Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology.

The NCCN Guidelines for Breast Cancer Screening and Diagnosis have been developed to facilitate clinical decision making. This manuscript discusses the diagnostic evaluation of individuals with suspected breast cancer due to either abnormal imaging and/or physical findings. For breast cancer screening recommendations, please see the full guidelines on NCCN.org.

Guided Tissue Regeneration in Four Teeth Using a Liquid Polymer Membrane.

Periodontal disease is one of the most common diseases diagnosed in dogs and cats. Guided tissue regeneration (GTR) is a treatment alternative to extraction of strategically important teeth. The barrier membrane used in the GTR procedure is of key importance. The purpose of this case series was to evaluate a liquid polymer gel as a membrane for GTR. The polymer gel ( N-methyl-2-pyrrolidone and poly [DL-lactide]) combined with 8.5% doxycycline hyclate was used in place of a traditional membrane in 4 teeth. The teeth were re-examined 6 months postoperatively for radiographic evaluation. A decrease in probing depth and new alveolar bone formation was seen 6 months postoperatively. Improvement in periodontal disease stage was seen in 2 of the 4 teeth. Larger controlled trials with histopathologic evaluation are indicated to further assess the use of this polymer as a membrane in GTR. However, the clinical outcomes of all 4 treated teeth were considered successful.

Surgical extractions for periodontal disease in a Western Lowland gorilla.

This case report describes surgical exraction of multiple premolar and molar teeth in a Western Lowland gorilla. Postoperative photographs and radiographs indicated complete healing of the extraction sites. This case report includes a review of gorilla dental anatomy, oral disease in primates, pathogenesis of periodontal disease, predisposing factors to periodontal disease, and principles of surgical tooth extraction.

The sonographic findings and differing clinical implications of simple, complicated, and complex breast cysts.

Although palpable and mammographic breast masses are common and frequently reflect underlying fibrocystic change, they must be distinguished from breast malignancy. Clinical characterization of these masses is often unreliable, and mammographic appearances alone cannot distinguish between those that are solid and those that are cystic. Sonography is an important adjunct to characterize these abnormalities further. Management of solid masses is well established, but overlap in appearance of cystic lesions has led to variability in reporting and management. With current high-resolution ultrasound, specific observations can accurately characterize most cystic masses, thereby facilitating management decisions.

The next-generation Hybrid Capture High-Risk HPV DNA assay on a fully automated platform.

BACKGROUND: A next-generation diagnostic system has been developed at QIAGEN. The QIAensemble system consists of an analytical subsystem (JE2000) that utilizes a re-engineered Hybrid Capture chemistry (NextGen) to maintain the high level of clinical sensitivity established by the digene High-Risk HPV DNA Test (HC2), while creating improved analytical specificity as shown both in plasmid-based analyses and in processing of clinical specimens. STUDY DESIGN: Limit-of-detection and cross-reactivity experiments were performed using plasmid DNA constructs containing multiple high-risk (HR) and low-risk (LR) HPV types. Cervical specimens collected into a novel specimen collection medium, DCM, were used to measure stability of specimens, as well as analytical specificity. Signal carryover, instrument precision, and specimen reproducibility were measured on the prototype JE2000 system using the automated NextGen assay. RESULTS: The Limit of Detection (LOD) is <1000 copies of HPV 16 plasmid in the automated assay. No cross-reactivity (signal above cutoff) was detected on the automated system from any of 13 LR types tested at 10(7) copies per assay. Within-plate, plate-to-plate, and day-to-day performance in the prototype system yielded a CV of 20%. No indication of target carryover was found when samples containing up to 10(9) copies/ml of HPV DNA type 16 were processed on the JE2000 instrument. In an agreement study with HC2, 1038 donor cervical specimens were tested in both the manual NextGen assay and HC2 to evaluate agreement between the two tests. After eliminating discrepant specimens that were adjudicated by HR-HPV genotyping, the adjudicated positive agreement was 98.5% (95% CI: 94.6, 99.6). CONCLUSIONS: The JE2000 prototype system automates NextGen assay processing, yielding accurate, reproducible, and highly specific results with both plasmid analytical model tests and cervical specimens collected in DCM. The final system will process more than 2000 specimens in an 8-hour shift, with fully continuous loading.

Pharmacokinetics of lumiracoxib in plasma and synovial fluid.

BACKGROUND: Lumiracoxib is a new cyclo-oxygenase-2 (COX-2) selective inhibitor in development for the treatment of rheumatoid arthritis, osteoarthritis and acute pain. OBJECTIVE: To investigate the pharmacokinetics of lumiracoxib in plasma and knee joint synovial fluid from patients with rheumatoid arthritis. DESIGN: Open-label multiple-dose study evaluating the steady-state pharmacokinetics of lumiracoxib in plasma and synovial fluid after 7 days of treatment with lumiracoxib 400 mg once daily. PATIENT POPULATION: Males and females aged 18-75 years with rheumatoid arthritis, having moderate to significant synovial fluid effusion of the knee. OUTCOME MEASURES: Following a 7-day washout period for previous nonsteroidal anti-inflammatory drugs, 22 patients (17 female, 5 male) received lumiracoxib 400 mg once daily for seven consecutive days. On day 7, following an overnight fast, a final dose of lumiracoxib was administered and serial blood and synovial fluid samples were collected for up to 28 hours. Lumiracoxib and its metabolites (4'-hydroxy-lumiracoxib and 5-carboxy-4'-hydroxy-lumiracoxib) were measured by validated high performance liquid chromatography-mass spectrometry methods. The steady-state pharmacokinetics of lumiracoxib were evaluated in plasma and synovial fluid by both a population pharmacokinetic model and noncompartmental analysis. RESULTS: Lumiracoxib was rapidly absorbed (peak plasma concentration at 2 hours) and the terminal elimination half-life in plasma was short (6 hours). Lumiracoxib concentrations were initially higher in plasma than in synovial fluid; however, from 5 hours after administration until the end of the 28-hour assessment period, concentrations of lumiracoxib were higher in synovial fluid than in plasma. Peak drug concentration in synovial fluid occurred 3-4 hours later than the peak plasma concentration. The mean steady-state trough concentration of lumiracoxib in synovial fluid (454 microg/L) was approximately three times higher than the mean value in plasma (155 microg/L), and the area under the concentration-time curve from 12 to 24 hours after administration was 2.6-fold higher for synovial fluid than for plasma. Median lumiracoxib protein binding was similar in plasma and synovial fluid (range 97.9-98.3%). Concentrations of 4'-hydroxy-lumiracoxib, the active COX-2 selective metabolite, remained low in comparison with parent drug in both plasma and synovial fluid. The concentration of lumiracoxib in synovial fluid at 24 hours after administration would be expected to result in substantial inhibition of prostaglandin E(2) formation. CONCLUSION: The kinetics of distribution of lumiracoxib in synovial fluid are likely to extend the therapeutic action of the drug beyond that expected from plasma pharmacokinetics. These data support the use of lumiracoxib in a once-daily regimen for the treatment of rheumatoid arthritis.

A Primary Care Clinician's and Consultant's Guide to Medicating for Pain and Anxiety Associated with Outpatient Procedures.

This article offers clinical suggestions for the design of a patient-specific outpatient treatment plan for managing and reducing short-term pain associated with outpatient procedures. These procedures may actually produce pain, or they may be perceived as causing pain and anxiety. The article will also focus on the design of a patient-specific outpatient treatment plan for managing and reducing short-term procedural-induced anxiety, as perceived pain and anxiety or pain and anxiety themselves may be a reason for which patients are noncompliant with their office visits. The treatment plan will focus on pre-procedure, peri-procedure, and post-procedure interventions using nonsteroidal anti-inflammatory drugs and anxiolytics (benzodiazepines, opiate agonists, and sedative hypnotics). The plan also includes adjuvant therapy to decrease the patient's perception of pain, anxiety, fear of procedure, and fear of outcomes in order to facilitate a higher degree of compliance with office procedures. This article also accounts for the patient's physiology, pathophysiology, pathology, and iatrogenic effects from drug treatment plans.