BREAST-Q measurement of the patient perspective in oncoplastic breast surgery: a systematic review

Background: Since BREAST-Q was developed in 2009, it has been widely used by clinicians and researchers to capture information regarding health-related quality of life (HRQoL) and patient satisfaction related to breast surgery. Yet clinical guidelines regarding the use of BREAST-Q for assessment of success of surgery in women with breast cancer remain limited. In order to maximise the benefits of using BREAST-Q to inform clinical decision making, this systematic review aimed to identify and appraise current evidence on patient reported outcomes (PROs) assessed by BREAST-Q associated with breast oncoplastic surgery. Methods: A detailed search strategy was implemented and electronic databases searched include PubMed, MEDLINE, CINAHL and PsycINFO. Review was limited to peer-reviewed studies published in English from 2009 to January 2018. Any interventional and observational studies that used BREAST-Q to assess PROs in the assessment of breast oncoplastic surgery were included. Results: Fifty-four peer-reviewed articles met inclusion criteria. Fifty-three studies were observational, one study was interventional. Current comparative studies using BREAST-Q indicated that abdominal flap, buttock flap or thigh flap reconstruction offered highest satisfaction with breast; contralateral prophylactic mastectomy with immediate reconstruction offered higher levels of satisfaction with breast, but poor post-surgical physical well-being. Silicone implant and no radiation therapy offered higher level satisfaction and HRQoL. Conclusions: Current evidence showed that BREAST-Q can effectively measure patient’s satisfaction and HRQoL in relation to different type of breast oncoplastic surgeries. BREAST-Q captured meaningful and reliable information from the patients’ perspective. and may be useful for clinical decision making

Why is it critical to achieve a deep molecular response in chronic myeloid leukemia?

The primary goal of tyrosine kinase inhibitor (TKI) therapy for patients with chronic myeloid leukemia is survival, which is achieved by the vast majority of patients. The initial response to therapy provides a sensitive measure of future clinical outcome. Measurement of BCR-ABL1 transcript levels using real-time quantitative polymerase chain reaction standardized to the international reporting scale is now the principal recommended monitoring strategy. The method is used to assess early milestone responses and provides a guide for therapeutic intervention. When patients successfully traverse the critical first 12 months of TKI therapy, most will head towards another milestone response, deep molecular response (DMR, BCR-ABL1 ≤0.01%). DMR is essential for patients aiming to achieve treatment-free remission and a prerequisite for a trial of TKI discontinuation. The success of discontinuation trials has led to new treatment strategies in order for more patients to reach this milestone response. DMR has been incorporated into endpoints of clinical trials and is considered by some expert groups as the optimal treatment response. But is DMR a stable response and does it provide the ultimate protection against TKI resistance and death? Do we need to increase the sensitivity of detection of BCR-ABL1 to better identify the patients who would likely remain in treatment-free remission after TKI discontinuation? Is it necessary to switch current TKI therapy to a more potent inhibitor if the goal is to achieve DMR? These are issues that I will explore in this review.Susan Branfor

Studying the impact of presence of alpha acid glycoprotein and protein glycoprotein in chronic myeloid leukemia patients treated with imatinib mesylate in the State of Qatar

Despite the efficacy of imatinib mesylate (IM) in treating chronic myeloid leukemia (CML), there is a high degree of resistance. Alpha- 1-acid glycoprotein may reduce drug efficacy through its ability to interact with IM and blocks it from reaching its target, while protein glycoprotein (PGP) may reduce the intracellular concentration of the drug via an active pump mechanism. We thus investigated the correlation between AGP and PGP levels and the resistance/response to treatment. A total of 26 CML patients were investigated for AGP and PGP levels at diagnosis and during treatment. There was no significant difference or correlation between AGP levels and the different groups of patients. There was also no significant difference in the fluorescence intensities of PGP levels among the different patient groups. The resistance observed in our CML patient population could not be correlated with AGP and PGP levels. There was no significant pattern of AGP and PGP expression, irrespective of the response or resistance to treatment

BCR::ABL1 transcripts and clinical outcome - interrogating the technique

Commentary on: Dominy et al., Assessment of quantitative PCR for BCR::ABL1 Transcripts in CML: are improved outcomes in patients with e14a2 transcripts an artefact of technologyAbstract not availableSusan Branfor

Emerging Chirality in Artificial Spin Ice

Artificial spin ice, made up of planar nanostructured arrays of simple ferromagnetic bars, is a playground for rich physics associated with the spin alignment of the bars and spin texture associated with the magnetic frustration at the bar vertices. The phase diagram is exotic, showing magnetic monopole-like defects and liquid and solid phases of spins arranged in loop states with predicted chiral order. We show that magnetotransport measurements in connected honeycomb structures yield the onset of an anomalous Hall signal at 50 kelvin. The temperature scale can be attributed to the long-range dipolar ice phase. The topological Hall signal arises because chiral loops form at the sample edges, indicating a generic route to exotic states via nanoarray edge structure

CVD of CrO2: towards a lower temperature deposition process

We report on the synthesis of highly oriented a-axis CrO2 films onto (0001) sapphire by atmospheric pressure CVD from CrO3 precursor, at growth temperatures down to 330 degree Celsius, i.e. close to 70 degrees lower than in published data for the same chemical system. The films keep the high quality magnetic behaviour as those deposited at higher temperature, which can be looked as a promising result in view of their use with thermally sensitive materials, e.g. narrow band gap semiconductors.Comment: 13 pages, 4 figure

Measurable residual disease in chronic myeloid leukemia.

Chronic myeloid leukemia is characterized by a single genetic abnormality resulting in a fusion gene whose mRNA product is easily detected and quantified by reverse-transcriptase polymerase chain reaction analysis. Measuring residual disease was originally introduced to identify patients relapsing after allogeneic stem cell transplantation but rapidly adopted to quantify responses to tyrosine kinase inhibitors. Real-time quantitative polymerase chain reaction is now an essential tool for the management of patients and is used to influence treatment decisions. In this review we track this development including the international collaboration to standardize results, discuss the integration of molecular monitoring with other factors that affect patients' management, and describe emerging technology. Four case histories describe varying scenarios in which the accurate measurement of residual disease identified patients at risk of disease progression and allowed appropriate investigations and timely clinical intervention.Susan Branford, and Jane F. Apperle

Spin polarized transport current in n-type co-doped ZnO thin films measured by Andreev spectroscopy

We use point contact Andreev reflection measurements to determine the spin polarization of the transport current in pulse laser deposited thin films of ZnO with 1% Al and with and without 2%Mn. Only films with Mn are ferromagnetic and show spin polarization of the transport current of up to 55 $\pm$ 0.5% at 4.2 K, in sharp contrast to measurements of the nonmagnetic films without Mn where the polarization is consistent with zero. Our results imply strongly that ferromagnetism in these Al doped ZnO films requires the presence of Mn.Comment: Published versio

The non-random walk of chiral magnetic charge carriers in artificial spin ice

The flow of magnetic charge carriers (dubbed magnetic monopoles) through frustrated spin ice lattices, governed simply by Coulombic forces, represents a new direction in electromagnetism. Artificial spin ice nanoarrays realise this effect at room temperature, where the magnetic charge is carried by domain walls. Control of domain wall path is one important element of utilizing this new medium. By imaging the transit of domain walls across different connected 2D honeycomb structures we contribute an important aspect which will enable that control to be realized. Although apparently equivalent paths are presented to a domain wall as it approaches a Y-shaped vertex from a bar parallel to the field, we observe a stark non-random path distribution, which we attribute to the chirality of the magnetic charges. These observations are supported by detailed statistical modelling and micromagnetic simulations. The identification of chiral control to magnetic charge path selectivity invites analogy with spintronics

The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction.

BACKGROUND: Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR. METHODS/DESIGN: The iBRA study is a trainee-led research collaborative project with four phases:Phase 1 - a national practice questionnaire (NPQ) to survey current practicePhase 2 - a multi-centre prospective cohort study of patients undergoing IBBR to evaluate the clinical and patient-reported outcomesPhase 3- an IBBR-RCT acceptability survey and qualitative work to explore patients' and surgeons' views of proposed trial designs and candidate outcomes.Phase 4 - phases 1 to 3 will inform the design and conduct of the future RCT All centres offering IBBR will be encouraged to participate by the breast and plastic surgical professional associations (Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons). Data collected will inform the feasibility of undertaking an RCT by defining current practice and exploring issues surrounding recruitment, selection of comparator arms, choice of primary outcome, sample size, selection criteria, trial conduct, methods of data collection and feasibility of using the trainee collaborative model to recruit patients and collect data. DISCUSSION: The preliminary work undertaken within the iBRA study will determine the feasibility, design and conduct of a definitive RCT in IBBR. It will work with the trainee collaborative to build capacity by creating an infrastructure of research-active breast and plastic surgeons which will facilitate future high-quality research that will ultimately improve outcomes for all women seeking reconstructive surgery. TRIAL REGISTRATION: ISRCTN37664281