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The advent and success of new drugs for treating HER2-positive metastatic breast cancer has led to a constant improvement in disease and progression-free survival as well as overall survival. Despite these advantages, the overall survival and quality of life of patients with HER2-positive breast cancer brain metastases are significantly worse than the ones of patients with HER2-positive breast cancer metastases outside the brain. For this reason, prevention and treatment of brain metastasis remain a major clinical challenge and the keys to further improving the clinical and survival outcomes of HER2-positive breast cancer patients. This review discusses the etiopathogenesis of brain metastasis, the currently available treatments, and the future perspective on new treatment strategies and diagnostic tools.

Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient’s spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians’ understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.

The advent and success of new drugs for treating HER2-positive metastatic breast cancer has led to a constant improvement in disease and progression-free survival as well as overall survival. Despite these advantages, the overall survival and quality of life of patients with HER2-positive breast cancer brain metastases are significantly worse than the ones of patients with HER2-positive breast cancer metastases outside the brain. For this reason, prevention and treatment of brain metastasis remain a major clinical challenge and the keys to further improving the clinical and survival outcomes of HER2-positive breast cancer patients. This review discusses the etiopathogenesis of brain metastasis, the currently available treatments, and the future perspective on new treatment strategies and diagnostic tools. [ABSTRACT FROM AUTHOR]

Abstract Background Intravenous drug abuse (IDA) is a known risk factor for infective endocarditis (IE) and is associated with frequent relapses, but its prognostic impact is still debated. The potential futility of surgery in this population is a further issue under discussion. We aimed to describe the clinical characteristics, the therapeutic strategy, and the prognosis associated with IDA in IE. Methods We retrospectively analysed 440 patients admitted to a single surgical centre for definite active IE from January 2012 to December 2020. Results Patients reporting IDA (N = 54; 12.2%) were significantly younger (p

Abstract Background Fragmentation and deforestation are one of the greatest threats to forests, and these processes are of even more concern in the tropics, where the seasonal dry forest is possibly one of the most threatened ecosystems with the least remaining surface area. Methods The deforestation and fragmentation patterns that had occurred in Ecuadorian seasonal dry forests between 1990 and 2018 were verified, while geographic information systems and land cover shapes provided by the Ecuadorian Ministry of the Environment were employed to classify and evaluate three types of seasonal dry forests: deciduous, semi-deciduous, and transition. The study area was tessellated into 10 km2 hexagons, in which six fragmentation parameters were measured: number of patches, mean patch size, median patch size, total edge, edge density and reticular fragmentation index (RFI). The RFI was also measured both outside and inside protected natural areas (unprotected, national protected areas and protected forest). Moreover, the areas with the best and worst conservation status, connectivity and risk of disappearance values were identified by means of a Getis-Ord Gi* statistical analysis. Results The deforestation of seasonal dry forests affected 27.04% of the original surface area still remaining in 1990, with an annual deforestation rate of − 1.12% between 1990 and 2018. The RFI has increased by 11.61% as a result of the fact that small fragments of forest have tended to disappear, while the large fragments have been fragmented into smaller ones. The semi-deciduous forest had the highest levels of fragmentation in 2018. The three categories of protection had significantly different levels of fragmentation, with lower RFI values in national protected areas and greater values in protected forests. Conclusions The seasonal dry forest is fragmenting, deforesting and disappearing in some areas. An increased protection and conservation of the Ecuadorian seasonal dry forest is, therefore, necessary owing to the fact that not all protection measures have been effective.

The research was conducted to determine if there was a mediating effect of employee satisfaction between psychosocial hazards and retention intention among Private Higher Education Institutions (PHEI) employees. With the aid of G*power, a sample size of 120 employees of selected PHEIs in Calamba City were included through a multistage sampling technique. The Job Descriptive Index was adopted to measure employee satisfaction and retention, and the Job-Demands-Control questionnaire (CVR = 1.00) (Cronbach's a = .767) was adapted to measure psychosocial hazards. Employing mediation analysis, data were gathered and analyzed using regression and the Sobel test. It was revealed that among PHEI employees, the level of psychosocial hazards was very low, and the level of employee satisfaction and retention was high. It was also revealed that psychosocial hazards had a significant impact on employee satisfaction (B = 2.281, p<.001), wherein psychosocial hazards accounted for 40.4% of the variance in employee satisfaction, employee satisfaction had a significant impact on retention level (B = -.996, p<.001) wherein, employee satisfaction accounted 63.9% of the variance in retention, and psychosocial hazards had significant impact with retention level (B = .691, p <.001) wherein, psychosocial hazards accounted 39.4% of the variance in retention. Furthermore, employee satisfaction carried a significant effect on the relationship between psychosocial hazards and retention of PHEI employees which meant that the relationship between psychosocial hazards and retention is mediated by employee satisfaction. Lastly, an action plan was proposed intended to be used by the Human Resource Department of each PHEI. [ABSTRACT FROM AUTHOR]

The study employed mixed-method research, specifically a preexperimental case study, to explore the influence of implementing local language explanation-infused learning material (LLE) and activity-based formative assessment (AFA) on mathematics learning. The t-test for dependent samples was used to analyze the influence of LLE and AFA on students' mathematics learning. Thematic analysis of the data from informal interviews, focus group discussions, and observations was used to support the findings. The participants were 38 Grade 9 students from one of the public secondary high schools in the Philippines, identified through purposive sampling and selection criteria. The findings showed that using LLE and AFA significantly improves mathematics learning along with illustrating, modeling, and problem-solving with small to medium effect sizes. The thematic analysis results show that the use of LLE is helpful for students to study independently because they find the lessons more straightforward to understand. The use of AFA helps students enjoy learning through individual and group activities, leading to the development of analytical and critical thinking. The study recommends integrating local languages into instructional materials, providing teacher training on LLE and AFA, ensuring resources of adequate sort for formative assessments, and strengthening monitoring mechanisms to enhance the implementation of these practices in the classroom. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive mitral valve surgery (MIMVS) has been increasingly adopted worldwide as an alternative to conventional sternotomy, especially for young patients. The remarkable results gained by MIMVS have encouraged its application in more complex and fragile patients, such as the elderly, though results in this subgroup remain controversial. It is the aim of this study to assess the postoperative outcomes of patients older than 75 years old undergoing MIMVS, and to compare these results to those of younger patients. Methods: The data of all patients undergoing MIMVS between 2015 and 2022 were retrospectively collected at seven high-volume cardiac surgery centers. Patients were divided into two age-based groups: the young (<65 years old) and the elderly (>75 years old). A propensity score (PS) matching analysis obtained two comparable groups. Postoperative outcomes were assessed in both the unmatched and PS-matched populations. Results: Out of 1113 patients undergoing MIMVS, 524 were young and 279 were elderly. Elderly patients were more commonly affected by multiple comorbidities, with a higher EuroSCORE II (4.6 ± 5.5% vs. 1.6 ± 3.3%, p < 0.001). There was no difference in postoperative mortality, though the elderly had a greater incidence of postoperative complications, such as re-exploration for bleeding, stroke, reintubation, and a need for hemodialysis and blood transfusions. After PS matching, 119 pairs of young and elderly patients with similar risk profiles (EuroSCORE II 2.5 ± 4.7% vs. 2.7 ± 3.2%, p = 0.7) were compared, and no differences in all postoperative outcomes were found. Conclusions: Adequately selected elderly patients can report hospital outcomes similar to young patients after MIMVS. [ABSTRACT FROM AUTHOR]

Abstract Background Valve repair is the treatment of choice for native mitral valve regurgitation. The feasibility of repair when the defect is caused by acute infective endocarditis (IE) is debated. This study aims to compare the outcome of repair and replacement procedures, to report the rate of repair in a single surgical center, and to review the literature on this topic. Results We retrospectively analyzed 108 patients with native mitral IE, potentially eligible for surgical repair. Of these 108, 90 (83%) underwent surgery, and 18 were treated conservatively. Among the 90 surgical patients, 57 (63%) underwent valve replacement and 33 valve repair (37%). The mean follow-up duration was 3 years. The two primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the post-operative incidence of major adverse events (hospitalization for any cause, pacemaker implantation, new onset of atrial fibrillation, sternal dehiscence), left ventricular systolic function (LVSF), and valvular function at 1-year echocardiographic follow-up. All-cause mortality was lower for valve repair, although not significantly (p = 0.86), as well as nonfatal adverse events (p = 0.92) and relapse rate (p = 0.20) at 3 years. We did not find differences between the two groups at echocardiographic follow-up, neither for left ventricular systolic function (p = 0.22), nor for valvular continence (p = 0.28). Conclusions In our experience, the mid-term outcome of repair in IE is comparable to valve replacement and should be considered whenever possible, as in degenerative valve disease. The review of the literature supports this strategy.

A 59-year-old woman was admitted to the emergency department for heart failure (HF), New York Heart Association (NYHA) IV, showing an anterior, evolved myocardial infarction (MI) with a wide apical left ventricular aneurysm (LVA), ejection fraction (EF) 24%, and global longitudinal strain (GLS) −5. 5% by echo. Cardiac magnetic resonance imaging (MRI) confirmed an apical LVA without thrombus, EF 20%, and a transmural delayed enhancement in the myocardium wall. Coronarography showed a three-vessel disease with occluded proximal left anterior descending (LAD) and proximal right coronary artery (RCA). Based on the cardiac CT scan, we decided to generate a three-dimensional (3D) print model of the heart, for better prediction of residual LV volumes. After LVA surgery plus complete functional revascularization, an optimal agreement was found between predicted and surgical residual LV end-diastolic (24.7 vs. 31.8 ml/m2) and end-systolic (54.1 vs. 69.4 ml/m2) volumes, with an improvement of NYHA class, from IV to I. The patient was discharged uneventfully and at 6- and 12-month follow-up, the NYHA class, and LV volumes were found unchanged. This is a second report describing the use of the 3D print model for the preoperative planning of surgical management of LVA; the first report was described by Jacobs et al. among three patients, one with a malignant tumor and the remaining two patients with LVA. This article focused on the use of the 3D print model to optimize surgical planning and individualize treatment of LVA associated with complete functional revascularization, leading to complete recovery of LV function with a favorable outcome.

We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.

This commentary describes positive political norm change on abortion despite a restrictive abortion law. As we describe it, the approach in Pakistan has involved careful efforts to maintain government ownership, leadership, and accountability for safe abortion care and service delivery by Pakistani health authorities early and throughout, with technical support from civil society as requested. This commentary suggests that careful collaboration and mutual support by NGOs working on expanding access to abortion can have a lasting and efficient impact on improving political norms and government ownership over abortion care. In most restrictive settings, political norms may be extremely challenging to address due to the institutionalised nature of abortion stigma and resistance, and NGOs can spend many years of resources trying unsuccessfully to challenge and eliminate these barriers. The experience in Pakistan has been a nontraditional approach to political norm change, as it starts by centring the issue of unsafe abortion squarely within the authority and responsibility of the Pakistani government to avert maternal deaths, within the current legal parameters. Emphasis on the public health needs for safe abortion care and current government obligations in Pakistan, as we describe, has led to increased dialogue and discussion about the need for further reforms by government stakeholders who were previously less willing to meaningfully address this health topic. We believe this approach demonstrates significant promise for future progressive change, and we hope this information will be a valuable resource for others working in the field.

Abstract Background Metastases to the thyroid gland are more frequent than previously thought, although most of them are occult or not clinically relevant. Overall, only 42 cases of metastases to thyroid from breast cancer have been reported thus far. Here we report the case of a patient with breast cancer metastatic to the thyroid. We also review the 42 previously reported cases (published between 1962 and 2012). This is the first review about metastases to thyroid gland from breast cancer. Case presentation A 64-year-old woman of Caucasian origin was diagnosed with a lobular invasive carcinoma of the breast (luminal A, stage II). She received adjuvant chemotherapy, followed by endocrine therapy. During follow-up, fine-needle cytology of a thyroid nodule revealed malignant cells that were estrogen-positive, which suggested a diagnosis of metastases to the thyroid. Imaging did not reveal any other metastatic site and showed only enlargement of the left thyroid lobe and an inhomogeneous pattern of colloid and cystic degeneration and calcifications. The patient underwent left hemithyroidectomy. Histology of thyroid tissue showed a colloid goitre containing dispersed small atypical neoplastic cells with eccentric nuclei. Immunohistochemistry showed cytokeratin-19 and oestrogen receptor, but not tireoglobulin, e-cadherin or cytokeratin-7, thereby confirming metastases from a lobular breast carcinoma. Hormonal treatment is ongoing. Conclusion This case report and first review of the literature on metastases to thyroid from breast cancer highlight the importance of a correct early diagnostic work-up in such cases. Indeed, a primary lesion should be distinguished from metastases given the different treatment protocol related to primary cancer and the clinical impact on prognosis.

Open in new tab Download slide OBJECTIVES Relevant paravalvular leakage (PVL) due to prosthesis dislodgement is a rare but potentially severe complication after transcatheter mitral valve implantation (TMVI). Due to the epicardial anchoring mechanism of the Tendyne® TMVI system, repositioning of the valve stent may be possible by retensioning of the tether. This multicentre study aimed to investigate the procedural and short-term safety as well as efficacy of retensioning manoeuvres. METHODS From 2017 to 2021, N  = 18 patients who underwent secondary tether retensioning were identified. Baseline, procedural and follow-up data were available from N  = 11 patients and analysed according to the Mitral Valve Research Consortium definitions. Continuous variables are shown as median with interquartile range. RESULTS All patients [age 75 years (73.5, 85.0), 64% male (N  = 7), EuroSCORE II 6.2% (5.8, 11.6)] presented with post-procedural PVL [63.6% (N  = 7) with PVL ≥3+]. Of these, 54% (N  = 6) showed signs of haemolysis. The majority were severely symptomatic [New York Heart Association ≥III (91%, N  = 10)]. Procedural outcomes revealed no acute complications and no mortality. At discharge, PVL was completely eliminated in 91% (N  = 10) of patients with 1 case of remaining moderate PVL. At 30 days, Mitral Valve Research Consortium device success was achieved in 82% (N  = 9) of patients. Two patients required open surgical mitral valve replacement due to persistent and recurrent PVL. In 89% (N  = 8) of patients with successful retensioning procedure, New York Heart Association class was I/II. There was no 30-day mortality. CONCLUSIONS This multicentre study demonstrates technical feasibility, procedural safety and acute efficacy of retensioning procedures in the majority of patients. The potential to retension the tether in transapical TMVI may provide additional management advantages in populations at high surgical risk. [ABSTRACT FROM AUTHOR]