Explore the vast range of titles available.

Background For patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design. Methods PDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the enhanced information group (standard information plus video) at 2, 4 or 6 months. Primary endpoint was the decisional conflict scale (0–100, higher scores indicating greater conflict) which was assessed on an individual participant level. Multilevel mixed effects models used a random effect for cluster and a fixed effect for each step to adjust for calendar time and clustering. Robust standard errors were also adjusted for the clustering effect. Results Five hundred twenty-one evaluable questionnaires were returned from 809 eligible patients (64%) in 24 clusters between April 2018 and October 2019. Mean decisional conflict scores in the standard group (N = 184) were 10.88 (SD 11.82) and 8.99 (SD 11.82) in the enhanced group (N = 337), with no statistically significant difference [mean difference − 1.78, 95%CI − 3.82–0.25, p = 0.09]. Compliance with patient information and diagrams was high in both groups although in the enhanced group only 121/337 (36%) reported watching the video. Conclusion The low levels of decisional conflict in PRIMETIME are reassuring and may reflect the high-quality information provision, such that not everyone required the video. This reinforces the importance of working with patients as partners in clinical trials especially in the development of patient-centred information and decision aids.

Background The impact of cancer transcends physical health, affecting mental wellbeing, financial stability, and ability to perform daily tasks, influencing not only patients but also the broader community. Methods Online anonymous surveys (24/01/2023–03/03/2023) were disseminated via charities to individuals treated for breast cancer in the UK and their carers. Multivariable ordered logistic regression models were used to investigate demographic, cancer-related and employment factors associated with physical, wellbeing and financial Quality-of-Life (QoL). Results 470 and 136 participants reported primary (PBC) and metastatic (MBC) breast cancer, respectively. 27% PBC and 35% MBC participants reported experience of financial problems. 17% PBC and 47% MBC participants reported trouble fulfilling caring responsibilities at the time of survey completion. For PBC participants, reports of financial problems were associated with difficulties seeking help for physical or wellbeing issues, which were associated with worse physical and wellbeing QoL. Financial problems, and other challenges were more commonly reported among MBC participants. These factors may impact QoL similarly, so there was no evidence of specific explanatory factors for MBC participants. Conclusions Better understanding of wider impact of breast cancer could lead to better policy and support. Future clinical trials should incorporate more comprehensive assessment of breast cancer’s wider effects.

The purpose of modern radiotherapy is to deliver a precise high dose of radiation which will result in reproductive death of the cells. Radiation should transverse within the tumour volume whilst minimising damage to surrounding normal tissue. Overall 40% of cancers which are cured will have received radiotherapy. Current state of the art treatment will incorporate cross-sectional imaging and multiple high energy X-ray beams in processes called intensity modulated radiotherapy and image guided radiotherapy. Brachytherapy enables very high radiation doses to be delivered by the direct passage of a radiation source through or within the tumour volume and similar results can be achieved using rotational stereotactic X-ray beam techniques. Protons have the characteristics of particle beams which deposit their energy in a finite fixed peak at depth in tissue with no dose beyond this point – the Bragg peak. This has advantages in certain sites such as the spine adjacent to the spinal cord and particularly in children when the overall volume of tissue receiving radiation can be minimised.

γ-Butyrolactone (GBL) is a popular drug of abuse which is easily available over the internet. Following a UK classification change to a class C drug in January 2010, internet supply has become difficult. Some of the effects have resulted in sourcing GBL from industrial solvents. We report a case of a 24-year-old man who was admitted for detoxification from GBL. He reported having sourced the GBL by diluting the contents of nail varnish remover pads with water. During his admission he developed a severe withdrawal delirium and acute renal failure. He required admission to the intensive care unit. Physicians and psychiatrists should be aware of toxic sources of GBL leading to renal failure and consider GBL in those presenting with agitation, psychosis or coma.

Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy. IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1–3, with a tumour size of 3 cm or less (pT1–2), none to three positive axillary nodes (pN0–1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase [non-inferiority margin] at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio [HR] was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634. Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7–83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5–2·3) of patients in the control group, 0·2% (0·02–1·2) in the reduced-dose group, and 0·5% (0·2–1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were −0·73% (−0·99 to 0·22) for the reduced-dose and −0·38% (−0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance [p=0·007 for partial-breast] and breast harder or firmer [p=0·002 for reduced-dose and p<0·0001 for partial-breast]) compared with whole-breast radiotherapy. We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide. Cancer Research UK.

Over a 2-year period, we brainstormed ideas, scoped the literature, obtained funding for dedicated pilot research that provided new data, and produced this Commission report to reduce the effects that breast cancer has on society. Costs and suffering can be financial, physical, psychological, emotional, and social, they affect children, families, local communities, and wider society, can occur at all stages of breast cancer, and are evident even within health-care services that are free at the point of delivery. Equitable access to early diagnosis and treatment is a fundamental need for all individuals to improve their breast cancer survival and quality of life. In collaboration with the WHO Global Breast Cancer Initiative, we call for action to deliver stage-shifting, as a sustained decline in breast cancer mortality rates is achieved by diagnosing at least 60% of invasive cancers at stages I–II.

...-Butyrolactone (GBL) is a popular drug of abuse which is easily available over the internet. Following a UK classification change to a class C drug in January 2010, internet supply has become difficult. Some of the effects have resulted in sourcing GBL from industrial solvents. We report a case of a 24-year-old man who was admitted for detoxification from GBL. He reported having sourced the GBL by diluting the contents of nail varnish remover pads with water. During his admission he developed a severe withdrawal delirium and acute renal failure. He required admission to the intensive care unit. Physicians and psychiatrists should be aware of toxic sources of GBL leading to renal failure and consider GBL in those presenting with agitation, psychosis or coma. (ProQuest: ... denotes formulae/symbols omitted.)

The long-term fluctuations in dry-wet spells were assessed at standard meteorological week (SMW) over India using Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) rainfall data. The weekly sum of rainfall was embedded in Markov Chain Probability Model in Google Earth Engine (GEE) platform to compute initial and conditional probabilities of dry-wet spells during 2009-2020. An effective monsoon window (23rd SMW-39th SMW) was identified where initial probabilities (IPs) of dry (Pd) and wet (Pw) spells intersect at 50% probability level. Significant spatiotemporal variation of IPs was observed with initiation and withdrawal of monsoon over India. The analysis of co-efficient of variation (CV) showed low CV (<60%) in Pd and high CV (>60%) in Pw in semi-arid and arid regions whereas northern, central and eastern regions observed high CV (>60%) in Pd and low CV (<40%) in Pw. The drought prone and moisture sufficient zones were indentified based on the analysis of long-term frequency distribution of dry-wet spells and trend. Inter-comparison of IPs between CHIRPs with IMD (Indian Meteorological Department) and NOAA CPC (National Oceanic and Atmospheric Administration/Climate Prediction Centre) showed encouraging results. The study provides baseline reference for climate-resilient agricultural crop planning with respect to food security.

A multitude of studies have explored the role of artificial intelligence (AI) in providing diagnostic support to radiologists, pathologists, and urologists in prostate cancer detection, risk-stratification, and management. This review provides a comprehensive overview of relevant literature regarding the use of AI models in (1) detecting prostate cancer on radiology images (magnetic resonance and ultrasound imaging), (2) detecting prostate cancer on histopathology images of prostate biopsy tissue, and (3) assisting in supporting tasks for prostate cancer detection (prostate gland segmentation, MRI-histopathology registration, MRI-ultrasound registration). We discuss both the potential of these AI models to assist in the clinical workflow of prostate cancer diagnosis, as well as the current limitations including variability in training data sets, algorithms, and evaluation criteria. We also discuss ongoing challenges and what is needed to bridge the gap between academic research on AI for prostate cancer and commercial solutions that improve routine clinical care.

A novel green method was developed to create pure, safe, and stable silver nanoparticles (AgNPs) using Trema orientalis (L.) leaf extract as a reducing and stabilizing agent and evaluated its antibacterial activity. UV-vis spectroscopy indicated the biogenesis of AgNPs based on the absorbance in the range of 400-500 nm. The Fourier transform infrared spectroscopy (FTIR) revealed that flavonoids play a crucial role in the synthesis and stability of green AgNPs, serving as the primary phytoconstituents involved. AgNPs were spherical, and crystalline in nature. The size ranged from 14.04-34.38 nm as determined by transmission electron microscopy (TEM). For phase determination of the crystalline structure, AgNPs were subjected to X-ray diffraction (XRD). The crystallinity percentage calculated was 79.28%. The investigation using atomic force microscopy (AFM) measured the average roughness, maximum height, and valley depth of AgNPs. The mean surface roughness measured was 12.054 nm. The well diffusion method demonstrated the antibacterial activity of AgNPs against Staphylococcus aureus, resulting in inhibition zones measuring 9 , 10 , 13 , and 14 mm. These effects were observed at concentrations of 25 µg/mL, 50 µg/mL, 75 µg/mL, and 100 µg/mL, respectively. The minimum inhibitory concentration observed against S. aureus was 55.31 μg/ml. This work provides a more sustainable and efficient method of bacterial treatment.