AD51B in Familial Breast Cancer

Common variation on 14q24.1, close to RAD51B, has been associated with breast cancer: rs999737 and rs2588809 with the risk of female breast cancer and rs1314913 with the risk of male breast cancer. The aim of this study was to investigate the role of RAD51B variants in breast cancer predisposition, particularly in the context of familial breast cancer in Finland. We sequenced the coding region of RAD51B in 168 Finnish breast cancer patients from the Helsinki region for identification of possible recurrent founder mutations. In addition, we studied the known rs999737, rs2588809, and rs1314913 SNPs and RAD51B haplotypes in 44,791 breast cancer cases and 43,583 controls from 40 studies participating in the Breast Cancer Association Consortium (BCAC) that were genotyped on a custom chip (iCOGS). We identified one putatively pathogenic missense mutation c.541C>T among the Finnish cancer patients and subsequently genotyped the mutation in additional breast cancer cases (n = 5259) and population controls (n = 3586) from Finland and Belarus. No significant association with breast cancer risk was seen in the meta-analysis of the Finnish datasets or in the large BCAC dataset. The association with previously identified risk variants rs999737, rs2588809, and rs1314913 was replicated among all breast cancer cases and also among familial cases in the BCAC dataset. The most significant association was observed for the haplotype carrying the risk-alleles of all the three SNPs both among all cases (odds ratio (OR): 1.15, 95% confidence interval (CI): 1.11–1.19, P = 8.88 x 10−16) and among familial cases (OR: 1.24, 95% CI: 1.16–1.32, P = 6.19 x 10−11), compared to the haplotype with the respective protective alleles. Our results suggest that loss-of-function mutations in RAD51B are rare, but common variation at the RAD51B region is significantly associated with familial breast cancer risk

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Astonishing diversity—the medicinal plant markets of Bogotá, Colombia

Abstract Background Despite the importance of local markets as a source of medicinal plants in Colombia, comparatively little comparative research reports on the pharmacopoeiae sold. This stands in contrast to wealth of available information for other components of plant use in Colombia and other countries. The present provides a detailed inventory of the medicinal plant markets in the Bogotá metropolitan area, hypothesizing that the species composition, and medicinal applications, would differ across markets of the city. Methods From December 2014 to February 2016, semi-structured interviews were conducted with 38 plant vendors in 24 markets in Bogotá in order to elucidate more details on plant usage and provenance. Results In this study, we encountered 409 plant species belonging to 319 genera and 122 families. These were used for a total of 19 disease categories with 318 different applications. Both species composition and uses of species did show considerable differences across the metropolitan area—much higher in fact than we expected. Conclusions The present study indicated a very large species and use diversity of medicinal plants in the markets of Bogotá, with profound differences even between markets in close proximity. This might be explained by the great differences in the origin of populations in Bogotá, the floristic diversity in their regions of origin, and their very distinct plant use knowledge and preferences that are transferred to the markets through customer demand. Our study clearly indicated that studies in single markets cannot give an in-depth overview on the plant supply and use in large metropolitan areas

No consensus in “traditional” medicine - Medicinal plants and their uses in the markets of Bogotá (Colombia), La Paz/El Alto (Bolivia) and Trujillo/Chiclayo (Perú)

494-498Local markets are an important source of medicinal plants in Bolivia, Colombia and Peru, and detailed information on larger markets in the countries has become available over the last decades. However, little comparative research reports on the pharmacopoeiae sold and the use-diversity between the markets of different countries. The present study provides a detailed comparison of medicinal plant markets in Bolivia, Peru and Colombia, hypothesizing that the species composition, and medicinal applications, should show similarities, based in the common colonial roots of medicinal plant use in the region. In this study, we encountered that both species composition and uses of species did show much larger differences across the evaluated countries than expected. Even in case of introduced species, we did hardly find any coincidence between the markets of the three countries. This might be explained by the great differences in the origin of populations, the floristic diversity, and the very distinct plant use knowledge and preferences of migrant populations in the respective cities that are transferred to the markets through customer demand. Our study clearly indicated that studies in single markets cannot give an in-depth overview on the plant supply across related regions

Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment

Abstract Background The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission. Methods A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Results Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp. Conclusions Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists

Scientists warning on climate change and medicinal plants

The recent publication of a World ScientistsÊ Warning to Humanity highlighted the fact that climate change, absent strenuous mitigation or adaptation efforts, will have profound negative effects for humanity and other species, affecting numerous aspects of life. In this paper, we call attention to one of these aspects, the effects of climate change on medicinal plants. These plants provide many benefits for human health, particularly in communities where Western medicine is unavailable. As for other species, their populations may be threatened by changing temperature and precipitation regimes, disruption of commensal relationships, and increases in pests and pathogens, combined with anthropogenic habitat fragmentation that impedes migration. Additionally, medicinal species are often harvested unsustainably, and this combination of pressures may push many populations to extinction. A second issue is that some species may respond to increased environmental stresses not only with declines in biomass production but with changes in chemical content, potentially affecting quality or even safety of medicinal products. We therefore recommend actions including conservation and local cultivation of valued plants, sustainability training for harvesters and certification of commercial material, preservation of traditional knowledge, and programs to monitor raw material quality in addition to, of course, efforts to mitigate climate change.</p

Plants in the spa – the medicinal plant market of Borjomi, Sakartvelo (Republic of Georgia), Caucasus

25-34As part of a larger ethnobotanical inventory of Skartvelo (Republic of Georgia) we studied the medicinal plant market in Borjomi Spa since 2013. All of the venders in Borjomi featured the same set of medicinal plant mixtures, and essentially no plants were sold separately. Overall, the same 17 distinct mixtures were sold by all venders. Plants, according to the venders, were collected by them in the wider surroundings of Borjomi, and all mixtures were prepared at home. Although the preparations of medicinal plant mixtures in Borjomi seemed very controlled and standardized, the separation of all mixtures into their respective ingredients revealed that most mixtures either contained contaminants, and/or lacked ingredients claimed to be included. This study underlines that in many cases natural remedies sold in markets can be problematic, and that great care should be taken before using any medicine, whether allopathic or complimentary. Linguistic explanations for all plant names and indications are given

Ethnobotany of Samtskhe-Javakheti, Sakartvelo (Republic of Georgia), Caucasus

7-24Samtskhe-Javakheti was formed in the 1990s in southern Georgia from the historical provinces of Meskheti, Javakheti and Tori. The majority of the inhabitants are ethnically Armenian, with a Georgian minority. We documented traditional plant use in Samtskhe-Javakheti, and hypothesized that (1) plant use knowledge in general would be higher in isolated high elevation communities, and that (2) use of home gardens would be much more restricted to lower elevations. Fieldwork was conducted July–August 2013, July–August 2014, and September–October 2015, using semi-structured questionnaires. We encountered 261 plant species belonging to 161 genera of 70 families being used in the region. Of these, 160 species were exclusively wild-collected, 81 grown in homegardens, and 20 were both grown in gardens and collected wild. Most species and uses were widely used across the region, with some particular species in the low lying villages, that allowed a wider variety of species to be grown and gathered. The elevation of informant community significantly fit the ordination in plant-space and use-space. In addition, community significantly fit the ordination for both plant-space and use-space. Informant age significantly fit the plant-space ordination only, while informant gender was not significant in either space