Ultrasound-Guided Optical Tomographic Imaging of Malignant and Benign Breast Lesions: Initial Clinical Results of 19 Cases

AbstractThe diagnosis of solid benign and malignant tumors presents a unique challenge to all noninvasive imaging modalities. Ultrasound is used in conjunction with mammography to differentiate simple cysts from solid lesions. However, the overlapping appearances of benign and malignant lesions make ultrasound less useful in differentiating solid lesions, resulting in a large number of benign biopsies. Optical tomography using near-infrared diffused light has great potential for imaging functional parameters of 1) tumor hemoglobin concentration, 2) oxygen saturation, 3) metabolism, as well as other tumor distinguishing characteristics. These parameters can differentiate benign from malignant lesions. However, optical tomography, when used alone, suffers from low spatial resolution and target localization uncertainty due to intensive light scattering. Our aim is to combine diffused light imaging with ultrasound in a novel way for the detection and diagnosis of solid lesions. Initial findings of two earlystage invasive carcinomas, one combined fibroadenoma and fibrocystic change with scattered foci of lobular neoplasia/lobular carcinoma in situ, 16 benign lesions are reported in this paper. The invasive cancer cases reveal about two-fold greater total hemoglobin concentration (mean 119 μmol) than benign cases (mean 67 μmol), suggest that the discrimination of benign and malignant breast lesions might be enhanced by this type of achievable optical quantification with ultrasound localization. Furthermore, the small invasive cancers are well localized and have wavelength-dependent appearance in optical absorption maps, whereas the benign lesions appear diffused and relatively wavelength-independent

On the (Parameterized) Complexity of Recognizing Well-covered (r,l)-graphs

An (r,ℓ)(r,ℓ)-partition of a graph G is a partition of its vertex set into r independent sets and ℓℓ cliques. A graph is (r,ℓ)(r,ℓ) if it admits an (r,ℓ)(r,ℓ)-partition. A graph is well-covered if every maximal independent set is also maximum. A graph is (r,ℓ)(r,ℓ)-well-covered if it is both (r,ℓ)(r,ℓ) and well-covered. In this paper we consider two different decision problems. In the (r,ℓ)(r,ℓ)-Well-Covered Graph problem ((r,ℓ)(r,ℓ) wcg for short), we are given a graph G, and the question is whether G is an (r,ℓ)(r,ℓ)-well-covered graph. In the Well-Covered (r,ℓ)(r,ℓ)-Graph problem (wc (r,ℓ)(r,ℓ) g for short), we are given an (r,ℓ)(r,ℓ)-graph G together with an (r,ℓ)(r,ℓ)-partition of V(G) into r independent sets and ℓℓ cliques, and the question is whether G is well-covered. We classify most of these problems into P, coNP-complete, NP-complete, NP-hard, or coNP-hard. Only the cases wc(r, 0)g for r≥3r≥3 remain open. In addition, we consider the parameterized complexity of these problems for several choices of parameters, such as the size αα of a maximum independent set of the input graph, its neighborhood diversity, or the number ℓℓ of cliques in an (r,ℓ)(r,ℓ)-partition. In particular, we show that the parameterized problem of deciding whether a general graph is well-covered parameterized by αα can be reduced to the wc (0,ℓ)(0,ℓ) g problem parameterized by ℓℓ, and we prove that this latter problem is in XP but does not admit polynomial kernels unless coNP⊆NP/polycoNP⊆NP/poly

Evolution of rare earth element and εNd compositions of Gulf of Mexico seawater during interaction with Mississippi River sediment

A closed-system batch reaction experiment was conducted for 270 days to evaluate the effects of interaction between Gulf of Mexico (GOM) seawater and Mississippi River sediments on the system’s dissolved rare earth elements (REE) concentrations and neodymium isotopic compositions (εNd). This study specifically focuses on geochemical reactions involving silicic sediments derived from weathering of the North American continent as they affect the REEs and εNd of seawater along continental margins, in contrast to previous studies that investigated the influence of basaltic rocks and sediments on REEs and εNd in the ocean. Our results show that the dissolution of labile phases of lithogenic Mississippi River sediments leads to an approximately 100-fold increase in dissolved REE concentrations within the first 33 days of the experiment. Secondary mineral precipitation appears to lower the REE concentrations between days 33 and 270 of the experiment, although seawater REE concentrations remain elevated compared to initial values. The two-way elemental transfer involving dissolution and precipitation results in a net increase by a factor of 24 ± 12 (mean ± 1σ) in the dissolved REE concentrations by the end of the experiment (i.e., day 270). The dissolved REE concentration maxima observed after 33 days of the experiment represent the mobilization of approximately 0.37 % of the REE content of the operationally defined “exchangeable” fraction of the riverine sediments. The εNd values of the reactive lithogenic components were −9.77 and −9.95, which are similar to the GOM value of −9.81 ± 0.36. Because of the similarity between εNd values, changes in the seawater Nd isotope value throughout the experiment were subtle (mean ± std, reacted seawater εNd of −9.87 ± 0.17). The highest REE concentrations coincided with the most radiogenic εNd (-9.65 ± 0.23; day 33), which suggests that REE concentrations and εNd compositions of the GOM may be buffered by fluxes from sediments in the system. Our results are comparable to previous studies involving basaltic rocks and/or sediments of basaltic composition in that they demonstrate that silicic, river sediments are highly reactive in marine environments with regard to REE mobilization. The experimental results further suggest that “boundary exchange” plays an important role in influencing the εNd of seawater along continental margins dominated by large river systems, although the impacts of boundary exchange will be most profound where ambient seawater and river sediments have distinct Nd isotopic compositions (e.g., basaltic, or Precambrian shield material). Finally, our results indicate that the εNd value of GOM seawater is largely controlled by the lithogenic sediment delivered to the basin by the Mississippi River

Congestion games with mixed objectives

We study a new class of games which generalizes congestion games and its bottleneck variant. We introduce congestion games with mixed objectives to model network scenarios in which players seek to optimize for latency and bandwidths alike. We characterize the existence of pure Nash equilibria (PNE) and the convergence of improvement dynamics. For games that do not possess PNE we give bounds on the approximation ratio of approximate pure Nash equilibria

Rare Earth Elements Geochemistry and Nd Isotopes in the Mississippi River and Gulf of Mexico Mixing Zone

Rare earth elements (REE) concentrations were measured in surface waters collected across the salinity gradient in the Mississippi River estuary (i. e., Mississippi River plume, MRP), which includes the near-shore portion of the Louisiana Shelf. In addition, the neodymium (Nd) isotope compositions of two river water samples, and the acid leachable fractions of the associated suspended particulate matter (SPM), were quantified to compare Mississippi River water, and SPM with Gulf of Mexico waters. Despite the spatial limitations associated with sampling due to the size of the Mississippi River system, this study provides some important insights into the REE geochemistry of the MRP. The Mississippi River and its estuarine waters are enriched in the heavy REE (HREE) compared to the light REE (LREE) when normalized to shale composites. All water samples from the estuary also exhibit substantial negative Ce anomalies. In contrast to the majority of other estuaries investigated, removal of REE in the low salinity reaches of the Mississippi River estuary is less substantial. For example, approximately 50% of the river borne Nd is removed in the low salinity region (S < 10) of the Mississippi River estuary, compared to the estimated global average of ca. 70% removal of Nd for estuaries worldwide. We propose that the relatively low REE removal in the Mississippi estuary reflects the high pH (~8) of the Mississippi River, where REE complexation with carbonate ions and natural organic ligands act to stabilize REE in solution. The Nd isotope composition of Mississippi River water near its outflow to the Gulf of Mexico is εNd(0) = −10.5. The acid leachable fraction of the associated SPM is more radiogenic (−9.95 ≤ εNd(0) ≤ −9.77), and closer to the generally more radiogenic Gulf of Mexico [εNd(0) = −9.0]. Sequential extraction of the Mississippi River bank sediment reveals substantially different Sm/Nd ratios for the operationally defined fractions of the sediment, which suggests variations in Nd isotope compositions between the labile fractions and the bulk sediment

Ultrasound-Guided Optical Tomographic Imaging of Malignant and Benign Breast Lesions: Initial Clinical Results of 19 Cases

The diagnosis of solid benign and malignant tumors presents a unique challenge to all noninvasive imaging modalities. Ultrasound is used in conjunction with mammography to differentiate simple cysts from solid lesions. However, the overlapping appearances of benign and malignant lesions make ultrasound less useful in differentiating solid lesions, resulting in a large number of benign biopsies. Optical tomography using near-infrared diffused light has great potential for imaging functional parameters of 1) tumor hemoglobin concentration, 2) oxygen saturation, and 3) metabolism, as well as other tumor distinguishing characteristics. These parameters can differentiate benign from malignant lesions. However, optical tomography, when used alone, suffers from low spatial resolution and target localization uncertainty due to intensive light scattering. Our aim is to combine diffused light imaging with ultrasound in a novel way for the detection and diagnosis of solid lesions. Initial findings of two earlystage invasive carcinomas, one combined fibroadenoma and fibrocystic change with scattered foci of lobular neoplasia/lobular carcinoma in situ, and 16 benign lesions are reported in this paper. The invasive cancer cases reveal about two-fold greater total hemoglobin concentration (mean 119 µmol) than benign cases (mean 67 µmol), and suggest that the discrimination of benign and malignant breast lesions might be enhanced by this type of achievable optical quantification with ultrasound localization. Furthermore, the small invasive cancers are well localized and have wavelength-dependent appearance in optical absorption maps, whereas the benign lesions appear diffused and relatively wavelength-independent

Utilizing Optical Tomography with Ultrasound Localization to Image Heterogeneous Hemoglobin Distribution in Large Breast Cancers

PURPOSE: Angiogenesis in advanced breast cancers is highly distorted and heterogeneous. Noninvasive imaging that can monitor angiogenesis may be invaluable initially for diagnosis and then for assessing tumor response to treatment. By combining ultrasound (US) and near-infrared (NIR) optical imaging, a reliable new technique has emerged for localizing and characterizing tumor angiogenesis within the breast. METHODS: This new technique employs a commercial US transducer coupled with an array of NIR optical fibers mounted on a hand-held probe. The US image is used for lesion localization and for guiding optical imaging reconstruction. Optical sensors are used for imaging tumor total hemoglobin distribution, which is directly related to tumor angiogenesis. RESULTS: Six large breast carcinomas were studied and microvessel density count was then performed on tissue samples obtained from these cancers. Two patients had locally advanced breast cancers and received neoadjuvant chemotherapy for 3 months. In one patient, before chemotherapy, the total hemoglobin distribution showed a high concentration at the cancer periphery; the distribution was later confined to the core area after 3 months of treatment. In another patient, as treatment progressed, the maximum hemoglobin concentration decreased from 255.3, to 147.5, to 76.9 wmol/I with an associated reduction in spatial extension. The other four patients had cancers of 2.0 to 3.0 cm in size and were imaged either at the time of core biopsy or definitive surgery. The histologic microvessel density counts from these tumor samples correlate to hemoglobin distributions with a correlation coefficient of 0.64 (P < .05). CONCLUSION: These initial results suggest that this new imaging technique may have great potential in imaging the heterogeneous vascular distribution of larger breast cancers in vivo and in monitoring treatment-related changes in angiogenesis during chemotherapy

Adherence to treatment guidelines and survival for older patients with stage II or III colon cancer in Texas from 2001 through 2011

BACKGROUND: Treatment guidelines for colon cancer recommend colectomy with lymphadenectomy of at least 12 lymph nodes for patients with stage I to stage III disease as surgery adherence (SA) and adjuvant chemotherapy for individuals with stage III disease. Herein, the authors evaluated adherence to these guidelines among older patients in Texas with colon cancer and the associated survival outcomes. METHODS: Using Texas Cancer Registry data linked with Medicare data, the authors included patients with AJCC stage II and III colon cancer who were aged ?66 years and diagnosed between 2001 and 2011. SA and adjuvant chemotherapy adherence rates to treatment guidelines were estimated. The chi-square test, general linear regression, survival probability, and Cox regression were used to identify factors associated with adherence and survival. RESULTS: The rate of SA increased from 47.2% to 84% among 6029 patients with stage II or stage III disease from 2001 to 2011, and the rate of adjuvant chemotherapy increased from 48.9% to 53.1% for patients with stage III disease during the same time period. SA was associated with marital status, tumor size, surgeon specialty, and year of diagnosis. Patient age, sex, marital status, Medicare state buy-in status, comorbidity status, and year of diagnosis were found to be associated with adjuvant chemotherapy. The 5-year survival probability for patients receiving guideline-concordant treatment was the highest at 87% for patients with stage II disease and was 73% for those with stage III disease. After adjusting for demographic and tumor characteristics, improved cancer cause-specific survival was associated with the receipt of stage-specific, guideline-concordant treatment for patients with stage II or stage III disease. CONCLUSIONS: The adherence to guideline-concordant treatment among older patients with colon cancer residing in Texas improved over time, and was associated with better survival outcomes. Future studies should be focused on identifying interventions to improve guideline-concordant treatment adherence