Evaluation Of Lymphatic Compensation By Lymphoscintigraphy In The Postoperative Period Of Breast Cancer Surgery With Axillary Dissection

Objective. To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection. Subjects and methods. Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of 99mTc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery. Results. In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment. Conclusions. The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.973309315(2010) [INCA] National Cancer Institute [On Line], , http://www.inca.gov.br_[15Jan2010], Brazil. Health DepartmentSoran, A., D'Angelo, G., Begovic, M., Ardic, F., Harlak, A., Samuel, W.H., Vogel, V.G., Johnson, R.R., Breast cancer-related lymphedema - What are the significant predictors and how they affect the severity of lymphedema? (2006) Breast Journal, 12 (6), pp. 536-543. , DOI 10.1111/j.1524-4741.2006.00342.xWerner, R.S., Mccormick, B., Petrek, J., Arm edema in conservatively managed breast cancer: Obesity is a major predictive factor (1991) Radiology, 180, pp. 177-1784Guedes Neto, H.L., Arm edema after treatment for breast cancer (1997) Lymphology, 30, pp. 35-36Warren, A.G., Brorson, H., Borud, L.J., Slavin, S.A., Lymphedema: A comprehensive review (2007) Annals of Plastic Surgery, 59 (4), pp. 464-472. , DOI 10.1097/01.sap.0000257149.42922.7e, PII 0000063720071000000022Lee, T.S., Kilbreath, S.L., Refshauge, K.M., Herbert, R.D., Beith, J.M., Prognosis of the upper limb following surgery and radiation for breast cancer (2008) Breast Cancer Research and Treatment, 110 (1), pp. 19-37. , DOI 10.1007/s10549-007-9710-9Szuba, A., Shin, W.S., Strauss, H.W., Rockson, S., The third circulation: Radionuclide lymphoscintigraphy in the evaluation of lymphedema (2003) Journal of Nuclear Medicine, 44 (1), pp. 43-57Howarth, D., Increased Lymphoscintigraphy flow pattern in the lower extremity under evaluation for lymphedema (1997) Mayo Clin Proc, 72, pp. 423-429Gloviczki, P., Calcagno, D., Schirger, A., Pairolero, P.C., Cherry, K.J., Hallet, J.W., Wahner, H.W., Noninvasive evaluation of the swollen extremity: Experiences with 190 lymphoscintigraphy examinations (1989) J Vasc Surg, 9, pp. 683-689Bourgeois, P., Leduc, O., Leduc, A., Imaging techniques in the management and prevention of posttherapeutic upper limb edemas (1998) Cancer, 83 (12 SUPPL. AMERICAN), pp. 2805-2813Baulieu, F., Itti, R., Taieb, W., Richard, G., Martinat, H., Barsotti, J., Lymphoscintigraphy. A predictive test of post-traumatic lymphedema of the lower limbs (1985) Rev Chir Orthop Reparatrice Appar Mot, 71, pp. 327-332Scarsbrook, A.F., Ganeshan, A., Bradley, K.M., Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: Evaluation of extremity lymphoedema (2007) British Journal of Radiology, 80 (951), pp. 219-226. , DOI 10.1259/bjr/68256780Celebioglu, F., Perbeck, L., Frisell, J., Grondal, E., Svensson, L., Danielsson, R., Lymph drainage studied by lymphoscintigraphy in the arms after sentinel node biopsy compared with axillary lymph node dissection following conservative breast cancer surgery (2007) Acta Radiologica, 48 (5), pp. 488-495. , DOI 10.1080/02841850701305440, PII 778956448Szuba, A., Pyszel, A., Jedrzejuk, D., Janczak, D., Andrzejak, R., Presence of functional axillary lymph nodes and lymph drainage within arms in women with and without breast cancer-related lymphedema (2007) Lymphology, 40 (2), pp. 81-86Yuan, Z., Chen, L., Luo, Q., Zhu, J., Lu, H., Zhu, R., The role of radionuclide lymphoscintigraphy in extremity lymphedema (2006) Annals of Nuclear Medicine, 20 (5), pp. 341-344. , http://www.jsnm.org/cgi-bin/select.cgi?file=06070801&filetype=2Petrek, J.A., Pressman, P.I., Smith, R.A., Lymphedema: Current issues in research and management (2000) CA Cancer J Clin, 50, pp. 292-307Szuba, A., Strauss, W., Sirsikar, S.P., Rockson, S.G., Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity (2002) Nuclear Medicine Communications, 23 (12), pp. 1171-1175. , DOI 10.1097/00006231-200212000-00004O'Mahony, S., Rose, S.L., Chilvers, A.J., Ballinger, J.R., Solanki, C.K., Barber, R.W., Mortimer, P.S., Peters, A.M., Finding an optimal method for imaging lymphatic vessels of the upper limb (2004) European Journal of Nuclear Medicine and Molecular Imaging, 31 (4), pp. 555-563Kim, C., Li, B., Papaiconomou, C., Zakharov, A., Johnston, M.G., Functional impact of lymphangiogenesis on fluid transport after lymph node excision (2003) Lymphology, 36 (3), pp. 111-119(2000) Ethical Principles for Medical Research Involving Human Subjects (On Line), , http//:www.ibemol.com.br/declaracoes/helsinque, World Medical Association Declaration of Helsinki: Edinburgh, Scotland. Out 7thAltman, D.G., (1991) Practical Statistics for Medical Research, , 1st edn Chapman &ampHall, LondonSuami, H., Pan, W.-R., Taylor, G.I., Changes in the lymph structure of the upper limb after axillary dissection: Radiographic and anatomical study in a human cadaver (2007) Plastic and Reconstructive Surgery, 120 (4), pp. 982-991. , DOI 10.1097/01.prs.0000277995.25009.3e, PII 0000653420070915000022Foldi, E., Foldi, M., Clodius, L., The lymphedema chaos: A lancet (1989) Annals of Plastic Surgery, 22 (6), pp. 505-515Clodius, L., Minimizing secondary arm lymphedema from axillary dissection (2001) Lymphology, 34, pp. 106-110Gashev, A.A., Zawieja, D.C., Physilogy of human lymphatic contractility: A historical perspective (2001) Lymphology, 34 (3), pp. 124-134Purushotham, A.D., Britton, T.M.B., Klevesath, M.B., Chou, P., Agbaje, O.F., Duffy, S.W., Lymph node status and breast cancer-related lymphedema (2007) Annals of Surgery, 246 (1), pp. 42-45. , DOI 10.1097/01.sla.0000259390.51203.7b, PII 000006582007070000000

From Perception to Activation: The Molecular-Genetic and Biochemical Landscape of Disease Resistance Signaling in Plants

More than 60 years ago, H.H. Flor proposed the “Gene-for-Gene” hypothesis, which described the genetic relationship between host plants and pathogens. In the decades that followed Flor's seminal work, our understanding of the plant-pathogen interaction has evolved into a sophisticated model, detailing the molecular genetic and biochemical processes that control host-range, disease resistance signaling and susceptibility. The interaction between plants and microbes is an intimate exchange of signals that has evolved for millennia, resulting in the modification and adaptation of pathogen virulence strategies and host recognition elements. In total, plants have evolved mechanisms to combat the ever-changing landscape of biotic interactions bombarding their environment, while in parallel, plant pathogens have co-evolved mechanisms to sense and adapt to these changes. On average, the typical plant is susceptible to attack by dozens of microbial pathogens, yet in most cases, remains resistant to many of these challenges. The sum of research in our field has revealed that these interactions are regulated by multiple layers of intimately linked signaling networks. As an evolved model of Flor's initial observations, the current paradigm in host-pathogen interactions is that pathogen effector molecules, in large part, drive the recognition, activation and subsequent physiological responses in plants that give rise to resistance and susceptibility. In this Chapter, we will discuss our current understanding of the association between plants and microbial pathogens, detailing the pressures placed on both host and microbe to either maintain disease resistance, or induce susceptibility and disease. From recognition to transcriptional reprogramming, we will review current data and literature that has advanced the classical model of the Gene-for-Gene hypothesis to our current understanding of basal and effector triggered immunity

Necrotroph Attacks on Plants: Wanton Destruction or Covert Extortion?

Necrotrophic pathogens cause major pre- and post-harvest diseases in numerous agronomic and horticultural crops inflicting significant economic losses. In contrast to biotrophs, obligate plant parasites that infect and feed on living cells, necrotrophs promote the destruction of host cells to feed on their contents. This difference underpins the divergent pathogenesis strategies and plant immune responses to biotrophic and necrotrophic infections. This chapter focuses on Arabidopsis immunity to necrotrophic pathogens. The strategies of infection, virulence and suppression of host defenses recruited by necrotrophs and the variation in host resistance mechanisms are highlighted. The multiplicity of intraspecific virulence factors and species diversity in necrotrophic organisms corresponds to variations in host resistance strategies. Resistance to host-specific necrotophs is monogenic whereas defense against broad host necrotrophs is complex, requiring the involvement of many genes and pathways for full resistance. Mechanisms and components of immunity such as the role of plant hormones, secondary metabolites, and pathogenesis proteins are presented. We will discuss the current state of knowledge of Arabidopsis immune responses to necrotrophic pathogens, the interactions of these responses with other defense pathways, and contemplate on the directions of future research

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection