Disseminated breast cancer cells acquire a highly malignant and aggressive metastatic phenotype during metastatic latency in the bone.

Background: Disseminated tumor cells (DTCs) in the bone marrow may exist in a dormant state for extended periods of time, maintaining the ability to proliferate upon activation, engraft at new sites, and form detectable metastases. However, understanding of the behavior and biology of dormant breast cancer cells in the bone marrow niche remains limited, as well as their potential involvement in tumor recurrence and metastasis. Therefore, the purpose of this study was to investigate the tumorigenicity and metastatic potential of dormant disseminated breast cancer cells (prior to activation) in the bone marrow.

"A novel in vivo model for the study of human breast cancer metastasis using primary breast tumor-initiating cells from patient biopsies".

Background: The study of breast cancer metastasis depends on the use of established breast cancer cell lines that do not accurately represent the heterogeneity and complexity of human breast tumors. A tumor model was developed using primary breast tumor-initiating cells isolated from patient core biopsies that would more accurately reflect human breast cancer metastasis.

Methods: Tumorspheres were isolated under serum-free culture conditions from core biopsies collected from five patients with clinical diagnosis of invasive ductal carcinoma (IDC).

The use of multislice CT angiography preoperative study for supraclavicular artery island flap harvesting.

Background: The vascular anatomy of the supraclavicular artery island (SAI) flap has been investigated using both cadaveric anatomic dissections and angiographic studies. Accurate preoperative evaluation and localization of its vascular pedicle confirms its location, course, anatomic variation, and improves flap success. The objective of this report is to demonstrate the utility of multislice computed tomography (CT) angiography for confirming the presence of the vascular pedicle of the SAI flap when planning head and neck reconstruction.

Breast tumor-initiating cells isolated from patient core biopsies for study of hormone action.

In recent years, evidence has emerged supporting the hypothesis that cancer is a stem cell disease. The cancer stem cell field was led by the discovery of leukemia stem cells (Tan, B.T.

Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements.

Purpose: Sentinel lymph node biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. The aim of this study was to determine the long-term prevalence of lymphedema after SLN biopsy (SLNB) alone and after SLNB followed by axillary lymph node dissection (SLNB/ALND).

Patients And Methods: At median follow-up of 5 years, lymphedema was assessed in 936 women with clinically node-negative breast cancer who underwent SLNB alone or SLNB/ALND.

Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors.

Purpose: Sentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery.

Patients And Methods: Nine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery.

Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?

Background: Recent military experience reported casualties who receive > 10 units of packed red blood cells (PRBC) in 24 hours have 20% versus 65% mortality when the fresh-frozen plasma (FFP) to PRBC ratio was 1:1 versus 1:4, respectively. We hypothesize a similar improvement in mortality in civilian trauma patients that require massive transfusion and are treated with a FFP to PRBC ratio closer to 1:1.

Methods: Four-year retrospective study of all trauma patients who underwent emergency surgery in an urban Level I Trauma Center.

Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27.

Purpose: National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-18 was designed to determine whether four cycles of doxorubicin and cyclophosphamide (AC) administered preoperatively improved breast cancer disease-free survival (DFS) and overall survival (OS) compared with AC administered postoperatively. Protocol B-27 was designed to determine the effect of adding docetaxel (T) to preoperative AC on tumor response rates, DFS, and OS.

Patients And Methods: Analyses were limited to eligible patients.

Perpendicular inked versus tangential shaved margins in breast-conserving surgery: does the method matter?

Background: In breast-conserving surgery (BCS), the method of margin assessment and the definition of a negative margin vary widely. The purpose of this study was to compare the incidence of positive margins and rates of reexcision between two methods of margin assessment at a single institution.

Study Design: In July 2004, our protocol for margin evaluation changed from perpendicular inked margins (Group A, n=263) to tangential shaved margins (Group B, n=261).

Maintaining excellence in physician nurse communication with CPOE: A nursing informatics team approach.

Designing and implementing CPOE systems is difficult, presenting many challenges to overcome related to workflow redesign. As part of the Mayo Clinic Arizona CPOE design and implementation, it was recognized that physicians would be placing inpatient orders from multiple locations; therefore nurses no longer would have the usual visual clues to identify new physician orders. This could easily lead to a delay in implementing orders that require immediate action.

Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents.

Objective: In a cohort that spanned all of childhood and suffered equivalent types of traumas, the authors examined diagnostic validity and risk factors for posttraumatic stress disorder (PTSD). For older children, parent-child agreement was investigated.

Method: Sixty-two children ages 0-18 years who were hospitalized with injuries were assessed 2 months later for PTSD.

Smoke inhalation enhances early alveolar leukocyte responsiveness to endotoxin.

Background: Pulmonary dysfunction after smoke inhalation and thermal injury is associated with excessive morbidity and mortality. The purpose of this study was to evaluate alveolar leukocyte function after thermal injury and smoke inhalation.

Methods: Twenty-one patients with thermal injury only (n = 8); thermal injury and smoke inhalation injury (n = 8); and nonburned controls (n = 5) were assessed by means of bronchoscopically directed lavage (bronchoalveolar lavage [BAL]) on the first and fourth days postinjury.

The Office of Advanced Technology: providing focus on the piloting and implementation of new technology.

Rarely does an organization have the luxury of employing full-time staff whose sole purpose is to seek out, select, pilot, and recommend new technology. If such an effort is not a dedicated activity, an organization will have a hard time keeping abreast of technological development with an eye towards successful deployment to the benefit of the business. This paper summarizes the role and activities of the Office of Advanced Technology (OAT) at the Mayo Clinic in Scottsdale, AZ.

Surgical cricothyroidotomy in trauma patients.

Background: Surgical airway intervention is occasionally necessary due to contraindicated or failed endotracheal intubation. In cricothyroidotomy patients, a choice exists between continued long-term ventilation via the cricothyroidotomy portal or conversion to tracheostomy. We examined whether conversion to tracheostomy reduces the risk of acute complications.