Breast Cancer (BC) is the most common malignancy affecting women worldwide [1]. Adjuvant radiation therapy (RT) of the breast plays a vital role in BC treatment and has been shown to improve overall survival [2]. Due to increased survivorship, the cardiac sequelae that develop due to BC treatments have become more apparent. Radiation therapy, a common BC treatment, exposes the heart to radiation due to its presence in the irradiation field. Although modern RT techniques aim to reduce cardiac radiation exposure, research suggests the persistence of cardiac damage. This scoping review aims to establish the types of cardiovascular disease (CVD) that manifest post‐RT, and create a timeline for early radiation‐induced cardiotoxicity detection and surveillance. A scoping review was conducted utilizing the methodology of the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐Scr). A literature search was conducted on MEDLINE and EMBASE in Ovid on July 29th, 2021 for papers published from 1995 to July 2021. MeSH/EMTREE terms and keywords were used for the following concepts: Breast Cancer, Radiation Therapy, Cardiovascular, Treatment Outcomes. Search strategies were optimized for each database. After removing duplicates, 1341 papers were sent to title and abstract screening, of which 276 were sent to full‐text review. 160 studies were included for final data extraction. Agreement from two reviewers was required for an article to move to the next stage of screening. Eligibility criteria included primary clinical studies reporting a cardiovascular outcome of interest for patients who underwent BC RT. Even with modern radiotherapy techniques, patients who have undergone BC RT face an increased risk of the development of cardiovascular morbidities. In the long term, the risk of cardiac disease increases with an increase in mean heart radiation dose. Early‐detection studies reveal that changes in cardiac dysfunction can be detected early on, often characterized by a decline in left ventricular ejection fraction. With most RT‐induced cardiac sequelae manifesting years after RT exposure, studies with a shorter follow‐up period often report lower CVD risk. Articles produced contrasting results regarding whether breast cancer radiation laterality increases the risk of CVD, with many indicating no difference while others concluded those with left‐sided radiation therapy have an increased risk. Detection and surveillance, with a combination of both cardiac biomarkers and imaging, is critical at an early stage for all women who have undergone BC RT. With the majority of current surveillance techniques only detecting cardiovascular damage once it is too late, early detection is a critical prerequisite in improving cardiac sequelae prediction and prevention to ultimately improve breast cancer patients’ quality of life and care. [1] Sung et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin; 72...
Endometriosis is one of the most prominent gynecological disorders often associated with several cardiovascular repercussions. Although no conclusive mechanism has been found, previous literature indicates potential links between endometriosis and atherosclerosis, a vital indicator of cardiovascular disease (CVD). However, with the majority of previous studies overlooking the impact of critical confounding variables and testing for only certain biomarkers, a strong argument towards a link cannot be made. Existing literature was thoroughly analyzed to identify major confounding variables that were unaccounted for to compile a list of vital biomarkers indicative of CVD in women with endometriosis. The stage and severity of the disease, surgery, hormone therapy, and presence of endometriosis in the control group were found to be major confounding variables that should be statistically accounted for. From previous literature, biomarkers that were shown to be highly indicative of CVD included lipid profile, arterial stiffness measures, as well as additional measures of vascular function and structure. Encapsulating vital confounding variables and biomarkers, a comprehensive framework was established for a longitudinal study design. This paper provides a narrative review of the common weaknesses and limitations of past investigations exploring the link between endometriosis and CVD and suggests methods to overcome these considerations. Although existing literature has significantly contributed to the surface-level understanding of the link between endometriosis and CVD, knowledge gaps persist. As a result, repercussions are experienced by women with endometriosis worldwide. To ensure better healthcare for women with endometriosis, greater CVD intervention and prevention is critical. Through the holistic longitudinal study design proposed, improved treatment plans considering the potential CVD risks that women with endometriosis are at a greater likelihood of developing can be implemented.
Research involving human subjects in ambulatory settings is a critical link in the chain comprising translational research, spanning preclinical research to human subject and patient cohort studies. There are presently a wide array of techniques and approaches available to investigators wishing to study blood flow, perfusion, and vascular structure and function in human subjects. In this multi-sectioned review, we discuss capillaroscopy, carotid intima-media thickness, flow-mediated dilation, laser Doppler flowmetry, near-infrared spectroscopy, peripheral arterial tonometry, pulse wave velocity, retinal fundus imaging, and vascular plethysmography. Each section contains a general overview and the physical basis of the technique followed by a discussion of the procedures involved and the necessary equipment, with attention paid to specific requirements or limitations. Subsequently, we detail which aspects of vascular function can be studied with a given technique, the analytical approach to the collected data, and the appropriate application and limitation(s) to the interpretation of the data collected. Finally, a modified scoping review provides a summary of how each assessment technique has been applied in previous studies. It is anticipated that this review will provide an efficient source of information and insight for preclinical investigators seeking to add translational aspects to their research programs.
Introduction: Neonatal growth is dependent on the ability of the mother’s placenta to deliver nutrients. As such, placental health is an important aspect of obstetric care. Existing literature has suggested an association between fetal sex and placental growth and development; however, no centralized study has been conducted. This paper aims to conduct a narrative review that summarizes findings from published literature on the effects of fetal sex on the growth and development of the placenta through three facets: placental function, structure, and outcome. Methods: Databases including Medline, Embase, and EMCare in Ovid, CINAHL, Web of Science, and Scopus were searched using keywords for the concepts of fetal sex and placenta. These were searched in combination with keywords relevant to placental function, placental structure, and pregnancy outcomes, using Boolean operators “OR/AND/NOT” as necessary. Studies written in English and published in peer reviewed journals were considered, with an emphasis on those published between 2017-2021. Results: Sexual dimorphism is evident in the fetal responses to stressful maternal environmental conditions, onset by conditions such as asthma and obesity. Sex-specific differences have also been observed in complications of pregnancy, including gestational diabetes mellitus (GDM), preeclampsia, preterm delivery, stillbirth, and insufficient uteroplacental circulation. Discussion: Despite the placentas from male and female births being categorized together in previous literature, this review highlights the sexually dimorphic nature of the ephemeral organ. Knowledge of fetal sex as early as possible during the pregnancy will help clinicians take proactive measures to optimize the health of the mother and the fetus. Conclusion: This study provides a holistic review of the effects of placental development among the fetal sexes, a critical aspect to monitor for effective obstetric care. Hence, further research into the sexually dimorphic nature is warranted.
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