To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer.
...The HIPAA-compliant protocol and the informed consent process were approved by the American College of Radiology Institutional Review Board and local-site institutional review boards. Women with invasive breast cancer of 3 cm or greater undergoing NACT with an anthracycline-based regimen, with or without a taxane, were enrolled between May 2002 and March 2006. MR imaging was performed before NACT (first examination), after one cycle of anthracyline-based treatment (second examination), between the anthracycline-based regimen and taxane (third examination), and after all chemotherapy and prior to surgery (fourth examination). MR imaging assessment included measurements of tumor longest diameter and volume and peak signal enhancement ratio. Clinical size was also recorded at each time point. Change in clinical and MR imaging predictor variables were compared for the ability to predict pathologic complete response (pCR) and residual cancer burden (RCB). Univariate and multivariate random-effects logistic regression models were used to characterize the ability of tumor response measurements to predict pathologic outcome, with area under the receiver operating characteristic curve (AUC) used as a summary statistic.
Data in 216 women (age range, 26-68 years) with two or more imaging time points were analyzed. For prediction of both pCR and RCB, MR imaging size measurements were superior to clinical examination at all time points, with tumor volume change showing the greatest relative benefit at the second MR imaging examination. AUC differences between MR imaging volume and clinical size predictors at the early, mid-, and posttreatment time points, respectively, were 0.14, 0.09, and 0.02 for prediction of pCR and 0.09, 0.07, and 0.05 for prediction of RCB. In multivariate analysis, the AUC for predicting pCR at the second imaging examination increased from 0.70 for volume alone to 0.73 when all four predictor variables were used. Additional predictive value was gained with adjustments for age and race.
MR imaging findings are a stronger predictor of pathologic response to NACT than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment.
To evaluate volumetric magnetic resonance (MR) imaging for predicting recurrence-free survival (RFS) after neoadjuvant chemotherapy (NACT) of breast cancer and to consider its predictive performance ...relative to pathologic complete response (PCR).
This HIPAA-compliant prospective multicenter study was approved by institutional review boards with written informed consent. Women with breast tumors 3 cm or larger scheduled for NACT underwent dynamic contrast-enhanced MR imaging before treatment (examination 1), after one cycle (examination 2), midtherapy (examination 3), and before surgery (examination 4). Functional tumor volume (FTV), computed from MR images by using enhancement thresholds, and change from baseline (ΔFTV) were measured after one cycle and before surgery. Association of RFS with FTV was assessed by Cox regression and compared with association of RFS with PCR and residual cancer burden (RCB), while controlling for age, race, and hormone receptor (HR)/ human epidermal growth factor receptor type 2 (HER2) status. Predictive performance of models was evaluated by C statistics.
Female patients (n = 162) with FTV and RFS were included. At univariate analysis, FTV2, FTV4, and ΔFTV4 had significant association with RFS, as did HR/HER2 status and RCB class. PCR approached significance at univariate analysis and was not significant at multivariate analysis. At univariate analysis, FTV2 and RCB class had the strongest predictive performance (C statistic = 0.67; 95% confidence interval CI: 0.58, 0.76), greater than for FTV4 (0.64; 95% CI: 0.53, 0.74) and PCR (0.57; 95% CI: 0.39, 0.74). At multivariate analysis, a model with FTV2, ΔFTV2, RCB class, HR/HER2 status, age, and race had the highest C statistic (0.72; 95% CI: 0.60, 0.84).
Breast tumor FTV measured by MR imaging is a strong predictor of RFS, even in the presence of PCR and RCB class. Models combining MR imaging, histopathology, and breast cancer subtype demonstrated the strongest predictive performance in this study.
This paper introduces a universal framework for service-based learning which provides information systems students with opportunities to gain invaluable hands-on experience. More specifically, ...through this framework, students can develop hard, soft, and interdisciplinary skills in preparation for their first professional careers upon graduation. In addition to introducing the framework, we provide student testimonials and feedback as well as lessons learned from our experience in efforts to prepare and help other schools interested in offering similar growth opportunities to their students to have a smooth and successful implementation.
Macrophage migration inhibitory factor (MIF), a multipotent protein that exhibits both cytokine and chemotactic properties, is expressed by many cell types, including hepatocytes and nonparenchymal ...cells. We hypothesized that MIF is a key contributor to liver injury after ethanol exposure. Female C57BL/6 or MIF−/− mice were fed an ethanol‐containing liquid diet or pair‐fed control diet for 4 (11% total kcal;early response) or 25 (32% kcal; chronic response) days. Expression of MIF messenger RNA (mRNA) was induced at both 4 days and 25 days of ethanol feeding. After chronic ethanol, hepatic triglycerides and plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased in wildtype, but not MIF−/−, mice. In order to understand the role of MIF in chronic ethanol‐induced liver injury, we investigated the early response of wildtype and MIF−/− to ethanol. Ethanol feeding for 4 days increased apoptosis of hepatic macrophages and activated complement in both wildtype and MIF−/− mice. However, tumor necrosis factor alpha (TNF‐α) expression was increased only in wildtype mice. This attenuation of TNF‐α expression was associated with fewer F4/80+ macrophages in liver of MIF−/− mice. After 25 days of ethanol feeding, chemokine expression was increased in wildtype mice, but not MIF−/− mice. Again, this protection was associated with decreased F4/80+ cells in MIF−/− mice after ethanol feeding. Chronic ethanol feeding also sensitized wildtype, but not MIF−/−, mice to lipopolysaccharide, increasing chemokine expression and monocyte recruitment into the liver. Conclusion: Taken together, these data indicate that MIF is an important mediator in the regulation of chemokine production and immune cell infiltration in the liver during ethanol feeding and promotes ethanol‐induced steatosis and hepatocyte damage. (HEPATOLOGY 2013)
ABSTRACT We present the H i mass inventory for the REsolved Spectroscopy Of a Local VolumE (RESOLVE) survey, a volume-limited, multi-wavelength census of >1500 z = 0 galaxies spanning diverse ...environments and complete in baryonic mass down to dwarfs of ∼109 . This first 21 cm data release provides robust detections or strong upper limits (1.4MH i < 5%-10% of stellar mass M*) for ∼94% of RESOLVE. We examine global atomic gas-to-stellar mass ratios (G/S) in relation to galaxy environment using several metrics: group dark matter halo mass Mh, central/satellite designation, relative mass density of the cosmic web, and distance to the nearest massive group. We find that at fixed M*, satellites have decreasing G/S with increasing Mh starting clearly at Mh ∼ 1012 , suggesting the presence of starvation and/or stripping mechanisms associated with halo gas heating in intermediate-mass groups. The analogous relationship for centrals is uncertain because halo abundance matching builds in relationships between central G/S, stellar mass, and halo mass, which depend on the integrated group property used as a proxy for halo mass (stellar or baryonic mass). On larger scales G/S trends are less sensitive to the abundance matching method. At fixed Mh ≤ 1012 , the fraction of gas-poor centrals increases with large-scale structure density. In overdense regions, we identify a rare population of gas-poor centrals in low-mass (Mh < 1011.4 ) halos primarily located within ∼1.5× the virial radius of more massive (Mh > 1012 ) halos, suggesting that gas stripping and/or starvation may be induced by interactions with larger halos or the surrounding cosmic web. We find that the detailed relationship between G/S and environment varies when we examine different subvolumes of RESOLVE independently, which we suggest may be a signature of assembly bias.
We relate transitions in galaxy structure and gas content to refueling, here defined to include both the external gas accretion and the internal gas processing needed to renew reservoirs for star ...formation. We analyze two z = 0 data sets: a high-quality ~200 galaxy sample (the Nearby Field Galaxy Survey, data release herein) and a volume-limited ~3000 galaxy sample with reprocessed archival data. Both reach down to baryonic masses ~10 super(9) M sub(middot in circle) and span void-to-cluster environments. Two mass-dependent transitions are evident: (1) below the "gas-richness threshold" scale (V ~ 125 km s super(-1)), gas-dominated quasi-bulgeless Sd-Im galaxies become numerically dominant; while (2) above the "bimodality" scale (V ~ 200 km s super(-1)), gas-starved E/S0s become the norm. Notwithstanding these transitions, galaxy mass (or V as its proxy) is a poor predictor of gas-to-stellar mass ratio M sub(gas)/M sub(*). We argue that this refueling underlies the tight M sub(gas)/M sub(*) versus color correlations often used to measure "photometric gas fractions."
Purpose
To estimate the accuracy of predicting response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast cancer using MR spectroscopy (MRS) measurements made very early in ...treatment.
Materials and Methods
This prospective Health Insurance Portability and Accountability Act (HIPAA)–compliant protocol was approved by the American College of Radiology and local‐site institutional review boards. One hundred nineteen women with invasive breast cancer of ≥3 cm undergoing NACT were enrolled between September 2007 and April 2010. MRS measurements of the concentration of choline‐containing compounds (tCho) were performed before the first chemotherapy regimen (time point 1, TP1) and 20–96 h after the first cycle of treatment (TP2). The change in tCho was assessed for its ability to predict pathologic complete response (pCR) and radiologic response using the area under the receiver operating characteristic curve (AUC) and logistic regression models.
Results
Of the 119 subjects enrolled, only 29 cases (24%) with eight pCRs provided usable data for the primary analysis. Technical challenges in acquiring quantitative MRS data in a multi‐site trial setting limited the capture of usable data. In this limited data set, the decrease in tCho from TP1 to TP2 had poor ability to predict either pCR (AUC = 0.53, 95% confidence interval CI: 0.27–0.79) or radiologic response (AUC = 0.51, 95% CI: 0.27–0.75).
Conclusion
The technical difficulty of acquiring quantitative MRS data in a multi‐site clinical trial setting led to a low yield of analyzable data, which was insufficient to accurately measure the ability of early MRS measurements to predict response to NACT.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. MAGN. RESON. IMAGING 2017;46:290–302
Abstract
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary ...inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.
This paper introduces a universal framework for service-based learning which provides information systems students with opportunities to gain invaluable hands-on experience. More specifically, ...through this framework, students can develop hard, soft, and interdisciplinary skills in preparation for their first professional careers upon graduation. In addition to introducing the framework, we provide student testimonials and feedback as well as lessons learned from our experience in efforts to prepare and help other schools interested in offering similar growth opportunities to their students to have a smooth and successful implementation.
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