Image-Guided Breast Conserving Surgery

Background: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p<0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p<0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p<0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach

PROTECTIVE EFFECT OF AQUEOUS EXTRACT POMEGRANATE PEEL AGAINST STERIGMATOCYSTIN TOXICITY IN RAT

Introduction and Aim: Sterigmatocystin (Stg) a mycotoxin with mutagenic and carcinogenic properties is commonly found as the contaminant in grains and animal feeds. Pomegranate peel is a rich source of antioxidants, flavonoids and other phenolic compounds. So the aim of the current study was to evaluate the protective effects of aqueous extract of red Pomegranate peel against Stg toxicity in liver, kidney, intestine and lung as well as final body weight using male rats. Methods: Forty eight Sprague-Dawley male rats were divided into six groups (8rats/group) including the control group that fed on a standard diet and water without any treatment, group 2 fed on standard diet plus aqueous extract of RPP (250 mg/rat/day), group 3 fed on standard diet plus aqueous extract of RPP (500 mg/ rat/day), group 4 fed on a standard diet and orally Stg. dissolved at a dose (18µg/rat/day), group 5 fed on a standard diet and Stg  plus aqueous extract of RPP (250mg/day) and group 6 fed on a standard diet and Stg. plus aqueous extract of RPP (500mg/day). At the end of the experimental period, blood samples were collected for serum biochemical analyses. After collecting the blood samples all animals were scarified and dissected samples of liver, kidney, intestine and lung were collected for histological examination. Results: The total phenols and total flavonoids, compounds in aqueous extract of RPP were 1.38 mg/ml and 680.28 mg/ml, respectively. However, the antioxidant activity amounted to 68.0% in the determination of radical DPPH scavenging activity. On the other hand, results indicated that rat orally Stg plus aqueous extract of RPP with low dose and high doses showed a significant improvement in final body weight compared with group administrated of Stg alone. While, the effect of aqueous extract of RPP on kidney and liver function of rats, the results indicated that the rat orally Stg alone caused significant increased in urea, creatinine and uric acid compared with the control group. The aqueous extract of RPP alone at the two tested doses did not induce any significant changes in the biochemical parameters or the histological picture. The combined treatment showed significant improvements in all tested parameters and histological pictures in the liver tissues. Moreover, this improvement was more pronounced in the group received the high dose of aqueous extract of RPP. Conclusion: From results it can be concluded that u the aqueous extract of RPP has a potent antioxidant activity and a protective effect against Stg toxicity and this protection was dose dependent. Keywords: Sterigmatocystin, Red pomegranate peels (RPP), aqueous extract, liver and kidney

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The prediction of axisymmetric free jet turbulent, reacting flows.

Imperial Users onl