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Background: Optimal pain control with limited muscle weakness is paramount for a swift initiation of physical therapy and early discharge. Fascia iliaca compartment block (FICB) has been recommended since it offers good pain control with a low risk of motor block. Pericapsular nerve group (PENG) block with lateral femoral cutaneous block (LFCN) has been proposed as an effective alternative to FICB that offers better pain control with a considerably lower risk of motor block. We aimed to compare the aforementioned blocks and determine which one yielded the lowest numeric rating scale (NRS) score. Methods: We designed a retrospective analysis of patients undergoing elective total hip arthroplasty. The primary outcome was the NRS score at 6, 12, and 24 hours. The secondary outcomes were total opioid consumption, time to first PRN opioid, and time to first postoperative ambulation. Results: 52 patients were recruited, (13 PENG plus LFCN, 39 FICB). PENG plus LCFN resulted in a lower NRS at all three-time points (mean difference and 95%CI at 6 h 0.378 [-0.483; 1.240], at 12 h 0.336 [-0.378; 1.050], and at 24 h 0.464 [0.013; 0.914] P = 0.02). Moreover, less PRN opioids were requested in the PENG plus LCFN vs. FICB group (0 [0;7.5] vs 60 [15;80] milligrams of morphine equivalents, P = 0.001). No delay in the first ambulation or initiation of physical rehabilitation was reported in either group. Conclusions: PENG plus LCFN seems to offer better pain control and lead to less PRN opioids. Neither block hindered physical therapy nor ambulation. These results need to be confirmed with a larger prospective and randomized study. [ABSTRACT FROM AUTHOR]

The aim of this review is to highlight the pivotal role of andr ogen excess in the development of breast cancer. Available evidence suggests that testosterone controls breast epithelial growth through a balanced interaction between its two active metabolites: cell proliferation is promoted by estradiol while it is inhibited by dihydrotestosterone. A chronic overproduction of testosterone (e.g. ovarian stromal hyperplasia) results in an increased estrogen production and cell proliferation that are no longer counterbalanced by dihydrotestosterone. This shift in the androgen/ estrogen balance partakes in the genesis of ER-positive tumors. The mammary gland is a modified apocrine gland, a fact rarely considered in breast carcinogenesis. When stimulated by androgens, apocrine cells synthesize epidermal growth factor (EGF) that triggers the ErbB family receptors. These include the EGF receptor and the human epithelial growth factor 2, both well known for stimulating cellular proliferation. As a result, an excessive production of androgens is capable of directly stimulating growth in apocrine and apocrine-like tumors, a subset of ER-negative/AR-positive tumors. The key role of androgen excess in the genesis of different subtypes of breast cancer has significant clinical implications for both treatment and prevention. Our belief stems from a thorough analysis of the literature, where an abundance of ev idence is present to justify a clinical trial that would investigate the effectiveness of treating the underlying excessive androgen production. [ABSTRACT FROM AUTHOR]

We conducted a systematic review of the literature to better understand whether preoxygenation in non-critically ill patients (i.e. elective surgery patients) should be recommended, as it lengthens safe apnea time (the time required to reach oxygen saturation < 90% in an apneic patient). Furthermore, we looked for the most efficient technique amongst those currently employed in clinical practice. We searched Scopus, CINAHL, the Cochrane Library, PubMed and MeSH using various combinations of the words "preoxygenation", "general anesthesia", "induction", "operating room" and "oxygen". RCTs conducted on adult (>18 years) and non-emergent patients between 2008 and 2017 were deemed eligible. A total of 11 papers were included. Our review suggests that preoxygenation is a safe and efficient technique that allows for longer safe apneic periods in obese (BMI > 30) non-critically ill patients. Non-obese (<30 BMI) patients do not seem to benefit as much from this procedure. However, there is insufficient evidence in the literature to provide a clear recommendation. For all patients, the procedure was safe and well tolerated with no harm reported. The best technique for preoxygenation appears to be pressure support ventilation plus positive end-expiratory pressure. In conclusion, preoxygenation should be employed during the induction of general anesthesia in obese patients as it allows for a longer safe apnea time and causes no harm. Although data regarding efficacy is limited for the non-obese population, the procedure was still harmless and should continue to be performed pending more robust RCTs. We believe there is sufficient evidence to support a RCT that could offer better evidence for this subset of patients undergoing non-emergent procedures. [ABSTRACT FROM AUTHOR]