Is mastectomy with immediate breast reconstruction an alternative to breast-conserving treatment?

Mimo że leczenie oszczędzające pierś uznawane jest za metodę z wyboru w leczeniu chorych na wczesnego raka piersi, w niektórych badaniach zaobserwowano wzrost częstości wykonywanych mastektomii. Coraz częściej w trakcie mastektomii wykonywana jest natychmiastowa rekonstrukcja piersi, mająca na celu zmniejszenie okaleczenia związanego z utratą piersi. Wykazano, że zarówno leczenie oszczędzające pierś, jak i mastektomia z natychmiastową rekonstrukcją piersi są zabiegami bezpiecznymi onkologicznie i przynoszą porównywalny komfort życia. Jednak zabieg mastektomii z rekonstrukcją natychmiastową piersi jest obarczony większym odsetkiem powikłań pooperacyjnych, zwłaszcza w przypadku zastosowania radioterapii uzupełniającej. Dodatkową korzyścią leczenia oszczędzającego pierś jest możliwość odstąpienia od wykonania limfadenektomii pachowej w przypadku przerzutów ograniczonych do 1–2 węzłów wartowniczych, przez co chore mogą uniknąć powikłań związanych z usunięciem węzłów chłonnych pachowych. Ustalając plan leczenia chorych, należy zwrócić uwagę na potencjalną przewagę, jaką posiada leczenie oszczędzające pierś, nad mastektomią z rekonstrukcją natychmiastową pod względem ryzyka wystąpienia powikłań.Beside the fact that breast-conserving treatment is the method of choice in early breast cancer, several studies have demonstrated good results when mastectomy is involved in the treatment. Such studies are currently increasing. Immediate breast reconstruction is gaining popularity as the method that mitigates post-mastectomy deformation. Comparing breast-conserving treatment and immediate breast reconstruction after mastectomy both methods did not worsen the treatment outcome and have a positive impact to quality of life. However, the complications rate is higher after mastectomy with immediate breast reconstruction, especially in the subgroup of patients receiving postmastectomy radiotherapy. Breast-conserving therapy additionally gives the opportunity to avoid axillary lymph nodes dissection in the subgroup of patients with positive 1–2 sentinel nodes. It should be taken into consideration when a treatment schedule is established, that breast-conserving therapy has an advantage regarding risk of complications

A New Statistical Reconstruction Method for the Computed Tomography Using an X-Ray Tube with Flying Focal Spot

Abstract This paper presents a new image reconstruction method for spiral cone- beam tomography scanners in which an X-ray tube with a flying focal spot is used. The method is based on principles related to the statistical model-based iterative reconstruction (MBIR) methodology. The proposed approach is a continuous-to-continuous data model approach, and the forward model is formulated as a shift-invariant system. This allows for avoiding a nutating reconstruction-based approach, e.g. the advanced single slice rebinning methodology (ASSR) that is usually applied in computed tomography (CT) scanners with X-ray tubes with a flying focal spot. In turn, the proposed approach allows for significantly accelerating the reconstruction processing and, generally, for greatly simplifying the entire reconstruction procedure. Additionally, it improves the quality of the reconstructed images in comparison to the traditional algorithms, as confirmed by extensive simulations. It is worth noting that the main purpose of introducing statistical reconstruction methods to medical CT scanners is the reduction of the impact of measurement noise on the quality of tomography images and, consequently, the dose reduction of X-ray radiation absorbed by a patient. A series of computer simulations followed by doctor's assessments have been performed, which indicate how great a reduction of the absorbed dose can be achieved using the reconstruction approach presented here

Ferritin and transferrin saturation cannot be used to diagnose iron-deficiency anemia in critically ill patients

Abstract Introduction: Iron-deficiency anaemia (IDA) is the most common anaemia globally. The frequency of IDA among critically ill patients is not known. The aim of our study was to analyse performance of standard iron metabolism parameters in diagnosis of IDA in the critically ill. Material and methods: We performed a retrospective analysis of consecutive anaemic patients admitted to the intensive care unit. Based on various cut-off values for ferritin and/or transferrin saturation (TfS), we determined the incidence of IDA. Results: The population consisted of 27 (53%) men and 24 (47%) women. The median haemoglobin concentration was well 96 [interquartile range (IQR 87–109)] g/L. The studied population had markedly increased concentration of C-reactive protein [119 (IQR 44–196) mg/L], ferritin [686 (385–1114) µg/L], whereas iron concentration and TfS were below reference value. Depending on cut-off value chosen, IDA could be diagnosed in between 7.8 (ferritin < 100 µg/L +TfS < 20%) and 56.9 % (TfS < 20%) of patients. Conclusions: Ferritin and transferrin saturation cannot be used for precise diagnosis of IDA caused by absolute or functional iron deficiency in the critically ill

The role of neuronal apoptosis inhibitory protein (NAIP) in acute myeloid leukemia patients

Acute myeloid leukemia (AML) is a heterogeneous, highly malignant neoplasm. Apoptosis is a complex process executed by caspases and suppressed by the inhibitor of apoptosis (IAP) family. Neuronal apoptosis inhibitory protein (NAIP), IAP’s member, may play an exceptional role in the mechanisms of tumors’ resistance to chemotherapy. The aims of the study were to assess the expression of NAIP in leukemic blasts of AML patients using flow cytometry and to evaluate its influence on disease outcome. NAIP expression was found in 106 out of 108 patients. A higher complete response rate was associated with a low expression of NAIP, age < 60 yo, and white blood cell count < 20 G/L ( = 0.009, = 0.033, and = 0.076, respectively) in univariate analyses and a low NAIP expression and age < 60 yo ( = 0.025 and = 0.013, respectively) in multivariate analyses. Longer overall survival (OS) in the univariate analysis was influenced by a low NAIP expression, age < 60 yo, and intensive chemotherapy ( = 0.033, < 0.001, and < 0.001, respectively). In the intensively treated group, better OS was observed in patients with age < 60 yo, AML, and a low NAIP expression ( = 0.03, = 0.024, and = 0.07, respectively). In multivariate analysis, longer OS was associated with age < 60 yo ( = 0.009) and AML ( = 0.007). In conclusion, we suggest that NAIP might play an adverse role in response to chemotherapy

Pojava mikotoksina u vodenom okolišu zbog njihove prisutnosti u usjevima

The aim of this study was to establish a relation between zearalenone contamination of crops in the Polish province of Wielkopolska and its occurrence in aquatic ecosystems close by the crop fields. Water samples were collected from water bodies such as drainage ditches, wells, or watercourses located in four agricultural areas. Moreover, control water samples were collected from the Bogdanka river, which was located outside the agricultural areas and near an urban area. Cereal samples were collected in the harvest season from each agricultural area close to tested water bodies. Zearalenone (ZEA) was found in all water and cereal samples. The highest concentrations were recorded in the postharvest season (September to October) and the lowest in the winter and spring. Mean ZEA concentrations in water ranged between 1.0 ng L-1 and 80.6 ng L-1, and in cereals from 3.72 ng g-1 to 28.97 ng g-1. Our results confi rm that mycotoxins are transported to aquatic systems by rain water through soil.Cilj ovog istraživanja bio je pojasniti učestalost pojave mikotoksina u vodenim ekosustavima i njihove korelacije sa stupnjem zaraze žitarica (uzgajanih u blizini vodospremnika), čija su zrna onečišćena (kontaminirana) mikotoksinima te problem prolaska mikotoksina kroz tlo u vodeni okoliš (onečišćenje podzemnih voda mikotoksinima). Uzorci vode prikupljeni su u regiji Wielkopolska iz vodenih tijela poput odvodnih jaraka i zdenaca, odnosno vodotoka smještenih u područjima koja se rabe za poljoprivredu. Dio uzoraka vode prikupljen je iz rijeke Bogdanka, u rubnom području grada Poznańa. U sezoni žetve sa svake poljoprivredne površine smještene u neposrednoj blizini testiranih vodenih tijela prikupljeni su uzorci žitarica. U svim analiziranim uzorcima vode i žitarica potvrđena je prisutnost zearalenona (ZEA). Najviše koncentracije mikotoksina u uzorcima sa svih poljoprivrednih površina zabilježene su u jesen nakon sezone žetve (rujan-listopad), dok su najniže vrijednosti izmjerene zimi i u proljeće. Srednje koncentracije zearalenona u vodi bile su u rasponu od 1,0 ng L-1 do 80,6 ng L-1. U žitarica je prosječna razina zearalenona iznosila 3,72 ng g-1 do 28,97 ng g-1, što govori u prilog vjerodostojnosti naše polazišne hipoteze o prijenosu mikotoksina kroz tlo nakon njihova ispiranja s površine u jarke za odvodnju