Multigene germline testing usefulness instead of BRCA1/2 single screening in triple negative breast cancer cases

Producción CientíficaTriple negative breast cancer is considered as the worst aggressive subtype with poor prognosis. Recent studies suggest a hereditary component is involve in TNBC development, especially in young patients. However, genetic spectrum remains unclear. Our purpose was to evaluate the usefulness of multigene panel testing in triple negative patients respect overall breast cancer cases as well as contributing to elucidate which genes are most implicated in TNBC development with respect to the remaining breast cancer subtypes. A breast cancer patients sample comprised of 100 triple negative breast cancer patients and 100 other breast cancer subtypes patients were analyzed by Next-Generation Sequencing using an On-Demand panel which included 35 predisposition cancer genes associated with inherited cancer susceptibility. Triple negative breast cancer patients obtained a higher percentage of germline variant carriers. ATM, PALB2, BRIP1 and TP53 were the most non-BRCA mutated genes. Moreover, triple negative breast cancer patients without family history related which proved to be carriers were diagnosed at significant earlier age. As conclusion, our study reinforces the usefulness of multigene panel testing in breast cancer cases but specifically in those with triple negative subtype regardless family history.Junta de Castilla y León. Dirección Regional de Salud de Castilla y León (GRS/2180/A/2020 y GRS/2351/A/2021

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Application of liquid biopsies in metastatic gastrointestinal cancer to identify candidate therapeutic targets

Producción CientíficaBackground:Next-generation sequencing (NGS) of cell-free tumor DNA (ctDNA) hasgreat potential for liquid biopsy in cancer diagnostics and to identify patients withactionable genomic alteration. This study, a prospective longitudinal study, focused ina cohort of metastatic cancer patients without standard effective active antineoplasticmedical treatment options to establish the rate of patients with actionable genomicalteration and the rate of patients accessing medical treatment. The final objective wasto determine the clinical performance based on non-invasive tumor sequencing.Methods:We collected plasma of 10 metastatic gastrointestinal patients with knownstatus of the RAS genes and microsatellites instability in tumor tissue. CtDNA wasextracted from plasma and genomic alterations were analyzed by Guardant 360(Guardant Health, Biosequence, OncoDNA), a next generation sequencing panel. Thispanel consists of 73 cancer related genes and is able to identify different types ofgenomic alterations. Informed consent was obtained from all patients.Results:We were able to identify 78 somatic mutations in total resulting in a mediannumber of eight somatic mutations per patient. The most common altered genes arewell known tumor suppressor and oncogenes like TP53, APC, KRAS, MYC andEGFR.At least one actionable alteration in plasma cfDNA were detected in eight from the 10patients (80%) but the proportion of patients for which a genomic identified recom-mended therapy was available to effectively initiate the treatment were only 37,5%(3/8). In these patients, the identification of alterations like c-MET amplification,FGFR1 amplification or PIK3CA c.1633G>A (p.E545K) mutation, involved inclinically actionable pathways, allowed the selection of a specific therapy. For the rest ofcases the main causes of non-access to medical treatment associated with a specificmutation were, among others, the advanced pre-treated patient and clinical triallogistical access difficulties.Conclusions:Our findings confirm the percentage of cases with potentially druggableaberrations is similar to other studies using this strategy and emphasizes their clinicalvalue to identify candidate therapeutic target

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care