Introduction: Breast cancer is the most common cancer in women and the world’s second leading cause of death in women, after lung cancer. Calreticulin (CRT), an endoplasmic reticulum (ER) multipurpose protein, has been proposed as a potential biomarker for breast cancer. However, reports on the correlation between CRT expression and cell invasiveness in breast cancer micro-tissues are scarce. Thus, in the current study, we analyzed the potential correlation between CRT and invasiveness of breast cancer in a biological scaffold-based 3D co-culture system. Methods: MCF7, MDA-MB-231 and MCF-10A breast cell lines were co-cultured in a 3-dimensional (3D) system with MRC-5 lung fibroblast cell line in the cell density ratio of 3:1. Thereafter, calreticulin gene and protein expression levels were determined based on quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and immunohistochemistry, respectively. Moreover, via RT-qPCR analysis, the gene expression levels of calreticulin-related candidate metastasis genes in breast cancer micro-tissues were carried out. Results: The results showed occasional foci of lumen-like morphology in the non-cancerous breast micro-tissues and the formation of solid clusters for breast cancer micro-tissues. Moreover, immunohistochemistry results revealed protein expression of calreticulin in non-cancerous and cancerous breast micro-tissues with cytoplasmic and nucleic acid localizations. It was found that PCMT1 and ER-α genes were significantly downregulated (p < 0.01) in invasive breast cancer micro-tissues. Conclusion: This study suggests that CRT and CRT-related candidate metastasis genes may potentially serve as prognostic biomarkers in invasive breast carcinoma.

Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.