Early detection in cases of familial breast cancer predisposition: What is appropriate and beneficial for the individual seeking advice?

A "high-risk situation" is present when the lifetime risk of developing breast cancer is ≥ 30%. Currently, the most accurate risk assessment is provided by the Tyrer-Cuzick model. This takes into account several factors including the presence of certain risk genes, age, family history of breast and ovarian cancer, as well as mammographic breast density. In addition to BRCA1 and BRCA2 several other risk genes are known that can be tested using gene panels. However specific familial risk constellations are prerequisites for indicating a genetic test. Prior to conducting a genetic test comprehensive counselling should take place and the individual seeking advice should be given time to consider. The individual seeking advice faces a series of questions regarding the potential implications of a genetic test which not only affect herself but also her environment. In high-risk situations prophylactic mastectomy is an established surgical measure and intensified surveillance is a conservative approach. The latter includes semi-annual clinical breast examination with ultrasound starting from age 25 as well as an annual MRI mammography which exhibits the highest reliability compared to other imaging methods. Medical consultation aims to enable a participatory decision-making process for the individual seeking advice. This requires comprehensive information for the individual seeking advice and incorporation of her preferences. Evidence-based decision aids from professional societies can improve the decisions of the individual seeking advice

THREE DIMENSIONAL MEASUREMENT OF THE GEOMETRY OF THE HUMAN MOTION APPARATUS

INTRODUCTION: This work is part of a project of the Department for Sports Medicine to calculate the internal stresses arising when jumping from a squat position. The goal of the project is to facilitate individual calculations by establishing a biomechanical model whose parameters are the major anatomical-geometrical and physiological quantities, gained by electromyogram (EMG) and radiological measurement. Procedures for acquiring the latter data are described here. METHODS: As the study did not involve pathologies, ionizing radiation was ruled out, and magnetic resonance imaging (MRI) was used. The biomechanical model required geometrical parameters from joint positions beyond those occurring during the squat-vault, so the Siemens Magnetom Open device was chosen. It has the disadvantage of relatively low magnetic field strength (0.2 T), but allows for almost unlimited movement in the table plane. Different measurement parameters were evaluated. As the length of the field of view was about 25 cm, the different joints had to be scanned separately. A positioning table was used to serve three purposes: 1. Positioning with defined joint angles, so the morphology could be related to the EMG measurements. 2. Exertion of force, to measure the geometry of muscles and tendons under strain. 3. Placement of markers with high MRI contrast, to relate the relative position of the scans of the different joints. [delete line space]. The evaluation of the images was done using the ‘Tübinger Medstation’ software developed by the Department of Computer Science at the University of Tübingen. RESULTS: Although the use of T2 weighted sequences resulted in better soft tissue contrast, the T1 weighted spin echo sequence was preferred because of shorter acquisition time, which was an important factor because measurements had to be made under strain. Bones and tendons, with their low hydrogen content, produce weak signals in MRI and thus contrast with the adjacent soft tissue. Even shorter acquisition times by use of a gradient sequence were ruled out because of their low signal/noise ratio, which rendered the fascies undetectable. Automatic segmentation of these fascies is extremely hard to achieve. The ‘Medstation’ software was used to extract coordinates of muscle and tendon insertions by hand and combine them in a common frame of reference. CONCLUSIONS: A procedure has been established to extract the geometrical data of muscles, tendons and osseous structures important for the biomechanical model. For this model, extended muscle and tendon insertions have to be reduced to a point by calculation of the center of mass of the insertion area. A table for the positioning of the probationer enabled positioning with reproducible joint angles under exertion of strain. To define the relative position of different scans a screen of markers was integrated into this plate

Dental and Maxillofacial Cone Beam CT-High Number of Incidental Findings and Their Impact on Follow-Up and Therapy Management.

Cone beam computed tomography (CBCT) is increasingly used for dental and maxillofacial imaging. The occurrence of incidental findings has been reported, but clinical implications of these findings remain unclear. The study's aim was to identify the frequency and clinical impact of incidental findings in CBCT. A total of 374 consecutive CBCT examinations of a 3 year period were retrospectively evaluated for the presence, kind, and clinical relevance of incidental findings. In a subgroup of 54 patients, therapeutic consequences of CBCT incidental findings were queried from the referring physicians. A total of 974 incidental findings were detected, involving 78.6% of all CBCT, hence 2.6 incidental findings per CBCT. Of these, 38.6% were classified to require treatment, with an additional 25.2% requiring follow-up. Incidental findings included dental pathologies in 55.3%, pathologies of the paranasal sinuses and airways in 29.2%, osseous pathologies in 14.9% of all CBCT, and findings in the soft tissue or TMJ in few cases. Clinically relevant dental incidental findings were detected significantly more frequently in CBCT for implant planning compared to other indications (60.7% vs. 43.2%, p < 0.01), and in CBCT with an FOV ≥ 100 mm compared to an FOV < 100 mm (54.7% vs. 40.0%, p < 0.01). Similar results were obtained for paranasal incidental findings. In a subgroup analysis, 29 of 54 patients showed incidental findings which were previously unknown, and the findings changed therapeutical management in 19 patients (35%). The results of our study highlighted the importance of a meticulous analysis of the entire FOV of CBCT for incidental findings, which showed clinical relevance in more than one in three patients. Due to a high number of clinically relevant incidental findings especially in CBCT for implant planning, an FOV of 100 × 100 mm covering both the mandible and the maxilla was concluded to be recommendable for this indication

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE

Search for the standard model Higgs boson decaying into two photons in pp collisions at sqrt(s)=7 TeV

A search for a Higgs boson decaying into two photons is described. The analysis is performed using a dataset recorded by the CMS experiment at the LHC from pp collisions at a centre-of-mass energy of 7 TeV, which corresponds to an integrated luminosity of 4.8 inverse femtobarns. Limits are set on the cross section of the standard model Higgs boson decaying to two photons. The expected exclusion limit at 95% confidence level is between 1.4 and 2.4 times the standard model cross section in the mass range between 110 and 150 GeV. The analysis of the data excludes, at 95% confidence level, the standard model Higgs boson decaying into two photons in the mass range 128 to 132 GeV. The largest excess of events above the expected standard model background is observed for a Higgs boson mass hypothesis of 124 GeV with a local significance of 3.1 sigma. The global significance of observing an excess with a local significance greater than 3.1 sigma anywhere in the search range 110-150 GeV is estimated to be 1.8 sigma. More data are required to ascertain the origin of this excess.Comment: Submitted to Physics Letters

Measurement of isolated photon production in pp and PbPb collisions at sqrt(sNN) = 2.76 TeV

Isolated photon production is measured in proton-proton and lead-lead collisions at nucleon-nucleon centre-of-mass energies of 2.76 TeV in the pseudorapidity range |eta|<1.44 and transverse energies ET between 20 and 80 GeV with the CMS detector at the LHC. The measured ET spectra are found to be in good agreement with next-to-leading-order perturbative QCD predictions. The ratio of PbPb to pp isolated photon ET-differential yields, scaled by the number of incoherent nucleon-nucleon collisions, is consistent with unity for all PbPb reaction centralities.Comment: Submitted to Physics Letters

Search for the standard model Higgs boson in the H to ZZ to ll tau tau decay channel in pp collisions at sqrt(s)=7 TeV

A search is reported for the standard model Higgs boson in the decay mode H to ZZ to tau plus lepton pairs, where the leptons are either electrons or muons, in proton-proton collisions at sqrt(s)=7 TeV, corresponding to an integrated luminosity of 4.7 inverse femtobarn collected with the CMS detector at the LHC. No evidence is found for a significant deviation from the background expectation. An upper limit four to twelve times larger than the predicted value is set at 95% confidence level for the product of the standard model Higgs boson production cross section and decay branching fraction in the mass range 190 < m(H) < 600 GeV.Comment: Submitted to JHE

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació