Causes of death in women with breast cancer: a risks and rates study on a population-based cohort

IntroductionThe increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors.Materials and methodsUsing data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area.ResultsThe study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50–69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II–III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and “other diseases” in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50–69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest.ConclusionThe integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Laparoscopic isolated caudate lobectomy of two symptomatic familiar giant liver hemangiomas, case reports and literature review

Background and objective: Liver hemangioma (LH) is the most common benign tumour of the liver, but its origin is still not clear and not much is known about a possible familiarity. Caudate lobectomy is the most effective surgical treatment for benign tumors arisen in segment I. The occurrence of giant LH within the same liver segments in different members of the same family has never been described in literature. Herein we report the first two consecutive laparoscopic caudate lobectomy for familiar giant LH in a father and his daughter. Methods: The father showed a lesion in the caudate lobe (CL) suggestive of LH steadily grown, asymptomatic for 24 years until it has caused abdominal discomfort and pain (Dmax 89 mm). The daughter showed multiple hepatic hemangiomas with the biggest one located in the CL compressing the inferior vena cava (Dmax 88 mm). Results: Despite the size of the masses, we opted for a pure laparoscopic approach and a caudate lobectomy was performed in both cases. Operation time was 140 and 180 min. Patients had an uneventful recovery and a good outcome after the scheduled follow up exams 6 months after the procedure. Conclusions: A chance of familiarity transmission for hemangiomas exists and therefore should be further investigated. Laparoscopic isolated caudate lobectomy for symptomatic GLH is feasible and safely performed on selected patients by experienced hepatobiliary surgeons. Prospective randomized studies on larger populations are needed to assess if this minimally invasive approach can be proposed as a standard of care for S-I LH

Seroprevalence of chronic Chlamydia pneumoniae infection in patients affected by chronic stable asthma.

OBJECTIVE: To evaluate the seroprevalence of Chlamydia pneumoniae and age, gender and smoking habits in stable asthmatic patients. METHODS: Over a period of 3 months, 197 adult patients affected by intermittent-to-severe chronic asthma were enrolled from 16 respiratory disease units in the south of Italy. As a control group, we tested 185 healthy, non-asthmatic subjects matched for age and gender, recruited among hospital staff. All patients were submitted to clinical examination, spirometry and blood collection for C. pneumoniae serology. The presence of infection was investigated by microimmunofluorescence (Micro-IF Test) for C. pneumoniae-specific IgG, IgM and IgA antibodies. RESULTS: C. pneumoniae IgG titers > or =1 : 64 were detected in 30.4% of asthmatics and in 30.8% of controls. Correlation of age, gender and smoking habit with C. pneumoniae seropositivity was evaluated by linear regression analysis. Age was significantly associated with C. pneumoniae IgG titer > or =1 : 64 when seropositive asthmatics were tested. Moreover, C. pneumoniae seroprevalence was higher among smokers with a diagnosis of chronic asthma. CONCLUSIONS: The seroprevalence of C. pneumoniae in stable asthmatics was comparable with the controls; therefore, the study does not support the association between C. pneumoniae antibody titers and stable asthma. However, the analysis for likely confounders such as age, gender and smoking status suggests a possible association of enhanced susceptibility to C. pneumoniae infection with age and smoking habitus

A dedicated simulation chain for Hypervelocity Impacts effects on DISC sensor

Comet Interceptor is an ESA Fast-class space mission, which will be launched in 2029 towards an as-yet undiscovered Dynamically New Comet, i.e. never having approached the Sun before, or even an interstellar body. Comet Interceptor consists of three spacecrafts that will flyby the selected DNC. DISC sensors (part of Dust Field and Plasma suite) will be mounted on board two of the three foreseen S/C, aiming to determine cometary dust dynamical properties retrieving information from the particles impinging its sensitive surface. The DISC sensing plate will be exposed to the cometary dust environment thus subjected to Hypervelocity Impacts (HVI), due to the high speed of the flyby (10 - 70 km/s). Nowadays facilities don't let to test all the possible impact cases DISC will be subjected into the cometary environment (very high relative speed during flyby). To overcome this limitation, we set up a simulations system for the sensor with ANSYS TM software and AUTODYN TM hydrocode, capable of simulating a wide range of impacts characteristics (e.g. speeds, particles sizes) DISC will face during the operative phase. The simulation system involves a hybrid model discretized with both Smooth Particles Hydrodynamic (SPH) and Finite Element methods, and it is organized in two main steps: 1. The first step includes the region very close to the impact point, discretized with SPH. Here is reproduced the impact and the impacted surface evolvement from the generated shockwave, large material deformation and compression, till the formation of Lamb waves and the start of the elastic regime. 2. The second step is a transient structural analysis involving Finite Element discretization. The output of the previous step is used as input for this second one, which is applied to the entire DISC sensing plate to obtain the HVI effects till the plate edges, where PZT sensors are placed. This simulation considers the PZTs characteristics to get as output of the simulation the PZT signals. Impacts by different particles diameters and velocities have been simulated. Here we report the simulations system and some of the most relevant final outputs