Cancer Stem Cells and Circulatory Tumor Cells Promote Breast Cancer Metastasis

Breast cancer (BC) is a highly metastatic, pathological cancer that significantly affects women worldwide. The mortality rate of BC is related to its heterogeneity, aggressive phenotype, and metastasis. Recent studies have highlighted that the tumor microenvironment (TME) is critical for the interplay between metastasis mediators in BC. BC stem cells, tumor-derived exosomes, circulatory tumor cells (CTCs), and signaling pathways dynamically remodel the TME and promote metastasis. This review examines the cellular and molecular mechanisms governing the epithelial to mesenchymal transition (EMT) that facilitate metastasis. This review also discusses the role of cancer stem cells (CSCs), tumor-derived exosomes, and CTs in promoting BC metastasis. Furthermore, the review emphasizes major signaling pathways that mediate metastasis in BC. Finally, the interplay among CSCs, exosomes, and CTCs in mediating metastasis have been highlighted. Therefore, understanding the molecular cues that mediate the association of CSCs, exosomes, and CTCs in TME helps to optimize systemic therapy to target metastatic BC.     

Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study

BackgroundThe fulfilment of birth expectations is important to women and strongly related to birth satisfaction.ObjectiveThe aim of this study was to investigate women’s expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled.MethodsA longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences.ResultsThe majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women’s expectations and experiences. Most likely to be fulfilled were women’s expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled.ConclusionsPregnant women’s expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.     

Assessment of collateral hand circulation by modified Allen’s test in normal Indian subjects

BackgroundAllen’s test (AT) and Modified Allen’s Test (MAT) are used as screening methods for assessment of the hand circulation. Few people lack the dual blood supply of hand and are at risk of hand ischemia after any intervention on radial artery. The Purpose of the study was to assess the collateral circulation of hand using MAT in normal Indian subjects and in elderly population to know the prevalence of positivity of Allen’s test.Methods900 participants (1800 hands) were divided in two groups. Group I had participants with age <50 years and group II had participants with age ≥50 years. MAT was performed in all participants and results were compared between the two groups.ResultsIn group I (n = 450, 900 hands), 313 were males and 137 were females, with mean age of 35.04 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 77.8%, 16.6%, 3.7% and 1.6%, respectively. In group II (n = 450, 900 hands), 248 were males and 202 were females, with mean age of 60.4 years. The relative percentages of a normal, equivocal, borderline and abnormal MAT were 69.0%, 18.6%, 6.60% and 5.66%, respectively. A positive/abnormal test was significantly more common (5.66% Vs 1.66%, P < 0.00001) in older group.ConclusionMAT is simple, time tested and non invasive test to assess collateral circulation of the hand. A negative MAT safely selects patients for radial artery harvest; however, if the test is positive and in older patients then a second objective test may be needed.