ACCURACY OF FNAC IN FEMALE BREAST LESIONS

Background: Various breast lesions are common lesions in females with a wide range of variability from inflammatory lesions, benign and malignant breast lesions. FNAC is first diagnostic test, as it has high sensitivity and specificity. Lesions were categorized on FNA into inflammatory lesions, benign neoplastic lesions, malignant neoplastic lesions, and suspicious for malignancy. Methods: This was a retrospective study done in the Department of Pathology, P.D.U. Medical College, Rajkot, Gujarat State, India from Aug-2013 to July 2014. FNAC of 392 cases of breast lesions were done and reported by expert pathologist. The histopathological specimens when available were reported by other pathologist without prior knowledge of FNA diagnosis. Sensitivity, Specificity and Accuracy of FNA diagnosis were then analyzed. Results: A total of 392 cases of breast lesions were diagnosed on FNA, out of them histopathological correlation was available in 87 cases. Benign breast lesions are more common in younger patients in 21-30 yrs age group and malignant lesions are more common in old age group patients of 41-60 yrs with few exceptions. In our setup fibroadenoma is the most common benign breast lesion (26.53%) and ductal carcinoma (17.86%) is the most common malignant lesion. The sensitivity, specificity and accuracy of FNAC for malignant lesions were found to be 91.43%, 100% and 96.25% respectively. Conclusion: FNAC is an effective and valid tool as the first line diagnostic modality in the preoperative diagnosis of the malignant and benign breast lesions.KEYWORDS: FNAC; Breast lesions; Fibroadenoma; Ductal carcinoma

Local properties of extended self-similarity in 3D turbulence

Using a generalization of extended self-similarity we have studied local scaling properties of 3D turbulence in a direct numerical simulation. We have found that these properties are consistent with lognormal-like behavior of energy dissipation fluctuations with moderate amplitudes for space scales $r$ beginning from Kolmogorov length $\eta$ up to the largest scales, and in the whole range of the Reynolds numbers: $50 \leq R_{\lambda} \leq 459$. The locally determined intermittency exponent $\mu(r)$ varies with $r$; it has a maximum at scale $r=14 \eta$, independent of $R_{\lambda}$.Comment: 4 pages, 5 figure

ACCURACY OF FNAC IN FEMALE BREAST LESIONS

Background: Various breast lesions are common lesions in females with a wide range of variability from inflammatory lesions, benign and malignant breast lesions. FNAC is first diagnostic test, as it has high sensitivity and specificity. Lesions were categorized on FNA into inflammatory lesions, benign neoplastic lesions, malignant neoplastic lesions, and suspicious for malignancy. Methods: This was a retrospective study done in the Department of Pathology, P.D.U. Medical College, Rajkot, Gujarat State, India from Aug-2013 to July 2014. FNAC of 392 cases of breast lesions were done and reported by expert pathologist. The histopathological specimens when available were reported by other pathologist without prior knowledge of FNA diagnosis. Sensitivity, Specificity and Accuracy of FNA diagnosis were then analyzed. Results: A total of 392 cases of breast lesions were diagnosed on FNA, out of them histopathological correlation was available in 87 cases. Benign breast lesions are more common in younger patients in 21-30 yrs age group and malignant lesions are more common in old age group patients of 41-60 yrs with few exceptions. In our setup fibroadenoma is the most common benign breast lesion (26.53%) and ductal carcinoma (17.86%) is the most common malignant lesion. The sensitivity, specificity and accuracy of FNAC for malignant lesions were found to be 91.43%, 100% and 96.25% respectively. Conclusion: FNAC is an effective and valid tool as the first line diagnostic modality in the preoperative diagnosis of the malignant and benign breast lesions.KEYWORDS: FNAC; Breast lesions; Fibroadenoma; Ductal carcinoma

Longitudinal Structure Functions in Decaying and Forced Turbulence

In order to reliably compute the longitudinal structure functions in decaying and forced turbulence, local isotropy is examined with the aid of the isotropic expression of the incompressible conditions for the second and third order structure functions. Furthermore, the Karman-Howarth-Kolmogorov relation is investigated to examine the effects of external forcing and temporally decreasing of the second order structure function. On the basis of these investigations, the scaling range and exponents $\zeta_n$ of the longitudinal structure functions are determined for decaying and forced turbulence with the aid of the extended-self-similarity (ESS) method. We find that $\zeta_n$'s are smaller, for $n \geq 4$, in decaying turbulence than in forced turbulence. The reasons for this discrepancy are discussed. Analysis of the local slopes of the structure functions is used to justify the ESS method.Comment: 15 pages, 16 figure

Dynamical equations for high-order structure functions, and a comparison of a mean field theory with experiments in three-dimensional turbulence

Two recent publications [V. Yakhot, Phys. Rev. E {\bf 63}, 026307, (2001) and R.J. Hill, J. Fluid Mech. {\bf 434}, 379, (2001)] derive, through two different approaches that have the Navier-Stokes equations as the common starting point, a set of steady-state dynamic equations for structure functions of arbitrary order in hydrodynamic turbulence. These equations are not closed. Yakhot proposed a "mean field theory" to close the equations for locally isotropic turbulence, and obtained scaling exponents of structure functions and an expression for the tails of the probability density function of transverse velocity increments. At high Reynolds numbers, we present some relevant experimental data on pressure and dissipation terms that are needed to provide closure, as well as on aspects predicted by the theory. Comparison between the theory and the data shows varying levels of agreement, and reveals gaps inherent to the implementation of the theory.Comment: 16 pages, 23 figure

Statistics of Dissipation and Enstrophy Induced by a Set of Burgers Vortices

Dissipation and enstropy statistics are calculated for an ensemble of modified Burgers vortices in equilibrium under uniform straining. Different best-fit, finite-range scaling exponents are found for locally-averaged dissipation and enstrophy, in agreement with existing numerical simulations and experiments. However, the ratios of dissipation and enstropy moments supported by axisymmetric vortices of any profile are finite. Therefore the asymptotic scaling exponents for dissipation and enstrophy induced by such vortices are equal in the limit of infinite Reynolds number.Comment: Revtex (4 pages) with 4 postscript figures included via psfi

Use of mechanical circulatory support devices among patients with acute myocardial infarction complicated by cardiogenic shock

Importance: Mechanical circulatory support (MCS) devices, including intravascular microaxial left ventricular assist devices (LVADs) and intra-aortic balloon pumps (IABPs), are used in patients who undergo percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock despite limited evidence of their clinical benefit. Objective: To examine trends in the use of MCS devices among patients who underwent PCI for AMI with cardiogenic shock, hospital-level use variation, and factors associated with use. Design, Setting, and Participants: This cross-sectional study used the CathPCI and Chest Pain-MI Registries of the American College of Cardiology National Cardiovascular Data Registry. Patients who underwent PCI for AMI complicated by cardiogenic shock between October 1, 2015, and December 31, 2017, were identified from both registries. Data were analyzed from October 2018 to August 2020. Exposures: Therapies to provide hemodynamic support were categorized as intravascular microaxial LVAD, IABP, TandemHeart, extracorporeal membrane oxygenation, LVAD, other devices, combined IABP and intravascular microaxial LVAD, combined IABP and other device (defined as TandemHeart, extracorporeal membrane oxygenation, LVAD, or another MCS device), or medical therapy only. Main Outcomes and Measures: Use of MCS devices overall and specific MCS devices, including intravascular microaxial LVAD, at both patient and hospital levels and variables associated with use. Results: Among the 28 304 patients included in the study, the mean (SD) age was 65.4 (12.6) years and 18 968 were men (67.0%). The overall MCS device use was constant from the fourth quarter of 2015 to the fourth quarter of 2017, although use of intravascular microaxial LVADs significantly increased (from 4.1% to 9.8%; P \u3c .001), whereas use of IABPs significantly decreased (from 34.8% to 30.0%; P \u3c .001). A significant hospital-level variation in MCS device use was found. The median (interquartile range [IQR]) proportion of patients who received MCS devices was 42% (30%-54%), and the median proportion of patients who received intravascular microaxial LVADs was 1% (0%-10%). In multivariable analyses, cardiac arrest at first medical contact or during hospitalization (odds ratio [OR], 1.82; 95% CI, 1.58-2.09) and severe left main and/or proximal left anterior descending coronary artery stenosis (OR, 1.36; 95% CI, 1.20-1.54) were patient characteristics that were associated with higher odds of receiving intravascular microaxial LVADs only compared with IABPs only. Conclusions and Relevance: This study found that, among patients who underwent PCI for AMI complicated by cardiogenic shock, overall use of MCS devices was constant, and a 2.5-fold increase in intravascular microaxial LVAD use was found along with a corresponding decrease in IABP use and a significant hospital-level variation in MCS device use. These trends were observed despite limited clinical trial evidence of improved outcomes associated with device use

Turbulence anisotropy and the SO(3) description

We study strongly turbulent windtunnel flows with controlled anisotropy. Using a recent formalism based on angular momentum and the irreducible representations of the SO(3) rotation group, we attempt to extract this anisotropy from the angular dependence of second-order structure functions. Our instrumentation allows a measurement of both the separation and the angle dependence of the structure function. In axisymmetric turbulence which has a weak anisotropy, this more extended information produces ambiguous results. In more strongly anisotropic shear turbulence, the SO(3) description enables one to find the anisotropy scaling exponent. The key quality of the SO(3) description is that structure functions are a mixture of algebraic functions of the scale with exponents ordered such that the contribution of anisotropies diminishes at small scales. However, we find that in third-order structure functions of homogeneous shear turbulence the anisotropic contribution is always large and of the same order of magnitude as the isotropic part. Our results concern the minimum instrumentation needed to determine the parameters of the SO(3) description, and raise several questions about its ability to describe the angle dependence of high-order structure functions

Pulmonary venous circulating tumor cell dissemination before tumor resection and disease relapse

Approximately 50% of patients with early-stage non-small-cell lung cancer (NSCLC) who undergo surgery with curative intent will relapse within 5 years1,2. Detection of circulating tumor cells (CTCs) at the time of surgery may represent a tool to identify patients at higher risk of recurrence for whom more frequent monitoring is advised. Here we asked whether CellSearch-detected pulmonary venous CTCs (PV-CTCs) at surgical resection of early-stage NSCLC represent subclones responsible for subsequent disease relapse. PV-CTCs were detected in 48% of 100 patients enrolled into the TRACERx study3, were associated with lung-cancer-specific relapse and remained an independent predictor of relapse in multivariate analysis adjusted for tumor stage. In a case study, genomic profiling of single PV-CTCs collected at surgery revealed higher mutation overlap with metastasis detected 10 months later (91%) than with the primary tumor (79%), suggesting that early-disseminating PV-CTCs were responsible for disease relapse. Together, PV-CTC enumeration and genomic profiling highlight the potential of PV-CTCs as early predictors of NSCLC recurrence after surgery. However, the limited sensitivity of PV-CTCs in predicting relapse suggests that further studies using a larger, independent cohort are warranted to confirm and better define the potential clinical utility of PV-CTCs in early-stage NSCLC

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease