Main controversies in breast cancer

In this article, we have reviewed available evidence for diagnosis, treatment, and follow-up in female breast cancer (BC). Into daily clinical practice some controversies are occurred. Especially, in the diagnosis field, despite the fact that the optimal age in which screening mammography should start is a subject of intense controversy, there is a shift toward the beginning at the age of 40 although it is suggested that the net benefit is small for women aged 40 to 49 years. In addition, a promising tool in BC screening seems to be breast tomosynthesis. Other tools such as 3D ultrasound and shear wave elastography (SWE) are full of optimism in BC screening although ultrasonography is not yet a first-line screening method and there is insufficient evidence to recommend the systemic use of the SWE for BC screening. As for breast magnetic resonance imaging (MRI), even if it is useful in BC detection in women who have a strong family history of BC, it is not generally recommended as a screening tool. Moreover, based on the lack of randomized clinical trials showing a benefit of presurgical breast MRI in overall survival, it’s integration into breast surgical operations remains debatable. Interestingly, in contrast to fine needle aspiration, core biopsy has gained popularity in presurgical diagnosis. Furthermore, after conservative surgery in patients with positive sentinel lymph nodes, the recent tendency is the shift from axillary dissection to axillary conserving strategies. While the accuracy of sentinel lymph node after neoadjuvant chemotherapy and second BC surgery remains controversial, more time is needed for evaluation and for determining the optimal interval between the two surgeries. Additionally, in the decision between immediate or delayed breast reconstruction, there is a tendency in the immediate use. In the prevention of BC, the controversial issue between tamoxifen and raloxifene becomes clear with raloxifene be more profitable through the toxicities of tamoxifen. However, the prevention of bone metastasis with bisphosphonates is still conflicting. Last but not least, in the follow-up of BC survivors, mammography, history and physical examination are the means of an early detection of BC recurrence.ed.     

Divergence of estimated fetal weight and birth weight in singleton fetuses

Objective: To evaluate differences in distribution of estimated fetal weight (EFW) and birth weight (BW) of ongoing fetuses and neonates of the same gestational age.

Methods: Reference curves for EFW (Hadlock BPD-HC-AC-FL formula, N?=?1191) and BW (N?=?1036) in singleton pregnancies from 24⁺⁰ to 40⁺⁶ gestational weeks were calculated. Multiple pregnancies, fetuses with major or multiple abnormalities or syndromes and iatrogenic preterm deliveries due to preeclampsia or abnormal fetal Doppler were excluded. The standardized residuals for EFW and BW were calculated and compared.

Results: EFW and BW can be accurately described by quadratic equations (R²?=?0.944 and 0.807, respectively). The distribution of standardized residuals for BW using the EFW formula was negative from 28⁺⁰ to 35⁺⁶ weeks. The 50th and 5th centiles of BW were lower than those of EFW throughout prematurity, and they converged at approximately 38 gestational weeks. The 5th centile for BW was 30% lower than the 5th centile for EFW at 27 weeks, 27.5% lower at 30 weeks and 19.4% at 34 weeks.

Conclusions: Preterm infants have lower BW distribution compared to the expected EFW of ongoing pregnancies of the same gestational age, supporting the concept of hidden intrauterine morbidity for a proportion of these infants.     

Aspects of the media and their relevance to bulimic attitudes and tendencies among female college students

We examined whether media pressures would mediate the association between two dimensions of the media (source of information and internalization) and bulimic attitudes/tendencies. The study sample consisted of 106 female college students (M age=19.9; range=18-22). Participants completed anonymous, self-report measures on media influences on body image and appearance as well as disordered eating attitudes/behaviors. Findings showed that the association between two dimensions of the media (source of information and internalization) and bulimic attitudes/tendencies was mediated by perceived media pressures. Such findings highlight the significant influence of media pressures on bulimic attitudes/tendencies. Future research and prevention implications are discussed.     

Immunization with West Nile virus envelope domain III protects mice against lethal infection with homologous and heterologous virus

The Japanese encephalitis virus (JEV) serocomplex-group consists of mosquito-borne flaviviruses, which include West Nile virus (WNV) and JEV, and both may cause severe encephalitis in humans. WNV has spread rapidly across the United States since its introduction in 1999 and its geographical distribution within the western hemisphere is expected to further expand, whereas, JEV is the most common cause of viral encephalitis in Southeast Asia, China and India. Currently, there is no registered human vaccine or specific therapy to prevent or treat WNV infection. Here we describe the efficacy of recombinant domain III (DIII) of WNV glycoprotein E in a mouse model. It induces high neutralizing antibody titers, as well as, protection against lethal WNV infection in C57BL/6 mice. This vaccine preparation also afforded partial protection against lethal JEV infection.     

Trichomegaly induced by erlotinib

Erlotinib (Tarceva, Roche) is a chemotherapeutic agent used in the management of advanced non-small cell lung cancer and other malignancies. We present the case of a patient who developed excessive eyelash growth, called trichomegaly, a rare ocular side effect of this drug.