Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer

Background: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance.Methods: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens.Results: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1–2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015).Conclusion: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery

ELECTRON CLOUD MODELING FOR THE ILC DAMPING RINGS

Abstract Electron cloud buildup is a primary concern for the performance of the damping rings under development for the International Linear Collider. We have performed synchrotron radiation rate calculations for the recent 3.2-km DSB3 2 lattice design using the SYNRAD utility in the Bmad accelerator software library. These results are then used to supply input parameters to the electron cloud modeling package ECLOUD. Contributions to coherent tune shifts from the field-free sections, and from the dipole and quadrupole magnets have been calculated, as well as the effect of installing solenoid windings in the field-free regions. For each element type, SYNRAD provides ring occupancy, average beam sizes, beta function values, and beta-weighted photon rates for the coherent tune shift calculation. An approximation to the antechamber design has been implemented in ECLOUD as well, moving the photoelectron source points to the edges of the antechamber entrance and removing cloud particles which enter the antechamber

One year duration of immunity of a combination Bordetella bronchiseptica - canine parainfluenza oral vaccine in dogs

IntroductionCanine infectious respiratory disease complex (CIRDC), widely known as kennel cough or infectious tracheobronchitis, is a highly contagious disease in dogs caused by multiple bacterial and viral pathogens. Two significant pathogens that contribute to CIRDC are Bordetella bronchiseptica (B. bronchiseptica) and canine parainfluenza virus (CPI). Recently, the first oral, modified live, vaccine to contain a combination of these two pathogens has become commercially available.MethodsTo evaluate the efficacy of both fractions of this vaccine, duration of immunity studies were conducted in six- to eight-week-old beagles. In both studies, dogs were randomized into two treatment groups and vaccinated once by the oral route with either test vaccine or placebo vaccine. In the CPI study, dogs were challenged with virulent CPI one year after vaccination and observed daily for 14 days post-challenge. Nasal swabs were also collected daily for 10 days post-challenge to evaluate the shedding of the challenge virus. In the B. bronchiseptica study, dogs were challenged with virulent B. bronchiseptica one year after vaccination and observed twice daily for 28 days post-challenge for clinical signs of disease.ResultsThe results from these studies demonstrated a significant reduction in nasal shedding of CPI (0.2 log10FAID50/mL in test-vaccinated compared to 1.1 log10FAID50/mL in placebo-vaccinated dogs) as well as a significant reduction in clinical signs associated with B. bronchiseptica (9% of test-vaccinated compared to 74% of placebo-vaccinated dogs).ConclusionTaken together, these studies demonstrated that oral vaccination with a combination vaccine containing B. bronchiseptica and CPI is effective at preventing disease for at least one year following vaccination

EGFR and HER2 expression in primary cervical cancers and corresponding lymph node metastases: Implications for targeted radiotherapy

<p>Abstract</p> <p>Background</p> <p>Proteins overexpressed on the surface of tumor cells can be selectively targeted. Epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) are among the most often targeted proteins. The level and stability of expression in both primary tumors and corresponding metastases is crucial in the assessment of a receptor as target for imaging in nuclear medicine and for various forms of therapy. So far, the expression of EGFR and HER2 has only been determined in primary cervical cancers, and we have not found published data regarding the receptor status in corresponding metastatic lesions. The goal of this study was to evaluate whether any of these receptors are suitable as target for clinical diagnosis and therapy.</p> <p>Methods</p> <p>Expression of EGFR and HER2 was investigated immunohistochemically in both lymph node metastases and corresponding primary cervical cancers (n = 53). HER2 and EGFR expression was scored using HercepTest criteria (0, 1+, 2+ or 3+).</p> <p>Results</p> <p>EGFR overexpression (2+ or 3+) was found in 64% (35/53) of the primary cervical tumors and 60% (32/53) of the corresponding lymph node metastases. There was a good concordance between the primary tumors and the paired metastases regarding EGFR expression. Only four patients who had 2+ or 3+ in the primary tumors changed to 0 or 1+ in lymph node metastases, and another two cases changed the other way around. None of the primary tumors or the lymph node metastases expressed HER2 protein.</p> <p>Conclusion</p> <p>The EGFR expression seems to be common and stable during cervical cancer metastasis, which is encouraging for testing of EGFR targeted radiotherapy. HER2 appears to be of poor interest as a potential target in the treatment of cervical cancer.</p

RECENT RESULTS FOR THE DEPENDENCE OF BEAM INSTABILITIES CAUSED BY ELECTRON CLOUDS AT CESRTA DUE TO VARIATIONS IN BUNCH SPACING AND CHROMATICITY*

Abstract At the Cornell Electron-Positron Storage Ring Test Accelerator (CesrTA) experiments have been studying the interaction of the electron cloud (EC) with 2.1 GeV stored electron and positron beams. These experiments are intended to characterize the dependence of beam-EC interactions on various beam parameters, such as bunch spacing and vertical chromaticity. Most experiments were performed with 30 or 45-bunch trains, at a fixed current of 0.75 mA/bunch. Earlier experiments with positrons had varied the bunch spacing between 4 and 56 ns at three different vertical chromaticity settings. More recent measurements have included electron-bunch trains to contrast the build up of EC between electron and positron beams. The dynamics of the stored beam was quantified using: a gated Beam Position Monitor (BPM) and spectrum analyzer to measure the bunch-by-bunch frequency spectrum of the bunch trains; an x-ray beam size monitor to record the bunch-by-bunch, turn-by-turn vertical size of each bunch within the trains. We report on recent observations from these experiments and additional studies, using witness bunches trailing 30 or 45-bunch positron trains, which were used for the generation of the ECs

The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients

<p>Abstract</p> <p>Background</p> <p>Prolonged and excessive drainage of serous fluid and seroma formation constitute the most common complications after mastectomy for breast carcinoma. Seroma formation delays wound healing, increases susceptibility to infection, skin flap necrosis, persistent pain and prolongs convalescence. For this, several techniques have been investigated to improve primary healing and minimize seroma formation.</p> <p>Materials and methods</p> <p>Between June 2009 and July 2010 forty patients with breast carcinoma, scheduled for modified radical mastectomy, were randomly divided into 2 groups, the study group (20) and the control group (20). In the study group; the mastectomy flaps were fixed to the underlying muscles in raws, at various parts of the flap and at the wound edge using fine absorbable sutures. In the control group; the wound was closed in the conventional method at the edges. Closed suction drains were used in both groups. Patients, tumor characteristics and operative related factors were recorded. The amount and color of drained fluid were recorded daily. The drains were removed when the amount become less than 50 cc. The total amount and duration of drained fluid and the formation of seroma were recorded and the results were compared between the two groups.</p> <p>Results</p> <p>In the flap fixation group, the drain was removed in significantly shorter time compared to the control group (p < 0.001). Also, the total amount of fluid drained was significantly lower in the flap fixation group (p < 0.001). The flap fixation group showed a significantly lower frequency of seroma formation compared to the control group, both clinically (p = 0.028) and ultrasonographically (p = 0.047).</p> <p>Conclusions</p> <p>The mastectomy flap fixation technique is a valuable procedure that significantly decreases the incidence of seroma formation, and reduces the duration and amount of drained fluid. However, it should be tried on a much wider scale to prove its validity.</p

Axillary lymph node dissection for breast cancer utilizing Harmonic Focus®

<p>Abstract</p> <p>Background</p> <p>For patients with axillary lymph node metastases from breast cancer, performance of a complete axillary lymph node dissection (ALND) is the standard approach. Due to the rich lymphatic network in the axilla, it is necessary to carefully dissect and identify all lymphatic channels. Traditionally, these lymphatics are sealed with titanium clips or individually sutured. Recently, the Harmonic Focus^®, a hand-held ultrasonic dissector, allows lymphatics to be sealed without the utilization of clips or ties. We hypothesize that ALND performed with the Harmonic Focus^®will decrease operative time and reduce post-operative complications.</p> <p>Methods</p> <p>Retrospective review identified all patients who underwent ALND at a teaching hospital between January of 2005 and December of 2009. Patient demographics, presenting pathology, treatment course, operative time, days to drain removal, and surgical complications were recorded. Comparisons were made to a selected control group of patients who underwent similar surgical procedures along with an ALND performed utilizing hemostatic clips and electrocautery. A total of 41 patients were included in this study.</p> <p>Results</p> <p>Operative time was not improved with the use of ultrasonic dissection, however, there was a decrease in the total number of days that closed suction drainage was required, although this was not statistically significant. Complication rates were similar between the two groups.</p> <p>Conclusion</p> <p>In this case-matched retrospective review, there were fewer required days of closed suction drainage when ALND was performed with ultrasonic dissection versus clips and electrocautery.</p