Clinical outcomes and patterns of care in the treatment of carcinosarcoma of the breast

Purpose: Carcinosarcoma of the breast is a rare yet highly aggressive tumor accounting for \u3c1% of all breast cancers, for which guidance on optimal management and prognosis are sparse. The purpose of this study was to investigate population-based treatment patterns and overall survival (OS) outcomes in patients with this diagnosis. Materials and Methods: We queried the National Cancer Database for patients diagnosed with carcinosarcoma of the breast. All patients included were treated with surgery in the form of mastectomy or lumpectomy, with or without chemotherapy and/or radiation therapy. Patients with metastatic disease were excluded. Kaplan-Meier analysis was used to estimate OS. Univariate and multivariable Cox analyses were used to determine predictive factors of OS. Results: A total of 329 patients from 2004 to 2012 were identified. Median age at diagnosis was 58 years (range, 24-90). Patients had T1 (21%), T2 (44%), T3 (25%), or T4 disease (10%). Most patients were node-negative at diagnosis (77%). Breast conservation surgery was utilized in 33% of patients. Chemotherapy was used in 66% of patients. Less than half (44%) of patients received radiation therapy to a median dose of 50.4 Gy (range 35-56 Gy), with a median 10 Gy boost used in 76%. With a median follow-up of 40.0 months, 3- and 5-year OS for all patients was 74% and 60%, respectively. Kaplan-Meier estimates revealed the 3-yr OS was 80% in patients receiving chemotherapy vs 59% without chemotherapy (P \u3c 0.001). The 3-yr OS was 82% in patients receiving RT vs 66% without RT (P = 0.001). On multivariable analysis, OS was significantly influenced by Charlson-Deyo comorbidity index, insurance status, clinical T stage, surgical margin status, and treatment group, with trimodality therapy (HR: 0.45, 95% CI: 0.27-0.78; P = 0.004) and surgery plus CT (HR: 0.54, 95% CI: 0.33-0.90; P = 0.02) being associated with the greatest OS. Logistic regression revealed only younger patients were more likely to receive trimodality therapy. Conclusions: Carcinosarcoma of the breast is associated with relatively poor rates of OS. The addition of CT and RT to surgery improves OS. Trimodality therapy and surgery plus CT were associated with the greatest OS compared to surgery alone

Microcomputer-based tests for repeated-measures: Metric properties and predictive validities

A menu of psychomotor and mental acuity tests were refined. Field applications of such a battery are, for example, a study of the effects of toxic agents or exotic environments on performance readiness, or the determination of fitness for duty. The key requirement of these tasks is that they be suitable for repeated-measures applications, and so questions of stability and reliability are a continuing, central focus of this work. After the initial (practice) session, seven replications of 14 microcomputer-based performance tests (32 measures) were completed by 37 subjects. Each test in the battery had previously been shown to stabilize in less than five 90-second administrations and to possess retest reliabilities greater than r = 0.707 for three minutes of testing. However, all the tests had never been administered together as a battery and they had never been self-administered. In order to provide predictive validity for intelligence measurement, the Wechsler Adult Intelligence Scale-Revised and the Wonderlic Personnel Test were obtained on the same subjects

Disodium (2RS,3SR)-tartrate

The asymmetric unit of the anhydrous title compound, 2Na+·C4H4O6 2−, contains two sodium cations and one tartrate anion. Each sodium ion is six coordinate, with bonding to six O atoms from both the carboxyl­ate and hydroxyl groups of the anion. A three-dimensional coordination network is formed with sodium ions stacking in layers along the c-axis direction. This network is supported by additional O—H⋯O hydrogen bonds

Exploring Cognitive States: Methods for Detecting Physiological Temporal Fingerprints

Cognitive state detection and its relationship to observable physiologically telemetry has been utilized for many human-machine and human-cybernetic applications. This paper aims at understanding and addressing if there are unique psychophysiological patterns over time, a physiological temporal fingerprint, that is associated with specific cognitive states. This preliminary work involves commercial airline pilots completing experimental benchmark task inductions of three cognitive states: 1) Channelized Attention (CA); 2) High Workload (HW); and 3) Low Workload (LW). We approach this objective by modeling these "fingerprints" through the use of Hidden Markov Models and Entropy analysis to evaluate if the transitions over time are complex or rhythmic/predictable by nature. Our results indicate that cognitive states do have unique complexity of physiological sequences that are statistically different from other cognitive states. More specifically, CA has a significantly higher temporal psychophysiological complexity than HW and LW in EEG and ECG telemetry signals. With regards to respiration telemetry, CA has a lower temporal psychophysiological complexity than HW and LW. Through our preliminary work, addressing this unique underpinning can inform whether these underlying dynamics can be utilized to understand how humans transition between cognitive states and for improved detection of cognitive states

Pseudotumor cerebri syndrome in childhood : incidence, clinical profile and risk factors in a national prospective population-based cohort study

Aim To investigate the epidemiology, clinical profile and risk factors of pseudotumor cerebri syndrome (PTCS) in children aged 1-16 years. Methods A national prospective population-based cohort study over 25 months. Newly diagnosed PTCS cases notified via British Paediatric Surveillance Unit (BPSU) were ascertained using classical diagnostic criteria and categorised according to 2013 revised diagnostic criteria. We derived national age, sex and weight-specific annual incidence rates and assessed effects of sex and weight category. Results We identified 185 PTCS cases of which 166 also fulfilled revised diagnostic criteria. The national annual incidence (95% CI) of childhood PTCS aged 1-16 years was 0.71 (0.57- 0.87) per 100,000 population increasing with age and weight to 4.18 and 10.7 per 100,000 in obese 12-15 year old boys and girls respectively. Incidence rates under 7 years were similar in both sexes. From 7 years onwards, the incidence in girls was double that in boys, but only in overweight (including obese) children. In 12-15 year old children, an estimated 82% of the incidence of PTCS was attributable to obesity. Two subgroups of PTCS were apparent: 168 (91%) cases aged from 7 years frequently presented on medication and with headache, and were predominantly female and obese. The remaining 17 (9%) cases under 7 years often lacked these risk factors and commonly presented with new onset squint. Conclusions This uniquely largest population-based study of childhood PTCS will inform the design of future intervention studies. It suggests that weight reduction is central to the prevention of PTCS

Two alternative approaches to access mixed hydride-amido zinc complexes : synthetic, structural and solution implications

Using bis(amide) Zn(HMDS)2 (HMDS = 1,1,1,3,3,3-hexamethyldisilazide) as a precursor, this study explores the synthesis of N-heterocyclic carbene stabilized mixed amido-hydride zinc complexes using two alternative hydride sources, namely dimethylamine borane (DMAB) and phenylsilane PhSiH3. Hydride-rich zinc cluster Zn4(HMDS)2H6·2IPr (1) (IPr = 1,3-bis(2,6-di-isopropylphenyl)imidazol-2-ylidene), which can be envisaged as a co-complex of IPr·ZnH2 and (HMDS)ZnH, is obtained when DMAB is employed, with the concomitant formation of heteroleptic bis(amido)borane [HB(NMe2)(HMDS)] and H2 evolution. NMR studies in d8-THF show that although the bulky carbene IPr does not bind to the zinc bis(amide), its presence in the reaction media is required in order to stabilise 1. Reactions using the slightly less sterically demanding NHC IXy (IXy = 1,3-bis-(2,6-dimethylphenyl)imidazol-2-ylidene) led to the isolation and structural elucidation of the carbene adduct Zn(HMDS)2·IXy (2). Contrastingly, mixtures of equimolar amounts of PhSiH3 and the zinc bis(amide) (60 °C, 3 h, hexane) afforded monomeric heteroleptic hydride (HMDS)ZnH·IPr (3). NMR studies, including DOSY experiments, revealed that while the integrity of 3 is retained in polar d8-THF solutions, in lower polarity C6D6 it displays a much more complex solution behaviour, being in equilibrium with the homoleptic species ZnH2·IPr, Zn(HMDS)2 and IPr