Background: Breast cancer is the second leading cause of death in women in developing countries. The activity of Warburg and Reverse-Warburg effects on breast cancer is reflected by the expression patterns of two molecules, namely caveolin-1 and Monocarboxylate Transporter-4 (MCT-4). MCT-4 is a transmembrane transport protein that transports lactate from the cytoplasm to the intercellular fluid.Method: This is a cross-sectional analytical study to determine the relationship between MCT-4 expression and breast cancer clinicopathology and subtypes. The study was conducted between April and May of 2020 with 62  breast cancer patients as samples in Sanglah General Hospital, Denpasar. Analysis was done with SPSS 25.Results: A logistic regression analysis was performed to analyze the relationship between the dependent variable (MCT-4) and the covariates (stage, grade, and subtype). Of the three variables significantly associated with MCT-4 expression, only clinical-stage and subtype (luminal and non-luminal) remained independently associated with MCT-4 expression. Analysis on the clinical stage and subtype variables showed an adjusted OR of 4.727 (p = 0.047; 95% CI: 1.109 - 21.922) and 17.850 (p = 0.009; 95% CI: 2.069 - 154.003) , respectively. This suggests that MCT-4 has a significant association with subtype and clinical-stage, increasing the risk of cancer stage progression and developing a more malignant (non-luminal) subtype.Conclusion: High MCT-4 expression was significantly associated with malignant subtypes, high histological-grade cancer and advanced breast cancer.

BACKGROUND: Based on the global cancer observatory (GLOBOCAN) data, in 2018, there were 18.1 million new breast cancer cases. Breast cancer is the second-most common malignancy after lung cancer, which contributed to 11.6% of all new cancer cases in 2018. Breast cancer is the second-leading cause of death in women in developing countries. The activity of Warburg and reverse Warburg effects on breast cancer is reflected by the expression patterns of two molecules, namely caveolin-1 and monocarboxylate transporter-4 (MCT-4). MCT-4 is a transmembrane transport protein that functions in the transport of lactate from the cytoplasm to the intercellular fluid. METHODS: This is a cross-sectional analytical study to determine the relationship between MCT-4 expression and breast cancer clinicopathology and subtypes. The study was conducted between April and May of 2020 with 62 breast cancer patients as samples in Sanglah General Hospital, Denpasar. Analysis was done with SPSS 25. RESULTS: A logistic regression analysis was performed to analyze the relationship between the dependent variable (MCT-4) and covariates (stage, grade, and subtype). Of the three variables that were significantly associated with MCT-4 expression, only clinical stage and subtype (luminal and non-luminal) remained independently associated with MCT-4 expression. Analysis on the clinical stage and subtype variables showed an adjusted OR of 4.727 (p = 0.047; 95% CI: 1.109–21.922) and 17.850 (p = 0.009; 95% CI: 2.069–154.003), respectively. This suggests that MCT-4 has a significant association with subtype and clinical stage which increases the risk of progression of the cancer stage as well as the risk of developing a more malignant (non-luminal) subtype. CONCLUSION: High MCT-4 expression was significantly associated with malignant subtypes, high histological-grade cancer, and an advanced breast cancer.

The incident of cervical spine injury and cervical spinal cord injury is between 2.0% to 5.0%. The advanced trauma life support (ATLS) stated that a patient with multiple traumas should be assumed tohave cervical spine injury especially if the patient loses consciousness when present in the ER. It is stressed that cervical spine injury requires continuous immobilization of the patient’s entire body using a semirigid collar as well as a backboard with tape and straps before and during transfer to a defnitive care facility. The understanding of the mechanism of injury is the most important as the forces transferred are signifcantly different causing different injuries. A serial case reported by Walter and Adkins found that there was no signifcant difference between the patients that have a bullet removed from the neck and patients that have a bullet left in the cervical cord. In both cases, there was no improvement to the neurologic outcome. Kupcha recommends doing selective wound management and observation of retained intracanal bullet fragments in a patient with complete lesion. Surgical decompression after the injury is not recommended. We report a case of 14 year old boy who was treated at Sanglah Hospital referred froman out-of-island Type C Hospital with a spinal cord injury - American Spinal Injury Association A (SCI ASIA A) caused by a gunshot wound in the cervical. Surgical decompression and bullet removal was performedas well as fusion stabilization. He is then treated in the intensive care unit for 48 hours with a slight improvement in motoric of upper and lower extremities.