Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland

AIMS

Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines.

MATERIALS AND METHODS

An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously.

RESULTS

Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively.

CONCLUSION

The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.

Toward the development of sensors for lung cancer: The adsorption of 1-propanol on hydrophobic zeolites

A healthy breath is mainly composed of water, carbon dioxide, molecular nitrogen, and oxygen and it contains many species, in small quantities, which are related to the ambient atmosphere and the metabolism. The breath of a person affected by lung cancer presents a concentration of 1-propanol higher than usual. In this context, the development of specific sensors to detect 1-propanol from breath is of high interest. The amount of propanol usually detected on the breath is of few ppb; this small quantity is a handicap for a reliable diagnostic. This limitation can be overcome if the sensor is equipped with a pre-concentrator. Our studies aim to provide an efficient material playing this role. This will contribute to the development of reliable and easy to use lung cancer detectors. For this, we investigate the properties of a few hydrophobic porous materials (chabazite, silicalite-1, and dealuminated faujasite). Hydrophobic structures are used to avoid saturation of materials by the water present in the exhaled breath. Our experimental and simulation results suggest that silicalite -1 (MFI) is the most suitable structure to be used as a pre-concentrator.

Electronic and electrocatalytic properties of PbTiO3: unveiling the effect of strain and oxygen vacancy

First-principles calculations based on density-functional theory have been used to investigate the effect of biaxial strain and oxygen vacancy on the electronic, photocatalytic, and electrocatalytic properties of PbTiO3 oxide. Our results show that PbTiO3 has a high exciton binding energy and a band gap that can be easily moderated with different strain regimes. From a reactivity viewpoint, the highly exothermic adsorption of hydrogen atoms in both pristine and strained PbTiO3 structures does not make it a potential electrocatalyst for the hydrogen evolution reaction. Fortunately, the presence of oxygen vacancies on the PbTiO3 surface induces moderate adsorption energies, making the reduced PbTiO3 suitable for hydrogen evolution reaction processes.

Sustainable Flame-Retardant Flax Fabrics by Engineered Layer-by-Layer Surface Functionalization with Phytic Acid and Polyethylenimine

New generation of mission-oriented fabrics meets advanced requirements; such as electrical conductivity, flame retardancy, and anti-bacterial properties. However, sustainability concerns still are on-demand in fabrication of multi-functional fabrics. In this work, we used a bio-based phosphorus molecule (phytic acid, PA) to reinforce flax fabrics against flame via layer-by-layer consecutive surface modification. First, the flax fabric was treated with PA. Then, polyethylenimine (PEI) was localized above it to create negative charges, and finally PA was deposited as top-layer. Fourier-transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDX), and inductively-coupled plasma atomic emission spectrometry (ICP-AES) proved successful chemical treatment. Pyrolysis-combustion flow calorimetry (PCFC) showed significant drop by about 77% in the peak of heat release rate (pHRR) from 215 W/g for untreated to 50 W/g for treated flax fabric. Likewise, the total heat release (THR) decreased by more than three times from 11 to 3.2 kJ/g. Mechanical behavior of the treated flax fabric was completely different from untreated flax fabrics, changing from almost highly-strengthened behavior with short elongation at break to a rubber-like behavior with significantly higher elongation at break. Surface friction resistance was also improved, such that the abrasion resistance of the modified fabrics increased up to 30,000 rub cycles without rupture.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10694-023-01387-7.

Thymol nanoemulsion promoted broiler chicken's growth, gastrointestinal barrier and bacterial community and conferred protection against Salmonella Typhimurium

The present study involved in vivo evaluation of the growth promoting effects of thymol and thymol nanoemulsion and their protection against Salmonella Typhimurium infection in broilers. One-day old 2400 chicks were randomly divided into eight groups; negative and positive control groups fed basal diet without additives and thymol and thymol nanoemulsion groups (0.25, 0.5 and 1% each). At d 23, all chicks except negative control were challenged with S. Typhimurium. Over the total growing period, birds fed 1% thymol nanoemulsion showed better growth performance even after S. Typhimurium challenge, which came parallel with upregulation of digestive enzyme genes (AMY2A, PNLIP and CCK). Additionally, higher levels of thymol nanoemulsion upregulated the expression of MUC-2, FABP2, IL-10, IgA and tight junction proteins genes and downregulated IL-2 and IL-6 genes expression. Moreover, 1% thymol nanoemulsion, and to lesser extent 0.5% thymol nanoemulsion and 1% thymol, corrected the histological alterations of cecum and liver postinfection. Finally, supplementation of 1% thymol, 0.5 and 1% thymol nanoemulsion led to increased Lactobacilli counts and decreased S. Typhimurium populations and downregulated invA gene expression postinfection. This first report of supplying thymol nanoemulsion in broiler diets proved that 1% nano-thymol is a potential growth promoting and antibacterial agent.

Imprinting isolated single iron atoms onto mesoporous silica by templating with metallosurfactants

HYPOTHESIS

One of the main drawbacks of metal-supported materials, traditionally prepared by the impregnation of metal salts onto pre-synthesized porous supports, is the formation of large and unevenly dispersed particles. Generally, the larger are the particles, the lower is the number of catalytic sites. Maximum atom exposure can be reached within single-atom materials, which appear therefore as the next generation of porous catalysts.

EXPERIMENTS

Herein, we designed single iron atom-supported silica materials through sol-gel hydrothermal treatment using mixtures of a non-ionic surfactant (Pluronic P123) and a metallosurfactant (cetyltrimethylammoniumtrichloromonobromoferrate, CTAF) as porogens. The ratio between the Pluronic P123 and the CTAF enables to control the silica structural and textural properties. More importantly, CTAF acts as an iron source, which amount could be simply tuned by varying the non-ionic/metallo surfactants molar ratio.

FINDINGS

The fine distribution of iron atoms onto the silica mesopores results from the iron distribution within the mixed micelles, which serve as templates for the polymerization of the silica matrix. Several characterization methods were used to determine the structural and textural properties of the silica material (XRD, N₂ sorption isotherms and TEM) and the homogeneous distribution and lack of clustering of iron atoms in the resulting materials (elemental analysis, magnetic measurements, pair distribution function (PDF), MAS-NMR and TEM mapping). The oxidation and spin state of single-iron atoms determined from their magnetic properties were confirmed by DFT calculations. This strategy might find straightforward applications in preparing versatile single atom catalysts, with improved efficiency compared to nanosized ones.

Improved tribological properties, thermal and colloidal stability of poly-α-olefins based lubricants with hydrophobic MoS2 submicron additives

HYPOTHESIS

Newtonian liquids, usually used as base oil lubricants, exhibit low viscosity under extreme thermal conditions, needed for the functioning of wind turbines. This is directly affecting the colloidal stability and the tribological properties of the formulations containing additives, such as MoS₂. Here, it was hypothesized that the surface hydrophobization of MoS₂ particles will allow for an increased colloidal stability of the resulting formulations, for temperatures as high as 80 °C.

EXPERIMENTS

The antifriction properties and the thermal stability of the designed formulations were determined on submicron MoS₂ particles dispersed in poly-α-olefins (PAO) base oils of different dynamic viscosities (from 32 to 1650 mPa·s at 25 °C). The submicron particles of MoS₂ (300-500 nm in diameter) were synthesised by a simple one-pot solvothermal method under mild conditions. The resulting particles were hydrophobized in situ in PAO base oils using alkyltrichlorosilane grafting agents with two chain lengths (C8 and C18).

FINDINGS

The covalent grafting of alkylsilanes through Mo-O-Si bonds was confirmed by DFT calculations and FT-IR measurements. Turbiscan optical analysis revealed that thermal and colloidal stabilities can be significantly improved depending on oil viscosity and chain length of the grafting agent. The formulations in the PAO65 oil remained highly stable (TSI < 1), even at 80 °C. Herein, we demonstrate the impact of hydrophobization degree on the tribological properties of the lubricants, which, importantly, could reach ultra-low friction coefficients, less than 0.02.

Testing for HTLV 1 and HTLV 2 among blood donors in Western Saudi Arabia: prevalence and cost considerations

BACKGROUND

Screening all blood donors for human T-cell lymphotropic viruses 1 and 2 (HTLV 1 and HTLV 2) is mandatory in Saudi Arabia. The aim of this study is to evaluate the results and costs associated with the current testing policy for HTLV 1 and HTLV 2 in blood donors at King Abdulaziz University Hospital (KAUH), Jeddah.

STUDY DESIGNS AND METHODS

Donor-testing results from Blood Transfusion Services at KAUH were reviewed over a 10-year period, from January 2006 through December 2015. All donors were screened using chemiluminescent microparticle immunoassay. Reactive samples were then tested by Western blot for confirmation. Costs associated with testing were calculated.

RESULTS

Data of 107 419 donations in the study period were reviewed. Saudi nationals constituted 51 168 donors (47·6%). Of 107 419 blood donors tested for HTLV 1 and HTLV 2 antibody, and 95 (0·088%) donors were reactive to screening tests. None of the samples found to be reactive to screening tests was positive by Western blot. The average cost of testing was US$ 171 870 per year.

CONCLUSION

No donors were confirmed to have HTLV 1 and HTLV 2 in this cohort exceeding 100 000 donors. We propose changes to the policy mandating universal testing by replacing it with universal leukodepletion coupled with targeted screening to donors coming from endemic area or donors at risk. Such changes are expected to lead to a reduction of testing cost without affecting safety.

Research Note. One minute, intraoperative assessment of the viability of hydatid cysts using a simple reagent strip test

The aim of the current work was to evaluate the possibility of using a rapid and simple reagent strip test to investigate the viability of hydatid cysts intraoperatively, via testing certain biochemical parameters. Thirty eight HCF samples were processed and examined by different methods for determining the viability status. Using the reagent strip test in the current study, the highest significant level of glucose was detected in HCF samples with the highest viability % at pH 7.5 and the lowest significant level of glucose was detected in HCF samples with the lowest viability % at pH 8.5, indicating a likely correlation between glucose concentration and the viability of PSs. On the contrary, protein was not detected in HCF containing viable PSs and was found to be higher in HCF containing non-viable PSs, denoting the possible degenerative processes in such PSs. Haemoglobin was found in trace amounts in all of our samples. In addition, the strip test detected bacterial contamination in 8 samples and biliary leakage in 7 samples. Our results suggest that the simple reagent strip test can assist in providing fast, uncomplicated primary data regarding the viability status of the hydatid cysts. Thus, it may aid the surgeons to make informed decisions for further management and appropriate follow up to minimise the risk of post-operative recurrence.

Thermodynamic and structural properties of binary calcium silicate glasses: insights from molecular dynamics

The thermodynamic and structural properties of calcium-modified binary silicate glasses have been computed using molecular dynamics simulations.

An epidemiologic, clinical, and therapeutic study of childhood Guillain-Barré syndrome in Kuwait: is it related to the oral polio vaccine?

We studied Guillain-Barré syndrome, affecting children 12 years old or less, throughout Kuwait, in the period between January 1, 1992, and March 31, 1997. Nineteen children had the diagnostic criteria of Guillain-Barré syndrome, with an overall annual incidence rate of 0.95/100,000 population at risk. Female patients outnumbered male patients with a sex ratio of 1.4:1. There was a clustering of cases in winter and spring and in the year 1996. The disease symptoms were relatively severe in our patients because only 16% (3 of 19) of them were able to walk at the height of their illness, whereas the rest were bed or chair bound or needed assisted ventilation. Two patients had the electrodiagnostic features of axonal neuropathy and both had residual deficits on follow-up, whereas the rest recovered fully. All the patients received intravenous immunoglobulin. The mean time to walk unaided was 23.5 days (range, 2-84 days) after intravenous immunoglobulin and excluding the two patients with axonal neuropathy, and full recovery was achieved in a mean time of 103 days (range, 30-300 days). Contrary to previous studies, we found no correlation between oral polio vaccine administration and Guillain-Barré syndrome in 2 successive years (1995 and 1996) during a nationwide campaign targeting children less than 5 years old.

Tuberculosis risk in funeral home employees

In order to estimate the risk of tuberculosis infection among employees in the funeral service industry, we conducted a risk-assessment study of a convenience sample of funeral home employees. Study participants completed a risk-assessment questionnaire and underwent tuberculin skin testing. Of 864 employees tested, 101 (11.7%) had a reactive tuberculin skin test. Reactivity to the tuberculin skin test was significantly associated with job category; funeral home employees with a present or past history of embalming deceased-human remains were twice as likely to be reactive as were non-embalming personnel (14.9% versus 7.2%, P < 0.01). Reactivity was also associated with age, gender, race, past history of close contact with a person diagnosed with tuberculosis, and work history. After controlling for age and other factors, tuberculin reactivity was found to be associated in embalming personnel with the number of years spent performing embalmings (> or = 20), and, in non-embalming personnel, with a history of close contact with infected individuals. Based on these results, it is recommended that funeral home employees who routinely embalm cadavers undergo annual tuberculin skin testing, receive initial training on tuberculosis prevention, and wear respiratory protection when preparing known tuberculosis cases.

Use of mental health services by households in the United States

OBJECTIVE

The study examined differences in the use of mental health services by persons living in different types of households.

METHODS

Data were obtained from the Epidemiologic Catchment Area (ECA) survey, a multistage probability sampling procedure of households in five U.S cities conducted in 1981-1984. Data from 12,417 persons living in four of the five ECA sites (Baltimore, St. Louis, Durham, North Carolina, and Los Angeles) were classified according to household categories used by the U.S. Bureau of the Census. Logistic regression analysis was used to examine the relationship of mental health service use to household type, relationship of survey respondent to head of household, household income and size, number of children in the household, ECA site, presence of mental disorders, and sociodemographic factors.

RESULTS

Use of mental health services varied by type of household but not by individual within the same household. Persons in female-headed families and persons living alone had the highest use of mental health services, even after other variables were controlled.

CONCLUSIONS

The findings highlight the need for outreach efforts to determine needs and preferences for health, mental health, and social services by persons in various households, especially persons in female-headed families and persons living alone.

Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset

OBJECTIVE

The concepts of prodrome and precursor are used to show how epidemiologic data on age at onset can be used in timing preventive interventions and selecting target populations.

METHODS

Data concerning onset of DSM-III major depression and panic disorder were taken from the Epidemiologic Catchment Area Program. Cumulative distributions of ages at onset of diagnosis and onset of precursors are presented, and the concept of attributable risk is introduced. Attributable risk is the maximum proportion of cases that would be prevented if an intervention were 100% effective in eliminating a specific precursor.

RESULTS

Illustrative results for depression and panic are presented. Precursors vary in the degree to which they predict onset of the full disorder; 2 or more weeks of sad mood in the year before full-blown depression is a better predictor (relative odds, 7.0) than weight loss or gain (relative odds, 3.0). The formula for population attributable risk was applied to the precursor relative risks and prevalences to estimate the potential success of interventions for specific precursors in preventing the disorder. The precursor attributable risks indicate that sleep problems would identify 47% of the new cases of major depression occurring in the following year, and the question "Are you a nervous person?" would identify 60% of persons with onset of panic disorder in the following year.

CONCLUSIONS

This conceptual framework links the early natural history of disorders with the search for syndromes. Knowledge of precursor prevalence and attributable risk, combined with other host characteristics and environmental risk factors, can be used in screening and prevention.

Boronic acids for affinity chromatography: spectral methods for determinations of ionization and diol-binding constants

Arylboronic acids attached to solid matrices have proved useful for the diol-specific chromatography of biomolecules and affinity purification of enzymes by exchangeable-ligand chromatography. The latter use has been limited by the intrinsic ionization constant (pKa approximately 9) of the most common commercial products. The synthesis of several arylboronic acids with ionization constants near neutrality are described, and the application of a new general, spectral-difference method for determining acid ionization constants and formation constants with fructose is developed. In particular 4-(N-methyl) carboxamido-benzeneboronic acid was found to have a pKa of 7.86 and a formation constant with D-fructose of 8600. It was stable toward acid or base hydrolysis. We suggest that 4-carboxybenzeneboronic acid might be useful for preparing matrices for enzyme affinity chromatography.

Changes in concentrations of serum prolactin, FSH, oestradiol and progesterone and of the sex skin during the menstrual cycle in the mangabey monkey (Cercocebus atys lunulatus)

Daily blood samples were collected from 6 regularly menstruating mangabey monkeys. Because serum LH could not be measured by a radioimmunoassay for human LH, Day 0 was taken as the day of maximum serum oestradiol concentration. The hormone patterns were very similar to those of other cercopithecids and women. However, the peak of serum progesterone was lower in mangabeys than in women. There was no distinct peak of serum oestradiol during the luteal phase of mangabeys but the average levels were higher than during the early follicular phase, a pattern more similar to that in other non-human primates than in women. Serum prolactin rose by about 50%, 48 h after the serum oestradiol peak, then declined during the mid-luteal phase before rising at the end of the cycle. Changes in the sex skin dimensions followed the same pattern as the serum oestradiol concentrations.

Prolactin response to TRH in diabetic ketoacidosis

The prolactin response to 200 microgram thyrotropin-releasing hormone (TRH) IV was studied in seven patients with diabetic ketoacidosis, at the start of the treatment, and again, in the same patients, five days after recovery, when the diabetes was well controlled. Normal basal prolactin concentrations and prolactin responses to TRH were found in both situations. There was no correlation between basal prolactin concentrations, or magnitude of prolactin responses to TRH, and any of the metabolic variables measured. These findings do no suggest a role for prolactin in the development of diabetic ketoacidosis.

Thyrotrophin, prolactin and growth hormone responses to TRH in barbiturate coma and in depression

The effects of 200 microgram thyrotrophin-releasing hormone (TRH) i.v. on thyrotrophin (TSH), prolactin (PRL), growth hormone (GH) and triiodothyronine (T3) were studied in eight patients with barbiturate coma due to attempted suicide, in the same patients after recovery, in eight depressive patients and in eight normal controls. The patients with barbiturate coma presented normal basal TSH and PRL, elevated basal GH and normal PRL but blunted TSH responses to TRH; their GH concentrations varied widely without consistent relation to TRH administration. The same patients after recovery from coma presented normal TSH and PRL, slightly elevated basal GH, and normal PRL but blunted TSH responses to TRH; in four of these patients, a clear-cut rise in GH (i.e. more than 10 ng/ml) occurred after TRH administration. The depressive patients presented normal basal TSH and PRL, slightly elevated basal GH, and normal PRL but blunted TSH responses to TRH; in four of these patients, a moderated rise in GH (less than 10 ng/ml) occurred after TRH administration. The increment in T3 concentrations 120 min after TRH was found reduced in the comatose patients only. Basal cortisol was measured in all the subjects and found elevated in the comatose patients only. It is concluded that the abnormal TSH and GH responses to TRH observed in patients with barbiturate coma are more likely related to depressive illness than to an effect of barbiturates at the pituitary level. Barbiturates might affect thyroid secretion.

Cord serum prolactin in relation to the time of the day, the sex of the neonate and the birth weight

Serum prolactin was measured in 581 blood samples collected immediately after birth from 563 single new-born and from 9 pairs of twins. Cord serum prolactin is high at birth: the mean level is some 5 times higher than in adults. There is no sex difference in cord serum prolactin concentration in the neonate. Mean serum prolactin is significantly higher at 1.00 and 2.00 a.m. Thus a circadian periodicity in serum prolactin concentration seems to appear already during foetal life well before the organization of sleep rhythm. Cord serum prolactin increases with birth weight ranging from 1500 g to 3500 g. Thus, the control of levels of circulating prolactin changes during foetal life resulting in a progressive increase starting from mid-pregnancy. Mean cord serum prolactin at birth is lower in twins than in single new-borns. There is no significant difference in serum prolactin between the first and the second twin.

[The influence of sulpirid on sleep. Results of polygraphic night sleep recordings (author's transl)]

Short and long term effects of sulpirid on the sleep EEG in humans were investigated in 8 patients aged 20-68 years (average 40.4) suffering from autonomic instability. In each patient seven polygraphic night sleep recording were performed. After an adaption night and two nights without medication each subject got 200-400 mg sulpirid i.m. for two days and then 300-600 mg orally for a three-week period. In both groups the short-term application of sulpirid caused a reduction of waking periods and a slight decrease of stage 3, while stage 2 was increased. In psychotic patients the long-term orally administered substance was followed by an increase of deep synchronous sleep (stage 4). As this alteration of sleep couldn't be revealed in the control group, we consider this finding as a result of the improvement of psychosis. In the patient group the amount of REM sleep was augmented during the short-term application as well as during the long-term application, where, as in the control group the amount of REM sleep decreased when sulpirid was given orally for three weeks. This result is discussed in comparison with the properties of the tricyclic antidepressant drugs and monoamine oxidase inhibitors and the clinical effects of sulpiride.