Age-related maculopathy (ARM) is a multifactorial disorder known to have a substantial genetic component. The epsilon4 allele of the apolipoprotein E gene (APOE-4) has previously been reported to have a protective effect on ARM risk, while the APOE-2 allele may increase disease risk. This study combined four independent data sets (three US and one European) of Caucasian ARM patients and controls in order to obtain better statistical power to examine the role of APOE in ARM. APOE genotype and allele frequencies were compared for 617 ARM cases and 1260 controls, adjusting for age and sex differences between the two groups via multiple logistic regression. The protective effect of the APOE-4 allele on ARM risk was confirmed (age- and sex-adjusted odds ratio (OR) for APOE-4 carriers 0.54, 95% confidence interval (CI) 0.41-0.70, p < 0.0001). The effect of APOE-4 did not differ significantly between males and females and was observed consistently for both atrophic and neovascular ARM. Evidence for an increased risk of ARM due to the APOE-2 allele was found for men, but not for women (OR for men 1.54, 95% CI 0.97-2.45; OR for women 0.74, 95% CI 0.52-1.06, p = 0.01 for interaction of sex and APOE-2 carrier status). These data confirm that the APOE-4 allele, or an allele in linkage disequilibrium with it, reduces the risk of ARM. They also suggest that the effect of the APOE-2 allele may vary by gender, and that APOE-2 may confer an increased risk only to males.
Although guidelines such as those of the National Comprehensive Cancer Network consider 18F-FDG PET/CT for systemic staging of newly diagnosed stage III breast cancer patients, factors in addition to stage may influence the utility of PET/CT. Because invasive lobular carcinoma (ILC) is less conspicuous than invasive ductal carcinoma (IDC) on 18F-FDG PET, we hypothesized that tumor histology may be one such factor. We evaluated PET/CT systemic staging of patients newly diagnosed with ILC compared with IDC.
Methods
In this Institutional Review Board–approved retrospective study, our Hospital Information System was screened for ILC patients who underwent PET/CT in 2006–2013 before systemic or radiation therapy. Initial stage was determined from examination, mammography, ultrasound, MR, or surgery. PET/CT was performed to identify unsuspected distant metastases. A sequential cohort of stage III IDC patients was evaluated for comparison. Upstaging rates were compared using the Pearson χ2 test.
Results
The study criteria were fulfilled by 146 ILC patients. PET/CT revealed unsuspected distant metastases in 12 (8%): 0 of 8 with initial stage I, 2 of 50 (4%) stage II, and 10 of 88 (11%) stage III. Upstaging to IV by PET/CT was confirmed by biopsy in all cases. Three of 12 upstaged patients were upstaged only by the CT component of the PET/CT, as the metastases were not 18F-FDG–avid. In the comparison stage III IDC cohort, 22% (20/89) of patients were upstaged to IV by PET/CT. All 20 demonstrated 18F-FDG–avid metastases. The relative risk of PET/CT revealing unsuspected distant metastases in stage III IDC patients was 1.98 times (95% confidence interval, 0.98–3.98) that of stage III ILC patients (P = 0.049). For 18F-FDG–avid metastases, the relative risk of PET/CT revealing unsuspected 18F-FDG–avid distant metastases in stage III IDC patients was 2.82 times (95% confidence interval, 1.26–6.34) that of stage III ILC patients (P = 0.007).
Conclusion
18F-FDG PET/CT was more likely to reveal unsuspected distant metastases in stage III IDC patients than in stage III ILC patients. In addition, some ILC patients were upstaged by non–18F-FDG-avid lesions visible only on the CT images. Overall, the impact of PET/CT on systemic staging may be lower for ILC patients than for IDC patients.
Building upon an established relationship between a college and a local school district, this project formally designated a Partnership School, at which education students conduct field experience. In addition to providing these participating pre-service teachers (students) with a clinically rich experience through closer supervision by and interaction with their faculty supervisor, the project enriched the experience of high school English students by providing appropriate technology in the classroom and integrating it with instruction. The project gave student teachers and educators the ability to collaborate upon and refine lesson planning and delivery, efficiently and effectively meeting the needs required of pre-service student teaching experiences. The study examined three aspects of the project as perceived by the participants: the effectiveness and benefit of using distance observation, the effectiveness and benefit of established technology for completing an edTPA, and the effectiveness and benefit of additional technology for use by the host teachers' classroom in cloud-based applications.
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