Delaying surgery for a non-invasive breast cancer can have dire consequences, a new study shows.

Longer delays in surgery for ductal carcinoma in situ (DCIS) breast cancer lead to a higher risk of invasive ductal carcinoma and a slightly lower survival rate, researchers found.

Long delays should be avoided

“For each month of delay, there was well under a 1% difference in survival. But for each month of delay, there was an approximate 1% increase in the finding of invasive cancer,” said study author Dr Richard Bleicher, a professor of surgical oncology at Fox Chase Cancer Center, in Philadelphia.

“The survival difference with a delay is small,” Bleicher noted in a centre news release. “While it’s not an emergency to get treated immediately, delays do have an effect and long delays should be avoided.”

DCIS occurs when abnormal cells form in the milk duct of the breast and is the earliest stage of breast cancer. When cancerous cells spread beyond the milk duct, it becomes invasive ductal carcinoma.

Standard treatment for DCIS is surgery and radiotherapy, along with endocrine therapy. But research suggests that some DCIS may never progress to invasive disease, and clinical trials are being conducted to determine whether DCIS can be observed, rather than surgically removed.

Observation represents infinite delay

This study “suggests that delays in operative management of DCIS are associated with invasion and slightly worse short-term outcomes,” Bleicher said. “Since observation represents infinite delay, it suggests that observation should not yet be pursued outside of a clinical trial in patients who will tolerate excision.”

The study included more than 140 600 US women (123 947 with DCIS, 16 668 with invasive ductal carcinoma). They were diagnosed between 2004 and 2014.

Survival was compared with five time intervals in delays to have surgery: less than 30 days, 31–60 days, 61–90 days, 91–120 days, or 121–365 days.

Overall survival was 95.8%, with a median time from diagnosis to surgery of 38 days. However, each increase in diagnosis-to-surgery interval was associated with a 7.4% increase in the risk of death.

The study was published in the Annals of Surgical Oncology.

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If you’ve ever experienced an immobilizing sense of panic when faced with a difficult or threatening situation, you’re not alone. It turns out that the well-documented fight-or-flight instinct for self-preservation isn’t a guaranteed reaction.

Research published in the Proceedings of the National Academy of Sciences has found that stress can actually lower your ability to effectively assess new threats because it can distract you, leading you to pay less attention to what’s going on around you and impair your ability to react in your own best interests.

‘Un-freeze’ your thinking

Furthermore, a study in the Journal of Neuroscience found that stress can keep you from making positive changes in your life by holding you back, as though your feet were stuck in mud. It can colour your thinking, making situations seem worse than they really are. So, for instance, just when you should be taking steps to get out of a difficult situation, you end up doing nothing.

If stress has you paralysed, it’s important to take steps to “un-freeze” your thinking. While relaxation techniques, like deep breathing, can help you refocus in moments of high stress, everyday actions can work together to lower daily low-grade stress levels. Specifically, find ways to exercise more – physical activity redirects your energy. To keep blood sugar on an even keel, limit your intake of sugary foods. If caffeine gives you the jitters, cut back on the amount you drink. And watch alcohol consumption since booze can also increase anxiety levels.

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Some Parkinson’s patients who have a deep brain stimulation device implanted to control their symptoms have reported an odd side effect – they lost the ability to swim.

Researchers report on the cases of nine patients who were still good swimmers even after they were diagnosed with Parkinson’s disease. After they had deep brain stimulation surgery, their Parkinson’s symptoms improved, but they lost their swimming skills.

Deep brain stimulation devices

One patient was a 69-year-old man who’d been a good swimmer and only found out he could no longer swim when he jumped into a lake. He said he would have drowned if he hadn’t been rescued by a family member.

Three of the nine patients were able to swim again after they turned off their deep brain stimulation devices. However, they turned them on again because their Parkinson’s symptoms worsened.

The study was published online in the journal Neurology.

“Until more research is done to determine why some people with deep brain stimulation can no longer swim, it is crucial that people be told now of the potential risk of drowning and the need for a carefully supervised assessment of their swimming skills before going into deep water,” said study author Dr Daniel Waldvogel, from the University of Zürich in Switzerland.

Highly coordinated movement

Parkinson’s is a progressive nervous system disorder that can result in tremors or movement problems. Deep brain stimulation involves placing electrodes in specific areas of the brain to control abnormal movements. The electrodes are connected to a device – placed under the skin in the upper chest – that controls the electrical impulses.

“Swimming is a highly coordinated movement that requires complicated arm and leg coordination,” Waldvogel explained in a journal news release. “Exactly how deep brain stimulation is interfering with this ability needs to be determined.”

He noted that the study reports on only a few cases and said further research is needed in a large number of patients to pinpoint the percentage who lose their ability to swim due to deep brain stimulation.

“Even though these reports affected only a few people, we felt this potential risk was serious enough to alert others with Parkinson’s disease, as well as their families and doctors,” Waldvogel said.

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Take a deep breath in. Slowly let it out.

A Dartmouth study finds that the conscious perception of visual location occurs in the frontal lobes of the brain, rather than in the visual system in the back of the brain. The findings are published in Current Biology.

Mitochondria, tiny structures present in most cells, are known for their energy-generating machinery. Now, Salk researchers have discovered a new function of mitochondria: they set off molecular alarms when cells are exposed to stress or chemicals that can damage DNA, such as chemotherapy. The results, published online in Nature Metabolism on December 9, 2019, could lead to new cancer treatments that prevent tumors from becoming resistant to chemotherapy.

Childhood obesity may be linked to changes in brain structure that might result in impulsive kids who struggle with problem-solving, a new study reports.

Overweight and obese children tend to have a thinner prefrontal cortex, a part of the brain associated with decision-making and problem-solving. These same kids performed more poorly on games designed to evaluate those skills, said lead researcher Jennifer Laurent. She is an associate professor with the University of Vermont College of Nursing and Health Sciences, in Burlington.

Risks of childhood obesity

“With escalating levels of BMI [body mass index], there was reduction in all of the cortical areas but specifically in the prefrontal cortex,” Laurent said. “In that situation, these kids had a poorer working memory. Working memory is what you use to make decisions.”

There are 13.7 million children and teens in the United States who are obese, and another 12 million are overweight, the researchers said in background notes.

Previous studies have associated childhood obesity with early risk of heart disease and type 2 diabetes, Laurent added.

She and her colleagues wondered if obesity then might have some effect on the developing brain, given that extra pounds affect blood flow, blood sugar levels and inflammation.

So, the researchers gathered data from a large-scale study of adolescent brain development, which recruited a large number of nine- and 10-year-old children at 21 sites across the United States in 2017.

Nearly 3 200 children were weighed and then given a battery of thinking and memory tests. The kids also underwent an MRI brain scan.

Underdeveloped prefrontal cortex

About 13% of the kids qualified as overweight and 15% were obese, the researchers said.

As BMI increased, the outer layer of the brain – the cortex – became thinner in these kids, brain scans revealed.

The effect was particularly apparent in the prefrontal cortex, which is at the front of the brain and is the last part of the cortex to develop in children, Laurent said.

“That’s one of the reasons adolescents are so impulsive, it’s because their prefrontal cortex isn’t fully developed,” Laurent said. “They don’t have that ability to walk away from something.”

Brain games showed an association between a thinner prefrontal cortex and poorer ability to reason, organise information, and decide.

The findings were published online in JAMA Pediatrics.

Poor decision-making

Because this was an observational study that did not prove cause and effect, it’s hard to say exactly how the association between weight and brain structure works, Laurent said.

It could be that obesity causes a thinner cortex, or it could be that a thin cortex leads to poor decision-making that causes obesity, she explained.

“Perhaps these particular children are making less appropriate decisions about what they eat or when they eat or how they eat,” Laurent said. “We really don’t know.

However, these results should serve as a wake-up call regarding the need to prevent childhood obesity, she added.

“Kids as early as 10 years old may be having metabolic dysfunction that’s affecting their heart and their brain,” Laurent said. “It hopefully is a public health alert that we really need to start addressing healthy eating behaviours and other healthy behaviours really early in life.”

However, Laurent warned that these findings should not be used to contribute to any sort of fat-shaming.

“We don’t want people to think if kids are obese, that they have a problem with their brain or that they’re stupid,” Laurent said. “It doesn’t have anything to do with their intellectual capability.”

As-yet unknown factor

Childhood obesity expert Dr Eliana Perrin, who co-wrote an editorial accompanying the study, agreed with Laurent.

“I am definitely concerned that these findings could be used out of context to further stigmatise children and adolescents with obesity, and that stigma we know is very harmful,” said Perrin, director of the Duke University Center for Childhood Obesity Research in Durham, North Carolina.

Perrin added that there might even be some as-yet-unknown additional factor that’s influencing the kids’ weight, brain structure, performance on brain games, or all three.

“Sometimes when people see that one thing happens alongside another thing, they think that first thing caused the other when we don’t know that at all,” Perrin said. “In research, this work is often stepwise. It’s important that we not turn it into something it’s not before we’ve completed all the steps.”

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When a seven-year-old’s tongue got stuck in a juice bottle, one savvy doctor used an old trick to release it.

The boy was trying to get the last drop of juice when his tongue created a vacuum and he couldn’t get it out of the bottle. When he arrived at Auf der Bult Children’s Hospital in Hannover, Germany, his tongue was swollen and discoloured.

At first doctors tried lubricating the tongue and twisting it out of the bottle. But that didn’t work. They wanted to avoid more invasive measures that would require general anaesthesia and cutting the bottle away.

So they next tried putting a thin catheter into the bottle around the boy’s tongue, hoping that would release the vacuum. That, too, had no effect.

That did the trick

Then, one doctor recalled a way he had once popped a cork out of a wine bottle when he couldn’t find a corkscrew. They attached a syringe to the catheter and forced air into the bottle.

That did the trick, and doctors were able to separate the boy from the bottle at last.

“We found only one previous report of a positive pressure technique similar to the one used by us in our patient,” said Dr Christoph Eich, a paediatric emergency doctor at the hospital.

“The idea to attempt to inject air into the bottle to produce positive pressure was inspired by my personal recollection of successfully uncorking a wine bottle while working as an anaesthetic registrar, with the use of a syringe-and-cannula technique on an occasion when no corkscrew was available,” he said in a news release from the European Society of Anaesthesiology.

The boy was admitted to the hospital for 24 hours of observation, and given prednisolone and ibuprofen to reduce the swelling in his tongue.

When he left the hospital, the swelling had mostly disappeared, but it took about three days for the discoloration to go away. After two weeks, he had fully recovered.

The report was published in the European Journal of Anaesthesiology.

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Psoriasis is a chronic, inflammatory skin disease that is often coupled with depression, anxiety and even bipolar disease, schizophrenia and dementia, two new studies show.

What is unclear, the researchers acknowledge, is which causes which.

Immune disorder link

In the first study, Danish researchers collected data on more than 13 600 men and women with psoriasis. Over five years of follow-up, 2.6% developed mental problems, and over 10 years, that number rose to nearly 5%.

These disorders included depression, anxiety, bipolar disease, schizophrenia and dementia. The researchers speculate that since immune disorders have been linked with the development of mental problems, and psoriasis is an immune-disorder disease, it might explain the connection.

“This report is very interesting, as it denotes possible relationships to other mental disorders as well as stated mechanisms, therefore highlighting an awareness of further conditions for providers to be aware of,” said Stacie Bell, vice president of research and clinical affairs at the National Psoriasis Foundation.

In the second paper, Korean researchers looked at more than 12 700 psoriasis patients. They found that the risk for anxiety, phantom medical problems, neurotic disorders and sleep problems was doubled and tripled among psoriasis sufferers compared to those without the disease.

Although both studies suggest a link between mental health and psoriasis, neither paper can prove that one causes the other, only that the two are associated.

Anxiety and depression

Both teams of researchers concluded that since patients with psoriasis are at risk for mental problems, dermatologists should be on the lookout and be prepared to assist patients in getting the help they need.

“Patients who are anxious or depressed are common to what I’ve seen in my practice,” said Dr Michele Green, a dermatologist at Lenox Hill Hospital in New York City. “They’ve got this disease that is literally taking over their skin, and they have anxiety about it and depression.”

Green believes psoriasis triggers the depression and anxiety, but she said it’s also known that stress and other mental problems can trigger immune diseases like psoriasis.

A report from the National Psoriasis Foundation and the American Academy of Dermatology recognised that anxiety and depression can be fellow travellers of the disease. They recommend that patients be told about the possibility of developing these problems.

Patients get insulted

In addition, doctors should ask their patients if they are feeling anxious or depressed and refer them to mental health professionals if necessary.

Treating psoriasis does seem, however, to reduce anxiety and depression, the report noted.

Green said she is careful about how she handles depression and anxiety among her patients. If they ask, she’ll refer them to a mental health professional.

“But I’ve found that if you suggest to patients they may need a psychiatrist, they get insulted,” she said.

The reports were published online in the journal JAMA Dermatology.

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Growing your own fruit and veg is already eco-friendly, but it could also help fight climate change.