Pregnancy-associated breast cancer - Special features in diagnosis and treatment

For obvious psychological reasons it is difficult to associate pregnancy - a life-giving period of our existence with life-threatening malignancies. Symptoms pointing to malignancy are often ignored by both patients and physicians, and this, together with the greater difficulty of diagnostic imaging, probably results in the proven delay in the detection of breast cancers during pregnancy. The diagnosis and treatment of breast cancer are becoming more and more important, as the fulfillment of the desire to have children is increasingly postponed until a later age associated with a higher risk of carcinoma, and improved cure rates of solid tumors no longer exclude subsequent pregnancies. The following article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular consideration of cytostatic therapy

Assessing Mediator Performance: The Usefulness of Participant Questionnaires

As part of their obligation to provide quality services, courts that offer mediation need to periodically assess the performance of mediators to whom they refer cases. One of several methods that have been proposed for monitoring mediator quality is participant assessments of mediator performance. The present article reports an empirical study that examined attorneys\u27 assessments of the skillfulness of mediators in a federal appellate civil medations program. The attorneys rated some of the mediators as being more skillful than others, and these differences generally remained whether or not favorable outcomes were achieved in mediation. In addition, the attorneys rated individual mediators as being more skillful on some dimensions than others. These finding suggest that participant assessments could provide an effective means for monitoring mediator performance. We conclude by discussing a number of factors that could affect the usefulness of participant assessments

Thoughts of a Chief Circuit Mediator on Federal Court-Annexed Mediation

Published in cooperation with the American Bar Association Section of Dispute Resolutio

Prognostic relevance of disseminated tumor cells in the bone marrow and biological factors of 265 primary breast carcinomas

Introduction The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined `tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow ( BM) status for HER2, Topoisomerase IIa ( Top IIa), Ki 67, and p53. Methods BM analysis was performed by cytospin preparation and immunocytochemical staining for cytokeratin (CK). TMAs were examined by immunohistochemistry (IHC) for HER2, Top IIa, Ki 67 and p53, and fluorescence in situ hybridization ( FISH) for HER2. Results HER2 ( 2+/ 3+) was positive in 35/167 (21%) cases ( FISH 24.3%), Top IIa (> 10%) in 87/187 (46%), Ki 67 in 52/ 184 (28%) and p53 (> 5%) in 61/174 cases (34%). Of 265 patients, 68 (25.7%) showed DTC-BM with a median of 2/2 x 106 cells ( 1 to 1,500). None of the examined factors significantly predicted BM positivity. Significant correlation was seen between HER2 IHC and Top IIa ( p = 0.06), Ki 67 ( p = 0.031), and p53 ( p <.001). Top IIa correlated with Ki 67 and p53, and Ki 67 also with p53 ( p = 0.004). After a median follow-up of 60.5 months ( 7 to 255), the presence of DTC-BM showed prognostic relevance for overall survival ( p = 0.03), whereas HER2 ( IHC, p = 0.04; FISH, p = 0.03) and Ki 67 ( p = 0.04) correlated with disease free survival, and HER2 with distant disease free survival ( IHC, p = 0.06; FISH, p = 0.05). Discussion The congruence of the examined factors' expression rates indicates a causal line of suppressor, proliferation, and mitosis markers, and growth factor receptors. Hematogenous tumor cell spread seems to be an independent process. The examination of these factors on DTC-BM is the aim of ongoing research

Snow-driven uncertainty in CryoSat-2-derived Antarctic sea ice thickness – insights from McMurdo Sound

Knowledge of the snow depth distribution on Antarctic sea ice is poor but is critical to obtaining sea ice thickness from satellite altimetry measurements of the freeboard. We examine the usefulness of various snow products to provide snow depth information over Antarctic fast ice in McMurdo Sound with a focus on a novel approach using a high-resolution numerical snow accumulation model (SnowModel). We compare this model to results from ECMWF ERA-Interim precipitation, EOS Aqua AMSR-E passive microwave snow depths and in situ measurements at the end of the sea ice growth season in 2011. The fast ice was segmented into three areas by fastening date and the onset of snow accumulation was calibrated to these dates. SnowModel captures the spatial snow distribution gradient in McMurdo Sound and falls within 2&thinsp;cm snow water equivalent (s.w.e) of in situ measurements across the entire study area. However, it exhibits deviations of 5&thinsp;cm&thinsp;s.w.e. from these measurements in the east where the effect of local topographic features has caused an overestimate of snow depth in the model. AMSR-E provides s.w.e. values half that of SnowModel for the majority of the sea ice growth season. The coarser-resolution ERA-Interim produces a very high mean s.w.e. value 20&thinsp;cm higher than the in situ measurements. These various snow datasets and in situ information are used to infer sea ice thickness in combination with CryoSat-2 (CS-2) freeboard data. CS-2 is capable of capturing the seasonal trend of sea ice freeboard growth but thickness results are highly dependent on what interface the retracked CS-2 height is assumed to represent. Because of this ambiguity we vary the proportion of ice and snow that represents the freeboard – a mathematical alteration of the radar penetration into the snow cover – and assess this uncertainty in McMurdo Sound. The ranges in sea ice thickness uncertainty within these bounds, as means of the entire growth season, are 1.08, 4.94 and 1.03&thinsp;m for SnowModel, ERA-Interim and AMSR-E respectively. Using an interpolated in situ snow dataset we find the best agreement between CS-2-derived and in situ thickness when this interface is assumed to be 0.07&thinsp;m below the snow surface.</p

Snow accumulation and compaction derived from GPR data near Ross Island, Antarctica

We present an improved method for estimating accumulation and compaction rates of dry snow in Antarctica with ground penetrating radar (GPR). Using an estimate of the emitted waveform from direct measurements, we apply deterministic deconvolution via the Fourier domain to GPR data with a nominal frequency of 500 MHz. This reveals unambiguous reflection horizons which can be observed in repeat measurements made one year apart. At two measurement sites near Scott Base, Antarctica, we extrapolate point measurements of average accumulation from snow pits and firn cores to a larger area by identifying a dateable dust layer horizon in the radargrams. Over an 800 m × 800 m area on the McMurdo Ice Shelf (77°45´ S, 167°17´ E) the average accumulation is found to be 269 ± 9 kg m−2 a−1. The accumulation over an area of 400 m × 400 m on Ross Island (77°40´ S, 167°11´ E, 350 m a.s.l.) is found to be higher (404 ± 22 kg m−2 a−1) and shows increased variability related to undulating terrain. Compaction of snow between 2 m and 13 m depth is estimated at both sites by tracking several internal reflection horizons along the radar profiles and calculating the average change in separation of horizon pairs from one year to the next. The derived compaction rates range from 7 cm m−1 at a depth of 2 m, down to no measurable compaction at 13 m depth, and are similar to published values from point measurements

Louse-borne relapsing fever (Borrelia recurrentis) diagnosed in 15 refugees from northeast Africa: epidemiology and preventive control measures, Bavaria, Germany, July to October 2015

We report 15 imported louse-borne relapsing fever (LBRF) cases in refugees in Bavaria, Germany. One patient died. Epidemiological findings confirmed that all were young males from the Horn of Africa (12 from Somalia), who had similar migration routes converging in Sudan continuing through Libya and Italy. The majority likely acquired their infection during migration. Healthcare workers should be aware of LBRF in refugees passing through north Africa to ensure correct treatment and preventive measures.</jats:p

Impact failure in two silicates revealed by ultrafast, in situ, synchrotron X-ray microscopy

From Springer Nature via Jisc Publications RouterHistory: received 2019-12-31, accepted 2020-05-28, registration 2020-06-03, pub-electronic 2020-06-25, online 2020-06-25, collection 2020-12Publication status: PublishedAbstract: To travel safely behind screens that can protect us from stones and hail, we must understand the response of glass to impact. However, without a means to observe the mechanisms that fail different silicate architectures, engineering has relied on external sensors, post-impact examination and best-guess to glaze our vehicles. We have used single and multi-bunch, X-ray imaging to differentiate distinct phases of failure in two silicates. We identified distinct micromechanisms, operating in tandem and leading to failure in borosilicate glass and Z-cut quartz. A surface zone in the amorphous glass densifies before bulk fracture occurs and then fails the block, whilst in quartz, fast cracks, driven down cleavage planes, fails the bulk. Varying the rate at which ejecta escapes by using different indenter tip geometries controls the failed target’s bulk strength. This opens the way to more physically based constitutive descriptions for the glasses allowing design of safer, composite panels by controlling the impulses felt by protective screens