Scientific Program

Day 1

KEYNOTE SPEAKERS
  • The Influence of Physical Activity on the Quality of Life of Patients with Systemic Lupus Erythematosus

    University Medical Center, Belgrade
    Serbia
    Biography

    Ljudmila Stojanovich received her Ph.D. in Medicine in 1999. She is the scientific director in the Bezhanijska Kosa, University Medical Center of Belgrade University, where she is currently a Full Research Professor. She is an author of three monographs and of about 250 articles on various aspects of Autoimmune Rheumatic disorders, published in international and domestic journals and in conference proceedings. She is in Editorial Boards (Editorial Boards LUPUS (LONDON). She is a member of number International Project, like of “the European Forum on Antiphospholipid Antibodies”. She was in Invited Speaker for many lectures in Congresses and Symposia; organizer and Chairman of many Seminars and Symposia; and member of the Steering Committee of the “EULAR recommendations for the prevention and management of adult antiphospholipid syndrome". Professor Stojanovich is EULAR Honorary Member; the Member of the international team of medical experts for the topic on APS (Hughes Sy), and the President of “12th meeting of the European Forum on APS” will be held in Belgrade, Serbia in April 2020. Professor Ljudmila Stojanovich’ Impact Point is 300.14, and number of citattions is 2.500.

    Abstract

    Title: The Influence of Physical Activity on the Quality of Life of Patients with Systemic Lupus Erythematosus Name: Ljudmila Stojanovich Affiliation: Head of Scientific Research Department Bezhanijska Kosa, University Medical Center, Belgrade University, Serbia Co-authors Gordana Bogdanovic, Aleksndra Djokovic, Marija Zdravkovic Abstract (upto 300 words) INTRODUCTION: Because of the fact that systemic lupus erythematosus (SLE) causes joint and muscle pain, fatigue, depression, obesity and osteoporosis, the very thought of exercising can be a challenge for patients. PATIENTS AND METHODS: This prospective study included 60 patients diagnosed with SLE in stable condition. A randomly selected group of 30 women had aerobic training on a bicycle ergometer for a period of 15 minutes, 3 times per week for 6 weeks, while the second group of 30 women did exercise for 30 minutes, 3 times per week during the same period. FSS(fatigue Severity Scale), Short Form 36 (SF36)questionnaire on the quality of life and Beck depression inventory (BDI) were analyzed at baseline and after 6 weeks. RESULTS: Fatigue was present in all patients (FSS score 53.8 ± 5.7; min 39, max 63) before starting the exercise. Fatigue was present in 11 patients(18.3%) after the physical activity while 49 (81.7% ) patients did not experience it (FSS score 29.1 ± 7.8; min 18, max 45). Before starting the exercise the largest number of patients, 40 (66.67%) of them, was in a moderate depressed state, while after physical activities the greatest number of patients, 37 (61.66%), had a mild mood disturbance. There are high statistical differences in values of all areas of quality of life questionnaire SF36 before and after the implementation of physical activity. A statistically significant difference was observed in terms of reducing the parameters of pain, general health and mental health in a group that had a physical activity on a bicycle ergometer evaluated by the SF36 questionnaire (p <0.05). CONCLUSION: Our study has shown that a continuous physical activity in SLE patients significantly improves their quality of life by reducing fatigue and depressive reactions without negative impacts on the activity of their disease. ACKNOWLEDGEMENTS: This work was supported by research grant number 175041 for 2011 - 2020, issued by the Ministry of Science of the Republic of Serbia, and by research grant number TR 32040 for 2011 - 2020, issued by the Ministry of Science of the Republic of Serbia. Biography (upto 150 words) Ljudmila Stojanovich received her Ph.D. in Medicine in 1999. She is the scientific director in the Bezhanijska Kosa, University Medical Center of Belgrade University, where she is currently a Full Research Professor. She is an author of three monographs and of about 250 articles on various aspects of Autoimmune Rheumatic disorders, published in international and domestic journals and in conference proceedings. She is in Editorial Boards (Editorial Boards LUPUS (LONDON). She is a member of number International Project, like of “the European Forum on Antiphospholipid Antibodies”. She was in Invited Speaker for many lectures in Congresses and Symposia; organizer and Chairman of many Seminars and Symposia; and member of the Steering Committee of the “EULAR recommendations for the prevention and management of adult antiphospholipid syndrome". Professor Stojanovich is EULAR Honorary Member; the Member of the international team of medical experts for the topic on APS (Hughes Sy), and the President of “12th meeting of the European Forum on APS” will be held in Belgrade, Serbia in April 2020. Professor Ljudmila Stojanovich’ Impact Point is 300.14, and number of citattions is 2.500. Email ID: Ljudmila_Stojanovich@yahoo.com Presenter Name: Ljudmila Stojanovich Type of Presentation: Speaker Contact Number: + (381 11) 20 95 617

  • Improving quality of care in breast cancer treatment: European criteria for certifying breast surgeons and breast units

    University of Athens Medical School
    Greece
    Biography

    Doctor Papanikolaou is born in Athens in 1985. In 2009 he takes the Medical Degree (MD) with Excellent votation. Afterwards, he is selected to participate in the 2 years Postgraduate Programme in Robotic Surgery, Minimally Invasive Surgery and Telesurgery, in the University of Athens, Medical School in Greece. In 2011 he is distinguished again with Excellent votation and obtains the title of “Master of Science” of the Athens Medical School in “Robotic Surgery, Minimally Invasive Surgery, and Telesurgery”. In 2011 he begins his Ph.D. research on stem cells transplantation in experimental models. In 2018 he is distinguished with the Ph.D. (Doctor of Philosophy) in the Athens Medical School, Greece with Excellent votation. In 2016 he begins a second 1,5 years Postgraduate Programme in “Reproductive and Regenerative Medicine” in the Athens Medical School. He has obtained many Scholarships in National and International level such from The Empeirikeion Foundation, The Experiment & Research Centre of Elpen, The Faculty of Medicine. He has gained the first Prize in the “Robotic Surgery Marathon”, as well as the First Prize in the “Laparoscopic Simulation Cup”. He is the author of many publications in international and national journals and he is also selected as the reviewer for many journals such as The British Medical Journal, Stem Cells International, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, Journal of Medical Robotics & Computer Assisted Surgery, The European Journal of Obstetrics, Gynecology and Reproductive Biology. He works in the 1st Department of Obstetrics & Gynecology of the University of Athens, Medical School in Greece, in “Alexandra” Hospital.

    Abstract

    Improving quality of care in breast cancer treatment: European criteria for certifying breast surgeons and breast units Ioannis G Papanikolaou1, 2 1University of Athens Medical School, Greece 2Alexandra Hospital, Greece Abstract As the topic of author’s Lecture suggests, he will focus on certification criteria of breast units and breast surgeons across Europe, which are crucial issues for the appropriate therapeutic management of breast cancer. The last GLOBOCAN estimates for breast cancer, classify this carcinoma as the most common in the female. Treatment options have changed and modern breast surgery tends to have a more conservative and cosmesis-preserving face. Breast cancer treatment involves many medical specialties and requires deep knowledge, training, expertise and dedication. The European Board for Surgical Qualification gives guidelines on eligibility criteria for involvement in breast surgery defining metrics for operations that a breast surgeon should have performed and defines with precise metrics the numbers of procedures in which a qualified breast surgeons should be involved. Different international societies are involved in education and certification of competency in breast surgery. Many authors highlight that treatment of breast cancer in high-volume centers is of crucial importance because it improves five year survival up to 33%. Furthermore, the number of breast cancer surgeries that a breast surgeon performs per year seems to be an independent prognostic factor for patient’s survival, recurrence and general outcome. For all these reasons, treatment of breast cancer in certified breast units by specialized breast surgeons is mandatory. New techniques of oncoplastic breast-conserving surgery challenge the current armamentarium of therapeutic options, proving excellent cosmetic results with comparable oncological outcome to the standard breast-conserving surgery. Furthermore, oncoplastic techniques improve patient’s satisfaction and quality of life after breast cancer diagnosis. Genetic counseling, psychological support and multimodal treatment from a breast-dedicated team which involves many specialties are mandatory for qualitative standards of care. There is an urgent need for certified education in breast surgery, not only for breast centers but also for breast surgeons. Dedication is a key principle in breast surgery, because it improves outcomes. Considering high incidence and mortality rates in the global population, current care for breast cancer needs to be based on quality. Breast surgery is a field with which, Obstetricians and Gynecologists should deal with and begin to be involved in Europe, after an accurate and strict training process which provided final certification. The future of breast surgery is in less invasive and more cosmoses-preserving approaches surgery in the treatment of breast disease, including breast carcinoma. Patient-centered care is a key component and quality indicator in the treatment of breast carcinoma. Biography Ioannis G Papanikolaou was born in Athens in 1985. In 2009 he takes the Medical Degree with excellent votation. Afterwards, he was selected to participate in the two years Postgraduate programme in Robotic surgery, minimally invasive surgery and Telesurgery, in the University of Athens, Medical School, Greece. In 2011 he was distinguished again with excellent votation and obtains the title of “Master of Science” from the Athens Medical School in “Robotic surgery, minimally invasive surgery and Telesurgery. He was distinguished with the PhD (Doctor of Philosophy) from Athens Medical School, Greece with Excellent votation in 2018. He has gained the first Prize in “Robotic Surgery Marathon”, as well as the First Prize in the “Laparoscopic Simulation Cup”. He is the author of many publications in national and international journals and he is also selected as reviewer for many journals such as The British Medical Journal, Stem Cells International, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, The International Journal of Medical Robotics & Computer Assisted Surgery, The European Journal of Obstetrics, Gynecology and Reproductive Biology. Currently he works in the 1st Department of Obstetrics & Gynecology of the University of Athens, Medical School in Greece, in “Alexandra” Hospital. papanikolaou85@gmail.com

  • Personalization of medical implants: design, simulate and 3d print of patient specific knee implant for total knee replacement.

    VOLMO Pvt. Ltd
    United Kingdom
    Biography

    Ash Harkara is a Founder Director of VOLMO LTD. He completed his PhD from Pune University, India. He completed his Postdoctoral Studies from school of EE, University of Leeds, United Kingdom. He has twenty years of experience in industry and academics. He has written number of papers in reputed journals and also presented papers in number of international conferences. Since last ten years he has been working in medical image processing and patient specific implants

    Abstract

    Personalization of medical implants: design, simulate and 3d print of patient specific knee implant for total knee replacement. Ash Harkara Volmo Ltd., United Kingdom Abstract Total knee replacement is the most effective treatment to relief pain and restores the normal function in a diseased knee joint. The aim of this research was to develop a patient-specific knee implant which can be fabricated using 3D Printing also called as additive manufacturing techniques. 3D printing is an emerging technology and its use in Orthopaedics is slowly gaining acceptance. This technique makes it easy to manufacture patient specific devices/guides and instrumentation of any shape and size. The patient-specific technology improves on conventional of the shelf process by allowing considering each patients anatomical structure, shape and size. In this study patient specific knee implant design, simulation and 3D print is discussed. In particular we want to highlight the role of computer simulations in testing and optimizing patient specific device. Patient knee CT scan data was modelled in Image Sim software and 3D model was generated. This model was used as the base model to capture the outer shape of distal femur and proximal tibia. Full set of J curves of condyles were captured and then exported. These set of J curves along with other landmarks were imported in Solid works and full implant for femur , tibia components and insert were designed. A detailed total knee-joint FE model was created in order to predict stress and strain at various flexion angles. Results from these simulations highlighted some initial stress riser sites especially in femur component. The design was accordingly changed and simulations were run again to make sure that design changes were correctly done. Finally, the patient-specific knee implant was successfully built using additive manufacturing techniques Figure [1] Patient CT Scan data model in ImageSim Software Biography Ash Harkara is a Founder Director of VOLMO LTD. He completed his PhD from Pune University, India. He completed his Postdoctoral Studies from school of EE, University of Leeds, United Kingdom. He has twenty years of experience in industry and academics. He has written number of papers in reputed journals and also presented papers in number of international conferences. Since last ten years he has been working in medical image processing and patient specific implants aharkara@volmopl.com Figure [2]: New knee implant for TKR

Arthritis & Rheumatic Disease
Chair
  • Allied Academies OrthoCongress 2019 Chair Speaker Ioannis G Papanikolaou photo
    Ioannis G Papanikolaou
    1st Department of Obstetrics and Gynecology, University of Athens Medical School, Alexandra Hospital
    Greece
Co-Chair
Speaker
  • Biography

    Ray Suhasish had done his graduation in Medicine and Surgery in 1991. Postgraduate in Orthopedic Surgery in 2001 with thesis in external fixation to heal open fractures of tibia, Postoperative Diploma in Rheumatology from Delhi in 2006 and M.Ch in Orthopaedics in 2010.

  • Day 1
    Electronic water can reduce oxidative stress in cancer and diabetes patients for 3 weeks drinking
    Speaker
    Dr. Masahiro Onuma
    Trisguide ltd
    Japan
    Biography

    Masahiro Onuma has expertise in oxidative disease prevention to use non-medical product based on GSK’s experience of Allopurinol which is the strongest anti-oxidant efficacy in this world. He creates a new indication of Allopurinol for stomatitis induced by cancer treatment which was approved by the Japanese Cancer treatment committee to propose a new mechanism of Allopurinol for anti-oxidant. And now, there are so many new research papers of Allopurinol in the world.

    Abstract

    Electronic water can reduce oxidative stress in cancer and diabetes patients for 3 weeks drinking Masahiro Onuma Trisguide Ltd. Japan Abstract Oxidative stress means a state there is imbalance between the oxidizing action and the reducing action due to reactive oxygen species (ROS) in a living body, resulting in the oxidizing action becoming dominant. Oxidative stress arises as the balance between production and removal is disrupted through excessive production of ROS and impairment of the antioxidant system. Oxidative stress has been reported to be involved in the onset and progress of various diseases. Characteristics of Type 2 diabetes are insulin secretion failure and insulin resistance, but it seems that oxidative stress is greatly involved in insulin secretion failure. In the insulin secretion-inducing ? cells of Langerhans islets in the pancreas, the amount of superoxide dismutase (SOD), which is representative of the ROS elimination system, is small and resistance to oxidative stress is considered to be weak. Regarding cancer, it is well known that chronic inflammatory conditions increase the risk of carcinogenesis. Cells such as neutrophils and macrophages are activated in the inflammation area leading to increase in production of active oxygen and nitric oxide. These free radicals cause DNA mutation and cell proliferation thereby promoting cancer development. When chronic inflammation is present, cancer develops more easily. Electronic water, which was developed to generate electron in water, was consumed for three weeks, after meals, between meals and before sleeping 6 times a day, and according to the test subjects' possible time periods. The amount of drinking water was 750-1000 mL, and BAP and d-ROMs checks for all cases were carried out at 4:30 pm. The results of cancer patients and diabetes patients were seen as attached. As a result, the d-ROMs value in the degree of oxidative stress has reduced, and the BAP value, which is an indicator of plasma antioxidant capacity, has improved significantly. Image Recent Publications 1. Potential of Electronic Water as a Therapeutic Treatment for Oxidative Stress-Related Diseases Int. J Diabetes Metab Disord, 2018 ?Volume 3 | Issue 2 | 1 of4?? Biography Masahiro Onuma has expertise in oxidative disease prevention to use non-medical product based on GSK’s experience of Allopurinol which is the strongest anti-oxidant efficacy in this world. He creates new indication of Allopurinol for stomatitis induced by cancer treatment which was approved by the Japanese Cancer treatment committee to propose new mechanism of Allopurinol for anti-oxidant. And now, there are so many new research papers of Allopurinol in the world. onuma@trisguide.com Notes/Comments:

  • How does a personalized rehabilitative model influence the functional response of different ankle foot orthoses in a cohort of patients affected by neurological gait pattern?
    Speaker
    Maurizio Falso
    Fondazione Madonna del Corlo
    Italy
    Biography

    Maurizio Falso received his Degree of Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation from the University of Medicine of Verona, Italy in 2004 followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona, Italy by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia, Italy and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity. In his career he also promoted the use of innovative dynamic carbon-kevlar custom made AFO (DAFONS), innovative postural devices in patients affected by neurological complex postural needs, the device treatment of idiopathic scoliosis by using an innovative dynamic spine brace called “BRIXIA” and the device treatment of gait disorders by using an innovative dynamic carbon Kevlar foot insole called “PRODYNAMIC”.

    Abstract

    Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: without AFO or free-walk (FW); wearing a Codivilla spring; wearing a carbon unjointed AFO (“Toe-Off”); wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3= time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). A statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test; a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off; a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2; a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4; a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4; in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses.

  • High rate of breast cancer in Catania: Our experience
    Speaker
    Marta Monari
    Humanitas Clinical and Research Center – IRCCS
    Italy
    Biography

    Marta Monari is a Biologist specialized in microbiology and virology with a II level master in virology and a Diploma en Genética Médica. She is the contract professor in two different Italian University: Humanitas Milano and Insubra Varese. She had worked as director of the clinical laboratory. Now she is the clinical and technical coordinator of laboratories of Humanitas Hospital group since 3 /05/2018, it is a group of 10 laboratories up 8 ML of exams, divided in all laboratory specialties.

    Abstract

    High rate of breast cancer in Catania: Our experience Marta Noemi Monari1, C Belgiovine1,2, L Paravizzini3, L Gullotti3, G Falzone3 and F Zangrandi1 1Humanitas Clinical and Research Center-IRCCS, Italy 2Università degli Studi di Pavia, Italy 3Humanitas Centro Catanese di Oncologia, Italy Abstract Breast cancer is the most common tumor in female; only in 2017 about 52.300 women fell it in Italy. This is a multifactorial pathology; it is a sporadic disease in the majority of the cases and it does not any kind of hereditary genes transmission, but sometimes, around 10%it could be hereditary, in particular for BRCA1-2, p53, PTEN, STK11, CDH1, PALB2, CHEK2, BARD1, BRIP1, NBN etc. Only in Sicily, 3.027 new cases every year are registered for this tumor with an incidence of 117 cases on 100.000 women and the two cities with the highest rate of this illness are Catania and Caltanissetta. After diagnosis, performed by histological analysis, the patients meet the Oncologic Genetic Counselling (OGC), where the oncologists end geneticist analyzed the clinical history of the patients and, on the bases of literature guidelines, decide if do or not the next generation sequencing (NGS) test, a second level test, before therapy. In 5 months the OGC of Hospital Centro Catanese di Oncology (CCO), decided to performed 48 NGS test in men and women. The aim of this study is to verify the accuracy of our enrolment, whether the percentage of the mutated gene in our samples is in line with the data present in literature. Between 48 patients suspected for a hereditary breast cancer, 2 are men and 46 women with a median age of 44, 08 (26-75 years). We have registered 75% of positive cases between men (37 years old and 65 years old both BRCA2+) and 27% between women (30,5 median age for BRCA1+, 48,01 median age for BRCA2+, 39 years old for family gene note mutation, and 34 years old for CHEK2). The total positivity for the test is 29, 16% and is very high compared to the Italian and world incidence. These results supported and confirmed the optimal skimming operated by physician and could help our EUSOMA (European Society of Breast Cancer Specialist) unit to understand the genetic bases of high rate of breast cancer in Sicily to ameliorate direct screening and treatment. The application of quality indicators is essential to improve organization, performance and outcome in breast care. Efficacy and compliance have to be constantly monitored to evaluate the quality of patient care and to allow appropriate corrective actions leading to improvements in patient care. Biography Marta Noemi Monari is a Biologist specialized in Microbiology and Virology with an II level master in virology, and a Diploma en Genética Médica. She is the contract professor in two different Italian Univeristies: Humanitas Milano and Insubra Varese. She had worked as Director of Clinical laboratory. Currently, she is the Clinical and Technical Coordinator of laboratories of Humanitas Hospital group since 2018; it is a group of 10 laboratories up 8 Medical Laboratories of exams divided in all laboratory specialities. marta_noemi.monari@humanitas.it

  • The Pannus adapter
    Speaker
    Paige L Long Sharps
    Montefiore Medical Center
    USA
    Abstract

    The Pannus adapter Paige L Long Sharps Montefiore Medical Center, USA Abstract The present invention relates to surgical equipment and in particular, to a device that is intended to support and contain a pannus during a surgical procedure to provide unobstructed access to the surgical site and provide, post-surgery, a clean site that is exposed to air to promote proper healing. A pannus is a medical term for a hanging flap of tissue. When involving the abdomen, it is called a panniculus and consists of skin, fat and sometimes contents of the internal abdomen as part of a hernia. A Pannus can be the result of obesity which unfortunately is becoming more and more widespread in society. The pannus is particularly troublesome and must be properly dealt with during the delivery of a child from an obese woman. It is generally understood that the term "obese" actually refers to anyone who is more than 30% over their ideal body weight. In 1962, 13% of the American population was classified as obese. By 1994, this number had increased to 23%. Yet, just six years later in 2000, this number had skyrocketed to over 30%.Today, an estimated two-thirds of Americans are considered overweight while one is three is obese. Obesity can put a woman and her baby at risk for serious health complications as well as complications during delivery of such a woman who is obese during pregnancy has an increased risk of experiencing problems during delivery and labor is more likely to be slow and prolonged, thus increasing the likelihood of cesarean section. The presence of a pannus during a cesarean section complicates the overall process and additional procedures must be followed to prepare the woman for surgery. As is known, in a conventional cesarean section procedure, after the skin is thoroughly cleansed with an aseptic solution and sterile drapes spread over the surgical field, the abdomen is entered my making an incision through all the layers of the abdominal wall: the skin, the fat and then several muscle layers and muscle sheaths (fascia).This incision can be made either vertically below the umbilicus like a zipper, or horizontally right above the pubic bone, a "bikini cut". Recent studies as well as personal experience have found that maternity units are not particularly well equipped for obese pregnant women. Presently, fairly crude techniques are used to deal with obese pregnant women that have a pannus that is obstructing the abdomen area where the cesarean section is to be performed. For example, in order to push the pannus back and hold the pannus away from the underlying tissue where the cesarean incision is to be made, an elongated band, such as adhesive tape, duct tape, surgical tape or the like, is attached to the lower abdomen above the incision on either side and is pulled up and back with sufficient force to lift the pannus away from the underlying tissue, and the other end of the band is fixedly attached to another structure. The structures to which ends of the band are attached can be legs of the bed or other fixtures in the operating room. Once the Pannus is lifted, the surgical procedure continues. After delivery of the baby, the incision is closed. Unfortunately, the Pannus is left to hang back over the incision. The hanging of the pannus over the incision provides a warm, moist area where the bacteria thrive, and proper healing is more difficult. Hence the Pannus Adapter is innovative in that it will provide proper sterile technical support that is worn by the patient and not attached to an IV pole in some archaic fashion. Not only is it designed to be worn prior to a surgical procedure, such as a cesarean section, but also after it during the recovery period for proper wound healing. It also appreciates that while a cesarean section is described herein as being a surgical procedure that is complicated by the presence of a pannus, any surgical procedure where an incision is made in the abdomen or proximate area that is covered by a pannus is equally complicated the presence of a Pannus. In effect it can be used for abdominal hysterectomies, or any surgical laparotomies. The Pannus Adapter as stated above solves the problem of a surgical field unobstructed by the pannus with a device that is sterile. The presence day of using duct tape and tying the ends of the tape to the surgical bed or IV pole is archaic and non-sterile. In addition, the decrease in wound infections, wound dehiscence and better back and abdominal support post-surgery would be solved by the Pannus Adapter. Biography Paige L Long Sharps graduated from the University of Medicine and Dentistry of New Jersey in 1988. She entered an Obstetrical and Gynecology residency program at Columbia University-Harlem Hospital. Her ultimate goal of becoming affiliated with a University-program within a multi-ethnic urban community was achieved upon joining Montefiore Medical Center. She was the Medical Director for the Grand Concourse Division for Montefiore’s Medical Center, Obstetrics & Gynecology and Women’s Health for the last 10 years. Never settling, she continue to pursue more career goals, and have recently developed a medical device which was patented on July 2014, the Pannus Adapter. Currently, because of her love for teaching she is working as an Adjunct Professor in the Physician Program at Pace University, New York. paigelynet@aol.com

  • 6
    Cross-cultural adaptation and validity of the Arabic version of the intermittent and constant osteoarthritis pain questionnaire
    Speaker
    Musab Alageel
    National Guard Hospital
    Saudi Arabia
    Biography

    Musab Alageel is a fifth-year medical student at King Saud University in Saudi Arabia and he is planning to do Orthopedic in the Residency Program.

    Abstract

    Cross-cultural adaptation and validity of the Arabic version of the intermittent and constant osteoarthritis pain questionnaire Musab Alageel, Abdullah AlTurki, Ali A Alhandi, Rakan AlSalem, Rawa AlOhali and Sami Al-Eissa National Guard Hospital, Saudi Arabia Abstract Introduction: The Intermittent and Constant Osteoarthritis Pain Scale (ICOAP) was developed in focus groups study to evaluate the severity of the pain among knee/hip osteoarthritis patients and its impact on the quality of life. Furthermore, it is the only scale that can evaluate the constant and intermittent pain that could present in osteoarthritis patients. It can also be used for following the progression of the disease, the treatment responsiveness, and the need to joint replacement. Objectives: This study aimed to translate and adapt ICOAP questionnaire into the Arabic language, and evaluate the validity and reliability of this scale in participants with Knee or Hip Osteoarthritis Methods: This questionnaire was translated based on Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. Test-retest reliability was calculated using Intraclass Correlation Coe?cient (ICC). Then, Cronbach’s alpha was used to assess the internal consistency of ICOAP. Lastly, criterion validity was evaluated against Knee injury and Osteoarthritis Outcome Score (KOOS). Results: A total number of 90 participants were included in this study, out of which 29 participants were re-evaluated for the reliability. The ICC of the knee ICOAP was 0.841, 0.923 and 0.911 for the total knee pain, constant and intermittent knee pain, respectively. Moreover, the ICC of the Hip ICOAP was 0.969, 0.98 and 0.95 for the total hip pain, constant and intermittent hip pain. Cronbach’s alpha was 0.88, 0.93 and 0.94 for the total score, Intermittent and constant knee pain respectively. Additionally, Cronbach’s alpha of hip ICOAP was 0.977, 0.963 and 0.985 for the total score, intermittent and constant hip pain, respectively. The criterion validity was r = 0, 24 (P< 0.05), it reveals that there is a correlation between the total score of ICOAP and KOOS pain subscale. Conclusion: The Arabic ICOAP is a valid and reliable instrument to be used in Arabic patients with knee/hip osteoarthritis Biography Musab Alageel is a fifth-year medical student at King Saud University in Saudi Arabia and he is planning to do Orthopedic in the Residency Program. alageelmusab@gmail.com

  • Treatment of stable vitiligo using both cultured and non-cultured autologous melanocytes from hair follicle ORS cell suspension
    Speaker
    Shereen Mahmoud Kamel Shawky
    Cairo University, Cairo, Egypt.
    Egypt
    Biography

    Shereen Mahmoud Kamel Shawky currently working as Professor of Clinical and Chemical pathology, Cairo University, and as a Head of Transfusion Medicine Department in Al Kasr Al Ainy Hospitals. After obtaining the MBBCH degree of excellence and grade of honor residency in Al Kasr Al Ainy Hospital from 1992-1995, she earned a thesis of Master's Degree in Immunology Entailing Expression and Distribution of MHC class II antigens on normal and malignant cells, and a Master's Degree in clinical pathology in November 1994, as well as an MD thesis entailing heterogeneity of T cell receptor variable ? region in rheumatoid arthritis in 1998. Later on, she earned her MD degree in Medical Immunology in 1998.

    Abstract

    Abstract Background: Treatment of stable vitiligo is mainly surgical. A plethora of methods are being studied and modified, however none of them guarantee 100% cure up till now. Arguments existed about the safety, efficacy and convenience of cultured melanocytes as compared to non-cultured technique. In 2012, Savkovic and Co-workers developed an improved culture method amplifying human melanocytes from the hair follicles; however, they did not apply this method clinically for treating vitiligo patients. Aim: To assess the efficacy and safety of a modified autologous cultured hair follicle outer root sheath cell suspension transplantation in the treatment of stable vitiligo lesions, and to compare it with the results of transplantation of autologous non-cultured hair follicle cell suspension within the same patient. Patients & Methods: Hair samples were epilated from 24 patients with stable vitiligo (each sample 60-80 anagen hairs), hair follicle ORS was separated by two methods, cultured [we modified the culture method of Savkovic et al. (2012)] and non-cultured methods. Melanocytes characteristics in both methods were determined via measuring cellular melanin content by ELISA and the fold change in pre-melanosome (Pmel-17) gene expression. Patients' response was evaluated clinically for up to one year following treatment. Results: Out of 24 patients, 19 patients completed the study, with a total of 40 lesions treated, 21 with cultured and 19 with non-cultured melanocyte cell suspension and continued the follow-up period. Eight (20%) lesions showed excellent response (2 (25%) of them with non- cultured and 6 (75%) with cultured), 10 (25%) good (3 (30%)of them with non- cultured & 7 (70%) with cultured), 7 (17.5%) fair (3 (43%) of them with non- cultured and 4 (57%) with cultured), and 15(37.5%) showed poor response (11(73%) of them with non- cultured and 4 (27%) with cultured). Melanin content and melanocyte viability were more with the modified cultured technique. Conclusion: Our provided modified autologous hair follicle ORS melanocytes cultured cell suspension transplantation method is a promising option for treating stable vitiligo lesions, however it is more expensive and time consuming than the non-cultured method. A plethora of interventions had been introduced for treating stable vitiligo lesions, however none could guarantee 100% cure. Arguments existed about the safety, efficacy and convenience of cultured melanocytes as compared to non-cultured technique. In 2012, Savkovic and Co-workers developed an improved culture method amplifying human melanocytes from the hair follicles; however, they did not apply this method clinically for treating vitiligo patients. We assessed the efficacy and safety of modified autologous cultured hair follicle outer root sheath cell suspension transplantation in the treatment of stable vitiligo lesions, in comparison to autologous non-cultured hair follicle cell suspension transplantation within the same patient. The modified cultured method seems to be promising although more expensive and more time consuming than the non-cultured technique. Biography: Shereen Mahmoud Kamel Shawky currently working as Professor of Clinical and Chemical pathology, Cairo University, and as a Head of Transfusion Medicine Department in Al Kasr Al Ainy Hospitals. After obtaining the MBBCH degree of excellence and grade of honor residency in Al Kasr Al Ainy Hospital from 1992-1995, she earned a thesis of Master's Degree in Immunology Entailing Expression and Distribution of MHC class II antigens on normal and malignant cells, and a Master's Degree in clinical pathology in November 1994, as well as an MD thesis entailing heterogeneity of T cell receptor variable ? region in rheumatoid arthritis in 1998. Later on, she earned her MD degree in Medical Immunology in 1998. shereenshawky2010@gmail.com

Day 2

KEYNOTE SPEAKERS
  • How does a personalized rehabilitative model influence the functional response of different ankle foot orthoses in a cohort of patients affected by neurological gait pattern?

    Fondazione Madonna del Corlo
    Italy
    Biography

    Maurizio Falso received his Degree of Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation from the University of Medicine of Verona, Italy in 2004 followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona, Italy by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia, Italy and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity. In his career he also promoted the use of innovative dynamic carbon-kevlar custom made AFO (DAFONS), innovative postural devices in patients affected by neurological complex postural needs, the device treatment of idiopathic scoliosis by using an innovative dynamic spine brace called “BRIXIA” and the device treatment of gait disorders by using an innovative dynamic carbon Kevlar foot insole called “PRODYNAMIC”.

    Abstract

    How does a personalized rehabilitative model influence the functional response of different ankle foot orthoses in a cohort of patients affected by neurological gait pattern? Maurizio Falso1, Eleonora Cattaneo1, Elisa Foglia1, Marco Zucchini1 and Franco Zucchini1 1Fondazione Madonna del Corlo, Italy Abstract Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: without AFO or free-walk (FW); wearing a Codivilla spring; wearing a carbon unjointed AFO (“Toe-Off”); wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3= time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). A statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test; a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off; a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2; a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4; a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4; in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses. Biography Maurizio Falso received his Degree of Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation from the University of Medicine of Verona, Italy in 2004 followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona, Italy by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia, Italy and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity. In his career he also promoted the use of innovative dynamic carbon-kevlar custom made AFO (DAFONS), innovative postural devices in patients affected by neurological complex postural needs, the device treatment of idiopathic scoliosis by using an innovative dynamic spine brace called “BRIXIA” and the device treatment of gait disorders by using an innovative dynamic carbon Kevlar foot insole called “PRODYNAMIC”. falsomaurizio@libero.it

  • Improving quality of care in breast cancer treatment: European criteria for certifying breast surgeons and breast units

    1st Department of Obstetrics and Gynecology, University of Athens Medical School, Alexandra Hospital
    Greece
    Biography

    Ioannis G Papanikolaou was born in Athens in 1985. In 2009 he takes the Medical Degree with excellent votation. Afterwards, he was selected to participate in the two years Postgraduate programme in Robotic surgery, minimally invasive surgery and Telesurgery, in the University of Athens, Medical School, Greece. In 2011 he was distinguished again with excellent votation and obtains the title of “Master of Science” from the Athens Medical School in “Robotic surgery, minimally invasive surgery and Telesurgery. He was distinguished with the PhD (Doctor of Philosophy) from Athens Medical School, Greece with Excellent votation in 2018. He has gained the first Prize in “Robotic Surgery Marathon”, as well as the First Prize in the “Laparoscopic Simulation Cup”. He is the author of many publications in national and international journals and he is also selected as reviewer for many journals such as The British Medical Journal, Stem Cells International, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, The International Journal of Medical Robotics & Computer Assisted Surgery, The European Journal of Obstetrics, Gynecology and Reproductive Biology. Currently he works in the 1st Department of Obstetrics & Gynecology of the University of Athens, Medical School in Greece, in “Alexandra” Hospital.

    Abstract

    Improving quality of care in breast cancer treatment: European criteria for certifying breast surgeons and breast units Ioannis G Papanikolaou1, 2 1University of Athens Medical School, Greece 2Alexandra Hospital, Greece Abstract As the topic of author’s Lecture suggests, he will focus on certification criteria of breast units and breast surgeons across Europe, which are crucial issues for the appropriate therapeutic management of breast cancer. The last GLOBOCAN estimates for breast cancer, classify this carcinoma as the most common in the female. Treatment options have changed and modern breast surgery tends to have a more conservative and cosmesis-preserving face. Breast cancer treatment involves many medical specialties and requires deep knowledge, training, expertise and dedication. The European Board for Surgical Qualification gives guidelines on eligibility criteria for involvement in breast surgery defining metrics for operations that a breast surgeon should have performed and defines with precise metrics the numbers of procedures in which a qualified breast surgeons should be involved. Different international societies are involved in education and certification of competency in breast surgery. Many authors highlight that treatment of breast cancer in high-volume centers is of crucial importance because it improves five year survival up to 33%. Furthermore, the number of breast cancer surgeries that a breast surgeon performs per year seems to be an independent prognostic factor for patient’s survival, recurrence and general outcome. For all these reasons, treatment of breast cancer in certified breast units by specialized breast surgeons is mandatory. New techniques of oncoplastic breast-conserving surgery challenge the current armamentarium of therapeutic options, proving excellent cosmetic results with comparable oncological outcome to the standard breast-conserving surgery. Furthermore, oncoplastic techniques improve patient’s satisfaction and quality of life after breast cancer diagnosis. Genetic counseling, psychological support and multimodal treatment from a breast-dedicated team which involves many specialties are mandatory for qualitative standards of care. There is an urgent need for certified education in breast surgery, not only for breast centers but also for breast surgeons. Dedication is a key principle in breast surgery, because it improves outcomes. Considering high incidence and mortality rates in the global population, current care for breast cancer needs to be based on quality. Breast surgery is a field with which, Obstetricians and Gynecologists should deal with and begin to be involved in Europe, after an accurate and strict training process which provided final certification. The future of breast surgery is in less invasive and more cosmoses-preserving approaches surgery in the treatment of breast disease, including breast carcinoma. Patient-centered care is a key component and quality indicator in the treatment of breast carcinoma. Biography Ioannis G Papanikolaou was born in Athens in 1985. In 2009 he takes the Medical Degree with excellent votation. Afterwards, he was selected to participate in the two years Postgraduate programme in Robotic surgery, minimally invasive surgery and Telesurgery, in the University of Athens, Medical School, Greece. In 2011 he was distinguished again with excellent votation and obtains the title of “Master of Science” from the Athens Medical School in “Robotic surgery, minimally invasive surgery and Telesurgery. He was distinguished with the PhD (Doctor of Philosophy) from Athens Medical School, Greece with Excellent votation in 2018. He has gained the first Prize in “Robotic Surgery Marathon”, as well as the First Prize in the “Laparoscopic Simulation Cup”. He is the author of many publications in national and international journals and he is also selected as reviewer for many journals such as The British Medical Journal, Stem Cells International, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, The International Journal of Medical Robotics & Computer Assisted Surgery, The European Journal of Obstetrics, Gynecology and Reproductive Biology. Currently he works in the 1st Department of Obstetrics & Gynecology of the University of Athens, Medical School in Greece, in “Alexandra” Hospital. papanikolaou85@gmail.com

  • Vertebral fracture prevalence among people treated for osteoporosis in Greece” Vertebral integrity assessment study-Vertinas study

    primary health care centre in Alexandra
    Greece
    Abstract

    “Vertebral fracture prevalence among people treated for osteoporosis in Greece” Vertebral integrity assessment study-Vertinas study Kosmidis Christos¹, Stathopoulos K¹ and Ibro E² 1Hellenic Society for the Study of Bone Metabolism, Greece 2Hellenic Patients Society-Butterfly, Greece Abstract Objectives: To assess vertebral fracture (T4 – L5) prevalence among people treated for osteoporosis in Greece and to evaluate the degree of accordance in diagnosis of fractures between radiologists and orthopedics Methods: Patients receiving medication for osteoporosis were recruited via announcement by the Greek national media. Inclusion criteria: Age > 50 (both sexes); Postmenopausal status for females >2 years; Current >1 year use of medication for osteoporosis and lack of radiological vertebral assessment for >1 year; Exclusion criteria: Bone metabolic disease other than osteoporosis; secondary osteoporosis; inability to stand/walk; previous high energy vertebral fractures Design: All patients completed short-form questionnaire indicating: Age, Sex, current pharmaceutical treatment for osteoporosis, history of previous vertebral fractures and consensus in performing lateral spine (T4–L5) x-rays. Radiographs were evaluated for fractures by radiologists as usual and then by three orthopedic consultants according to the “Genant semi-quantitative method”, blinded for the patient data. Results: 1652 patients were recruited with properly filled questionnaires (age 50 – 102, mean 70,4); 1516 women (91,8%, age 50 – 102, mean 70); 136 men (8,2%, age 52 – 94, mean 74,8) Current treatment: SERMS 1%, BPs 85,7%, Denosumab 11,6%, Strontium Ranelate 0,2%, Teriparatide 1, 6%. Vitamin D: 40, 6%, Alphacalcidol: 8, 1%, Calcium supplements: 38, 6%. History of vertebral fracture: 11, 1%; fractures were diagnosed in 25,4% of the patients (the prevalence of vertebral fractures among people treated for osteoporosis in Greece. Among 419 patients actually found with fracture(s), only 98 (23,4%) knew about the existence of the fracture(s). On the contrary, among the rest 1233 patients actually found without fracture(s), 86 (7, 0%) had declared knowledge about the existence of fracture(s) in their history. For 1289 patients (78%) out of the total 1652, orthopedics could read the opinion of the radiologist about the existence of fracture(s). In accordance with the diagnosis about the existence of fracture(s) between radiologist and orthopedic was achieved in 1088 patients (84, 4%). Conclusions: Vertebral fracture prevalence among people treated for osteoporosis in Greece is 25, 4%; 76, 6% of people treated for osteoporosis in Greece, think they don’t have fracture(s), although they do. According to the existence of vertebral fractures between radiologists and orthopedics in Greece is not very high (84, 4%). Biography Christos Kosmidis is an orthopedic surgeon at Private office from 1987 to 2017. He is the Director of Orthopedics in primary health care center “Alexandras” 1st Health Division of Attica, Greece in general orthopedic and osteoporosis cases. He is a Primary health care physician at Department of Orthopedics and Osteoporosis in health care center “Alexandras” since 1993. He has almost 19 years of teaching experience as a Professor of Anatomy and Orthopedics for the Technological School of Paramedics (Nurses, physiotherapists etc.). He is the member of Hellenic Association of Orthopedic Surgery and Traumatology since 1986; Member of Hellenic Society for the Study of Bone Metabolism since 1997; Member of the Board as Secretary General from 2009 to 2012; Vice President from 2013 to 2014 and President of the Board of the Society from 2015-2016; Member of Hellenic Osteoporosis Foundation since 1997; Member of the Board as secretary general from 2003 to 2009; International Society of Musculoskeletal and Neuronal Interactions since 1999. He completed his residency in Orthopedics from Athens University Orthopedic Clinic (KAT Accident Hospital of Athens) from 1983 to 1986. He completed his Residency in general surgery: Nautical Military Hospital of Salamis Naval Station from 1981 to 1982; Doctor of Medicine from University of Athens 1974 to 1980. He did his PhD in Fractures of atlas (C1)”, Athens University, 1989. He attended more than 240 conferences since 1983, in Greece as a speaker and abroad, being in the Organizing Committee of ECTS 2011 in Athens. He is regular attendee of WCO-IOF-ESCEO, ECTS and ASBMR for the last 15 years, sometimes with an abstract or poster. chrikos1@otenet.gr

Alternative Medicine in Orthopedics and Rheumatology
Chair
Co-Chair
Speaker
  • Case of pregnancy after treatment of breast cancer
    Speaker
    Stela Popi Kostic
    General Hospital Zrenjanin
    Serbia
    Abstract

    Abstract Introduction: Breast cancer ist the one of the important disease responsible for the death of women, both in Serbia and in the world. The incidence of breast cancer in Serbia is 20, 2%, from allleading cancer sites in females (data obteined from Cancer registry of Serbia 2015). In 2008 Serbia had the highest mortality rate from breast cancer (ASR-W 2008: 22.7/100,000), among all European countries. Case report: Patient M.T. P3 G3, 37 years old with invasiv ductal cancer ofright breast (treated from 2012 till 2016), moderately differentiated histological type with present lymphovascular and perineural invasion of pTT1, HG2, pN2, receptor status ER 7, PR 8, HER2 0, Ki-67 30% tumor cells, admitted to the gynecology department because the NMR recording of small pelvis confirmed pregnancy in the uterus. This recording was done because doubts on metastatic changeon segment LS on the spine. Last period was in 2012. The interval of birth beetwin this and least pregnancy was 15 years. On the gynecological ultrasound was diagnosted a live normal fetus, the crown-rump lenth (CRL) was 74mm, (13 week and 4 day). Nuchal translucency was 1, 6mm, and the values of Free-Beta HCG-2,53 MoM, PAPP-A 0,7 MoM. The pregnancy has come from natural cycle. The amniocentesis is recomandet and the result show a normal XX karyotype of fetus. The pregnancy was developed normally, the baby was born in 35-36 weeks (13.02.2018) of gestation with cesarean section because of previous two cesarean section of mother. The female neonatus has body mass 2390g/48 cm, AS:8/9. Postoperation decurzus was normally. The metastatic change was not confirmet during pregnancy and after the delivery. Discussion: In the literature, cases of natural pregnancy after the treatment of breast cancer are rarely described. Conclusion: The patient M.T. was the first patient with treated breast cancer who delivery in our Hospital. Reference 1. Ilic M and Ilic I (2018) Cancer mortality in Serbia, 1991–2015: an age-period-cohort and joinpoint regression analysis. Cancer Communications 38(1): 10.

  • 10 millimeters at a time, a world without needless breast cancer deaths
    Speaker
    Carman Kobza
    Lady B Well- THE BREAST HEALTH PEOPLE
    USA
    Biography

    Carman Kobza was the Creator of India’s first viable Breast Health Education & Digital Screening outreach program. He is from Texas, founded a women’s digital diagnostics company in Bangalore in 2015. With an efficient high capacity yet personalized “We Come to You” approach, he exerts full passion to improve women’s lives and to end an unconscionable world affliction – Needless Breast Cancer. Lady B Well – THE BREAST HEALTH PEOPLE launched to rapidly expand the reach and impact by offering a welcoming, certified & de-stigmatized women’s health experience. Seeking interested B2B partners now to serve deserving ladies around the world

    Abstract

    “A healthy woman is the heart of a happy family” so, why do we allow breast cancer to increase as the largest cancer killer in the developing world? Why is breast cancer identified as curable (in the West) and largely fatal in the rest? Why don’t our hospitals “do something” and why does awareness alone fall short and fail? We know breast cancer is 99% curable when caught early. Research shows when a lump is found under 10 millimeters in size (the size of a pea)…no ladies die. We know that current detection techniques such as mammogram and ultrasonography are almost exclusively performed within clinics, yet most women are never examined. Clinical breast exams performed by a specialist and self-breast exams, while great practices, are not capable of 10 mm detection. A completely new approach to preventing breast cancer is a must. We must reach high numbers of ladies…where “they are” and we must do so with more than awareness and “feel good” participation. We must do so with accessible/affordable/acceptable “welcoming and de-stigmatizing” digital screening programs. The latest FDA certified technologies must be deployed to find early breast cancer indications before 10 mm. We must. Breast cancer is occurring in younger and younger ages in the developing world and is not being discovered until later stages. The rate of breast cancer is increasing and the average age is decreasing from the mid 50’s to the mid 40’s while rates for twenty and thirty-somethings increase the fastest. For urban and rural, the prospects are dim. It doesn’t have to be this way. Our model is successful. The Lady B Well program is offered to anyone, anywhere to make it their own, to be fully trained, and to use our innovative mobile health platform to reach more deserving ladies in more places. Join us.

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