Recurrence of Breast Cancer After Primary Treatment: A Matched Comparison Study of Disease-Free Survival in Women Who Do and Do Not Receive Adjunctive Naturopathic Oncology Care.

PURPOSE: To compare disease free survival experienced by women who received usual oncologic care compared to a cohort of women who received naturopathic oncology care in addition to usual care. METHODS: Women with breast cancer who received naturopathic oncology (NO) care in Western Washington State (WA) (N = 176) were recruited to a prospective study of clinical health-related quality of life outcomes and then matched to women who received usual care (UC) only (N = 334). RESULTS: Among 510 women with breast cancer stages 1 to 3, a total of 50 women (10%) experienced a disease-free survival (DFS) ending event within the observation period; 23 (6.8% of those in the UC cohort, and 27 (15.3% of those in the NO cohort (P < .05). Although, women in the 2 cohorts received similar surgical, chemotherapy, and radiation treatment, women with breast cancer who received naturopathic oncology adjunctive care were less likely to use anti-estrogen therapy, and experienced poorer DFS (logrank test, P < .05). However, differences in DFS could not be shown to be due to cohort differences in anti-estrogen therapy, baseline HRQOL, or naturopathic oncology therapies prescribed. The stage 3 women in the naturopathic oncology group had more advanced disease at diagnosis. They were more likely to have 5 or more metastatic lymph nodes at baseline (18.5%) compared to their usual care matched control group (13%). Women in the naturopathic oncology group also had higher grade tumors at diagnosis. CONCLUSIONS: Results show that recurrence of breast cancer was associated with more advanced malignant lymph node involvement; and that naturopathic oncology services provided in 2009-2015 did not improve disease-free survival in these high-risk breast cancer patients.

3D printed microfluidic circuitry via multijet-based additive manufacturing.

The miniaturization of integrated fluidic processors affords extensive benefits for chemical and biological fields, yet traditional, monolithic methods of microfabrication present numerous obstacles for the scaling of fluidic operators. Recently, researchers have investigated the use of additive manufacturing or "three-dimensional (3D) printing" technologies - predominantly stereolithography - as a promising alternative for the construction of submillimeter-scale fluidic components. One challenge, however, is that current stereolithography methods lack the ability to simultaneously print sacrificial support materials, which limits the geometric versatility of such approaches. In this work, we investigate the use of multijet modelling (alternatively, polyjet printing) - a layer-by-layer, multi-material inkjetting process - for 3D printing geometrically complex, yet functionally advantageous fluidic components comprised of both static and dynamic physical elements. We examine a fundamental class of 3D printed microfluidic operators, including fluidic capacitors, fluidic diodes, and fluidic transistors. In addition, we evaluate the potential to advance on-chip automation of integrated fluidic systems via geometric modification of component parameters. Theoretical and experimental results for 3D fluidic capacitors demonstrated that transitioning from planar to non-planar diaphragm architectures improved component performance. Flow rectification experiments for 3D printed fluidic diodes revealed a diodicity of 80.6 ± 1.8. Geometry-based gain enhancement for 3D printed fluidic transistors yielded pressure gain of 3.01 ± 0.78. Consistent with additional additive manufacturing methodologies, the use of digitally-transferrable 3D models of fluidic components combined with commercially-available 3D printers could extend the fluidic routing capabilities presented here to researchers in fields beyond the core engineering community.

Functional outcomes of pediatric liver transplantation.

UNLABELLED: The functional status and health-related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50). METHODS: The CHQ-PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391). RESULTS: Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5-17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 +/- 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 +/- 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores. CONCLUSIONS: Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self-esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.

Splenic torsion in a wandering spleen, presenting as an acute abdominal mass.

A childhood splenic torsion presenting as an acute abdominal mass is reported.

Alterations in endothelial superoxide dismutase levels as a function of growth state in vitro.

Damage to the retinal vasculature in retinopathy of prematurity is primarily at the level of the growing neovascular front. This clinical observation in combination with experimental observations that correlate the induction of superoxide dismutase (SOD) activity with differentiation led to the hypothesis that the basis for the relative vulnerability to oxygen lies in the relative "undifferentiated" nature of proliferating endothelial cells (EC). To test this hypothesis, an in vitro model of microvascular EC was used and levels of SOD activity were assayed as a function of growth state and differentiation. The SOD activity was elevated significantly in EC that stopped growing as a contact-inhibited monolayer compared with its activity in cells in their log phase of growth. In addition, SOD levels were elevated in microvascular cells that stopped growing and were organized into a network of capillary-like tubes, the ultimate differentiated state of microvascular EC. To understand the mechanism of increases in SOD activity with differentiation, the effect of extracellular matrix synthesized by a confluent monolayer of EC was examined as was artificial growth arrest caused by mitomycin. Both treatments led to an increase in SOD activity over control cells. Thus, it is possible that SOD activity in cells is modulated by information provided from the extracellular matrix and "intracellular" signals that indicate cessation of cell growth. These data support the hypothesis that the growing front of retinal microvessels is more vulnerable to effects of oxygen-induced damage because of their relatively undifferentiated state with respect to the oxygen radical-scavenging enzyme system of SOD.

Eye care by primary care physicians. A survey of internists and family practitioners in the Sacramento, California, area.

To assess the status of eye care as provided by primary care physicians, 193 internists or family practitioners were asked to complete a survey that focused on screening methods and referral patterns. In screening adult patients for glaucoma, 14% of 74 respondents await visual complaints before evaluation and/or referral. Eighteen percent of respondents first refer type II diabetic patients only after personally noting typical funduscopic changes in the undilated fundus. Other ophthalmic care issues are addressed. Results of the survey suggest that greater effort in ophthalmic education of primary care physicians could result in improved ophthalmic care.

Calcified and ossified meningiomas

Seven cases of mengiomas with areas of calcification and ossification are reported, comprising 2.5 per cent of our 274 cases meningiomas. Six of these tumors occured in womwn (85,7 per cent). Six were located intracranially, and one within the spinal canal. The osteogenic meningioma in case 1 was situated within Meckel's cave, rare location of ossified meningioma that we have no found in the literature. In case 2, there was late recurrence of a tumor of entirely different histopathological features. Multiple, small osteogenic meningiomas, possibily associated with Von Recklingghausen's disease, were found in the right temporal lobe in case 5

Calcified and ossified meningiomas / Calcified and ossified meningiomas

Seven cases of meningiomas with areas of calcification and ossification are reported, comprising 2.5 per cent of our 274 cases meningiomas. Six of these tumors ocurred in women (85.7 per cent). Six were located intracranially, and one within the spinal canal. The osteogenic meningioma in case 1 was situated within Meckel's cave, rare location of ossified meningioma that we have not found in the literature. In case 2, there was late recurrence of a tumor of entirely different histopathological features. Multiple, small osterogenic meningiomas, possibly associated with Von Recklinghausen's disease, were found in the right temporal lobe in case 5.

Rational use of diagnostic imaging in paediatrics. The report of a World Health Organization Study Group.

The World Health Organization (WHO) is the agency of the United Nations with primary responsibility for international health matters and public health. Through the exchange of the knowledge and experience of health professionals from 165 nations WHO promotes comprehensive health services worldwide. As a part of this effort WHO has in recent years been concerned with improving the availability and utilization of diagnostic imaging, especially as it relates to health services in developing countries. Having devised and specified suitable basic radiographic equipment (the WHO BRS) a WHO Scientific Group was convened in 1982 to study the utilization of radiographic procedures and to to recommend their more efficacious and rational use. Then in 1984, recognizing the implications of newer imaging technology on world health, a second WHO Scientific Group considered the design, impact and future use of ultrasonography and computed tomography in developing countries. The findings of these scientific groups were published as part of the WHO Technical Report Series which makes available the recommendations of such international groups of experts. Although some of the needs of children were considered in these previous Technical Reports, WHO felt that the size and socioeconomic importance of the paediatric population worldwide warranted a further study and report to address the particular technical and clinical problems of diagnostic imaging in the paediatric age group. Thus a third WHO Scientific Group met in Geneva from 18 to 24 November 1985 to review established practices and experience in paediatric imaging throughout the world; and to recommend rational guidelines for diagnostic imaging for children to age 14 years.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of fluorouracil on the corneal endothelium.

The utility of the antiproliferative agent fluorouracil has been demonstrated recently in glaucoma-filtering surgery and in the management of proliferative vitreoretinopathy after vitrectomy. Because of the potential for contact with the corneal endothelium, its toxicity to the endothelium is an important consideration. The effect of fluorouracil on corneal endothelial integrity in an in vitro animal model was studied. Freshly excised sheep corneal buttons were exposed to increasing concentrations of fluorouracil for four hours and were subsequently evaluated microscopically using vital staining with alizarin red and trypan blue. Exposure to normal saline and chlorhexidine gluconate was used to establish negative- and positive-staining controls. Corneal buttons exposed to normal saline or to 1.0 mg/mL or less of fluorouracil had intact endothelial monolayers that completely excluded trypan blue. Corneal buttons exposed to chlorhexidine gluconate or to 10 mg/mL of fluorouracil, however, had severely or totally disrupted endothelial monolayers in which the remaining cells, if any, all had blue-staining nuclei. These results suggest that the threshold concentration for fluorouracil toxicity to corneal endothelium lies between 1 and 10 mg/mL when exposure time is four hours.

Preferential expression of a 130,000-Da cell surface protein by vascular wall cells in vitro and in vivo.

Monoclonal antibodies have been raised against cell surface proteins of cultured bovine retinal pericytes. One antibody was selected, designated PC4, which preferentially stained primary cultures of bovine pericytes and smooth muscle cells, but not endothelial cells and fibroblasts. In freshly plated cells a homogeneous cell surface staining was observed, whereas in well-spread cells the antigen was concentrated at cell attachment sites. The antigen remained at these sites after spontaneous detachment of the cells. PC4 monoclonal antibodies reacted with a major protein of 130,000 Da and two minor antigens of 75,000 and 70,000 Da in immunoblots of extracts from cultured pericytes and smooth muscle cells and from fibroblasts cultured for an extended period of time. In frozen sections of bovine tissues the antigen was found in the vascular wall. There was no staining of skeletal muscle cells or duodenal smooth muscle cells, indicating that the antigen may be a specific component of the vascular wall.

Cholelithiasis in childhood: a follow-up study.

Fifteen children with cholelithiasis who were treated at the Royal Hospital for Sick Children, Glasgow between 1973 and 1985 are reviewed. Ten patients had idiopathic gallstones and five had gallstones in association with hereditary spherocytosis. All patients have been followed up for between 4 months and 12 years (mean 4.1 years): ultrasonography has been carried out on 13. Fourteen patients underwent surgery of whom only seven had symptoms from their gallstones. Nine patients had cholecystostomy and removal of gallstones, four patients had cholecystectomy (one had negative exploration of the common bile duct in addition) and one patient with choledocholithiasis underwent choledochotomy with transduodenal sphincterotomy. One patient did not have surgery; she has remained asymptomatic and ultrasound examination confirms that she still has a solitary gallstone in her gallbladder. Clinical review with ultrasonography shows that cholecystostomy with removal of gallstones appears to be an acceptable alternative to cholecystectomy.

Uses of thrombin in ocular surgery. Effect on the corneal endothelium.

Thrombin is a hemostatic factor that induces platelet aggregation and catalyzes the conversion of fibrinogen to fibrin. The potential for its increasing application to a variety of anterior and posterior segment surgery led us to investigate the in vitro effect of thrombin on the corneal endothelium in a sheep model. We examined freshly excised sheep corneas stained with alizarin red and trypan blue after exposure to two different concentrations of thrombin for four hours. The structure of the corneal endothelium appeared to be intact even after prolonged exposure to thrombin at concentrations of 100 and 1000 U/mL. Thrombin appears to be nontoxic to the corneal endothelium in this experimental model.

Effects of hyperoxia on microvascular cells in vitro.

Microvascular cells are most vulnerable to direct oxygen damage. Using an in vitro model system we have investigated the effect of elevated oxygen on the proliferation, morphology, and integrity of microvascular endothelial cells (EC) and pericytes. Cultivation of these cells at oxygen concentrations of 40% for 1 wk resulted in the inhibition of EC proliferation but had no effect on the growth of the pericytes. Similarly, hyperoxia induced a dramatic change in the shape of the EC, increasing their spread area by close to six-fold. Under the same conditions, the spread area of the pericytes was unaffected. To understand the effect of the hyperoxic treatment on the cells, the integrity of various membrane systems was assessed. 51Chromium release was used to monitor plasma membrane integrity. There was no difference in chromium release by EC and pericytes over the 7 d of growth under normoxic and hyperoxic conditions. Mitochondrial integrity was examined by staining the cells with Rhodamine 123, which is selectively accumulated by the mitochondria. The staining pattern of the mitochondria of both EC and pericytes was altered by growth in the elevated oxygen. Finally, the lysosomes were visualized using acridine orange. The acridine orange staining pattern revealed enlarged and perinuclear lysosomes in the EC but no change in the pericyte lysosomal staining pattern. Thus, the cells of the microvasculature seem to be differentially affected by hyperoxia, a fact that may be significant in the etiology of reperfusion injury, ischemic disease, and pathologies associated with prematurity.

Lethal neonatal chondrodysplasias in the West of Scotland 1970-1983 with a description of a thanatophoric, dysplasialike, autosomal recessive disorder, Glasgow variant.

Complete ascertainment of lethal neonatal short-limb chondrodysplasias was attempted in the West of Scotland for the period 1970-1983. Forty-three cases were identified, representing a minimum incidence of 1 in 8,900. The differential diagnosis included 11 well-delineated skeletal dysplasias, one case of warfarin embryopathy, and one apparently new condition with presumed autosomal recessive inheritance that has radiographic similarities to those of thanatophoric dysplasia (TD). In this series TD had an incidence of 1 in 42,221, which is consistent with new dominant mutation at a rate of 11.8 +/- 4.1 X 10(-6) mutations per gene per generation. Ultrasonic measurement of fetal long bone length was performed in eight subsequent pregnancies at risk. Five unaffected fetuses were predicted correctly and three affected fetuses were detected during the second trimester (one with rhizomelic chondrodysplasia punctata-second trimester prenatal diagnosis not previously reported; one with achondrogenesis type II; and one with the new lethal condition).

Crossed Wernicke's aphasia.

Severe Wernicke's aphasia occurred suddenly in a right-handed man and persisted with little improvement until he died 54 days later. Postmortem examination showed an infarct in the posterior temporoparietal region of the right hemisphere. This case demonstrates two new features of crossed dextral aphasia. First, language skills may be fully lateralized to the right hemisphere in right-handed patients. Second, when crossed lateralization occurs, the usual localization of aphasic syndromes is common, suggesting that the intrahemispheric organization mediating language activities is the same in the right hemisphere of the crossed dextral and the left hemisphere of the typical right-handed individual.