Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Deformation modes and crashworthiness energy absorption of sinusoidally corrugated tubes manufactured by direct metal laser sintering

Thin-walled structures are used for crashworthiness energy absorption applications such as automobile vehciles and aircraft. Structures of sinusoidally corrugated profiles were of great interest because of their ability to reduce the peak crushing forces and provide stable energy-absorbing patterns. Studies on structures of sinusoidally corrugated profiles are limited to numerical studies due to manufacturing limitations. Advancement in additive manufacturing enables the fabrication of structures of complex profiles such as corrugated tubes. This could solve the issue of mass productions of such structures for energy absorption applications. This paper aims to additively manufacture and test sinusoidally corrugated tubes experimentally. A sample of 8 sinusoidally corrugated tubes was additively manufactured and tested under a quasi-static displacement rate of 20 mm/min. The results showed that corrugated tubes exhibit lower and stable crushing forces compared to conventional straight tubes. It was found that increasing the wavelength from 10 to 20 mm results in changing deformation mode from ring to diamond, while increasing the amplitude from 1 to 2 mm has no effect when the thickness is 1 mm. Corrugated tubes achieved a maximum peak force reduction of 75%, and a maximum crushing force efficiency increase of 63%. However, they also resulted in a reduction of 46 and 55% in energy absorption and specific energy absorption, respectively. - 2019 Elsevier LtdScopu

Experimental analysis of additively manufactured thin-walled heat-treated circular tubes with slits using AlSi10Mg alloy by quasi-static axial crushing test

In this study, additively manufactured aluminum thin-walled tubes with different slit dimensions are proposed to improve energy absorption efficiency. A total of 18 samples, which varied in the number of slits, slit length, slit width, and slit ends, were tested under quasi-static axial compression at a rate of 20 mm/min. The deformation and failure modes, load-displacement curves, and a number of crashworthiness factors were investigated. The factors considered included, but were not limited to, the specific energy absorption, crushing force efficiency, and energy absorbed per stroke. The results indicated that all the considered physical parameters, except for the slit ends, had an influence on the crashworthiness of the structures. The initial peak load decreases significantly as the number, width, and length of the slits increase. The bulk of the tested tubes exhibited a crushing force efficiency greater than 0.8. Overall, the presence of slits with length 15 mm and width 5 mm resulted in lower and smoother crushing forces than the straight tubes and, therefore, greater crushing force efficiency, validating them as crashworthy structures.The authors are grateful to the Department of Mechanical and Industrial Engineering at Qatar University for the financial support provided to this research project.Scopu

Analysis of the Interobserver Variability in Penile Length Assessment

ABSTRACT Introduction Many men seek penile augmentation treatments—a standard tool for their counseling is to inform them of what is “normal.” Although some studies suggest good correlation between stretched and erect penile length, those that have measured stretched and erect length simultaneously have shown significant variability. Aim To assess the accuracy of differing penile measurements with multiple observers. Methods We recruited 201 adult men (mean age 49.6 years) who achieved full erection using intracavernosal injection. Main Outcome Measures Penile measurements were taken by one of seven andrology specialists in a private, temperature-controlled (21°C, 72°F) environment. Stretched flaccid and erect length and circumference were measured. We analyzed the accuracy of each flaccid measurement using the erect measurements as a reference, for the overall patient population and for each observer. Results The mean underestimate of length from stretched flaccid to erect was 2.64 cm (21.4%) and girth 2.27 cm (19.5%). Interobserver variability ranged from a mean underestimate of 16–27% (length) and 15–27% (girth). Conclusions In this large, multicenter, multi-observer study of penis size, flaccid measurements underestimated erect size. It also seems likely that there is significant interobserver variability. We believe erect penis measurements should be used for men being considered for treatment of small penis anxiety. </jats:sec

The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA)

Background: Patients with rheumatoid arthritis (RA) have increased coronary atherosclerosis possibly related to several factors including insulin resistance. Anti-CCP antibodies are highly specific for RA but their association with cardiovascular morbidity has not been examined by enough studies. Aim: The aim of this study was to evaluate the role of anti ccp antibodies and IR for detection of early and sub-clinical atherosclerosis in RA patients. Subjects and methods: 56 RA patients and 19 age and sex matched healthy subjects were included in the present study. All patients and controls were subjected to full history, clinical examination, and laboratory investigations (including CBC, ESR, high sensitive CRP, rheumatoid factor and lipid profile). All patients were also subjected to measurement of intima-media thickness (IMT) of both carotid arteries as well as the flow mediated dilatation (FMD) of brachial artery. Also, measurements of IR (by HOMA 2) and anti-CCP were done for all subjects. Results: IMT was significantly increased (P = 0.01) and FMD significantly decreased (P = 0.001) in RA patients than controls in spite of the absence of significant differences in traditional atherosclerotic risk factors. Both IR and anti-CCP (which are significantly increased in RA compared to controls, P = 0.02 and 0.001 respectively) were significantly positively correlated to IMT (P = 0.009 and 0.001 respectively) and negatively correlated to FMD (P = 0.0005 and 0.005 respectively). Conclusion: IR and anti-CCP may be helpful in the early detection of subclinical atherosclerosis in RA patients

PCR: a sensitive diagnostic tool for Trypanosoma evansi in camels in Egypt

Camel Trypanosomiasis, or Surra, or El Debab as better known, caused by Trypanosoma evansi constitutes an economically important disease that affects the health and production of camels. Two-hundred and ninety-five samples from camels of different ages and sexes were collected from five geographic locations in Egypt (Behera, Cairo, South Sinai, Matrouh, Halayeb and Shalateen). Giemsa-stained smears that were prepared from blood samples were examined microscopically, while PCR coupled with DNA sequencing was applied for molecular detection and phylogenetic analysis. Microscopic and molecular findings revealed a prevalence of 0.34% and 50.51% in the examined camels through stained blood smears and PCR techniques, respectively. T. evansi is enzootic in Egypt, and the PCR technique could preferably be applied in surveillance studies as a more sensitive detection method

Emergence and genetic analysis of variant pathogenic 4/91 (serotype 793/B) infectious bronchitis virus in Egypt during 2019

Infectious bronchitis virus (IBV) affects both vaccinated and unvaccinated flocks worldwide, with a significant impact on the poultry industry. The aim of the present study is to characterize an emerging variant pathogenic IBV originating from field outbreaks in vaccinated Egyptian layer flock. Samples were collected from disease-suspected flock with a history of administration of live and inactivated IBV vaccines (Ma5 type). Virus propagation in embryonated chicken eggs (ECEs), after three successive passages, revealed typical IBV lesions such as curling and dwarfism. The reported isolate was identified by a real-time reverse transcriptase PCR assay targeting nucleocapsid (N) gene and, further characterized by full-length spike (S1) gene sequencing. Phylogenetic analysis revealed clustering of the isolated virus within 4/91 genotype of GI-13 lineage. Deduced amino acid sequences identity revealed 75-76% and 88-90% similarity with the currently used classic (H120, Ma5, and M41) and variant vaccine strains (4/91 and CR88) in Egypt, respectively. Recombination analysis gave an evidence for distinct patterns of origin for the studied isolate providing another example of intra-genotypic recombination among IBVs and the first example of recombination within the GI-13 lineage in the Egyptian field. The studied isolate (IBV/CK/EG/Fadllah-10/2019) emerged as a result of recombination between the variant group (Egy/var I genotype, GI-23 lineage) as a major parent and the CR88 variant vaccine strain (4/91 genotype, GI-13 lineage) as minor parent. Our data suggest that both mutation and recombination may be contributing to the emergence of IBV variants which ascertain the importance of disease monitoring in vaccinated flocks as well as re-appropriation for the current vaccine strategies