ABSTRACT
The treatment of locally advanced and metastatic BCC presents a significant clinical challenge. Treatment options have evolved recently to include the use of hedgehog inhibitors Vismodigib and Sonidigib and immunotherapy with Cemiplimab.
ABSTRACT
Axillary nodal status is an inherent part of prognostic tools such as the Nottingham Prognostic Index (NPI). Literature suggests that nodal ratio is a stronger predictive parameter than the total number of positive nodes sampled. Studies also note improved survival in node-negative patients with a larger proportion of nodes excised. The aim of this study was to assess disease-free survival (DFS) comparing the number of negative and positive nodes excised and nodal ratio as the predictive parameters. Consecutive axillary lymph node dissections (ALND) were analyzed over a 25-year period. Data were analyzed using Cox Regression and Kaplan-Meier survival curves. Eight hundred and forty-nine ALNDs were identified, with 327 positive ALNDs and 268 node negative ALNDs incorporated in the study following exclusions. A prognostic index based on nodal ratio was devised and applied retrospectively to 327 positive ALNDs prior to 2002. This index was then prospectively validated in 116 consecutive positive ALNDs from 2002 to 2005. In node negative ALNDs, no significant difference in DFS was noted in patients having
Subject(s)
Breast Neoplasms/mortality , Breast Neoplasms/pathology , Lymph Nodes/pathology , Neoplasm Recurrence, Local/pathology , Axilla/pathology , Breast Neoplasms/therapy , Cohort Studies , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Lymph Node Excision , Lymph Nodes/surgery , Lymphatic Metastasis/pathology , Middle Aged , Neoplasm Recurrence, Local/therapy , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Reproducibility of Results , Retrospective StudiesABSTRACT
INTRODUCTION: Partial-thickness scalds are the most common pediatric burn injury, and primary management consists of wound dressings to optimize the environment for reepithelialization. Operative intervention is reserved for burns that fail to heal using conservative methods. Worldwide, paraffin-based gauze (Jelonet) is the most common burn dressing; but literature suggests that it adheres to wounds and requires more frequent dressing change that may traumatize newly epithelialized surfaces. Hydrocolloid dressings (DuoDERM) provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes. AIM: The aim of the study was to retrospectively analyze pediatric burns in a single tertiary referral center over a 10-year period comparing the impact of Jelonet and DuoDERM dressings relative to operative intervention rates. METHODS: All pediatric burns admitted between 1997 and 2007 were identified using the Hospital Inpatient Enquiry system. Demographics were collected from hospital records and theater logbooks. Acute, partial-thickness burns in patients younger than 15 years were analyzed according to dressing type applied (Jelonet or DuoDERM). RESULTS: Two hundred forty-eight pediatric burns were analyzed between 1997 and 2007. One hundred thirty-nine patients were treated with Jelonet dressings, and 109 were treated with DuoDERM. Debridement and grafting were required in 60 (43%) of the Jelonet patients compared with 10 (9%) of the DuoDERM patients (P < .05). The DuoDERM-managed patients maintained a significantly lower graft rate on subanalysis of scalds excluding early grafting within 5 days (P < .001). CONCLUSION: Observational evidence suggests that DuoDERM leads to less operative intervention and should be preferentially used in pediatric burns.
Subject(s)
Bandages, Hydrocolloid , Bandages , Burns/therapy , Debridement/methods , Petrolatum , Skin Transplantation/methods , Adolescent , Burns/diagnosis , Burns/surgery , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Injury Severity Score , Length of Stay , Male , Pain Measurement , Probability , Retrospective Studies , Risk Assessment , Treatment Outcome , Wound Healing/physiologyABSTRACT
Over 70% of patients with advanced breast cancer will develop bone metastases for which there is no cure. Mesenchymal Stem Cells (MSCs) and their derivative osteoblasts are subpopulations of cells within the bone marrow environment, postulated as potential interacting targets for disseminating cancer cells because of their ability to secrete a range of chemokines. This study aimed to investigate chemokine secretion throughout MSC differentiation into osteoblasts and their effect on the breast cancer cells. Primary MSCs and osteoblast progenitors were cultured in appropriate conditions to induce differentiation into mature osteoblasts. Chemokines secreted throughout differentiation were detected using ChemiArray and ELISA. Migration of breast cancer cells in response to the bone-derived cells was quantified using Transwell inserts. Breast cancer cells were cocultured with MSCs, retrieved using magnetic beads, and changes in CCL2 expression were analyzed. MSCs secreted a range of factors including IL-6, TIMP-1 and CCL2, the range and level of which changed throughout differentiation. CCL2 secretion by MSCs increased significantly above control cells as they differentiated into mature osteoblasts (p<0.05). The bone-derived cells stimulated migration of breast cancer cells, and this was inhibited (21-50%) in the presence of a CCL2 antibody. CCL2 gene expression in breast cancer cells was upregulated following direct coculture with MSCs. The varying levels of chemokines secreted throughout MSC differentiation may play an important role in supporting tumor cell homing and progression. These results further highlight the distinct effect MSCs have on breast cancer cells and their potential importance in supporting development of metastases.
