Breast Cancer Recurrence Rate Not Up With Autologous Fat Transfer

THURSDAY, Nov. 15, 2018 — For patients with breast cancer, reconstruction with autologous fat transfer (AFT) seems not to increase the rate of locoregional recurrence versus conventional breast reconstruction, according to a study published online Oct. 10 in JAMA Surgery.

Todor Krastev, M.D., Ph.D., from the Maastricht University Medical Center in the Netherlands, and colleagues matched 287 patients with 300 affected breasts receiving AFT between 2006 and 2014 to 300 nonexposed control patients based on age, type of oncologic surgery, tumor invasiveness, and disease stage. AFT patients were followed for a mean of 9.3 years, including 5.0 years following AFT; control patients were followed for a mean of 8.6 years after primary surgery.

The researchers identified eight locoregional recurrences in the treatment group and 11 among the control group, for an unadjusted hazard ratio of 0.63 (95 percent confidence interval, 0.25 to 1.60; P = 0.33). In relevant subgroups based on the type of oncologic surgery, tumor invasiveness, or pathologic stage, there were no increased locoregional recurrence rates. With respect to distant recurrences or breast cancer-specific mortality, no increased risks were detected with AFT.

“In line with reported rates from other published matched cohorts, there is no clinical evidence so far to suggest that AFT leads to increased rates of cancer relapse in patients with breast cancer,” the authors write.

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Posted: November 2018

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Rest easy: Insomnia does NOT cause an early death

Rest easy: Insomnia does NOT cause an early death, finds largest study ever into lack of sleep

  • Review of more than 36m people found no evidence it affects mortality
  • But critic argues while most can cope with insomnia, it is serious for some
  • Insomnia is the most common sleep disorder; affects 10-to-30% of people 
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Insomnia sufferers should rest easy as the largest ever study into the lack of sleep found it does not cause an early death.

A review of more than 36million people revealed there is no evidence struggling to nod off or waking in the night affects mortality.

But a critic argues that while the majority may be able to cope with a few sleepless nights, for some the health consequences can be devastating.


The largest ever study into lack of sleep found insomnia does not cause an early death (stock)

In the first review of its kind, researchers from Flinders University, Adelaide, analysed 17 studies investigating a possible link between insomnia and mortality.

The studies were carried out all over the world for an average of 11 years. Most were made up of patients who self-reported insomnia, while some were officially diagnosed.

Insomnia was defined as either being frequent – struggling to nod off on three or more nights a week – or ongoing – sleeplessness lasting more than a month.

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Results suggest that while insomnia may lead to everything from depression and anxiety to diabetes and dementia, it does not actually affect a person’s lifespan.

The study was published in the journal Sleep Medicine Reviews. 

The researchers, led by Dr Nicole Lovato, believe this should reassure those who toss and turn at night that they are not more likely to pass away prematurely.

WHAT IS INSOMNIA?

Insomnia means you regularly have problems sleeping. It usually gets better by changing your sleeping habits.

You have insomnia if you regularly: find it hard to go to sleep, wake up several times during the night, lie awake at night, wake up early and can’t go back to sleep, still feel tired after waking up

Everyone needs different amounts of sleep. On average, adults need 7 to 9 hours, while children need 9 to 13 hours.

You probably don’t get enough sleep if you’re constantly tired during the day.

The most common causes of insomnia are: stress, anxiety or depression, excessive noise, an uncomfortable bed or alcohol, caffeine or nicotine.

Insomnia usually gets better by changing your sleeping habits. For example, going to bed and waking up at the same time every day, and only going to bed when you feel tired.

Source: NHS

But, they stress, only 17 studies were analysed, which all had a relatively short follow-up time. Longer trials are therefore required to confirm the findings.

They also note cognitive behavioural therapy, which aims to help insomniacs develop coping skills, correct attitudes about sleep and modify poor habits, remains the gold standard of treatment.   

But Dr Russell Foster, head of the Sleep and Circadian Neuroscience Institute at the University of Oxford, argues insomnia can be serious for some.

He told The Times: ‘We recently did a study on teenage sleep. If you just took the average, you would think, “What is all the fuss about?”.

‘However, if you look at the spread of the data you can see 30 per cent are showing really poor sleep.’

For these select few, insomnia may be extremely serious, he added.  

Insomnia is the most common sleep disorder, affecting between 10 and 30 per cent of people. 

It is generally defined as difficulty nodding off, staying asleep or feeling exhausted during the day. 

Previous studies have suggested a lack of sleep increases a person’s heart rate and the time between beats, which was thought to lead to an early death.

However, the current study’s authors argue evidence supporting this is limited, with many studies being small and not adjusting for factors such as smoking or obesity. 

This comes after scientists discovered a ‘sleep switch’ that may be essential to a decent night’s shut eye last month.

A cluster of cells in the region of the brain responsible for sleep become activated as mice are nodding off, according to a study by the Beth Israel Deaconess Medical Center.

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“The work we still will not give”

The Saratov public organization for many years helped patients with diabetes mellitus will cease to exist. The liquidation procedure will start immediately after the widely celebrated world day of struggle against diabetes. NGOs did not survive the pressure of the state, accusing diabetics in violation of the law Oberosterreich agents. Last year, the organization spent to fend off questionable status, and to date, no activities does not, of money in her accounts there.

Last week, the October district court of Saratov has satisfied the claim of Prosecutor’s office of compulsory inclusion of the Saratov regional public organization of disabled patients with diabetes mellitus (SROOMS) toregistry NKO acting as a foreign agent. Although de facto the organization no longer exists discredited the existing trial and ruined the fines imposed by the court for administrative Affairs. The organization is no money for the registration as a foreign agent, notary services now all that goes to bills, charged the bailiffs. Moreover, the appeal is considered by the Supreme court, and the people thought that there is still no final decision, they will be left alone.

Saratov spies

SROOMS worked since 2004 successfully defended the rights of patients with diabetes, beat them to medications, find the doctors.And analyze problem areas in the supply of drugs and was not silent about it.At the beginning of 2017, the social worker wrote a letter to the Governor and the chief Federal inspector, in which he criticized the system of procurement of medicines in the region, indicated that it is not effective, contains corruption risks, etc. And they even thanked for the tip. The facts were confirmed, and several senior officials of the regional Ministry of health and even lost their jobs.

And then begins a incredible. The district Prosecutor’s office receives a statement from not having any relation to Saratov diabetics student of medical University, which I read on the Internet that the NGO is funded by foreign companies. Later he will take his statement, but it won’t change anything.Prosecutor’s office initiated a case on an administrative offence and shall appoint expert check. Speaking expert, Professor of the Saratov state Academy of law Ivan Konovalov gives the conclusion: the text provides a detailed listing of financial aid received from medical organizations in Europe and the United States. The amount is very small only about 645 thousand rubles received since 2009 from several Russian subsidiaries of foreign pharmaceutical companies. But the Law on foreign agents is no minimum donation from abroad.

In addition, the expert enumerates the signs of political activities of public statements in media interviews about the problems of diabetics in the region, as well as that of patients not satisfied with the quality of domestic insulin.And concludes that ROOMSD forms the background to the discredit of authorities and reports to foreign partners information about the so-called pressure points in the region. As a result, in may 2018 diabetics were convicted of an administrative offense under part 1 of article 19.34 of the administrative code (the organization that is a foreign agent without registering in the appropriate register). The court fined the organization for 300 thousand rubles, and thereby, in fact it destroyed. Another 50 thousand roubles of the penalty was awarded to the head of SROOMS Catherine Rogadinae.

People don’t want to do this anymore

Not helped Saratov diabetics and intercession of other public organizations.In particular, the appeal to the Prosecutor General of the Russian Federation, signed by the heads of the Russian Union of patients of the Russian diabetes Association and other major patient communities of the country.

The question of the elimination of the society of chlamydialinfection will consider on November 23. Immediately after widely celebrated in the country of the world day of struggle against diabetes. We still nedadut to work, said the current official head of the organization Laryssa Sagina. People don’t want to do this anymore. All donations that come of nanash account, write off the bailiffs. We cannot hold any event no school available or conference.

She Sagina now helps people more privately, you can do this, as before, she can’t. For example, last year we were able to help 20-year-old boy from the area who was suffering from a terrible pain in my legs, said the social worker. He had walked on the Saratov doctors, but to no avail. The organization is then able to help him with mom to go for a consultation to Moscow. We agreed with the doctors who examined the man, found the cause of his pain, gave recommendations, and now he has got a job. But if we had addressed on behalf of the organization, wrote collective letters and to achieve something, now I can only recommend to people where to go to explain how to write the letter.

Public organization in Russia is in fact helping the government to carry out its functions come to the rescue when the patients are seeing the problem, sounding the alarm, but to reach officials can’t. And yet, when asked about it cares for patients, but forced to remain silent doctors. When you submit a formal organization that can speak on behalf of many people to get on the same level with Ministers and deputies, – says the mother diabetic girl reporter Saratov news Free news (Saratov) Anna Mukhina. It’s one thing when I’m just a mom, or a sick person. It’s quite another when my back is organized. It’s good that we still have social networks and instant messengers which allow people to organize themselves.

None of the NGOs in Russia have not experienced such pressure

According to the Bureau member of the Public Council of premonstrate of Russia Nikolay Dronov, representing the interests of the organization in court, arranged in Saratov judgment, very similar to revenge because of the complaints of diabetics is broken corrupt system of public procurement of medicines in the region. According to him, there are no legal grounds for the recognition of an organization as a foreign agent was not, and the proceedings were conducted with many procedural violations (for example, procuratorsgeneral ordered examination, without waiting for the appointment of the court, and not even releasing the corresponding definition). At the same time, judging by the unprecedented pressure on the organization, this is clearly not the level of the middle of the region and its activities, Ministry of health of the Saratov diabetics interested even FSB and Ministry of justice. It is obvious that behind all this is someone’s commercial interest. I can’t tell who exactly this small organization crossed the road, but none of the NGOs in Russia have not experienced such pressure. It is usually sufficient inspections of the Department and local authorities, the human rights activist believes.

Well, to protect the rights of diabetics now no one: according to the law it should deal with the Prosecutor’s office, but instead she pursues patient organizations than herself, without any foreign agents undermines the authority of the government, says the drones. Recently became widely known history of the 28-year-old Saratovsky, who died in September from complications of diabetes. The last months of her life she spent in the struggle for vital medication. From January 2018, the employees of the city polyclinic №20 do not write out preferential recipes on the necessary drugs.

As found by the regional Prosecutor’s office, this was done in tacit indication of the regional Ministry of health, not in time to buy drugs for beneficiaries. Auction for delivery was announced only in may, and the contract concluded in August. All this time the girl’s family was forced to buy medicines at their own expense, but the right amount of money is not enough. Desperate people turned for help to the Commissioner for human rights in the Saratov region from which the complaint came to the Prosecutor’s office. But that at this time was busy dealing with a foreign agent.

Irina Reznik

Pediatric anesthesia does not affect development outcomes

(HealthDay)—Young children who have surgical procedures that require general anesthesia do not have an increased risk for adverse child development outcomes, according to a study published online Nov. 5 in JAMA Pediatrics.

James D. O’Leary, M.D., from The Hospital for Sick Children in Toronto, and colleagues examined the correlation between surgical procedures that require general anesthesia before primary school entry and child development in a retrospective sibling-matched cohort study, including sibling pairs aged 5 to 6 years with the same birth mother. Participants completed the Early Development Instrument (EDI) population-based measure of child development that assessed readiness to learn in five major domains. Data were included for 2,346 sibling pairs with only one sibling exposed to surgery.

The researchers found that after adjustment for confounding factors, exposed and unexposed children had no significant differences in early developmental vulnerability (22.6 versus 20.0 percent; adjusted odds ratio, 1.03; 95 percent confidence interval, 0.98 to 1.14; P = 0.58). There were also no significant differences for each of the five major EDI domains (language and cognitive development; physical health and well-being; social knowledge and competence; emotional health and maturity; and communication skills and general knowledge).

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