Evaluation of total choline from in-vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer

Results of the proton magnetic resonance spectroscopy carried out on normal, benign breast disease and locally advanced breast cancer patients are presented. The in-vivo MR spectra of malignant breast tissue of patients (n = 67) suffering from infiltrating ductal carcinoma are dominated by the water resonance, while the spectra of the unaffected contralateral breast tissue of these patients are mainly dominated by resonance arising from lipids which is similar to the spectra of normal breast tissue obtained from volunteers (controls, n = 16). In addition to the water and lipid peaks, in majority of the patients (~80%) the water suppressed spectra showed a resonance at 3.2 ppm due to choline containing compounds (TCho) before treatment. In patients receiving neoadjuvant chemotherapy, absence/reduction in choline was observed in 89% of the patients. TCho was also observed in 2 of 14 benign lesions. The sensitivity and specificity of in-vivo MRS in detecting TCho in malignant tumours was 78% and 86%, respectively. Observation of TCho before treatment and its disappearance (or reduction) after treatment may be a useful indicator of response of locally advanced breast cancer to neoadjuvant chemotherapy. © 2001 Cancer Research Campaign http://www.bjcancer.co

Multicentric myxoid liposarcoma: report of two cases

<p>Abstract</p> <p>Background</p> <p>Multicentric myxoid liposarcoma is a rather infrequent tumour that tends to behave aggressively.</p> <p>Case presentation</p> <p>We herein report two further cases of this tumour that have been managed in our Hospital. Both were young men with multiple sites of involvement at the moment of diagnosis and both have shown a bad prognosis with frequent recurrences after treatment and rapid death in one case.</p> <p>Conclusion</p> <p>We comment on the diagnosis of this entity and on the therapeutic options available for these patients.</p

Clinical Study Content of Trans Fatty Acids in Human Cheek Epithelium: Comparison with Serum and Adipose Tissue

Studies pertaining to trans fatty acids (TFA), which have been implicated in development of chronic diseases, are more relevant in developing countries where nutrition transition is changing traditional habits and practices. Measuring TFA is an arduous task because of the need for fat biopsies. This study identifies a tissue, which can be easily accessed for analytical measurement of trans fatty acid. In this cross-sectional study, fatty acid in adipose tissue, cheek epithelium, and blood samples were assessed by gas chromatography. Spearman correlation coefficient was computed to study the correlation of fatty acid distribution among the three tissues. The correlation coefficient of total trans fatty acid between cheek epithelium and serum was 0.30 ( &lt; 0.02) and between cheek epithelium and adipose tissue was 0.33 ( &lt; 0.019). This study is the first to report trans fatty acid profile in cheek epithelium giving scope for utilizing the cheek epithelium as a tissue for objective assessment of trans fatty acid intake

Second echelon node predicts metastatic involvement of additional axillary nodes following sentinel node biopsy in early breast cancer

BACKGROUND : In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS : SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS : We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION : Station II nodes may predict metastatic involvement of additional nodes in the axilla

Evaluation of very high- and very low-dose intravitreal aflibercept in patients with neovascular age-related macular degeneration.

PURPOSE: To determine bioactivity and duration of effect of intravitreal aflibercept injection (also known as vascular endothelial growth factor Trap-Eye) for neovascular age-related macular degeneration (AMD). METHODS: In this double-masked, phase 1 study, 28 patients with lesions ≤12 disc areas, ≥50% active choroidal neovascularization (CNV), and best corrected visual acuity (BCVA) ≤20/40 were randomized 1:1 to a single intravitreal injection of aflibercept 0.15 or 4 mg. The primary end point was the change from baseline in central retinal/lesion thickness (CR/LT) at week-8. Secondary outcomes were the change from baseline BCVA, the change in CNV lesion size and area of leakage, and proportion of patients requiring repeat injection at 8 weeks. RESULTS: Mean percent decrease in CR/LT for the 4-mg and 0.15-mg groups was, respectively, 34.2 versus 13.3 at week 4 (P=0.0065), 23.8 versus 5.9 at week 6 (P=0.0380), and 25.2% versus 11.3% at week 8 (P=0.150). The 4-mg group gained a mean of 4.5 letters in BCVA (6/14 patients gaining ≥10 letters) versus 1.1 letters in 0.15-mg group (1/14 gaining ≥10 letters) at week 8. Fewer patients needed retreatment in the 4-mg group at week 8. No serious adverse event or ocular inflammation was reported in either group. CONCLUSIONS: Intravitreal aflibercept 4 mg had a safety profile similar to that of the very low dose 0.15 mg, and was well-tolerated. The 4-mg dose significantly reduced foveal thickening at weeks 4 and 6, significantly improved BCVA at weeks 6, and reduced the need for repeat injection after 8 weeks compared with intravitreal aflibercept 0.15 mg in neovascular AMD patients

Adaptive Self-Explication of Multi-attribute Preferences

In this research we propose a web-based adaptive self-explicated approach for multi-attribute preference measurement (conjoint analysis) with a large number (ten or more) of attributes. In the empirical application reported here the proposed approach provides a substantial and significant improvement in predictive ability over current preference measurement methods designed for handling a large number of attributes. Our approach also overcomes some of the limitations of previous self-explicated approaches. Two methods are commonly used to estimate attribute importances in self-explicated studies: ratings and constant-sum allocation. A common problem with the ratings approach is that it does not explicitly capture the tradeoff between attributes; it is easy for respondents to say that every attribute is important. The constant-sum approach overcomes this limitation, but with a large number of product attributes it becomes difficult for the respondent to divide a constant sum among all the attributes. We developed a computer-based self-explicated approach that breaks down the attribute importance question into a sequence of constant-sum paired comparison questions. We first used a fixed design in which the set of questions is chosen from a balanced orthogonal design and then extend it to an adaptive design in which the questions are chosen adaptively for each respondent to maximize the information elicited from each paired comparison question. Unlike the traditional self-explicated approach, the proposed approach provides (approximate) standard errors for attribute importance. In a study involving digital cameras described on twelve attributes, we find that the predictive validity (correctly predicted top choices) of the proposed adaptive approach is 35%-52% higher than that of Adaptive Conjoint Analysis, the Fast Polyhedral approach, and the traditional self-explicated approach, irrespective of whether the part-worths were estimated using classical or hierarchical Bayes estimation. Additionally, the proposed adaptive approach reduces the respondents' burden by keeping the number of paired comparison questions small without significant loss of predictive validity.

The Impact of Unit Cost Reductions on Gross Profit: Increasing or Decreasing Returns?

When asked about the impact of unit manufacturing cost reductions on gross profit, many managers and academics assume that returns will be diminishing, i.e., that the first cent of unit cost reduction will generate more incremental gross profit than the last cent of unit cost savings, consistent with the economic intuition about diminishing returns. (The product's appeal to the market is assumed to remain constant.) The present paper shows why gross profits actually increase in a convex fashion under typical demand assumptions, providing increasing returns with each additional cent of reduction in unit manufacturing cost. The intuition is that if q units are sold at the current price, the first cent of unit cost reduction increases the gross profits by q cents (keeping the price at the current level). But further cost reductions bring about greater pricing flexibility so that the optimal price decreases, thereby increasing the quantity to q'. Thus, the last cent of cost reduction produces an incremental profit of q' cents, where q' > q. The convex returns are captured graphically in the "profit saddle," a simple plot of gross profit as a function of unit cost and unit price. Decreasing unit costs produce additional returns from learning curve effects, reduced per unit channel costs, quality improvements, and strategic considerations. Of course, the fixed investment entailed in reducing unit-manufacturing costs must be weighed against the returns from doing so, suggesting some optimal level of unit cost reduction efforts. Cost reduction has traditionally been the purview of the manufacturing function within the firm, and has been emphasized in the later phases of the product-process life cycle. Marketing managers, on the other hand, have focused on generating sales revenues through pricing, product positioning, promotion, and channel placement. The present paper suggests that the traditional view be questioned. The marketing function, and new product planning in particular, may want to consider unit manufacturing cost reduction a potent tool in pricing new products for marketing success.

The Asymmetric Share Effect: An Empirical Generalization on Absolute Cross-Price Effects

Past empirical literature states that asymmetry in cross-price effect favors the large-share brand. That is, when large-share brands discount, they have a greater impact on small-share brands than the reverse. This conclusion is based on consideration of cross-price elasticities. This paper points out that focusing on cross-elasticities for measuring asymmetry is inappropriate for assessing incremental profitability from price promotions. Instead, we should investigate asymmetries in absolute cross-price effects (i.e., change in market share of a competing brand for a unit price change of the focal brand). We theoretically and empirically demonstrate that asymmetry reverses when absolute cross-price effect is considered. That is, the absolute cross-price effect of a price reduction of a lower-share brand on the market share of a higher-share brand is greater than the reverse. The general intuition is that a small-share brand has a greater pool of consumers to draw from when it discounts than does a large-share brand. The implications of the findings and future research directions are discussed.

The Impact of Feature Advertising on Customer Store Choice

A heavily used competitive tactic in the grocery business is the weekly advertising of price reductions in newspaper inserts and store fliers. Store managers commonly believe that advertisements of price reductions and loss leaders help to build store traffic by diverting customers from competing stores, thereby increasing store volume and profitability. It is therefore not surprising that grocery retail planners across competing stores expend considerable thought on what items to advertise each week and at what levels of prominence. What is surprising, however, is that we marketing scientists do not know much about the manner and extent to which feature advertising in a competitive environment influences where and how customers shop. The marketing science literature has not even been able to establish that feature advertising has a substantial impact on store choice, let alone the more operational question of which categories are better at drawing consumers away from one store and into a competing store. In this paper we employ a stochastic choice modeling framework to propose and empirically estimate a disaggregate, consumer-level model of the effects of feature advertising on store choice. We use this model to understand which categories are more influential drivers of store traffic and better at diverting consumers from competing stores.