Breast cancer awareness among Greek women and potential determinants

Aim-Background

Despite the rise in the incidence of breast cancer (BC), a steady increase in the rate of survival has also been noted which can be directly attributed to early diagnosis, among others. Therefore, keeping women informed of the latest advances in BC treatment and prevention is crucial. The aim of this study is an attempt to quantify the level of awareness of Greek women on issues related to female BC prevention.

Methods

An online questionnaire of 24 items divided into three sections (sociodemographic, personal experience, as well as beliefs concerning BC prevention and screening) was completed and submitted anonymously by 2565 Greek women of all adult age groups and of various socioeconomic backgrounds.

Results

Only 42.8% of women used credible sources of information on health issues such as BC. Regular breast self-examination was adopted by one in three women. It emerged that 89% of women erroneously associated in vitro fertilization with an increased risk of BC, while half the women were unaware of the possibility of a false-negative result from breast screening. Low BC awareness was associated with low education, low economic status, younger age, single women from non-urban areas who did not have (or did not know if they had) a BC family history and who usually refrained from any kind of preventive actions.

Conclusions

The study revealed that there is a significant proportion of Greek women with a misperception or ignorance of BC prevention and the significance of early diagnosis. Since timely diagnosis is directly related to BC survival rate, specific actions (e.g. targeted educational interventions in specific subpopulations) should be assumed.

     

Defective glycosylation of coagulation factor XII underlies hereditary angioedema type III

Hereditary angioedema type III (HAEIII) is a rare inherited swelling disorder that is associated with point mutations in the gene encoding the plasma protease factor XII (FXII). Here, we demonstrate that HAEIII-associated mutant FXII, derived either from HAEIII patients or recombinantly produced, is defective in mucin-type Thr309-linked glycosylation. Loss of glycosylation led to increased contact-mediated autoactivation of zymogen FXII, resulting in excessive activation of the bradykinin-forming kallikrein-kinin pathway. In contrast, both FXII-driven coagulation and the ability of C1-esterase inhibitor to bind and inhibit activated FXII were not affected by the mutation. Intravital laser-scanning microscopy revealed that, compared with control animals, both F12^–/– mice reconstituted with recombinant mutant forms of FXII and humanized HAEIII mouse models with inducible liver-specific expression of Thr309Lys-mutated FXII exhibited increased contact-driven microvascular leakage. An FXII-neutralizing antibody abolished bradykinin generation in HAEIII patient plasma and blunted edema in HAEIII mice. Together, the results of this study characterize the mechanism of HAEIII and establish FXII inhibition as a potential therapeutic strategy to interfere with excessive vascular leakage in HAEIII and potentially alleviate edema due to other causes.     

Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases

Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases.

Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.

12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.

Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.     

Single centre clinical study of a Greek patient population with triple-negative breast cancer

Aim

The aim of this study is to describe the characteristics of triple-negative breast cancer (TNBC) among patients of a Greek population and investigate the extent to which international TNBC patterns apply to the particular ethnic group.

Material and methods

In this single-centre, retrospective study, medical records of 1455 female patients undergoing breast cancer surgery from 1999 to 2013 were examined in order to identify TNBC patients and evaluate their clinicopathologic characteristics.

Results

In total, 91 TNBC patients (6.3%) were identified, with a median age of 50 years, 91.2% of whom had high-grade tumours. Only nine relapses and four deaths occurred during the study period. Overexpression of Ki-67 and p53 was observed in 95.5% and 76.8% of cases, respectively. Significant correlation was found between relapse and age at first breast surgery (p-value = 0.007) and also between Ki-67 and lymph vessel metastasis (p-value = 0.02).

Conclusions

Our study revealed that in this specific population of Greek patients with breast cancer, TNBCs are characterized by aggressive prognostic factors such as increased expression of Ki-67, EGFR, mutations of p53, high grade and presence of metastatic disease to the regional lymph nodes with concomitant lymph vessel dissemination. The relationship between young age and TNBC reported in other international studies was not observed here. On the other hand, it seems that there is a strong correlation between age at first diagnosis and age at the time of relapse.     

Valve of plastic repair of the deep femoral artery in chronic circulatory disease of the lower extremities]

It is reported about indication, surgical technique, early and late postoperative results of the plastic of the profunda femoris artery. On 17, mainly old patients with chronic circulatory disease of the lower limbs was this operation carried out, because a longer angioplastic operative procedure would have been a great risk. The statement, that 47% of our patients were practically without symptoms after four years is promising for the plastic of the profunda femoris artery with chronic ischemia syndrome of the lower limbs.     

Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases

Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases.

Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.

12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.

Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.     

Rapid sequence quadruple joint replacement in a rheumatoid Jehovah's Witness

We report the case of a wheelchair-bound rheumatoid Jehovah's Witness who underwent rapid sequence, staged, simultaneous ipsilateral hip and knee replacements. Using perioperative erythropoietin and postoperative blood salvage, all four joints were reconstructed without homologous blood transfusion. One year following surgery, the patient has achieved an independent functional status, and all four replaced joints remain painless.     

Development of a new Clinical Engineering Management Tool & Information System (CLE-MANTIS)

The evolution of the field of biomedical technology has led to the diffusion of an impressive number of medical devices into healthcare institutions. In this environment, Clinical Engineering Departments (CEDs) are expanding their role in healthcare technology management, by changing their structure and introducing quality systems in order to improve their services and monitor the outcomes. In the framework of the national project BIOTECHNET II, a software tool for the management of biomedical technology, named CLE-MANTIS, has been developed, with the aim to assist CEDs in their tasks. CLE-MANTIS functions include the upkeep of an inventory, the support and monitoring of scheduled maintenance, corrective maintenance, vigilance, equipment acquisition and replacement, service contract management and user training. The system offers clinical engineers the possibility to monitor and evaluate the quality and cost-effectiveness of their departments through the monitoring of quality and cost indicators. This paper presents the main features and functions of the system.