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

Independent Predictors of Mortality in COVID-19 Myocardial Injury: The Role of Troponin Levels, GRACE Score, SOFA Score, and TIMI Score.

Background Coronavirus disease 2019 (COVID-19) infection is associated with troponin elevation, which is associated with increased mortality. However, it is not clear if troponin elevation is independently linked to increased mortality in COVID-19 patients. Although there is considerable literature on risk factors for mortality in COVID-19-associated myocardial injury, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and Sequential Organ Failure Assessment (SOFA) scores have not been studied in COVID-19-related myocardial injury. This data is important in risk-stratifying COVID-19 myocardial injury patients. Methodology Of the 1,500 COVID-19 patients admitted to our hospitals, 217 patients who had troponin levels measured were included. Key variables were collected manually, and univariate and multivariate cox regression analysis was done to determine the predictors of mortality in COVID-19-associated myocardial injury. The differences in clinical profiles and outcomes of COVID-19 patients with and without troponin elevation were compared. Results Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (p = 0.01), oxygen support (p \u3c 0.01), low absolute lymphocyte (p \u3c 0.01), elevated blood urea nitrogen (p \u3c 0.01), higher C-reactive protein (p \u3c 0.01), higher D-dimer (p \u3c 0.01), higher lactic acid (p \u3c 0.01), and higher Quick SOFA (qSOFA), SOFA, TIMI, and GRACE (all scores p \u3c 0.01). On univariate cox regression, troponin elevation (hazard ratio (HR) = 1.85, 95% confidence interval (CI) = 1.18-2.88, p \u3c 0.01), TIMI score \u3e3 (HRv = 1.79, 95% CI = 1.11-2.75, p = 0.01), and GRACE score \u3e140 (HR = 2.27, 95% CI = 1.45-3.55, p \u3c 0.01) were highly associated with mortality, whereas cardiovascular disease (HR = 1.40, 95% CI = 0.89-2.21, p = 0.129) and cardiovascular risk factors (HR = 1.15, 95% CI = 0.73-1.81, p = 0.52) were not. After adjusting for age, use of a non-rebreather or high-flow nasal cannula, hemoglobi

Anatomically Standardized Maps Reveal Distinct Patterns of Cartilage Thickness With Increasing Severity of Medial Compartment Knee Osteoarthritis.

While cartilage thickness alterations are a central element of knee osteoarthritis (OA), differences among disease stages are still incompletely understood. This study aimed to quantify the spatial-variations in cartilage thickness using anatomically standardized thickness maps and test if there are characteristic patterns in patients with different stages of medial compartment knee OA. Magnetic resonance images were acquired for 75 non-OA and 100 OA knees of varying severities (Kellgren and Lawrence (KL) scores 1-4). Three-dimensional cartilage models were reconstructed and a shape matching technique was applied to convert the models into two-dimensional anatomically standardized thickness maps. Difference thickness maps and statistical parametric mapping were used to compare the four OA and the non-OA subgroups. This analysis showed distinct thickness patterns for each clinical stage that formed a coherent succession from the non-OA to the KL 4 subgroups. Interestingly, the only significant difference for early stage (KL 1) was thicker femoral cartilage. With increase in disease severity, typical patterns developed, including thinner cartilage in the anterior area of the medial condyle (significant for KL 3 and 4) and thicker cartilage in the posterior area of the medial and lateral condyles (significant for all OA subgroups). The tibial patterns mainly consisted of thinner cartilage for both medial and lateral compartments (significant for KL 2-4). Comparing anatomically standardized maps allowed identifying patterns of thickening and thinning over the entire cartilage surface, consequently improving the characterization of thickness differences associated with OA. The results also highlighted the value of anatomically standardized maps to analyze spatial variations in cartilage thickness. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2442-2451, 2017

Identifying the consequences of ocean sprawl for sedimentary habitats

Extensive development and construction in marine and coastal systems is driving a phenomenon known as “ocean sprawl”. Ocean sprawl removes or transforms marine habitats through the addition of artificial structures and some of the most significant impacts are occurring in sedimentary environments. Marine sediments have substantial social, ecological, and economic value, as they are rich in biodiversity, crucial to fisheries productivity, and major sites of nutrient transformation. Yet the impact of ocean sprawl on sedimentary environments has largely been ignored. Here we review current knowledge of the impacts to sedimentary ecosystems arising from artificial structures. Artificial structures alter the composition and abundance of a wide variety of sediment-dependent taxa, including microbes, invertebrates, and benthic-feeding fishes. The effects vary by structure design and configuration, as well as the physical, chemical, and biological characteristics of the environment in which structures are placed. The mechanisms driving effects from artificial structures include placement loss, habitat degradation, modification of sound and light conditions, hydrodynamic changes, organic enrichment and material fluxes, contamination, and altered biotic interactions. Most studies have inferred mechanism based on descriptive work, comparing biological and physical processes at various distances from structures. Further experimental studies are needed to identify the relative importance of multiple mechanisms and to demonstrate causal relationships. Additionally, past studies have focused on impacts at a relatively small scale, and independently of other development that is occurring. There is need to quantify large-scale and cumulative effects on sedimentary ecosystems as artificial structures proliferate. We highlight the importance for comprehensive monitoring using robust survey designs and outline research strategies needed to understand, value, and protect marine sedimentary ecosystems in the face of a rapidly changing environment