Fashion And Beauty

For breast cancer patients who underwent a mastectomy who undergo radiation therapy after immediate breast reconstruction, autologous tissue reconstruction provides fewer long-term complications and better cosmetic results than tissue expander and implant reconstruction, according to a study in the November issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

After undergoing a mastectomy (surgical removal of the breast), many women choose to have a breast reconstruction procedure performed immediately to better cope with the psychological and esthetic side effects of the surgery. However, the reconstruction can complicate radiation therapy treatments and sometimes radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.

With radiation therapy increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy, this can cause a problem for both patients and their radiation oncologists.

Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., sought to determine if the type of reconstruction performed on women who were receiving radiation after a mastectomy had an impact on their long-term outcomes.

Two types of reconstruction are available for patients undergoing mastectomy for breast cancer: ATR (autologous tissue reconstruction), which involves the placement of a tissue flap - most commonly from the transverse rectus abdominus muscle - as a breast mound, and TE/I (tissue expander and implant reconstruction), which involves placing an inflatable tissue expander over the chest wall and exchanging it for a permanent implant at a later date.

This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for 38 months following their reconstruction and radiation treatments, and researchers found that ATR is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than TE/I.

None of the 23 ATR patients required surgical intervention, while 33 percent of TE/I patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of ATR patients reported acceptable cosmetic outcome, as opposed to only 54 percent of TE/I patients.

“This study is useful for patients who are candidates for either ATR or TE/I and are making a decision with regards to reconstruction technique,” Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. “Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/ implant reconstruction and radiation therapy.”

ASTRO is the largest radiation oncology society in the world, with 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on ASTRO, visit http://www.astro.org. Visit http://www.rtanswers.org to learn more about radiation therapy.

An editorial published in this week’s Lancet is highly optimistic regarding President-elect Obama’s ability to influence real change in health care policy - one of the United States’ most divisive political issues.

“Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care,” say the writers of the editorial. “Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported.”

They add that, “It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality.”

According to the editorial, Obama’s plan for global health must consider climate change, two ongoing wars, and trade relations. The writers propose six steps with which Obama can effect meaningful change:

1. “Health equity and human security should be a stated objective of foreign policy.”
2. “The DHHS Director of Global Health Affairs, Bill Steiger - who has badly hurt America’s reputation in global health - should be replaced with a more experienced and appropriate politician.”
3. “Mark Dybul, the head of PEPFAR - the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies - will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies - for example, its preference for abstinence-until-marriage programmes.”
4. “Just as George W Bush reinstated the global gag rule - a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning - in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke.”
5. “A public commitment to agree to spend the internationally agreed target of 0.7% of gross national income on aid by 2015 would set a good example to the international community.”
6. “As a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights.”

The writers also hope that Obama will not be as antagonistic towards the UN system as the Bush administration was.

“The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains,” concludes the editorial. “An increase in support - including financial support - for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, ‘change can happen’. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans - and those affected by American foreign policy.”

Obama and health: change can happen
The Lancet (2008). 372[9651]: p. 1708.
Click Here to View Journal Website

Researchers at McGill University, King’s College London and GlaxoSmithKline Inc. have identified two genetic variants in caucasians that together produce an astounding sevenfold increase in the risk of male pattern baldness. Their results were published Oct. 12 in the journal Nature Genetics.

About a third of all men are affected by male pattern baldness by age 45. The condition’s social and economic impact is considerable: expenditures for hair transplantation in the United States alone exceeded $115 million (U.S.) in 2007, while global revenues for medical therapy for male-pattern baldness recently surpassed $405 million. Male pattern baldness is the most common form of baldness, where hair is lost in a well-defined pattern beginning above both temples, and results in a distinctive M-shaped hairline. Estimates suggest more than 80 per cent of cases are hereditary.

This study was conducted by Dr. Vincent Mooser of GlaxoSmithKline, Dr. Brent Richards of McGill University’s Faculty of Medicine and the affiliated Jewish General Hospital (and formerly of King’s College), and Dr. Tim Spector of King’s College. Along with colleagues in Iceland, Switzerland and the Netherlands, the researchers conducted a genome-wide association study of 1,125 caucasian men who had been assessed for male pattern baldness. They found two previously unknown genetic variants on chromosome 20 that substantially increased the risk of male pattern baldness. They then confirmed these findings in an additional 1,650 caucasian men.

“I would presume male pattern baldness is caused by the same genetic variation in non-caucasians,” said Richards, an assistant professor in genetic epidemiology, “but we haven’t studied those populations, so we can’t say for certain.”

Though the researchers consider their discovery to be a scientific breakthrough, they caution that it does not mean a treatment or cure for male pattern baldness is imminent.

“We’ve only identified a cause,” Richards said. “Treating male pattern baldness will require more research. But, of course, the first step in finding a way to treat most conditions it is to first identify the cause.”

“Early prediction before hair loss starts may lead to some interesting therapies that are more effective than treating late stage hair loss,” added Spector, of King’s College and director of the TwinsUK cohort study.

Researchers have long been aware of a genetic variant on the X chromosome that was linked to male pattern baldness, Richards said.

“That’s where the idea that baldness is inherited from the mother’s side of the family comes from,” he explained. “However it’s been long recognized that that there must be several genes causing male pattern baldness. Until now, no one could identify those other genes. If you have both the risk variants we discovered on chromosome 20 and the unrelated known variant on the X chromosome, your risk of becoming bald increases sevenfold.”

“What’s startling is that one in seven men have both of those risk variants. That’s 14 per cent of the total population!”

Mark Shainblum
McGill University

Scientists in Italy have found bacteria in the root of a tropical grass whose oils have been used in the cosmetic and perfumery industries. These bacteria seem to promote the production of essential oils, but also they change the molecular structure of the oil, giving it different flavours and properties: termicidal, insecticidal, antimicrobial and antioxidant.

Studying the root of the tropical Vetiver grass through interdisciplinary research, the microbiologists Pietro Alifano and Luigi Del Giudice, the plant biologist Massimo Maffei and their colleagues found that Vetiver root cells produce a few oil precursors, which are then metabolised by the root bacteria to build up the complexity of the Vetiver oil. The bacteria were found in the oil-producing cells as well as in root locations that are closely associated with the essential oil.

The Vetiver grass is the only grass cultivated specifically for its root essential oil, which is made up of chemicals called sesquiterpenes. These are used in plants as pheromones and juvenile hormones. The essential oils also contain alcohols and hydrocarbons, which, together with the sesquiterpenes are primarily used in perfumery and cosmetics. The perfumery and flavouring industry could benefit from the increased variety that these bacteria provide to the smells and tastes of these oils.

The bacteria responsible for this transformation include alpha-, beta- and gamma-proteobacteria, high-G+C Gram-positive bacteria as well as microbes which belong to the Fibrobacteres / Acidobacteria group.

“This research opens new frontiers in the biotech arena of natural bioactive compounds” said Professor Alifano “Pharmaceutical, perfumery and flavouring industries may now exploit the selected microbial strains and widen their metabolic libraries”.

“The ecological role of plant-microbial associations shows another fascinating aspect” said Professor Maffei “The metabolic interplay between a plant, which offers a few simple molecules, with root bacteria, that biotransform them into an array of bioactive compounds, increases fitness and reveals new cost-efficient survival strategies”

Lucy Collister
Wiley-Blackwell

Surgeons at the University of Illinois Medical Center at Chicago have performed an innovative robotic-assisted procedure to remove parathyroid glands without an incision or scar on the patient’s neck.

Bilal Akbar, 53, suffered from hyperparathyroidism caused by chronic kidney failure. His overactive parathyroid glands produced too much parathyroid hormone (PTH), which caused dangerously high calcium levels in the blood. This can lead to bone, blood vessel and heart damage.

“I’m so glad they didn’t have to cut my neck,” said Akbar, who is the first person in the United States or Europe to undergo a robotic parathyroidectomy. He was released from the hospital one day after surgery.

Most people have four tiny parathyroid glands behind or near the thyroid gland. Traditional surgery to remove the parathyroid glands, or the larger thyroid gland, involves making a 4-inch incision in the lower neck, leaving a noticeable scar after surgery.

A surgical team led by Dr. Pier Cristoforo Giulianotti, chief of minimally invasive, general and robotic surgery at the medical center, used the robotic-assisted da Vinci Surgical System to delicately remove two of Akbar’s four parathyroid glands.

One small incision was made under the patient’s right arm and another tiny incision was made in the chest to accommodate the robotic arms and endoscopic camera.

The parathyroid glands are often difficult to locate, according to Giulianotti, but the da Vinci system provides 3-dimensional visualization, enhanced magnification and a greater range of motion to locate and remove the glands in the delicate and narrow space of the neck.

During surgery, doctors monitored the patient’s parathyroid hormone concentration in the blood. After removing two enlarged non-cancerous tumors of the parathyroid glands, the patient’s hormone levels dropped by more than 50 percent, signifying that the glands removed were over-producing the hormone.

“The cosmetic and psychological benefits of the surgery are evident immediately,” said Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. He anticipates that many patients who need parathyroid and thyroid surgery but who are hesitant to have an incision in the neck will be excellent candidates for the robotic-assisted surgery.

In the United States, about 100,000 people develop hyperparathyroidism each year, according to the National Institutes of Health. Women outnumber men two to one, and risk increases with age.

“Robotic parathyroidectomy and thyroidectomy without neck incision can currently be safely performed at the University of Illinois at Chicago,” said Dr. Enrico Benedetti, the Warren H. Cole Chair in Surgery and professor and head of surgery at UIC. “Considering that the vast majority of patients requiring thyroid surgery are women with benign thyroid disease, the avoidance of a neck incision will be extremely important from a cosmetic standpoint in this patient population.”

A small percent of patients who have traditional parathyroid or thyroid surgery may experience temporary or permanent paralysis of the vocal chords.

The risk of injuring the larynx or vocal cords during robotic-assisted surgery is very low, said Giulianotti, an international pioneer in robotic general surgery and past-president of the Minimally Invasive and Robotic Association (MIRA).

For more information about the University of Illinois Medical Center at Chicago, visit http://www.uillinoismedcenter.org