Nurhussen, Akram

Background Much research has been done into finding specific molecular pathways involved in the metastatic and invasive potential of breast cancer cells. One of the major discoveries of this past decade has been microRNAs; which are single‐stranded non‐coding RNA molecules. Interestingly a single microRNA can influence the expression of hundreds of proteins, thereby highlighting their significance as modulators of gene expression. Apart from their role in regulating various intracellular processes, abnormal changes in microRNA expression have been linked to various human cancers. Until recently the nature and impact of most of these changes in breast cancer were unclear. However, some of the microRNA dysregulations have now been correlated with clinic‐pathological features such as Her2, ER and PR status, tumor stage, angiogenesis, metastasis and invasion. Of note to our study, compiling data has shown that microRNAs regulate cancer metastasis by influencing multiple steps in the metastatic cascade. This review will focus on key microRNAs associated with breast cancer invasion and metastasis; recently referred to as ‘metastamirs’. Methods We used the program EndNote X7 to research PubMed published articles regarding microRNAs in Breast Cancer. The terms “miRNAs” and “Breast cancer” were used as search words and the publication years were specified to range from 2005 to 2016. Our preliminary search revealed no articles pertaining to our topic before the year 2005, hence our paper covers nearly the entire literature on the topic. The retrieved records were then reviewed, and all those pertaining to metastasis and invasion in breast cancer were included in our study. Results Our EndNote search retrieved a total of 2820 abstracts, of which more than 280 were pertaining to metastasis and invasion in breast cancer. These abstracts were then read thoroughly, and roughly 130 metastasis/invasion specific microRNAs or clusters of microRNAs were identified. Interestingly, some microRNAs were shown to promote metastasis and invasion when up‐regulated, while others did so when they were down‐regulated. Nonetheless, all the identified microRNAs brought about their effects through various molecular pathways, some at more critical stages in the metastasis cascade than others. presents some of the commonly identified pro‐metastatic & anti‐metastatic microRNAs. Conclusion The last decade has been revelationary with regards to non‐coding RNAs, microRNAs, and their association with various cancers. Our comprehensive review highlights the various microRNAs involved in key pathways within the breast cancer metastatic pathway. Co‐relating these microRNAs to clinically targetable pathophysiological points could revolutionize our fight against breast cancer; by not only serving as diagnostic & prognostic markers, but also being potential therapeutic targets. Carefully designed translational studies seem to be the call of the hour, to finally give us the much‐needed edge over breast cancer. Support or Funding Information The authors report no source of funding or support.

Objectives The qualitative subjective assessment has been exercised either by self-reflection (self-assessment (SA)) or by an observer (peer assessment (PA)) and is considered to play an important role in students’ development. The objectivity of PA and SA by students as well as those by faculty examiners has remained debated. This matters most when it comes to a high-stakes examination. We explored the degree of objectivity in PA, SA, as well as the global rating by examiners being Examiners’ Subjective Assessment (ESA) compared with Objective Structured Clinical Examinations (OSCE). Design Prospective cohort study. Setting Undergraduate medical students at Alfaisal University, Riyadh. Participants All second-year medical students (n=164) of genders, taking a course to learn clinical history taking and general physical examination. Main outcome measures A Likert scale questionnaire was distributed among the participants during selected clinical skills sessions. Each student was evaluated randomly by peers (PA) as well as by himself/herself (SA). Two OSCEs were conducted where students were assessed by an examiner objectively as well as subjectively (ESA) for a global rating of confidence and well-preparedness. OSCE-1 had fewer topics and stations, whereas OSCE-2 was terminal and full scale. Results OSCE-1 (B=0.10) and ESA (B=8.16) predicted OSCE-2 scores. ‘No nervousness’ in PA (r=0.185, p=0.018) and ‘confidence’ in SA (r=0.207, p=0.008) correlated with ‘confidence’ in ESA. In ‘well-preparedness’, SA correlated with ESA (r=0.234, p=0.003). Conclusions OSCE-1 and ESA predicted students’ performance in the OSCE-2, a high-stakes evaluation, indicating practical ‘objectivity’ in ESA, whereas SA and PA had minimal predictive role. Certain components of SA and PA correlated with ESA, suggesting partial objectivity given the limited objectiveness of ESA. Such difference in ‘qualitative’ objectivity probably reflects experience. Thus, subjective assessment can be used with some degree of objectivity for continuous assessment.