Circulating tumor cells, disease recurrence and survival in newly diagnosed breast cancer

Introduction The presence of circulating tumor cells (CTC) is an independent prognostic factor for progression-free survival and breast cancer-related death (BRD) for patients with metastatic breast cancer beginning a new line of systemic therapy. The current study was undertaken to explore whether the presence of CTC at the time of diagnosis was associated with recurrence-free survival (RFS) and BRD. Methods In a prospective single center study, CTC were enumerated with the CellSearch system in 30 ml of peripheral blood of 602 patients before undergoing surgery for breast cancer. There were 97 patients with a benign tumor, 101 did not meet the inclusion criteria of which there were 48 patients with DCIS, leaving 404 stage I to III patients. Patients were stratified into unfavorable (CTC ≥1) and favorable (CTC = 0) prognostic groups. Results ≥1 CTC in 30 ml blood was detected in 15 (15%) benign tumors, in 9 DCIS (19%), in 28 (16%) stage I, 32 (18%) stage II and in 16 (31%) patients with stage III. In stage I to III patients 76 (19%) had ≥1 CTC of whom 16 (21.1%) developed a recurrence. In 328 patients with 0 CTC 38 (11.6%) developed a recurrence. Four-year RFS was 88.4% for favorable CTC and 78.9% for unfavorable CTC (P = 0.038). A total of 25 patients died of breast cancer-related causes and 11 (44%) had ≥1 CTC. BRD was 4.3% for favorable and 14.5% for unfavorable CTC (P = 0.001). In multivariate analysis ≥1 CTC was associated with distant disease-free survival, but not for overall recurrence-free survival. CTC, progesterone receptor and N-stage were independent predictors of BRD in multivariate analysis. Conclusions Presence of CTC in breast cancer patients before undergoing surgery with curative intent is associated with an increased risk for breast cancer-related death

Social Presence and the void in distant relationships: How do people use communication technologies to turn absence into fondness of the heart, rather than drifting out of mind?

In general terms, Social Presence is a feeling of togetherness regardless of spatial or temporal separation. It is a socioemotional attitude that reflexively centres on other people, via perceptions of their affective attitudes towards oneself. Communication technologies contribute to the maintenance of close personal relationships by facilitating welcome and timely socioemotional presence in the mind of an absent other. Presence of this kind may be ‘in the moment’ of communication and also persist over time, as it is ‘topped up’ through repeated interactions. In this paper, we consider how type of personal relationship and degree of physical separation might condition the Social Presence value of a range of media. We report ratings of Closeness and Social Presence that were gathered over 21 days by 64 participants about the close personal relationships that were meaningful to them. We contrast the communication media they chose to use across four relationship types and whether separations were in the same or in a different city. Our findings are used to discuss new ways of thinking about the connection between people who care about one another, and the meaning of the void that separates them, through the time course of Social Presence and Closeness experiences

Magnetic domain tuning and the emergence of bubble domains in the bilayer manganite La 2−2x Sr 1+2x Mn 2 O 7 (x=0.32)

We report a magnetic force microscopy study of the magnetic domain evolution in the layered manganite La2-2x Sr1+2x Mn2O7 (with x = 0.32). This strongly correlated electron compound is known to exhibit a wide range of magnetic phases, including a recently uncovered biskyrmion phase. We observe a continuous transition from dendritic to stripelike domains, followed by the formation of magnetic bubbles due to a field-and temperaturedependent competition between in-plane and out-of-plane spin alignments. The magnetic bubble phase appears at comparable field and temperature ranges as the biskyrmion phase, suggesting a close relation between both phases. Based on our real-space images we construct a temperature-field phase diagram for this composition.open115Ysciescopu

Early and Late Direct Costs in a Southern African Antiretroviral Treatment Programme: A Retrospective Cohort Analysis

Gary Maartens and colleagues describe the direct heath care costs and identify the drivers of cost over time in an HIV managed care program in Southern Africa

Anatomy and Taxonomic Status of the Chasmosaurine Ceratopsid Nedoceratops hatcheri from the Upper Cretaceous Lance Formation of Wyoming, U.S.A

Background: The validity of Nedoceratops hatcheri, a chasmosaurine ceratopsid dinosaur known from a single skull recovered in the Lance Formation of eastern Wyoming, U.S.A., has been debated for over a century. Some have argued that the taxon is an aberrant Triceratops, and most recently it was proposed that N. hatcheri represents an intermediate ontogenetic stage between ‘‘young adult’ ’ and ‘‘old adult’ ’ forms of a single taxon previously split into Triceratops and Torosaurus. Methodology/Principal Findings: The holotype skull of Nedoceratops hatcheri was reexamined in order to map reconstructed areas and compare the specimen with other ceratopsids. Although squamosal fenestrae are almost certainly not of taxonomic significance, some other features are unique to N. hatcheri. These include a nasal lacking a recognizable horn, nearly vertical postorbital horncores, and relatively small parietal fenestrae. Thus, N. hatcheri is tentatively considered valid, and closely related to Triceratops spp. The holotype of N. hatcheri probably represents an ‘‘old adult,’ ’ based upon bone surface texture and the shape of the horns and epiossifications on the frill. In this study, Torosaurus is maintained as a genus distinct from Triceratops and Nedoceratops. Synonymy of the three genera as ontogenetic stages of a single taxon would require cranial changes otherwise unknown in ceratopsids, including additions of ossifications to the frill and repeated alternation of bone surface texture between juvenile and adult morphotypes

Can We Really Prevent Suicide?

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essentia

Advances in small lasers

M.T.H was supported by an Australian Research council Future Fellowship research grant for this work. M.C.G. is grateful to the Scottish Funding Council (via SUPA) for financial support.Small lasers have dimensions or modes sizes close to or smaller than the wavelength of emitted light. In recent years there has been significant progress towards reducing the size and improving the characteristics of these devices. This work has been led primarily by the innovative use of new materials and cavity designs. This Review summarizes some of the latest developments, particularly in metallic and plasmonic lasers, improvements in small dielectric lasers, and the emerging area of small bio-compatible or bio-derived lasers. We examine the different approaches employed to reduce size and how they result in significant differences in the final device, particularly between metal- and dielectric-cavity lasers. We also present potential applications for the various forms of small lasers, and indicate where further developments are required.PostprintPeer reviewe

Citrobacter freundii infection after acute necrotizing pancreatitis in a patient with a pancreatic pseudocyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>Infections are the most frequent and severe complications of acute necrotizing pancreatitis with a mortality rate of up to 80 percent. Although experimental and clinical studies suggest that the microbiologic source of pancreatic infection could be enteric, information in this regard is controversial.</p> <p>Case presentation</p> <p>We describe a <it>Citrobacter freundii </it>isolation by endoscopy ultrasound fine needle aspiration in a 80-year-old Caucasian man with pancreatic pseudocyst after acute necrotizing pancreatitis.</p> <p>Conclusion</p> <p>Our case report confirms that this organism can be recovered in patients with a pancreatic pseudocyst. On-site cytology feedback was crucial to the successful outcome of this case as immediate interpretation of the fine needle aspiration sample directed the appropriate cultures and, ultimately, the curative therapy. To the best of our knowledge, this is the first reported case of isolated pancreatic <it>C. freundii </it>diagnosed by endoscopy ultrasound fine needle aspiration.</p

‘Nedoceratops’: An Example of a Transitional Morphology

Background: The holotype and only specimen of the chasmosaurine ceratopsid dinosaur ‘Nedoceratops hatcheri ’ has been the source of considerable taxonomic debate since its initial description. At times it has been referred to its own genus while at others it has been considered synonymous with the contemporaneous chasmosaurine Triceratops. Most recently, the debate has focused on whether the specimen represents an intermediate ontogenetic stage between typical young adult Triceratops and the proposed mature morphology, which was previously considered to represent a distinct genus, ‘Torosaurus’. Methodology/Principal Findings: The only specimen of ‘Nedoceratops hatcheri ’ was examined and the proposed diagnostic features of this taxon were compared with other chasmosaurine ceratopsids. Every suggested autapomorphy of ‘Nedoceratops ’ is found in specimens of Triceratops. In this study, Triceratops includes the adult ‘Torosaurus ’ morphology. The small parietal fenestra and elongate squamosals of Nedoceratops are consistent with a transition from a short, solid parietalsquamosal frill to an expanded, fenestrated condition. Objections to this hypothesis regarding the number of epiossifications of the frill and alternations of bone surface texture were explored through a combination of comparative osteology and osteohistology. The synonymy of the three taxa was further supported by these investigations. Conclusions/Significance: The Triceratops, ‘Torosaurus’, and ‘Nedoceratops ’ morphologies represent ontogenetic variatio