Breast cancer on the world wide web: cross sectional survey of quality of information and popularity of websites.

OBJECTIVES: To determine the characteristics of popular breast cancer related websites and whether more popular sites are of higher quality. DESIGN: The search engine Google was used to generate a list of websites about breast cancer. Google ranks search results by measures of link popularity---the number of links to a site from other sites. The top 200 sites returned in response to the query "breast cancer" were divided into "more popular" and "less popular" subgroups by three different measures of link popularity: Google rank and number of links reported independently by Google and by AltaVista (another search engine). MAIN OUTCOME MEASURES: Type and quality of content. RESULTS: More popular sites according to Google rank were more likely than less popular ones to contain information on ongoing clinical trials (27% v 12%, P=0.01 ), results of trials (12% v 3%, P=0.02), and opportunities for psychosocial adjustment (48% v 23%, P<0.01). These characteristics were also associated with higher number of links as reported by Google and AltaVista. More popular sites by number of linking sites were also more likely to provide updates on other breast cancer research, information on legislation and advocacy, and a message board service. Measures of quality such as display of authorship, attribution or references, currency of information, and disclosure did not differ between groups. CONCLUSIONS: Popularity of websites is associated with type rather than quality of content. Sites that include content correlated with popularity may best meet the public's desire for information about breast cancer.

A case-control study of bilateral compared with unilateral breast cancer

Approximately 10 to 15% of breast cancer patients develop a primary cancer in the contralateral breast. This study examined differences between women with unilateral compared with bilateral primary breast cancer. It focused on hormonal factors and family history, and evaluated the prevalences of invasive lobular histology and the replication error phenotype in the tumors. ^ Cases (n = 82) were patients at M.D. Anderson Cancer Center (MDACC) in Houston, Texas diagnosed with primary breast cancer in each breast between 1985 and 1994 inclusive. Controls (n = 82) were MDACC patients with primary cancer in a single breast diagnosed during the same interval, individually matched to cases. Data were obtained by in-person and/or telephone interview with the patient and/or proxy. Replication error phenotype was determined from archival tissue. ^ Diagnosis of breast, but not ovarian, cancer in a female first-degree relative (FFDR) was a strong risk factor for bilateral cancers. Cases had a significantly 3-fold higher excess of familial breast cancer than did controls (cases: O/E = 2.65, 95% CI = 1.85–3.69; controls: 0.86, 0.46–1.47; homogeneity: p = 0.00). Risk did not vary with menopausal status of the patient, but was greatest if a relative was diagnosed before age 45 (O/E = 38.9; 95% CI = 21.7–64.1). By implication, young first-degree relatives of patients with bilateral breast cancer are at very high risk of breast cancer themselves. Cases also had significantly fewer siblings than did controls. ^ Earlier menarche, and parity in the absence of lactation, were associated with bilateral cancers; age at menopause and parity with lactation were not. A history of alcohol consumption, particularly if heavy, carried a 3.4-fold risk (p = 0.03). The data suggested a slightly different pattern in risk factors according to menopausal status and interval between cancers. ^ Replication error phenotype was available for 59 probands. It was associated with bilateral cancers (particularly if diagnosed within one year of each other), increased age (p = 0.02) and negative nodal status. Invasive lobular histology was associated with bilateral disease but numbers were small. ^ These data suggest bilateral breast cancer arises in the context of a combination of familial and hormonal factors, and alcohol consumption. The relative importance of each factor may vary by age of the patient. ^

Alcohol consumption and breast cancer risk among Hispanic and non-Hispanic women in New Mexico

Breast cancer incidence and mortality rates for Hispanic women are lower than for non-Hispanic white (NHW) women, but recently rates have increased more rapidly among Hispanic women. Many studies have shown a consistent increased breast cancer risk associated with modest or high alcohol intake, but few included Hispanic women. Alcohol consumption and risk of breast cancer was investigated in a New Mexico statewide population-based case-control study. The New Mexico Tumor Registry ascertained women, newly diagnosed with breast cancer (1992–1994) aged 30–74 years. Controls were identified by random digit dialing and were frequency-matched for ethnicity, age-group, and health planning district. In-person interviews of 712 cases and 844 controls were conducted. Data were collected for breast cancer risk factors, including alcohol intake. Recent alcohol intake data was collected for a four-week period, six months prior to interview. Past alcohol intake included information on alcohol consumption at ages 25, 35, and 50. History of alcohol consumption was reported by 81% of cases and 85% of controls. Of these women, 42% of cases and 48% of controls reported recent alcohol intake. Results for past alcohol intake did not show any trend with breast cancer risk, and were nonsignificant. Multivariate-adjusted odds ratios for recent alcohol intake and breast cancer suggested an increased risk at the highest level for both ethnic groups, but estimates were unstable and statistically nonsignificant. Low level of recent alcohol intake (<148 grams/week) was associated with a reduced risk for NHW women (Odds Ratio (OR) = 0.49 95% Confidence Interval (CI) 0.35–0.69). This pattern was independent of hormone-receptor status. The reduced breast cancer risk for low alcohol intake was present for premenopausal (OR = 0.29, 95% CI 0.15–0.56) and postmenopausal NHW women (OR = 0.56, 95% CI 0.35–0.90). The possibility of an increased risk associated with high alcohol intake could not be adequately addressed, because there were few drinkers with more than light to moderate intake, especially among Hispanic women. An alcohol-estrogen link is hypothesized to be the mechanism responsible for increased breast cancer risk, but has not been consistently substantiated. More studies are needed of the underlying mechanism for an association between alcohol intake and breast cancer. ^

Recommendations from GEC ESTRO Breast Cancer Working Group (I): Target definition and target delineation for accelerated or boost Partial Breast Irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery

OBJECTIVE The aim was to develop a delineation guideline for target definition for APBI or boost by consensus of the Breast Working Group of GEC-ESTRO. PROPOSED RECOMMENDATIONS Appropriate delineation of CTV (PTV) with low inter- and intra-observer variability in clinical practice is complex and needs various steps as: (1) Detailed knowledge of primary surgical procedure, of all details of pathology, as well as of preoperative imaging. (2) Definition of tumour localization before breast conserving surgery inside the breast and translation of this information in the postoperative CT imaging data set. (3) Calculation of the size of total safety margins. The size should be at least 2 cm. (4) Definition of the target. (5) Delineation of the target according to defined rules. CONCLUSION Providing guidelines based on the consensus of a group of experts should make it possible to achieve a reproducible and consistent definition of CTV (PTV) for Accelerated Partial Breast Irradiation (APBI) or boost irradiation after breast conserving closed cavity surgery, and helps to define it after selected cases of oncoplastic surgery.

Survival analysis of circulating tumor cells in triple-negative breast cancer

Background. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% (1.38 million) of the total new cancer cases and 14% (458,400) of the total cancer deaths in 2008. [1] Triple-negative breast cancer (TNBC) is an aggressive phenotype comprising 10–20% of all breast cancers (BCs). [2-4] TNBCs show absence of estrogen, progesterone and HER2/neu receptors on the tumor cells. Because of the absence of these receptors, TNBCs are not candidates for targeted therapies. Circulating tumor cells (CTCs) are observed in blood of breast cancer patients even at early stages (Stage I & II) of the disease. Immunological and molecular analysis can be used to detect the presence of tumor cells in the blood (Circulating tumor cells; CTCs) of many breast cancer patients. These cells may explain relapses in early stage breast cancer patients even after adequate local control. CTC detection may be useful in identifying patients at risk for disease progression, and therapies targeting CTCs may improve outcome in patients harboring them. Methods . In this study we evaluated 80 patients with TNBC who are enrolled in a larger prospective study conducted at M D Anderson Cancer Center in order to determine whether the presence of circulating tumor cells is a significant prognostic factor in relapse free and overall survival . Patients with metastatic disease at the time of presentation were excluded from the study. CTCs were assessed using CellSearch System™ (Veridex, Raritan, NJ). CTCs were defined as nucleated cells lacking the presence of CD45 but expressing cytokeratins 8, 18 or 19. The distribution of patient and tumor characteristics was analyzed using chi square test and Fisher's exact test. Log rank test and Cox regression analysis was applied to establish the association of circulating tumor cells with relapse free and overall survival. Results. The median age of the study participants was 53years. The median duration of follow-up was 40 months. Eighty-eight percent (88%) of patients were newly diagnosed (without a previous history of breast cancer), and (60%) of patients were chemo naïve (had not received chemotherapy at the time of their blood draw for CTC analysis). Tumor characteristics such as stage (P=0.40), tumor size (P=69), sentinel nodal involvement (P=0.87), axillary lymph node involvement (P=0.13), adjuvant therapy (P=0.83), and high histological grade of tumor (P=0.26) did not predict the presence of CTCs. However, CTCs predicted worse relapse free survival (1 or more CTCs log rank P value = 0.04, at 2 or more CTCs P = 0.02 and at 3 or more CTCs P < 0.0001) and overall survival (at 1 or more CTCs log rank P value = 0.08, at 2 or more CTCs P = 0.01 and at 3 or more CTCs P = 0.0001. Conclusions. The number of circulating tumor cells predicted worse relapse free survival and overall survival in TNBC patients.^

Breast cancer risk factors among Mexican-American women

Introduction: The average age of onset of breast cancer among Hispanic women is 50 years, more than a decade earlier than non-Hispanic white women. Age at diagnosis is an important prognostic factor for breast cancer; younger age at onset is more likely to be associated with advanced disease, poorer prognosis, hormone receptor negative breast tumors, and a greater likelihood of hereditary breast cancer. Studies of breast cancer risk factors including reproductive risk factors, family history of breast cancer, and breast cancer subtype have been conducted predominately in non-Hispanic whites. Breast cancer is a heterogeneous disease with the presence of clinically, biologically, and epidemiologically distinct subtypes that also differ with respect to their risk factors. The associations between reproductive risk factors and family history of breast cancer have been well documented in the literature. However, only a few studies have assessed these associations with breast cancer subtype in Hispanic populations. Methods: To assess the associations between reproductive risk factors and family history of breast cancer we conducted three separate studies. First, we conducted a case-control study of 172 Mexican-American breast cancer cases and 344 age matched controls residing in Harris County, TX to assess reproductive and other risk factors. We conducted logistic regression analysis to assess differences in cases and controls adjusted for age at diagnosis and birthplace and then we conducted a multinomial logistic regression analysis to compare reproductive risk factors among the breast tumor subtypes. In a second study, we identified 139 breast cancer patients with a first- or second-degree family history of breast cancer and 298 without a family history from the ELLA Bi-National Breast Cancer Study. In this analysis, we also computed a multinomial logistic regression to evaluate associations between family history of breast cancer and breast cancer subtypes, and logistic regression to estimate associations between breast cancer screening practices with family history of breast cancer. In the final study, we employed a cross-sectional study design in 7279 Mexican-American women in the Mano a Mano Cohort Study. We evaluated associations with family history of breast cancer and breast cancer risk factors including body mass index (BMI), lifestyle factors, migration history, and adherence to American Cancer Society (ACS) guidelines. Results: In the results of our first analyses, reproductive risk factors differed in the magnitude and direction of associations when stratified by age and birthplace among cases and controls. In our second study, family history of breast cancer, and having at least one relative diagnosed at an early age (<50 years) was associated with triple negative breast cancer (TNBC). Mammography prior to receiving a breast cancer diagnosis was associated with family history of breast cancer. In our third study that assessed lifestyle factors, migration history and family history of breast cancer; we found that women with a first-degree family history of breast cancer were more overweight or obese compared with their counterparts without a family history. There was no indication that having a family history contributed to women practicing healthier lifestyle behaviors and/or adhering to the ACS guidelines for cancer prevention. Conclusions: We observed that among Mexican-American women, reproductive risk factors were associated with breast cancer where the woman was born (US or Mexico). Having a family history of breast cancer, especially having either a first- or second-degree relative diagnosed at a younger age, was strongly associated with TNBC subtype. These results are consistent with other published studies in this area. Further, our results indicate that women with strong family histories of breast cancer are more likely to undertake mammography but not to engage in healthier lifestyle behaviors.^

Activation of matrix metalloproteinase -9 (MMP-9) by heregulin in human breast cancer cells involves multiple signaling pathways

Matrix metalloproteinase-9 (MMP-9) plays an important role in tumor invasion and angiogenesis. Secretion of MMP-9 has been reported in various cancer types including lung cancer, brain cancer, colon cancer, and breast cancer. Heregulin is a growth factor that regulates growth and differentiation of normal breast cells as well as mammary tumor cells. To study the role of heregulin in breast cancer metastasis, we tested whether heregulin may regulate MMP-9 secretion. By screening a panel of breast cancer cell line for their ability to respond to heregulin and produce MMP-9, we have found that MMP-9 secretion can be induced by heregulin-β1 in two breast cancer cell lines, SKBr3 and MCF-7. In both cell lines, increase of MMP-9 activity as shown by zymography was accompanied by increased protein level as well as mRNA level of MMP-9. Using a reporter luciferase assay, we have identified that proximal −670bp promoter of MMP-9 had similar activity to a 2.2kb MMP-9 promoter in response to heregulin stimulation. Heregulin treatment of SKBr3 and MCF-7 activated multiple signaling pathways inside cells. These include the Erk pathway, the p38 kinase pathway, PKC pathway, and PI-3K pathway. To examine which pathways are involved in MMP-9 activation by heregulin, we have used a panel of chemical inhibitors to specifically inhibit each one of these pathways. Ro-31-8220 (PKC inhibitor) and SB203580 (p38 kinase inhibitor) completely blocked heregulin activation of MMP-9. On the other hand, PD098059 (MEK-1 inhibitor) partially blocked MMP-9 activation, whereas PI-3K inhibitor, wortmannin, had no effect. Therefore, at least three signaling pathways are involved in activation of MMP-9 by heregulin. Since MMP-9 is tightly associated with metastatic potential, our study also suggests that heregulin may enhance breast tumor metastasis through induction of MMP-9 expression. ^

Microcalcifications Detection using PFCM and ANN

This work presents a method to detect Microcalcifications in Regions of Interest from digitized mammograms. The method is based mainly on the combination of Image Processing, Pattern Recognition and Artificial Intelligence. The Top-Hat transform is a technique based on mathematical morphology operations that, in this work is used to perform contrast enhancement of microcalcifications in the region of interest. In order to find more or less homogeneous regions in the image, we apply a novel image sub-segmentation technique based on Possibilistic Fuzzy c-Means clustering algorithm. From the original region of interest we extract two window-based features, Mean and Deviation Standard, which will be used in a classifier based on a Artificial Neural Network in order to identify microcalcifications. Our results show that the proposed method is a good alternative in the stage of microcalcifications detection, because this stage is an important part of the early Breast Cancer detection

Running away from side effects: physical exercise as a complementary intervention for breast cancer patients

The number of breast cancer survivors increases every year, thanks to the development of new treatments and screening techniques. However, patients present with numerous side effects that may affect their quality of life. Exercise has been demostrated to reduce some of these side effects, but in spite of this, few breast cancer patientes know and follow the exercise recommendations needed to remain healthy. In this review, we describe the differente breast cancer treatments and the related side effects and implications of exercise in relation to these. We propose that exercise could be and integrative complementary intervention to improve physiological, physical and psychological factors that affect survival and quality of life of these patients. For that reason, the main objective of this review is to provide a general overview of exercise benefits in breast cancer patients and recommendations of how to design exercise interventions in patients with different side effects.

Detection and pattern recognition applied to leaves and chromosomes

The Project you are about to see it is based on the technologies used on object detection and recognition, especially on leaves and chromosomes. To do so, this document contains the typical parts of a scientific paper, as it is what it is. It is composed by an Abstract, an Introduction, points that have to do with the investigation area, future work, conclusions and references used for the elaboration of the document. The Abstract talks about what are we going to find in this paper, which is technologies employed on pattern detection and recognition for leaves and chromosomes and the jobs that are already made for cataloguing these objects. In the introduction detection and recognition meanings are explained. This is necessary as many papers get confused with these terms, specially the ones talking about chromosomes. Detecting an object is gathering the parts of the image that are useful and eliminating the useless parts. Summarizing, detection would be recognizing the objects borders. When talking about recognition, we are talking about the computers or the machines process, which says what kind of object we are handling. Afterwards we face a compilation of the most used technologies in object detection in general. There are two main groups on this category: Based on derivatives of images and based on ASIFT points. The ones that are based on derivatives of images have in common that convolving them with a previously created matrix does the treatment of them. This is done for detecting borders on the images, which are changes on the intensity of the pixels. Within these technologies we face two groups: Gradian based, which search for maximums and minimums on the pixels intensity as they only use the first derivative. The Laplacian based methods search for zeros on the pixels intensity as they use the second derivative. Depending on the level of details that we want to use on the final result, we will choose one option or the other, because, as its logic, if we used Gradian based methods, the computer will consume less resources and less time as there are less operations, but the quality will be worse. On the other hand, if we use the Laplacian based methods we will need more time and resources as they require more operations, but we will have a much better quality result. After explaining all the derivative based methods, we take a look on the different algorithms that are available for both groups. The other big group of technologies for object recognition is the one based on ASIFT points, which are based on 6 image parameters and compare them with another image taking under consideration these parameters. These methods disadvantage, for our future purposes, is that it is only valid for one single object. So if we are going to recognize two different leaves, even though if they refer to the same specie, we are not going to be able to recognize them with this method. It is important to mention these types of technologies as we are talking about recognition methods in general. At the end of the chapter we can see a comparison with pros and cons of all technologies that are employed. Firstly comparing them separately and then comparing them all together, based on our purposes. Recognition techniques, which are the next chapter, are not really vast as, even though there are general steps for doing object recognition, every single object that has to be recognized has its own method as the are different. This is why there is not a general method that we can specify on this chapter. We now move on into leaf detection techniques on computers. Now we will use the technique explained above based on the image derivatives. Next step will be to turn the leaf into several parameters. Depending on the document that you are referring to, there will be more or less parameters. Some papers recommend to divide the leaf into 3 main features (shape, dent and vein] and doing mathematical operations with them we can get up to 16 secondary features. Next proposition is dividing the leaf into 5 main features (Diameter, physiological length, physiological width, area and perimeter] and from those, extract 12 secondary features. This second alternative is the most used so it is the one that is going to be the reference. Following in to leaf recognition, we are based on a paper that provides a source code that, clicking on both leaf ends, it automatically tells to which specie belongs the leaf that we are trying to recognize. To do so, it only requires having a database. On the tests that have been made by the document, they assure us a 90.312% of accuracy over 320 total tests (32 plants on the database and 10 tests per specie]. Next chapter talks about chromosome detection, where we shall pass the metaphasis plate, where the chromosomes are disorganized, into the karyotype plate, which is the usual view of the 23 chromosomes ordered by number. There are two types of techniques to do this step: the skeletonization process and swiping angles. Skeletonization progress consists on suppressing the inside pixels of the chromosome to just stay with the silhouette. This method is really similar to the ones based on the derivatives of the image but the difference is that it doesnt detect the borders but the interior of the chromosome. Second technique consists of swiping angles from the beginning of the chromosome and, taking under consideration, that on a single chromosome we cannot have more than an X angle, it detects the various regions of the chromosomes. Once the karyotype plate is defined, we continue with chromosome recognition. To do so, there is a technique based on the banding that chromosomes have (grey scale bands] that make them unique. The program then detects the longitudinal axis of the chromosome and reconstructs the band profiles. Then the computer is able to recognize this chromosome. Concerning the future work, we generally have to independent techniques that dont reunite detection and recognition, so our main focus would be to prepare a program that gathers both techniques. On the leaf matter we have seen that, detection and recognition, have a link as both share the option of dividing the leaf into 5 main features. The work that would have to be done is to create an algorithm that linked both methods, as in the program, which recognizes leaves, it has to be clicked both leaf ends so it is not an automatic algorithm. On the chromosome side, we should create an algorithm that searches for the beginning of the chromosome and then start to swipe angles, to later give the parameters to the program that searches for the band profiles. Finally, on the summary, we explain why this type of investigation is needed, and that is because with global warming, lots of species (animals and plants] are beginning to extinguish. That is the reason why a big database, which gathers all the possible species, is needed. For recognizing animal species, we just only have to have the 23 chromosomes. While recognizing a plant, there are several ways of doing it, but the easiest way to input a computer is to scan the leaf of the plant. RESUMEN. El proyecto que se puede ver a continuación trata sobre las tecnologías empleadas en la detección y reconocimiento de objetos, especialmente de hojas y cromosomas. Para ello, este documento contiene las partes típicas de un paper de investigación, puesto que es de lo que se trata. Así, estará compuesto de Abstract, Introducción, diversos puntos que tengan que ver con el área a investigar, trabajo futuro, conclusiones y biografía utilizada para la realización del documento. Así, el Abstract nos cuenta qué vamos a poder encontrar en este paper, que no es ni más ni menos que las tecnologías empleadas en el reconocimiento y detección de patrones en hojas y cromosomas y qué trabajos hay existentes para catalogar a estos objetos. En la introducción se explican los conceptos de qué es la detección y qué es el reconocimiento. Esto es necesario ya que muchos papers científicos, especialmente los que hablan de cromosomas, confunden estos dos términos que no podían ser más sencillos. Por un lado tendríamos la detección del objeto, que sería simplemente coger las partes que nos interesasen de la imagen y eliminar aquellas partes que no nos fueran útiles para un futuro. Resumiendo, sería reconocer los bordes del objeto de estudio. Cuando hablamos de reconocimiento, estamos refiriéndonos al proceso que tiene el ordenador, o la máquina, para decir qué clase de objeto estamos tratando. Seguidamente nos encontramos con un recopilatorio de las tecnologías más utilizadas para la detección de objetos, en general. Aquí nos encontraríamos con dos grandes grupos de tecnologías: Las basadas en las derivadas de imágenes y las basadas en los puntos ASIFT. El grupo de tecnologías basadas en derivadas de imágenes tienen en común que hay que tratar a las imágenes mediante una convolución con una matriz creada previamente. Esto se hace para detectar bordes en las imágenes que son básicamente cambios en la intensidad de los píxeles. Dentro de estas tecnologías nos encontramos con dos grupos: Los basados en gradientes, los cuales buscan máximos y mínimos de intensidad en la imagen puesto que sólo utilizan la primera derivada; y los Laplacianos, los cuales buscan ceros en la intensidad de los píxeles puesto que estos utilizan la segunda derivada de la imagen. Dependiendo del nivel de detalles que queramos utilizar en el resultado final nos decantaremos por un método u otro puesto que, como es lógico, si utilizamos los basados en el gradiente habrá menos operaciones por lo que consumirá más tiempo y recursos pero por la contra tendremos menos calidad de imagen. Y al revés pasa con los Laplacianos, puesto que necesitan más operaciones y recursos pero tendrán un resultado final con mejor calidad. Después de explicar los tipos de operadores que hay, se hace un recorrido explicando los distintos tipos de algoritmos que hay en cada uno de los grupos. El otro gran grupo de tecnologías para el reconocimiento de objetos son los basados en puntos ASIFT, los cuales se basan en 6 parámetros de la imagen y la comparan con otra imagen teniendo en cuenta dichos parámetros. La desventaja de este método, para nuestros propósitos futuros, es que sólo es valido para un objeto en concreto. Por lo que si vamos a reconocer dos hojas diferentes, aunque sean de la misma especie, no vamos a poder reconocerlas mediante este método. Aún así es importante explicar este tipo de tecnologías puesto que estamos hablando de técnicas de reconocimiento en general. Al final del capítulo podremos ver una comparación con los pros y las contras de todas las tecnologías empleadas. Primeramente comparándolas de forma separada y, finalmente, compararemos todos los métodos existentes en base a nuestros propósitos. Las técnicas de reconocimiento, el siguiente apartado, no es muy extenso puesto que, aunque haya pasos generales para el reconocimiento de objetos, cada objeto a reconocer es distinto por lo que no hay un método específico que se pueda generalizar. Pasamos ahora a las técnicas de detección de hojas mediante ordenador. Aquí usaremos la técnica explicada previamente explicada basada en las derivadas de las imágenes. La continuación de este paso sería diseccionar la hoja en diversos parámetros. Dependiendo de la fuente a la que se consulte pueden haber más o menos parámetros. Unos documentos aconsejan dividir la morfología de la hoja en 3 parámetros principales (Forma, Dentina y ramificación] y derivando de dichos parámetros convertirlos a 16 parámetros secundarios. La otra propuesta es dividir la morfología de la hoja en 5 parámetros principales (Diámetro, longitud fisiológica, anchura fisiológica, área y perímetro] y de ahí extraer 12 parámetros secundarios. Esta segunda propuesta es la más utilizada de todas por lo que es la que se utilizará. Pasamos al reconocimiento de hojas, en la cual nos hemos basado en un documento que provee un código fuente que cucando en los dos extremos de la hoja automáticamente nos dice a qué especie pertenece la hoja que estamos intentando reconocer. Para ello sólo hay que formar una base de datos. En los test realizados por el citado documento, nos aseguran que tiene un índice de acierto del 90.312% en 320 test en total (32 plantas insertadas en la base de datos por 10 test que se han realizado por cada una de las especies]. El siguiente apartado trata de la detección de cromosomas, en el cual se debe de pasar de la célula metafásica, donde los cromosomas están desorganizados, al cariotipo, que es como solemos ver los 23 cromosomas de forma ordenada. Hay dos tipos de técnicas para realizar este paso: Por el proceso de esquelotonización y barriendo ángulos. El proceso de esqueletonización consiste en eliminar los píxeles del interior del cromosoma para quedarse con su silueta; Este proceso es similar a los métodos de derivación de los píxeles pero se diferencia en que no detecta bordes si no que detecta el interior de los cromosomas. La segunda técnica consiste en ir barriendo ángulos desde el principio del cromosoma y teniendo en cuenta que un cromosoma no puede doblarse más de X grados detecta las diversas regiones de los cromosomas. Una vez tengamos el cariotipo, se continua con el reconocimiento de cromosomas. Para ello existe una técnica basada en las bandas de blancos y negros que tienen los cromosomas y que son las que los hacen únicos. Para ello el programa detecta los ejes longitudinales del cromosoma y reconstruye los perfiles de las bandas que posee el cromosoma y que lo identifican como único. En cuanto al trabajo que se podría desempeñar en el futuro, tenemos por lo general dos técnicas independientes que no unen la detección con el reconocimiento por lo que se habría de preparar un programa que uniese estas dos técnicas. Respecto a las hojas hemos visto que ambos métodos, detección y reconocimiento, están vinculados debido a que ambos comparten la opinión de dividir las hojas en 5 parámetros principales. El trabajo que habría que realizar sería el de crear un algoritmo que conectase a ambos ya que en el programa de reconocimiento se debe clicar a los dos extremos de la hoja por lo que no es una tarea automática. En cuanto a los cromosomas, se debería de crear un algoritmo que busque el inicio del cromosoma y entonces empiece a barrer ángulos para después poder dárselo al programa que busca los perfiles de bandas de los cromosomas. Finalmente, en el resumen se explica el por qué hace falta este tipo de investigación, esto es que con el calentamiento global, muchas de las especies (tanto animales como plantas] se están empezando a extinguir. Es por ello que se necesitará una base de datos que contemple todas las posibles especies tanto del reino animal como del reino vegetal. Para reconocer a una especie animal, simplemente bastará con tener sus 23 cromosomas; mientras que para reconocer a una especie vegetal, existen diversas formas. Aunque la más sencilla de todas es contar con la hoja de la especie puesto que es el elemento más fácil de escanear e introducir en el ordenador.

Combined effect of tumor necrosis factor-related apoptosis-inducing ligand and ionizing radiation in breast cancer therapy

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a potent endogenous activator of the cell death pathway and functions by activating the cell surface death receptors 4 and 5 (DR4 and DR5). TRAIL is nontoxic in vivo and preferentially kills neoplastically transformed cells over normal cells by an undefined mechanism. Radiotherapy is a common treatment for breast cancer as well as many other cancers. Here we demonstrate that ionizing radiation can sensitize breast carcinoma cells to TRAIL-induced apoptosis. This synergistic effect is p53-dependent and may be the result of radiation-induced up-regulation of the TRAIL-receptor DR5. Importantly, TRAIL and ionizing radiation have a synergistic effect in the regression of established breast cancer xenografts. Changes in tumor cellularity and extracellular space were monitored in vivo by diffusion-weighted magnetic resonance imaging (diffusion MRI), a noninvasive technique to produce quantitative images of the apparent mobility of water within a tissue. Increased water mobility was observed in combined TRAIL- and radiation-treated tumors but not in tumors treated with TRAIL or radiation alone. Histological analysis confirmed the loss of cellularity and increased numbers of apoptotic cells in TRAIL- and radiation-treated tumors. Taken together, our results provide support for combining radiation with TRAIL to improve tumor eradication and suggest that efficacy of apoptosis-inducing cancer therapies may be monitored noninvasively, using diffusion MRI.

Low frequency of E-cadherin alterations in familial breast cancer

In order to explore the possible role of E-cadherin in familial cancer, 19 familial breast cancer patients, whose tumours demonstrated loss of heterozygosity (LOH) at the E-cadherin locus, were screened for germline mutations. No pathogenic germline alterations were detected in these individuals. However, a somatic mutation was found (49-2A→C) in one of the tumours. This tumour showed a pattern of both ductal and lobular histology. Another 10 families with cases of breast, gastric and colon cancer were also screened for germline mutations, and no mutations were found. A missense mutation in exon 12 of E-cadherin (1774G→A; Ala592Thr) was previously found in one family with diffuse gastric cancer, and colon and breast cancer. An allelic association study was performed to determine whether the Ala592Thr alteration predisposes to breast cancer. In total, we studied 484 familial breast cancer patients, 614 sporadic breast cancer patients and 497 control individuals. The frequencies of this alteration were similar in these groups. However, a correlation between the Ala592Thr alteration and ductal comedo-type tumour was seen. These results, together with previously reported studies, indicate that germline mutations and, more commonly, somatic mutations in E-cadherin may have an influence on the behaviour of the tumours, rather than predispose to breast cancer.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

Changes in survival after breast cancer: improvements in diagnosis or treatment?

We have compared 5-year survival rates in two cohorts of women diagnosed with breast cancer in Brisbane, Australia, between 1981-1984 and 1990-1994. Tumours diagnosed in the early 1990s were significantly smaller and less likely to have nodal involvement than those diagnosed 10 years earlier (P < 0.0001). The size difference was particularly striking for women aged over 50 at diagnosis, those targeted for screening. Five-year survival was greater among women diagnosed in the 1990s (84% vs. 74%; hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.46-0.81). After adjusting for the effects of tumour size and nodal status this difference was reduced, but women diagnosed more recently still showed improved survival (HR 0.75; 95% CI 0.56-1.01) and disease-free survival (HR 0.72; 0.56-0.92) at 5 years. This suggests that both earlier diagnosis and changes in breast cancer treatment have contributed to improved breast cancer survival. (C) 2003 Elsevier Ltd. All rights reserved.

Ratiometric and nonratiometric Ca2+ indicators for the assessment of intracellular free Ca2+ in a breast cancer cell line using a fluorescence microplate reader

Transporters of Ca2+ are potential drug targets and Ca2+ is a useful signal in the assessment of G-protein-coupled receptor activation. Assays involving the assessment of intracellular Ca2+ using microplate readers most often use Ca2+ indicators which do not exhibit a spectra shift on Ca2+ binding (e.g. fluo-3). Indicators that do exhibit a spectral shift upon Ca2+ binding (e.g. fura-2) offer potential advantages for the calibration of intracellular Ca2+ levels. However, experimental limitations may limit the use of ratiometric dyes in microplate readers capable of screening. In this study, we compared the assessment of intracellular Ca2+ in adherent breast cancer cells using ratiometric and nonratiometric Ca2+ indicators. Our results demonstrate that both fluo-3 and fura-2 detect ATP dose-dependent increases in intracellular Ca2+ in the MCF-7 breast cancer cell line and that some of the limitations in the use of fura-2 appear to be overcome by the use of glass bottom microplates. The calibrated intracellular Ca2+ levels derived using fura-2 are consistent with those from microscopy and cuvette-based studies. Fura-2 may be useful in microplate studies, where cell lines with different properties are compared or where screening treatments lead to differences in the number of cells or dye loading. (C) 2003 Elsevier B.V. All rights reserved.