“Just live with it”: Having to live with breast cancer related lymphedema

AbstractAn exploratory qualitative research approach was selected for this study aiming to explore how people living with breast cancer related lymphedema experience this complication. Unstructured interviews were conducted with nine purposively selected participants. Living with breast cancer related lymphedema was not easy. Participants were not informed of the possibility of developing lymphedema and felt let down by the medical professionals they consulted. They had to face the physical, psychological and practical consequences without the continuous support of a knowledgeable therapist. Managing the lymphedema was a challenge as they could not afford the necessary treatment and the self-care items. In addition, treatment failure resulted in them feeling exploited and using various treatment options. Nurses should maintain a high level of suspicion of breast cancer related lymphedema, assess patients for lymphedema and refer them to a therapist specifically trained in the management of this debilitating condition.Hierdie studie ondersoek die belewenis van mense met borskanker verwante limfedeem. ‘n Kwalitatiewe eksploratiewe navorsingsontwerp is gekies en ongestruktureerde onderhoude is met nege doelgerig gekose persone gevoer. Limfedeem kompliseer die lewe en die proefpersone het die nie maklik gevind om daarmee saam te leef nie. Hulle is nie ingelig oor die moonlikhied om limfedeem te ontwikkel nie en was van mening dat hulle deur die medici wat hulle behandel het in die steek gelaat is. Die proefpersone moes die fisiese, psigologiese en praktiese gevolge van limfedeem sonder die bystand van ‘n kundige terapeut te bowe kom. Die hantering van die limfedeem was ‘n uitdaging aangesien hulle nie die behandeling en self-sorg artikels kon bekostig nie. Die slegte resultate van behandeling het tot gevolg gehad dat die proefpersone uitgebuit gevoel het en ook verskillende behandelingsopsies gevolg het. Verpleegkundiges moet ‘n hoë vlak van bewustheid ten opsigte van limfedeem handhaaf, pasiënte hiervoor beraam en na ‘n terapeut wat in limfedeem spesialieer verwys

First Responders to Hyperosmotic Stress in Murine Astrocytes: Connexin 43 Gap Junctions Are Subject to an Immediate Ultrastructural Reorganization

In a short-term model of hyperosmotic stress, primary murine astrocytes were stimulated with a hyperosmolar sucrose solution for five minutes. Astrocytic gap junctions, which are mainly composed of Connexin (Cx) 43, displayed immediate ultrastructural changes, demonstrated by freeze– fracture replica immunogold labeling: their area, perimeter, and distance of intramembrane particles increased, whereas particle numbers per area decreased. Ultrastructural changes were, however, not accompanied by changes in Cx43 mRNA expression. In contrast, transcription of the gap junction regulator zonula occludens (ZO) protein 1 significantly increased, whereas its protein expression was unaffected. Phosphorylation of Serine (S) 368 of the Cx43 C–terminus has previously been associated with gap junction disassembly and reduction in gap junction communication. Hyperosmolar sucrose treatment led to enhanced phosphorylation of Cx43S368 and was accompanied by inhibition of gap junctional intercellular communication, demonstrated by a scrape loading-dye transfer assay. Taken together, Cx43 gap junctions are fast reacting elements in response to hyperosmolar challenges and can therefore be considered as one of the first responders to hyperosmolarity. In this process, phosphorylation of Cx43S368 was associated with disassembly of gap junctions and inhibition of their function. Thus, modulation of the gap junction assembly might represent a target in the treatment of brain edema or trauma

Modeling the response of Greenland outlet glaciers to global warming using a coupled flow line-plume model

In recent decades, the Greenland Ice Sheet has experienced an accelerated mass loss, contributing to approximately 25 % of contemporary sea level rise (SLR). This mass loss is caused by increased surface melt over a large area of the ice sheet and by the thinning, retreat and acceleration of numerous Greenland outlet glaciers. The latter is likely connected to enhanced submarine melting that, in turn, can be explained by ocean warming and enhanced subglacial discharge. The mechanisms involved in submarine melting are not yet fully understood and are only simplistically incorporated in some models of the Greenland Ice Sheet. Here, we investigate the response of 12 representative Greenland outlet glaciers to atmospheric and oceanic warming using a coupled line–plume glacier–flow line model resolving one horizontal dimension. The model parameters have been tuned for individual outlet glaciers using present-day observational constraints. We then run the model from present to the year 2100, forcing the model with changes in surface mass balance and surface runoff from simulations with a regional climate model for the RCP8.5 scenario, and applying a linear ocean temperature warming with different rates of changes representing uncertainties in the CMIP5 model experiments for the same climate change scenario. We also use different initial temperature–salinity profiles obtained from direct measurements and from ocean reanalysis data. Using different combinations of submarine melting and calving parameters that reproduce the present-day state of the glaciers, we estimate uncertainties in the contribution to global SLR for individual glaciers. We also perform a sensitivity analysis of the three forcing factors (changes in surface mass balance, ocean temperature and subglacial discharge), which shows that the roles of the different forcing factors are diverse for individual glaciers. We find that changes in ocean temperature and subglacial discharge are of comparable importance for the cumulative contribution of all 12 glaciers to global SLR in the 21st century. The median range of the cumulative contribution to the global SLR for all 12 glaciers is about 18 mm (the glaciers' dynamic response to changes of all three forcing factors). Neglecting changes in ocean temperature and subglacial discharge (which control submarine melt) and investigating the response to changes in surface mass balance only leads to a cumulative contribution of 5 mm SLR. Thus, from the 18 mm we associate roughly 70 % with the glaciers' dynamic response to increased subglacial discharge and ocean temperature and the remaining 30 % (5 mm) to the response to increased surface mass loss. We also find a strong correlation (correlation coefficient 0.74) between present-day grounding line discharge and their future contribution to SLR in 2100. If the contribution of the 12 glaciers is scaled up to the total present-day discharge of Greenland, we estimate the midrange contribution of all Greenland glaciers to 21st-century SLR to be approximately 50 mm. This number adds to SLR derived from a stand-alone ice sheet model (880 mm) that does not resolve outlet glaciers and thus increases SLR by over 50 %. This result confirms earlier studies showing that the response of the outlet glaciers to global warming has to be taken into account to correctly assess the total contribution of Greenland to sea level change

Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Children

Childhood stunting can have negative long-term consequences on cognitive development, academic achievement, and economic productivity later in life. We determined the prevalence of stunting and examined whether stunting and associated risk factors (low dietary diversity, insufficient hemoglobin, food insecurity, and soil-transmitted helminth (STH) infections) are associated with academic achievement and cognitive function among South African children living in marginalized communities. A cross-sectional sample of 1277 children (aged 5-12 years) was analyzed. Stunting was defined according to 2007 WHO growth references. Cognitive functioning was measured with the computerized Flanker task and academic performance via school grades. Blood and stool samples were collected to obtain hemoglobin level and STH infection. Dietary diversity was assessed by a food frequency questionnaire. Associations were examined via mixed linear regression (with school class as a random intercept). Nine percent of the children were stunted (95% CI: 7.6-10.8%). Low dietary diversity (β = 0.13,; p; = 0.004), food insecurity (β = -0.12,; p; = 0.034), and stunting (β = -0.13,; p; = 0.031) were associated with poorer end of the year results among girls. No such associations were found among boys. No significant associations were found for socioeconomic status and hemoglobin levels. The prevalence of stunting and STH infections were low in the present sample. Risk factors seem differently associated with girls' and boys' academic achievement. Promoting nutrition may help to promote academic achievement among girls living in low- and middle-income countries

Associations of growth impairment and body composition among South African school-aged children enrolled in the KaziAfya project

(1) Background: Early childhood malnutrition may result in increased fat mass (FM) among school-aged children in low- and middle-income countries (LMICs). We explored whether South African children with shorter stature have greater overall and abdominal FM compared to normal stature children. (2) Methods: Baseline assessments of body composition and weight were determined among school-aged children enrolled in a randomized controlled trial in Port Elizabeth, South Africa, using bioelectrical impedance analysis. Multiple linear regression models tested associations of children's height and degree of stunting with FM, fat free mass (FFM), truncal fat mass (TrFM), and truncal fat free mass (TrFFM) overall and by sex. (3) Results: A total of 1287 children (619 girls, 668 boys) were assessed at baseline. Reduced child height was associated with higher FM and lower FFM and TrFFM, but these associations were reversed with increases in height. Girls classified as mildly or moderately/severely stunted had higher FM and TrFM but lower FFM and TrFFM, while no association was found for boys. (4) Conclusions: Our study suggests that efforts to reduce the non-communicable disease burden in LMICs should target growth-impaired children who may have greater overall FM and greater abdominal FM

Evaluation of a Physical Activity and Multi-Micronutrient Intervention on Cognitive and Academic Performance in South African Primary Schoolchildren

Executive functions (EFs) are essential for optimal academic development. Appropriate nutrition and physical activity (PA) have been shown to facilitate optimal cognitive development. Therefore, this study examined whether a 12-week school-based PA and multi-micronutrient supplementation (MMNS) intervention would improve cognitive and academic performance. A cluster-randomized controlled trial (RCT) was conducted. Children from four schools located in a peri-urban area of South Africa were randomly assigned to (i) PA + MMNS, (ii) PA + placebo, (iii) MMNS or (iv) placebo. Information processing and inhibitory control were measured with a computerized Flanker task. End-of-year results provided insight into academic achievement. Anthropometric measures were used to determine nutritional status. Data were analyzed with linear mixed-models, adjusting for baseline scores, school classes and age; 932 children (458 girls (49.1 completed baseline and post-intervention assessments. Cognitive performance improved among all four groups, with no significant group x time effects. For academic achievement, there was no significant interaction effect between the combined intervention group and placebo. We encourage future studies in this neglected area in order to determine the most optimal design of school-based nutrition and PA programs to enhance overall cognitive performance

Simulation of the future sea level contribution of Greenland with a new glacial system model

We introduce the coupled model of the Green- land glacial system IGLOO 1.0, including the polythermal ice sheet model SICOPOLIS (version 3.3) with hybrid dy- namics, the model of basal hydrology HYDRO and a param- eterization of submarine melt for marine-terminated outlet glaciers. The aim of this glacial system model is to gain a better understanding of the processes important for the future contribution of the Greenland ice sheet to sea level rise under future climate change scenarios. The ice sheet is initialized via a relaxation towards observed surface elevation, impos- ing the palaeo-surface temperature over the last glacial cycle. As a present-day reference, we use the 1961–1990 standard climatology derived from simulations of the regional atmo- sphere model MAR with ERA reanalysis boundary condi- tions. For the palaeo-part of the spin-up, we add the temper- ature anomaly derived from the GRIP ice core to the years 1961–1990 average surface temperature field. For our pro- jections, we apply surface temperature and surface mass bal- ance anomalies derived from RCP 4.5 and RCP 8.5 scenar- ios created by MAR with boundary conditions from simula- tions with three CMIP5 models. The hybrid ice sheet model is fully coupled with the model of basal hydrology. With this model and the MAR scenarios, we perform simulations to estimate the contribution of the Greenland ice sheet to future sea level rise until the end of the 21st and 23rd centuries. Fur- ther on, the impact of elevation–surface mass balance feed- back, introduced via the MAR data, on future sea level rise is inspected. In our projections, we found the Greenland ice sheet to contribute between 1.9 and 13.0 cm to global sea level rise until the year 2100 and between 3.5 and 76.4 cm until the year 2300, including our simulated additional sea level rise due to elevation–surface mass balance feedback. Translated into additional sea level rise, the strength of this feedback in the year 2100 varies from 0.4 to 1.7 cm, and in the year 2300 it ranges from 1.7 to 21.8 cm. Additionally, taking the Helheim and Store glaciers as examples, we inves- tigate the role of ocean warming and surface runoff change for the melting of outlet glaciers. It shows that ocean temper- ature and subglacial discharge are about equally important for the melting of the examined outlet glaciers

Ki67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment

<p>Abstract</p> <p>Background</p> <p>The pathological complete response (pCR) after neoadjuvant chemotherapy is a surrogate marker for a favorable prognosis in breast cancer patients. Factors capable of predicting a pCR, such as the proliferation marker Ki67, may therefore help improve our understanding of the drug response and its effect on the prognosis. This study investigated the predictive and prognostic value of Ki67 in patients with invasive breast cancer receiving neoadjuvant treatment for breast cancer.</p> <p>Methods</p> <p>Ki67 was stained routinely from core biopsies in 552 patients directly after the fixation and embedding process. HER2/neu, estrogen and progesterone receptors, and grading were also assessed before treatment. These data were used to construct univariate and multivariate models for predicting pCR and prognosis. The tumors were also classified by molecular phenotype to identify subgroups in which predicting pCR and prognosis with Ki67 might be feasible.</p> <p>Results</p> <p>Using a cut-off value of > 13% positively stained cancer cells, Ki67 was found to be an independent predictor for pCR (OR 3.5; 95% CI, 1.4, 10.1) and for overall survival (HR 8.1; 95% CI, 3.3 to 20.4) and distant disease-free survival (HR 3.2; 95% CI, 1.8 to 5.9). The mean Ki67 value was 50.6 ± 23.4% in patients with pCR. Patients without a pCR had an average of 26.7 ± 22.9% positively stained cancer cells.</p> <p>Conclusions</p> <p>Ki67 has predictive and prognostic value and is a feasible marker for clinical practice. It independently improved the prediction of treatment response and prognosis in a group of breast cancer patients receiving neoadjuvant treatment. As mean Ki67 values in patients with a pCR were very high, cut-off values in a high range above which the prognosis may be better than in patients with lower Ki67 values may be hypothesized. Larger studies will be needed in order to investigate these findings further.</p