A Rhode Island Hospital radiation oncologist says in a new editorial that research exploring the impact of radiotherapy in older women with low risk of breast cancer recurrence has little effect on actual clinical decisions. The editorial written by David E. Wazer, MD, chief of the department of radiation oncology, is published in the currently being published.
Breast-conserving therapy (BCT) has shown to have comparable outcomes to mastectomy, allowing women to preserve their breast without compromising their chance of being cured of cancer. BCT also has been associated with improved quality of life, as compared to mastectomy. Radiation therapy is an integral part of BCT, and its benefit is clearly dependent on the baseline risk of ipsilateral breast tumor recurrence (IBTR) after surgical excision alone, and is small in patients at low risk of recurrence. Multiple trials have shown that the IBTR risk decreases with age, and has prompted analysis of the benefit of radiotherapy for older patients with breast cancer.
‘If an older patient has been treated for breast cancer, and has a low risk of recurrence, there may be no clinical reason to subject them to radiation therapy,’ Wazer said. ‘It

Psychological factors can have as much-or more-impact on pediatric chest pain as physical ones, a University of Georgia study found recently. UGA psychologists discovered pediatric patients diagnosed with non-cardiac chest pain have higher levels of anxiety and depression than patients diagnosed with innocent heart murmurs-the noise of normal turbulent blood flow in a structurally normal heart.
The UGA research was done in collaboration with Children’s Healthcare of Atlanta and Emory University.
‘The fact that these psychological symptoms are higher in non-cardiac chest pain patients suggests the psychological symptoms may be playing a role in the presentation of chest pain,’ said Jennifer Lee, a doctoral candidate in the UGA Franklin College of Arts and Sciences and the study’s lead author.
The results of the study show a statistically significant increase in anxiety and depression among patients who are later diagnosed with non-cardiac chest pain when compared to patients diagnosed with innocent heart murmurs. Lee said it is not clear if the anxiety is a cause of the pain or if pain caused the anxiety in the sample group.
‘The higher levels weren’t so high as to cause a clinical diagnosis on their own, but when you contrast the two groups, there were statistically significant differences,’ said study co-author Ronald Blount, a psychology professor in the Franklin College.
The study included 129 patients ages 8 to 18. The group completed surveys prior to diagnosis. All patients were essentially in the same situation-sitting in a cardiology office awaiting their unknown medical diagnosis.
‘We are highlighting that psychology has a part in these symptoms,’ Blount said, ‘and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation.’
Chest pain can indicate serious medical conditions that require a doctor’s evaluation. In adults, pain in the chest is often linked to a cardiac problem. In children, however, less than 2 percent of patients receive a cardiac diagnosis for their pain.
The Sibley Heart Center at Children’s Healthcare of Atlanta is one of the largest pediatric heart centres in the world, seeing an average of 2,500 new patients with acute chest pain each year.
‘We know up front that 99 percent of these patients will not have a heart complication at all. The trick is, it is not zero, and I cannot miss the one patient with heart disease because the consequences could be catastrophic,’ said Dr. Robert Campbell, chief of the Sibley Heart Center and division director of the department of pediatrics at the Emory University School of Medicine.
The study also observed that non-cardiac chest pain patients have a higher level of functional disability-or the inability to participate in everyday activities like running across a football field or making it through a day without a nap. They also spent less time at school and were less involved in extra-curricular activities.
‘These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, head aches,’ Lee said. ‘These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn’t tell you that you are stressed out, but your body does, so you will experience symptoms like these.’
Pediatric patients with non-cardiac chest pain also reported higher levels of anxiety sensitivity, a fear of experiencing physical symptoms and additionally fearing that those symptoms are related to a catastrophic health issue.
‘Psychological functioning is heavily related to pain,’ Blount said. ‘Pain is a sensory experience, but your attention to one thing or another and your emotions can impact your experience of pain. And how debilitating the pain is for you can be determined by psychological and social factors. That is what we were interested in looking at.’
Previous studies have shown reducing emotional symptoms can lead to better coping ability with pain, Lee said. ‘A goal with these patients would be to create a clearer, more comprehensive picture of what is going on and determine a better way to help these kids and adolescents.’
Campbell said the UGA research helps him serve the majority of his patients who leave his office with a clean bill of health but unexplained chest pain.
‘Most importantly what we’ve learned is that after a physical evaluation of the patient, we take the time to sit down with the family and find out what they are most worried about so we can address their psychological issues,’ Campbell said. ‘We’ve learned to pay attention and to be confident and reassuring. I need to make it clear to my patients and their parents that I’m not saying you are not having pain, but that the pain is not caused by your heart.’ University of Georgia

Researchers have created a new type of miniature pump activated by body heat that could be used in drug-delivery patches powered by fermentation.
The micropump contains Baker’s yeast and sugar in a small chamber. When water is added and the patch is placed on the skin, the body heat and the added water causes the yeast and sugar to ferment, generating a small amount of carbon dioxide gas. The gas pushes against a membrane and has been shown to continually pump for several hours, said Babak Ziaie, a Purdue University professor of electrical and computer engineering and biomedical engineering.
Such miniature pumps could make possible drug-delivery patches that use arrays of ‘microneedles’ to deliver a wider range of medications than now possible with conventional patches. Unlike many other micropumps under development or in commercial use, the new technology requires no batteries, said Ziaie, who is working with doctoral student Manuel Ochoa.
‘This just needs yeast, sugar, water and your own body heat,’ Ziaie said.
The robustness of yeast allows for long shelf life, and the design is ideal for mass production, Ochoa said.
‘It would be easy to fabricate because it’s just a few layers of polymers sandwiched together and bonded,’ he said.
The paper was written by Ochoa and Ziaie, and the research is based at Purdue’s Birck Nanotechnology Center in the university’s Discovery Park.
The ‘the microorganism-powered thermopneumatic pump’ is made out of layers of a rubberlike polymer, called polydimethylsiloxane, which is used commercially for diaphragms in pumps. The prototype is 1.5 centimeters long.
Current ‘transdermal’ patches are limited to delivering drugs that, like nicotine, are made of small hydrophobic molecules that can be absorbed through the skin, Ziaie said.
‘Many drugs, including those for treating cancer and autoimmune disorders cannot be delivered with patches because they are large molecules that won’t go through the skin,’ he said. ‘Although transdermal drug delivery via microneedle arrays has long been identified as a viable and promising method for delivering large hydrophilic molecules across the skin, a suitable pump has been hard to develop.’
Patches that used arrays of tiny microneedles could deliver a multitude of drugs, and the needles do not cause pain because they barely penetrate the skin, Ziaie said. The patches require a pump to push the drugs through the narrow needles, which have a diameter of about 20 microns, or roughly one-fourth as wide as a human hair.
Most pumps proposed for drug-delivery applications rely on an on-board power source, which is bulky, costly and requires complex power-management circuits to conserve battery life.
‘Our approach is much more simple,’ Ziaie said. ‘It could be a disposable transdermal pump. You just inject water into the patch and place it on your skin. After it’s used up, you would throw it away.’ Purdue University