Clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histologic sections

BACKGROUND: Breast carcinoma is a heterogeneous group of diseases deviating from each other not only in their clinical manifestations and outcome but also in their histologic appearance. The submacroscopic morphology of breast carcinomas, the distribution of the lesions, and the extent of the disease are seldom studied. Even more infrequently are these parameters included in surgical pathology reports. Conversely, the routine use of large-format histologic sections in workup of operated breast specimens provides better insight into the significance of these parameters. The aim of the study was to identify breast carcinoma growth patterns indicating increased metastatic potential of the tumor and a need for more aggressive therapy. METHODS: In all, 500 consecutive breast cancer cases, all of which were documented on large-format histologic sections, were retrospectively analyzed. The distribution of both in situ and invasive components of the tumors (unifocal/multifocal/diffuse) was defined, determined, and compared with the type of surgical intervention performed and the frequency of ipsilateral lymph node metastasis as endpoints. The extent of the disease, the size of the tumor, the presence or absence of lymphovascular invasion (LVI), and the proportion of invasive lobular carcinomas in the categories with different distributions were also analyzed. RESULTS: Only 34% of the analyzed cases could be categorized as unifocal. This kind of tumor distribution was associated with lymph node metastasis in 28% of the cases, with LVI in 18%, with breast-conserving surgery in 67%, and with a proportion of 4% invasive lobular carcinomas. Tumors with a unifocal invasive component upgraded to multifocal or diffuse because of the distribution of the associated in situ component had similar characteristics. With their larger extent, tumors with a diffuse in situ component required mastectomy in 43% of cases. Multifocal distribution of the invasive component in the tumors was associated with higher frequency of LVI (42%) and lymph node metastases (48%), with a substantially lower number of cases undergoing breast-conserving surgery (33%) and with a higher proportion of lobular carcinomas (25%). If the multifocal invasive foci were associated with a diffuse in situ component, the proportion of invasive lobular carcinomas was only 5%. The extent of the lesions (defined as the area of breast tissue involved by in situ, invasive, and/or intravascular tumor foci) was >or=2 cm in >90% of multifocal cases and >or=4 cm in >70%. Diffusely growing invasive carcinomas were rare (only 20 cases), but were associated with lymph node metastasis in 60% of cases and resulted in mastectomy in 85% of the cases. Approximately two-thirds (65%) of these tumors belonged to invasive lobular carcinomas. The extent of diffusely growing invasive carcinomas was >or=4 cm in 75% of the cases. Although LVI was detected in only 10% of tumors with a diffusely growing invasive component, such tumors were found to have lymph node metastasis significantly more often (odds ratio of 2.33) and required mastectomy much more frequently (odds ratio of 2.58) compared with purely unifocal breast carcinomas. CONCLUSIONS: These results indicate that the distribution of invasive and in situ tumor structures in breast carcinomas as defined in the current study, together with the extent of disease, are important morphologic parameters which determine the required surgical intervention and are related to biologic factors such as metastatic capacity. The method of large-section histology allows the examiner to properly document and demonstrate these important parameters, thus facilitating understanding of their clinical relevance.     

Generalization ability of fractional polynomial models

In this paper, the problem of learning the functional dependency between input and output variables from scattered data using fractional polynomial models (FPM) is investigated. The estimation error bounds are obtained by calculating the pseudo-dimension of FPM, which is shown to be equal to that of sparse polynomial models (SPM). A linear decay of the approximation error is obtained for a class of target functions which are dense in the space of continuous functions. We derive a structural risk analogous to the Schwartz Criterion and demonstrate theoretically that the model minimizing this structural risk can achieve a favorable balance between estimation and approximation errors. An empirical model selection comparison is also performed to justify the usage of this structural risk in selecting the optimal complexity index from the data. We show that the construction of FPM can be efficiently addressed by the variable projection method. Furthermore, our empirical study implies that FPM could attain better generalization performance when compared with SPM and cubic splines.     

《黄帝内经》脏气法时理论的变通

目的：引入五行休王理论及病证相参思路,对《黄帝内经》脏气法时理论的变通进行探讨。方法：运用阅读原文、归纳、总结、分析等方法。结果：脏气法时理论的变通符合形式逻辑及临床实际。可贵之处是将“天人合一”观念落到实处,形成规律性认识,符合气一阴阳一五行化的天人之道。但由于时代的局限或形式逻辑略疏,其推导方式尚存可商之处。结论：五行休王理论及病证相参思路,能在具体运用中发挥更大的指导实效。     

Application of Orem's Self‐Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE. This paper aims to illustrate the process of theory‐based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN. Orem's self‐care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS. Theory‐based nursing care and standardized nursing language enhanced the client's ability to self‐manage the chronic illness: diabetes. CONCLUSION. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self‐manage a chronic illness.     

Orem自理理论在社区老年人护理中的应用现状

阐述Orem自理理论的主要内容,综述我国老年人护理的现状、影响社区老年人自理能力的因素以及Orem自理理论在社区老年人护理实践中的应用效果。     

试论乌梅丸以气味配伍组方

乌梅丸出自《伤寒论》厥阴病篇，其为历代医家推崇的关键在于紧扣病机，方证对应，组方合理，配伍精当。本文从酸辛苦甘，刚柔相济；清上温下，攻补兼施；辛开苦降，土木两调3个方面讨论了乌梅丸按照气味配伍组方的特点。     

温病学理论指导下的新型冠状病毒肺炎诊治刍议

基于温病学理论,探讨新型冠状病毒肺炎的中医病因病机与诊治思路。温病学说源于明清之前的历代中医理论积累,经过长期的温热病防治实践而形成,其对于外感热病(包括烈性传染病)的病因病机、证治方药有着较为系统的论述,近年来在我国的新发传染病防治中发挥出积极的作用。温瘟相通,瘟疫病因多为热毒疫邪,表现为热证阳证,可按温病学中的卫气营血或三焦辨证分期论治,或治以吴又可、庞安时等的经方验方,这些因、机、证、治理论可试用于新型冠状病毒肺炎的中医诊疗。且肺与大肠相表里,胃肠道也是新型冠状病毒侵袭或繁殖的部位,采用中医清热通下之法,使邪从肠道而出,可能是减轻体内病毒感染与肺脏炎症的一种途径。     

浅谈五行学说与五脏相关论的关系

五行学说本是具有很大的灵活性,它不是固化的理论,五行配属五脏是互藏的,五行之间的联系是双向的。于是,为了弥补五行学说缺陷而提出的五脏相关论,不可能是独立的理论体系,而是对五行学说的阐释。     

Orem自护理论对脑中风偏瘫患者自护能力和生活质量的影响研究

目的：探讨 Orem 自护理论对脑中风偏瘫患者自护能力和生活质量的影响。方法将该院收治的90例脑中风偏瘫患者随机分为干预组和对照组各45例,对照组采用常规护理方法;干预组按照 Orem 自护理论实施护理干预。比较二组患者护理后日常生活能力、焦虑情绪、社会支持水平和生活质量。结果护理后二组患者 BI 评分显著增加,SAS 评分显著降低（P＜0．05）,其中护理后干预组 BI 、SAS 评分显著优于对照组,二组间相比差异具有统计学意义（P＜0．05）;护理后干预组各 SSRS 评分指标显著高于对照组（P＜0．05）;护理后二组患者角色功能、社会功能、身体功能、情绪功能以及总生活质量评分均显著高于对照组,组间相比差异具有统计学意义（P＜0．05）。结论 Orem 自护理论应用于脑中风偏瘫患者能够提高患者的自护能力能和生活质量,值得临床推广。