Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast.

Rates of positive margins after surgical resection of invasive lobular carcinoma (ILC) are high (ranging from 18 to 60%), yet the efficacy of re-excision lumpReceptor subtypeectomy for clearing positive margins is unknown. Concerns about the diffuse nature of ILC may drive increased rates of completion mastectomy to treat positive margins, thus lowering breast conservation rates. We therefore determined the success rate of re-excision lumpectomy in women with ILC and positive margins after surgical resection. We identified 314 cases of stage I-III ILC treated with breast conserving surgery (BCS) at the University of California, San Francisco. Surgical procedures, pathology reports, and outcomes were analyzed using univariate and multivariate statistics and Cox-proportional hazards models. We evaluated outcomes before and after the year 2014, when new margin management consensus guidelines were published. Positive initial margins occurred in 118 (37.6%) cases. Of these, 62 (52.5%) underwent re-excision lumpectomy, which cleared the margin in 74.2%. On multivariate analysis, node negativity was significantly associated with successful re-excision (odds ratio [OR] 3.99, 95% CI 1.15-13.81, p = 0.029). After 2014, we saw fewer initial positive margins (42.7% versus 25.5%, p = 0.009), second surgeries (54.6% versus 20.2%, p < 0.001), and completion mastectomies (27.7% versus 4.5%, p < 0.001). In this large cohort of women with ILC, re-excision lumpectomy was highly successful at clearing positive margins. Additionally, positive margins and completion mastectomy rates significantly decreased over time. These findings highlight improvements in management of ILC, and suggest that completion mastectomy may not be required for those with positive margins after initial BCS

Development of Metalinguistic Awareness: Evidence from Children’s Overt Productions

This study examined whether metalinguistic frequency increases or utterance type changes with age in children with typical language. Overt metalinguistic productions of 32 children, 3;0-5;7, were collected during recast intervention. Overall, the data showed changes in frequency and proportion of types with age

(De)Constructing the student body: a post-structural analysis of dress codes in secondary schools

This thesis conducts a post-structural analysis of the bodily management demanded by the wording and enforcement of dress codes in the secondary school setting as well as potential sites for resistance. Specifically, in chapter one, this project uses the work of three theorists - Judith Butler, Michele Foucault, and Sara Ahmed - to historicize discourses around the body in Western philosophy and sociopolitical life and to apply a post-structural lens to the deconstruction of both the body and the dress codes applied to bodies in secondary school settings. What follows in chapter two is an application of the theoretical deconstruction to actual dress codes from twenty-eight Guilford County public schools and three secular, independent schools in Guilford County, North Carolina. This is accomplished through a process of thematic coding and textual analysis, which reveals the ideal body that students should have, according to the parameters of the dress code: white, male, heteronormative, middle class, and professional. Finally, based on both the historicized philosophical and sociopolitical discourses of the body and the concrete analyses of dress codes in secular secondary schools in Guilford County, chapter three delves into potentials for resistance, both large and small, to dress codes. Having revealed dress codes' multiple vectors of social control, chapter three reveals both the subtle, everyday resistances that are possible through subversive repetition and appropriation as well as the intersectional resistance through which to incite cultural crises in order to broad structural changes in the construction, regulation, surveillance, disciplining, and punishment of bodies. The overall message that these analyses, both philosophical and concrete, reveal is the highly political meaning of the body, of education, and of the body in education, which makes imperative a future semiotic analysis of language around bodies, language in dress codes, and bodies themselves as well as deep exploration of the process and meaning of learning in a body

New constraints on equatorial temperatures during a Late Neoproterozoic snowball Earth glaciation

Intense glaciation during the end of Cryogenian time (∼635 million years ago) marks the coldest climate state in Earth history – a time when glacial deposits accumulated at low, tropical paleolatitudes. The leading idea to explain these deposits, the snowball Earth hypothesis, predicts globally frozen surface conditions and subfreezing temperatures, with global climate models placing surface temperatures in the tropics between −20 °C and −60 °C. However, precise paleosurface temperatures based upon geologic constraints have remained elusive and the global severity of the glaciation undetermined. Here we make new geologic observations of tropical periglacial, aeolian and fluvial sedimentary structures formed during the end-Cryogenian, Marinoan glaciation in South Australia; these observations allow us to constrain ancient surface temperatures. We find periglacial sand wedges and associated deformation suggest that ground temperatures were sufficiently warm to allow for ductile deformation of a sandy regolith. The wide range of deformation structures likely indicate the presence of a paleoactive layer that penetrated 2–4 m below the ground surface. These observations, paired with a model of ground temperature forced by solar insolation, constrain the local mean annual surface temperature to within a few degrees of freezing. This temperature constraint matches well with our observations of fluvial deposits, which require temperatures sufficiently warm for surface runoff. Although this estimate coincides with one of the coldest near sea-level tropical temperatures in Earth history, if these structures represent peak Marinaon glacial conditions, they do not support the persistent deep freeze of the snowball Earth hypothesis. Rather, surface temperatures near 0 °C allow for regions of seasonal surface melting, atmosphere–ocean coupling and possible tropical refugia for early metazoans. If instead these structures formed during glacial onset or deglaciation, then they have implications for the timescale and character for the transition into or out of a snowball state

The Early Impact of the Affordable Care Act upon Colorectal Cancer Screening Utilization in Florida

Background: Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Although preventable and curable through screening, early detection and treatment, a lack of health insurance is a major obstacle to receiving colorectal cancer screening (CRCS). Despite the Affordable Care Act (ACA) increasing access to health insurance by mandating coverage of CRCS, disparities in utilization rates continue. Therefore, researchers sought to better understand ACA related facilitators and impediments that affect the utilization of CRCS and collect specific recommendations from healthcare professionals to increase screening utilization rates in Florida. Methods: Researchers conducted in-depth interviews with 22 healthcare professionals. Data were coded and analyzed using an applied thematic analysis approach and interpreted according to levels of the Social Ecological Model. Results: Eight physicians and nurses, 7 healthcare workers/care coordinators, 5 administrators and insurers, and 2 health advocates completed interviews. In their view, the early days of the ACA facilitated CRCS uptake through use of frontline staff, patient provider communication, and increased access to healthcare. Barriers that remained, included out of pocket patient costs, limited Medicaid expansion, acceptance of ACA plans by only certain providers and removal of patient incentives. Recommendations for increasing CRCS included more promotion and awareness, removing costs and ensuring patient navigation. Conclusions: The ACA offered increased access to healthcare coverage, utilization of CRCS and encouraged better communication between healthcare providers and patients. However, persistent barriers remain and include varied CRCS-related patient costs and restricted provider networks included in ACA sponsored plans. Continued healthcare policy reform is needed to make CRCS affordable for all Americans

Recurrent postmenopausal bleeding:Pathological findings and predictive factors. A multicenter, prospective, observational study

Introduction: Recurrent postmenopausal bleeding (PMB) occurs in 6%–25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. Material and Methods: A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. Results: A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44–73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75–23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64–6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07–3.04). Conclusions: Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.</p

Hepatotoxicity of a Cannabidiol-rich cannabis extract in the mouse model

© 2019 Xide Ye et al. Gastrodia elata Blume belongs to the Orchidaceae family. G. elata is often processed when used in traditional Chinese medicine (TCM). In the current study, a traditional processing method, known as Jianchang Bang, was applied. Steamed and dried (S&D) G. elata was processed with ginger juice for up to 5 days (GEP5D). An UHPLC-MS/MS combined with a chemometric method was developed for the analysis of processed G. elata along with the raw material as well as steamed and dried G. elata. As a result, the primary marker compounds were identified with the aid of TOF-MS and MS/MS analyses. Compared with the raw material of G. elata with GEP5D, three new parishin-type compounds were identified according to their retention time, accurate mass, and fragmentation patterns. The chromatographic peak areas for marker compounds, including S-(gastrodin)-glutathione, S-(4-hydroxybenzylamine)-glutathione, and parishin-type compounds, changed significantly. This result indicated that by applying the Jianchang Bang method, changes in chemical composition in G. elata contents were observed. The study also demonstrated that chemometric analysis is helpful in understanding the processing mechanism and will provide scientific support for the clinical application of G. elata

Safety and molecular-toxicological implications of cannabidiol-rich cannabis extract and methylsulfonylmethane co-administration

© 2020 by the authors. Cannabidiol (CBD) is a biologically active, non-psychotropic component of Cannabis sativa whose popularity has grown exponentially in recent years. Besides a wealth of potential health benefits, ingestion of CBD poses risks for a number of side effects, of which hepatotoxicity and CBD/herb-drug interactions are of particular concern. Here, we investigated the interaction potential between the cannabidiol-rich cannabis extract (CRCE) and methylsulfonylmethane (MSM), a popular dietary supplement, in the mouse model. For this purpose, 8-week-old male C57BL6/J mice received MSM-containing water (80 mg/100 mL) ad libitum for 17 days. During the last three days of treatment, mice received three doses of CRCE administered in sesame oil via oral gavage (123 mg/kg/day). Administration of MSM alone did not result in any evidence of liver toxicity and did not induce expression of mouse cytochrome P450 (CYP) enzymes. Administration of CRCE did produce significant (p \u3c 0.05) increases in Cyp1a2, Cyp2b10, Cyp2c29, Cyp3a4, Cyp3a11, Cyp2c65, and Cyp2c66 messenger RNA, however, this effect was not amplified by MSM/CRCE cotreatment. Similarly, no evidence of liver toxicity was observed in MSM/CRCE dosed mice. In conclusion, short-term MSM/CRCE co-administration did not demonstrate any evidence of hepatotoxicity in the mouse model

Paradoxical patterns of sinusoidal obstruction syndrome-like liver injury in aged female CD-1 mice triggered by cannabidiol-rich cannabis extract and acetaminophen co-administration

© 2019 The Authors. Environmental Toxicology published by Wiley Periodicals, Inc. Exposure to environmental contaminants and consumption of a high, saturated fatty diet has been demonstrated to promote precursors for metabolic syndrome (hyperglycemia, hyperinsulinemia, and hypertriglyceridemia). The purpose of this study was to determine if exposure to the most prevalent environmental persistent organic pollutants (POPs) would act as causative agents to promote metabolic syndrome independent of dietary intake. We hypothesized that POPs will activate the advanced glycated end-product (AGE)-and receptor for AGE (RAGE) signaling cascade to promote downstream signaling modulators of cardiovascular remodeling and oxidative stress in the heart. At 5-weeks of age nondiabetic (WT) and diabetic (ob/ob) mice were exposed POPs mixtures by oral gavage twice a week for 6-weeks. At the end of 6-weeks, animals were sacrificed and the hearts were taken for biochemical analysis. Increased activation of the AGE-RAGE signaling cascade via POPs exposure resulted in elevated levels of fibroblast differentiation (α-smooth muscle actin) and RAGE expression indicated maladaptive cardiac remodeling. Conversely, the observed decreased superoxide dismutase-1 and -2 (SOD-1 and SOD-2) expression may exacerbate the adverse changes occurring as a result of POPs treatment to reduce innate cardioprotective mechanisms. In comparison, ventricular collagen levels were decreased in mice exposed to POPs. In conclusion, exposure to organic environmental pollutants may intensify oxidative and inflammatory stressors to overwhelm protective mechanisms allowing for adverse cardiac remodeling