligned carbon and titanium dioxide nanotubes are designed at the electrode interface to improve the charge separation and transport. The resulting organic photovoltaic wire exhibits high power conversion efficiency. This flexible photovoltaic wire can be easily integrated into a textile by a conventional weaving technique.

Colorectal carcinoma at Al-Gamhouria Teaching Hospital, Aden, Yemen.

OBJECTIVE: Colorectal cancer is the first common cause of cancer in men and the fourth cause after breast, NHL and ovary in women in Aden. This study aims to retrospectively analyze the pattern of patients with colorectal cancer seen in Oncology Unit, at Al-Gamhouria Teaching Hospital from January to December 2008. MATERIAL AND METHODS: All cases of colorectal cancer presented at oncology unit, Al-Gamhouria Teaching Hospital in Aden Yemen between January and December 2008 were reviewed and the data was analyzed to determine age, gender, residency, clinical presentation, histological types and staging of disease and treatment. RESULTS: A total of 50 cases were included in the study, 34 (68%) male and 16 (34%) were female. (M:F 2.1:1). The mean age at presentation was 48.8 years for females and 56.4 for males. Abdominal pain (70%) and bleeding per rectum (50%) were the main presenting complaints. The most common sites are rectum (34%), caecum and ascending colon (30%) and sigmoid in 18% of cases. 82% of tumors of colorectal region were adenocarcinomas, the majority of which (66%) were well to moderately differentiated adenocarcinoma. Stages at presentation were: stage I (12%), stage II (18%), stage III (52%) and stage IV (18%). CONCLUSION: There is an increased incidence of colorectal carcinoma. Bad outcome directly related to late detection of cancer and >70 % of cases in stages III and IV. There is need to increase awareness through public education about this malignancy and its management. Any adult with complaints of vague abdominal pain, blood or mucus in the stool or features of haemorrhoids which may herald the onset of colorectal cancer should be adequately investigated with digital rectal examination (DRE) and proctosigmoidoscopy and barium enema where appropriate.

A novel synthesis of graphene nanoscrolls with tunable dimension at a large scale.

Graphene nanoscrolls which could overcome the chirality dependence of metallic or semiconducting behavior in carbon nanotubes have been recently investigated and proposed for a wide variety of applications. In order to further improve their practical applications, a variety of synthetic approaches have been widely explored but with various limitations. For instance, it remains challenging to produce graphene nanoscrolls with tunable dimensions and high quantity, which greatly hinders their potential applications. Herein, we report a new and general approach to synthesize graphene nanoscrolls with accurately tunable widths and lengths at a large scale. The resulting high-quality graphene nanoscrolls show promising applications in a wide variety of electronic devices.

Late presentation of breast cancer in Aden, Yemen.

UNLABELLED: The aim of this study is to determine the frequency and characteristics of patients who presented with late stage breast cancer at Al-Amal Oncology Unit in Aden. It was conducted retrospectively in Aden, at Al-Amal Oncology Unit of Al-Gamhouria Modern General Hospital, by reviewing all records of breast cancer patients at any stage and attended with histopathologically documented breast cancer from the time of establishment of the unit on December 1, 2007 to December 31, 2009. The total number of documented breast cancer patients was 197 and classified according to the stage at presentation and after the exclusion of 21 patients who were not staged. 118 patients with late inoperable stages were selected and carefully evaluated of their demographic characteristics and was found that they represented 67.0% of the total staged breast cancer patients. Most of these patients are in the reproductive age and residents of Aden governorate and neighboring governorates. Metastasis was mainly evident at the lymph nodes, bones, liver and lungs. The case fatality rate for late stage breast cancer is 8.5 per 100 patients. This study concludes that a high percentage of Yemeni patients in Aden presented with late stage breast cancer which led to the failure of possible curative surgical intervention and resulted to high metastatic disease and fatality rate. KEYWORDS: Late Presentation, Aden, Yemen, Breast Cancer, Stages.

Pattern of head and neck cancer in Yemen.

Head and neck cancer constitutes one of the commonest malignancies in Yemen. There may be a role for the use of Shamma and Zarda and Khat for the increase of HNC in Yemen. This study was conducted retrospectively with an overall aim to describe the pattern of head and neck cancers among Yemeni patients attending the Oncology Department of Al-Gamhouria Teaching Hospital, Aden, for the period from Jan. 2001 to Dec. 2004. The study included 183 patients with head and neck cancers (Lymphoma and thyroid were excluded), 134 were males (73.2%) and 49 were females (26.8%) , with male to female ratio of 2.7:1. The mean age was 51.3 +/- 14.9 years (range: 3 - 82 years). Statistically, there is significant difference between the mean age of male (49.5 +/- 15.1 years) and female (45.4 +/- 16.3 years) patients with head and neck cancers [t= 2.1, p: 0.03]. The common types of head and neck cancers in this study are cancers of the oral cavity (31.7%), followed by pharyngeal (22.9%) and laryngeal (19.1%). In relation to sex, there is a significant statistical relationship between certain head and neck cancers and sex (p: 0.0000). In males, the common cancers are oral cavity cancers (22.7%), laryngeal (22.1%) and pharyngeal cancers (20.8%). The common histopathological type of head and neck cancers in this study is the well differentiated squamous cell carcinoma (70.5%). This study concluded that head and neck cancers are among the common health problems affecting Yemeni patients and recommended further wide national studies to determine the real incidence and the risk factors associated with such cancer.

Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade.

The sciatic nerve (SN) originates from the L4-S3 roots in the form of two nerve trunks: the tibial nerve (TN) and the common peroneal nerve (CPN). The TN and CPN are encompassed by a single epineural sheath and eventually separate (divide) in the popliteal fossa. This division of the SN occurs at a variable level above the knee and may account for frequent failures reported with the popliteal block. We studied the level of division of the SN in the popliteal fossa and its relationship to the common epineural sheath of the SN. The level of division of the SN sheath into TN and CPN above the knee was measured in 30 cadaver specimens. The SN was invariably formed of independent trunks (TN and CPN) encompassed in one common epineural sheath. The SN divided at a distance range of 50 to 180 mm above the popliteal fossa crease. The present findings suggest that the TN and CPN leave the common SN sheath at variable distances from the popliteal crease. This finding and the relationship of the TN and CPN sheaths may have significant implications for popliteal nerve block.

Comparison of bone marrow aspiration and bone marrow biopsy in neoplastic diseases.

Naturally trephine biopsies have definitive advantages over aspirates in case of dry tap bone marrow aspirates as a result of fibrosis or densely packed bone marrow by tumour cells and may be informative independent of cytology especially in bone marrow involvement by lymphomas and carcinomas. In this prospective descriptive study we aimed to compare between the bone marrow trephine biopsy (BMTB) and bone marrow aspirates (BMAs) regarding the detection rate of solid tumours, lymphoma and myeloma involvement of the bone marrow. The study was carried out in the department of pathology and Haematology-Oncology of Al-Gamhouria Teaching Hospital/Aden during the period between Jan 2005 to Dec 2005. A total of 32 patients with suspected or confirmed malignancy undergone both BMTB and BMA from the posterior superior iliac crest and both results were compared. We divided them into three groups: those with solid tumours (21) patients, lymphoma (7) patients and with MM (4) patients. Our results showed that BMA had a 47.6% sensitivity, 100.0% specificity, with positive predictive value (100%), and negative predictive value (50.0%). In solid tumours alone it had a sensitivity of (40.0%), 100% specificity, with positive predictive value (100%), and negative predictive value (64.7%). This gives the BMA a lower sensitivity in detecting solid tumour metastasis and lymphoma involvement in comparison to BMTB. In conclusion, any patient with suspected or confirmed cancer should undergo BMTB because of its high sensitivity compared to BMA.

Selective botulinum toxin injection in the treatment of recurrent deformity following surgical correction of club foot: a preliminary report of 3 children.

Management of a child with club foot deformity that recurs after an apparently successful posteromedial soft tissue release remains a challenge. Revision surgery is often attempted, but this carries a high risk of significant scarring or neurovascular complications. We have treated 3 children (3 feet) with relapsed club foot and fixed deformities, using Botulinum toxin A (BTX-A) injection into muscle groups clinically thought to be responsible for recurrent deformity, followed by moulded plaster casts. Two cases have maintained a good foot position with an minimum follow-up of 18 months, and one other is also doing well having had a tibialis anterior tendon transfer as well as the BTX-A therapy. In our limited experience, targeted BTX-A injection with plaster casting has been safe, and may obviate the need for major revision surgery in a proportion of cases with recurrent club foot deformity following previous posteromedial soft tissue release.

The hypoxia-inducible factor-1 alpha is a negative factor for tumor therapy.

Tumor hypoxia negatively regulates cell growth and causes a more malignant phenotype by increasing the expression of genes encoding angiogenic, metabolic and metastatic factors. Of clinical importance, insufficient tumor oxygenation affects the efficiency of chemotherapy and radiotherapy by poorly understood mechanisms. The hypoxia-inducible factor (HIF)-1 is a master transcriptional activator of oxygen-regulated genes and HIF-1 is constitutively upregulated in several tumor types. HIF-1 might thus be implicated in tumor therapy resistance. We found that transformed mouse embryonic fibroblasts deficient for HIF-1alpha are more susceptible to the treatment with carboplatin, etoposide and ionizing radiation than wild-type cells. Increased cell death in HIF-1alpha-deficient cells was because of apoptosis and did not involve p53 induction. Tumor chemotherapy of experimental fibrosarcoma in immunocompromised mice with carboplatin and etoposide confirmed the enhanced susceptibility of HIF-1alpha-deficient cells. Agents that did not cause DNA double-strand breaks, such as DNA-synthesis inhibitors or a DNA single-strand break-causing agent equally impaired cell growth, independent of the HIF-1alpha genotype. Functional repair of a fragmented reporter gene was decreased in HIF-1alpha-deficient cells. Thus, hypoxia-independent basal HIF-1alpha expression in tumor cells, as known from untransformed embryonic stem cells, is sufficient to induce target gene expression, probably including DNA double-strand break repair enzymes.

Breast cancer in south-east Republic of Yemen.

A retrospective study of breast cancer was carried out using the treatment registry of Aden Health Office and archives of Al-Gamhoria Teaching Hospital from January 1989 to December 1996 and the records of patients registered at Aden Cancer Centre from January 1997 to December 1998. The data analysed included age, sex, residence, breast affected and type of cancer. There were 227 patients with breast cancer registered between January 1989 and December 1998; 225 were female and 2 were male. Most of the patients (81.5%) had infiltrating ductal carcinoma. About 90% of the patients had lymph node involvement. The age groups most affected were 30-39 years and 40-49 years.

Defective Function of Peripheral Blood Monocytes from Patients with Non-Hodgkin's Lymphoma.

The aim of the study was to analyze the function of peripheral blood monocytes from patients with Non-Hodgkin's lymphoma before and after incubation with zymosan and indomethacin. Peripheral blood samples were collected from 28 patients with malignant lymphoma (13 males and 15 females with age range 20-65) years. Their clinical record and pathologic material were reviewed. The control group consisted of 17 normal subjects, (9 men and 8 women) of age range of 20-45 years. The following investigations were carried out in all patients: Bactericidal activity against Escherichia coli. Level of superoxide anion and Chemiluminescence's Technique for analysis of oxygen metabolite Results. The mean bactericidal indices of E. coli by peripheral blood monocytes without indomethacin were 56.75 (SD ± 10.5) in control group at 60 minutes and it was 36.88% (SD ± 11.3) in Non-Hodgkin's lymphoma patients. The level of INT was greater in healthy control than NHL-patients. The improvement after addition of zymosan was significant in all groups. The peak generation of chemiluminescence in Non-Hodgkin lymphoma patients was 11256 x 10-3 CPM at 20 minutes and in healthy controls 16575 x 10-3 CPM at 5 minutes and after incubation with zymosan and indomethacin were 13843 x 10-3 CPM at 5 minutes in NHL patients and 16312 x 10-3 CPM in healthy controls. The time of appearance of CL peak improved in Non-Hodgkin's lymphoma patients (p< 0.01) but there is no difference in the time of CL peak of the healthy controls.

Breast cancer in south-east Republic of Yemen

A retrospective study of breast cancer was carried out using the treatment registry of Aden Health Office and archives of Al-Gamhoria Teaching Hospital from January 1989 to December 1996 and the records of patients registered at Aden Cancer Centre from January 1997 to December 1998. The data analysed included age, sex, residence, breast affected and type of cancer. There were 227 patients with breast cancer registered between January 1989 and December 1998; 225 were female and 2 were male. Most of the patients [81.5%] had infiltrating ductal carcinoma. About 90% of the patients had lymph node involvement. The age groups most affected were 30-39 years and 40-49 years

Available data on cancer in the south eastern governorate of Yemen

We studied the distribution of cancer by sex, age, region of residence and system and organ affected of 685 patients obtained through the Treatment Abroad Register of the Aden Health Office [1989-1983]. The most common malignancies, excluding specific sites for each sex, were gastrointestinal tract [19.4%], lymphoma [16.4%], head and neck [13.2%], bone and soft tissue [12.2%] and thyroid [11.2%]. The most common malignancies among males were gastrointestinal, lymphoma, head and neck, bone and soft tissue and leukaemia; and among females were breast, female genital system, thyroid, gastrointestinal and lymphoma