Analysis of circulating tumor cells in breast cancer.

Over the past few decades, substantial progress has been made in the diagnosis and treatment of breast cancer. Early identification of relapsed and metastatic disease has been a primary focus of ongoing research. Circulating tumor cells (CTCs) are implicated as harbingers of metastases. With advances in detection technologies, CTCs offer the option for real-time liquid biopsies. Methods to identify CTCs in the bloodstream by physical or biochemical properties, although feasible, still require improvements to promote widespread, reproducible use. Sufficient data support enumeration and assessment of changes in the number of CTCs as prognostic indicators, but controversy around their predictive utility for selecting treatments remains. As the technology to detect CTCs and characterize their heterogeneous molecular profile evolves, additional information will likely be obtained to guide targeted and individualized therapies.

Prolonged recovery time from zoledronic Acid induced acute tubular necrosis: a case report and review of the literature.

Acute tubular necrosis (ATN) due to bisphosphonates has been reported with Zoledronic acid but the time to recovery (if any) has been usually less than 4 months. Possible recovery time from ATN of any cause is usually less than 6 months. In this paper, we present the case of a 59-year-old Caucasian female with metastatic breast cancer who had received 16 monthly injections of Zoledronic acid for treatment of tumor induced hypercalcemia and developed several episodes of mild acute kidney injury which resolved by withholding treatment. Unfortunately, after the sixteenth injection, the patient experienced severe acute kidney injury, with a peak serum creatinine of 8.0 mg/dL. Although urinalysis showed muddy brown casts, because of atypical recovery time and presence of eosinophiluria and subnephrotic range proteinuria, a kidney biopsy was performed. Diagnosis of typical acute tubular necrosis was confirmed without any other concomitant findings. The course was remarkable for an unusually slow recovery of renal function over 15 months without need for renal replacement therapy until the patient expired from her metastatic cancer two years later. We reviewed all the published cases of acute kidney injury due to Zoledronic acid and suggest recommendations for clinicians and researchers.

Short-term reproducibility of ambulatory blood pressure monitoring in autosomal dominant polycystic kidney disease.

BACKGROUND AND OBJECTIVES: Nondipping, defined as a less than 10% decline in Night:Day (N:D) ratio of blood pressure using 24 h ambulatory blood pressure monitoring, is associated with poor cardiovascular outcomes. However, its reproducibility has been questioned in autosomal dominant polycystic kidney disease. MATERIALS AND METHODS: Twenty-five of 29 recruited hypertensive or prehypertensive patients with autosomal dominant polycystic kidney disease completed ambulatory blood pressure monitoring on two occasions, 7-15 days apart, on a stable antihypertensive regimen. Daytime and night-time were defined as 6:00-21:59 h and 22:00-5:59 h, respectively. Correlation and concordance coefficients for systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were determined based on N:D and Asleep:Awake (A:A) ratios. Consistency of dipping was assessed by using Cohen's Kappa statistics. RESULTS: Mean (±standard deviation) for age, estimated glomerular filtration rate, differences in daytime and night-time SBP and DBP were 43.12 years (8.55 years), 63.1 ml/min (20.5 ml/min), 11.74 mmHg (8.2 mmHg), and 10.82 mmHg (6.4 mmHg), respectively. Seventeen of 25 (68%) and 18 of 25 (72%) participants maintained the same dipping category based on D:N or A:A separation. Cohen's Kappa was 0.34 for D:N ratio and 0.38 for A:A ratio. Correlation and concordance coefficients were 0.89 and 0.88 for daytime SBP, 0.91 and 0.91 for daytime DBP, 0.79 and 0.78 for night-time SBP, 0.81 and 0.80 for night-time DBP, 0.58 and 0.56 for N:D ratio of SBP, and 0.56 and 0.53 for N:D ratio of DBP. Coefficients for A:A ratio were almost identical to N:D values except for A:A ratios of SBP (0.69 and 0.67) and DBP (0.48 and 0.45). CONCLUSION: Repeated measures of SBP and DBP, 7-15 days apart, are highly correlative and concordant in the studied population, but nondipping, even though predominant, was found to be modestly reproducible.

Attitudes toward and beliefs about prenatal HIV testing policies and mandatory HIV testing of newborns among drug users.

BACKGROUND: Controversy remains about perinatal HIV testing in many clinical settings. We sought to examine the attitudes and health beliefs among drug users about mandatory HIV testing of newborns and about voluntary versus mandatory testing of pregnant women. We also examined to what extent negative experiences and stigmatization affected attitudes toward HIV testing. METHODS: To establish a baseline, we examined 610 structured interviews conducted from 1997 to 2001, of active drug users who were recruited using respondent-driven sampling. We then conducted five focus groups of five subjects per group to further analyze responses in September 2003. The responses of the members of the focus groups were transcribed, coded, and analyzed using Microsoft Word 2000. RESULTS: Quantitative Longitudinal Cohort Studies. Of the 610 drug users interviewed in the two longitudinal cohort studies conducted from 1997 to 2001, nearly all (89 percent) had been previously tested for HIV Nearly all subjects (91 percent) believed that pregnant women should be tested for HIV. More subjects who had prior HIV testing believed all pregnant women should be tested for HIV (92.9 percent versus 82.6 percent, p = 0.008). Although 86 percent of the subjects agreed that all newborns should be tested, only 57 percent of all of the subjects believed that it should be mandatory. Among the female subjects, however, more injectors than non-injectors would avoid prenatal care if HIV testing was required during pregnancy (16.2 percent versus 6.1 percent, p < 0.01). Of the 499 subjects who reported that they had a usual site for care, 31.8 percent believed that "certain types of people" received better treatment than others. Not using drugs, being of a certain race/ethnicity, and having private insurance were associated with receiving better care. The majority of subjects believed that being a drug user resulted in receiving suboptimal care from the healthcare establishment. Qualitative Focus Group Study. In the focus groups, arguments against mandatory testing of pregnant women included the loss of choice, the right not to know one's HIV status, and the belief that mandatory testing was both a means of provoking rebellion and promoting discrimination. Concern for a baby's health was the primary reason for supporting mandatory testing. Perceived discrimination by the healthcare system was cited as a barrier to acceptance of testing strategies, as it was in the structured interviews. CONCLUSIONS: The current practice of mandatory newborn and voluntary prenatal screening for HIV in the State of Connecticut appears to have been acceptable to a population of highly stigmatized drug users who have been or were at risk for HIV. Despite this acceptance, perceived discrimination by the healthcare system persists and may result in adverse outcomes for a minority of high-risk women, particularly where drug misuse is more highly stigmatized.