History Of Lactation Research Articles

What Patient-related Factors Most Strongly Influence Autologous Fat Grafting Volume Retention in Breast Augmentation?

Background: Regarding autologous fat grafting for breast augmentation, the factors influencing volume retention are unclear. Few studies have assessed which factors, particularly patient-related variables, could affect volume retention and to what extent, without performing multivariate analysis. In this study, we performed three-dimensional breast volume measurements before and after autologous fat grafting, calculated the volume and volume retention, and investigated factors that may affect volume retention. Methods: A total of 204 breasts that underwent autologous fat grafting by the same surgeon at our hospital between May 25 and December 25, 2021 were included. Volumetric measurements were taken preoperatively and at 1, 3, and 6 months postoperatively using a three-dimensional camera; volume retention was calculated. Linear mixed model analysis was performed to examine the effects of age, body mass index, number of total autologous fat grafting procedures, pregnancy and lactation history, smoking status, fat processing techniques (sedimentation versus centrifugation), preoperative volume, and weight change at the 3- and 6-month postoperative volume retention analyses. Results: Using multivariate analysis, the preoperative volume was found to be a significant factor at 3 and 6 months. The preoperative volume affected fat volume retention rate by 0.004 (P = 0.001) and 0.008 (P = 0.011) per 10 mL at 3 and 6 months, respectively. Conclusions: The preoperative volume likely affected fat volume retention. Specifically, a 100-mL increase in the preoperative breast volume might increase the volume retention by 4%–8%. Preoperative volume is an important confounding factor for future studies.

Granulomatous mastitis and other inflammatory mastitis simulating breast neoplasms – A retrospective study in the fine needle aspiration cytology clinic of a tertiary care center in eastern India

Background: Fine needle aspiration cytology (FNAC) is an important diagnostic modality in palpable breast lesions. This together with imaging modality is important in distinguishing benign from malignant lesions of the breast. Granulomatous/inflammatory mastitis forms a small subset of breast lesions that may present as a breast lump. Clinical and radiological features in these cases may mimic malignant breast pathology. Aims and Objectives: The aim of this study was to study the frequency of granulomatous mastitis and other inflammatory mastitis with respect to other neoplastic lesions of the breast, presented in FNAC clinics and to correlate the cytological findings with the clinical presentation of granulomatous and other inflammatory mastitis. Materials and Methods: A retrospective study was conducted in the Department of Pathology in a tertiary care center in Eastern India for duration of 4 years 5 months. Details of all patients who underwent FNAC for breast lesions during the study period were recorded in terms of their clinical presentation, cytological findings, imaging, and ancillary investigations. The findings were then tabulated in a master sheet and analysis done by descriptive statistics using SPSS 25. Results: A total of 154 cases were included with 5 cases (3.2%) of granulomatous and 12 cases (7.8%) of inflammatory mastitis. Age range for granulomatous/inflammatory mastitis was 20–70 years. Lump and pain were the most common complaints followed by inflammatory skin changes and nipple discharge. Very few cases also showed nipple retractions and very occasional systemic symptoms like fever. History of lactation was seen among five cases. Three cases showed positive acid-fast bacilli in Ziehl–Neelsen stain. Radiology was discordant with cytological findings in three cases, where the former suggested a breast neoplastic process. Conclusion: Granulomatous/inflammatory mastitis is a rarely diagnosed entity in breast cytopathology with no standard guidelines for management. Antibiotics antitubercular therapy and corticosteroids are some proposed lines of medical management. In treatment-resistant cases, wide local excision may be done depending on available resources and surveillance opportunities.

Effects of a Person's Lactation History on Later-Life Development of Alzheimer's Disease: An Integrative Review.

Objective: The purpose of this integrative review is to assess the existing evidence regarding the effects of a person's lactation history on later-life development of Alzheimer's disease. Methods: The authors searched the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Excerpta Medica dataBASE, and performed backward reference searches using search terms such as, "Alzheimer's disease, dementia," and "breastfeeding, lactation." Authors selected relevant records through the application of inclusion and exclusion criteria and reading the titles, abstracts, or records in full. Results: In total, 400 articles were identified, and 10 articles meeting inclusion criteria were analyzed. Authors extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and scored levels of evidence according to Melnyk and Fineout-Overholt. Data were organized according to themes of breastfeeding duration, ever having breastfed, and indirect effects of breastfeeding. Conclusions: Breastfeeding may have neuroprotective effects for the lactating person and reduce the risk of later-life development of Alzheimer's disease. However, future research is necessary to determine the generalizability of this association.

Crystallizing galactocele: A rare case report and review of literature.

Crystallizing galactocele is an uncommon condition that produces a viscous, chalky substance on fine needle aspiration cytology. (FNAC). Both the diagnosis and the management of this illness include the use of FNAC. Here, we discuss the case of a 25-year-old nursing woman who experienced left breast edema lump for two years. The upper outer quadrant of the leftt breast was involved by the hard, small, non-tender, and movable enlargement. The lesion's FNAC produced a thick, milky, and chalky substance. Numerous semi-transparent crystals of various sizes and shapes with angulated edges could be seen in cytological smears against a background of granular and amorphous proteinaceous material. A diagnosis of crystallizing galactocele was made on the basis of the patient's clinical history of lactation and characteristic cytological findings. Due to the rarity of this condition-to the best of our knowledge, less than ten cases of crystallizing galactocele have been documented in medical literature.

Breast Cancer: Epidemiology, Risk Factors and Survival Analysis in the Pakistani Population

Objective: To find out the association of genetic, reproductive and socio demographic factors with breast cancer in Pakistani women along with the sur- vival percentage of patients having breast cancer.Methodology: A case control study was carried out for a period of 3 years. Data were collected from different hospitals in Pakistan and the survival rate was determined by having direct contact with patients through telephone calls. For the estimation of survival probability Kaplan-Meier curve was used. Association of various demographic and epidemiological factors with breast cancer occurrence was estimated by using the odds ratio (OR) and 95% confidence interval (CI). Various tests used to find out the significance of results included student t-test, chi-square test, Fisher exact test and ANOVA. A statistical tool SPSS version 22 was used to analyze the data and results orientation.Results: The mean age for breast cancer diagnosis 47.3±11.8 years of age was found as mean age for breast cancer diagnosis. Higher BMI was the major contributing factors in developing breast cancer (OR=3.5, 95% CI=2.6-4.5). Significant risk factors found to be associated with the breast cancer included long reproductive period (menarche to menopause), family history of disease and habit of passive smoking (P<0.05). Out of 448 married patients, 23% were nulliparous and 26% of patients did not have a lactation history. Chemotherapy along with radiotherapy and surgery have been found to be effective methods for breast cancer treatment (80% survival).Conclusion: Present study concluded that age, body mass index, oral contraceptives usage, lactation duration, reproductive duration and marital status of the female are significant factors in developing breast cancer in Pakistani women.
 Keywords: Breast Cancer, Nulliparous, Chemotherapy, Radiotherapy.

THU302 Protective Effects Of Lactation On Maternal Metabolism

Abstract Disclosure: J.R. Hens: None. Y. Ding: None. S. Brown: None. H. Song: None. J.J. Wysolmerski: None. R. Belfort De Aguiar: None. A history of lactation significantly lowers the risk of developing Type 2 diabetes (T2D) by almost 50%. However, little is known about how milk production durably changes maternal metabolism. We hypothesized that lactation protects against diabetes by improving maternal glucose metabolism. Changes in body composition, glucose metabolism, insulin secretion and tissue triglyceride levels were measured in age-matched cohorts of mice that lactated (L) or did not lactate but went through a pregnancy (NL); age-matched virgins served as controls (V). L and NL mice were studied 4 weeks after weaning of pups from the L group. An euglycemic-hyperinsulinemic clamp was used to further examine glucose metabolism. Multiple rounds of lactation were examined to determine if body composition or glucose metabolism changed with repeated cycles of reproduction. Liver weight was higher in L mice when compared to V mice. Liver triglycerides were lower in L and NL mice when compared to V mice. Circulating fasting levels of plasma free fatty acids were unchanged between the three groups. Perigonadal fat trended higher in NL mice compared to L and V mice after one round of lactation. However, after two rounds of lactation, NL mice had significantly more perigonadal fat than L or V mice. Fasting glucose trended lower in L mice compared to NL mice, but there was no difference in insulin levels between groups. The area under the curve of glucose tolerance test was not different between groups. Pancreases from L mice had increased numbers of islets compared to NL and V mice. Insulin action was assessed in chow-fed, conscious, unrestrained L, NL, and V mice using the euglycemic-hyperinsulinemic clamp technique. Tail-vein glucose was clamped at 100-120 mg/dL. The normalized glucose infusion rate to insulin was significantly lower (p=0.01) in NL mice (41.9 +/- 17) compared to V mice (91.8 +/- 14 and L mice (83.8 +/- 27). Our results suggest that pregnancy and lactation significantly alter the metabolic functions of liver, adipose, muscle, and pancreas. Furthermore, a history of lactation improves insulin sensitivity in parous mice. Further study of the metabolic changes occurring during lactation may have wide-ranging implications for women’s health. Presentation: Thursday, June 15, 2023

46-OR: Amelioration of Insulin Resistance after Delivery Lowers the Risk of Postpartum Type 2 Diabetes in Women with Gestational Diabetes Mellitus

Background: Detecting the risk of postpartum diabetes in women with gestational diabetes mellitus (GDM) is essential for proper intervention. We investigated whether changes in insulin sensitivity after delivery affect the risk of diabetes in Korean women with GDM. Method: In a prospective cohort including women with GDM, we included those who attended the postpartum visit at 2 months and yearly thereafter. The change in insulin sensitivity was defined as ∆Matsuda index, the difference between the initial postpartum visit and during pregnancy. We analyzed the risk of diabetes according to tertiles of ∆Matsuda index. Results: During 3.4 years of follow-up, 60 out of 347 subjects (17.3%) developed diabetes. The incidence of diabetes decreased as the tertile of ∆Matsuda index increased (26.7%, 17.2%, and 7.8%, P = 0.001). Subjects in the second and third tertile of ∆Matsuda index showed lower risk of diabetes compared to the subjects in the first tertile (HR, 0.45; 95% CI, 0.24-0.82; HR, 0.18; 95% CI, 0.07-0.48) after adjusting for age, family history of diabetes, gravida, lactation, fasting glucose, and postpartum BMI. Conclusion: Amelioration of insulin resistance lowers the risk of diabetes in Korean women with GDM. Although the assessment of insulin sensitivity is not standardized, changes in insulin sensitivity may be a useful predictor for diabetes in women with GDM. Disclosure H.Son: None. J.Moon: None. N.H.Cho: None. H.Jang: None.

143 Retrospective Look at Cow-Calf Performance in Spring-Calving Dexter Cattle Scored for Winter Hair Shedding Level

Abstract Delayed winter hair coat loss in beef cows through the spring and summer may contribute to heat stress and reduce herd performance. This study evaluated the performance history of cows in the years that preceded scoring and during the first year, cows were scored for hair shedding levels. Hair shedding levels of purebred Dexter cows (n = 72; mean age = 5.6 years; mean body weight = 321.6 kg) in the university herd were recorded based on the percentage of their body exhibiting winter hair loss (0% = thick winter coat, 100% = short summer coat) at eight biweekly evaluation periods from April to August 2019. Hair shedding levels were observed by two herd managers. Average hair shedding levels for the eight periods were 9%, 31%, 58%, 73%, 83%, 93%, 96%, and 96%, respectively. Cow reproductive performance from 2016 to 2020 (reflective of 2015 to 2019 breeding seasons) and calf growth performance from 2016 to 2019 were analyzed. Cows were exposed to Dexter bulls by natural service annually for an average of 56 days in July and August. Spring-born calves (n =39) were weighed at birth, at the midpoint of the preweaning period (3.5 mo of age), and at weaning (7 mo of age). Hair shedding levels averaged across periods 3 (May 20-21) and 4 (June 3-4) were used to classify cows as low shedders (0 to 50%; LoShed; n = 26) or high shedders (51 to 100%; HiShed; n = 46). Calf weights were tested using SAS MIXED models. Along with dam hair shedding group, dam lactation history, dam hair color, and calf sex were also used as model terms. Cow reproductive rates (n = 239 matings) were tested using SAS GLIMMIX models that included hair shed class, lactation history, and hair color. The HiShed cow group had greater (P < 0.01) winter hair shedding levels compared with the LoShed cow group (86 ± 2% vs. 30 ± 3%). Birth weight was not affected (P = 0.39) by dam shedding level. The midpoint calf weights tended to be heavier (P = 0.07) for HiShed cows than for LoShed cows (91.9 ± 3.7 vs. 84.9 ± 4.6 kg). Calf weaning weights were heavier (P < 0.05) for HiShed cows than for LoShed cows (139.8 ± 7.0 vs.26.3 ± 8.2 kg). Calving rates and weaning rates were greater (P < 0.05) for HiShed cows (86.9 ± 5.3%; 86.8 ± 5.2%) than for LoShed cows (78.9 ± 8.1%; 77.3 ± 8.2%). Results indicated that cow groups based on high or low winter hair shedding level had historically different reproductive rates and calf weaning weights. The high shedding cow group weaned heavier calves and had greater levels of reproductive success.

Clinical characteristics and microbiota analysis of 44 patients with granulomatous mastitis.

Granulomatous mastitis (GM) is a chronic inflammatory breast disease. In recent years, the role of Corynebacterium in GM onset has received more and more attention. This study aims to detect the dominant bacterium in GM patients and analyze the association between clinical characteristics and infectious factors. In this study, 88 samples from 44 GM patients, six acute lactation mastitis (ALM) patients, and 25 non-inflammatory breast disease (NIB) patients were divided into a GM pus group, a GM tissue group, an ALM pus group, and a NIB tissue group; then, 16S ribosomal DNA sequencing was used to explore their microbiota. The clinical data of all 44 GM patients were also retrospectively collected and analyzed to determine their relationship with infection. The median age of the 44 GM patients was 33 years, and 88.6% of patients had primary-onset cases, while 11.4% were recurrences; additionally, 89.5% of patients were postpartum and 10.5% were nulliparous. The serum prolactin level was abnormal in nine patients (24.3%). Samples from 15 GM patients (34.1%) had a Corynebacterium abundance of >1% (1.08-80.08%), with eight (53.3%) displaying an abundance of >10%. Corynebacterium was the only genus with significant differences between the GM pus group and the other three groups (p < 0.05). Corynebacterium kroppenstedtii was the predominant Corynebacterium species. Among clinical characteristics, a statistical difference in breast abscess formation was observed according to Corynebacterium abundance in Corynebacterium-positive and- negative patients (p < 0.05). This study explored the relationship between Corynebacterium infection and GM, compared the clinical characteristics between Corynebacterium-positive and- negative patients, and provided support for the role of Corynebacterium species-in particular, C. kroppenstedtii-in the pathogenesis of GM. The detection of Corynebacterium can predict GM onset, especially in patients with high prolactin levels or a history of recent lactation.

Abstract P1-05-29: Breast cancer laterality: Is age a factor?

Abstract BACKGROUND: Studies have consistently demonstrated that breast cancers arise in the left breast more often than the right breast, but no factors have been able to account for this. Some studies have shown age younger than 45 years and late age at menarche to be associated with somewhat higher incidence of cancer in the right breast. However, most of these studies were conducted in the 1990s. We sought to determine if demographic factors, pathologic findings, or treatment impact laterality. METHODS: We performed a single-institution IRB-approved retrospective chart review of US female breast cancer patients diagnosed with DCIS (stage 0) or stages I-III breast cancer from 1997 to April 2020. Clinicopathologic characteristics, demographic, and treatment information were collected. Statistical analyses evaluated differences in laterality. Association between laterality and continuous variables was determined using Kruskal-Wallis test. Association of laterality and categorical variables was determined using Chi-square test or Fisher exact test if applicable. RESULTS: 5328 female patients with 5474 breast cancers were evaluated with a median age of 60 years old. Majority of tumors were stage T1(2542, 54.4%) and 75% were IDC. Overall left-sided cancer showed a predominance (2797, 51.1%). Breast cancer laterality was not significantly associated with grade, receptor status, tumor size, pathologic type, or recurrent tumors. Laterality was evaluated regarding age, based on age less than 61 years old versus greater than or equal to age 61. Laterality was significantly associated with age overall with an increase in left-sided breast cancers (2797 vs 2677, p=0.029). Left-sided breast cancer was significantly increased in women greater than or equal to age 61, 1456 (53%) vs right-sided 1290 (47%). Whereas, right-sided breast cancer was significantly associated with age less than 61, (1387, 50.8% vs left 1341, 49.2%, p=0.004). CONCLUSION: Our analysis confirms prior studies that overall left-sided breast cancer is more common in women. However, there are age differences with left-sided breast cancers more prevalent in older age women greater than or equal to age 61. On the other hand, right-sided breast cancer was seen more often in women under the age of 61. Further studies are needed to better ascertain why the overall laterality of breast cancer occurs more frequently in the left breast, but also to determine an explanation for the laterality age differences. Anatomical factors such as blood supply, breast size, inherited genetic mutations, tumor genomics, lactation history and others are possible factors that need to be further explored. Studies are ongoing. This information will be potentially helpful in allocating diagnostic and therapeutic resources for breast cancer patients. Citation Format: Kelly Elleson, Gerald H. Sokol, Weihong Sun, Junmin Whiting, Marie C. Lee, Brian J. Czerniecki, Loretta Loftus. Breast cancer laterality: Is age a factor? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-29.

Correlation between nicotine dependence and inflammatory biomarkers in Thai smokers: Eight weeks of synbiotic intervention

&lt;span&gt;Cigarette smoke contains thousands of man-made substances, and many may contribute to addiction and inflammation. This study examined the effect of synbiotics on the Fagerstrom test for nicotine dependence (FTND) and inflammatory markers in Thai smokers. 14 smokers with a Nicotine Dependence Fagerstrom Test scores of 4 or higher and no pregnancy or lactation history participated in this study. We gave them surveys about the FTND and continued blood tests for Lipopolysaccharide (LPS), lactulose and mannitol ratios (LMR), Quinolinic acid (QA), and 5-hydroindoleacetic acid (5-HIAA) to record inflammatory marker levels and leaky gut information. Pearson's R-values for LPS and LMR were 0.444 and -0.465. FTND showed a positive correlation with LPS and a negative correlation with leaky gut, but both relationships were weak due to no correlation for LPS but leaky gut. The R&lt;sup&gt;2&lt;/sup&gt; of the LPS correlation coefficient was 0.197, p = 0.112, and the R&lt;sup&gt;2&lt;/sup&gt; of the leaky gut correlation was 0.217, &lt;/span&gt;&lt;em&gt;&lt;span&gt;p&lt;/span&gt;&lt;/em&gt;&lt;span&gt; 0.001. FTND, LMR, and QA were significantly reduced, while 5-HIAA was elevated. Further investigation is needed to determine the association between smoking and inflammation. In conclusion, synbiotics improved FTND, gut permeability, and inflammation. &lt;/span&gt;

Postpartum Hemorrhage Complicated by Pan-hypopituitarism: Sheehan’s Syndrome; Case Report, 2022

Background: Sheehan’s syndrome is hypopituitarism due to postpartum ischemic necrosis of the pituitary gland. Due to its potentially life-threatening and very rare complications; it still remains important to pregnant women, clinicians, and public health services around the world. Case Report: 38 years parity three Eritrean mother from Ghone subzone of Gash Barka, Eritrea; had history of postpartum hemorrhage and blood transfusion before 10 years (2011) on her last delivery. She presented with history of failed lactation, amenorrhea and infertility of 10 years. She had also constipation, lethargy and generalized body weakness with her current complaint. Hormone analysis revealed pan-hypopituitarism of most anterior pituitary hormones and Magnetic Resonance Imaging of the brain revealed empty sella. She was started on Levothyroxine and fertility supplements based on her fertility desire, and on subsequent follow-ups, her menses was resumed and constipation had subsided and she was attached to endocrinology department for further followup and management. Conclusion: The history of failed lactation, amenorrhea and infertility following postpartum hemorrhage, hormone analysis and imaging findings were consistent with a rare complication of Sheehan’s syndrome. This case was reported for its rarity. Physicians should aware about this complication and should have high index of suspicion for cases with common manifestation of uncommon syndromes.

O47 - What modifiable factors improve breastfeeding exclusivity and duration in Australian women?

Australian breastfeeding rates, particularly exclusive breastfeeding rates, are low and have been low for many years because strategies to increase them have been inadequate. New approaches for promoting and supporting breastfeeding are required. Data collected in 2008 suggested that Australian Breastfeeding Association (ABA) members had much higher exclusive breastfeeding rates (41.2% at 5 to 6 months) than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted (EMBER) project was undertaken 1) to determine whether ABA volunteer trainees had better breastfeeding outcomes and were, in fact, positive deviants regarding breastfeeding practices, 2) to explore attitudes, characteristics and behaviours underpinning beneficial breastfeeding practices and 3) to identify modifiable characteristics to inform breastfeeding promotion and support. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with ABA and analysed using descriptive statistics. Participants in this project had much higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Modifiable factors that positively influenced breastfeeding outcomes included knowledge of and motivation to breastfeed, birthing outcomes, immediate skin-to-skin contact, lack of in-hospital formula supplementation and partner and peer support. EMBER participants can be defined as positive deviants with positive attitudes, characteristics and behaviours towards breastfeeding that lead to much better breastfeeding outcomes compared to the general Australian population. Many of the modifiable factors that positively impacted their breastfeeding outcomes can be influenced by midwives supporting pregnant women, women giving birth and breastfeeding mothers. Midwives are uniquely positioned to provide breastfeeding education and information, and timely and well-informed breastfeeding support to mothers, to give them the best chance to breastfeed exclusively and breastfeed for longer.

Comparison of the Efficacy of Intralesional Tranexamic Acid Versus Topical 4% Hydroquinone in Treating Melasma.

Objectives: To compare the efficacy of intralesional tranexamic acid and topical 4% hydroquinone in the treatment of melasma.Study design: This comparative prospective study was conducted at the Dermatology Department, Pak Emirates Military Hospital Rawalpindi, Pakistan from October 16, 2018 to April 16, 2019.Methodology: A total of 290 patients with melasma, 18 to 50 years of age, were included in this study. Patients with a history of discoid lupus erythematosus, pregnancy, lactation, anemia, and oral contraceptives or hormone replacement therapy were excluded from the study. Randomization was 1:1 for groups A and B, i.e., each upcoming patient was included in the next group. This randomization was supervised by another clinician. One hundred forty-five patients were placed in group A (intralesional tranexamic acid), while 145 were enrolled in group B (topical 4% hydroquinone). Follow-up was done at four weekly intervals for 12 weeks. After 12 weeks, the final response was assessed.Results: In group A, the average age was 33.74 ± 6.67 years, while in group B it was 32.08 ± 6.08 years. Among the entire patients, the majority of the patients, 207 (71.38%), were in the age range of 18 to 35 years. Intralesional tranexamic acid was efficacious in 64 (44.14%) patients, while 47 (32.41%) of group B (topical 4% hydroquinone) showed complete improvement (p-value = 0.040).Conclusion: This study concluded that using intralesional tranexamic acid is more effective in treating melasma than topical 4% hydroquinone.

Epidemiological Study of CA Breast in Diyala

Background: Breast cancer is becoming the most common cancer among women in both developed and developing countries . Breast cancer has been the leading cause of death among Iraqi women for three decades, and it is the second leading cause of death after cerebrovascular illnesses.Objective: To investigate the epidemiological and clinic pathological behavior of breast cancer in Diyala province.Patients and Methods: A retrospective cross-sectional study conducted at the Oncology Clinic of Baquba Teaching Hospital for 24 months between April 1st and March 31st, 2021. A sample of (257) patients was selected to collect socio-demographic information (age, gender, marital status, history of breast lactation ,history of contraceptive pills, history of breast cancer in family, parity status). Results: The current study shows that more than 55% of the patients were under the age of (50) years. Two hundred fifty one patients (97.6%) were female and( 6) patients (2.4%)were male. from the 251 female patient . Right breast tumor was found in 120 patients (48%) and left breast tumor was found in (127) patients (50.4%) and bilateral breast tumor in (4) patients(1.6%). In terms of breast cancer family history, 28 patients(11%) had a positive family history, while 223 patients (89%) had a negative family history. One hundred fifty seven of patients(63%) had history of breastfeeding and( 94) of patients(37%) had no history of breastfeeding . One hundred forty six patients (58%) had positive history of oral contraceptive pill while 105 patients (42%) had negative history of oral contraceptive pill. twenty two patients (9%) had positive history of smoking while (229) patients (91%) had negative history of smoking . The histopathological result were Invasive ductal carcinoma (I.D.C) in (233) patients (93%) and Invasive lobular carcinoma (I.L.C) in (18) patients. Breast cancer patients were married in 73% of cases, widowed in 13.5 percent of cases, divorced in 2.5 percent of cases, and single in 11% of cases. Most cases belonged to differentiation stage II ( 159) patients (63%), followed by stage III ( 57) patients (23%) , stage I ( 13) patients (5%) and stage IV (22) patients(9%) . Conclusion: The current study concludes that In Iraq, the majority of breast cancer patients were in the second stage, and patients' ages at diagnosis were younger than in other communities. The development and execution of screening programs, as well as the management of risk factors, appear to be critical. Keywords: Breast, Cancer, Patients

Uncommon Location of Idiopathic Granulomatous Mastitis: A Case Report

Background Idiopathic granulomatous mastitis (IGM) is a rare benign disease involving breast parenchyma mostly in periareolar region. Women of childbearing with recent history of pregnancy and lactation are more at risk of IGM. The common locations of IGM are retro areolar and periareolar of the breast, however involvement of axillary region has never been reported elsewhere.&#x0D; Case presentation A 36-year-old female with history of two times pregnancy and lactation 8 months prior to presentation, referred with pain and swelling in the right axillary area. The past medical history and habitual history were negative and she did not use oral contraceptives or other medications. Local physical examination showed normal breasts with bilateral accessory breasts. A tender mass with the size of 4x6cm was palpable in the right axillary region accompanied by erythema and a few secretory fistulas without lymphadenopathy. Routine blood test came back negative and serum prolactin was normal. Ultra-sonography (US) demonstrated a soft tissue swelling, edema, and decreased echogenicity area in the right axillary region compatible with IGM. The patient started on prednisolone 50 mg per day, and the condition has not been improved for two months. To exclude other possible etiologies due to atypical location, the patient underwent a second US and core-needle biopsy which confirmed the diagnosis of axillary IGM. Prednisolone tapered off and a non-steroidal anti-inflammatory drug (NSAID) started. All the symptoms improved in a month and fully resolved in 3 months.&#x0D; Conclusion Since IGM is not fully known yet, the presentation and the location can be variable. Considering IGM as a probable diagnosis in inflammatory presentation in the axillary region in patients with accessory breasts is suggested.

Targeting FoxP3 gene to check out the impairment of tolerance in breast cancer patients

ObjectiveFoxP3 gene is a potential gene in the development of Breast Cancer (BC). Mutated expression of this gene shows some correspondence with tumorigenic activity for this reason it is important to understand. The principal goal of this study was the mutational analysis of the FoxP3 gene in BC patients. This research also provides the basic functions and genetic details on the FoxP3 gene in the Lahore population, especially how the FoxP3 gene acts as a risk factor in BC development. The study design was Cross-sectional. MethodsGenomic DNA was extracted from peripheral blood samples of BC patients. Amplified products were electrophoretically separated and target PCR products were sequenced with a Sanger sequencing analyzer. The main purpose is to determine the order of nucleotides in the FoxP3 gene. Further mutations were analyzed by the chromatograms using Chromas, NCBI nucleotide BLAST X, and the Mutation Surveyor. After that, different protein-coding sequences were studied. ResultsThe substitution occurs at location 324 where T is replaced by A and in another sample G is replaced by A at position 328 while in the third sample InDel mutation was observed at position 28. ConclusionIn the current study, intronic variants typically in the FoxP3 gene exon 2 region were confirmed by computational analysis using a gene database. We investigated nucleotide mutations in FoxP3 in patients with malignant breast tumors, along with their association with various characteristics such as marriage status, age of menopause, miscarriage and lactation history, and family history. A better understanding of the FoxP3 gene in the etiology and progression of breast cancer can reveal many explorable problems, including the clinical implications of the FoxP3 gene. However, these intronic variations are of massive importance and demonstrated that this enhancer can establish a physical interaction with a promoter site binding nuclear factor-κB components necessary for T cell regulation.

Structural role of osteocyte lacunae on mechanical properties of bone matrix: A cohesive finite element study

Despite the extensive studies on biological function of osteocytes, there are limited studies that evaluated the structural role of osteocyte lacunae on local mechanical properties of the bone matrix. As a result, the goal of this study was to elucidate the independent contribution of osteocyte lacunae structure on mechanical properties and fracture behavior of the bone matrix uncoupled from its biological effects and bone tissue composition variation. This study combined cohesive finite element modeling with experimental data from a lactation rat model to evaluate the influence of osteocyte lacunar area porosity, density, size, axis ratio, and orientation on the elastic modulus, ultimate strength, and ultimate strain of the bone matrix as well as on local crack formation and propagation. It also performed a parametric study to isolate the influence of a single osteocyte lacunae structural property on the mechanical properties of the bone matrix. The experimental measurements demonstrated statistically significant differences in lacunar size between ovariectomized rats with lactation history and virgin groups (both ovariectomized and intact) and in axis ratio between rats with lactation history and virgins. There were no differences in mechanical properties between virgin and lactation groups as determined by the finite element simulations. However, there were statistically significant linear relationships between the physiological range of osteocyte lacunar area porosity, density, size, and orientation and the elastic modulus and ultimate strength of the bone matrix in virgin and lactation rats. The parametric study also revealed similar but stronger relationships between elastic modulus and ultimate strength and lacunar density, size, and orientation. The simulations also demonstrated that the osteocyte lacunae guided the crack propagation through local stress concentrations. In summary, this study enhanced the limited knowledge on the structural role of osteocyte lacunae on local mechanical properties of the bone matrix. These data are important in gaining a better understanding of the mechanical implications of the local modifications due to osteocytes in the bone matrix.

Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5years of follow-up of 152 cases from Turkey and a review of the literature.

The goals of this study were to report our clinical experience in a single center at a high-volume tertiary university hospital in Istanbul and to introduce a diagnostic algorithm based on a 5-year follow-up of 152 women with biopsy-proven idiopathic granulomatous mastitis (IGM). IGM is an uncommon, non-malignant, chronic inflammatory disease of the mammary gland with an unknown etiology. The symptoms, clinical presentation, and radiologic findings of IGM may resemble carcinomas. To our knowledge, this study comprises the largest series of IGM, especially with a 5-year follow-up, yet reported in the English literature. The present study reported our single-center clinical experience at a tertiary university hospital in Istanbul, Turkey, and introduced a diagnostic algorithm using our treatment protocol based on a 5-year follow-up of 152 women with biopsy-proven IGM. Our database of 10years' experience containing over 700 patients with IGM was evaluated. However, to assess recurrence and resistance to treatment, only the 152 patients with a long follow-up period of 5years were included in the study group. The analysis included 152 women with biopsy-proven IGM who were treated between January 2009 and March 2014. The clinical data of the presentation, histopathology, and treatment modalities were analyzed by reviewing the medical records. Of the 152 patients diagnosed with granulomatous mastitis, 32 (21%) recovered by expectant management, while 14 (9%) responded to antibiotics, 65 (43%) received corticosteroids, 20 (13%) had antituberculosis medication, 16 (11%) underwent excision, and 5 (3%) responded to non-steroidal anti-inflammatory drugs. Fifty-one patients (33%) had recurrence; of these, 30 achieved a cure with second-line treatment, 16 underwent excision, and 5 achieved a cure with observation. IGM is a rare benign breast disorder, and clinicians need a high index of suspicion to diagnose it, as IGM can be mistaken for breast cancer. Unlike periductal mastitis, IGM does not evolve secondary to nicotine addiction and is typically seen in women of childbearing age with a recent history of pregnancy and lactation. The diagnosis can be challenging, and an evaluation with a multidisciplinary team is necessary. There is no consensus concerning the definitive treatment approach. We suggested a diagnostic algorithm in the present study, using our treatment protocol based on the 5years' follow-up of 152 women.

Detection of Corynebacterium kroppenstedtii in Granulomatous Lobular Mastitis Using Real-Time Polymerase Chain Reaction and Sanger Sequencing on Formalin-Fixed, Paraffin-Embedded Tissues.

Associations between granulomatous lobular mastitis (GLM) and Corynebacterium kroppenstedtii have been reported since 2002, but large-scale studies to assess the actual prevalence of this bacterium in GLM have not been performed. To assess the prevalence of C kroppenstedtii in GLM using real-time polymerase chain reaction and Sanger sequencing. We analyzed formalin-fixed, paraffin-embedded tissues from 67 cases of GLM by sequential DNA amplification and sequencing to assess the rate of C kroppenstedtii detection in GLM. A retrospective analysis including patient demographics, history of pregnancy and lactation, clinical signs and symptoms, radiographic findings, histologic pattern, Gram stain results, and microbial cultures was performed on 67 cases of GLM. In addition, 10 cases of nongranulomatous breast abscess were included as controls. C kroppenstedtii 16S rRNA SYBR real-time polymerase chain reaction was positive on formalin-fixed, paraffin-embedded tissues from 46 of 67 (68.7%) GLM cases, while all control cases were negative. Among the positive cases, the majority showed features of cystic neutrophilic granulomatous mastitis. C kroppenstedtii was highly prevalent in GLM cases and was not found to be associated with nongranulomatous breast abscess in our study (P < .001).