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With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy. Patients whose clinical response to therapy was not available or undetermined should be allowed an ICU trial that consists of unlimited invasive support, including anti-cancer therapies such as ambulatory chemotherapy. Do everything that can be done to save the patients who might benefit from ICU treatment. The second is the option of therapeutic end point. An interdisciplinary meeting, including an ethics consultation, should be held after 3-6 days′ICU trial to make end-of-life decisions with relatives of patients if the SOFA score shows clinical deterioration with no available therapeutic options. The treatment goals should shift from curative or supportive therapies to end-of-life care. we could integrate hospice and palliative care with intensive care more effectively and efficiently. That would be the future of oncological ICUs. [ABSTRACT FROM AUTHOR]

Objective To explore the diagnostic, value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results of EBUS-TBNA. Methods A retrospective analysis of the clinical and imaging data of 389 patients who underwent EBUS-TBNA for sampling enlarged hilar and mediastinal lymph nodes from October 2009 to October 2015 in Shandong Tumor Hospital, to evaluate its significance in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results. Results Among the 389 collected cases, positive biopsy results were obtained in 362 cases, and false negative results in 27 cases. The sensitivity, specificity, positive predictive value and negative predictive value were 92.9%, 100%, 100% and 25.0%, respectively. There was a positive correlation between the size of lymph node and biopsy positive rate ( P = 0.021). The subcarinal lymph nodes had the highest positive rate ( 97. 7% ) , followed by the paratracheal lymph nodes ( 91. 2% ) , with a statistically significant difference (P= 0.006). The positive rates obtained by cytology (88.7%) and pathology (92.5%,) showed no significant difference ( P = 0. 065 ) . The positive rate of EBUS-TBNA was not correlated with pathological types (P =0.932). Needle types (21G, 22G) had no significant effect on diagnosis accuracy (P = 0.142). Conclusions EBUS-TBNA is a practical technology for diagnosis of enlarged mediastinal lymph nodes, with unique characteristics such as minimally invasiveness, local anesthesia, good safety and repeatability. Along with the accumulation of surgical experience, improvement of operative skills, more close cooperation between surgeons, cytologists and pathologists, false negative results will be reduced and positive rate of EBUS-TBNA examination will be further improved. [ABSTRACT FROM AUTHOR]

Objective This investigation sought to delineate the associations among colorectal adenomatous polyps, diabetes, and biomolecules involved in glucose metabolism. Method Data were collected from 40 patients who underwent endoscopic polypectomy at the Endoscopy Department of Shandong Cancer Hospital between June 2019 and September 2021. This cohort included 27 patients with inflammatory polyps and 13 with adenomatous polyps. We assessed fasting insulin (Fins), fasting blood glucose (FBG), and the mRNA expressions of fibroblast growth factor 19 (FGF-19) and insulin-like growth factor 1 (IGF-1) in the polyp tissues. Both univariate and multivariate logistic regression analyses were employed to ascertain the determinants influencing the emergence of adenomatous polyps. From these analyses, a predictive nomogram was constructed to forecast the occurrence of adenomatous polyps, and evaluations on the discriminative capacity, calibration, and clinical utility of the model were conducted. Results The adenomatous polyp group exhibited markedly elevated levels of glucose, insulin, FGF-19, and IGF-1, with respective concentrations of (8.67±2.70) mmol/L, (12.72±7.69) μU/L, 2.20±1.88, and 1.36±0.69. These figures were significantly higher compared to the inflammatory polyp group, which showed levels of (5.51±0.72) mmol/L, (5.49±2.68) μU/L, 0.53±0.97, and 0.41±0.46, respectively, P= 0.001. Multivariate logistic regression revealed that the relative expression of IGF-1 served as an independent risk factor for the development of colorectal adenomatous polyps (OR=5.622, 95% CI: 1.085-29.126). The nomogram displayed a C-index of 0.849, indicating substantial discriminative capability. The calibration curve affirmed the model's accuracy in aligning predicted probabilities with actual outcomes, and the clinical decision curve demonstrated thepractical clinical applicability of the model. Conclusions There was a significant correlation between the occurrence of colorectal adenomatous polyps and glucose metabolic pathways. Individuals with diabetes showed a higher propensity to develop such polyps. [ABSTRACT FROM AUTHOR]

Objective To investigate the response characteristics of patients with locally advanced/metastatic non-squamous non-small cell lung cancer (nsq-NSCLC) treated with tislelizumab in combination with chemotherapy in the first line. Methods Patients with nsq-NSCLC who achieved complete or partial remission after treatment with tislelizumab in combination with chemotherapy or chemotherapy alone in the RATIONALE 304 study, as assessed by an independent review board, were selected to analyze the response characteristics and safety profile of the responders. Time to response (TTR) was defined as the time from randomization to the achievement of first objective response. Depth of response (DpR) was defined as the maximum percentage of tumor shrinkage compared with the sum of the baseline target lesion length diameters. Results As of January 23, 2020, 128 patients treated with tislelizumab in combination with chemotherapy achieved objective tumor response (responders), representing 57.4%(128/223) of the intention-to-treat population, with a TTR of 5.1 to 33.3 weeks and a median TTR of 7.9 weeks. Of the responders (128), 50.8%(65) achieved first remission at the first efficacy assessment (week 6), 31.3%(40) at the second efficacy assessment (week 12), and 18.0%(23) at the third and subsequent tumor assessments. The percentages of responders who achieved a depth of tumor response of 30% to <50%, 50% to <70% and 70% to 100% were 45.3%(58/128), 28.1%(36/128) and 26.6%(34/128), respectively, with median progression-free survival (PFS) of 9.0 months (95% CI: 7.7 to 9.9 months), 11.5 months (95% CI: 7.7 months to not reached) and not reached (95% CI: 11.8 months to not estimable), respectively. Tislelizumab plus chemotherapy were generally well tolerated in responders with similar safety profile to the overall safety population. Conclusion Among responders to tislelizumab in combination with chemotherapy for nsq-NSCLC, 82.0%(105/128) achieves response within the first two tumor assessments (12 weeks) and 18.0%(23/128) achieves response at later (18 to 33 weeks) assessments, and there is a trend toward prolonged PFS in responders with deeper tumor response. [ABSTRACT FROM AUTHOR]

Ｏｂｊｅｃｔｉｖｅ 　Ｔｏ ｅｘｐｌｏｒｅ ｔｈｅ ｉｍｐａｃｔ ｏｆ ｍｉｃｒｏｗａｖｅ ｄｅａｌｉｎｇ ｗｉｔｈ ｃｕｔｔｉｎｇ ｓｕｒｆａｃｅ ｏｎ ｐｅｒｉｏｐｅｒａｔｉｖｅ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｃｕｒｒｅｎｃｅ ａｎｄ ｍｅｔａｓｔａｓｉｓ ａｆｔｅｒ ｈｅｐａｔｅｃｔｏｍｙ ｆｏｒ ＨＣＣ． Ｍｅｔｈｏｄｓ　Ｃｌｉｎｉｃａｌ ｄａｔａ ｏｆ １３３ ｐａｔｉｅｎｔｓ ｗｉｔｈ ＨＣＣ ｆｒｏｍ Ｍａｒｃｈ ２００９ ｔｏ Ｎｏｖｅｍｂｅｒ ２０１０ ｗｅｒｅ ｒｅｔｒｏｓｐｅｃｔｉｖｅｌｙ ａｎａｌｙｚｅｄ． Ｔｈｅｙ ｗｅｒｅ ｄｉｖｉｄｅｄ ｉｎｔｏ ｔｈｅ ｃｏｎｖｅｎｔｉｏｎａｌ ｓｕｒｇｅｒｙ ｇｒｏｕｐ （６６ ｃａｓｅｓ） ａｎｄ ｍｉｃｒｏｗａｖｅ ｔｒｅａｔｍｅｎｔ ｇｒｏｕｐ （６７ ｃａｓｅｓ）． Ａ ｄｏｍｅｓｔｉｃ ＥＣＯ⁃１００ ｍｉｃｒｏｗａｖｅ ｋｎｉｆｅ ｗａｓ ｉｎｓｅｒｔｅｄ ｉｎｔｏ ｔｈｅ ｌｉｖｅｒ ｃｕｔｔｉｎｇ ｓｕｒｆａｃｅ ０．５ ｃｍ ｆｒｏｍ ｔｈｅ ｃｕｔｔｉｎｇ ｅｄｇｅ， ａｎｄ ｒｅｐｅａｔｅｄ ｍｕｌｔｉ⁃ｐｏｉｎｔ ｂｕｒｎｉｎｇ ｗｉｔｈ ａｎ ａｖｅｒａｇｅ ｔｉｍｅ ｏｆ ２５ ｍｉｎｕｔｅｓ ｉｎ ｔｈｅ ｍｉｃｒｏｗａｖｅ ｔｒｅａｔｍｅｎｔ ｇｒｏｕｐ． Ｔｈｅｎ ｔｈｅ ｐｅｒｉｏｐｅｒａｔｉｖｅ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｃｕｒｒｅｎｃｅ ａｎｄ ｍｅｔａｓｔａｓｉｓ ｉｎ ｔｈｅ ｔｗｏ ｇｒｏｕｐｓ ｗｅｒｅ ｃｏｍｐａｒｅｄ． Ｒｅｓｕｌｔｓ　Ｔｈｅ ｏｐｅｒａｔｉｏｎ ｔｉｍｅ ｏｆ ｃｏｎｖｅｎｔｉｏｎａｌ ｓｕｒｇｅｒｙ ｇｒｏｕｐ ｗａｓ （１５８． ０ ± ３１． ０） ｍｉｎｕｔｅｓ， ａｎｄ ｔｈａｔ ｏｆ ｍｉｃｒｏｗａｖｅ ｔｒｅａｔｍｅｎｔ ｇｒｏｕｐ ｗａｓ ｓｉｇｎｉｆｉｃａｎｔｌｙ ｌｏｎｇｅｒ （１８１．０±２８．０） ｍｉｎｕｔｅｓ （Ｐ ＝ ０．０２７）． Ｔｈｅｒｅ ｗｅｒｅ ｎｏ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅｓ ｉｎ ｔｈｅ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｒｅｃｏｖｅｒｙ ｂｅｔｗｅｅｎ ｔｈｅ ｔｗｏ ｇｒｏｕｐｓ （Ｐ＞０．０５）． Ｔｈｅｒｅ ｗｅｒｅ ６ ｃａｓｅｓ ｏｆ ｒｅｃｕｒｒｅｎｃｅ ａｎｄ ｍｅｔａｓｔａｓｉｓ ａｆｔｅｒ ６ ｍｏｎｔｈｓ ａｎｄ ９ ｃａｓｅｓ ａｆｔｅｒ １２ ｍｏｎｔｈｓ ｉｎ ｔｈｅ ｍｉｃｒｏｗａｖｅ ｔｒｅａｔｍｅｎｔ ｇｒｏｕｐ， ｗｈｉｌｅ ｔｈｅｒｅ ｗｅｒｅ １５ ｃａｓｅｓ ｏｆ ｒｅｃｕｒｒｅｎｃｅ ａｎｄ ｍｅｔａｓｔａｓｉｓ ａｆｔｅｒ ６ ｍｏｎｔｈｓ ａｎｄ ２０ ｃａｓｅｓ ａｆｔｅｒ １２ ｍｏｎｔｈｓ ｉｎ ｔｈｅ ｃｏｎｖｅｎｔｉｏｎａｌ ｓｕｒｇｅｒｙ ｇｒｏｕｐ， ｓｈｏｗｉｎｇ ａ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅ （ Ｐ ＝ ０． ０３４ ａｎｄ ０． ０２２， ｒｅｓｐｅｃｔｉｖｅｌｙ）． Ｃｏｎｃｌｕｓｉｏｎｓ　Ｍｉｃｒｏｗａｖｅ ｄｅａｌｉｎｇ ｗｉｔｈ ｔｈｅ ｃｕｔｔｉｎｇ ｓｕｒｆａｃｅ ｈａｓ ｎｏ ｓｉｇｎｉｆｉｃａｎｔ ｅｆｆｅｃｔ ｏｎ ｐｅｒｉｏｐｅｒａｔｉｖｅ ｌｉｖｅｒ ｆｕｎｃｔｉｏｎ ｒｅｃｏｖｅｒｙ ｉｎ ｈｅｐａｔｅｃｔｏｍｙ． Ｈｏｗｅｖｅｒ， ｍｉｃｒｏｗａｖｅ ｔｒｅａｔｍｅｎｔ ｃａｎ ｒｅｄｕｃｅ ｔｈｅ ｉｎ ｓｉｔｕ ｒｅｃｕｒｒｅｎｃｅ ｉｎ ＨＣＣ ｐａｔｉｅｎｔｓ ｗｉｔｈｉｎ ｔｈｅ ｆｉｒｓｔ ｙｅａｒ ａｆｔｅｒ ｓｕｒｇｅｒｙ， ｉｎｄｉｃａｔｉｎｇ ａ ｇｏｏｄ ｃｌｉｎｉｃａｌ ａｐｐｌｉｃａｔｉｏｎ ｖａｌｕｅ． [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between insulin resistance, glucose and lipid metabolism related molecules and colorectal polyps. Methods A total of 262 healthy people who underwent colonoscopy in Shandong cancer hospital from June 2019 to September 2020 were selected. The levels of serum vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 19 (FGF19), insulin like growth factor (IGF-1), fasting blood glucose and fasting blood insulin were detected by enzyme-linked immunosorbent assay (ELISA). Insulin resistance index (HOMA-IR) was calculated, and the influencing factors of occurrence, pathological type, size and number of polyps were analyzed. Results Among 262 cases, 116 cases were polyp free, 113 cases were adenomatous polyp and 33 cases were inflammatory polyp. HOMA-IR, VCAM-1 and FGF19 in polyp group were 2.904±1.754, (334.415±139.573) ng/ ml and (135.865± 98.470) pg/ ml, respectively, which were higher than 2. 369 ± 1. 306, (302.480± 99. 946) ng/ ml and (110.694±76.044) ng/ ml in non-polyp group, respectively (P < 0.05). Multivariate Logistic regression analysis showed that the gender (OR =4.269, 95%CI: 1.963-9.405) and FGF19 (77.0-131.4 pg/ ml: OR = 2.385, 95%CI: 1.155-4.926) were independent factors of colorectal polyps. The gender (OR =3.799, 95% CI: 1.650-8.748) and FGF19 (77.0-131.4 pg/ ml: OR = 2.290, 95%CI: 1.072-4.891) were independent factors of colorectal adenomatous polyps. The gender(OR = 6.725, 95% CI: 1.853-24.410) and fasting plasma glucose (=6.5 mmol/ L: OR =0.047, 95%CI: 0.009-0.245) were independent factors of colorectal inflammatory polyps. The gender (OR = 3.539, 95% CI: 1.293-9.689) was an independent factor for the occurrence of single polyp. The gender (OR =5.063, 95% CI: 2.048-12.515), FGF19 (77.0-131.4 pg/ ml: OR =2.502, 95%CI: 1.102-5.681), fasting plasma glucose (=6.5 mmol/ L: OR = 0.282, 95%CI: 0.095- 0.839) were independent factors of multiple polyps. The gender (OR =3.416, 95% CI: 1.134-10.289) and fasting insulin (=9.4 µU/ ml: OR = 9.480, 95% CI: 1.485-60.521) were independent risk factors for colorectal polyps<0.5 cm. The gender (OR=3.151, 95%CI: 1.244-7.984) and fasting plasma glucose (=6.5 mmol/ L: OR =0.310, 95%CI: 0.102-0.941) were independent risk factors for colorectal polyps with the size of 0.5-0.9 cm. The gender (OR =22.649, 95%CI: 4.154-123.485), age (55 to 64 years old: OR = 4.473, 95%CI: 1.070-18.704; =65 years old: OR = 5.815, 95%CI: 1.300-26.009), BMI (=28 kg/ m2: OR = 5.310, 95%CI: 1.224-23.032) and FGF19 (77.0-131.4 pg/ ml: OR =7.474, 95%CI: 1.903-29.351) were independent factors for colorectal polyps with size = 1.0 cm. Gender stratification analysis showed that FGF19 was an independent factor for the occurrence of male polyps (77.0-131.4 pg/ ml: OR =6.109, 95%CI: 1.688-22.104) and adenomas (77.0-131.4 pg/ ml: OR =6.401, 95%CI: 1.717-23.864). The age (55 to 64 years old: OR = 3.783, 95%CI: 1.052-13.611) and VCAM-1 (=352.8 ng/ ml: OR = 4.341, 95%CI: 1.142-16.493) were independent risk factors of female polyps. The age (55 to 64 years old: OR = 5.743, 95%CI: 1.205-27.362, =65 years old: OR =6.885, 95%CI: 1.143-41.467), VCAM-1 (=352.8 ng/ ml: OR =6.313, 95%CI: 1.415-28.159) and IGF-1 (=7.6 ng/ ml: OR = 5.621, 95%CI: 1.069-29.543) were independent factors of female adenoma. Conclusions The occurrences of colorectal polyps and adenomatous polyps are related to insulin resistance and glucose and lipid metabolism. Serum FGF19 is an independent influencing factor for the occurrence of colorectal polyps and adenomatous polyps, and is a potential serological diagnostic marker and therapeutic target for colorectal polyps and adenomatous polyps. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between total prostate specific antigen (TPSA), free prostate specific antigen/total prostate specific antigen [RAT(FIT)], Gleason score, other factors and the whole-body bone phme imaging which was used to evaluate the bone metastasis of prostate cancer (PCa), and the diagnostic value of the abnormal concentration of bone imaging agent for single lesion. Methods A retrospective analysis of 99Tc100 -methylene diphosphonate (99Tc100-MOP) whole-body bone imaging data of 93 patients with confirmed PCa in The First Hospital of Shanxi Medical University from Jan 2018 to Jan 2019 was conducted. The hone metastasis was diagnosed by whole-body bone imaging. The factors related to PCa bone metastasis, including age, TPSA, RAT (FIT), Gleason score were analysed by Chi-square test and logstic two-class regression. The optimal cut-off point of TPSA was defined by receiver operating characteristic (ROC) curve. The region of interest (ROI) Techni clue was used to repeatedly delineate the lesion (T) and the background area (NT) outside the bone and calculate the abnormal concentration value of bone imaging agent (T-NT)INT, and the ROC curve was used to determine its diagnostic value. Results The result of Chi-square analysis showed that Gleason score, TPSA and RAT (F/T) were associated with hone metastasis (P<0.05). Logistic regression analysis showed that TPSA and RAT (F/T) were associated with hone metastasis (P<0.01). TPSA >92.82 ng/ml was the best diagnosis for bone metastasis, and the sensitivity and specificity were 77.1%. and 81.0%, respectively. There were 320 sites of high concentration of imaging agents in the whole-body bone imaging of PCa patients (194 in the metastatic group and 126 in the non-metastasis group). The (T-NT)/NT in the hone metastasis group was 7111±0.29, the non-bone metastasis group was 2.69±0.20. (T-NT)/Nf >3.52 was the best diagnosis for bone metastasis of single lesion, and the sensitivity and specificity were 86.1% and 80.2%, respectively. Conclusions Gleason score, RAT (FIT) and TPSA arc important risk factors of PCa hone metastasis. TPSA >92.82 ng/ml is the most supportive diagnosis for PCa bone metastasis. The abnormal concentration of bone imaging agent >3.52 owns the best diagnosis effect for the single lesion of PCa. [ABSTRACT FROM AUTHOR]

Objective To investigate the expressional levels and diagnostic values of miR-18a and miR-21 in esophageal carcinoma. Methods The expressions of miR-18a and miR-21 in esophageal cancer tissues and adjacent tissues from 45 esophageal cancer patients, peripheral blood from 45 esophageal cancer patients and 50 healthy donors respectively were detected by RT-PCR. The expressions of miR-18a and miR-21 in normal esophageal epithelial cell HET-1A, esophageal cancer cell lines including ECA109, KYSE150 and TE1 were also detected. Chemiluminescence immunoassay was used to quantitatively detect the concentrations of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), CYRFA21-1 and TPA (tissue polypeptide antigen) in peripheral blood serum from esophageal cancer patients and healthy controls. Meanwhile, the diagnostic effects of miR-18a and miR-21 on esophageal cancer were compared with those of tumor markers in serum. Results The expression levels of miR-18a and miR-21 in esophageal cancer cells ECA109, KYSE150 and TE1 were 1.64±0.17, 1.62±0.19, 1.46±0.12 and 20.52±1.48, 6.73±0.73, 1.43±0.19, respectively, higher than those in normal esophageal epithelial cells (both P<0.01). The expressions of miR-18a and miR-21 in esophageal cancer tissues were 32.48±28.62 and 8.67±11.98, respectively, significantly higher than those in adjacent tissues (all P<0.001). The expression levels of miR-18a and miR-21 in peripheral blood of patients with esophageal cancer were 12.66±11.92 and 9.15±8.14, respectively, significantly higher than those in the normal control group (both P<0.001). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of miR-18a and miR-21 for diagnosis of esophageal cancer were 0.948 and 0.913 5, respectively. Compared with traditional esophageal tumor markers, the expressions of miR-18a and miR-21 were more sensitive in the diagnosis of esophageal cancer. The sensitivity and accuracy of the expressions of miR-18a and miR-21 combined with traditional esophageal tumor markers in diagnosis of esophageal cancer can be further improved to 97.8% and 68.4%, respectively. Conclusion Our study reveals that the expressions of miR-18a and miR-21 play important roles in the diagnosis of esophageal cancer and may be potentially novel biomarkers. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. Methods Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received ultrasonographic and mammographic examination and didn′t undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor-positive resection margins were analyzed using Logistic regression model. Results In 28 patients (28/72, 38.9%), dynamic contrast-enhanced MRI could correct or supplement the ultrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group (n=30) had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma (23.3% vs 40.0%, P=0.02), but there was no significant difference (21.4% vs 26.9%, P=0.10) between two groups for ductal carcinoma in situ (n=28). The preoperative MRI examination group (n=14) had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma (14.3% vs 38.9%, P=0.02). The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins. Conclusion Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. [ABSTRACT FROM AUTHOR]