Alterations in Breast Cancer Biomarkers Following Neoadjuvant Therapy

Annals of Surgical Oncology - Biomarker changes in patients with residual disease (RD) after neoadjuvant systemic therapy (NAT) have unclear consequences. This study examined the prevalence of...     

Comparison of multiple oncotype DX® from the same patient

For women with breast cancer in whom multiple Oncotype DX^® Recurrence Scores (RS) are obtained, RS concordance utilizing current NCCN recommendations has not been evaluated. Patients with two or more RS were identified. RS were stratified by NCCN guidelines and compared for concordance. Twenty-four patients were evaluated. RS concordance varied by tumor type: 100% in the same tumor, 91.7% in multiple ipsilateral tumors, 71.4% in contralateral tumors, and 66.7% in in-breast recurrent tumors. RS concordance for multiple assays in the same patient is not high enough to omit Oncotype DX^® testing for each tumor.     

Transradial approach for percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia.

Chronic mesenteric ischemia (CMI) occurs in the presence of slowly progressive, long-standing stenoses of the visceral arteries secondary to atherosclerosis. Angioplasty and stenting are emerging as therapeutic alternatives to surgery in treating CMI. The transradial approach is an attractive alternative access for performing stenting in CMI at improved safety and ease. A case of CMI treated with stenting of the visceral arteries by both transradial and femoral approaches is presented here. The main difficulty in accessing the celiac and mesenteric arteries through the femoral approach is the angle between the aorta and these vessels, which often leads the operator to use multiple catheters. The main advantage of the radial approach (as well as the brachial one) is that it allows easy coaxial alignment of the catheter with the artery. The main problem is the inadequate length of the currently available catheters. The radial approach eliminates the risk for vascular complications and permits early ambulation.     

A Behavioral Economics Perspective on Tobacco Taxation

Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco''s hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country''s circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.A growing international consensus favors measures to reduce tobacco use in both developed and developing countries^1,2 despite the controversy such policies often engender. Tobacco taxation, which affects both public health and public finance, is especially contentious.³By some estimates, taxes that raise the real price of cigarettes by 10% can reduce consumption between 1.2% and 3.36% in high-income countries and by 4% to 6% in low-income countries, where consumers are more price sensitive.⁴ From a public health perspective, raising taxes has a straightforward logic: it encourages smokers to quit, saving more lives.By contrast, economists’ skepticism of tobacco taxation as a policy tool stems from theoretical and empirical concerns regarding efficiency and equity. Economists typically agree that taxes are required when prices in a market understate the harm that individual decisions cause to society as a whole, but they also hold that taxes should not interfere with private choices that do not harm others. Higher taxes are inefficient if the harm from restricting individuals’ overall consumption choices exceeds the societal benefits of reducing tobacco use. Further, higher tobacco taxes can be regressive if poorer groups bear a disproportionately larger burden because of reduced overall ability to purchase and consume other goods.A more recent and growing body of economic research suggests that this conventional analysis might be inadequate as applied to tobacco taxation. The recognition that tobacco is addictive, that intent to quit is widespread, and that attempts to quit are difficult underlie most tobacco control policies, from cessation assistance to advertising restrictions. But the issue of self-control has generally not been incorporated into analyses of optimal tobacco tax levels.Self-control problems in economic contexts are among the phenomena investigated by behavioral economics. This field uses psychological research on individual decision making to analyze market outcomes where some individuals display common cognitive and perceptual limitations and complications disregarded by more conventional economic models.⁵ Jonathan Gruber and Botond Köszegi^6,7 used a behavioral economics approach to suggest that taxes higher than the rates typically recommended may be appropriate.The main rationale for recommending higher taxes is that price increases can counter some of the harm to society that private markets ignore. Like conventional economic approaches, behavioral economics holds that tobacco use reflects interactions of supply and demand factors. Traditional economic models usually predict that the amount of tobacco individuals consume at any given price precisely reflects their private preferences. Behavioral economics instead suggests that some demand for tobacco reflects overconsumption attributable to poor self-control. Although current tax structures often redress some harm smokers cause others, they are not specifically designed to reduce the harm that smokers inflict on themselves when they are unable to reduce consumption despite an intent to do so.     

Hyperinsulinemia and dyslipidemia in non-obese, normotensive offspring of hypertensive parents in northern India.

Insulin resistance contributes to initiation and acceleration of hypertension and atherosclerosis. This study attempted to detect occurrence of pre-hypertensive metabolic abnormalities, including hyperinsulinemia, in the offspring of hypertensive patients. Thirty-eight healthy offspring of hypertensive parents (group I, mean age 23.6+/-3.7 years) and 18 control offspring of normotensive parents (group II, mean age 24.2+/-2.8 years) were clinically examined, subjected to oral glucose tolerance test (OGTT), and the samples were analysed for blood glucose, insulin and lipid profile. Subjects in group I with fasting serum insulin <90 nmol/L constituted group Ia (n = 23, 62%) and those with >90 nmol/L constituted group Ib (n = 15, 38%). Both groups consisted of non-obese and normotensive subjects matched for body mass index and waist-hip ratio. There were no statistically significant differences in blood glucose levels between groups Ia, Ib and II during OGTT. Serum insulin levels during OGTT in group I were significantly higher than in group II (p<0.05), except at 30 min. Fasting insulin and 2 h post-OGTT insulin in group Ib were significantly higher than the other groups. Serum triglyceride levels, though within normal range, were higher in group I than group II (p<0.01). Similarly, high-density lipoprotein cholesterol levels in groups Ia and Ib were lower than those observed in group II (p<0.01). In conclusion, non-obese, normotensive offspring of hypertensive parents were observed to be hyperinsulinemic and dyslipidemic at an early age. These metabolic abnormalities may be associated with hypertension, glucose intolerance and accelerated atherosclerosis in adulthood.     

Biochemical,clinical, and morphologic studies on lungs of infants with bronchopulmonary dysplasia

We correlated clinical, biochemical, and morphologic findings in the lungs of 48 infants dying of either bronchopulmonary dysplasia (BPD) or hyaline membrane disease (HMD) to obtain a better idea of the disease process. The infants ranged from 24 weeks of gestation to 1½ postnatal years. The lungs of BPD and HMD infants had higher contents of DNA, alkali-soluble protein, hydroxyproline, and desmosine, as well as increased concentrations of DNA, hydroxyproline, and desmosine when compared with the lungs of 72 control infants. BPD was classified histologically into 4 groups: Group I was a phase of acute lung injury; Group II the proliferative phase; Group III the phase of early repair; and Group IV the phase of late repair. We saw a significant increase in hydroxyproline concentration in Groups II and III. The ratio of type VIII collagen decreased in BPD Groups II to IV. Desmosine was significantly higher only in Group III than in controls. When the pathological classification was related to biochemical and clinical features of BPD, the classification showed dependence on the number of days the infant survived postnatally and not on the gestational age of the infant. The number of days on assisted ventilation was a slightly better predictor of the disease classification than days on > 60% oxygen. A statistical model correctly predicted the pathologic classification 83% of the time. Pediatr Pulmonol. 1996; 22:215–229. © 1996 Wiley-Liss, Inc.     

Changes of growth hormone, somatomedin C, and bombesin following pneumonectomy.

Left pneumonectomy (PX) was performed on 14-day-old pregnant rats. Serum growth hormone (GH), lung somatomedin-C-like immunoreactivity (SmC), and lung bombesin-like immunoreactivity (BLI), using optimized radioimmunoassays and lung protein concentration (P), were measured 3 h, and 1, 2, 3, 5, and 7 days following pneumonectomy. These levels were compared to two groups of similar animals: sham operated animals and animals not subjected to surgery. Serum GH, lung SmC, and BLI levels were similar in the last two groups of animals, suggesting that surgery had no effect on GH, SmC, and BLI levels. These two control groups were combined and compared to the post-pneumonectomy animals. The post-pneumonectomy animals had significantly higher levels of serum GH at postoperative day 3 and significantly higher levels of SmC at days 2 and 5 without any significant difference in total BLI level and body weight. These results suggest that, first, GH and SmC may play a part in post-pneumonectomy compensatory lung growth and these two may also be interrelated in this response and, second, BLI material(s) perhaps do not play a role in post-pneumonectomy lung growth.