With the Iowa State Home Economics Association

Miss Emma Bliven of Sioux City has prepared this summary of helpful articles which have appeared in recent issues of the Journal of Home Economics

A Review of Case-Control and Cohort Studies Examining Pesticides and the Risk of Parkinson\u27s Disease

Parkinson\u27s disease (PD) is the second most common neurodegenerative disease after Alzheimer disease, having an annual incidence of approximately 20 per 100,000 people (Schapira 2004, Fischer 1999). An estimated one million persons in the United States have PD, and this prevalence is likely to rise as the population ages (Schapira 2004). This disorder is characterized pathologically by a loss of dopamine neurons in the substantia nigra pars compacta that produces the neurotransmitter dopamine. The clinical features of PD are motor function abnormalities including tremor, rigidity, slowness of movement, and difficulty with balance. In the early stages of PD, treatments may help to control symptoms, but over time the disease progresses with the development of symptoms such as freezing, falling, autonomic dysfunction, and dementia (Schapira 2004). While the cause of PD is unknown, genetic susceptibility and environmental factors seem to be associated with the disease based on epidemiologic and laboratory studies. Among the environmental risk factors, exposures to pesticides have been researched as a possible cause of PD. This focus on pesticides was sparked by the discovery that a chemical metabolite, similar in structure to the pesticide Paraquot, caused PD-like symptoms in heroin users who were exposed to a synthetic impurity of the drug (Li 2005)

Challenges in Geriatric Oncology—A Surgeon’s Perspective

As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient’s vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians—a shared care approach between surgical oncologists and geriatricians is required

An overview of the Nottingham Research Programme on Primary Breast Cancer in Older Women: breast cancer in older women

The incidence of breast cancer increases with age. Despite this, most research in this field is aimed at the younger patient. Preliminary studies have shown that older women with breast cancer have distinct biological features compared to their younger counterparts. In addition, the focus of treatment of older women may not simply be curative but may be a trade-off between risks of treatment and impact on independence and quality of life. The Nottingham research programme is a unique programme dedicated to primary breast cancer in older women. There are two arms of the research programme 1) determining the biological differences of breast cancer in this cohort 2) exploring the use of geriatric assessment to understand the complex needs and factors contributing to treatment decision making in this group of patients. The overall aim of the research programme is to optimise both the biological and geriatric assessment of older women with primary breast cancer, to provide personalised data at diagnosis, on likely survival and quality of life outcomes following breast cancer treatment. This article will outline why this research programme is important, what it has achieved so far and future aspirations

A Study of Water Clusters Using the Effective Fragment Potential and Monte Carlo Simulated Annealing

Simulated annealing methods have been used with the effective fragment potential to locate the lowest energy structures for the water clusters (H2O)n with n=6, 8, 10, 12, 14, 16, 18, and 20. The most successful method uses a local minimization on each Monte Carlo step. The effective fragment potential method yielded interaction energies in excellent agreement with those calculated at the ab initio Hartree–Fock level and was quite successful at predicting the same energy ordering as the higher-level perturbation theory and coupled cluster methods. Analysis of the molecular interaction energies in terms of its electrostatic,polarization, and exchange-repulsion/charge-transfer components reveals that the electrostatic contribution is the dominant term in determining the energy ordering of the minima on the (H2O)n potential energy surfaces, but that differences in the polarization and repulsion components can be important in some cases

Invasive Lobular Breast Cancer as a Distinct Disease: Implications for Therapeutic Strategy

Invasive lobular carcinoma comprises 10–15% of all breast cancers and is increasingly recognised as a distinct and understudied disease compared with the predominant histological subtype, invasive ductal carcinoma. Hallmarks of invasive lobular carcinoma include E-cadherin loss, leading to discohesive morphology with cells proliferating in single-file strands and oestrogen receptor positivity, with favourable response to endocrine therapy. This review summarises the distinct histological and molecular features of invasive lobular carcinoma with focus on diagnostic challenges and the impact on surgical management and medical therapy. Emphasis is placed on recent advances in our understanding of the unique molecular biology of lobular breast cancer and how this is optimising our therapy approach in the clinic

Does Breast Cancer Surgery Impact Functional Status and Independence in Older Patients? A Narrative Review

Surgery is the recommended treatment modality for primary breast cancer. Breast cancer surgery is non-visceral; therefore, it is often assumed that the subsequent impact on functional status in older women is less significant compared to other cancer types such as colorectal cancer. Evidence for this however, is lacking. The definition of functional status varies amongst healthcare professionals and patients, making comparisons between studies difficult. From the literature, the two most common themes in relation to functional status following breast cancer surgery are activities of daily living and quality of life. Both of these elements of functional status are adversely impacted in patients following breast cancer surgery. A more significant decline is seen in patients with pre-existing comorbidities and with greater intensity of surgery, which includes more invasive breast and/or axillary surgery as well as additional reconstructive procedures. Identifying and optimising pre-existing factors which may predict post-operative decline in functional status, such as cognitive impairment and deteriorating functional decline over the preceding year, may help in reducing deterioration in functional status after breast cancer surgery. Methods which may be employed to detect and optimise these factors include geriatric assessment and exercise intervention

Biology of oestrogen-receptor positive primary of core needle biopsy samples and correlation with clinical outcome

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. The majority of biological profiling studies use surgical excision (SE) samples, excluding patients receiving nonsurgical and neoadjuvant therapy. We propose using core needle biopsy (CNB) for biological profiling in older women. Over 37 years (1973–2010), 1 758 older (≥70 years) women with operable primary breast cancer attended a dedicated clinic. Of these, 693 had sufficient quality CNB to construct tissue microarray (TMA). The pattern of biomarkers was analysed in oestrogen receptor (ER)-positive cases, using immunohistochemistry and partitional clustering analysis. The biomarkers measured were: progesterone receptor (PgR), Ki67, Epidermal Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor (HER)-2, HER3, HER4, p53, cytokeratins CK5/6 and CK7/8, Mucin (MUC)1, liver kinase B1 (LKB1), Breast Cancer Associated gene (BRCA) 1, B-Cell Lymphoma (BCL)-2, phosphate and tensin homolog (PTEN), vascular endothelial growth factor (VEGF), and Amplified in breast cancer 1 (AIB1). CNB TMA construction was possible in 536 ER-positive cases. Multivariate analysis showed progesterone receptor (PgR) (p = 0.015), Ki67 (p = 0.001), and mucin (MUC)1 (p = 0.033) as independent predictors for breast-cancer-specific survival (BCSS). Cluster analysis revealed three biological clusters, which were consistent with luminal A, luminal B, and low-ER luminal. The low-ER luminal cluster had lower BCSS compared to luminal A and B. The presence of the low-ER luminal cluster unique to older women, identified in a previous study in SE TMAs in the same cohort, is confirmed. This present study is novel in its use of core needle biopsy tissue microarrays to profile the biology of breast cancer in older women

The impact of tumour biology on the management of primary breast cancer in older women—based on a research programme in Nottingham

The incidence of breast cancer increases with age. Average life expectancies are increasing; the older population is expanding globally. This presents a huge challenge on an international scale in the coming years as more older people are living with breast cancer. Despite this, most research in this field remains focused in younger patients. In this article, we outline the current issues facing understanding of the biology of primary breast cancer in older women with regards to treatment decision making. The main treatment dilemmas concern (I) primary treatment [surgery versus non-operative therapies in estrogen receptor (ER) positive and negative tumours] and (II) adjuvant treatment (such as endocrine therapy or chemotherapy). We then discuss work in this field from the Nottingham Breast Cancer Research Centre, which includes biological assessment of a large (N=1,758) cohort of older (aged ≥70 years) women with primary breast cancer with long-term follow-up data. At a biological level, we understand breast cancer belongs to four main subtypes [luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) over-expression, or triple negative breast cancer (TNBC)], with treatment plans based upon these. The Nottingham group have found a biological cluster unique to older women with primary breast cancer (low ER luminal type), which is not seen in their younger (< 70 years) counterparts, as well as differences between age and clinical outcome in patients with ER-positive, HER2-positive and TNBC. This adds further evidence that the biology of breast cancer in older women is different to that of younger women and therefore, should be treated as such. Finally; we outline future considerations to achieve personalised breast cancer treatment in this cohort which includes optimisation of biological assessment with integrated geriatric assessment