Search

Figure S2. Hazard ratios (black line) and 95% confidence intervals (blue area) from the univariate survival analyses according to the presence of CTCs categorized using different cutoff values (e.g., cutoff 0: 0 CTCs vs. > 0; cutoff 1: 0-1 CTCs vs. > 1; cutoff 2: 0-2 CTCs vs. > 2). Panel A shows breast-cancer-specific survival, and Panel B shows distant disease-free survival.

supplemental figure legend

Purpose: Although unequivocal evidence has shown the prognostic relevance of circulating tumor cells (CTC) in the peripheral blood of patients with metastatic breast cancer, less evidence is available for the prognostic relevance of CTCs at the time of primary diagnosis.Experimental Design: We conducted a pooled analysis of individual data from 3,173 patients with nonmetastatic (stage I–III) breast cancer from five breast cancer institutions. The prevalence and numbers of CTCs were assessed at the time of primary diagnosis with the FDA-cleared CellSearch System (Janssen Diagnostics, LLC). Patient outcomes were analyzed using meta-analytic procedures, univariate log-rank tests, and multivariate Cox proportional hazard regression analyses. The median follow-up duration was 62.8 months.Results: One or more CTCs were detected in 20.2% of the patients. CTC-positive patients had larger tumors, increased lymph node involvement, and a higher histologic tumor grade than did CTC-negative patients (all P < 0.002). Multivariate Cox regressions, which included tumor size, nodal status, histologic tumor grade, and hormone receptor and HER2 status, confirmed that the presence of CTCs was an independent prognostic factor for disease-free survival [HR, 1.82; 95% confidence interval (CI), 1.47–2.26], distant disease-free survival (HR, 1.89; 95% CI, 1.49–2.40), breast cancer–specific survival (HR, 2.04; 95% CI, 1.52–2.75), and overall survival (HR, 1.97; 95% CI, 1.51–2.59).Conclusions: In patients with primary breast cancer, the presence of CTCs was an independent predictor of poor disease-free, overall, breast cancer–specific, and distant disease-free survival. Clin Cancer Res; 22(10); 2583–93. ©2016 AACR.

Table S1. Patients and study variables according to study center for the pooled analysis of circulating tumor cells in early breast cancer

The role of modified radical mastectomy (MRM) in patients with de novo stage IV inflammatory breast cancer (IBC) remains controversial. We evaluated the impact of MRM on outcomes in this population.Ninety-seven women presenting with stage IV IBC were identified in an institutional database (2007-2016) and were stratified by receipt of MRM or no surgery (non-MRM). Demographic, clinicopathologic, and treatment factors were compared. Local-regional recurrence patterns were described and survival analyses were conducted.All patients initially received chemotherapy. Fifty-two patients (53.6%) underwent MRM; 47 received post-mastectomy radiation. Differences between the non-MRM and MRM groups included tumor receptor subtypes (hormone receptor-positive [HR+]/human epidermal growth factor receptor 2-positive [HER2+]: 4.4% vs. 19.2%; HR+/HER2-negative [HER2-]: 31.1% vs. 44.2%; HR-negative [HR-]/HER2+: 24.4% vs. 15.4%; and HR-/HER2-: 40.0% vs. 21.2%; p = 0.03), number of metastatic sites (3 vs. 2; p = 0.01), and clinical partial/complete response to chemotherapy (13.3% vs. 75.0%; p 0.001). Of the 47 patients who completed trimodality therapy, 6 (12.8%) had a local-regional recurrence. Median overall survival (OS) was 19 months in the non-MRM group and 58 months in the MRM group (p 0.001). On multivariable analysis, clinical N3 disease (hazard ratio 2.16, 95% confidence interval [CI] 1.07-4.37; p = 0.03) as well as tumor subtypes HR+/HER2- (hazard ratio 4.98, 95% CI 1.15-21.47; p = 0.03) and HR-/HER2- (hazard ratio 7.18, 95% CI 1.66-31.07; p = 0.008) were associated with decreased OS. Partial/complete response of distant disease to chemotherapy (hazard ratio 0.43, 95% CI 0.24-0.77; p = 0.005) and receipt of MRM (hazard ratio 0.52, 95% CI 0.29-0.93; p = 0.03) were independently associated with improved OS.In our retrospective study, MRM in de novo stage IV IBC patients is an independent factor associated with improved OS. Our findings strongly support the need for prospective randomized trials evaluating possible survival benefits of MRM in de novo stage IV IBC patients.

Last month, Annual Meeting Steering Committee Vice Chair Cengiz Esmersoy and SEG Executive Director John Koehr described two SEG 2020 Annual Meeting panels devoted to preparing geophysicists for the future needs of our industry. This month, we continue with a similar theme of preparing future generations for earth science careers and informing and enlightening oil and gas (O&G) geophysicists about important work outside of their native profession.

With active screening for early detection and advancements in treatment, there has been a significant decrease in mortality from breast cancer. However, a significant proportion of patients with non-metastatic breast cancer at time of diagnosis will relapse. Therefore, it is suggested that the dissemination of bloodstream tumor cells (circulating tumor cells, CTCs) undetectable by currently available diagnostic tools occurs during the early stages of breast cancer progression, and may be the potential source of micrometastases responsible for treatment failures. Here, we review the clinical significance of CTCs, as detected by the FDA-approved CellSearch

Sharing knowledge is essential if Australian politicians are to effectively support farmers to be more resilient and adapt to climate change. Transformational change takes time; it can be fostered by on-ground examples of best practice in land management and innovative new approaches such as landscape rehydration. Farmers and politicians need to connect, to view and understand these methods and approaches and share their learnings. However, we need to go from connections for resilience to actions in the form of outcomes-based policy and financial support to achieve change.

Bacterial counts of "soul foods" obtained from 10 farm families and 10 supermarkets were determined. Total plate count means for farm family vegetables ranged from 1.5 × 106/g to 2.9 × 106/g, and 2.0 × 102/g to 3.1 × 105/g for vegetables purchased at the retail sales establishments. Pig offal samples with the highest total plate counts were pigtails, 4.8 × 108/g and maws, 4.5 × 108/g from farm families; and pigtails, 2.8 × 109/g, neck bones, 2.4 × 109/g from the retail sources. Fecal coliforms were not detected in any of the vegetable samples but were isolated from 24% of the pig offals. Sixty percent of all of the foods were positive for Salmonella and 96% were positive for coagulase-positive Staphylococcus aureus . Clostridium perfringens was only detected in one sample, chitterlings from a retail source.

The nursing and midwifery workforce is key to improving the performance of the health system overall. Health workforce shortages are significantly influenced by the productive capacity of health professions education institutions. Long-standing underinvestment in preservice nursing and midwifery education severely limits the capacity of institutions to educate nurses and midwives in sufficient numbers, and with the necessary clinical skills, for current and anticipated population health needs. The Nursing Education Partnership Initiative (NEPI) was established in 2011 by the U.S. President's Emergency Plan for AIDS Relief in response to key capacity-building challenges facing preservice nursing and midwifery education in Sub-Saharan Africa. NEPI has formed partnerships with governments and key stakeholders in Ethiopia, Democratic Republic of Congo, Lesotho, Malawi, and Zambia and supports 19 nursing and midwifery education institutions and 1 nursing council. NEPI has been informed by activities that strengthen education systems, institutions, and organizations as well as faculty capacity building. Ministry of health-led advisory groups were established to provide strategic direction and oversight for the work, fostering intersectoral dialogue and ensuring country ownership and sustainability. Three illustrative examples of innovations at the system, institution, and workforce levels describe approaches for country ownership, for addressing the shortage of highly qualified faculty, and for remedying the inadequate teaching and learning infrastructure.

With nearly 33 million global citizens living with HIV or AIDS, the need for a highly qualified, competent nursing workforce is critical. With the recent increase in global funding to expand access to antiretroviral therapy, there have been considerable efforts to improve the capacity of nurses to initiate and maintain antiretroviral therapy while evaluating its effectiveness, monitoring for side effects, reducing the incidence of drug–drug interactions (including drug interactions related to therapies provided by traditional healers), promoting adherence to therapies, and providing management of symptoms. Therefore, using a participatory action approach, nursing leaders from six sub-Saharan African countries collaborated to develop the essential nursing competencies related to HIV and AIDS. These competencies can help to guide preservice education related to HIV and AIDS, to strengthen in-service or capacity-building programs designed for already qualified nurses, and to guide policy and regulatory reform in the context of task-shifting, task-sharing, and scope of nursing practices. This is an online Supplement to the Journal of the Association of Nurses in AIDS Care. Visit www.nursesinaidscarejournal.org for easy navigation. A Supplement Preview was published in the January/February 2011 issue, Volume 22, Number 1. The Supplement Preview and Online Supplement are supported by grant number U92HA07230 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, funded by the President's Emergency Plan for AIDS Relief.

Major (1883) is also a tale of voluntary amnesia stemming from a reluctance to face particular facts about the postbellum United States. Though the novella speaks only sparingly of the American Civil War, it addresses some of the scars left in its wake, particularly those involv ing women's social position, racial passing, and a fear of the postwar new order. The novella's Major and Madam Carroll are the figureheads of the North Carolina mountain town of Far Edgerley, where much of Marion Carroll's time and energy is spent helping her ailing husband keep up appearances by hiding the effects of his increasing dementia. While her efforts to spare the Major's feelings suggest love and devotion, the behavior simultaneously bespeaks a desire to maintain a life that is no longer true, a desire the entire town shares and that causes the rest

Tumor cells that disseminate to the bone marrow (disseminated tumor cells [DTCs]) have been identified in 30% of patients with stage I through II breast cancer (BC) and predict outcome. Neoadjuvant chemotherapy (NACT) is effective in reducing the size of primary tumors or eradicating lymph node metastases before surgery, but little is known regarding the presence or significance of DTCs after NACT.The authors evaluated DTCs in 95 patients with clinical stage I through III BC. Bone marrow samples were collected after completion of NACT at the time they underwent surgery for primary BC. DTCs were assessed using an anticytokeratin antibody cocktail. Primary tumor markers, the extent of lymph node (LN) involvement, they type of NACT administered, and response to NACT were compared with presence of DTCs. Chi-square and Fisher exact tests were used for statistical analyses.The median patient age at diagnosis was 51 years, and the median follow-up was 24 months. Forty-six percent of patients had tumors classified as T1/T2, 20% had T3 tumors, 34.5% had T4 tumors, and 81% had lymph node metastasis before NACT. DTCs were identified in 26% of patients after NACT. No associations were observed between DTCs and primary tumor characteristics or LN involvement. A pathologic complete response was observed in 25 patients (26%) but was not predictive of DTCs after NACT (P = .83). DTCs after NACT predicted worse BC-specific survival (P.02).The presence of DTCs was an independent predictor of outcome after NACT. The current results indicated that monitoring hematogenous micrometastatic disease after NACT may be useful in selecting patients who might benefit from additional systemic adjuvant therapies.

With nearly 33 million global citizens living with HIV or AIDS, the need for a highly qualified, competent nursing workforce is critical. With the recent increase in global funding to expand access to antiretroviral therapy, there have been considerable efforts to improve the capacity of nurses to initiate and maintain antiretroviral therapy while evaluating its effectiveness, monitoring for side effects, reducing the incidence of drug-drug interactions (including drug interactions related to therapies provided by traditional healers), promoting adherence to therapies, and providing management of symptoms. Therefore, using a participatory action approach, nursing leaders from six sub-Saharan African countries collaborated to develop the essential nursing competencies related to HIV and AIDS. These competencies can help to guide preservice education related to HIV and AIDS, to strengthen in-service or capacity-building programs designed for already qualified nurses, and to guide policy and regulatory reform in the context of taskshifting, task-sharing, and scope of nursing practices.