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

ISOLATION AND PURIFICATION OF ANTIBACTERIAL PRINCIPLE FROM AVICENNIA MARINA L IN METHANOL

Objective: The antibacterial principle of Avicennia marina L stem extract was determined by agar well diffusion method followed by GC-MS,1H NMR and 13C NMR.Methods: Methanol was used as the solvent for the isolation of bioactive principle from the stem of Avicennia marina L. Agar well diffusion method was used to screen the antibacterial activity and FRAP method was employed to determine the antioxidant activity for raw and crude extract as well as the purified compound. GC-MS followed by 1H NMR and 13C NMR were used to elucidate the compound responsible for the antibacterial and antioxidant activity.Results: The degree of antioxidant and antibacterial activity differs between raw extract, crude extract and the pure compound. The antioxidant activity is more crude extract (p<0.05) and the antibacterial activity is more of pure compound (p<0.05) than the standard antibiotic gentamicin. GC-MS followed by 1H NMR and 13C NMR revealed that the compound is 2-propenoicacid, 3-(4-hydroxy-3-methoxyphenyl)- also called ferulic acid.Conclusion: The stem extract in methanol shows potential antibacterial and antioxidant activity. It is due to presence of ferulic acid in methanol extract in 14th fraction.Â