Standardized method for quantification of developing lymphedema in patients treated for breast cancer.

Purpose: To develop a simple and practical formula for quantifying breast cancer-related lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal changes.

Methods And Materials: We analyzed bilateral perometer measurements of the upper extremity in a series of 677 women who prospectively underwent lymphedema screening during treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and November 2008. Four sources of variation were analyzed: between repeated measurements on the same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up measurements; and between patients.

Utility of an automated notification system for recruitment of research subjects.

Background: Experience with a novel method of notifying investigators about research subjects in a university-based emergency department (ED) is reported.

Methods: An automated paging system was linked to the electronic medical record to identify inclusion criteria and notify investigators at the time of ED triage. The rate of study enrolment 2 months before and after implementation of the automated system was compared and the time from triage completion to investigator notification was assessed.

Clinical applications of breast pathology: management of in situ breast carcinomas and sentinel node biopsy issues.

The purpose of this article is to review the current clinical management of in situ breast carcinomas, including how specific aspects of a pathology report are used in clinical decision-making, and to discuss the current role of sentinel node biopsy in management of invasive breast carcinomas and ductal carcinoma in situ of the breast.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case-control study.

Aim: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction.

Materials And Methods: Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group).

The association between biological subtype and isolated regional nodal failure after breast-conserving therapy.

Purpose: To evaluate the risk of isolated regional nodal failure (RNF) among women with invasive breast cancer treated with breast-conserving surgery (BCS) and radiation therapy (RT) and to determine factors, including biological subtype, associated with RNF.

Methods And Materials: We retrospectively studied 1,000 consecutive women with invasive breast cancer who received breast-conserving surgery and RT from 1997 through 2002. Ninety percent of patients received adjuvant systemic therapy; none received trastuzumab.

Nipple-sparing mastectomy.

Background: Although effective local control is the primary goal of surgery for breast cancer, the long-term aesthetic outcome is also important. Nipple-sparing mastectomy aims to address this, but there is no consensus on its clinical application. Evidence relating to oncological safety, surgical technique and early data on aesthetic outcome was reviewed.

High-resolution melting analysis (HRMA): a highly sensitive inexpensive genotyping alternative for population studies.

High-resolution melting analysis (HRMA) is a highly sensitive closed-tube genotyping method used primarily in clinical studies. As the method is rapid, inexpensive and amenable to high throughput, we decided to investigate its applicability to population studies. Small amplicons and unlabelled probes were used to genotype the nuclear genes, lactate dehydrogenase-A (ldh-A), myosin light chain-2 (mlc-2), acidic ribosomal phosphoprotein P0 (ARP) and calmodulin (CaM) in populations of swordfish, Xiphias gladius.

Complex fluid analysis with the advanced distillation curve approach.

An improved method for measuring distillation curves reveals the physicochemical properties of complex fluids such as fuels.

The relationship of the Reynolds Intellectual Assessment Scales and the Wechsler Adult Intelligence Scale-Third Edition.

The purpose of this study was to compare scores on the Reynolds Intellectual Assessment Scales (RIAS) with scores on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) in a group of college students diagnosed with a Learning Disability, Attention-Deficit Hyperactivity Disorder (ADHD), or a combination of the two. The RIAS Composite Index score was significantly higher than the WAIS-III Full Scale IQ, although scores on both tests were in the average range. Correlations between the two tests were significant on all measures.

Diagnosis of breast cancer in women age 40 and younger: delays in diagnosis result from underuse of genetic testing and breast imaging.

Background: The impact of newer breast imaging technologies and genetic testing on the detection of breast cancer in women age 40 and younger remains unknown.

Methods: A records review identified 628 women age 40 and younger diagnosed with breast cancer from 1996 to 2008. Patient and tumor characteristics, means of diagnosis, imaging results, and genetic testing were examined.

Occult nipple involvement in breast cancer: clinicopathologic findings in 316 consecutive mastectomy specimens.

Purpose: Although breast-conserving surgery is a standard approach for patients with breast cancer, mastectomy often becomes necessary. Surgical options now include nipple-sparing mastectomy but its oncological safety is still controversial. This study evaluates frequency and patterns of occult nipple involvement in a large contemporary cohort of patients with the retroareolar margin as possible indicator of nipple involvement.

Outcome of multiple-wire localization for larger breast cancers: do multiple wires translate into additional imaging, biopsies, and recurrences?

Background: Breast conservation is possible in breast cancer patients whose mammographic lesions are large enough to require multiple localizing wires for excision.

Methods: A retrospective review of 112 patients who underwent multiple-wire and 160 controls who underwent single-wire lumpectomy for breast cancer. Rates of in-breast recurrence, metastasis, and additional imaging and biopsy procedures were calculated.

How cancer at the primary site and in the lymph nodes contributes to the risk of cancer death.

Background: : It has long been appreciated that tumor size, lymph node status, and patient survival are related qualities, although how to isolate their interactions has not been obvious, nor has it been obvious how to integrate tumor size and lymph node status into predictions of the risk of death for individual patients.

Methods: : The authors describe a mathematical method, the binary-biological model of cancer metastasis, based on the spread of cancer cells, in which the equations capture the relations between tumor size, lymph node status, and cancer lethality.

Results: : For melanoma, renal cell carcinoma, and breast carcinoma, the relation between tumor size and the risk of cancer death was captured by the SizeOnly equation.

Why cancer at the primary site and in the lymph nodes contributes to the risk of cancer death.

Background: : Cancer at both the primary site and in the lymph nodes is associated with lethality, although the mechanism by which lethality arises from each site has been poorly understood. For breast carcinoma, each positive lymph node contributes an approximately 6% risk of death, and each millimeter of primary tumor greatest dimension contributes approximately 1%; whereas, for melanoma, each positive lymph node contributes an approximately 23% risk, and each millimeter of tumor thickness contributes approximately 8%: This is described by a pair of linked equations, the Size+Nodes method.

Methods: : A simple expression, the ProbabilityEstimation equation, which was derived from the authors' binary-biologic model of cancer metastasis, was used to calculate the probabilities of spread of cancer cells from data on tumor size, lymph node status, and death rate.

The impact of primary tumor size, lymph node status, and other prognostic factors on the risk of cancer death.

Background: : Although many prognostic factors are associated with differences in cancer lethality, it may not be obvious whether a factor truly makes an independent contribution to lethality or simply is correlated with tumor size. There is currently no method for integrating tumor size, lymph node status, and other prognostic information from a patient into a single risk of death estimate.

Methods: : The SizeOnly equation, which captures the relation between tumor size and risk of death, makes it possible to determine whether a prognostic factor truly makes an independent contribution to cancer lethally or merely is associated with tumor size (SizeAssessment method).

Mutation-specific antibodies for the detection of EGFR mutations in non-small-cell lung cancer.

Purpose: Activating mutations within the tyrosine kinase domain of epidermal growth factor receptor (EGFR) are found in approximately 10% to 20% of non-small-cell lung cancer (NSCLC) patients and are associated with response to EGFR inhibitors. The most common NSCLC-associated EGFR mutations are deletions in exon 19 and L858R mutation in exon 21, together accounting for 90% of EGFR mutations. To develop a simple, sensitive, and reliable clinical assay for the identification of EGFR mutations in NSCLC patients, we generated mutation-specific rabbit monoclonal antibodies against each of these two most common EGFR mutations and aimed to evaluate the detection of EGFR mutations in NSCLC patients by immunohistochemistry.

Effects and mechanisms of action of the ergopeptides ergotamine and ergovaline and the effects of peramine on reticulum motility of sheep.

Objective: To investigate effects and mechanisms of ergotamine and ergovaline and effects of peramine on reticulum motility of sheep.

Sample Population: 3 sheep with indwelling electrodes in the reticulum and samples of reticulum collected from 126 sheep at an abattoir.

Procedures: In conscious sheep, motility was recorded as integrated electromyograms from the reticulum.

Real-time identification of serious infection in geriatric patients using clinical information system surveillance.

Objectives: To develop and characterize an automated syndromic surveillance mechanism for early identification of older emergency department (ED) patients with possible life-threatening infection.

Design: Prospective, consecutive-enrollment, single-site observational study.

Setting: A large university medical center with an annual ED census of 75,273.

Evaluation of corn grain with the genetically modified input trait DAS-59122-7 fed to growing-finishing pigs.

A growth performance experiment was conducted to assess the feeding value of a double-stacked transgenic corn grain for growing-finishing pigs. The genetically modified corn grain contained event DAS-59122-7, which expresses the Cry34/35Ab1 binary insecticidal protein for the control of corn rootworm. This modified transgenic grain is resistant to western corn rootworm and is also tolerant to herbicides containing the active ingredient glufosinate-ammonium.

A Boston Yankee: Paul M. Lerner and the heart of assessment.

In this article, I review the contributions of Paul M. Lerner to the theory and practice of personality assessment. I contrast Lerner's clinical approach with a narrow empirical approach along several dimensions.

Variation in ptaquiloside content In bracken (Pteridium esculentum (Forst. f) Cockayne ) in New Zealand.

Aim: To examine stands of bracken fern (Pteridium esculentum) from throughout New Zealand for the presence and concentration of ptaquiloside (Pta), and to compare the presence and/or concentrations of Pta in areas where bovine enzootic haematuria (BEH) and/or acute haemorrhagic syndrome (AHS) has been known to occur with those where BEH/AHS has not been recorded.

Methods: Stands of bracken fern were sampled from 275 sites throughout New Zealand. Sixty-two stands were from a regional survey predominantly from the Waikato and Coromandel regions, 27 were from a farm in the King Country where BEH/AHS had been investigated previously, and 186 were from a national survey of the North and South Islands.