Circadian disrupting exposures and breast cancer risk: a meta-analysis

Purpose

Shift work, short sleep duration, employment as a flight attendant, and exposure to light at night, all potential causes of circadian disruption, have been inconsistently associated with breast cancer (BrCA) risk. The aim of this meta-analysis is to quantitatively evaluate the combined and independent effects of exposure to different sources of circadian disruption on BrCA risk in women.

Methods

Relevant studies published through January 2014 were identified by searching the PubMed database. The pooled relative risks (RRs) and corresponding 95 % confidence intervals (CIs) were estimated using fixed- or random effects models as indicated by heterogeneity tests. Generalized least squares trend test was used to assess dose–response relationships.

Results

A total of 28 studies, 15 on shift work, 7 on short sleep duration, 3 on flight attendants, and 6 on light at night were included in the analysis. The combined analysis suggested a significantly positive association between circadian disruption and BrCA risk (RR = 1.14; 95 % CI 1.08–1.21). Separate analyses showed that the RR for BrCA was 1.19 (95 % CI 1.08–1.32) for shift work, 1.120 (95 % CI 1.119–1.121) for exposure to light at night, 1.56 (95 % CI 1.10–2.21) for employment as a flight attendant, and 0.96 (95 % CI 0.86–1.06) for short sleep duration. A dose–response analysis showed that each 10-year increment of shift work was associated with 16 % higher risk of BrCA (95 % CI 1.06–1.27) based on selected case–control studies. No significant dose–response effects of exposure to light at night and sleep deficiency were found on BrCA risk.

Conclusions

Our meta-analysis demonstrates that circadian disruption is associated with an increased BrCA risk in women. This association varied by specific sources of circadian disrupting exposures, and a dose–response relationship remains uncertain. Therefore, future rigorous prospective studies are needed to confirm these relationships.

     

Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network,an International Initiative

A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.     

Changes in the Occurrence,Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Context

Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.

Choroidal thickness profile in healthy Indian children

Purpose:

The purpose was to study choroidal thickness and its profile based on location in healthy Indian children using enhanced depth spectral-domain-optical coherence tomography (SD-OCT).

Methods:

In this cross-sectional observational study 255 eyes of 136 children with no retinal or choroidal disease were consecutively scanned using enhanced depth SD-OCT. Eyes with any ocular disease or axial length (AXL) >25 mm or < 20 mm were excluded. A single observer measured choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-microns intervals up to 2500 microns temporal and nasal to the fovea. Generalized estimating equations were used to evaluate the correlation between choroidal thickness at various locations and age, AXL, gender and spherical equivalent (SEq).

Results:

Mean age of the subjects was 11.9 ± 3.4 years (range: 5–18 years). There were 62 Females and 74 males. The mean AXL was 23.55 ± 0.74 mm. Mean subfoveal choroidal thickness was 312.1 ± 45.40 μm. Choroid was found to be thickest subfoveally, then temporally. Age, AXL and SEq showed a significant correlation with choroidal thickness, whereas gender did not affect choroidal thickness.

Conclusion:

Our study provides a valid normative database of choroidal thickness in healthy Indian children. This database could be useful for further studies evaluating choroidal changes in various chorioretinal disorders. Age and AXL are critical factors, which negatively correlated with choroidal thickness.     

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Purpose

To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period.

Methods

Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline.

Results

Mean follow-up was 63.5±35.3 months. MMC was applied in 145 eyes (49%). Kaplan–Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P=0.002). Cox''s proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P=0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%.

Conclusions

This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.     

Using big data to retrospectively validate the COMPASS-CAT risk assessment model: considerations on methodology

Journal of Thrombosis and Thrombolysis - External validation is a prerequisite in order for a prediction model to be introduced into clinical practice. Nonetheless, methodologically intact external...     

Feasibility of thrombolytic therapy--a one year prospective study.

A one year prospective study was conducted on all the patients admitted with clinical diagnosis of acute myocardial infarction (AMI) to determine the proportion of patients who can be given thrombolytic therapy. Factors responsible for non-administration were analysed. 213 patients with AMI entered the study. Standard inclusion criteria for thrombolytic therapy were used. 101 (47%) patients failed to meet the inclusion criteria. This included 7 (3.3%) who failed to satisfy the electrocardiographic (ECG) criteria. Nine patients with atypical symptoms were unable to reach within the stipulated 6 hours while the remaining 85 (40%) patients were delayed inspite of typical features due to inability of the patient to attribute the symptoms to the heart, lack of proper transport facility and self medication. 112 patients (53%) met the inclusion criteria but 7 patients were excluded because of age (> 70 years), and another 8 because of contraindications. Of the remaining 97 patients, 47 failed to receive thrombolytic therapy due to lack of awareness of the benefits of thrombolytic therapy by the first treating physician, misinterpretation of ECG, inability to afford and refusal to give consent. Only 50 patients (23%) received thrombolytic therapy. This low figure can be easily improved upon by the correction of a number of remediable factors.