The optimal sequence of radiotherapy and chemotherapy in adjuvant treatment of breast cancer

<p>Abstract</p> <p>Background</p> <p>The optimal time sequences for chemotherapy and radiation therapy after breast surgery for patients with breast cancer remains unknown. Most of published studies were done for early breast cancer patients. However, in Egypt advanced stages were the common presentation. This retrospective analysis aimed to assess the optimum sequence for our population.</p> <p>Methods</p> <p>267 eligible patients planned to receive adjuvant chemotherapy [FAC] and radiotherapy. Majority of patients (87.6%) underwent modified radical mastectomy while, 12.4% had conservative surgery.</p> <p>We divided the patients into 3 groups according to the sequence of chemotherapy and radiotherapy. Sixty-seven patients (25.1%) received postoperative radiotherapy before chemotherapy [group A]. One hundred and fifty patients (56.2%) were treated in a sandwich scheme (group B), which means that 3 chemotherapy cycles were given prior to radiotherapy followed by 3 further chemotherapy cycles. A group of 50 patients (18.7%) was treated sequentially (group C), which means that radiotherapy was supplied after finishing the last chemotherapy cycle. Patients' characteristics are balanced between different groups.</p> <p>Results</p> <p>Disease free survival was estimated at 2.5 years, and it was 83.5%, 82.3% and 80% for patient receiving radiation before chemotherapy [group A], sandwich [group B] and after finishing chemotherapy [group C] respectively (p > 0.5). Grade 2 pneumonitis, which necessitates treatment with steroid, was detected in 3.4% of our patients, while grade 2 radiation dermatitis was 17.6%. There are no clinical significant differences between different groups regarded pulmonary or skin toxicities.</p> <p>Conclusion</p> <p>Regarding disease free survival and treatment toxicities, in our study, we did not find any significant difference between the different radiotherapy and chemotherapy sequences.</p

Prevalence Rate of Congenital Fetal Malformations in Second Trimester by Ultrasound Scanning in Zagazig University Outpatient Clinic

Background: All pregnancies are at a risk of producing congenital malformations, though only some of them are at a greater risk. Congenital anomalies its problem in which abnormalities of structure, function or body metabolism resulting in physical or mental disability or it may be fatal.Objective: This study aimed for early detection of major fetal anomalies to improve fetal and maternal outcome.Patients and methods: This cross-sectional study that include 422 pregnant females was carried out at the Ultrasound Unit and Obstetrics &amp; Gynecology Department, Faculty of Medicine, Zagazig University during the period from December 2018 to July 2019. Results: Ultrasonography can identify at least 35-50% of major fetal malformations with a specificity of 90-100%. Though other methods of screening like biochemical markers and karyotyping are available, ultrasonography has the advantage of being non- invasive, safe, fast, accurate and reproducible with real time display, causing no discomfort to the patient at any time of gestation.Conclusions: The Prevalence of congenital fetal malformations (CFMF) among the study participants using ultrasonography scanning was 3.6%. The most prevalent anomalies were Hydrops fetalis and CVS anomalies. Therefore screening for congenital anomalies in obstetric sonography is an important component of primary healthcare for maternal and child health

Reliability of Spectrum-Efficient Mixed Satellite-Underwater Systems

The combination of radio-frequency (RF) communication and underwater optical wireless communication (UOWC) plays a vital role in the underwater Internet of Things (UIoT). This correspondence proposes a dual-hop hybrid satellite underwater system that exploits non-orthogonal multiple access (NOMA) as a spectrum-efficient access technique. The RF link from the satellite to the relay on an oil platform is presumptively subject to a Shadowed-Rician (SR) fading, while the UOWC channels from the relay to the underwater destinations are suggested to follow Exponential-Generalized Gamma (EGG) distributions. The reliability of the system is characterized in terms of both underwater destinations and system outage probabilities (OPs). We derive new closed-form expressions for the OPs under imperfect successive interference cancellation (SIC) conditions. Furthermore, the asymptotic OP and the diversity order (DO) are obtained to learn more about the system’s performance. The results are verified through an extensive representative Monte-Carlo simulation. Also, we investigate the performance against the turbulence of the salty water, air bubbles level (BL), temperature gradients (TG), shadowing parameters, and satellite pointing errors due to satellite motion, even if the beam is pointed at the center of the directive antenna relay, the beam will randomly oscillate. Finally, we contrast our approach with the conventional orthogonal multiple access (OMA) scheme to demonstrate its superiority

Ultrasonographic Monitoring of Uterine Involution in Postpartum Buffalo Cows

A description of normal ultrasonographic alternations of the uterus in the postpartum (PP) in buffaloes is essential for the diagnosis of pathological conditions and improves the ability to differentiate puerperal pathology from normal physiological changes. The current study aimed to characterize the changes in uterine features assessed ultrasonographically in normal parturient Egyptian buffaloes (n=20) during the post-calving period (Until Day 60 PP). In the current data, ultrasonographic findings indicated that the uterine involution was completed at 4-6 weeks PP in normal calved Egyptian buffaloes. Moreover, calving during the spring season and female new born calves were associated with an enhanced uterine involution. Early cyclicity positively influences endometrial thickness (during early PP), dorsal and ventral uterine curvature, and uterine lumen diameter (during late PP) as compared with the late cyclic group. In conclusion, the uterine involution is ended by the 6th weeks PP in normal parturient Egyptian buffaloes. Moreover, season and calves gender implicate in the changes associated with uterine involution in buffaloes. It is extremely recommended to employ ultrasound examinations in the dairy herd to improve the reproductive efficiency of females by reducing the days open and increasing the number of milking animals

Ultrasonographic Monitoring of Uterine Involution in Postpartum Buffalo Cows: Uterine involution in Buffaloes

A description of normal ultrasonographic alternations of the uterus in the postpartum (PP) in buffaloes is essential for the diagnosis of pathological conditions and improves the ability to differentiate puerperal pathology from normal physiological changes. The current study aimed to characterize the changes in uterine features assessed ultrasonographically in normal parturient Egyptian buffaloes (n=20) during the post-calving period (Until Day 60 PP). In the current data, ultrasonographic findings indicated that the uterine involution was completed at 4-6 weeks PP in normal calved Egyptian buffaloes. Moreover, calving during the spring season and female new born calves were associated with an enhanced uterine involution. Early cyclicity positively influences endometrial thickness (during early PP), dorsal and ventral uterine curvature, and uterine lumen diameter (during late PP) as compared with the late cyclic group. In conclusion, the uterine involution is ended by the 6th weeks PP in normal parturient Egyptian buffaloes. Moreover, season and calves gender implicate in the changes associated with uterine involution in buffaloes. It is extremely recommended to employ ultrasound examinations in the dairy herd to improve the reproductive efficiency of females by reducing the days open and increasing the number of milking animals

Tumor Anti-Initiation and Anti-Progression Properties of Sulphated-Extract of Colocasia esculenta

Colocasia esculenta (Taro) is an edible tuberous plant; however, corms are its most worldwide consumed part while the corm powder is widely used in food industries. In this work, a sulphated polysaccharide extract of C. esculenta corm (SCE) was prepared and its cancer chemopreventive properties was explored. The amending of carcinogen metabolism and radical scavenging affinity revealed that SCE is a strong tumor anti-initiation agent via suppressing cytochrome P450-1A and enhancing glutathione and the carcinogen detoxification enzyme; glutathione S-transferase. SCE exhibited a strong scavenging affinity towards critical radicals (hydroxyl and peroxyl). It induced lymphocyte growth and modulated the macrophage functions into an anti-inflammatory profile, via elevating macrophage proliferation and its binding affinity of fluorescein isothiocyanate-lipopolysaccharide (FITC-LPS) and inhibiting nitric oxide and tumor necrosis factor-α generation. Furthermore, SCE showed a potent cytotoxicity against human breast MCF-7 carcinoma cells (IC50 27.73 µg/mL), whereas SCE treatment inhibited the activity of histone deacetylase (HDAC IC50 37.70 µg/mL) and disturbed the pattern of cell cycle phases. An arrest in both S- and G2/M-phases was linked with shifted cell populations towards late apoptosis and necrosis, as detected by flow cytometry. SCE is a promising cancer chemopreventive agent to be used in healthy food industries and for high breast cancer-risk population

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially