Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera

<p>Abstract</p> <p>Background</p> <p>Sentinel lymph node (SLN) procedure is now a widely accepted method of LN staging in selected invasive breast cancers (unifocal, size ≤ 2 cm, clinically N0, without previous treatment). Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall is the failure to visualize SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence. Operative gamma cameras have therefore been developed to optimize the SLN visualization and the quality control of surgery.</p> <p>Case presentation</p> <p>A 44-year-old female patient with a 14-mm infiltrative ductal carcinoma underwent the SLN procedure. An operative gamma camera was used during and after the surgery. The conventional lymphoscintigraphy showed only one SLN, which was also detected by the operative gamma camera, then removed and measured (9.6 kBq). It was analyzed by frozen sections, showing no cancer cells. During this analysis, the exploration of the axillary area with the operative gamma camera enabled the identification of a second SLN with low activity (0.5 kBq) that conventional lymphoscintigraphy, surgical probe and blue staining had failed to visualize. Histological examination revealed a macrometastasis. Axillary clearance was then performed, followed by a postoperative image proving that no SLN remained. Therefore, the use of the operative gamma camera prevented an under-estimation of staging which would have resulted in a suboptimal treatment for this patient.</p> <p>Conclusion</p> <p>This case report illustrates that an efficient operative gamma camera may be able to decrease the risk of false negative rate of the SLN procedure, and could be an additional tool to control the quality of the surgery.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT00357487</p

Facial expressions depicting compassionate and critical emotions: the development and validation of a new emotional face stimulus set

Attachment with altruistic others requires the ability to appropriately process affiliative and kind facial cues. Yet there is no stimulus set available to investigate such processes. Here, we developed a stimulus set depicting compassionate and critical facial expressions, and validated its effectiveness using well-established visual-probe methodology. In Study 1, 62 participants rated photographs of actors displaying compassionate/kind and critical faces on strength of emotion type. This produced a new stimulus set based on N = 31 actors, whose facial expressions were reliably distinguished as compassionate, critical and neutral. In Study 2, 70 participants completed a visual-probe task measuring attentional orientation to critical and compassionate/kind faces. This revealed that participants lower in self-criticism demonstrated enhanced attention to compassionate/kind faces whereas those higher in self-criticism showed no bias. To sum, the new stimulus set produced interpretable findings using visual-probe methodology and is the first to include higher order, complex positive affect displays

An exposure-effect approach for evaluating ecosystem-wide risks from human activities

Ecosystem-based management (EBM) is promoted as the solution for sustainable use. An ecosystem-wide assessment methodology is therefore required. In this paper, we present an approach to assess the risk to ecosystem components from human activities common to marine and coastal ecosystems. We build on: (i) a linkage framework that describes how human activities can impact the ecosystem through pressures, and (ii) a qualitative expert judgement assessment of impact chains describing the exposure and sensitivity of ecological components to those activities. Using case study examples applied at European regional sea scale, we evaluate the risk of an adverse ecological impact from current human activities to a suite of ecological components and, once impacted, the time required for recovery to pre-impact conditions should those activities subside. Grouping impact chains by sectors, pressure type, or ecological components enabled impact risks and recovery times to be identified, supporting resource managers in their efforts to prioritize threats for management, identify most at-risk components, and generate time frames for ecosystem recovery

Post-Training Reward Partially Restores Chronic Stress Induced Effects in Mice

Reduced responsiveness to positive stimuli is a core symptom of depression, known as anhedonia. In the present study, we assessed the expression of anhedonia in our chronic stress mouse model using a subset of read-out parameters. In line with this, we investigated in how far chronic stress would affect the facilitating effect of post-training self-administration of sugar, as we previously observed in naïve mice. Male C57BL/6J mice were repeatedly and at unpredictable times exposed to rats (no physical contact) over the course of two weeks. Following novelty exploration, (non-) spatial learning and memory processes with and without post-training sugar acting as reinforcer, emotionality, reward sensitivity and corticosterone levels were determined. We found that (1) the effects of chronic stress persisted beyond the period of the actual rat exposure. (2) Post-training self-administration of sugar as reinforcer improved spatial performance in naïve mice, whereas (3) in stressed mice sugar partially “normalized” the impaired performance to the level of controls without sugar. Chronic stress (4) increased behavioral inhibition in response to novelty; (5) induced dynamic changes in the pattern of circadian corticosterone secretion during the first week after rat stress and (6) increased the intake of sucrose and water. (7) Chronic stress and sugar consumed during spatial training facilitated the memory for the location of the sucrose bottle weeks later. Concluding, our chronic stress paradigm induces the expression of anhedonia in mice, at different levels of behavior. The behavioral inhibition appears to be long lasting in stressed mice. Interestingly, sugar consumed in close context with spatial learning partially rescued the stress-induced emotional and cognitive impairments. This suggests that reward can ameliorate part of the negative consequences of chronic stress on memory

Precursors to Natural Grammar Learning: Preliminary Evidence from 4-Month-Old Infants

When learning a new language, grammar—although difficult—is very important, as grammatical rules determine the relations between the words in a sentence. There is evidence that very young infants can detect rules determining the relation between neighbouring syllables in short syllable sequences. A critical feature of all natural languages, however, is that many grammatical rules concern the dependency relation between non-neighbouring words or elements in a sentence i.e. between an auxiliary and verb inflection as in is singing. Thus, the issue of when and how children begin to recognize such non-adjacent dependencies is fundamental to our understanding of language acquisition. Here, we use brain potential measures to demonstrate that the ability to recognize dependencies between non-adjacent elements in a novel natural language is observable by the age of 4 months. Brain responses indicate that 4-month-old German infants discriminate between grammatical and ungrammatical dependencies in auditorily presented Italian sentences after only brief exposure to correct sentences of the same type. As the grammatical dependencies are realized by phonologically distinct syllables the present data most likely reflect phonologically based implicit learning mechanisms which can serve as a precursor to later grammar learning