Surgical-Site Infection is Associated With Increased Risk of Breast Cancer-Related Lymphedema: A Nationwide Cohort Study.

BACKGROUND: Surgical-site infection (SSI) is one of the most common short-term complications following breast cancer treatment and can inhibit lymphatic drainage. It is currently not known whether SSI increases the risk of long-term breast cancer-related lymphedema (BCRL). Thus, the objective of this study was to examine the association between surgical-site infection and the risk of BCRL METHODS: This nationwide study identified all patients treated for unilateral, primary invasive, nonmetastatic breast cancer in Denmark between January 1, 2007, and December 31, 2016 (n = 37,937). A redemption of antibiotics after breast cancer treatment was used as a disease proxy for SSI, included as a time-varying exposure. The risk of BCRL was analyzed up to 3 years after breast cancer treatment using multivariate Cox regression and adjusted for cancer treatment, demographics, comorbidities, and socioeconomic variables. RESULTS: There were 10,368 (27.33%) patients with a SSI and 27,569 (72.67%) without a SSI (incidence rate per 100 patients, 33.10 (95%CI, 32.47-33.75). The BCRL incidence rate per 100 person-years for patients with SSI was 6.72 (95%CI: 6.41-7.05) and 4.86 (95%CI: 4.70-5.02) for patients without an SSI. There was an overall significant increased risk of BCRL in patients with an SSI (adjusted HR, 1.11; 95%CI: 1.04-1.17), with the highest risk 3 years after breast cancer treatment (adjusted HR, 1.28; 95%CI: 1.08-1.51) CONCLUSION: This large nationwide cohort study showed that SSI was associated with an overall 10% increased risk of BCRL. These findings may be used to identify patients at high risk of BCRL that would benefit from enhanced BCRL surveillance.

The effect of circadian rhythm changes on fetal and placental development (experimental study).

OBJECTIVE: To investigate the effect of circadian rhythm changes on fetal-placental development in pregnant rats. MATERIAL AND METHOD: Pregnant rats were randomly allocated to 4 groups with 10 rats in each group. Group 1: 12 hours light 12 hours dark period (n:10, Control Group); Group 2: 6 hours light 6 hours dark period (n:10); Group 3: constant light group (n:10); Group 4: constant dark group (n:10). Rats were made to deliver by cesarean birth at the end of their pregnancy and their placenta, number and weight of the offspring, and placental histopathological changes were examined. FINDING: Fetal number in the constant dark group was found significant in comparison to constant light group (p<0.01). Fetal weight in all groups with altered circadian rhythm was significantly lower than that in the control group (p<0.01). The decrease in fetal weight was more evident in the constant light group than in the constant dark group (p<0.01). Comparison of the histopathological findings of the placenta showed that placental edema, fibrin accumulation and leukocyte infiltration were significantly higher in constant light and constant dark groups than in other groups (p<0.01). CONCLUSION: Circadian rhythm change in pregnancy adversely affects the fetal-placental development. More detailed studies are needed to clarify this mechanism.