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Puneeth Iyengar Eric A. Strom Yu‐Jing Zhang Gary J. Whitman Benjamin D. Smith Wendy A. Woodward Tse‐Kuan Yu Thomas A. Buchholz 《The oncologist》2012,17(11):1402-1408
Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We retrospectively analyzed data from patients who were treated curatively in 1996–2006 at The University of Texas MD Anderson Cancer Center for clinical stage III breast cancer. We compared differences in regional lymph node staging based on ultrasound versus mammography and physical examination in the 865 of 1,200 patients who had external-beam radiation as part of their treatment and regional ultrasound studies as part of their initial evaluation. Ultrasound uniquely identified additional lymph node involvement beyond the level I or II axilla in 37% of the patients (325 of 865), leading to a change in clinical nodal stage. Ninety-one percent of these abnormalities that could be biopsied (266 or 293) were confirmed to contain disease. The sites of additional regional nodal disease were: infraclavicular disease, 32% (275 of 865); supraclavicular disease, 16% (140 of 865); and internal mammary disease, 11% (98 of 865). All patients with involvement in the extra-axillary regional nodal basins received a radiation boost to the involved areas ≥10 Gy. Thus, over one third of patients with advanced breast cancer had their radiation plan altered by the ultrasound findings. Regional ultrasound evaluation in patients with advanced breast cancer commonly revealed abnormalities within and beyond the axilla, which changed the clinical stage of disease and the radiation treatment strategy. Therefore, regional ultrasound is beneficial in the initial staging evaluation for such patients. 相似文献
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Sonal Josan Jae Mo Park Ralph Hurd Yi‐Fen Yen Adolf Pfefferbaum Daniel Spielman Dirk Mayer 《NMR in biomedicine》2013,26(12):1680-1687
Hyperpolarized 13C MRS allows the in vivo assessment of pyruvate dehydrogenase complex (PDC) flux, which converts pyruvate to acetyl‐coenzyme A (acetyl‐CoA). [1‐13C]pyruvate has been used to measure changes in cardiac PDC flux, with demonstrated increase in 13C‐bicarbonate production after dichloroacetate (DCA) administration. With [1‐13C]pyruvate, the 13C label is released as 13CO2/13C‐bicarbonate, and, hence, does not allow us to follow the fate of acetyl‐CoA. Pyruvate labeled in the C2 position has been used to track the 13C label into the TCA (tricarboxylic acid) cycle and measure [5‐13C]glutamate as well as study changes in [1‐13C]acetylcarnitine with DCA and dobutamine. This work investigates changes in the metabolic fate of acetyl‐CoA in response to metabolic interventions of DCA‐induced increased PDC flux in the fed and fasted state, and increased cardiac workload with dobutamine in vivo in rat heart at two different pyruvate doses. DCA led to a modest increase in the 13C labeling of [5‐13C]glutamate, and a considerable increase in [1‐13C]acetylcarnitine and [1,3‐13C]acetoacetate peaks. Dobutamine resulted in an increased labeling of [2‐13C]lactate, [2‐13C]alanine and [5‐13C]glutamate. The change in glutamate with dobutamine was observed using a high pyruvate dose but not with a low dose. The relative changes in the different metabolic products provide information about the relationship between PDC‐mediated oxidation of pyruvate and its subsequent incorporation into the TCA cycle compared with other metabolic pathways. Using a high dose of pyruvate may provide an improved ability to observe changes in glutamate. Copyright © 2013 John Wiley & Sons, Ltd. 相似文献
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A. Hernández‐Martín A. Torrelo S. Ciria I. Colmenero A. Aguilar R. Grimalt R. González‐Sarmiento 《Clinical and experimental dermatology》2013,38(7):787-790
Ectodermal dysplasia–skin fragility syndrome (EDSFS) is an autosomal recessive genodermatosis characterized by skin fragility, palmoplantar hyperkeratosis, onichodystrophy, perioral fissuring and noncicatricial alopecia. It is caused by plakophilin‐1 (PKP1) deficiency, which results in desmosomal abnormality and poor intercellular cohesion between the epidermal cells. We report a case with a novel PKP1 mutation in intron 6. 相似文献
997.
Many medical schools have introduced problem‐based learning (PBL) in the traditional “basic science”; years, but there has not been a great movement to connect PBL methodology with clinical teaching. An attempt to integrate PBL and the clinical component of a 3rd‐year course was undertaken by the Department of Obstetrics and Gynecology, University of Toronto. Evaluations of the preparation, introduction, process, and outcomes were undertaken, using qualitative and survey methodology. Analysis of data revealed that logistics, attitudes of faculty and students, and the degree of faculty preparation were the major influences on the perceived success of the project. 相似文献
998.
Validation of a Frailty Index from The Older Persons and Informal Caregivers Survey Minimum Data Set
Jennifer E. Lutomski MS Maria A.E. Baars PhD Janneke A. van Kempen MD Bianca M. Buurman PhD Wendy P.J. den Elzen PhD Aaltje P.D. Jansen PhD Gertrudis I.J.M. Kempen PhD Paul F.M. Krabbe PhD Bas Steunenberg PhD Ewout W. Steyerberg PhD Marcel G.M. Olde‐Rikkert PhD René J.F. Melis PhD 《Journal of the American Geriatrics Society》2013,61(9):1625-1627
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