Systematic review of the impact of breast-conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Background

The clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).

Methods

Comprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.

Results

Twenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.

Conclusion

The available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

Exploring the acceptability of using low-friction bedding for patients with burns: Qualitative results from the SILKIE study

BACKGROUND

Skin grafts following deep burns are needed to ensure healing. Grafts that fail and require re-grafting cause significant distress to patients and additional costs for the NHS. Shearing, which leads to graft loss, may be reduced through the use of low-friction bedding. A feasibility study was conducted to assess proof of concept for the use of low-friction bedding for patients with burns. Patient, parent and staff views on the acceptability of this material were explored through semi-structured interviews.

METHOD

Patient views were gathered through telephone interviews (n=17; 11 adult patients and 6 parents of child patients). One patient completed the questionnaire in written form because of hearing difficulties. Staff views were gathered at two time points: at the start of the study through open-ended questionnaires (n=20) and at the end of the study through focus group (n=12) and telephone interviews (n=3). Data were analysed using framework analysis.

RESULTS

Three themes were identified describing both patient and staff views of the sheets: Slippery feel of the sheets; leaking wounds and sheet changes; and movement and friction. Overall patients' views of the sheets were positive; they were comfortable to use the sheets and experienced reduced pain and itching. However, issues related to the slipperiness were highlighted. Staff views were largely negative because of difficulty in use, lack of absorbency, and increased workload.

CONCLUSION

The use of low-friction bedding is acceptable to patients undergoing a skin graft following a burn injury; however, problems related to sliding down the bed and soiling of sheets need addressing. Staff were supportive of the concept of low-friction bedding; however, they reported significant challenges in day-to-day use of sheets. Low-friction bedding presents a promising alternative to standard cotton sheets for patients with burns and those at risk of pressure sores; however, further work is needed to address current challenges in use.

An assessment of adherence to basic ecological principles by payments for ecosystem service projects

Programs and projects employing payments for ecosystem service (PES) interventions achieve their objectives by linking buyers and sellers of ecosystem services. Although PES projects are popular conservation and development interventions, little is known about their adherence to basic ecological principles. We conducted a quantitative assessment of the degree to which a global set of PES projects adhered to four ecological principles that are basic scientific considerations for any project focused on ecosystem management: collection of baseline data, identification of threats to an ecosystem service, monitoring, and attention to ecosystem dynamics or the formation of an adaptive management plan. We evaluated 118 PES projects in three markets-biodiversity, carbon, and water-compiled using websites of major conservation organizations; ecology, economic, and climate-change databases; and three scholarly databases (ISI Web of Knowledge, Web of Science, and Google Scholar). To assess adherence to ecological principles, we constructed two scientific indices (one additive [ASI] and one multiplicative [MSI]) based on our four ecological criteria and analyzed index scores by relevant project characteristics (e.g., sector, buyer, seller). Carbon-sector projects had higher ASI values (P < 0.05) than water-sector projects and marginally higher ASI scores (P < 0.1) than biodiversity-sector projects, demonstrating their greater adherence to ecological principles. Projects financed by public-private partnerships had significantly higher ASI values than projects financed by governments (P < 0.05) and marginally higher ASI values than those funded by private entities (P < 0.1). We did not detect differences in adherence to ecological principles based on the inclusion of cobenefits, the spatial extent of a project, or the size of a project's budget. These findings suggest, at this critical phase in the rapid growth of PES projects, that fundamental ecological principles should be considered more carefully in PES project design and implementation in an effort to ensure PES project viability and sustainability.

Topology of a human equilibrative, nitrobenzylthioinosine (NBMPR)-sensitive nucleoside transporter (hENT1) implicated in the cellular uptake of adenosine and anti-cancer drugs

The human equilibrative nucleoside transporter hENT1, the first identified member of the ENT family of integral membrane proteins, is the primary mechanism for the cellular uptake of physiologic nucleosides, including adenosine, and many anti-cancer nucleoside drugs. We have produced recombinant hENT1 in Xenopus oocytes and used native and engineered N-glycosylation sites in combination with immunological approaches to experimentally define the membrane architecture of this prototypic nucleoside transporter. hENT1 (456 amino acid residues) is shown to contain 11 transmembrane helical segments with an amino terminus that is intracellular and a carboxyl terminus that is extracellular. Transmembrane helices are linked by short hydrophilic regions, except for a large glycosylated extracellular loop between transmembrane helices 1 and 2 and a large central cytoplasmic loop between transmembrane helices 6 and 7. Sequence analyses suggest that this membrane topology is common to all mammalian, insect, nematode, protozoan, yeast, and plant members of the ENT protein family.

Subcellular Distribution and Membrane Topology of the Mammalian Concentrative Na+-Nucleoside Cotransporter rCNT1

The rat transporter rCNT1 is the archetype of a family of concentrative nucleoside transporters (CNTs) found both in eukaryotes and in prokaryotes. In the present study we have used antibodies to investigate the subcellular distribution and membrane topology of this protein. rCNT1 was found to be expressed predominantly in the brush-border membranes of the polarized epithelial cells of rat jejunum and renal cortical tubules and in the bile canalicular membranes of liver parenchymal cells, consistent with roles in the absorption of dietary nucleosides, of nucleosides in the glomerular filtrate, or of nucleosides arising from the action of extracellular nucleotidases, respectively. The effect of endoglycosidase F treatment on wild-type and mutant rCNT1 expressed in Xenopus oocytes revealed that the recombinant transporter could be glycosylated at either or both of Asn605 and Asn643, indicating that its C terminus is extracellular. In contrast, potential N-glycosylation sites introduced near the N terminus, or between putative transmembrane (TM) helices 4 and 5, were not glycosylated. The deduced orientation of the N terminus in the cytoplasm was confirmed by immunocytochemistry on intact and saponin-permeabilized Chinese hamster ovary cells expressing recombinant rCNT1. These results, in conjunction with extensive analyses of CNT family protein sequences using predictive algorithms, lead us to propose a revised topological model, in which rCNT1 possesses 13 TM helices with the hydrophilic N-terminal and C-terminal domains on the cytoplasmic and extracellular sides of the membrane, respectively. Furthermore, we show that the first three TM helices, which are absent from prokaryote CNTs, are not essential for transporter function; truncated proteins lacking these helices, derived either from rCNT1 or from its human homolog hCNT1, were found to retain significant sodium-dependent uridine transport activity when expressed in oocytes.

Hyperosmotic shock induces both activation and translocation of glucose transporters in mammalian cells

The effect of osmotic stress on sugar transport was investigated in Clone 9 epithelial cells, which express the glucose uniporter GLUT1, and in 3T3-L1 adipocytes, which express both GLUT1 and GLUT4. An acute hyperosmotic shock increased the uptake of sugars in both cell types. In Clone 9 cells, this was followed by a regulatory volume increase (RVI) response. Stimulation of transport was rapid and reversible, with half-lives (t 1/2) for stimulation of 2-deoxy-D-glucose uptake of 5.6 +/- 0.9 (n=6) and 22.7 +/- 1.5 (n=4) min for Clone 9 cells and adipocytes respectively. The effect was dose dependent, reaching a maximum at 1.1 osM of 2.9 +/- 0.1-fold (n=3) for Clone 9 cells and 8.2 +/- 0.8-fold (n=3) for adipocytes. In the latter, this stimulation correlated with translocation of the glucose transporter isoform GLUT4 to the cell surface and was not significantly different from that elicited by 160 nM insulin (7.6 +/- 1.2-fold, n=3). The effect of osmotic shock was not, however, influenced by inhibitors of either phosphoinositide 3-kinase (PI 3-kinase) (wortmannin, 250 nM) or of p38 mitogen-activated protein kinase (p38 MAP kinase) (SB203580, 20 microM), which reportedly prevent GLUT4 translocation and/or activation by insulin respectively. These inhibitors also had no effect on the stimulation of transport by osmotic shock in Clone 9 cells. However, in contrast to adipocytes, the effect of osmotic shock on glucose transport in Clone 9 cells reflected primarily a change in the intrinsic activity of cell surface transporters and there was only a minor change in their subcellular distribution as assessed by cell immunostaining or no change as assessed by surface biotinylation. These results indicate that the response of cells to osmotic shock can involve changes both in transporter activity and location. The signal transduction pathways involved include neither PI 3-kinase nor the classical, osmotically-activated component, p38 MAP kinase.

Semantic priming in Alzheimer's dementia: evidence for dissociation of automatic and attentional processes

The nature of the semantic memory deficit in dementia of the Alzheimer's type (DAT) was investigated in a semantic priming task which was designed to assess both automatic and attention-induced priming effects. Ten DAT patients and 10 age-matched control subjects completed a word naming semantic priming task in which both relatedness proportion (RP) and stimulus-onset asynchrony (SOA) were varied. A clear dissociation between automatic and attentional priming effects in both groups was demonstrated; however, the DAT subjects' pattern of priming deviated significantly from that of the normal controls. The DAT patients failed to produce any priming under conditions which encouraged automatic semantic processing and produced facilitation only when the RP was high. In addition, the DAT group produced hyperpriming, with significantly larger facilitation effects than the control group. These results suggest an impairment of automatic spreading activation in DAT and have implications for theories of semantic memory impairment in DAT as well as models of normal priming.

Secondary ion mass spectrometric characterization of nail polishes and paint surfaces

A variety of paint and fingernail polish samples, which were visually similar, but had different chemical compositions and formulations, was analyzed using quadrupole static secondary ion mass spectrometry (SIMS). Coating distinction was easily achieved in many cases because of the presence of dominant ions derived from the components of the coating, which could be observed in the SIMS spectra. In other instances, coating distinction was difficult within a product line because of spectral complexity; for this reason and because of the large numbers of spectra generated in this study, multivariate statistical techniques were employed, which allowed the meaningful classification and comparison of spectra. Partial Least Squares (PLS) and Principal Component Analysis (PCA) were applied to quadrupole SIMS data. PCA showed distinct spectral differences between most spectral groups, and also emphasized the reproducibility of the SIMS spectra. When using PLS analysis, reasonably accurate coating identification was achieved with the data. Overall, the PLS model is more than 90% effective in identifying the spectrum of a particular coating, and nearly 100% effective at telling which coating components represented in the PLS models are not present in a spectrum. The level of spectral variation caused by sample bombardment in the SIMS analysis was investigated using Fourier transform infrared spectroscopy (FT-IR) and quadrupole static SIMS. Changes in the FT-IR spectra were observed and were most likely a result of a number of factors involving the static SIMS analysis. However, the bulk of the sample is unaltered and may be used for further testing.

Maternal predictors of early breast milk output

Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio-economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante- and postnatally) from finger-prick blood spots by fluoro-immunoassay. Milk output at 1 and 4 weeks was determined from 24-h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period.

The resolution of lexical ambiguity with reference to context in dementia of the Alzheimer's type

The present study investigated how a dementing illness such as Alzheimer's disease, might affect an individual's recourse to higher order contextual information in the access and integration of lexical material in on-line discourse comprehension. More specifically, the experiment investigated the priming of homophones in a discourse context, by use of a cross-modal lexical decision task, and compared the performances of a group of six subjects with mild to moderate dementia of the Alzheimer's type (DAT) with those of a matched control group. The subjects listened to 2-sentence paragraphs and performed a lexical decision on visually presented targets that followed ambiguous prime words (or homophones) at two inter-stimulus intervals (ISIs): 330 and 1000 msec. When the target was a word, it was either an associate of the prime word, a probable inference suggested by the discourse, or an unrelated word. The control subjects primed both the discourse-appropriate and discourse-inappropriate associate of the homophone at short (330 msec) ISIs (but not an appropriate inference word), a finding which supports the exhaustive access model of ambiguity resolution. As the ISI was lengthened to 1000 msec, however, the discourse-appropriate inference word was primed, and reflects the operation of attention-dependent integrative strategies. The subjects with DAT primed both appropriate associates and inference words at the short ISI. At ISI of 1000 msec, the DAT subjects primed the appropriate associate and showed substantial inhibition priming of the inappropriate associate. These results point to disturbances in the selective automatic activation of lexical material, and in the conscious integration and elaboration of lexical material in ongoing discourse comprehension in persons with DAT.

Language, context, and speaker effects in the identification and discrimination of English /r/ and /l/ by Japanese and Korean listeners

Japanese and Korean listeners' identification and discrimination of English /r/ and /l/ were compared using a common set of minimal pair stimuli. The effects of speakers (two native speakers of Australian English), position of the contrast within the word (word initial, initial consonant cluster. and medial positions), and listening task (forced choice identification versus oddball discrimination) were examined, with a view to assessing the relative importance of language-specific and language-independent factors operating at the acoustic-phonetic and phonological levels of signal processing in "foreign sound" speech perception. Both prior phonological learning and the relative acoustic discriminability of the items affected subjects' performance on the identification test. Where both factors were engaged, phonological learning effects predominated over the effects of acoustic discriminability. The extent to which a speaker encoded critical acoustic cues for the /r-l/ distinction was found to affect /r-l/ identification. Dynamic spectral features known to be relevant for the /r-l/ contrast were effective in predicting (in a linear regression analysis) speaker-dependent differences in identification scores. Although the discrimination test may have been influenced by ceiling effects, the performance profiles on the identification and discrimination tests were quite different, indicating that the identification and discrimination tests imposed quite different task demands upon listeners and that phonological processing of the signal was more engaged by the former task.

Static secondary ionization mass spectrometry analysis of tributyl phosphate on mineral surfaces: Effect of Fe(II)

The static secondary ionization mass spectrometry (SIMS) spectrum of tri-n-butyl phosphate (TBP) on a variety of basalt and quartz samples is affected by the chemical composition of the mineral surface. When TBP is adsorbed on Fe(II)-bearing surfaces, the compound undergoes concomitant H(-) abstraction and reduction, followed by the elimination of two C4H8 molecules to form an ion at m/z 137(+). When TBP is adsorbed to quartz or other nonreducing surfaces, it merely undergoes protonation and elimination of three C4H8 molecules to form H4PO 4 (+) . When TBP is adsorbed to Fe(III)-bearing surfaces, it undergoes H(-) abstraction and elimination of two C4H8 molecules, to form an ion at m/z 153(+). These conclusions are supported by model studies that employed FeO, Fe203, TBP, and tributyl phosphite. The results show that the SIMS spectrum is very sensitive to the mode of TBP adsorption on the mineral surface.

The effect of repeated prime-target presentation in manipulating attention-induced priming in persons with dementia of the Alzheimer's type

The present experiment manipulated attention-induced semantic priming in seven persons with dementia of the Alzheimer's type (DAT) and 16 healthy aged controls in a word-nonword lexical decision task by means of repeated prime-target presentations. The experimental paradigm allowed for the simultaneous comparison of automatic processing and attention-induced strategic processing. The results showed that both the healthy aged subjects and the subjects with DAT demonstrated semantic facilitation in the automatic processing of information. The two groups differed, however, on the attention-induced component of the task. The control subjects consciously generated a strategic response bias favoring the real word targets and thus used their processing of the prime to induce an expectancy about the following target. The DAT subjects showed no such attention-dependent expectancy, a deficit which is most probably related to the general cognitive impairments which are a hallmark of the disease.

Nursing and medical staffing in neonatal units

Organizational aspects of neonatal care were documented in a large scale national survey: these included the provision of cots, the nursing establishment, medical staffing and the use of nurses qualified in the specialty. Fifty-six unidentified neonatal units in England were contacted and information requested on staffing arrangements, policies and facilities. To gain an accurate picture, four representative units were selected in each health region: a regional centre, a sub-regional centre and two district units. Comparisons were made using data on cot provision, the nursing establishment set, the numbers of trained nurses and medical staffing in the target units. Large inter-unit differences were found and in many units the levels of staffing were found to be at lower levels than those recommended. The relationship between the nursing establishment and numbers of designated cots was examined using different models of staffing based on successive recommendations. The more recent the recommendation, the greater the discrepancy between the establishment in operation and that recommended. Large inter-unit variation was also found in the proportion of staff qualified in the specialty, ranging from 0% to 92% of qualified nurses in individual units. Overall 1544 (83%) trained nurses were working in the study units, of whom 820 (53%) were qualified in the specialty. Significant differences were found between the types of unit: regional and sub-regional units had a higher 'Qualified in Specialty' rate (50% and 49%) than district units (32%).(ABSTRACT TRUNCATED AT 250 WORDS)

Do changes in pattern of breast usage alter the baby's nutrient intake?

Twelve mother/baby pairs took part in a study of the difference in effect of two patterns of breast feeding--either feeding at one breast or at two breasts during a feed. Baseline measures were taken at 4 weeks, and the test patterns of feeding were followed for a week each, in random order. The two patterns of feeding led to differences in milk volume intake and mean feed fat concentration, but not in the baby's net fat intake per 24 h. The results indicate that the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice "baby-led" feeding.

Respiratory function in Parkinson's subjects exhibiting a perceptible speech deficit: a kinematic and spirometric analysis

The respiratory abilities of a group of 19 speech-disordered subjects with idiopathic Parkinson's disease were assessed using both spirometric and kinematic techniques and compared to those of a group of 19 nonneurologically impaired controls matched for age and sex. Results of the spirometric assessment showed that only a minority of the Parkinson's subjects had lung volumes and capacities outside normal limits. Consequently in the majority of cases, the speech disorder could not be related to any abnormality in lung function determined spirometrically. Chest wall dynamics during both conversation and reading were essentially normal in all cases. Approximately half of the Parkinson's subjects, however, exhibited irregularities in their chest wall movements while performing vowel prolongation and syllable repetition tasks. The same irregularities were not present in the chest wall movements exhibited by the control subjects, suggesting that their presence was in some way related to the Parkinson's disease. Results are discussed in terms of the effects of Parkinson's disease on neuromuscular function.

Recidivism, perceived problem-solving abilities, MMPI characteristics, and violence: a study of black and white incarcerated male adult offenders

This study examined recidivism, perceived problem-solving abilities, type of offense, and personality characteristics in an incarcerated male population. Twenty black males and 32 white males were selected systematically from inmate populations. The MMPI, its special scales, and the PSI scales were analyzed; F, L, Re, and Do scales reported significant results. Recidivists scored significantly higher than nonrecidivists on the impulsive scale of the Problem Solving Inventory. Black recidivists generated significantly higher scores on the F scale than did black or white nonrecidivists. The Pd scale reported a significant main effect for type of offense (p less than .05). Offenders incarcerated for violent crimes scored higher on the Pd scale than the nonviolent criminals. This research study demonstrated the utility of the MMPI and the PSI in discriminating between nonviolent and violent criminals.

Language analysis in schizophrenia: diagnostic implications

Language profiles were developed for schizophrenic, manic and nonpsychotic control subjects from the analysis of free speech samples. The profiles comprised syntactic variables reflecting the complexity, integrity and fluency of spoken language. Linguistic differences between the 3 diagnostic groups enabled accurate (95%) classification by discriminant function analysis. The results suggest an important role for language analysis in psychiatric diagnosis.

Husbandry and observation methods of a breeding colony of marmosets (Callithrix jacchus) for behavioural research

By allowing families to increase in size, co-operation between parents and adolescents in infant care was encouraged. Young adult pairs were subsequently created with these marmosets which had experience of handling infants to provide a stable basis for breeding 2nd and 3rd generation marmosets in captivity.