Is the breast-conserving treatment with radiotherapy appropriate in mutation carriers? Long-term results and review of the literature

International audienceAs tumours in mutation carriers might be more sensitive to radiation, we investigated after long-term follow-up whether mutation status influenced the rate of ipsilateral and contralateral breast cancers after breast-conserving treatment (BCT). and genes were screened for germline mutations in 131 patients with a family history of breast and/or ovarian cancer who had undergone BCT and radiotherapy. Patients were matched to 261 controls with sporadic breast cancer according to age at diagnosis and year of treatment. Controls were followed up for at least as long as the interval between diagnosis and genetic screening in familial cases. Rates of ipsilateral and contralateral cancer between groups were compared by the log-rank test. The mutations occurred in 20.6% of tested patients. Tumours in mutation carriers were more likely to be grade III ( < 10) and oestrogen receptor negative ( = 0.005) than in non-carriers and controls. Overall median follow-up was 161 months. There was no significant difference in ipsilateral tumours between mutation carriers, non-carriers and controls ( = 0.13). On multivariate analysis, age was the most significant predictor for ipsilateral recurrence ( < 10). The rate of contralateral cancer was significantly higher in familial cases: 40.7% (mutation carriers), 20% (non-carriers), and 11% (controls) ( < 10). After 13.4 years of follow-up, the rate of ipsilateral tumours was no higher in mutation carriers than in non-carriers or controls. As tumours in mutation carriers might be more sensitive to radiation, BCT is a possible treatment option

Neither Major, nor Minor: The Affective Fluctuating Third in Central-European Art Music ca. 1840–1940

From the middle of the nineteenth century onwards, several composers have attempted to capture a phenomenon of unstable major and minor intervals in folk music. Looking at the transcultural impact of this representational drive, this paper focuses on one particular scale degree – the third – and on particular contexts where the modal fluctuation of the third subverts the traditional ethos of major and minor, inherited from the eighteenth-century art music. Bartók’s interest in the neutral third has received some attention from Olsvai (1969) and more recently Riskó (2015), but the affective meaning of this third within Bartók’s largely triadic harmony deserves more attention, even if of a speculative nature. Applying a circumplex model of affects (originally devised by Russell, 1980) to ‘Major and Minor’ from Bartók’s Mikrokosmos suggests the manipulation of traditional mode-related affect had additional consequences for the perception beginning, middle and ending of this short masterpiece. In the second part of this paper, a similar application of both formal and affective analysis will look at earlier works by Dvořák, Brahms and Liszt, where triadic harmony would normally invite a tonal analysis that would cover up the phenomenon of the fluctuating third and its transcultural affective impact. To narrow down the analysis to comparable cases, this part is limited to works by art-music genres that represent traditional Central European musics, all exhibiting an energetic and positive mood

The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging

Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of 'Interventional Imaging' for SHD interventions and a new dedicated professional figure, the 'Interventional Imager' with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.Cardiolog

Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging.

peer reviewedHeart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment