The expression and distribution of neuropilin-1 (NRP-1) was examined in the samples of normal human breast tissues and in non-neoplastic and neoplastic areas of breast tissue removed for carcinoma using RT-PCR as well as conventional and tissue microarrays immunohistochemical analyses. The NRP-1 mRNA expression was significantly higher in neoplastic tissues as compared to normal breast samples. Immunohistochemically, the myoepithelial cells of the mammary ducts and lobules display positive reactions for NRP-1, whereas the inner ductal and lobular epithelial cell layers failed to react. The myoepithelial cells of ducts and lobules in both neoplastic and non-neoplastic tissue specimens displayed a stronger positive reaction for NRP-1 than those in the normal breast. A positive reaction for NRP-1, but with a gradual reduction in intensity, was observed in the myoepithelial cells of ducts with atypical epithelial hyperplasia and ductal carcinoma in situ (DCIS). The reaction was undetected or minimally detected in the areas of invasive carcinoma. NRP-1 positive immunolabeling was also localized in the vascular smooth muscle cells and in some endothelial cells of the blood vessels in normal, non-neoplastic and neoplastic breast tissue samples. In areas of breast carcinoma, NRP-1 immunolabeling was more prominent in both vascular smooth muscle cells and in some endothelial cells than in similar cells in normal breast. The specificity of the newly developed antibody for NRP-1 was confirmed by in situ hybridization with DIG-labeled PCR generated probe. These results suggest that NRP-1 may be a multiple function protein in human breast and may be involved in the induction of local invasiveness of neoplasia and angiogenesis and have direct relevance to the progression of breast cancer.

Telehealth is a way to provide health-care services to a patient from a provider who is at another location. The most common methods include a live interactive visit with the patient, interpretation of imaging, and monitoring of patient progress. Principally, telehealth is a way of providing a service rather than a type of service. It is about patient care, not data care.Examples of orthopaedic applications include conducting patient examinations, interpreting imaging studies, and providing postoperative care. Teleconsultation has been shown to be cost-effective. Other examples in orthopaedic research include the application of telemedicine when measuring patient-reported outcomes. Especially in cases when the patient lives far away from the provider, telehealth reduces time, produces good patient satisfaction, and costs less than hands-on care. As in everyday life, consumers have learned to demand convenience, ease of use, choice, control, and direct access. The ubiquity of telecommunications, combined with consumer technology savviness, drives the demand for telehealth. Unfortunately, the nation's largest payer for health services is one of the most restrictive for telehealth coverage. Medicare's restrictions are mostly the work of the U.S. Congress under Part B law. Video visits are very narrowly covered. Another major policy barrier is that interstate telehealth requires multiple state licenses for the physician, who must be licensed in the jurisdiction of each patient as well as the provider's physical locations. As Medicare shifts toward capitated payment and other value-based methods, there are opportunities to remove such restrictions.Despite these challenges, some states have been proactive in implementing telehealth systems. Arkansas is one of these states, and being a rural state with 2 main population centers, specialty care is relatively sparse. Implemented in 2014, the hand trauma program has been a partnership between the University of Arkansas for Medical Sciences (UAMS) and the Arkansas Trauma Communications Center (ATCC). This program has been very successful in decreasing the rate of hand trauma transfer, allowing patients to be treated closer to home while having coordinated access to fellowship-trained hand surgeons when necessary.More widespread innovation of orthopaedic applications for telehealth requires physician buy-in and health-systems partnerships. The regulatory environment will need streamlining. Ultimately, consumer demand will drive the implementation of technology to make care more accessible, convenient, and cost-effective.

No abstract

No abstract