Factors which influence women\u27s decisions for choice of primary surgery for Stage I and Stage II breast cancer

A descriptive correlational study was conducted to describe the factors that Western Australian women with either Stage I or Stage II Breast Cancer, perceived to be important considerations when deciding upon either Modified Radical Mastectomy (MRM) or Breast Conserving Treatment (BCT) for surgical treatment. The Conflict Theory of Decision Making (Janis & Mann, 1977) was used as the theoretical framework to guide this study. Ward, Heidrich and Wolberg\u27s (1989) Factor List, the Multidimensional Health Locus of Control (MHLC) Scale (Wallston, Wallston & De Vellis, 1978) and a demographic questionnaire were used to measure variables. Questionnaires were mailed to a consecutive sample of370 women diagnosed with breast cancer during a six-month period and selected from the Cancer Registry at the Health Department of Western Australia. Results revealed that women who had undergone BCT rated the surgeon\u27s preference as a more important factor and influence on decision-making than the MRM group, t (101.10) = -2.30, p = .02. These women also rated the factor concerning no difference in long term survival between the two surgeries as a more important influence than the MRM group, t (106) = -3.33, p = .00. Area of residence was also significantly associated with surgical choice. Women in rural areas tended to choose MRM rather than BCT, x2(1, N = 160) = 12.75, p = .00. Important sources of information that women used to assist them in decision-making were the surgeon, their family and General Practitioner (GP). There was a significant association between women\u27s involvement in decision-making and use of GP as an information source, x2 (3, N = 164) = 9.94, p = .02. The majority of women (54.30%) wanted the decision for surgery to be fully their own with women in the BCT group preferring a more active role in decision-making compared to the MRM group, u = 2368.00, p = .01. Most women had participated in making their decisions as much as they desired, had enough time in which to make their decisions and had received enough information. A moderate correlation between adequacy of information and enough time for decision making was found, r (158) = .58, p = .00. Correlations were also found between the subscales of MHLC and age, information adequacy, enough time for decision-making, and level of emotional distress. These results will assist health professionals to focus on ways of providing valid information and support to women and their families at the time of decision-making. In particular, findings will assist nurses to better understand the process of decision-making for breast cancer surgery and the main issues of importance to women. Furthermore, nurses will be better able to assist women with their treatment decisions according to their preferred level of involvement

Sequential treatment for idiopathic osteoporosis in premenopausal women: A case report

Idiopathic osteoporosis (IOP) affects young, otherwise healthy individuals with intact gonadal function and no secondary cause for bone loss or fragility. IOP may be associated with major osteoporotic fractures such as low-trauma spine or hip. Aim: To evaluate the safety and effectiveness of sequential treatment in premenopausal women diagnosed with IOP. Case Presentation: A33-year-old premenopausal woman was referred by the Gynecology Department to evaluate bone and mineral metabolism.At 28 years of age, the patient had shown a fracture for bone fragility on her right hip. Attaining menarche at age 9, she had regular menstrual cycles (estradiol: 39.3pg/ml and follicle-stimulating hormone: 8.4mIU/l).At the time of consultation, she showed a bone mineral density (BMD, Hologic Equipment, Discovery Wi) in lumbar spine:0.720g/cm2; Z-score: -3.2, and in total left femur: 0.536g/cm2; Z-score: -3.3. No osteoporosis-provoking secondary causes were identified; thus, it was interpreted as IOP. She received sequential therapy (ST) with teriparatide(PTH1-34; Forteo; Eli Lilly&Co., Indianapolis, IN, USA) for two years, and then with densoumab 60mg s.c. (Prolia; Amgen Inc., California, CA, USA) associated with a calcium dietary supply of 1000mg/day and vitamin D3100.000IU/bi-monthly. Results: A 19% increase in LS BMD (least significant change [LSC]: 2.2%) and 16% in FIT (LSC: 3.0%) was observed. Conclusion: The ST was associated with large increase in BMD of LS and FIT in our patient. No adverse effects associated with teriparatide or denosumab were observed. Further clinical studies are necessary to determine the safety and effectiveness of ST in those premenopausal women withIOP. Until then, ST should be used with caution.Fil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaThe Argentinian Society of Osteology and Mineral Metabolism Annual MeetingCiudad de Buenos AiresArgentinaAsociación Argentina de Osteología y Metabolismo Minera

Mitochondria and neuroprotection in stroke: Cationic arginine-rich peptides (CARPs) as a novel class of mitochondria-targeted neuroprotective therapeutics

Stroke is the second leading cause of death globally and represents a major cause of devastating long-term disability. Despite sustained efforts to develop clinically effective neuroprotective therapies, presently there is no clinically available neuroprotective agent for stroke. As a central mediator of neurodamaging events in stroke, mitochondria are recognised as a critical neuroprotective target, and as such, provide a focus for developing mitochondrial-targeted therapeutics. In recent years, cationic arginine-rich peptides (CARPs) have been identified as a novel class of neuroprotective agent with several demonstrated mechanisms of action, including their ability to target mitochondria and exert positive effects on the organelle. This review provides an overview on neuronal mitochondrial dysfunction in ischaemic stroke pathophysiology and highlights the potential beneficial effects of CARPs on mitochondria in the ischaemic brain following stroke

Sleep disturbance and serum ferritin levels associate with high impulsivity and impulse control disorders in male Parkinson\u27s Disease patients

Impulse control disorders (ICDs) occur in a subset of Parkinson’s disease (PD) patients on dopaminergic medications however there are currently no reliable markers to identify patients at risk. Sleep disturbances are more common in patients with an ICD. Serum ferritin levels have been associated with PD disease stage and progression, but have not previously been associated with impulsivity levels. The objective of this study was to determine if serum ferritin levels and sleep disturbance are associated with high traits of impulsivity and ICD in a cohort of PD patients attending a movement disorders clinic. This study assessed impulsiveness in 87 PD patients using the Barratt Impulsiveness Scale. Severity of sleep disturbance was determined using the sleep-related items of the MDS-UPDRS. Serum ferritin, iron and transferrin levels were measured in patients, as well as 36 age-matched healthy controls. Serum ferritin levels were significantly elevated in male PD patients in the high impulsivity group compared to patients in the low (p=.022) and normal range groups (p=.024) and showed a linear increase across the three groups. Sleep disturbance also demonstrated a linear trend, which was most severe in the high impulsivity group (p=.030). A subgroup of 11 male PD patients who fulfilled the DSM-5 criteria for an ICD had significantly higher ferritin levels and more severe sleep disturbance when compared with the remaining male PD cohort. Serum ferritin levels and sleep disturbance severity are highlighted as potential markers for abnormal impulsivity and ICD in PD patients

Lack of evidence for decreased protein stability in the 2397 (Met) haplotype of the leucine rich repeat kinase 2 protein implicated in Parkinson’s disease

Missense mutations in the leucine rich repeat kinase 2 (LRRK2) gene are the leading genetic cause of autosomal dominant familial Parkinson’s disease. We previously reported that two mutations within the ROC domain, namely R1441C and A1442P, exhibit increased protein degradation leading to lowered steady state LRRK2 protein levels in HEK293 cells. More recently, the common WD40 domain LRRK2 haplotype, Met2397, which is a risk factor for Crohn’s disease, has been shown to lower steady state protein levels in HEK293 cells. In view of recent evidence implicating LRRK2 and inflame-mation in PD, we investigated the effects of Met2397 on LRRK2 expression, and compared them to the Thr2397 variant and other LRRK2 mutants. In this study, we transfected HEK293 cells with plasmid constructs encoding the different LRRK2 variants, and analyzed the resulting protein levels by Western blot and flow cytometry. Here we found that both the Met2397 and Thr2397 haplotypes yield similar levels of LRRK2 protein expression and do not appear to impact cell viability in HEK293 cells, compared to other LRRK mutants. Thus, we have concluded that the Met2397 haplotype is unlikely to play a role in LRRK2 mediated or idiopathic PD

Jurisdiction of the International Court of Justice : analysis of the cases against Chile

Resumen: El presente trabajo aborda el análisis de la problemática de la jurisdicción de la Corte Internacional de Justicia a partir de los casos planteados ante dicho tribunal contra Chile. Desde esa perspectiva y encuadre del análisis se examina la jurisprudencia de la Corte sobre aspectos procesales relativos a su competencia, específicamente, sobre la procedencia de un pronunciamiento preliminar o en oportunidad de expedirse sobre el fondo del asunto atendiendo a las dificultades surgidas de la aplicación del artículo VI del Pacto de Bogotá, así como de la determinación del “objeto” de la diferencia que debe efectuar la Corte para decidir sobre su competencia y sus efectos en la sentencia definitiva del casoAbstracts: This work analyzes the jurisdiction of the International Court of Justice through the cases against Chili submitted to that tribunal. From that perspective and framework it is examined the jurisprudence of the Court concerning procedurals matters on its competence, in particular, whether in the circumstances of the case, an objection lacks an exclusively preliminary character or the Court must reserve its decision on this issue for further proceedings, considering the difficulties relating to the application of article VI of the Pact of Bogotá and the determination of the subject-matter of the dispute by the Court in order to decide about its jurisdiction and its effects on the final judgmen

Proteomic analysis of cortical neuronal cultures treated with poly-arginine peptide-18 (R18) and exposed to glutamic acid excitotoxicity

Poly-arginine peptide-18 (R18) has recently emerged as a highly effective neuroprotective agent in experimental stroke models, and is particularly efficacious in protecting cortical neurons against glutamic acid excitotoxicity. While we have previously demonstrated that R18 can reduce excitotoxicity-induced neuronal calcium influx, other molecular events associated with R18 neuroprotection are yet to investigated. Therefore, in this study we were particularly interested in protein expression changes in R18 treated neurons subjected to excitotoxicity. Proteomic analysis was used to compare protein expression patterns in primary cortical neuronal cultures subjected to: (i) R18-treatment alone (R18); (ii) glutamic acid excitotoxic injury (Glut); (iii) R18-treatment and glutamic acid injury (R18 + Glut); (iv) no treatment (Cont). Whole cell lysates were harvested 24 h post-injury and subjected to quantitative proteomic analysis (iTRAQ), coupled with liquid chromatography-tandem mass spectrometry (LC-MS/ MS) and subsequent bioinformatic analysis of differentially expressed proteins (DEPs). Relative to control cultures, R18, Glut, and R18 + Glut treatment resulted in the detection of 5, 95 and 14 DEPs respectively. Compared to Glut alone, R18 + Glut revealed 98 DEPs, including 73 proteins whose expression was also altered by treatment with Glut and/or R18 alone, as well as 25 other uniquely regulated proteins. R18 treatment reversed the up- or down-regulation of all 73 Glut-associated DEPs, which included proteins involved in mitochondrial integrity, ATP generation, mRNA processing and protein translation. Analysis of protein-protein interactions of the 73 DEPs showed they were primarily associated with mitochondrial respiration, proteasome activity and protein synthesis, transmembrane trafficking, axonal growth and neuronal differentiation, and carbohydrate metabolism. Identified protein pathways associated with proteostasis and energy metabolism, and with pathways involved in neurodegeneration. Collectively, the findings indicate that R18 neuroprotection following excitotoxicity is associated with preservation of neuronal protein profiles, and differential protein expression that assists in maintaining mitochondrial function and energy production, protein homeostasis, and membrane trafficking

Sarcopenia: clinical approach

La sarcopenia, disminución de la masa y rendimiento muscular, es un importante factor de riesgo para la salud en general e, independientemente de la densidad mineral, aumenta el riesgo de sufrir fracturas no vertebrales, especialmente en el hombre. La masa muscular alcanza su mayor desarrollo alrededor de los 40 años y luego disminuye constantemente. Aun después de los 70 años puede disminuir anualmente alrededor del 1% en el hombre y 0,5% en la mujer. Desde el punto de vista clínico, la mejor valoración es la medición de la masa muscular apendicular por DXA. El estudio debe incluir prueba de fuerza (apriete del puño), potencia (pararse/sentarse, subir escalones) y rendimiento (velocidad de la marcha) muscular. La detección/diagnóstico de la sarcopenia debería efectuarse en los sujetos mayores de 65 años e incluso en los menores de esa edad, si sufren caídas frecuentes, fracturas osteoporóticas o falta de fuerza manifiesta. Las intervenciones destinadas a restaurar o prevenir la pérdida de masa y rendimiento muscular deben incluir ejercicios de resistencia, dieta con contenido proteico de 1,0 a 1,2 g/kg de peso y administración de vitamina D para mantener niveles de 25 HOD mayores de 30 ng/ml. Los agentes terapéuticos en investigación incluyen, entre otros, a los anticuerpos antimiostatina y los SARM (moduladores selectivos de los andrógenos).Sarcopenia, the diminution of muscular mass and performance, is an important risk factor for general health and specifically for bone fractures independently of the bone mineral density. After reaching a maximal development around 40 years of age, the muscular mass (MM) diminishes constantly, even after 70 years of age at a rate of 1% per year in men and 0.5% per year in women. From the clinical approach the best measure of MM is accomplished by DXA measuring the appendicular MM. The study of the patient should include physical test to assess strength (hand grip), power (sit/stand test and climb stairs) and muscular performance (walking speed). Subjects over 65 years of age, or those with frequent fall, osteoporotic fractures or manifest diminution of their physical performance could undergo studies for sarcopenia detection. Medical interventions to restore or prevent MM loss should include resistance exercises, protein content of the diet between 1.0 to 1.2 g/kg and vitamin D administration to keep 25 HOD over 30 ng/ml. Intensive research of new agents include, among others, antibodies anti-miostatin and SARM.Fil: Mastaglia, Silvina Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Mautalen, Carlos Alfredo. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin