Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid metastasis compared to other subtypes. Predicting long-term survival post-chemotherapy in patients with TNBC is difficult, yet enhanced infiltration of tumor infiltrating lymphocytes (TILs) has been associated with therapeutic response and reduced risk of metastatic relapse. Immune biomarkers that predict the immune state of a tumor and risk of metastatic relapse pre- or mid-neoadjuvant chemotherapy are urgently needed to allow earlier implementation of alternate therapies that may reduce TNBC patient mortality. Utilizing a neoadjuvant chemotherapy trial where TNBC patients had sequential biopsies taken, we demonstrate that measurement of T-cell subsets and effector function, specifically CD45RO expression, throughout chemotherapy predicts risk of metastatic relapse. Furthermore, we identified the tumor inherent interferon regulatory factor IRF9 as a marker of active intratumoral type I and II interferon (IFN) signaling and reduced risk of distant relapse. Functional implications of tumor intrinsic IFN signaling were demonstrated using an immunocompetent mouse model of TNBC, where enhanced type I IFN signaling increased anti-tumor immunity and metastasis-free survival post-chemotherapy. Using two independent adjuvant cohorts we were able to validate loss of IRF9 as a poor prognostic biomarker pre-chemotherapy. Thus, IRF9 expression may offer early insight into TNBC patient prognosis and tumor heat, allowing for identification of patients that are unlikely to respond to chemotherapy alone and could benefit from further immune-based therapeutic intervention.

Objective: Identifying modifiable factors affecting work ability among cancer survivors is important. The primary aim of the present study was to examine the effects of depression and related psychological factors on work ability among breast cancer survivors in Australia. Methods:In this cross-sectional electronic and postal survey, Australian breast cancer survivors were investigated. Work status and conditions before and after cancer treatment were analysed. Work ability was measured using the Work Limitation Questionnaire©-Short Form (WLQ-SF) with its four domains (time management, physical tasks, mental-interpersonal tasks, and output tasks). Three psychological factors were investigated: depression, fear of cancer recurrence, and demoralisation. Sociodemographic and clinical data were also collected. Multivariate regression analysis was used to identify the associations of psychological factors with WLQ-SF.Results: Among eligible survivors, 310 (50%) responded to the survey and were analysed. Nearly one third reported their work conditions had changed after cancer treatment. The depressed group reported limited work ability in 35%-44% of the four domains of WLQ-SF, while the non-depressed group reported limited work ability in only 8%-13%. At-work productivity loss was approximately fourfold higher in the depressed group than in the non-depressed group. In multivariate analysis, at-work productivity loss was associated with depression, demoralisation, and past history of anxiety. Conclusions: After breast cancer treatment, work conditions changed toward lower wages and working hours. Depression, demoralisation, and past history of anxiety were associated with lower work ability. Further evaluations of work rehabilitation in breast cancer survivors are warranted.

We report a rare case of Kimura disease in a 50‐year old female patient who attended our tertiary level Breast Surgery Clinic.

Impaired gastric emptying post-surgery causes a change in eating habits. Patients in this study did not lose a significant amount of weight despite all indicating worse eating comfort. Patients required more regular meals or snacks throughout the day and avoid foods that are difficult to swallow. It is likely that gastric motility only plays a small role in the emptying process and gravity combined with appropriate drainage procedures (pyloroplasty/pyloromyotomy) at the time of surgery are more important.

Aorto-appendiceal fistula presenting with bleeding per rectumFistula formation between the gastrointestinal tract and aortic graft is an infrequent but well recognized complication. There have been seven previously reported cases of graft appendiceal fistula in the literature between 1969 and 1992. 1-4 We report an eighth case of aorto-appendiceal fistula presenting with bleeding per rectum.A 75-year-old man presented to a major hospital having passed approximately 400 mL of liquid dark red stool. His past history included an elective aortobiiliac aneurysm repair with a dacron graft 12 years earlier and a left hemicolectomy with splenectomy 5 years previously for carcinoma of the colon.On admission, he was haemodynamically stable with a haemoglobin level of 14.9 g/dL and evidence of fresh blood on rectal examination. He continued to bleed intermittently with a drop in haemoglobin level at 24 h and a nuclear labelled red cell scan performed was inconclusive. Colonoscopy performed showed fresh blood in the colon but no site of active bleeding was seen.At 48 h, he continued to bleed with signs of haemodynamic instability. A repeat nuclear labelled red cell scan showed positive gastrointestinal blood loss which appeared to arise from the caecum. Following resuscitation, an emergency laparotomy was undertaken. At laparotomy, the appendix was found adherent to the distal end of the right limb of the aortic graft. An appendicectomy, excision of the infected right limb graft and iliac artery was performed. An in-situ replacement with a 8-mm gelsoft plus dacron was used. His postoperative course was uneventful and he was discharged home at 2 weeks with ongoing antibiotics.The diagnosis and management of an aorto-appendiceal fistula can be complex and challenging. The majority of the previous cases presented with a history of gastrointestinal bleeding with or without shock.In this case report, the patient had a history of aortic reconstruction many years previously and there was a low index of suspicion of an aorto-enteric fistula. Nevertheless, the investigations undertaken were prompt and appropriate. Endoscopy is generally accepted as a first line investigation of choice. It is also useful to exclude other causes of gastrointestinal haemorrhage. Colonoscopy has only been useful in one previous report in demonstrating a fistula. 3 Tagged red cell scan has not been mentioned as a common tool in the literature in the investigation of an aorto-enteric fistula. However, as in one other case reported, a red cell scan assisted in identifying the site of bleeding. 2 As the bleeding is intermittent, a labelled red cell scan has a higher chance of identifying the bleeding site as the patient is scanned over a longer period of time. Other investigations mentioned in the literature which may be helpful were angiography and computed tomography scan. A barium gastrointestinal study may also be useful if the patient is stable but generally most diagnostic tests had a poor yield. 5 Often, the site of an aorto-enteric fistula is not ap...