The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Understanding the new threat of microplastic pollution in the Ross Sea: a review

Microplastics are defined as plastic particles less than 5mm in diameter. They have spread to the furthest reaches of our marine environments, including coastal waters, deep sea sediments, and Arctic sea ice. Recently they have also been found in the most remote and pristine oceans around the Antarctic, including the Ross Sea. Apart from the frighteningly pervasive presence of microplastics in the world’s oceans, they have emerged as an important area of research because of their potential impacts on the health of marine organisms. Despite the proliferation of research on this topic, none has yet investigated the impact of microplastics in the Ross Sea region in Antarctica. Having been identified as one of the most pristine marine ecosystems on earth, the rapidly increasing prevalence of microplastics poses a new threat to this unique ecosystem. It may be possible to infer the likely impacts of microplastics in this ecosystem based on global findings, but the unique nature of the Ross Sea demands focused research efforts. These should focus on a more accurate understanding of the quantity, distribution and sources of microplastics in this region with the view to mitigate local contributions where possible. Of even greater importance is research dedicated to understanding the impact of microplastics on the key species in the food web of the Ross Sea, as identified by Pinkerton et al. (2014)

Microplastics in the Southern Ocean: Findings from the Continuous Plankton Recorder in the Ross Sea and the East Antarctic Regions

Microplastics are extremely abundant and widely distributed in the marine environment. Recently they have been found in the Southern Ocean around the continent of Antarctica. Research from around the world has begun to demonstrate that microplastics can have detrimental effects on marine organisms. There is almost no information about how microplastics might affect Antarctic marine species. The present article reviews the current state of knowledge about microplastics in the Southern Ocean. The growing alarm about the ubiquitous nature of microplastic pollution has led the Antarctic and Southern Ocean Coalition (ASOC) to recommend that the Continuous Plankton Recorder (CPR) be used as a source of information about microplastics in the Southern Ocean. The CPR analysts from the Australian Antarctic Division (AAD) and New Zealand’s National Institute for Water and Atmospheric research (NIWA) have been collecting a limited amount of data about microplastics alongside their primary research on plankton since 2008. Their data is presented for the first time in this report. The findings support the growing body of evidence that demonstrates the pervasiveness of microplastics, even in remote places such as the Southern Ocean. The findings also demonstrate that while the CPR has some value, it is not the ideal tool for understanding the abundance, distribution and impacts of microplastics on the Antarctic marine ecosystem. There needs to be a more formal protocol for the identification and reporting of microplastics from the CPR. Furthermore, a deliberate and comprehensive survey of the potential sources of microplastics needs to occur, using higher-powered techniques such as FTIR or Ramen spectroscopy for the identification and characterisation of microplastics. We also call for urgent studies that seek to understand how microplastics will affect Antarctic marine organisms, especially the key-stone species, which appear to have the greatest exposure to microplastic pollution

Antarctic sea ice and its implications.

Global warming has caused a significant decrease in sea ice coverage in the Arctic. This is having far reaching implications for the ecosystems, as well as dramatically changing the way that humans interact with the Arctic environment. Climate models predicted that a similar decrease in sea ice would occur in the Antarctic. However, since regular observations began in 1979, the sea ice extent in the Antarctic has been increasing. We review current research that identifies numerous atmospheric and oceanic factors that are influencing sea ice trends. These factors have helped to explain some of the changes observed in sea ice extent at a regional level, but still do not accurately predict sea ice trends for the Southern Ocean as whole. A significant anomaly in sea ice extent that occurred in the austral spring of 2016-17 has confounded scientists, and highlights the limitations of current science and climate models to foresee the trend in sea ice in the Antarctic. Furthermore, we explore the potential implications for Antarctic ecosystems through a review of current literature. This emphasises the critical role of sea ice in the life history of a vast majority of Antarctic species, making them extremely vulnerable to changes in sea ice extent. Finally, we consider the implications for human activities in the Antarctic through a series of case studies. These identify the organisations and industries that will be affected by changes in sea ice, and who will rely on the development of accurate models and predictions to safely plan their future activities in the Antarctic