Safety of Targeted Axillary Dissection After Neoadjuvant Therapy in Patients With Node-Positive Breast Cancer.

Importance: The increasing use of neoadjuvant systemic therapy (NST) has led to substantial pathological complete response rates in patients with initially node-positive, early breast cancer, thereby questioning the need for axillary lymph node dissection (ALND). Targeted axillary dissection (TAD) is feasible for axillary staging; however, data on oncological safety are scarce.

Objective: To assess 3-year clinical outcomes in patients with node-positive breast cancer who underwent TAD alone or TAD with ALND.

Thermal imaging of dust hiding the black hole in NGC 1068.

In the widely accepted 'unified model' solution of the classification puzzle of active galactic nuclei, the orientation of a dusty accretion torus around the central black hole dominates their appearance. In 'type-1' systems, the bright nucleus is visible at the centre of a face-on torus. In 'type-2' systems the thick, nearly edge-on torus hides the central engine.

A Prospective, Multicenter Registry Study to Evaluate the Clinical Feasibility of Targeted Axillary Dissection (TAD) in Node-positive Breast Cancer Patients.

Objective: This study aimed to investigate the feasibility and accuracy of non-radioactive TLN biopsy and TAD in routine clinical practice.

Background Data: TAD involves TLN biopsy (TLNB) and sentinel lymph node biopsy and was recently introduced as a new standard for less invasive axillary staging in BC patients undergoing neoadjuvant systemic therapy (NST); however, clinical evidence is limited.

Methods: The SenTa study is a prospective registry study conducted at 50 centers.

Quality management in medical rehabilitative care by the German statutory pension insurance scheme.

This paper aims to provide an insight into the quality management approach for medical rehabilitation services of the German statutory pension insurance scheme. In the 1990s, the German statutory pension insurance scheme initiated a quality management programme in rehabilitation, which is subject to continuous development. The main objective of implementing quality management in rehabilitative care was quality control and quality improvement.

Postoperative euglycaemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitors (gliflozins): a report of two cases and review of the literature.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euglycaemic diabetic ketoacidosis (euDKA) is a serious and increasingly recognised complication of treatment with this class of oral hypoglycaemic agents and can present a diagnostic challenge, resulting in delayed recognition, inappropriate treatment and potentially life-threatening acidosis. We present two cases of patients developing SGLT2i-associated euDKA in the early postoperative period. We support ceasing SGLT2i for 72 hours preoperatively and would suggest continuing to withhold the medication until oral intake is restored, and recommend a wider awareness of SGLT2i-associated diabetic ketoacidosis (DKA) amongst patients and their healthcare providers with an emphasis on checking ketone levels irrespective of blood glucose levels in the postoperative setting.

Allergic asthma after flour inhalation in subjects without occupational exposure to flours: an experimental pilot study.

Objective: Cross-reactivity between grass pollen and grain flour allergens is well known, but their significance in apprentice bakers with primary sensitization to grass pollen is not known.

Methods: Twenty-five subjects with mild asthma (most of them with hay fever), but without prior occupational flour exposure, underwent standardized experimental inhalation challenges with placebo and wheat and rye flours in randomized order on three consecutive days. Sensitization to flours and environmental allergens was assessed by skin prick tests and specific IgE antibodies in sera.

[Quality assurance of rehabilitation by the German pension insurance: an overview].

The German pension insurance has in recent years developed a comprehensive programme for quality assurance in rehabilitation, and has implemented the programme into routine practice. Different aspects of rehabilitation are evaluated with differentiated instruments. Issues dealt with inter alia include the quality of rehabilitative care in a narrower sense, the structure and organisation of the rehabilitation centres, as well as quality from the patients' perspective.

[Empowerment and health literacy in medical rehabilitation - recommendations for strengthening patient education].

Unlabelled: The recommendations aim to increase patient participation and health literacy by strengthening the role of patient education in medical rehabilitation. Research shows patient education to be effective and efficient; making the implementation of high quality patient education a top priority. To strengthen the role of patient education it is important to address known obstacles, identify potential for improvement, and define future demands for rehabilitative care.

The dust halo of Saturn's largest icy moon, Rhea.

Saturn's moon Rhea had been considered massive enough to retain a thin, externally generated atmosphere capable of locally affecting Saturn's magnetosphere. The Cassini spacecraft's in situ observations reveal that energetic electrons are depleted in the moon's vicinity. The absence of a substantial exosphere implies that Rhea's magnetospheric interaction region, rather than being exclusively induced by sputtered gas and its products, likely contains solid material that can absorb magnetospheric particles.

[Quality assurance in outpatient medical rehabilitation - concept and results of a pilot project to develop a quality assurance programme for musculoskeletal and cardiac diseases].

Purpose: The concept and results of a pilot project to develop a quality assurance programme for outpatient medical rehabilitation in musculoskeletal and cardiac diseases are discussed. The processes developed and the results that were achieved using the instruments in 24 pilot institutions are described.

Methods: The quality of structure was assessed by defining and applying basic and detailed criteria; a version of peer review for outpatient treatment was developed to test the quality of process.

1:1 Adduct of (S,S)-4-amino-3,5-bis(1-hydroxyethyl)-1,2,4-triazole with (S,S)-1,2-bis(2-hydroxypropionyl)hydrazine stabilized by eight hydrogen bonds.

The structure of the cocrystallized 1:1 adduct of (S,S)-4-amino-3,5-bis(1-hydroxyethyl)-1,2,4-triazole and (S,S)-1,2-bis(2-hydroxypropionyl)hydrazine, C6H12N4O2.C6H12N2O4, has tetragonal symmetry. All eight O- and N-bound H atoms are involved in intermolecular hydrogen bonds, resulting in infinite zigzag chains of the triazole molecules, with the hydrazine molecules filling the gaps between the chains and completing a three-dimensional hydrogen-bonded array.

Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care.

Objective: Transportation of critically ill patients within the hospital poses important risks. We sought to identify causes, outcomes and contributing factors associated with intra-hospital transport.

Design: Cross-sectional case review.

Evaluation of two methods for quality improvement in intensive care: facilitated incident monitoring and retrospective medical chart review.

Objective: Quality assurance techniques applied within the healthcare industry have been widely used and are intended to improve patient outcomes. Two methods that have been utilized are incident reporting and medical chart review (MCR). The objectives for this study were to evaluate facilitated incident monitoring (FIM) and MCR in the intensive care setting.

Dinuclear cyano complexes of cobalt(III) and Iron(III) containing noninnocent 1,2,4,5-tetrakis(2-pyridinecarboxamido)benzene bridging ligands.

Two new dinucleating ligands 1,2,4,5-tetrakis(2-pyridinecarboxamido)benzene, H(4)(tpb), and 1,2,4,5-tetrakis(4-tert-butyl-2-pyridinecarboxamido)benzene, H(4)(tbpb), have been synthesized, and the following dinuclear cyano complexes of cobalt(III) and iron(III) have been isolated: Na(2)[Co(III)(2)(tpb)(CN)(4)] (1); [N(n-Bu)(4)](2)[Co(III)(2)(tbpb)(CN)(4)] (2); [Co(III)(2)(tbpb(ox2))(CN)(4)] (3); [N(n-Bu)(4)](2)[Fe(III)(2)(tpb)(N(3))(4)] (4); [N(n-Bu)(4)](2)[Fe(III)(2)(tpb)(CN)(4)] (5); [N(n-Bu)(4)](2)[Fe(III)(2)(tbpb)(CN)(4)] (6). Complexes 2-4 and 6 have been structurally characterized by X-ray crystallography at 100 K. From electrochemical and spectroscopic (UV-vis, IR, EPR, Mössbauer) and magnetochemical investigations it is established that the coordinated central 1,2,4,5-tetraamidobenzene entity in the cyano complexes can be oxidized in two successive one-electron steps yielding paramagnetic (tbpb(ox1))(3)(-) and diamagnetic (tbpb(ox2))(2)(-) anions.

Incidents relating to arterial cannulation as identified in 7,525 reports submitted to the Australian incident monitoring study (AIMS-ICU).

Arterial cannulation is frequently used in the critical care environment. Literaturefocuses on insertion techniques and complications. This report utilized data from the Australian Incident Monitoring Study (AIMS-ICU) national database to identify common problems and contributing factors associated with the use and maintenance of arterial lines.

The effects of nursing staff inexperience (NSI) on the occurrence of adverse patient experiences in ICUs.

Although many studies have attempted to define levels of staff experience appropriate for the care of critically ill patients, minimal data is available on the effect of nursing staff inexperience (NSI) on the occurrence of incidents in the intensive care environment. The Australian Incident Monitoring Study in Intensive Care Units (AIMS-ICU), an anonymous, voluntary incident reporting system, can help to identify problems in which NSI may be implicated. NSI may be an incident in itself or contribute to the occurrence of other incidents.

Efficacy of continuous venovenous hemodialysis in the treatment of severe lithium toxicity.

The syndrome of lithium toxicity has been well described. Hemodialysis is the recommended treatment for severe toxicity. We report a case in which continuous venovenous hemodialysis was used in the treatment of lithium toxicity.

Factors associated with reintubation in intensive care: an analysis of causes and outcomes.

Introduction: Reports on reintubation have focused on patients in whom planned extubation has been unsuccessful or those who have been accidentally extubated. However, reintubation is often required in events not related to accidental extubation. These cases have not been well described previously.

1,2-bis(pyridine-2-carboxamido)benzenate(2-), (bpb)2-: a noninnocent ligand. Syntheses, structures, and mechanisms of formation of [(n-Bu)4N][FeIV2(mu-N)(bpb)2(X)2] (X = CN-, N3-) and the electronic structures of [MIII(bpbox1)(CN)2] (M = Co, Fe).

The well-known tetradentate ligand 1,2-bis(pyridine-2-carboxamido)benzenate(2-), (bpb)2-, and its 4,5-dichloro analogue, (bpc)2-, are shown to be "noninnocent" ligands in the sense that in coordination compounds they can exist in their radical one- and diamagnetic two-electron-oxidized forms (bpbox1)- and (bpbox2)0 (and (bpcox1)- and (bpcox2)0), respectively. Photolysis of high-spin [(n-Bu)4N][FeIII(bpb)(N3)2] and its (bpc)2- analogue in acetone solution at room temperature generates the diamagnetic dinuclear complex [(n-Bu)4N][FeIV2(mu-N)(bpb)2(N3)2] and its (bpc)2- analogue; the corresponding cyano complex [(n-Bu)4N][FeIV2(mu-N)(bpb)2(CN)2] has been prepared via N3- substitution by CN-. Photolysis in frozen acetonitrile solution produces a low-spin ferric species (S = 1/2) which presumably is [FeIII(bpbox2)(N)(N3)]-, as has been established by EPR and Mössbauer spectroscopy.

Morphometric measurements to quantify the cerulein induced hyperstimulatory pancreatitis of rats under the protective effect of lectins.

In preceding papers we demonstrated an inhibitory effect of wheat germ agglutinin (WGA) and Ulex europaeus agglutinin (UEA) on the cholecystokinin (CCK) binding to the CCK receptor of rat pancreatic cells and also on the CCK induced Ca2+ release and alpha-amylase secretion in vitro as well as on pancreatic secretion of intact rats in vivo. In the present study we show the same inhibitory effect of both lectins on the cerulein pancreatitis of rats. This acute pancreatitis was induced by supramaximal injections (5 microg/kg/h i.

ORSAT and modifications of SEFT and APT.

Up to now, three subspectra are usually needed for the complete assignment of all signals in 13C spectrum: two DEPT spectra (phi = 90 degrees and phi = 135 degrees) and a proton decoupled spectrum. In this paper, we present a method in which a complete assignment becomes possible with merely two spectra. For this purpose, a new pulse sequence (ORSAT) has been elaborated by using off-resonance irradiation.

Conflicts of thermal adaptation and fever--a cybernetic approach based on physiological experiments.

Cold adaptation aims primarily at a better economy, i.e., preservation of energy often at the cost of a lower mean body temperature during cold stress, whereas heat adaptation whether achieved by exposure to a hot environment or by endogenous heat produced by muscle exercise, often brings about a higher efficiency of control, i.

Problems associated with nursing staff shortage: an analysis of the first 3600 incident reports submitted to the Australian Incident Monitoring Study (AIMS-ICU).

Although many studies have attempted to define appropriate nursing staff levels, allocation and patient dependency, minimal data is available on the effect of nursing staff shortage (NSS) on quality of care provided in intensive care. This study aimed to identify incidents associated with staff shortage as reported to the Australian Incident Monitoring Study-ICU (AIMS-ICU) project and to assess their estimated effect on patient outcome. A search of narrative keywords and contributing factors identified 89 nursing staff shortage incidents (NSS-INCIDENTS) and 373 incidents involving nursing staff shortage contributing factors (NSS-CF).