Oncoplastic Approaches to Breast Conservation

When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemibatwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, inframammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate

Mammographic Findings after Intraoperative Radiotherapy of the Breast

Intraoperative Radiotherapy (IORT) is a form of accelerated partial breast radiation that has been shown to be equivalent to conventional whole breast external beam radiotherapy (EBRT) in terms of local cancer control. However, questions have been raised about the potential of f IORT to produce breast parenchymal changes that could interfere with mammographic surveillance of cancer recurrence. The purpose of this study was to identify, quantify, and compare the mammographic findings of patients who received IORT and EBRT in a prospective, randomized controlled clinical trial of women with early stage invasive breast cancer undergoing breast conserving therapy between July 2005 and December 2009. Treatment groups were compared with regard to the 1, 2 and 4-year incidence of 6 post-operative mammographic findings: architectural distortion, skin thickening, skin retraction, calcifications, fat necrosis, and mass density. Blinded review of 90 sets of mammograms of 15 IORT and 16 EBRT patients demonstrated a higher incidence of fat necrosis among IORT recipients at years 1, 2, and 4. However, none of the subjects were judged to have suspicious mammogram findings and fat necrosis did not interfere with mammographic interpretation

923-6 Intravenous Adenosine and Lidocaine to Limit Reperfusion Injury During Acute Myocardial Infarction: Preliminary Data

Adenosine (ADO) and lidocaine (LDO) given prior to restoration of blood flow reduces reperfusion injury in animals. We conducted a pilot study of intravenous ADO and LDO in pts undergoing direct angioplasty for acute myocardial infarction (AMI). Pts with ≤12 hours of chest pain and electrocardiographic evidence of AMI were given LDO 1mg/kg iv bolus and 2mg/min iv infusion beginning at the time of recruitment, and ADO 70mcg/kg iv infusion beginning when coronary occlusion (TIMI grade 0–1 blood flow) was confirmed angiographically. Pts with bronchospasm, blood pressure <100mmHg, or<1° heart block were excluded. ADO and LDO were given for 1 hour after vessel patency was restored. Myocardial area at risk and final infarction area were measured with serial Tc-99m-sestamibi perfusion studies (prior to angioplasty, before hospital discharge and 6 weeks after discharge). A salvage index (S1) was constructed by correcting the change in sestamibi perfusion defect for the mass of myocardium at risk. Analysis of 25 patients completing the protocol revealed a mean (±SD) salvage of 20±17% and S1=0.55. Salvage and S1 were 25±18% and 0.54 for anterior infarctions, 13±5% and 0.57 for inferior infarctions, respectively. These data were compared to an historical control group consisting of 50 patients undergoing direct angioplasty for AMI without adjunctive ADO/LDO. After adjustment for time to treatment and perfusion nadir, analysis of covariance revealed a similar degree of early salvage in the study and control groups (p=0.3). However, at 6 weeks, the median infarct size for study pts was 0. Using logistic regression analysis, significantly more study pts had no final measureable infarction at 6 weeks than control pts at hospital discharge (p=0.007). After adjusting for infarct size, location and time to treatment, this difference persisted (p=0.04).ConclusionsAdjunctive ADO and LDO during angioplasty for AMI may favorably affect late final infarction size. Randomized studies assessing 6 week final infarction size are needed

Frequent Cross-Species Transmission of Parvoviruses among Diverse Carnivore Hosts

Although parvoviruses are commonly described in domestic carnivores, little is known about their biodiversity in nondomestic species. A phylogenetic analysis of VP2 gene sequences from puma, coyote, gray wolf, bobcat, raccoon, and striped skunk revealed two major groups related to either feline panleukopenia virus (“FPV-like”) or canine parvovirus (“CPV-like”). Crossspecies transmission was commonplace, with multiple introductions into each host species but, with the exception of raccoons, relatively little evidence for onward transmission in nondomestic species

Use of bioengineered human commensal gut bacteria-derived microvesicles for mucosal plague vaccine delivery and immunization

Plague caused by the Gram-negative bacterium, Yersinia pestis, is still endemic in parts of the world today. Protection against pneumonic plague is essential to prevent the development and spread of epidemics. Despite this, there are currently no licensed plague vaccines in the western world. Here we describe the means of delivering biologically active plague vaccine antigens directly to mucosal sites of plague infection using highly stable microvesicles (outer membrane vesicles; OMVs) that are naturally produced by the abundant and harmless human commensal gut bacterium Bacteroides thetaiotaomicron (Bt). Bt was engineered to express major plague protective antigens in its OMVs, specifically Fraction 1 (F1) in the outer membrane and LcrV (V antigen) in the lumen, for targeted delivery to the gastrointestinal (GI) and respiratory tracts in a non-human primate (NHP) host. Our key findings were that Bt OMVs stably expresses F1 and V plague antigens, particularly the V antigen, in the correct, immunogenic form. When delivered intranasally V-OMVs elicited substantive and specific immune and antibody responses, both in the serum [immunoglobulin (Ig)G] and in the upper and lower respiratory tract (IgA); this included the generation of serum antibodies able to kill plague bacteria. Our results also showed that Bt OMV-based vaccines had many desirable characteristics, including: biosafety and an absence of any adverse effects, pathology or gross alteration of resident microbial communities (microbiotas); high stability and thermo-tolerance; needle-free delivery; intrinsic adjuvanticity; the ability to stimulate both humoral and cell-mediated immune responses; and targeting of primary sites of plague infection

Ernst Freund as Precursor of the Rational Study of Corporate Law

Gindis, David, Ernst Freund as Precursor of the Rational Study of Corporate Law (October 27, 2017). Journal of Institutional Economics, Forthcoming. Available at SSRN: https://ssrn.com/abstract=2905547, doi: https://dx.doi.org/10.2139/ssrn.2905547The rise of large business corporations in the late 19th century compelled many American observers to admit that the nature of the corporation had yet to be understood. Published in this context, Ernst Freund's little-known The Legal Nature of Corporations (1897) was an original attempt to come to terms with a new legal and economic reality. But it can also be described, to paraphrase Oliver Wendell Holmes, as the earliest example of the rational study of corporate law. The paper shows that Freund had the intuitions of an institutional economist, and engaged in what today would be called comparative institutional analysis. Remarkably, his argument that the corporate form secures property against insider defection and against outsiders anticipated recent work on entity shielding and capital lock-in, and can be read as an early contribution to what today would be called the theory of the firm.Peer reviewe

A new era for studies on cross-Strait relations: introduction

After more than half a century’s separation, interaction between China and Taiwan has increased and has progressively changed from a politico-economic interaction to a more civic interaction. Scholars working on cross-Strait relations have recently begun to pay attention to the civic influence of Taiwanese businesses on the relationship. Some emphasize the importance of sub-governmental interactions in the process of cross-Strait integration. Others assert that Taiwanese businesses can exercise economic leverage to constrain the Chinese government in cross-Strait policymaking. These scholars stress bottom–up processes by observing current phenomena, then deducing the emerging pattern of cross-Strait relations that may be influenced by business activities. Taking account of changing trends in scholarly discussions of the cross-Strait relationship, this special issue of China Information presents current research in this field. Unlike studies on top–down processes that affect political and economic interactions between China and Taiwan, several contributions in the special issue highlight bottom–up mechanisms affecting such interactions by examining the identity of Taiwanese businesspeople and migrants, as well as the activities and implications of Taiwanese charitable organizations operating in China. This issue focuses not only on the impact of China on Taiwan, but also the impact of Taiwanese investments, migrants, and exports on Chinese society

Learning to teach data journalism: Innovation, influence and constraints

Journalism education has tended to respond slowly to developments in digital journalism, such as data journalism, despite or because of close links with the industry. This paper examines the obstacles to innovation in journalism education with particular reference to data journalism, drawing on the literature, a review of stakeholders and course documents, and the author’s reflections on developing a data journalism module as part of a new MA programme. It highlights the complexities linked to the particular demands of data journalism, and identifies critical issues around student satisfaction; reputation and job/career outcomes; relevance, currency and appeal; programme management; and coherence. Rather than holding it back, more specialized socialization could assist journalism education to innovate effectively, the author suggests