In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.
According to the American Cancer Society, there are currently 2 million breast cancer (BC) survivors in the USA and 20% of them cope with lymphedema (LE). The primary aim of this study was to determine the predictive factors of BC-related LE. The secondary aim was to investigate the impact of predictors on the severity of LE. The study design was intended to be a 1:2 matched case-control study. Instead, we stratified on age (+/-10 years), radiation therapy (y/n), and type of operation (SM/MRM/MRM with tram). Patients who underwent BC surgery between 1990 and 2000 at UPMC Magee-Womens Hospital were reviewed for LE. Data were collected on 52 women with LE and 104 female controls. Logistic regression was utilized to assess the relationship between risk factors and LE. Ordinal logistic regression was performed to determine the association between risk factors and severity of LE. Severity was defined according to the volume difference between affected and unaffected limbs. Risk factors considered were occupation/hobby (hand use), TNM stage, number of dissected nodes, number of positive nodes, tumor size, infection, allergy, diabetes mellitus, hypertension, hypothyroidism, chronic obstructive pulmonary disease, and body mass index (BMI). LE was mild in 43 patients and was moderate/severe in nine patients. The level of hand use in the control group was categorized as low in 56 (54%), medium in 15 (14%), and high in 33 (32%) patients. The corresponding frequencies were 14 (33%), 6 (14%) and 23 (53%) for patients with mild LE and 3 (33%), 1 (11%), 5 (56%) for patients with moderate/severe LE (p < 0.05). Infection of the operated side arm was reported by two (2%) patients in the control group, 14 (33%) patients with mild LE and five (56%) patients with moderate/severe LE (p < 0.05). The mean BMI was 26.1 kg/m(2) (SD 4.9) for the control group, 29.0 kg/m(2) (SD 5.9) for the mild LE group and 30.9 kg/m(2) (SD 7.5) for patients with moderate/severe LE (p < 0.05). The results of this stratified case-control study demonstrated that the risk and severity of LE was statistically related to infection, BMI, and level of hand use.
Moisture stress during pollination of maize (Zea mays L.) can greatly reduce kernel set, yet little quantitative information is available on the effects of plant water status on male and female floral development. The purpose of this study was to establish different drought stress regimes during pollination and to measure synchronization of male and female floral development, pollen viability, and diurnal silk elongation rates. Single cross hybrids were field‐grown in large pots and exposed to different soil moisture treatments at the time of tassel emergence. Compared to well‐watered control plants, mild (no visible wilting) and severe (visible wilting) drought treatments increased the interval from initial silking to initial pollen shed by an average of 3 and 4 days, respectively. Increasing moisture deficits caused no change in in vitro pollen germination even though the severest drought treatment caused visible symptoms of midday wilting and of lower leaf senescence. Diurnal silk elongation measurements indicated that on clear days the majority of silk elongation occurs at night when ear leaf water potentials are highest. At similar morning leaf water potentials, stressed plants maintained a lower silk elongation rate than well#x2014;watered plants. Positive silk elongation ceased at ear leaf water potentials of about #x2014; 9 bars in droughted plants and at #x2014; 14 bars in well—watered plants, suggesting that factors other than water potential may also regulate rate of silk growth. It is concluded that drought beginning at anthesis has a greater effect on female than male floral development.
Periodic monitoring of women at high risk for LE with BIS allows early detection and timely intervention for LE, which reduces the incidence of clinical LE from 36.4% to 4.4%. This may have implications for quality of life and health care costs.
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