Axillary Ultrasound in the Management of the Newly Diagnosed Breast Cancer Patient

Axillary lymph node status remains an important prognostic factor in patients with breast cancer. Axillary ultrasound (AUS) is an important tool in the workup of patients with newly diagnosed breast cancer and also has an emerging role evaluating the axilla after neoadjuvant chemotherapy. This review discusses the value of AUS in the workup and management of patients with newly diagnosed breast cancer and describes its role given the recent changes in axillary management.     

Delivery and Biodistribution of Traceable Polymeric Micellar Diclofenac in the Rat

The nonsteroidal anti-inflammatory drugs elevate cardiovascular risk, perhaps, due to their accumulation in the heart and kidneys. We designed nanodelivery systems for cardiotoxic diclofenac to reduce its presence in these organs. Diclofenac ethyl ester (DFEE) was encapsulated in traceable micelles based on poly(ethylene oxide)-b-poly(ε-caprolactone) (DFEE-PCL-TM) or poly(ethylene oxide)-b-poly(α-benzyl carboxylate-ε-caprolactone) (DFEE-PBCL-TM). Diclofenac pharmacokinetics and tissue distribution were studied after intravenous (iv) and intraperitoneal administration of the nanoformulations and compared with those after iv doses of free diclofenac (n = 3-6/group). The average diameters for DFEE-PBCL-TM and DFEE-PCL-TM were 37.2 ± 0.06 and 45.1 ± 0.06 nm, respectively. Drug concentration dropped below the assay sensitivity after free drug administration in 6 h, but persisted for 24 h following DFEE-PBCL-TM (2.3 ± 1.4 μg/mL) and DFEE-PCL-TM (1.9 ± 0.6 μg/mL) iv administration. The diclofenac heart:blood and kidney:blood ratios were 5- to 12-fold lower with the nanoformulations than with free diclofenac. Near-infrared fluorescence measurements in tissues suggested exposure patterns to nanocarriers parallel with those achieved for delivered diclofenac by nanoformulations. Administration of DFEE-PCL-TM by iv or intraperitoneal injection, resulted in comparable pharmacokinetics and 6 h postdose near-infrared fluorescence in the heart, kidneys, liver, and spleen. When compared to each other, DFEE-PBCL-TM showed significantly lower diclofenac levels in the heart compared to DFEE-PCL-TM (0.3 ± 0.03 vs. 0.5 ± 0.1 μg/g). Developed nanoformulations of diclofenac prolonged diclofenac circulation and reduced its presence in the heart and kidneys, strongly suggesting cardiac-safe delivery vehicles for diclofenac.     

Prevalence, predictors, and outcomes of conservative medical management in non-ST-segment elevation acute coronary syndromes in Gulf RACE-2

We assessed the prevalence, predictors, and in-hospital and long-term outcomes of conservative medical management for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) compared with percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). This prospective study conducted from October 2008 to June 2009 in 65 hospitals from 6 Arabian Gulf countries included 30-day and 1-year mortality follow-up for 3661 patients. Compared with conservative management group (2859 patients; 78.1%), the PCI group (638; 17.4%) had significantly better unadjusted and adjusted in-hospital (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.17-0.97), 30-day (OR: 0.44, 95% CI: 0.24-0.76) and 1-year (OR: 0.58, 95% CI: 0.40-0.87) mortality rates. Comparison with the CABG group (164; 4.5%) yielded similar results with inclusion of patients scheduled for CABG after hospital discharge. Independent predictors of conservative medical management were mainly country of residence and history of prior CABG.     

Relationship between white blood cell count and in-hospital outcomes in acute coronary syndrome patients from the Middle East

We evaluated the relationship between admission white blood cell (WBC) count and in-hospital outcomes in acute coronary syndrome (ACS) patients from the Middle East. Data were analyzed from 7806 consecutive patients with ACS who were divided into 4 groups (G) according to their WBC count (× 10(9)/L; G1: < 6.00; G2: 6.00-9.99; G3: 10.00-11.99; G4: ≥ 12.00). After significant covariate adjustment, those in G4 were 68% more likely to have cardiogenic shock than those in G1 (95% confidence interval [CI]: 1.05-2.68; P = .030) and G2 (odds ratio [OR], 2.02; 95% CI: 1.51-2.71; P < .001). Those in G4 were 2.02 times (95% CI: 1.11-3.67; P = .021) and 65% (95% CI: 1.17-2.32; P = .004) more likely to die in hospital than those in G1 and G2, respectively. Admission WBC count is an independent risk factor for in-hospital cardiogenic shock and mortality, in Middle Eastern patients with ACS. Novel therapeutic agents targeting WBCs in patients with ACS may improve outcomes.     

Compaction of Cohesive Granular Material: Application to Carbon Paste

Carbon-like materials such as the anode and the ramming paste play a crucial role in the efficiency of the Hall–Héroult process. The mechanical behavior of these materials during forming processes is complex and still ill-understood. This work aimed to investigate experimentally the mechanical behavior of a carbon paste used in the aluminum industry under different loading conditions. For this purpose, experiments consisting of (1) relaxation tests at different compaction levels, (2) quasi-static cyclic tests at several amplitudes, (3) monotonic compaction tests at varied strain rates, and (4) vibrocompaction tests at different frequencies were carried out. The obtained results highlight some fundamental aspects of the carbon paste behavior such as the strain rate’s effect on the paste compressibility, the hardening-softening behavior under cyclic loadings, the effect of cycling amplitude on the stress state and the paste densification, and the frequency effect on the vibrocompaction process. These results pave the way for the development of reliable rheological models for the modeling and the numerical simulation of carbon pastes forming processes.     

Cross sectional quality of life assessment in patients with androgenetic alopecia

Assessment of quality of life (QOL) of patients with androgenetic alopecia (AGA) has become increasingly important, both in order to evaluate the influence of the disease on patients and the therapy they require. We aimed to assess QOL in subjects complaining from AGA and evaluated the effects of various sociodemographic factors affecting their QOL. QOL was assessed in 400 patients with AGA and 100 controls using the World Health Organization Quality of life (WHOQOL‐BREF) questionnaire. Four domains (physical, psychological, social, and environmental) and two items (overall perception of QOL and health) of the WHOQOL‐BREF were the primary end points of this study. Patients had a lower QoL and less general satisfaction in all four domains of assessment than controls. The social impact was significantly higher in patients < 30 years of age (P = .003). Patients with severer form of AGA significantly had higher scores in all domains compared to those with less severe forms. Disease severity negatively impacted all the four domains significantly (P = .021). AGA harmfully affected the patient's QOL which warns the physicians to pay more attention to QOL impairment in patients of AGA for the better understanding of the disease burden on individual patients.     

Primary Melanoma of the Adrenal Gland,a Continuous Dilemma: Report of a Case

The adrenal gland can frequently be the site of metastatic deposits, including malignant melanocytic tumors; however, primary melanoma of the adrenal gland is exceptional. We reviewed 18 cases reported in the English literature to date, and here add another case which occurred in a 78-year-old man. The patient underwent right suprarenalectomy and the pathology report showed a malignant melanoma of the adrenal gland. Immunohistochemical staining revealed a positive antibody-specific cytoplasmic reactivity to S-100 and HMB-45 proteins with a negative reaction for cytokeratin (AE1, AE3), synaptophysin, chromogranin and neuron-specific enolase. There are diagnostic criteria for accepting an adrenal melanoma as primary; however, an autopsy is the final step to confirm this infrequent pathology.