The allergic potential of patent blue V dye compares favourably with isosulfan blue however both the surgeon and anaesthetist need to be alert to the risk of allergic reactions.
tion options with patients, irrespective of whether they are available locally. 6 Fifty three per cent of women having surgery for breast cancer will undergo mastectomy (box 1). 7 8 In the UK and United States, bilateral mastectomy is increasingly being used for risk reduction in BRCA carriers, for those with a high risk of developing breast cancer (lifetime risk of 30%), or as a planned management strategy for unilateral cancer (fig 1, bmj.com). 9-15 In general, bilateral mastectomy is associated with a higher rate of breast reconstruction. A recent Cochrane review showed that bilateral prophylactic (risk reduction) mastectomy reduced the incidence of, and death from, breast cancer, but it highlighted that more rigorous prospective studies are needed to assess absolute risk reduction. 16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 How is a mastectomy performed?When performing a mastectomy, the anatomical (oncological) plane between breast tissue and subcutaneous fat needs to be identified. It is, however, impossible to remove all breast tissue because the oncological plane is not uniform throughout the breast. A standard (simple) mastectomy removes the breast skin envelope, but a skin sparing mastectomy preserves the breast skin envelope Breast cancer is the most common cancer in women, with almost 1.38 million new cases a year worldwide; it accounts for 23% of all cancers and 14% of deaths from cancer. 1 However, mortality from breast cancer is d eclining-increasing numbers of women are long term survivors (>5 years) (currently 549 000 in the United K ingdom). 2 3 Surgery remains a mainstay of treatment, either breast conservation or mastectomy, but any breast surgery can greatly alter breast aesthetics and body image.Breast reconstruction restores breast symmetry after a mastectomy by creating a breast mound, similar in size, shape, contour, and "out of bra position" to the contralateral breast. In England and Wales in 2002, about 10% of women had immediate breast reconstruction; by 2009 this had risen to 21%. 4 Post-mastectomy breast reconstruction is associated with improved body image, quality of life, self confidence, and wellbeing. 5 In this review, we outline the indications for breast reconstruction along with the timing and techniques available to patients after mastectomy. What is post-mastectomy breast reconstruction?Breast reconstruction is a surgical procedure that restores shape to the breast after mastectomy. Although it will not re-create the exact look and feel of a natural breast, it aims to create a breast mound contour similar to that before mastectomy. When, and to whom, should breast reconstruction be offered?In 2009 the National Institute for Health and Clinical Excellence (NICE) revised guidance on improving breast cancer outcomes. It recommended discussing immediate reconstruction with all patients ha...
Abstract. Typical ontology matching applications, such as ontology integration, focus on the computation of correspondences holding between the nodes of two graph-like structures, e.g., between concepts in two ontologies. However, for applications such as web service integration, we need to establish whether full graph structures correspond to one another globally, preserving certain structural properties of the graphs being considered. The goal of this paper is to provide a new matching operation, called structure-preserving semantic matching. This operation takes two graph-like structures and produces a set of correspondences, (i) still preserving a set of structural properties of the graphs being matched, (ii) only in the case if the graphs are globally similar to one another. Our approach is based on a formal theory of abstraction and on a tree edit distance measure. We have evaluated our solution in various settings. Empirical results show the efficiency and effectiveness of our approach.
In response to Philipsen et al.'s (Educ Technol Res Dev 67:1145–1174, 2019) article titled “Improving teacher professional development [TPD] for online and blended learning [OBL]: a systematic meta-aggregative review”, we apply their proposed framework of important components of TPD for OBL to the support we provided to primary and secondary teachers as they engaged with online education during the COVID-19 pandemic. We reflect on observations of particular challenges for school teachers and the reasons behind them. While this framework is a useful reflection tool to guide professional learning for teachers beyond the emergency situations, we found that it is biased towards TPD for OBL in higher education settings. Thus, we suggest future work to differentiate educational levels in order to account for operational differences.
BackgroundGene expression is widely used for the characterisation of breast cancers. Variability due to tissue heterogeneity or measurement error or systematic change due to peri-surgical procedures can affect measurements but is poorly documented. We studied the variability of global gene expression between core-cuts of primary ER+ breast cancers and the impact of delays to tissue stabilisation due to sample X-ray and of diagnostic core cutting.MethodsTwenty-six paired core-cuts were taken immediately after tumour excision and up to 90 minutes delay due to sample X-ray; 57 paired core-cuts were taken at diagnosis and 2 weeks later at surgical excision. Whole genome expression analysis was conducted on extracted RNA. Correlations and differences were assessed between the expression of individual genes, gene sets/signatures and intrinsic subtypes.ResultsTwenty-three and 56 sample pairs, respectively, were suitable for analysis. The range of correlations for both sample sets were similar with the majority being >0.97 in both. Correlations between pairs for 18 commonly studied genes were also similar between the studies and mainly with Pearson correlation coefficients >0.6 except for a small number of genes, which had a narrow-dynamic range (e.g. MKI67, SNAI2). There was no systematic difference in intrinsic subtyping between the first and second sample of either set but there was c.15 % discordance between the subtype assignments between the pairs, mainly where the subtyping of individual samples was less certain. Increases in the expression of several stress/early-response genes (e.g. FOS, FOSB, JUN) were found in both studies and confirmed findings in earlier smaller studies. Increased expression of IL6, IGFBP2 and MYC (by 17 %, 14 % and 44 %, respectively) occurred between the samples taken 2 weeks apart and again confirmed findings from an earlier study.ConclusionsThere is generally good correlation in gene expression between pairs of core-cuts except where genes have a narrow dynamic range. Similar correlation coefficients to the average gene expression profiles of intrinsic subtype, particularly LumA and LumB, can lead to discordances between assigned subtypes. Substantial changes in expression of early-response genes occur within an hour after surgery and in IL6, IGFB2 and MYC as a result of diagnostic core-cut biopsy.Trial registrationTrial number CRUK/07/015. Study start date September 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-016-0696-2) contains supplementary material, which is available to authorized users.
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