Primary Foci Research Articles

Comparing Nonparametric Tests of Equality of Means for Randomized Block Designs

A number of nonparametric tests are compared empirically for a randomized block layout. We assess tests appropriate for when the data are not consistent with normality or when outliers invalidate traditional analysis of variance (ANOVA) tests. The objective is to assess, within this setting, tests that use ranks within blocks, the rank transform procedure that ranks the complete sample and continuous analogs of the Cochran–Mantel–Haenszel tests. The usual linear model is assumed, and our primary foci are tests of equality of means and component tests that assess linear and quadratic trends in the means. These tests include the traditional Page and Friedman tests. We conclude that the rank transform tests have competitive power and warrant greater use than is currently apparent.

Cancer-specific uptake of a liganded protein nanocarrier targeting aggressive CXCR4+ colorectal cancer models

Unliganded drug-nanoconjugates accumulate passively in the tumor whereas liganded nanoconjugates promote drug internalization in tumor cells via endocytosis and increase antitumor efficacy. Whether or not tumor cell internalization associates with enhanced tumor uptake is still under debate. We here compared tumor uptake of T22-GFP-H6, a liganded protein carrier targeting the CXCR4 receptor, and the unliganded GFP-H6 carrier in subcutaneous and metastatic colorectal cancer models. T22-GFP-H6 had a higher tumor uptake in primary tumor and metastatic foci than GFP-H6, with no biodistribution or toxicity on normal tissues. T22-GFP-H6 was detected in target CXCR4+ tumor cell cytosol whereas GFP-H6 was detected in tumor stroma. SDF1-α co-administration switched T22-GFP-H6 internalization from CXCR4+ tumor epithelial cells to the stroma. Therefore, the incorporation of a targeting ligand promotes selective accumulation of the nanocarrier inside target tumor cells while increasing whole tumor uptake in a CXCR4-dependent manner, validating T22-GFP-H6 as a CXCR4-targeted drug carrier.

Combined Effect of Opioids and Corticosteroids for Alleviating Dyspnea in Terminal Cancer Patients: A Retrospective Review

ABSTRACTDyspnea is a prognostic factor that affects the quality of life of terminal cancer patients, and many reports have described opioid treatment for dyspnea alleviation. Here, we retrospectively evaluated differences in the effects of various opioids administered concomitantly with corticosteroids on dyspnea in 20 terminal-stage cancer patients (13 men, 7 women; mean age [range]: 71 [49–94] years) who received opioids concomitantly with corticosteroids. Effectiveness was assessed throughout administration using the Support Team Assessment Schedule, Japanese version (STAS-J), particularly the subscale indicating how strongly a patient is affected by symptoms. The effectiveness of combined opioid and corticosteroid therapy against dyspnea and the opioid dose comprised the primary and secondary foci, respectively. Among concomitantly treated patients, STAS-J scores at initiation (mean ± SD: 3.1 ± 0.24) and lowest recorded STAS-J scores (1.4 ± 0.22) differed significantly (P = .0034) among those receiving morphine, but not among those receiving oxycodone (P = .068) or fentanyl (P = .18). Concomitant opioid and corticosteroid treatment was associated with a ≥2-point STAS-J score improvement in 14/20 patients (effectiveness: 70%). The opioid dose did not significantly affect dyspnea alleviation. We conclude that concomitant opioid and corticosteroid treatment can effectively alleviate dyspnea in terminal cancer patients.

Sectoral CO2 emission reductions in Turkey: Preparing for DOHA 2020

ABSTRACTIn this study, CO2 emissions in different sectors in Turkey were examined in order to serve as a foundation for planning future reduction of greenhouse gas emissions. These reductions are being planned in accordance with the Kyoto Protocol, of which Turkey is a signatory, and which was re-examined by the Doha Climate Change Conference in 2009. For this purpose, variation of the total factor efficiencies of CO2 emissions per capita for many developed and developing countries including Turkey (35 countries in total) were examined by data envelopment analysis and Malmquist Index approaches. It was aimed to determine the sectors in Turkey that should be the primary foci for reductions of CO2 emissions and which actions might be taken before Doha 2020 oriented towards reductions in CO2 emissions in these sectors. Meanwhile, current regulations and perspectives for greenhouse gas plans developed within the scope of Vision 2023 were discussed.

CT differentiation of diffuse malignant peritoneal mesothelioma and peritoneal carcinomatosis

Diffuse malignant peritoneal mesothelioma (DMPM) and peritoneal carcinomatosis (PC) have similar imaging in computer tomography (CT). We aimed to distinguish them. Computer tomography findings were evaluated in 48 DMPM and 47 PC for the peritoneal, mesenteric, omentum, lymph nodes, viscera infiltration, ascites and pleural plaques. Two groups had no difference in terms of thickness, clinical manifestation, diameter of lymph nodes, ascites, and viscera infiltration. But they showed differences in the following: Ratio of asbestos exposure in DMPM group was higher. Smooth and irregular peritoneal thickening were more seen in DMPM group; peritoneal nodules were more commonly detected in PC group. Forty-eight cases of peritoneum in DMPM showed mild enhanced, while 14 patients in PC showed severe enhanced. Nodular type of omentum was more common in PC group than in DMPM group; omental cake was more commonly detected in DMPM group. Mesentery involvement was more commonly seen in DMPM group. Location of enlarged lymph nodes in cardiophrenic region was more frequently identified in DMPM, whereas location of enlarged lymph nodes in retroperitoneal region was more frequently identified in PC. Lymph nodes fusion was more frequently visualized in PC. Fixation of the intestinal wall was more common in DMPM. Pleural plaque was more common in DMPM. PC had distant metastasis except primary foci and peritoneum. In PC, tumor origins were ovary in 10, digestive system in 21, breast in one. Using a combination of CT findings may increase our ability to distinguish PC from DMPM.

THE CLINICAL UTILITY OF 18F-FDG POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY SCAN VERSUS 99MTC-HMPAO WHITE BLOOD CELL SINGLE-PHOTON EMISSION COMPUTERIZED TOMOGRAPHY IN THE EXTRA-CARDIAC WORK-UP OF PATIENTS WITH DUKE DEFINITE INFECTIVE ENDOCARDITIS

The extra-cardiac work-up in infective endocarditis (IE) is comprises a search for both primary and secondary infective foci. Whether 18F-FDG PET/CT (PET/CT) or 99mTc-HMPAO white blood cell SPECT/CT (SPECT/CT) is superior in detection of extra-cardiac manifestations in IE is unexplored. The purposes

S&T-61 NOVEL DNA METHYLATION APPROACH IDENTIFIES THE AGGRESSIVENESS OF FOCI IN MULTIFOCAL PROSTATE CANCER

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-61 NOVEL DNA METHYLATION APPROACH IDENTIFIES THE AGGRESSIVENESS OF FOCI IN MULTIFOCAL PROSTATE CANCER Gangning Liang, Kamilla Mundbjerg, Sameer Chopra, Mehrdad Alemozaffar, Christopher Duymich, Peter Nichols, Manju Aron, Kimberly Siegmund, Osamu Ukimura, Torben Ørntoft, Karina Sørensen, Daniel Weisenberger, Peter Jones, and Inderbir Gill Gangning LiangGangning Liang More articles by this author , Kamilla MundbjergKamilla Mundbjerg More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Mehrdad AlemozaffarMehrdad Alemozaffar More articles by this author , Christopher DuymichChristopher Duymich More articles by this author , Peter NicholsPeter Nichols More articles by this author , Manju AronManju Aron More articles by this author , Kimberly SiegmundKimberly Siegmund More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Torben ØrntoftTorben Ørntoft More articles by this author , Karina SørensenKarina Sørensen More articles by this author , Daniel WeisenbergerDaniel Weisenberger More articles by this author , Peter JonesPeter Jones More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2890AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate Cancer (PC) is a slow-growing malignancy, but takes on an aggressive form in a subset of cases. There is a critical need to develop prognostic biomarkers to identify the aggressive PCs. Here, we take advantage of the propensity of PC to be multifocal and categorize aggressiveness of individual PC foci based on DNA methylation patterns in primary and matched metastatic tumors. Therefore, we studied specimens from patients who had undergone radical prostatectomy and were found to have positive lymph nodes and correlated these to different lesions in the prostate. METHODS 16 patients were found to have positive lymph nodes and multiple distinct areas of cancer within the prostate. A minimum of 4 different foci and an area of normal prostate as well as cancerous lymph nodes were microdissected from paraffin blocks and the DNA was purified. Epigenetic DNA methylation analysis was performed on each foci using the 450k infinium array. Correlations of the epigenetic profile from each tumor focus within the prostate was made to the metastatic lymph node. RESULTS Indeed, DNA methylation of metastatic sites is highly similar to one or more of the primary foci, allowing us to categorize individual foci as aggressive or non-aggressive and build an aggressiveness classifier. The classifier shows promising prognostic value in a large independent PC cohort, and we find among others a significant association between aggressive tumors and the presence of lymph node metastases (P = 9.2x10-5) and invasive tumor stages (P = 7.7x10-7). CONCLUSIONS Overall, this study provides molecular-based support for determination of PC aggressiveness with importance for clinical decision-making regarding the choice between active surveillance and ablative treatment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e333 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Gangning Liang More articles by this author Kamilla Mundbjerg More articles by this author Sameer Chopra More articles by this author Mehrdad Alemozaffar More articles by this author Christopher Duymich More articles by this author Peter Nichols More articles by this author Manju Aron More articles by this author Kimberly Siegmund More articles by this author Osamu Ukimura More articles by this author Torben Ørntoft More articles by this author Karina Sørensen More articles by this author Daniel Weisenberger More articles by this author Peter Jones More articles by this author Inderbir Gill More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract P4-11-09: A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners

Abstract Background: Health-related quality of life (HRQoL) is one of the important outcomes in cancer control trials and has increasingly become the one of the primary foci. Obtaining informed consent from participants is essential for participation in randomized controlled trials (RCTs), but the participation in these RCTs may directly influence HRQoL, because treatment options are determined according to the allocation schedule. To date, only a few studies have compared HRQoL between clinical trial participants and decliners. Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized controlled trial in women with HER2-positive primary breast cancer who are over 70 years of age. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with combination therapy using trastuzumab and chemotherapy. The study concept and design were published in concept paper (Sawaki M. et al., Jpn J Clin Oncol. 2011). In this study, patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, HRQoL, comprehensive geriatric assessment (CGA) and cost effectiveness (protocol ID; NCT01104935). HRQoL and CGA were assessed at registration (baseline), 2 month, 1 year, and 3 years after the start of protocol treatments using the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), EuroQol 5 Dimension (EQ-5D), Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, and the Philadelphia Geriatric Center (PGC) Morale Scale. The patients who declined to participate in N-SAS BC 07 were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). The same questionnaire that was used in N-SAS BC 07 was used in 07-Cohort to evaluate HRQoL and CGA at entry. Results: Patients were enrolled from October 2012 to October 2016. During this period, 275 and 123 patients were registered in N-SAS BC 07 and 07-Cohort, respectively. The mean age at entry of the patients in the N-SAS BC 07 and 07-Cohort groups was 73.9 and 74.6 years, respectively. The questionnaire response rates at baseline in the patients in N-SAS BC 07 and 07-Cohort groups were 89% and 82%, respectively. There were no significant differences in FACT-G, HADS, EQ-5D, or TMIG index of competence at baseline between the groups, but the mean (standard deviation) scores of PGC Morale Scale in N-SAS BC 07 and 07-Cohort groups were 10.8 (3.3) and 9.9 (3.7), respectively, with the scores being significantly greater in the N-SAS BC 07 group (p=0.020, t-test). Conclusion: The PGC Morale Scale provides a multidimensional approach to assess the psychological state of older people. This study indicated that participation in the RCT did not affect the baseline QoL of elderly patients but suggested that the baseline QoL of the RCT participants was better than decliners. Citation Format: Saito T, Sawaki M, Hozumi Y, Sagawa N, Iwata H, Kashiwaba M, Kawashima H, Kobayashi K, Taira N, Takashima T, Takahashi M, Tsuneizumi M, Nakayama T, Baba S, Bando H, Mizuno T, Yamaguchi M, Yamamoto Y, Uemura Y, Ohashi Y, Mukai H. A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-09.

The inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients among Chinese women, an indication for chemotherapy?

Patients with Luminal A breast cancer often have favorable prognosis, but some of these patients still have lymph node metastases, it remains unclear what the role of adjuvant chemotherapy is in Luminal A subtype with lymph node metastases. The aim of this study was to find a new method to distinguish which Luminal A patient can be benefited from chemotherapy. We retrospectively investigated the inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients, and analyzed the clinicopathologic characteristics, Recurrence score (RS), disease-free survival (DFS), and overall survival (OS) in 146 Luminal A breast cancer patients. The discordance of molecular subtypes between primary foci and metastatic lymph nodes were explored by univariate and multivariate logistic regression. The DFS and OS were calculated by the Kaplan-Meier survival curves, and the Cox regression analyses were performed to identify independent prognostic factors for DFS and OS. In our results, the inconsistency was found in 55 patients (55/146, 37.67%). Lymphatic vascular invasion (OR 6.402, 95% CI 2.371-17.287, P < 0.001), lymph node stage (OR 2.147, 95% CI 1.095-4.209, P = 0.026), and histological grade (OR 3.319, 95% CI 1.101-8.951, P = 0.032) were significantly related to the inconsistency. The inconsistent group (non-Luminal A variations) had a poor prognosis compared with the consistent group, the DFS between the two groups was significantly different (P = 0.022), but the OS did not have obvious difference (P = 0.140). Moreover, the inconsistency was associated with high RS (P = 0.036). In conclusion, more aggressive molecular subtypes in metastatic lymph nodes, which associated with poor prognosis, were observed in Luminal A breast cancer patients, which indicate that chemotherapy is necessary for these patients.

Hepatic Lesions Detected after Mastectomy, in Breast Cancer Patients with Hepatitis Background May Need to Undergo Liver Biopsy to Rule Out Second Primary Hepatocellular Carcinoma.

PurposeLiver metastasis is a common phenomenon in breast cancer patients. Hepatic lesions detected in breast cancer patients may be easily misdiagnosed as metastatic sites, rather than being treated as primary foci. This descriptive study aims to investigate the clinicopathological characteristics of second primary hepatocellular carcinoma in breast cancer patients and to infer in which circumstances liver biopsy is needed.MethodsEighty-one consecutive breast cancer patients with hepatic lesions admitted to our department were retrospectively studied and analyzed from January 2009 to March 2014 according to Warren and Gates’ criteria for second primary cancers.ResultsSecond primary hepatocellular carcinoma was observed in sixteen of seventy eight patients with breast cancer. There was a significant difference in HBV status between the second HCC group and liver metastases group (P<0.0001). There was no significant difference in age (P = 0.2254) and family history (P = 0.1160) between second primary HCC and metastases group. Two of these patients had synchronous second primary hepatocellular carcinoma and the remaining fourteen patients had metachronous second primary HCC. All sixteen patients were infected with hepatitis, including hepatitis virus B and C, or resolved HBV infection.ConclusionsBreast cancer patients with either HBV infection or resolved HBV infection, regardless of an elevated AFP level, may receive liver biopsy to avoid unnecessary and inappropriate treatments for metastasis. Awareness of second primary HCC in breast cancer patients needs to be emphasized.

Aggressive recurrence of early breast invasive ductal carcinoma with gastric metastasis during adjuvant hormonal therapy

Introduction: Gastric metastasis of breast invasive ductal carcinoma is rare. We present a case of a patient developing aggressive recurrence of early breast invasive ductal carcinoma with gastric metastasis in the third year of adjuvant hormonal therapy. A rarely observed increase in human epidermal growth factor receptor 2 (HER2) overexpression was also observed at the recurrent metastatic sites, and this situation strongly influenced therapeutic management. Case presentation: A 49-year-old Japanese female with prolonged back pain was examined by abdominal ultrasound to eliminate the possibility of abdominal malignancy; she was found to have multiple tumors in the liver. Contrast-enhanced computed tomographic (CT) imaging was performed for thorough examination, revealing multiple tumors in abdominal lymph nodes and in the lungs in addition to the liver. An integrated positron emission tomographic CT scan showed metabolically active foci distributed throughout the body, including the thoracic and lumbar vertebrae, para-aortic lymph nodes, liver, and stomach. At the age of 46, the patient had undergone a lumpectomy without axillary lymph node dissection for early breast invasive ductal carcinoma (pT1N0M0 Stage I), and the cancer was positive for both estrogen and progesterone receptors while not overexpressing HER2. Currently, however, biopsies from gastric and liver tumors showed adenocarcinoma with histological and immunohistochemical properties similar to those of the previous breast invasive ductal carcinoma, indicating metastatic breast cancer. Interestingly, HER2 was overexpressed in the metastatic foci, and the difference in expression status influenced the choice of treatment. Conclusions: Aggressive recurrence of early breast invasive ductal carcinoma with gastric metastasis is rare. Furthermore, HER2 expression status differed between primary and metastatic foci, and reassessment of expression status was helpful for informing decisions on optimal treatment strategy.

CK13 expression in prostate tumors of patients with bone metastases at diagnosis.

257 CK13 Expression in Prostate Tumors of Patients with Bone Metastases at Diagnosis Sandy T. Liu, Radu Cadaneanu, Kevin Lai, Bao Zhang, Haibo Liu, Lihong Huo, Colette Galet, William Aronson, Matthew Rettig, Michael Lewis, Isla P. Garraway; University of California Los Angeles, Los Angeles, CA Background: Biomarkers of lethal prostate cancer (PCa) are needed for appropriate clinical management. Benign stem/progenitor (S/P) cells reside in the basal layer of prostatic ducts/acini and function as cells of origin for PCa. Aggressive tumor cells may co-opt properties of S/P cells, such as mechanisms of resistance to castration. Distinct prostate epithelial populations, including stem-like tubule-initiating cells (TIC), basal cells (BC), and luminal cells (LC) can be isolated from benign prostate tissue. In this study, gene expression analysis was performed on benign prostate to identify TIC markers that may persist in cancer. Methods: Microarray analysis was performed on Epcam+CD44-CD49fHi TIC, Epcam+CD44+CD49fHi BC, and Epcam+CD44-CD49fLoLC using Affymetrix Array. Data was analyzed using Partek Genomics and validated with RT-PCR. Immunohistochemistry (IHC) was performed on 1) prostate tissue microarray (TMA) from 332 prostatectomies 2) pretreatment tissue from stage M1 patients and 3) post-treatment prostate tissue. Results: Affymetrix identified increased cytokeratin 13 (CK13) expression in TIC relative to BC and LC. Rare CK13+ epithelia are seen in ducts/acini of benign prostate tissue. TMA IHC revealed CK13+ cancer cores in 9% of cases, and significantly correlated with recurrence (p = 0.031), progression to castration-resistance (p = 0.05), and metastases (p = 0.009). Biopsy tissue from hormone-naive patients with diffuse bone metastases displayed CK13+ tumors in primary and metastatic foci. Epithelial cells populating residual prostate glands following radiation and ADT also displayed CK13 expression. Conclusions: CK13+ tumors reflect a “stem-like” state, enabling survival in low-androgen conditions and interactions that support invasion/metastases. Further characterization of CK13+ PCa variants could lead to clinical trials investigating agents that may prevent/treat dissemination and progression.

Immunohistochemistry of Primary and Metastatic Foci of Hepatocellular Carcinoma in Dogs.

Immunohistochemistry of Primary and Metastatic Foci of Hepatocellular Carcinoma in Dogs.

Sibbald Research Wetland: Mountain peatland form and ecohydrologic function as influenced by beaver

Sibbald Research Wetland is a 1.3 km2 peatland in the foothills of the Rocky Mountains. The primary research foci are 1) the influence of beaver ponds on mountain peatland hydrology and 2) the potential influence of climate change on these beaver-impacted peatlands. This paper summarizes initial results and implications of the research.

Renal tuberculosis

Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if necessary, or to resolve the consequent urinary obstruction using different reconstructive techniques.

Association between Tumor Size and Bilateral Involvement in Papillary Thyroid Carcinoma.

Background. Tumor multifocality and bilaterality of papillary thyroid carcinoma (PTC) are important factors when selecting the most appropriate surgical procedure. The aim of this study was to assess the bilaterality rate in PTC and the relationship between the tumor size and bilaterality. Materials and Methods. Thyroidectomy specimens with a diagnosis of PTC were retrospectively reviewed in the Pathology Department of a tertiary care medical center. Specimens were divided into three groups according to the size of the primary and contralateral tumor foci. Tumors less than or equal to 1 cm in each lobe were included in group 1. Group 2 consisted of tumors greater than 1 cm in one lobe and less than 1 cm in the other lobe. Tumors greater than 1 cm in each lobe were included in group 3. Results. We identified 868 total thyroidectomy specimens with a diagnosis of PTC between 2001 and 2011. Of these cases, both thyroid lobes were involved in 262 cases (32%). There were 109 (42%), 121 (46%), and 32 cases (12%) in group 1, group 2, and group 3, respectively. Conclusion. Bilaterality is frequent in PTC and is not related to tumor size. Accordingly, the high frequency of bilateral disease in PTC should be kept in mind when determining the extent of the surgical procedure.

Recurrent Benign Salivary Gland Neoplasms.

The most important causes of recurrence of benign pleomorphic adenoma are enucleation with intraoperative spillage and incomplete tumor excision in association with characteristic histologic findings for the lesion (incomplete pseudocapsule and the presence of pseudopodia). Most recurrent pleomorphic adenomas (RPAs) are multinodular. MRI is the imaging method of choice for their assessment. Nerve integrity monitoring may reduce morbidity of RPA surgery. Although treatment of RPA must be individualized, total parotidectomy is generally recommended given the multicentricity of the lesions. However, surgery alone may be inadequate for controlling RPA over the long term. There is growing evidence from retrospective series that postoperative radiotherapy results in significantly better local control. A high percentage of RPAs are incurable. All patients should therefore be informed about the possibility of needing multiple treatment procedures, with possible impairment of facial nerve function, and radiation therapy for RPA. Reappearance of Warthin tumor is a metachronous occurrence of a new focus or residual incomplete excision of all primary multicentric foci of Warthin tumor. Selected cases can be observed. Conservative surgical management can include partial superficial parotidectomy or extracapsular dissection. Not uncommonly, other major and minor salivary gland neoplasms, including myoepithelioma, basal cell adenoma, oncocytoma, canalicular adenoma, cystadenoma, and ductal papilloma, follow an indolent course after surgical resection, with rare cases of recurrence.

&lt;em&gt;Why Black Lives (and Minds) Matter: Race, Freedom Schools &amp; the Quest for Educational Equity&lt;/em&gt;

In 2013 in response to a preponderance of violence and unaccounted for destruction of lives in the United States, in particular unarmed men and boys being murdered at the hands of police and law enforcement, the Lives Matter (BLM) movement was born. In a period of two brief years, the Lives Matter movement became an international, politically driven activist movement that says it campaigns, organizes, and protests against violence toward people. One of the primary foci of BLM has been protest around the shootings of people at the hands of the police and police brutality that has been rampant in this country for centuries, but has become increasingly visible over the past two decades in what is purported to be a civil and democratic society (Marable, 2007). The Lives Matter movement began with the use of the hashtag, #BlackLivesMatter on social media and gained increased and intense attention after the acquittal of George Zimmerman in the shooting death of African American teenager Trayvon Martin. The Lives Matter movement gained additional attention after the 2014 deaths of Michael Brown in Ferguson, Missouri; Eric Garner in New York City, Tamir Rice in Cleveland, Ohio, and Ezell Ford in Los Angeles when supporters spoke out vehemently about the senseless murders of unarmed lives, that did not include any officers being held accountable for these deaths. Several other African Americans who died at the hands of police officers have had their deaths protested by the movement, including Eric Harris, Natasha McKenna, Walter Scott, Janisha Fonville, Jonathan Ferrell, Sandra Bland, Tanisha Anderson, Samuel DuBose and Freddie Gray. The Lives Matter movement calls itself a decentralized network, enhanced by social media, with no formal or designated hierarchy, elected leaders or prescribed structure.A perusal of the Lives Matter website (www.blacklivesmatter.com) states that the movement is unapologetically Black and has often been described as the millennial movement, and not a moment, and on its website it also considers itself the following:* The protest movement of the 21st century* Intersectional, Intergenerational* Family affirming, queer affirming* Empathetic and global.Mobilizing through social media, organizing around police brutality, anti-Black racism, blatant racism, and seeking for justice to be recognized where justice has been denied, the movement has gained in scope and attention beyond police brutality. The organization's website states that Lives Matter is:a unique contribution that goes beyond extrajudicial killings of black people by police and vigilantes. . . . Lives Matter affirms the lives of black queer and trans folks, disabled folks, black undocumented folks, folks with records, women and all black lives along the gender spectrum.One of its founders, Alicia Garza (2014) has summed up the philosophy behind Lives Matter by stating: When we say Lives Matter, we are talking about the ways in which people are deprived of our human rights and dignity. It is the aspect of people being deprived of basic human rights and that serves as the impetus for why BLM's aims and goals have direct implications for the education of children in the U.S. in 2016. It could be stated that the dignity that all students deserve has been denied for countless numbers of children. Overwhelming data suggest the children perhaps more than any other group of students experience unique challenges in schools that interrupt their learning opportunities and hinder their educational outcomes (Carter & Welner, 2013; Howard, 2010, 2013; Howard & Reynolds, 2009; Ladson-Billings, 2006; Milner, 2015; Nasir, 2012). This article seeks to shed a spotlight on some of the aspects of students' dignity being compromised in their learning pursuits. …

Value of contrast-enhanced ultrasound in the evaluation of neoadjuvant chemotherapy for breast cancer

Objective To explore the application value of contrast-enhanced ultrasound(CEUS) in evaluating the effect of neoadjuvant chemotherapy(NAC) on breast cancer. Methods Image features of 80 breast cancer patients with neoadjuvant chemotherapy were observed and analyzed by CEUS. In the process, the changes of primary foci before and after neoadjuvant chemotherapy and the changes of qualitative and quantitative indexes of blood perfusion were evaluated. The correlation between qualitative change and pathological response was also studied. Results The change of focus size measured by CEUS was higher than that of conventional ultrasound before and after neoadjuvant chemotherapy(P 0.05). All the qualitative observation indexes of the ultrasound contrast after NAC revealed obviously benign conversion(P<0.05). Among them, the pathological response was closely related to the changes of the enhancement degree, the distribution of the contrast agent, the order of the contrast and the contrast mode. After NAC, the perfusion parameters of the lesions showed slowly crawl and slowly retreat, low enhancement and the diminished total amount of microcirculation perfusion. Conclusions Before and after neoadjuvant chemotherapy, the changes of the lesion size deteted by CEUS were more close to the pathological evaluation than those detected by conventional ultrasound. The benign outcome of qualitative and quantitative indexes of the CEUS was more obvious than the changes of the lesion size, which had practical value for guiding the neoadjuvant chemotherapy for breast cancer, especially the CEUS indexes related to pathological assessment. Key words: Ultrasonography; Microbubbles; Breast neoplasms; Neoadjuvant chemotherapy; Treatment outcome

Lightning characteristics of derecho producing mesoscale convective systems

Derechos, or widespread, convectively induced wind storms, are a common warm season phenomenon in the Central and Eastern United States. These damaging and severe weather events are known to sweep quickly across large spatial regions of more than 400 km and produce wind speeds exceeding 121 km h−1. Although extensive research concerning derechos and their parent mesoscale convective systems already exists, there have been few investigations of the spatial and temporal distribution of associated cloud-to-ground lightning with these events. This study analyzes twenty warm season (May through August) derecho events between 2003 and 2013 in an effort to discern their lightning characteristics. Data used in the study included cloud-to-ground flash data derived from the National Lightning Detection Network, WSR-88D imagery from the University Corporation for Atmospheric Research, and damaging wind report data obtained from the Storm Prediction Center. A spatial and temporal analysis was conducted by incorporating these data into a geographic information system to determine the distribution and lightning characteristics of the environments of derecho producing mesoscale convective systems. Primary foci of this research include: (1) finding the approximate size of the lightning activity region for individual and combined event(s); (2) determining the intensity of each event by examining the density and polarity of lightning flashes; (3) locating areas of highest lightning flash density; and (4) to provide a lightning spatial analysis that outlines the temporal and spatial distribution of flash activity for particularly strong derecho producing thunderstorm episodes.