Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year Review

BACKGROUND

Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM.

METHODS

A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables.

RESULTS

Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively.

CONCLUSIONS

Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.

The ATLAS ASMA Study: Assessing the Impact of Asthma on Patients' Life - The Spanish Patients' Perspective

Purpose

ATLAS ASMA described the psychosocial impact of asthma on patients' daily life from patients' perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life.

Patients and Methods

This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients' data are included.

Results

A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p<0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p<0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%).

Conclusion

The study reported important insights on psychosocial impact of asthma on patients' daily life from patients' perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors.

Perineal Surgery: A Novel Use for the Keller Funnel

What are the effects of radiation therapy on local tissue and structures seen in anterior perineal resection requiring vertical rectus abdominis myocutaneous flap coverage?What are the indications and benefits of the Keller Funnel?What are important factors that affect vertical rectus abdominis myocutaneous flap viability in anterior perineal resection?Why was the Keller Funnel indicated compared with other techniques in the setting of a narrow pelvic inlet?

Social Capital and Lifestyle Impacts on Mental Health in University Students in Colombia: An Observational Study

Introduction

For young adults, the first year of higher education represents a transition period into adulthood associated with an increased risk of developing depression, anxiety, and stress, contributing to deteriorating physical and mental health. The present study aimed to analyze the relationship between depressive symptoms and social capital and lifestyles among Colombian university students.

Methods

In 2020, a longitudinal repeated measures study was conducted on first year students at Universidad de los Andes in Bogota, Colombia. The study was conceptualized and approved by the university before the COVID-19 pandemic appeared. Each student completed a self-administered questionnaire including questions on sociodemographic characteristics, depressive symptoms, perceived stress, social capital, and lifestyles. The study's pilot was conducted in November 2019, and the two measurement points were in January 2020 (wave 1, before the COVID-19 pandemic was declared) and in August 2020 (wave 2, during the COVID-19 pandemic). A binary logistic regression analysis was performed to assess the relationship between depressive symptoms, perceived stress, social capital, and lifestyles.

Findings

A total of 609 first year students (response rate = 58.11%) participated in wave 1, and 42% of the participants showed signs of clinically relevant depressive symptoms. In wave 2, despite the difficulties encountered in collecting data due to the COVID-19 pandemic, 216 students from wave 1 participated (35.47%). An increase in a sedentary lifestyle was observed (31.49%). We found that cognitive and behavioral social capital levels decreased by 12.03 and 24.54%, respectively. In addition, we observed a 6.5% increase in students with clinically relevant depressive symptoms compared to wave 1. A low level of behavioral [OR: 1.88; 95% CI (1.16, 3.04)] social capital was associated with clinically relevant depressive symptoms.

Conclusion

The health of university students continues to be a public health concern. The study suggests that social capital may play an important role in preventing depressive symptoms. Therefore, universities should put effort into programs that bring students together and promote the creation of social capital.

Novel variant in the CNNM2 gene associated with dominant hypomagnesemia

The maintenance of magnesium (Mg2+) homeostasis is essential for human life. The Cystathionine-β-synthase (CBS)-pair domain divalent metal cation transport mediators (CNNMs) have been described to be involved in maintaining Mg2+ homeostasis. Among these CNNMs, CNNM2 is expressed in the basolateral membrane of the kidney tubules where it is involved in Mg2+ reabsorption. A total of four patients, two of them with a suspected disorder of calcium metabolism, and two patients with a clinical diagnosis of primary tubulopathy were screened for mutations by Next-Generation Sequencing (NGS). We found one novel likely pathogenic variant in the heterozygous state (c.2384C>A; p.(Ser795*)) in the CNNM2 gene in a family with a suspected disorder of calcium metabolism. In this family, hypomagnesemia was indirectly discovered. Moreover, we observed three novel variants of uncertain significance in heterozygous state in the other three patients (c.557G>C; p.(Ser186Thr), c.778A>T; p.(Ile260Phe), and c.1003G>A; p.(Asp335Asn)). Our study shows the utility of Next-Generation Sequencing in unravelling the genetic origin of rare diseases. In clinical practice, serum Mg2+ should be determined in calcium and PTH-related disorders.

Parkinsonism and mental health disorders among Latino migrants

Introduction

Mental health disorders and parkinsonism (mobility slowness, rigidity, rest tremor, gait instability) often co-exist. Approximately 40% of the 7-10 million people living with Parkinson's disease globally experience co-existent depression and/or anxiety. Furthermore, people treated with dopamine-blocking medications (antipsychotics, antiemetics) or those who suffer vascular, infectious, toxic, or structural brain insults may have symptoms of “secondary” parkinsonism.

Objectives

To describe the existence of parkinsonism among Latino immigrants with behavioral health and substance abuse problems.

Methods

Data from the International Latino Partnership (ILRP) gathered at primary care clinics in Boston, Madrid, and Barcelona included 4 parkinsonism screening questions.

Results

A total of 151 participants out of 567 (26.6%) screened positive for at least one parkinsonism question and 15 (2.6%) screened positive for all 4 questions. A small group of participants who screened positive for parkinsonism had co-existent schizophrenia, schizoaffective disorder, bipolar disorder, and/or exposure to lithium or valproic acid. We found that age 50+, depression, and anxiety were more often associated with people having parkinsonism (P < 01). Gender, race, language, and educational level were not significant predictors of parkinsonism.

Conclusions

Parkinsonism and behavioral health disorders co-exist among Latino immigrants in the United States and Spain. This may be related in part to exposure to dopamine-blocking medications. Future studies should focus on early detection of mental health co-morbidities among Parkinson's disease patients as well as on prevention of “secondary” parkinsonism among people living with mental health disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

An On-Site Thermoelectric Cooling Device for Cryotherapy and Control of Skin Blood Flow

Cryotherapy involves the surface application of low temperatures to enhance the healing of soft tissue injuries. Typical devices embody a remote source of chilled water that is pumped through a circulation bladder placed on the treatment site. In contrast, the present device uses thermoelectric refrigeration modules to bring the cooling source directly to the tissue to be treated, thereby achieving significant improvements in control of therapeutic temperature while having a reduced size and weight. A prototype system was applied to test an oscillating cooling and heating protocol for efficacy in regulating skin blood perfusion in the treatment area. Data on 12 human subjects indicate that thermoelectric coolers (TECs) delivered significant and sustainable changes in perfusion for both heating (increase by (±SE) 173.0 ± 66.0%, P < 0.005) and cooling (decrease by (±SE) 57.7 ± 4.2%, P < 0.0005), thus supporting the feasibility of a TEC-based device for cryotherapy with local temperature regulation.

Hypophosphatemia and growth

Over the last decade the discovery of fibroblast growth factor 23 (FGF23) and the progressive and ongoing clarification of its role in phosphate and mineral metabolism have led to expansion of the diagnostic spectrum of primary hypophosphatemic syndromes. This article focuses on the impairment of growth in these syndromes. Growth retardation is a common, but not constant, feature and it presents with large variability. As a result of the very low prevalence of other forms of primary hypophosphatemic syndromes, the description of longitudinal growth and the pathogenesis of its impairment have been mostly studied in X-linked hypophosphatemia (XLH) patients and in Hyp mice, the animal model of this disease. In general, children with XLH have short stature with greater shortness of lower limbs than trunk. Treatment with phosphate supplements and 1α vitamin D derivatives heals active lesions of rickets, but does not normalize growth of XLH patients. Patients might benefit from recombinant human growth hormone (rhGH) therapy, which may accelerate the growth rate without increasing body disproportion or correcting hypophosphatemia. These clinical data as well as research findings obtained in Hyp mice suggest that the pathogenesis of defective growth in XLH and other hypophosphatemic syndromes is not entirely dependent on the mineralization disorder and point to other effects of hypophosphatemia itself or FGF23 on the metabolism of bone and growth plate.

Crystallization and preliminary X-ray analysis of the formiminotransferase domain from the bifunctional enzyme formiminotransferase-cyclodeaminase

Formiminotransferase-cyclodeaminase (E.C. 2.1.2.5-E.C. 4.3.1.4) is a bifunctional enzyme involved in the histidine-degradation pathway which exhibits specificity for polyglutamylated folate substrates. The first function of the enzyme transfers the formimino group of formiminoglutamate to the N5 position of tetrahydrofolate, while the second function catalyses the cyclodeamination of the formimino group, yielding N5,10-methenyl-tetrahydrofolate, with efficient channeling of the intermediate between these activities. Initial studies have shown that the enzyme consists of eight identical subunits of 62 kDa each, arranged as a circular tetramer of dimers. It is this formation which results in two different dimeric interfaces, which are necessary for the two different activities. The identical subunits have been shown to consist of two domains, each of which can be obtained as dimers. The formiminotransferase domain has been crystallized in the presence of the substrate analogue folinic acid. The crystals belong to space group P212121, with unit-cell dimensions a = 64.4, b = 103.7, c = 122.3 A. Both a native data set and a mercurial derivative data set have been collected to 2.8 A resolution.

Methylenetetrahydrofolate dehydrogenases in normal and transformed mammalian cells

Transformed mammalian cells express both the usual NADP-dependent trifunctional methylenetetrahydrofolate dehydrogenase-cyclohydrolase-synthetase as well as the bifunctional NAD-dependent methylenetetrahydrofolate dehydrogenase-cyclohydrolase. Antisera to these proteins do not crossreact, and Western blots of cell extracts indicate that there is no inactive form of the NAD-dependent enzyme in normal tissues. Immunofluorescence studies suggest a cytosolic location for the NAD-dependent enzyme, although sequence homology seen in the N-terminal 10 residues indicates a closer relationship with the mitochondrial form of the yeast NADP dependent trifunctional enzyme.