Molecular basis of breast cancer

Breast cancer is the most frequent cancer in women and represents the second leading cause of cancer death among women after lung cancer. A common phenotypic abnormality of breast cancer cells is dysregulation of cell cycle control. The transformation of normal cell to a cancer cell appears to depend on mutation in genes that normally control cell cycle progression, thus leading to loss of the regulatory cell growth. We summarize here the molecular regulation of mammary carcinoma with regards to the most prominent oncogenes and tumor suppressor genes and their outcome in terms of cellular prognosis, and tumor development.     

Association between personality and adolescent smoking

The present study examined the association between adolescents' personality traits and smoking, and tested whether this association was moderated by birth order or gender. Participants were 832 Dutch siblings aged 13 to 17 years participating at baseline assessment (T1) and at follow-up 12 months later (T2). Personality was assessed by applying a variable-centered approach including five personality dimensions (Extraversion, Agreeableness, Conscientiousness, Emotional Stability and Openness to Experience), and a person-oriented approach using three personality types (i.e., Resilients, Overcontrollers and Undercontrollers). Cross-sectional findings indicated that Extraversion (at T1 and T2), Agreeableness (at T2), Conscientiousness (at T2), and Emotional Stability (at T2) were related to adolescent smoking. Longitudinal findings indicated that only Extraversion and Emotional Stability were related to onset of adolescent smoking. Using a person-oriented approach, Overcontrollers and Undercontrollers did not differ from Resilients on smoking onset. No indication was found for a moderating effect of birth order on the association between personality and smoking. Additional findings showed that gender moderated the effect of Agreeableness on adolescents' smoking onset. Implications for prevention are also addressed.     

Third trimester ultrasound accuracy and delivery outcome in obese and morbid obese pregnant women

Objective: Several studies have highlighted the negative impact of maternal obesity on ultrasound accuracy for fetal weight estimation (EFW). However, the evidence is conflicting. We aimed in our study to find if the ultrasound accuracy for EFW would differ or decrease in obese and morbid obesity classes. We also studied the mode of delivery within the same cohort.

Methods: It is a retrospective study of obese patients with recorded BMI ≥30?kg/m², class I and II (BMI: 30–39.9?kg/m²) compared with extreme obese class III (BMI ≥40?kg/m²), who gave birth after 28-week gestation of viable singleton, who had an ultrasound within 7 d of delivery with reported normal amniotic fluid and no major fetal anomaly; the EFW was consistently measured through Hadlock regression formula in the period of 2014–2015 inclusive. Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ±10% of error and the Pearson correlation coefficient were used to correlate EFW with the ABW. The study’s secondary outcome was to study the mode of delivery and the rate of cesarean section in obese and morbid obese patients.

Results: Total 106 cases fulfilled our criteria. Class I and II as the first group (n?=?53). Class III as the second group (n?=?53). Maternal and birth characteristics were similar. The Pearson correlation coefficient equal 1 in both groups. The overall mean absolute difference (MAD) in grams of the whole obese cohort was 242?±?213. The MAD was 242?±?202 and 242?±?226?g for the first and second group, respectively (p?=?1.0). The overall mean absolute percentage error (MAPE) in this obese cohort was 8%. The MAPE for the first and second group, respectively were 8 and 7% (p?=?0.4). The overall rate of cesarean delivery was 60% (64/106) with no differences between the obese and morbid obese BMI classes. Sixty-six percentage (42/64) of these cesarean cases was for repeat cesarean section.

Conclusion: Despite what has been previously reported about the negative impact of maternal obesity on EFW accuracy, we could not demonstrate this relationship in our obese cohort (MAPE <10%). In addition, we could not illustrate a significant difference in ultrasound accuracy across various obesity classes. However, we found a significantly increased rate of delivery by repeated cesarean section in this obese cohort.     

Parental rules and communication: their association with adolescent smoking

AIMS: To examine the association between parental rules and communication (also referred to as antismoking socialization) and adolescents' smoking. DESIGN AND PARTICIPANTS: A cross-sectional study including 428 Dutch two-parent families with at least two adolescent children (aged 13-17 years). MEASUREMENTS: Parents' and adolescents' reports on an agreement regarding smoking by adolescents, smoking house rules, parental confidence in preventing their child from smoking, frequency and quality of communication about smoking, and parent's reactions to smoking experimentation. FINDINGS: Compared with fathers and adolescents, mothers reported being more involved in antismoking socialization. There were robust differences in antismoking socialization efforts between smoking and non-smoking parents. Perceived parental influence and frequency and quality of communication about smoking were associated with adolescents' smoking. The association between antismoking socialization practices and adolescents' smoking was not moderated by birth order, parents' smoking or gender of the adolescent. CONCLUSIONS: Encouraging parents, whether or not they themselves smoke, to discuss smoking-related issues with their children in a constructive and respectful manner is worth exploring as an intervention strategy to prevent young people taking up smoking.     

Fetal behavioral and structural abnormalities in high risk fetuses assessed by 4D sonography

We have realized that the way we are looking at the motoric activity influenced the way we assessed the motoric activity. Throughout the years of these investigations, it has been influenced by those who thought that all motility was caused by generation of CNS or matured CNS. However, there remains an incomplete view of the neurological development of fetuses over the course of the life span, with methods of assessment remaining grounded in newborn models of the CNS. It is through this review hat we attempt to develop a continuous line of understanding of fetal behavior assessment in abnormal fetuses after ascertaining the normal standard behavioral pattern parameters.     

Artecoll: The Arizona Experience and Lessons Learned

Background. Artefill is one of several new materials being introduced to the US market as a soft tissue augmenting agent.
Objective. The objectives were to evaluate the safety and efficacy of injecting Artecoll (Rofil Medical International Breda, the Netherlands) in facial wrinkles compared with injecting Zyderm or Zyplast (INAMED, Santa Barbara, CA, USA) and discuss the practical lessons learned.
Methods. Thirty-eight patients were randomly selected to receive Artecoll or Zyderm/Zyplast into facial defects. Wrinkles were evaluated by the treating physician, the subject, and masked physician evaluators. Similar evaluations were performed on several collagen patients crossing over to Artecoll. Adverse reactions were recorded.
Results. All evaluators felt Artecoll to be superior to collagen in all treated areas except for the glabella and upper lip lines. In these areas, differentiation by photographs between the two products became more difficult for the masked evaluators. The adverse side effects of Artecoll were almost equal with those of collagen, but most were of minimal consequence. Three patients developed persistent nodules (all in perioral sites), which were treatable with intralesional steroids.
Conclusion. Artecoll treatment of wrinkles and folds was found to be effective, long lasting, safe, and associated with a high percentage of patient acceptance. There is a learning curve in injecting this thicker, more permanent product.     

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

Background

Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements.

Methods

The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2).

Results

Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P < 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P < 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P < 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P < 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P < 0.001].

Conclusions

Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery.