Secretory breast carcinoma with metastatic sentinel lymph node

BACKGROUND: Secretory mammary carcinoma is a rare breast neoplasia originally described in children but sometimes also found in adults. It presents a more favourable outcome than more common histological types of breast carcinoma; published literature in fact reports only a few cases with axillary lymph node metastases and only four cases with distant metastases. CLINICAL PRESENTATION: In this paper we report a rare case of secretory breast carcinoma with axillary lymph node metastases in a 33-year-old woman. To our knowledge, this is the first case of secretory carcinoma involving biopsy of the sentinel lymph node and investigation of the e-cadherin expression. We found positivity for e-cadherin, which would support the hypothesis that this type of tumour is a variant of the infiltrating ductal carcinoma. CONCLUSION: After a careful analysis of reported data, we have come to the conclusion that the treatment of choice for patients with secretory breast carcinoma should be conservative surgery with sentinel lymph node biopsy, followed by accurate follow-up. We are of the opinion that while post-operative radiotherapy is indicated in adult patients who have undergone quadrantectomy, it should not be used in children. Although several cases of secretory carcinoma have been treated with adjuvant chemotherapy, there are still no reliable data regarding the real value of such a choice

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations.

peer reviewedCancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis

Perceived motion in structure from motion: Pointing responses to the axis of rotation

We investigated the ability to match finger orientation to the direction of the axis of rotation in structure-from-motion displays. Preliminary experiments verified that subjects could accurately use the index finger to report direction. The remainder of the experiments studied the perception of the axis of rotation from full rotations of a group of discrete points, the profiles of a rotating ellipsoid, and two views of a group of discrete points. Subjects' responses were analyzed by decomposing the pointing responses into their slant and tilt components. Overall, the results indicated that subjects were sensitive to both slant and tilt. However, when the axis of rotation was near the viewing direction, subjects had difficulty reporting tilt with profiles and two views and showed a large bias in their slant judgments with two views and full rotations. These results are not entirely consistent with theoretical predictions. The results, particularly for two views, suggest that additional constraints are used by humans in the recovery of structure from motion

Design and prediction performance of Venturi injectors in drip irrigation

[EN] The design and prediction performance of four Venturi injector prototypes have been studied using Computational Fluid Dynamics (CFD) techniques. Results were compared with experimental tests carried out in the laboratory of the Universitat Politecnica de Valencia, Valencia, Spain. The analysed and selected geometries for each prototype were used to simulate the operation without nutrient injection (G1) and with nutrient injection (G2). In first case (G1), the results were presented in the form of pressure profile at the injector axe under different velocities and the pressure distribution in the whole geometry. Additionally, this paper analysed the evolution of pressures and head loss versus main water flow in the different prototypes. The relative error was estimated to compare CFD and experimental results. The second case (G2), the graphical representation for the relations between the nutrient aspiration flow and water main flow were obtained for numerical and experiment approaches. In conclusion, CFD techniques appear as a suitable tool for the analysis of the Venturi injector operation, but its validation with experimental data is recommended.[ES] En la Universitat Politècnica de València, Valencia, España, se ha estudiado el diseño y funcionamiento de cuatro prototipos del inyector Venturi con técnicas de Dinámica de Fluidos Computacional (CFD), comparándo las con ensayos en laboratorio. Para cada prototipo, las geometrías definidas y analizadas han permitido simular el funcionamiento sin (G1) y con inyección (G2) para quimigación. En el caso G1, se presentan los gráficos del perfil de presiones en el eje del inyector para diversas velocidades, así como la distribución del campo de presiones y de la evolución de las diferencias de presión y pérdidas de carga frente al caudal principal. Para comparar los resultados obtenidos con CFD frente al resultado experimental, se calculó el error relativo. En el caso G2, se obtuvo la representación gráfica del el caudal de inyección frente al caudal principal. Las técnicas CFD exigen un buen ajuste del modelo para dar un resultado aceptable. Son interesantes para comparar geometrías, analizar sus variantes, realizar prediseños y aproximar ordenes de magnitud, pero es recomendable su ensayo en laboratorio para validar los resultados.Manzano Juarez, J.; De Azevedo, BM.; Do Bomfim, GV.; Royuela, A.; Palau Estevan, CV.; Viana, TVDA. (2014). Diseño y predicción del funcionamiento de inyectores Venturi en riego localizado. Revista Brasileira de Engenharia Agrícola e Ambiental - Agriambi. 18(12):1209-1217. doi:10.1590/1807-1929/agriambi.v18n12p1209-1217S120912171812Baylar, A., Aydin, M., Unsal, M., & Ozkan, F. (2009). Numerical Modeling of Venturi Flows for Determining Air Injection Rates Using Fluent V6.2. Mathematical and Computational Applications, 14(2), 97-108. doi:10.3390/mca14020097CIPOLLA, E., Silva, F., FILHO, G., & BARROS, R. (2011). Avaliação da Distribuição de Velocidades em Uma Bomba Centrífuga Radial Utilizando Técnicas de CFD. Revista Brasileira de Recursos Hídricos, 16(3), 71-79. doi:10.21168/rbrh.v16n3.p71-79Davis, J. A., & Stewart, M. (2002). Predicting Globe Control Valve Performance—Part I: CFD Modeling. Journal of Fluids Engineering, 124(3), 772-777. doi:10.1115/1.1490108Coutier-Delgosha, O., Fortes-Patella, R., & Reboud, J. L. (2003). Evaluation of the Turbulence Model Influence on the Numerical Simulations of Unsteady Cavitation. Journal of Fluids Engineering, 125(1), 38-45. doi:10.1115/1.1524584Franklin, R. E., & Wallace, J. M. (1970). Absolute measurements of static-hole error using flush transducers. Journal of Fluid Mechanics, 42(1), 33-48. doi:10.1017/s0022112070001052Guo, B., Langrish, T. A. ., & Fletcher, D. F. (2002). CFD simulation of precession in sudden pipe expansion flows with low inlet swirl. Applied Mathematical Modelling, 26(1), 1-15. doi:10.1016/s0307-904x(01)00041-5Hatano, S., Kang, D., Kagawa, S., Nohmi, M., & Yokota, K. (2014). Study of Cavitation Instabilities in Double-Suction Centrifugal Pump. International Journal of Fluid Machinery and Systems, 7(3), 94-100. doi:10.5293/ijfms.2014.7.3.094Lindau, J. W., Kunz, R. F., Boger, D. A., Stinebring, D. R., & Gibeling, H. J. (2002). High Reynolds Number, Unsteady, Multiphase CFD Modeling of Cavitating Flows. Journal of Fluids Engineering, 124(3), 607-616. doi:10.1115/1.1487360Norton, T., Sun, D.-W., Grant, J., Fallon, R., & Dodd, V. (2007). Applications of computational fluid dynamics (CFD) in the modelling and design of ventilation systems in the agricultural industry: A review. Bioresource Technology, 98(12), 2386-2414. doi:10.1016/j.biortech.2006.11.025Palau-Salvador, G., Gonzalez Altozano, P., & Arviza-Valverde, J. (2007). Numerical modeling of cavitating flows for simple geometries using FLUENT V6.1. Spanish Journal of Agricultural Research, 5(4), 460. doi:10.5424/sjar/2007054-269Palau-Salvador, G., González-Altozano, P., & Arviza-Valverde, J. (2007). Three-Dimensional Modeling and Geometrical Influence on the Hydraulic Performance of a Control Valve. Journal of Fluids Engineering, 130(1). doi:10.1115/1.2813131Reader-Harris, M. ., Brunton, W. ., Gibson, J. ., Hodges, D., & Nicholson, I. . (2001). Discharge coefficients of Venturi tubes with standard and non-standard convergent angles. Flow Measurement and Instrumentation, 12(2), 135-145. doi:10.1016/s0955-5986(01)00007-3Singhal, A. K., Athavale, M. M., Li, H., & Jiang, Y. (2002). Mathematical Basis and Validation of the Full Cavitation Model. Journal of Fluids Engineering, 124(3), 617-624. doi:10.1115/1.1486223Sun, Y., & Niu, W. (2012). Simulating the Effects of Structural Parameters on the Hydraulic Performances of Venturi Tube. Modelling and Simulation in Engineering, 2012, 1-7. doi:10.1155/2012/458368Teruel, B. J. (2010). Controle automatizado de casas de vegetação: variáveis climáticas e fertigação. Revista Brasileira de Engenharia Agrícola e Ambiental, 14(3), 237-245. doi:10.1590/s1415-43662010000300001Vortmann, C., Schnerr, G. H., & Seelecke, S. (2003). Thermodynamic modeling and simulation of cavitating nozzle flow. International Journal of Heat and Fluid Flow, 24(5), 774-783. doi:10.1016/s0142-727x(03)00003-1Wei, Q., Shi, Y., Dong, W., Lu, G., & Huang, S. (2006). Study on hydraulic performance of drip emitters by computational fluid dynamics. Agricultural Water Management, 84(1-2), 130-136. doi:10.1016/j.agwat.2006.01.016Xing, T., & Frankel, S. H. (2002). Effect of Cavitation on Vortex Dynamics in a Submerged Laminar Jet. AIAA Journal, 40(11), 2266-2276. doi:10.2514/2.1563Yeoh, G. H., Liu, C., Tu, J., & Timchenko, V. (2012). Computational Fluid Dynamics and Its Applications 2012. Modelling and Simulation in Engineering, 2012, 1-2. doi:10.1155/2012/61061

Epigenetic modulators as therapeutic targets in prostate cancer

Prostate cancer is one of the most common non-cutaneous malignancies among men worldwide. Epigenetic aberrations, including changes in DNA methylation patterns and/or histone modifications, are key drivers of prostate carcinogenesis. These epigenetic defects might be due to deregulated function and/or expression of the epigenetic machinery, affecting the expression of several important genes. Remarkably, epigenetic modifications are reversible and numerous compounds that target the epigenetic enzymes and regulatory proteins were reported to be effective in cancer growth control. In fact, some of these drugs are already being tested in clinical trials. This review discusses the most important epigenetic alterations in prostate cancer, highlighting the role of epigenetic modulating compounds in pre-clinical and clinical trials as potential therapeutic agents for prostate cancer management.info:eu-repo/semantics/publishedVersio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The use of recombinant activated factor VIIa in coagulopathic traumatic brain injuries requiring emergent craniotomy: is it beneficial?

OBJECT: The role of recombinant activated factor VII (rFVIIa) in traumatic brain injury (TBI) has not been well established. This study evaluates the outcomes of using rFVIIa as first-line therapy in patients with a severe TBI requiring emergent craniotomy that are coagulopathic. METHODS: The authors retrospectively reviewed patients admitted between 2003 and 2006 to a Level I trauma center with a severe TBI requiring an emergency craniotomy. Eighteen patients with coagulopathy that was corrected using rFVIIa were identified. Variables evaluated included age, injury severity score, head abbreviated injury score, Glasgow Coma Scale score, international normalized ratio, time to operation, operative procedure, thromboembolic events, and death. RESULTS: The cohort consisted of 18 patients, predominantly male (55.6%) with a mean age of 80.5 years. The most common mechanism of injury was a fall. Coagulopathy was due to premorbid anticoagulants in 50% of the cohort. Time from admission to operation was 130 minutes. Coagulopathy reversal was complete in all 18 cases (100%). A high mortality rate (55.6%) was attributed to a high incidence of withdrawal of care (50%). The incidence of thromboembolic events was low (5.6%). Survivors, when compared with nonsurvivors, had a \u3e 3-fold increase in postoperative Glasgow Coma Scale score for similar preoperative scores. A good functional outcome was achieved in 75% of survivors with a mean follow-up period of 4.2 months. CONCLUSIONS: The use of rFVIIa in the correction of coagulopathy in patients having sustained severe TBI requiring emergency craniotomy appears to be safe and effective even among the elderly. This allows a shorter transit time to craniotomy. Its effects on mortality and long-term neurological outcome requires further investigation prospectively