Nodule heterogeneity as shown by size differences between the targeted nodule and the tumor in thyroidectomy specimen

BACKGROUND. Missed papillary thyroid carcinoma (PTC) diagnoses on fine-needle aspiration (FNA) can result from many causes. To the authors' knowledge, the issue of whether the detection of PTC is correlated with nodule heterogeneity has not been studied to date. METHODS. The authors identified all thyroidectomy specimens with a diagnosis of PTC that had undergone at least 1 prior FNA in the study institution between 1998 and 2003. The tumor size at the time of the resection, the ultrasound (US)-determined nodule size, and other parameters were compared between the 2 groups in which PTC was or was not diagnosed on FNA. RESULTS. Of a total of 89 specimens, 47 were diagnosed on FNA with an average tumor size of 1.7 cm and an US-determined nodule size of 2.1 cm (a difference of 0.4 cm). Forty-two specimens with a smaller average tumor size of 0.9 cm ( P <.0001) and a US-determined nodule size of 2.4 cm (a difference of 1.5 cm) were missed. The differences with regard to the US-determined nodule size and tumor size between the 2 groups were significant (0.4 cm vs 1.5 cm; P < .0001). In the missed group, 29 specimens were found to have PTC foci that measured ≤1.0 cm and 26 had a reasonable size difference (RSD; defined as a PTC size outside the range of ±50% of the US-determined nodule size) as the indicator of the mixed nature of nodules targeted for FNA, whereas in the diagnostic group, 9 foci measured ≤1.0 cm and 6 had RSD. There was no cytologic evidence with which to render a diagnosis of PTC on further review in the missed group. CONCLUSIONS. The major reason for a missed diagnosis of PTC on FNA is because of inadequate tumor sampling due to the heterogeneity of the nodule targeted for FNA. This is illustrated by the RSD noted between the targeted nodule and the actual PTC tumor focus in the resection specimen. Cancer (Cancer Cytopathol) 2008. © 2007 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58022/1/23253_ftp.pd

Toxicity of radiotherapy in patients with collagen vascular disease

BACKGROUND. A diagnosis of collagen vascular disease (CVD) may predispose to radiotherapy (RT) toxicity. The objective of the current study was to identify factors that influence RT toxicity in the setting of CVD. METHODS. A total of 86 RT courses for 73 patients with CVD were delivered between 1985 and 2005. CVD subtypes include rheumatoid arthritis (RA; 33 patients), systemic lupus erythematosus (SLE; 13 patients), scleroderma (9 patients), dermatomyositis/polymyositis (5 patients), ankylosing spondylitis (4 patients), polymyalgia rheumatica/temporal arteritis (4 patients), Wegener granulomatosis (3 patients), and mixed connective tissue disorders (MCTD)/other (2 patients). Each patient with CVD was matched to 1 to 3 controls with respect to sex, race, site irradiated, RT dose (±2 Gray), and age (±5 years). RESULTS. There was no significant difference between CVD patients (65.1%) and controls (72.5%) experiencing any acute toxicity. CVD patients had a higher incidence of any late toxicity (29.1% vs 14%; P = .001), and a trend toward an increased rate of severe late toxicity (9.3% vs 3.7%; P = .079). RT delivered to the breast had increased risk of severe acute toxicity, whereas RT to the pelvis had increased risk of severe acute and late toxicity. RT administered in the setting of scleroderma carried a higher risk of severe late toxicity, whereas RT to SLE patients carried a higher risk of severe acute and late toxicity. CONCLUSIONS. Although generally well tolerated, RT in the setting of CVD appears to carry a higher risk of late toxicity. RT to the pelvis or in the setting of SLE or scleroderma may predispose to an even greater risk of severe toxicity. These issues should be considered when deciding whether to offer RT for these patients. Cancer 2008. © 2008 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60460/1/23591_ftp.pd

Fertility and Childbearing Among American Female Physicians

Background: Female physicians may experience unique challenges regarding fertility and family planning. We sought to determine childbearing patterns and decision-making among American female physicians. Materials and Methods: In 2012?2013, we surveyed a random sample of 600 female physicians who graduated medical school between 1995 and 2000. Primary outcome measures included fertility and childbearing history, reflections regarding decision-making, perceptions of workplace support, and estimations of childbearing potential. Results: Response rate was 54.5% (327/600). A majority (82.0%) of the sample were parents, 77.4% had biological children with an average of 2.3 children. Average age at medical school graduation was 27.5 years, at completion of training (completion of medical school, residency, and/or fellowship) was 31.6 years, and at first pregnancy was 30.4 years. Nearly one quarter (24.1%) of respondents who had attempted conception were diagnosed with infertility, with an average age at diagnosis of 33.7 years. Among those with infertility, 29.3% reported diminished ovarian reserve. When asked what they would do differently in retrospect, most respondents (56.8%) would do nothing differently regarding fertility/conception/childbearing, 28.6% would have attempted conception earlier, 17.1% would have gone into a different specialty, and 7.0% would have used cryopreservation to extend fertility. Fewer of those whose first pregnancy was in medical school perceived substantial workplace support (68.2%) than those whose first pregnancies followed training (88.6%). Conclusions: A substantial proportion of female physicians have faced infertility or have regrets about family planning decisions and career decision-making. Combining a medical career with motherhood continues to pose challenges, meriting further investigation and targeted support.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140144/1/jwh.2015.5638.pd

Clinical Utility of Serum Autoantibodies Detected by Protein Microarray in Melanoma

Better prognostic and predictive markers in melanoma are needed to select patients for therapy. We utilized a dual-lectin affinity chromatography and a natural protein microarray-based analysis to select a subproteome of target glycoproteins to profile serum antibodies against melanoma associated antigens that may predict nodal positivity. We identified 5 melanoma-associated antigens using this microarray coupled to mass spectrometry; GRP75, GRP94, ASAH1, CTSD and LDHB. We evaluated their predictive value for nodal status adjusting for age, gender, Breslow thickness, mitotic rate and ulceration using standard logistic regression. After adjustment, ASAH1, CTSD and LDHB were significantly negatively associated with nodal status (P = 0.0008) and GRP94 was significantly positively associated (P = 0.014). Our best multivariate model for nodal positivity included Breslow thickness, presence of serum anti-ASAH1, anti-LDHB or anti-CTSD, and presence of serum anti-GRP94, with an area under the ROC curve of 0.869. If validated, these results show promise for selecting clinically node negative patients for SLN biopsy. In addition, there is strong potential for glycoprotein microarray to screen serum autoantibodies that may identify patients at high risk of distant metastases or those likely or unlikely to respond to treatment, and these proteins may serve as targets for intervention

Toxicity of Radiotherapy in Patients With Collagen Vascular Disease

Background A diagnosis of collagen vascular disease (CVD) may predispose to radiotherapy (RT) toxicity. The objective of the current study was to identify factors that influence RT toxicity in the setting of CVD. Methods A total of 86 RT courses for 73 patients with CVD were delivered between 1985 and 2005. CVD subtypes include rheumatoid arthritis (RA; 33 patients), systemic lupus erythematosus (SLE; 13 patients), scleroderma (9 patients), dermatomyositis/polymyositis (5 patients), ankylosing spondylitis (4 patients), polymyalgia rheumatica/temporal arteritis (4 patients), Wegener granulomatosis (3 patients), and mixed connective tissue disorders (MCTD)/other (2 patients). Each patient with CVD was matched to 1 to 3 controls with respect to sex, race, site irradiated, RT dose (±2 Gray), and age (±5 years). Results There was no significant difference between CVD patients (65.1%) and controls (72.5%) experiencing any acute toxicity. CVD patients had a higher incidence of any late toxicity (29.1% vs 14%; P = .001), and a trend toward an increased rate of severe late toxicity (9.3% vs 3.7%; P = .079). RT delivered to the breast had increased risk of severe acute toxicity, whereas RT to the pelvis had increased risk of severe acute and late toxicity. RT administered in the setting of scleroderma carried a higher risk of severe late toxicity, whereas RT to SLE patients carried a higher risk of severe acute and late toxicity. Conclusions Although generally well tolerated, RT in the setting of CVD appears to carry a higher risk of late toxicity. RT to the pelvis or in the setting of SLE or scleroderma may predispose to an even greater risk of severe toxicity. These issues should be considered when deciding whether to offer RT for these patients. Cancer 2008;113:648–53

NMR reveals the surface functionalisation of Ti3C2 MXene.

(1)H and (19)F NMR experiments have identified and quantified the internal surface terminations of Ti3C2Tx MXene. -F and -OH terminations are shown to be intimately mixed and there are found to be significantly fewer -OH terminations than -F and -O, with the proportions highly dependent on the synthesis method.We are grateful for financial support by the Oppenheimer Foundation and EPSRC. Material synthesis and characterization at Drexel University was supported by the US National Science Foundation under grant number DMR-1310245.This is the final version of the article. It first appeared from the Royal Society of Chemistry via http://dx.doi.org/10.1039/C6CP00330

Factors associated with endowed chair allocation in medical oncology in the United States

To explore persisting gender disparities across leadership roles in medicine, we examined factors associated with holding endowed chairs in US oncology divisions. In 2019, we identified 95 academic oncology divisions, using the Oncology Division Chiefs and Department Chairs listing in the American Society of Clinical Oncology myConnection forum. We collected public information on gender, degree, total National Institutes of Health funding as principal investigator, H-indices, publication and citation numbers, and graduation year and constructed a multivariable logistic regression model. All statistical tests were 2-sided. We identified 1087 oncology full professors. Of these, 287 (26.4%) held endowed chairs: 60 of 269 women (22.3%) vs 227 of 818 men (27.8%) (P = .08). On multivariable analysis, greater research productivity and National Institutes of Health funding were associated with having an endowed chair (P \u3c .001), whereas gender was not (P = .45). Though sample size was limited, if gender differences are in fact smaller in certain subspecialties than other fields of internal medicine, insights might emerge to guide efforts to promote equity

Differences between Breast Conservation‐Eligible Patients and Unilateral Mastectomy Patients in Choosing Contralateral Prophylactic Mastectomies

There has been an increasing use of bilateral mastectomy (BM) for breast cancer. We sought to examine our trends among breast conservation (BCT) candidates and women recommended for unilateral mastectomy (UM). Our prospective breast cancer database was queried for women with a first‐time, unilateral breast cancer. Patient and histologic factors and surgical treatment, including reconstruction, were evaluated. A detailed chart review was performed among patients from two representative time periods as to the reasons the patient underwent mastectomy. We identified 3,892 women between 2000 and 2012 of whom 60% underwent BCT, 1092 (28%) had UM and 12% underwent BM. BM rose from 4% in 2000 to a high of 19% in 2011, increasing around 2002 for women <40. BCT was less likely with decreasing age (p < 0.0001), lobular histology (p < 0.0001), higher stage (p < 0.0001) and decreasing BMI (p < 0.0001). Among mastectomy patients, contralateral mastectomy was associated with decreasing age (p < 0.0001), Caucasian race (p < 0.0001), and lower stage (p = 0.005). Over time, indications for mastectomy decreased while patients deemed BCT‐eligible opting for UM or BM increased dramatically. Increases in the use of BM are in large part among women who were otherwise BCT‐eligible. Factors associated with BM use are different for BCT‐eligible patients and those recommended for UM. A better understanding of the factors driving individual patient choices is needed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135041/1/tbj12648_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135041/2/tbj12648.pd

The Role of Ionic Liquid Breakdown in the Electrochemical Metallization of VO2: An NMR Study of Gating Mechanisms and VO2 Reduction.

Metallization of initially insulating VO2 via ionic liquid electrolytes, otherwise known as electrolyte gating, has recently been a topic of much interest for possible applications such as Mott transistors and memory devices. It is clear that the metallization takes place electrochemically, and, in particular, there has previously been extensive evidence for the removal of small amounts of oxygen during ionic liquid gating. Hydrogen intercalation has also been proposed, but the source of the hydrogen has remained unclear. In this work, solid-state magic angle spinning NMR spectroscopy (1H, 2H, 17O, and 51V) is used to investigate the thermal metal-insulator transition in VO2, before progressing to catalytically hydrogenated VO2 and electrochemically metallized VO2. In these experiments electrochemical metallization of bulk VO2 particles is shown to be associated with intercalation of hydrogen, the degree of which can be measured with quantitative 1H NMR spectroscopy. Possible sources of the hydrogen are explored, and by using a selectively deuterated ionic liquid, it is revealed that the hydrogenation is due to deprotonation of the ionic liquid; specifically, for the commonly used dialkylimidazolium-based ionic liquids, it is the "carbene" proton that is responsible. Increasing the temperature of the electrochemistry is shown to increase the degree of hydrogenation, forming first a less hydrogenated metallic orthorhombic phase then a more hydrogenated insulating Curie-Weiss paramagnetic orthorhombic phase, both of which were also observed for catalytically hydrogenated VO2. The NMR results are supported by magnetic susceptibility measurements, which corroborate the degree of Pauli and Curie-Weiss paramagnetism. Finally, NMR spectroscopy is used to identify the presence of hydrogen in an electrolyte gated thin film of VO2, suggesting that electrolyte breakdown, proton intercalation, and reactions with decomposition products within the electrolyte should not be ignored when interpreting the electronic and structural changes observed in electrochemical gating experiments.Oppenheimer Foundation The Winston Churchill Foundation of the United States Herchel Smith Scholarship EPSRC (EP/MO09521/1) EU H2020 program “Phase Change Switch” Alexander von Humboldt Foundatio