Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index.

INTRODUCTION Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes. METHODS Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER-, PR-, HER2-, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2-, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2-, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER-, PR-, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER-, PR-, HER2-, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER-, PR-, HER2-, any Ki-67, CK 5/6-, EGFR-). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value. RESULTS Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months. CONCLUSIONS Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.

Recurrent left colonic diverticulitis episodes: more severe than the initial diverticulitis?

BACKGROUND: Until recently, it was accepted that the rate of complications and failure of medical therapy were higher during recurrent episodes of diverticulitis. New data and new interpretation of older studies have challenged this opinion. The aim of the present study was to determine whether recurrent diverticulitis in comparison with the initial episode has a different short-term outcome after medical or surgical treatment. METHODS: This was a retrospective cohort study of 271 consecutive patients admitted for diverticulitis confirmed by computed tomography (CT) between 2001 and 2004. Altogether 202 patients had an initial episode (group I), and 69 had recurrent diverticulitis (group R). A total of 20 clinical and 15 radiologic parameters were analyzed and compared between the two groups, including need for surgery, clinical presentation at admission, response to treatment, complications, laboratory parameters, and pathologic CT features (colonic wall thickening, abscess, pneumoperitoneum, free intraperitoneal fluid). An unpaired Student's t-test and Fisher's and Wilcoxon's tests were applied for statistical analysis. RESULTS: None of the clinical or radiologic parameters was statistically different between the two groups. Regarding surgery, 15.8% of the group I patients needed surgery at admission compared to 5.8% in group R (p = 0.04). Conservative treatment failure was similar in the two groups (10.7% vs. 10.0%; p = 0.84). There was 3% mortality at 30 days in group I compared to 0% in group R. CONCLUSIONS: Recurrent episodes of diverticulitis do not lead to more complications and more conservative treatment failure. Moreover, surgery at admission was less frequent among patients who presented with a recurrence.

Mise au point concernantl'utilisation du dosagede l'antigène carcino-embryonnaire (CEA)en clinique

The carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA have been detected by radioimmunoassay in 20-90 per cent of cases of colorectal carcinomas depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several non malignant conditions greatly limit the value of the CEA test for the early diagnosis of colorectal carcinoma. Thus, the CEA assay should not be used as a screening test for cancer. Repeatecl CEA mesurements, however, appear to be of importance for the evaluation of tumor resection and the detection of tumor recurrence. The only localized tumors known to produce elevation of CEA above the levels observed in non malignant diseases are carcinomas of the large bowel and the pancreas. In carcinomas derived from other organs a marked increase of CEA level is always associated with the presence of distant metastasis. Therefore at the present time the clinical applications of the CEA radioimmunoassay should be limited to the differentiai diagnosis of patients with suspicion of primary colorectal or pancreatic carcinoma, to the detection of distant metastasis in other types of carcinomas and to the post operative follow up of patients who had elevated levels of CEA before surgery. Well-controlled studies are still needed to determine if therapeutic decisions based on CEA results can lead to improved survival.

Structural and electrical characterization of semiconducting barium-lead-titanate ceramics

BaTiO3 is usually doped to achieve the temperature stability required by device applications, as well as to obtain a large positive temperature coefficient anomaly of resistivity (PTCR). Uniform distribution of dopants among the submicron dielectric particles is the key for optimal control of grain size and microstructure to maintain a high reliability. The system Ba0.84Pb0.16TiO3 was synthesized from high purity BaCO3, TiO2, PbO oxide powders as raw materials. Sb2O3, MnSO4 and ZnO were used as dopants and Al2O3, TiO2 and SiO2 as grain growth controllers. Phase composition was analyzed by using XRD and the microstructure was investigated by SEM. EDS attached to SEM was used to analyze phase composition specially related to abnormal grain growth. Electrical resistivities were measured as a function of temperature and the PTCR effect characterized by an abrupt increase on resistivity.

High Curie point CaBi2Nb2O9 thin films: A potential candidate for lead-free thin-film piezoelectrics

CaBi2Nb2O9 (CBNO) thin films deposited on platinum coated silicon substrates by the polymeric precursor method exhibited good structural, dielectric, and piezoelectric characteristics. Capacitance-voltage measurements indicated good ferroelectric polarization switching characteristics. Remanent polarization and drive voltage values were 4.2 mu C/cm(2) and 1.7 V for a maximum applied voltage of 10 V. The film has a piezoelectric coefficient d(33) equal to 60 pm/V, current density of 0.7 mu A/cm(2), and Curie temperature of 940 degrees C. The polar-axis-oriented CBNO is a promising candidate for use in lead-free high Curie point in ferroelectric and piezoelectric devices. (c) 2006 American Institute of Physics.

Effect of barium titanate seed particles on the sintering and lattice parameters in PbMg1/3Nb2/3O3 ceramics

PbMg1/3Nb2/3O3 (PMN) powder was prepared by citrate organic solution, and barium titanate (BT) seed particles were added to encourage the perovskite phase formation. Sintering was followed using the constant heating rate mode of a dilatometer, and it was observed that the seed concentration affected the PMN shrinkage rate and crystal structure. The study of the lattice parameters of the samples after the sintering process indicates that the diffusion of the titanium and of the barium inside perovskite and pyrochlore PMN phases occurs. Moreover, this substitution provoked a decrease of the lattice parameters as showed by the Rietveld refinement.

Microscopic and dielectric analyses of vanadium and tungsten modified barium zirconium titanate ceramics

Dielectric spectroscopy was used in this study to examine polycrystalline vanadium and tungstendoped BaZr 0.1Ti 0.90O 3 (BZT10:2V and BZT10:2W) ceramics obtained by the mixed oxide method. According to X-ray diffraction analyses, addition of vanadium and tungsten lead to ceramics free of secondary phases. SEM analyses reveal that both dopants result in slower oxygen ion motion and consequently lower grain growth rate. Temperature dependence dielectric study showed normal ferroelectric to paraelectric transition well above the room temperature for the BZT10 and BZT10:2V ceramics. However, BZT10:2W ceramic showed a relaxor-like behavior near phase transition characterized by the empirical parameter γ. Piezoelectric force microscopy images reveals that the piezoelectric coefficient is strongly influenced by type of donor dopant suggesting promising applications for dynamic random access memories and data-storage media. Copyright © 2010 American Scientific Publishers All rights reserved.

Effects of verum acupuncture compared to placebo acupuncture on quantitative EEG and heart rate variability in healthy volunteers

OBJECTIVES: The aim of this single-blind randomized crossover study was to evaluate specific effects of manual acupuncture on central and vegetative nervous system activity measured by quantitative electroencephalography (qEEG) and heart rate variability (HRV). DESIGN: Twenty (20) healthy volunteers (mean: 25.2 +/- 3.6 years) were monitored simultaneously using a qEEG system and a 12-channel electrocardiogram recorder during verum acupuncture (VA) at acupuncture point Large Intestine 4 (Hegu) (LI4) or placebo acupuncture (PA) at a sham point. RESULTS: In the EEG conduction of the occipital area, needle stimulation in VA increased alpha1-frequency significantly, and the ratio alpha1/theta was shifted to the benefit of alpha1 over all electrodes. The HRV parameters showed a significant increase of the low frequency/high frequency (HF) ratio during the first minute of stimulation in VA, indicating an initial increase of sympathetic activation. However, an increase of HF power in the minute after stimulation followed by a decrease in heart rate suggests delayed vagal activation. De qi (a sensation that is typical of acupuncture needling) occurred in 16 subjects during VA and in 9 volunteers during PA (80% versus 45%). CONCLUSIONS: Manual stimulation on LI4 seems to lead to specific changes in alpha EEG-frequency and in HRV parameters. A linear relationship between the HRV parameters and the alpha EEG band might point to a specific modulation of cerebral function by vegetative effects during acupuncture.

Failure Rate and Conductor Externalization of the Biotronik Linox / Sorin Vigila Implantable Cardioverter Defibrillator Lead

BACKGROUND We observed a case of conductor externalization in a Biotronik Linox lead. OBJECTIVE To investigate lead performance of the Linox and identical Sorin Vigila lead and prevalence of conductor externalization. METHODS We compared lead performance of all Linox and Vigila leads implanted at our center (BL group; n=93) with all Boston Scientific Endotak Reliance leads (ER group; n=190) and Medtronic Sprint Quattro leads (SQ group; n=202) implanted during the same period. We screened all BL group patients for conductor externalization. RESULTS We identified 8 cases of lead failures in the BL group (index case of conductor externalization; 6 cases of non-physiological high rate sensing; one case of high voltage conductor fracture). Prospective, fluoroscopic screening of 98% of all active BL group cases revealed one additional case of conductor externalization. Median follow-up was 41, 27 and 29 months for the BL group, ER group and SQ group, respectively, lead survival 94.9%, 99.2% and 100% at 3 years, and 88%, 97.5% and 100% at 5 years (p=0.038 for BL group vs. ER group, and p=0.007 for BL group vs. SQ group by the log-rank test). Younger age at implant was an independent predictor for lead failure in the BL group (adjusted HR 0.85 [95% confidence interval 0.77-0.94]; p=0.001). CONCLUSION At our center, survival of the Linox lead is 88% at five years and significantly worse than its comparators. Conductor externalization is present in a minority of failed Linox leads. Younger age at implant is an independent predictor of Linox lead failure.

The effect of yoga on cardiovascular health as measured by heart rate variability in a sample of breast cancer patients

The study is a three-armed randomized controlled trial comparing values for heart rate variability (HRV), a measure of cardiovascular health, throughout a yoga intervention of breast cancer patients undergoing radiotherapy. Patients attended either a yoga (n=45), stretch, (n=46), or control (n=42) condition 3 times per week for 6 weeks of radiation. Electrocardiograms (ECGs) were conducted on each participant to provide the values necessary for HRV analysis. Analyses focused on examining scores for those participants with HRV baseline values considered to be below the cutoff point for healthy HRV levels, defined by the authors as below the cutpoint of 68 ms. From the entire sample of 133 with available baselines, 26 yogis, 26 stretchers, and 23 controls were determined to be “pathologic” in terms of HRV, and selected for follow-up analysis at 3 weeks and then again at 6 weeks. Though no statistically significant differences were found between either group means at each timepoint or group change score means, the yoga group had consistently higher mean score and mean change scores. These findings are suggestive and indicate the need to refine the use of ECGs and HRV analysis programs to more accurately and comprehensively assess the effects of yoga on cardiovascular health in cancer patients.^

Crete fault scarp point cloud data

This paper assesses the along strike variation of active bedrock fault scarps using long range terrestrial laser scanning (t-LiDAR) data in order to determine the distribution behaviour of scarp height and the subsequently calculate long term throw-rates. Five faults on Cretewhich display spectacular limestone fault scarps have been studied using high resolution digital elevation model (HRDEM) data. We scanned several hundred square metres of the fault system including the footwall, fault scarp and hanging wall of the investigated fault segment. The vertical displacement and the dip of the scarp were extracted every metre along the strike of the detected fault segment based on the processed HRDEM. The scarp variability was analysed by using statistical and morphological methods. The analysis was done in a geographical information system (GIS) environment. Results show a normal distribution for the scanned fault scarp's vertical displacement. Based on these facts, the mean value of height was chosen to define the authentic vertical displacement. Consequently the scarp can be divided into above, below and within the range of mean (within one standard deviation) and quantify the modifications of vertical displacement. Therefore, the fault segment can be subdivided into areas which are influenced by external modification like erosion and sedimentation processes. Moreover, to describe and measure the variability of vertical displacement along strike the fault, the semi-variance was calculated with the variogram method. This method is used to determine how much influence the external processes have had on the vertical displacement. By combining of morphological and statistical results, the fault can be subdivided into areas with high external influences and areas with authentic fault scarps, which have little or no external influences. This subdivision is necessary for long term throw-rate calculations, because without this differentiation the calculated rates would be misleading and the activity of a fault would be incorrectly assessed with significant implications for seismic hazard assessment since fault slip rate data govern the earthquake recurrence. Furthermore, by using this workflow areas with minimal external influences can be determined, not only for throw-rate calculations, but also for determining samples sites for absolute dating techniques such as cosmogenic nuclide dating. The main outcomes of this study include: i) there is no direct correlation between the fault's mean vertical displacement and dip (R² less than 0.31); ii) without subdividing the scanned scarp into areas with differing amounts of external influences, the along strike variability of vertical displacement is ±35%; iii) when the scanned scarp is subdivided the variation of the vertical displacement of the authentic scarp (exposed by earthquakes only) is in a range of ±6% (the varies depending on the fault from 7 to 12%); iv) the calculation of the long term throw-rate (since 13 ka) for four scarps in Crete using the authentic vertical displacement is 0.35 ± 0.04 mm/yr at Kastelli 1, 0.31 ± 0.01 mm/yr at Kastelli 2, 0.85 ± 0.06 mm/yr at the Asomatos fault (Sellia) and 0.55 ± 0.05 mm/yr at the Lastros fault.

Geochemistry, lithology, and bulk density of Cricket Flat paleosol samples

The high-resolution marine isotope climate record indicates pronounced global cooling during the Langhian (16-13.8 Ma), beginning with the warm middle Miocene climatic optimum and ending with significant Antarctic ice sheet expansion and the transition to "icehouse" conditions. Terrestrial paleoclimate data from this interval is sparse and sometimes conflicting. In particular, there are gaps in the terrestrial record in the Pacific Northwest during the late Langhian and early Serravallian between about 14.5 and 12.5 Ma. New terrestrial paleoclimate data from this time and region could reconcile these conflicting records. Paleosols are particularly useful for reconstructing paleoenvironment because the rate and style of pedogenesis is primarily a function of surface environmental conditions; however, complete and well-preserved paleosols are uncommon. Most soils form in erosive environments that are not preserved, or in environments such as floodplains that accumulate in small increments; the resulting cumulic soils are usually thin, weakly developed, and subject to diagenetic overprinting from subsequent soils. The paleosol at Cricket Flat in northeastern Oregon is an unusually complete and well-preserved paleosol from a middle Miocene volcanic sequence in the Powder River Volcanic Field. An olivine basalt flow buried the paleosol at approximately 13.8 ± 0.6 Ma, based on three 40Ar/39Ar dates on the basalt. We described the Cricket Flat paleosol and used its physical and chemical profile and micromorphology to assess pedogenesis. The Cricket Flat paleosol is an Ultisol-like paleosol, chemically consistent with a high degree of weathering. Temperature and rainfall proxies suggest that Cricket Flat received 1120 ± 180 mm precipitation y-1 and experienced a mean annual temperature of 14.5 ± 2.1 °C during the formation of the paleosol, significantly warmer and wetter than today. This suggests slower cooling after the middle Miocene climatic optimum than is seen in the existing paleosol record.

Equilibrium distributions of microsatellite repeat length resulting from a balance between slippage events and point mutations

We describe and test a Markov chain model of microsatellite evolution that can explain the different distributions of microsatellite lengths across different organisms and repeat motifs. Two key features of this model are the dependence of mutation rates on microsatellite length and a mutation process that includes both strand slippage and point mutation events. We compute the stationary distribution of allele lengths under this model and use it to fit DNA data for di-, tri-, and tetranucleotide repeats in humans, mice, fruit flies, and yeast. The best fit results lead to slippage rate estimates that are highest in mice, followed by humans, then yeast, and then fruit flies. Within each organism, the estimates are highest in di-, then tri-, and then tetranucleotide repeats. Our estimates are consistent with experimentally determined mutation rates from other studies. The results suggest that the different length distributions among organisms and repeat motifs can be explained by a simple difference in slippage rates and that selective constraints on length need not be imposed.