Relationship between the change in tumour-infiltrating lymphocyte level and residual tumour after neoadjuvant chemotherapy in patients with locally advanced breast cancer

To evaluate the tumour-infiltrating lymphocyte (TIL) rates in breast tissue before and after neoadjuvant chemotherapy (NAC) and their impact on survival, eighty-four patients with locally advanced breast cancer (LABC) were assessed. Pre- and post-NAC TIL levels were determined using biopsy and surgical specimens, respectively. The median TIL rate was significantly different before (17.5%) and after (5%) NAC. Pre- and postoperative Ki-67 index, molecular subtype, pre- and post-NAC TIL concentration, and preoperative residual-cancer-burden TIL were significantly associated with pathological complete response (pCR). Specifically, higher pre-NAC TIL levels were associated with higher pCR rates. Postoperative Ki-67 index and pCR, and postoperative Ki-67 index were significant predictors of disease-free (DFS) and overall survival, respectively. The independent prognostic factors for DFS were postoperative Ki-67 score (hazard ratio [HR]: 6.16; p = 0.012), post-NAC TIL score (HR: 0.42; P = 0.041), and pCR (HR: 0.10; P = 0.038). Our study confirms that higher pre-NAC and lower postoperative TIL levels may be surrogate factors for longer DFS, and postoperative TIL rate may predict post-NAC pCR in patients with LABC.

Efficacy of proprioceptive neuromuscular facilitation in improving shoulder biomechanical parameters, functionality, and pain after axillary lymph node dissection for breast cancer: A randomized controlled study

PURPOSE

Axillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT).

METHODS

The study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale).

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05288036.

RESULTS

The results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05).

CONCLUSION

PNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.

The Role of 18F-FDG PET/CT in Predicting the Neoadjuvant Treatment Response in Patients with Locally Advanced Breast Cancer

Purpose

Patients with locally advanced breast cancer (LABC) should be treated with neoadjuvant chemotherapy (NAC). Pathological complete response (pCR) is related to better disease-free survival (DFS). The best strategy for assessing the efficacy of NAC has not been established yet, but several studies have shown that 18F-FDG PET/CT is a potential imaging tool for assessing pCR. The aim of this study is to investigate the merits of 18F-FDG PET/CT imaging in predicting pCR in both axillary and breast tissue and to establish a threshold maximum standard uptake value (SUVmax) for predicting the response after completion of NAC.

Methods

A total of 186 LABC patients, treated with an NAC regimen according to tumor subtype, were retrospectively analyzed in this study. All patients underwent 18F-FDG PET/CT imaging before and after completion of NAC. PET parameters were measured in the most FDG avid breast tissue and axillary lymph nodes. We analyzed the correlation between the tumor SUVmax of the PET/CT response and the pCR after surgery. DFS was also evaluated with respect to pCR.

Results

Higher pCR rates were significantly associated with a higher tumor grade, an initial Ki-67 ≥20% (p = 0.03 and p = 0.003, respectively), a triple-negative subtype (32.9%), and a human epidermal growth factor receptor 2 (HER-2)-positive subtype (24.7%) (p < 0.001). There was a significant correlation between the pCR and a complete response in 18F-FDG PET/CT (p < 0.001). The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT to determine the pCR after NAC were 100%, 72.2%, 85%, 75.2%, and 100%, respectively. We demonstrated a 1.1 cutoff SUVmax for breast tumors after NAC (OR: 3.94, 95% CI: 1.14-5.05, p = 0.004), the 18F-FDG PET/CT response to NAC (OR: 0.50, 95% CI: 0.25-0.99, p = 0.003), and the molecular subtype of breast tumors (OR: 0.58, 95% CI: 0.38-0.88, p = 0.011).

Conclusion

Our results confirm that 18F-FDG PET/CT is a useful method for predicting the NAC response in LABC.

YouTube English videos as a source of information on arm and shoulder exercise after breast cancer surgery

PURPOSE

To examine the reliability, quality and content of YouTube videos on exercises that can be performed after breast cancer (BC) surgery.

METHODS

Videos selected from YouTube using the search terms 'shoulder exercise and BC surgery', 'arm exercise and BC surgery' and 'physiotherapy/physical therapy and BC surgery' were categorised as useful or misleading by a surgeon and a physiotherapist. The videos were analysed using the 5-point DISCERN scale for reliability, the Global Quality Scale for quality and a 10-item scale for comprehensiveness.

RESULTS

Of the 180 videos initially analysed, 82 were included in the study, and 42 (51.2%) were classified as having misleading information and 40(48.8%) as having useful information. The reliability, quality and content scores of the videos containing useful information were higher (p < 0.001). Most of the videos in the useful information group (80%) were uploaded by universities/professional organisations/physicians/physiotherapists, while the majority of those in the misleading information group (47.6%) were uploaded by websites providing independent healthcare information.

CONCLUSION

YouTube can be an important instrument to protect patients from musculoskeletal system complications after BC treatment and improve existing complications. Universities, physicians and physiotherapists should be encouraged to prepare more videos containing full and accurate information on this subject.

Monocyte-to-High-Density Lipoprotein Cholesterol Ratio: a Candidate Parameter for a Risk Assessment Model in COVID-19

BACKGROUND

COVID-19 has become a pandemic and threatened human public health across the world. Determining effective predictive biomarkers that can classify patients according to risk levels is critical to identify cases that can potentially progress to severe complications and death with the rapid progression of the disease. Therefore, we aimed to investigate the utility of the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), a recently emerging inflammatory marker, as a clinically useful inflammation-based marker in determining patients at higher risk of decreased overall survival in patients with COVID-19.

METHODS

The demographics, laboratory data, and MHR of 127 patients with laboratory confirmed COVID-19 were evaluated in terms of clinical outcomes. The patients discharged from the hospital constituted the survivor group, while those that died were evaluated as the non-survivor group.

RESULTS

The MHR values were found to be significantly higher in the non-survivor group compared to the survivors (p < 0.05). The high-density lipoprotein cholesterol (HDL-C) values were significantly lower in the non-survivor group (p < 0.05), while there was no statistically significant difference in the monocyte values (p > 0.05). Spearman's analyses revealed no correlation between the MHR values and white blood cell, neutrophil, ferritin, D-dimer, and C-reactive protein (CRP) in the non-survivor group (p > 0.05). According to the binary logistic regression analysis model, the neutrophil, ferritin, D-dimer, CRP, and MHR values the most significant factors in predicting survival (p = 0.021, p = 0.004, p = 0.000, p = 0.001, and p = 0.016, respectively), and an increase in the neutrophil, ferritin, D-dimer, CRP and MHR values decreased the survival rate by 1.1, 1.5, 1.8, 1.6, and 1.7 times, respectively.

CONCLUSIONS

MHR can help predict the severity of the COVID-19 disease and patient outcomes. Therefore, this parameter can serve as a clinically useful and potentially predictive inflammation-based marker for identifying patients with COVID-19 who are at higher risk of decreased overall survival. Considering the serious consequences of the current and possible future pandemics, the establishment of a risk assessment model, including MHR in COVID-19 and similar infections is of vital importance in reducing morbidity and mortality by identifying potential risk factors that can predict the course of the disease.

Risk Factors for Idiopathic Granulomatous Mastitis Recurrence after Patient-Tailored Treatment: Do We Need an Escalating Treatment Algorithm?

<b><i>Objective:</i></b> Idiopathic granulomatous mastitis (IGM) is a rare, relapsing, benign inflammatory breast disease. Due to the conflicting etiology and differential diagnosis, the effect of varied treatment regimens on high recurrence is controversial. Therefore, we aimed to report our clinical experience in determining risk factors for recurrence after patient-tailored treatment. <b><i>Methods:</i></b> This study evaluated 122 patients diagnosed with IGM according to sociodemographic characteristics, reproductive history, clinical presentation, time of diagnosis and radiological examinations, treatment management, and outcomes. The patients were classified into three groups based on curative treatment settings: medical therapy alone, surgery alone, and combined therapy. <b><i>Results:</i></b> The rates of patients receiving medical therapy alone, surgical therapy alone, and combined therapy were 23, 15.6, and 62.4%, respectively. Low vitamin B₁₂ levels, accompanying rheumatological disease, complaints-fistulae, number of complaints ≥3, presence of erythema nodosum, multicentricity, and treatment modality had a significant effect on disease recurrence (<i>p</i> &#x3c; 0.05). The effect on IGM recurrence was 2.8 times greater for the patients with lower vitamin B₁₂ levels, 4.5 times greater for those with rheumatological disease, 3.3 times greater for those with fistulae, 2.4 times greater for those presenting with ≥3 complaints, 2 times greater for the presence of multicentricity, 2.3 times greater for the presence of erythema nodosum, and 4.5 times greater for the patients receiving medical therapy alone. <b><i>Conclusion:</i></b> Describing a low-risk patient profile can be an alternative while choosing monotherapy methods. For IGM patients at high risk of recurrence, an escalating treatment system may be effective in preventing relapses.

A Qualitative Analysis of Ostomy-Related Patient Education Videos on YouTube

OBJECTIVE

To analyze the content, reliability, and quality of the most viewed YouTube videos targeting patients with ostomies intending to learn about ostomy care (OC).

METHODS

Using the keywords "stoma care," "colostomy care," and "ileostomy care," researchers assessed the publicly visible English-language ostomy patient education videos available on YouTube. A total of 84 videos were independently analyzed by two physicians experienced in OC. Data on video characteristics, source, content, reliability, and quality were collected and recorded for each video separately.

RESULTS

Of the 84 videos analyzed, 49 were classified as useful (58.33%) and 35 as misleading (41.66%). There were statistically significant differences between the groups in terms of the time elapsed since upload (P < .017), reliability (P < .001), comprehensiveness (P < .001), Global Quality Scale scores (P < .001), source (P < .001), and lecturer types (P < .011). The reliability, comprehensiveness, and Global Quality Scale scores were statistically higher for videos uploaded by universities, professional healthcare communities, and nonprofit physicians (P < .001). However, the popularity of the OC videos posted on YouTube was not related to their reliability, comprehensiveness, or quality.

CONCLUSIONS

The open-access nature of the YouTube platform may impair patient education video quality and accuracy. YouTube may be an additional educational tool for OC, but clinicians need to be familiar with specific and reliable resources to guide and educate new patients with ostomies to achieve the best outcomes.

Comparison of Ultrasound-Guided Type-II Pectoral Nerve Block and Rhomboid Intercostal Block for Pain Management Following Breast Cancer Surgery: A Randomized, Controlled Trial

PURPOSE

Although breast-conserving surgery-axillary dissection (BCS-AD) is a minimally invasive surgery, patients may suffer from moderate-to-severe pain. Several regional techniques can be used for pain control. The type II pectoral nerve block (PECS II) and the rhomboid intercostal block (RIB) are interfascial plane blocks that have been reported to provide effective analgesia after breast surgery. This study aims to compare the analgesic efficacy of the PECS II block and the RIB after breast surgery.

PATIENTS AND METHODS

Ninety female patients aged 18 to 65 years with American Society of Anesthesiologists (ASA) classes I and II physical status who underwent unilateral BCS-AD surgery were included. Patients were divided into three groups (n = 30 in each): the PECS II group, the RIB group, or the control group. PECS II block and RIB were performed with 30 mL 0.25% bupivacaine. Ibuprofen 400 mg IV 3 × 1 was given in the postoperative period. A patient control analgesia device included a dose of 10 µg/mL fentanyl, which was prepared and connected to the patients.

RESULTS

There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the PECS II and RIB groups than the control group. The need for rescue analgesia use was significantly higher in the control group than the other groups. At all times, visual analog scale scores were significantly lower in the PECS II and RIB groups than the control group.

CONCLUSIONS

The PECS II block and the RIB provide similar effective analgesia after BCS-AD.

Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients

The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with anogenital condylomata acuminata (CA) and their association with recurrence and squamous intraepithelial neoplasia development. We conducted a descriptive study in 95 patients that had undergone surgical treatment for CA. The descriptive data, disease characteristics, and pre-treatment peripheral inflammatory biomarkers (PIBs) were recorded retrospectively. All parameters were compared in those with recurrent and non-recurrent CA. All PIBs were significantly higher in patients with the greatest genital wart size of >2 cm in the squamous intraepithelial lesion (SIL) group. Human papillomavirus (HPV) types 16, 18, 31 and 33, known to carry high risk for anogenital cancer, were significantly related to higher SII. Greater wart size, high-grade squamous intraepithelial lesion (HSIL), and higher PLR and SII values were highly associated with recurrent disease (p = 0.003, 0.006, 0.005 and 0.000, respectively). Of all recurrences, 34.1% were explained by HSIL and increased PLR and SII values. The prediction of CA recurrence is important to determine those patients at high risk. PLR and SII can be used for risk analysis in selected patient groups.

The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats

Purpose

To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy.

Methods

Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared.

Results

The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536).

Conclusion

Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.