Young women with germline
mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients ...with
mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline
mutations.
This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline
mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors.
Of 1,252 patients with germline
mutations (
, 811 patients;
, 430 patients;
, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio HR, 0.87; 95% CI, 0.61 to 1.23;
= .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56;
= .66) were observed between the pregnancy and nonpregnancy cohorts.
Pregnancy after breast cancer in patients with germline
mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with
-mutated breast cancer interested in future fertility.
Objectives This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest ...perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). Background MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. Methods 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤0.80 in vessels >2mm. Results On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. Conclusions MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.
To quantify the vitreous traction created by pneumatic (20-, 23-, and 25-gauge) and electric cutters (20- and 25-gauge) during vitrectomy.
Experimental study.
This is a preclinical study, and no ...patients were involved.
Five separate cutters for each drive mechanism and gauge (20-, 23-, and 25-gauge pneumatic and 20- and 25-gauge electric) were used for each cut speed at predetermined aspiration rates. The retinal layers of fresh porcine eyes were transfixed with a 0.15-mm steel wire and fixed to the load cell of a strain gauge. The cutter to be assessed was introduced into the eye by a micromanipulator at a 45-degree angle adjacent to the retina. The traction force was determined and evaluated at a distance of 3 and 5 mm from the retina with different vacuum and cut rates.
Vacuum, cut speed, force (dynes), distance (millimeters), vitreoretinal traction, and gauge.
The 20-, 23-, and 25-gauge pneumatic cutters have a range of traction from 2.06 to 37.22 dynes, 3.85 to 15.38 dynes, 5.13 to 27.91 dynes, respectively. The 20- and 25-gauge electric cutters have a range of traction from 3.60 to 41.78 dynes and 5.28 to 27.91 dynes, respectively. All results are related to distance, cut, and aspiration rate. With an increase of 100 mmHg of vacuum/aspiration, the traction increased from 7.89 to 3.14 dynes (e.g., 4.96 for 20-gauge pneumatic). The traction decreased as the cut rate was increased, from 5.71 to 2.51 dynes (e.g., 3.41 for 20-gauge pneumatic).
The results indicate that retinal traction increased with increasing aspiration vacuum and proximity to the retina; conversely, retinal traction decreased with increasing cut rate. The present study demonstrates that the effects of aspiration, distance from the retina, and cut rate are crucial factors in the amount of retinal traction created by vitreous cutters.
Proprietary or commercial disclosure may be found after the references.
Summary The objective of the study was to investigate the role of endothelin-1 in the pathogenesis of scleroderma renal crisis in patients with systemic sclerosis. We used immunohistochemical ...analysis with anti–endothelin-1 and anti–von Willebrand factor antibodies in comparing kidney biopsies from patients with systemic sclerosis and scleroderma renal crisis (n = 14); from normal kidneys (n = 5); and from patients with typical hemolytic uremic syndrome and thrombotic microangiopathy (n = 5), antiphospholipid syndrome (n = 6), diabetic nephropathy (n = 5), minimal change disease with cyclosporine toxicity (n = 5), or nephroangiosclerosis (n = 5). Kidney biopsies from all systemic sclerosis patients presented specific lesions: glomerular lesions with thickened capillary walls (n = 6, 42.8%), mesangiolysis (n = 3, 21.4%), fibrin thrombi (n = 3, 21.4%), hypertrophy of juxtaglomerular apparatus (n = 5, 35.7%), arteriolar lesions showing mucinous intimal thickening and lumen mucoid occlusions (n = 13, 92.8%), proliferation of intimal cells (ie, “onion-skin” lesions; n = 13, 92.8%), fibrinoid necrosis (n = 3, 21.4%), and fibrin thrombosis (n = 4, 28.6%). Chronic lesions in large arteries showed modifications such as fibrous intimal thickening (n = 13, 92.8%). The pattern of endothelial staining for endothelin-1 in both glomeruli and arteriolar lesions appears to be specific for scleroderma renal crisis. Glomerular endothelin-1 staining without arteriolar staining was seen in hemolytic uremic syndrome; and isolated arteriolar staining (without glomerular staining) was seen in a number of conditions including antiphospholipid nephropathy, cyclosporine toxicity, and diabetic nephropathy. Endothelin-1 is overexpressed in glomeruli and arterioles of patients with scleroderma renal crisis, which suggests that endothelin-1 might be a therapeutic target in this condition.
Abstract Objective The addition of androgen deprivation therapy (ADT) to conventional radiation therapy improves overall survival (OS) in intermediate- and high-risk prostate cancer. The benefit of ...ADT to added to dose-escalated radiotherapy is less clear. The aim of this study was to report disease control outcomes and to identify prognostic variables associated with favorable outcomes in patients with intermediate- and high-risk prostate cancer treated with dose-escalated radiation therapy without ADT. Methods and materials From September 2001 to March 2010, 127 patients with intermediate- or high-risk prostate cancer were treated with dose-escalated radiation otherapy without ADT. Biochemical recurrence-free survival (bRFS), distant metastases-free survival (DMFS), prostate cancer–specific mortality, and OS were assessed. Univariate and multivariate analyses using Cox regression modeling were performed. Results The median follow-up was 6.5 years, and the 5-year estimated bRFS, DMFS, prostate cancer–specific mortality, and OS for all patients was 89%, 96.1%, 98.4%, and 96.9% respectively. On multivariate analysis, factors that predict bRFS include risk group and PSA nadir, and factors that predict DMFS include perineural invasion, risk group, and PSA nadir. Conclusions Patients with favorable intermediate-risk cancer could likely be treated with dose-escalated radiation therapy without ADT. Patients with high-risk and unfavorable intermediate-risk cancer, perineural invasion, and PSA nadir ≥1ng/dL had worse outcomes and likely need distinct therapeutic approaches.
Linear Immunoglobulin A Bullous Dermatosis Gouveia, Ana Isabel, MD; Teixeira, Ana, MD; Freitas, João Pedro, MD ...
The Journal of pediatrics,
03/2016, Volume:
170
Journal Article
Sexuality is a multifaceted and makes up part of the lives of all individuals.
To evaluate the teaching of sexual health to students in the basic cycle of an undergraduate course in medicine.
A ...descriptive, cross-sectional study was conducted using primary data on the teaching of sexual health in the first 4 years of the course. The students were contacted personally and given a self-administrated questionnaire on the teaching of sexual health. The questionnaire was based on studies conducted with physicians and medical students regarding their educational background in sexual health. The degree of satisfaction regarding the learning process was determined using a ten-point scale; on which, a score of 1 to 5 indicated dissatisfaction and of 6 to 10 satisfaction.
The main outcome measure was a self-administered questionnaire addressing the teaching of sexual health in the first 4 years and how this knowledge affected relationships with patients.
A total of 216 students answered the questionnaire. Only 27.27% and 22% of the students in the first and second years, respectively, reported having classes related to sexual medicine, whereas 38.1% (third year) and 54.40% (fourth year) had such classes. Regarding satisfaction, the weighted mean was 4.55 and the modes were 5 and 6. In the evaluation of their expectations about learning sexual health, 46 (67.6%) reported feeling non-confident, 18 (26.5%) did not answer the question, and 4 (5.9%) reported feeling confident.
This study revealed a gradual progression in the offer of content related to sexual medicine to students throughout the medicine course, with weighted means of 2.6 (first year), 2.82 (second year), 3.58 (third year), and 4.55 (fourth year). However, the findings indicate that the teaching of this subject remains deficient and students feel unsatisfied and unprepared for their future practice of medicine.
Teixeira Santos AU, Fava Spessoto LC, Fácio FN. Sexual Health Teaching in Basic Science Courses Among Medical Students. Sex Med 2021;9:100309.
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