Minimally invasive technology in the management of breast disease

Minimally invasive surgery is gaining popularity around the world because it achieves the same or even superior results when compared to standard surgery but with less morbidity. Minimally invasive breast surgery is a broad concept encompassing new developments in the field of breast surgery that work on this minimally invasive principle. In this regard, breast-conserving surgery and sentinel lymph node biopsy are good illustrations of this concept. There are three major areas of progress in the minimally invasive management of breast disease. First, percutaneous excisional devices are now available that can replace the surgical excision of breast mass lesions. Second, various ablative treatments are capable of destroying breast cancers in situ instead of surgical excision. Third, mammary ductoscopy provides a new approach to the investigation of mammary duct pathology. Clinical experience and potential applications of these new technologies are reviewed.     

Oncolytic Reovirus Effectively Targets Breast Cancer Stem Cells

Recent evidence suggests that cancer stem cells (CSCs) play an important role in cancer, as these cells possess enhanced tumor-forming capabilities and are resistant to current anticancer therapies. Hence, novel cancer therapies will need to be tested for both tumor regression and CSC targeting. Herein we show that oncolytic reovirus that induces regression of human breast cancer primary tumor samples xenografted in immunocompromised mice also effectively targets and kills CSCs in these tumors. CSCs were identified based on CD24⁻CD44⁺ cell surface expression and overexpression of aldehyde dehydrogenase. Upon reovirus treatment, the CSC population was reduced at the same rate as non-CSCs within the tumor. Immunofluorescence of breast tumor tissue samples from the reovirus- and mock-treated mice confirmed that both CSCs and non-CSCs were infectible by reovirus, and terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) assay showed that both populations died by apoptosis. Ras, which has been shown to mediate reovirus oncolysis, was found to be present at similar levels in all cell types, and this is consistent with their comparable sensitivity to reovirus. These experiments indicate that oncolytic reovirus has the potential to induce tumor regression in breast cancer patients. More important, the CSC population was equally reduced and was as susceptible to reovirus treatment as the non-CSC population.     

Ocular complications of paediatric patients with nephrotic syndrome

Purpose : To investigate ocular complications arising from nephrotic syndrome and/or its treatments in children. Methods : A cross‐sectional study was conducted in a teaching hospital. A total of 31 paediatric patients with nephrotic syndrome were studied. Comprehensive ophthalmic assessments on best‐corrected visual acuity, intraocular pressure, slit‐lamp and fundus examination were taken. Information regarding histological diagnosis of nephrotic syndrome and its treatment regimen in each patient was reviewed and analysed. Results : Bilateral posterior subcapsular cataracts were detected in three of 29 patients (10.3%) who received steroid therapy. Two had normal vision while one had visual acuity reduced to 6/15 in both eyes. The age of onset of the nephrotic syndrome in these three patients was 2 years, which was significantly younger than those without cataract (5.4 ± 3.2 years, P < 0.001). Three patients (9.7%) had isolated asymptomatic fundal findings of tortuous and dilated retinal vessels. Hypertensive retinopathy was found in one patient (3.2%). No steroid‐induced glaucoma, uveitis, ocular infection, or other eye complications related to the use of steroids or other immunosuppressive agents were noted. Conclusions : Children who have nephrotic syndrome often require prolonged, intermittent high dose of systemic corticosteroid therapy. Paediatricians should be aware of the potential risk of developing steroid‐related complications, especially posterior subcapsular cataract. It appears to have a higher risk when steroid therapy is used in very young patients. Early detection would help to prevent amblyopia development, particularly in the group of immature eyes.     

Mechanical model testing of rebreathing potential in infant bedding materials

Rebreathing of expired air may be a lethal hazard for prone sleeping infants. This paper describes a mechanical model to simulate infant breathing, and examines the effects of bedding on exhaled air retention. Under simulated rebreathing conditions, the model allows the monitoring of raised carbon dioxide (CO2) inside an artificial lung-trachea system. Resulting levels of CO2 (although probably exaggerated in the mechanical model compared with an infant, due to the model's fixed breathing rate and volume) suggest that common bedding materials vary widely in inherent rebreathing potential. In face down tests, maximum airway CO2 ranged from less than 5% on sheets and waterproof mattresses to over 25% on sheepskins, bean bag cushions, and some pillows and comforters. Concentrations of CO2 decreased with increasing head angle of the doll, away from the face down position. Recreations of 29 infant death scenes also showed large CO2 increases on some bedding materials, suggesting these infants could have died while rebreathing.     

E-Cigarette Use in the Past and Quitting Behavior in the Future: A Population-Based Study

Objectives. We examined whether smokers who used e-cigarettes are more likely to quit after 1 year than smokers who had never used e-cigarettes.Methods. We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up.Results. Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97).Conclusions. Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.The use of electronic cigarettes (e-cigarettes)—also known as electronic nicotine delivery systems, personal vaporizers, and vaping cigarettes—is a recent and rapidly expanding phenomenon. These names refer to a battery-operated device that electronically heats a liquid (sometime referred to as “e-juice”) containing nicotine and propylene glycol, plus flavors, to create a misty vapor mimicking cigarette smoke that is inhaled by the smoker (who is commonly known as the “vaper”). This increasing use of e-cigarettes has become a controversial issue among health professionals, policymakers, vapers, and the general public. According to the surgeon general’s recent recommendations, e-cigarettes need to be regulated and their use in the population closely monitored, especially given the doubling of use among youths within just 1 year (between 2011 and 2012).1The main controversy surrounding the use of e-cigarettes is whether they are of benefit to smokers, as an alternative to cigarettes and for harm reduction, or whether they cause more harm to society by introducing and propagating new forms of nicotine addiction.2 At present, there is a scarcity of data to help guide decisions regarding the potential harm versus benefits of e-cigarettes, a situation that has led to claims and counterclaims by opponents and proponents of e-cigarette use.3 If smokers quit traditional cigarettes and instead use e-cigarettes to maintain their nicotine addiction (but without the degree of exposure to known carcinogenic byproducts of tobacco combustion), this may be a viable harm reduction strategy that can become a powerful tool for tobacco control.Most of the evidence that users and proponents of e-cigarettes employ have been anecdotal and not scientifically validated; recently, however, more studies on this topic have appeared. One of the first, a pilot study funded by the manufacturers of an e-cigarette brand from Italy, included 40 smokers who were given e-cigarettes and followed up for 24 weeks. The authors reported a 22.5% rate of sustained abstinence from cigarettes among e-cigarette users, a rate comparable to the effects of nicotine replacement therapy in experimental settings.4 However, this study was underpowered because of the small number of participants. A more recent and larger 3-arm trial of e-cigarette use from New Zealand randomized participants to use e-cigarettes (nicotine or placebo) or nicotine patches to quit smoking. Abstinence rates at 6-month follow-up were low across conditions (4.1%–7.8%), with the highest rate found with nicotine e-cigarettes and the lowest with placebo e-cigarettes,5 but no significant differences emerged. In addition to its low statistical power, the study included a potential methodological bias because those in the e-cigarette arm of the trial were mailed the device and cartridges while those in the nicotine patch arm were mailed a voucher (thus requiring that they obtain the nicotine patches). The difference in dose of nicotine and type of e-cigarettes is an additional major limiting factor in interpreting these results across different studies.An earlier study of a convenience sample of 81 ever-users of e-cigarettes concluded that most participants were using them to quit smoking,6 but it provided no clear indication of how successful they were. A larger follow-up survey of e-cigarette users by the same authors indicated that almost all former smokers (96%) agreed that e-cigarettes helped them quit smoking and 57.7% of current smokers believed that e-cigarettes would help them quit or avoid relapsing.7 However, these studies were biased toward self-selected current users without any comparison groups, and the actual influence on quitting among ever-users versus never-users is unknown. More recently, a meta-analysis by Grana et al. found that all 4 prospective studies that assessed the influence of e-cigarette use on quitting behavior found that e-cigarette use did not assist smokers in quitting.8We prospectively assessed how ever using e-cigarettes, compared with never using them, affected abstinence and smoking habits among smokers in the general population. Given that previous data suggest that smokers mostly use e-cigarettes to quit smoking, we hypothesized that smokers in the general population who have tried or who currently use e-cigarettes are more likely to succeed in quitting than smokers who never used them, after controlling for level of addiction, quitting intentions, and smoking behavior.