Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.

Our study is the largest to date examining the role of tamoxifen in idiopathic gynecomastia, and our results show approximately nine in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. We support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits.

Translational medicine bridges the gap between discoveries in biomedical science and their safe and effective clinical application. Despite the gross opportunity afforded by modern research for unparalleled advances in this field, the process of translation remains protracted. Efforts to expedite science translation have included the facilitation of interdisciplinary collaboration within both academic and clinical environments in order to generate integrated working platforms fuelling the sharing of knowledge, expertise, and tools to align biomedical research with clinical need. However, barriers to scientific translation remain, and further progress is urgently required. Collective intelligence and crowdsourcing applications offer the potential for global online networks, allowing connection and collaboration between a wide variety of fields. This would drive the alignment of biomedical science with biotechnology, clinical need, and patient experience, in order to deliver evidence-based innovation which can revolutionize medical care worldwide. Here we discuss the critical steps towards implementing collective intelligence in translational medicine using the experience of those in other fields of science and public health.

Up to 3.8% of human T-lymphotropic virus type-1 (HTLV-1)-infected asymptomatic carriers (AC) eventually develop HTLV-1-associated myelopathy (HAM). HAM occurs in patients with high (> 1%) HTLV proviral load (PVL). However, this cut-off includes more than 50% of ACs and therefore the risk needs to be refined. As HAM is additionally characterised by an inflammatory response to HTLV-1, markers of T cell activation (TCA), β2-microglobulin (β2M) and neuronal damage were accessed for the identification of ACs at high risk of HAM. Retrospective analysis of cross-sectional and longitudinal routine clinical data examining differences in TCA (CD4/CD25, CD4/HLA-DR, CD8/CD25 & CD8/HLA-DR), β2M and neurofilament light (NfL) in plasma in ACs with high or low PVL and patients with HAM. Comparison between 74 low PVL ACs, 84 high PVL ACs and 58 patients with HAM revealed a significant, stepwise, increase in TCA and β2M. Construction of receiver operating characteristic (ROC) curves for each of these blood tests generated a profile that correctly identifies 88% of patients with HAM along with 6% of ACs. The 10 ACs with this ‘HAM-like’ profile had increased levels of NfL in plasma and two developed myelopathy during follow-up, compared to none of the 148 without this viral-immune-phenotype. A viral-immuno-phenotype resembling that seen in patients with HAM identifies asymptomatic carriers who are at increased risk of developing HAM and have markers of subclinical neuronal damage.

Male breast cancer (MBC) is rare and accounts for 1% all breast cancers. 1 Approximately, 350 men are diagnosed with the condition each year within the UK and its incidence is increasing. 2 However, due to the rare nature of the disease, MBC has been poorly studied in relation to female breast cancer (FBC). 3 We aimed to investigate the prognosis of MBC in our center's past 10-year experience, and to compare the patient, tumor, and treatment differences between men who were treated successfully and those who suffered breast cancer recurrence or all-cause mortality.We undertook a prospective cohort study of all patients diagnosed with MBC over a 10-year period from 1 January 2005 until 31 December 2014. The identifiers of all men were prospectively recorded over the study period and at the end of this study, the clinical notes were retrieved and reviewed. Outcome and treatment-related information was extracted from the clinical notes. The primary outcome measure of interest was adverse outcome, defined as ipsilateral disease recurrence, contralateral breast cancer occurrence, metastatic disease, or all-cause mortality.A total of 30 primary cases of MBC were identified; 27 unilateral and 3 bilateral cases. All patients were treated with mastectomy and either sentinel lymph node biopsy or axillary clearance, followed by adjuvant endocrine therapy. Radiotherapy and chemotherapy were reserved for cases of metastatic disease or high risk of recurrence.Of these, 24 patients adhered to adjuvant endocrine therapy, six had adjuvant chemotherapy, and 16 patients had adjuvant radiotherapy.No patients were lost to follow-up.The mean age was 68.3 years (SD 11.8) and patient characteristics are shown in Table 1. All patients were followed up annually with surveillance contralateral imaging and clinical examination. Five patients had an adverse outcome, of which three patients had a subsequent recurrence (10%) and two died from their disease (7%). Of the five patients with adverse outcome, three patients had invasive ductal carcinoma and two had invasive cribiform carcinoma. Tumor size and nodal status did not reach statistical significance (P = 0.13 and 0.14, respectively) for adverse outcome (Table 2).There is limited evidence on the prognosis of MBC; however, it is generally worse than for FBC. 4 MBC is predominantly ER-positive, 5 suggesting that underlying endocrine factors may play an important role in pathogenesis. In more recent years, a number of other receptors have also been identified with MBC such as glucocorticoid, androgen, HER2, and EGF receptors although the prognostic value of these receptors is still poorly understood. 6While not identified in our cohort, axillary nodal involvement and tumor size have previously been identified as key prognostic determinants for MBC. Although there is heterogeneous evidence on the prognosis of men with breast cancer, their prognosis is generally worse than their female counterparts. The reason for this is unclear, but since this difference in prognosis appears to be independe...