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Calciphylaxis, or calcific uremic arteriolopathy, is a rare but particularly morbid condition involving systemic medial calcification of arterioles causing ischemia and subsequent tissue necrosis. Although most commonly occurring over the abdomen and proximal extremities, calciphylaxis can present on nearly any skin surface with a tendency toward areas of increased adiposity. We report a case of a 53-year-old female with end-stage renal disease who presented with bilateral palpable breast masses and overlying skin changes. Diagnostic mammography and percutaneous biopsy of the lesion facilitated the diagnosis of calciphylaxis and she was treated with medical therapy, local wound care, and eventual tissue extirpation. Due to the morbidity attributed to calciphylaxis and associated wound complications, surgical extirpation is at times unavoidable. Once malignancy has been excluded, we recommend nonoperative management with prompt referral to Nephrology for medical optimization, reserving surgical debridement for nonhealing wounds and superinfection.
To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass-like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI-RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false-negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI-RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.
High income, high socioeconomic status, and affluence increase breast cancer incidence. Socioeconomic status in USA breast cancer studies has been assessed by block-group socioeconomic measures. A block group is a portion of a census tract with boundaries that segregate, as far as possible, socioeconomic groups. In this study, we used US Census income data instead of block groups to gauge socioeconomic status of breast cancer patients in relationship with incidence, prognostic markers, and survival. US state breast cancer incidence and mortality data are from the U.S. Cancer Statistics Working Group, United States Cancer Statistics: 1999–2011. Three-Year-Average Median Household Income by State, 2010 to 2012, is from the U.S. Census Bureau, Current Population Survey, 2011 to 2013 Annual Social and Economic Supplements. County incomes are from the 2005–2009 American Community Survey of the U.S. Census Bureau. The American Community Survey is an ongoing statistical survey that samples a small percentage of the population yearly. Its purpose is to provide communities the information they need to plan investments and services. Breast cancer county incidence and survival data are from the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER) data base. We analyzed SEER data from 198 counties in California, Connecticut, Georgia, Hawaii, Iowa, New Mexico, Utah, and Washington. SEER uses the Collaborative Stage (CS) Data Collection System. We have retained the SEER CS variables. There was a significant relationship of income with breast cancer incidence in 50 USA states and the District of Columbia in White women (r = 0.623, p < 0.001). There was a significant relationship between node involvement and income in Whites in 198 USA counties. Income was significantly correlated with 5-year relative survival in Whites with localized breast cancer. Income was not correlated with 5-year survival of Black race (p = 0.364) or other races (p = 0.624). The multivariate general linear model with income as covariate, 5-year survival by race as a dependent variable, showed a significant effect of income and White race on 5-year survival (p < 0.001), unrelated to Black race (p = 0.780) or other races (p = 0.618). In men, we found a nonsignificant positive correlation between county breast cancer incidence and income (r = 0.098, p = 0.168). Breast cancer risk factors, such as delayed childbirth, less breast-feeding, and use of hormone supplements, are more common in affluent women. Affluent women are more likely to have mammograms, which detect many cancers that might not otherwise be diagnosed. In addition, women in certain affluent ethnic groups—Ashkenazi Jews, Icelanders and the Dutch—are more likely to carry genetic mutations known to predispose to breast cancer. We hypothesize that women with more income can afford better cancer care and survive longer than poorer women. But our hypothesis does not explain why this effect should be limited to White women; or why node involvement increased with income in White women but not in Blacks or Hispanics. Further studies may be worthwhile.
Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management.
Aromatase inhibitors (AIs) are widely used as adjuvant hormonal therapy in postmenopausal women with hormone receptor-positive breast cancer. The purpose of this study was to investigate the potential impact of AIs on the anterior segment of the eye and especially the ocular surface. Participants in our study were 41 hormone receptor-positive early stage breast cancer patients (80 eyes), treated with AIs, while 80 eyes of 40 age- and gender-matched healthy controls, not previously used AIs for any purpose, were also evaluated. All participants underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA) assessment, slit-lamp biomicroscopy, and dilated fundus examination. Ocular surface disease-related symptoms and signs were also recorded. The most common symptom was found to be blurred vision, while other symptoms included foreign body sensation, tearing, redness, and photophobia. Slit-lamp examination revealed blepharitis and meibomian gland dysfunction in 75% and 42.5% of patients, respectively. Superficial punctate keratitis and conjunctival injection were also present. Our results demonstrated a high prevalence of ocular surface disease-related symptoms and signs in patients receiving AIs compared to healthy controls. This study may raise a flag regarding the use of AIs. However, further and larger prospective longitudinal studies are needed to examine the possible effect of AIs alone or in combination with chemotherapy in the eyes of breast cancer patients.
Idiopathic granulomatous mastitis (IGM) is a benign, frequently severe chronic inflammatory lesion of the breast. Its etiology remains unknown and reported cases vary in their presentation and histologic findings with an optimal treatment algorithm yet to be described owing mainly to the disease's heterogeneity. IgG4-related disease (IgG4-RD) is a newly recognized systemic fibroinflammatory condition characterized by a dense lymphoplasmacytic infiltrate with many IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. Immunosuppressive therapy is considered to be an effective first-line therapy for IgG4-RD. We sought to clarify and classify chronic mastitis according to the histologic findings of IgG4-RD mastitis with respect to IGM and to develop a robust diagnostic framework to help select patients for optimal treatment strategies. Using the largest collection to date (43 cases from Egypt and Morocco), we show that despite sharing many features, IGM and IgG4-RD mastitis are separate diseases. To diagnostically separate the diseases, we created a classification schema—termed the Michigan Classification—based upon our large series of cases, the consensus statement on IgG4-RD, and the histologic description of IGM in the literature. Using our classification, we discerned 17 cases of IgG4-RD and 8 cases of IGM among the 43 chronic mastitis cases, with 18 indeterminate cases. Thus, our Michigan Classification can form the basis of rational stratification of chronic mastitis patients between these two clinically and histopathologically heterogeneous diseases.
We present the case of a 73-year-old woman with pure squamous cell carcinoma in situ of the left breast. This non-invasive malignancy exhibited pure squamous type of architectural and cytologic features without any evidence of glandular differentiation either in the initial needle core biopsy or in the subsequently performed excisional biopsy and simple mastectomy. The tumor spanned 1.6 cm, involved numerous ducts and terminal ducts and extended into lobules, and was characterized by keratinizing squamous cells with intermediate-grade nuclei. Intercellular bridges extended between the malignant squamous cells. Keratinous debris with "pearl" formation was evident in most involved glands. No invasive carcinoma was identified. There was no evidence of metastatic disease in the ipsilateral sentinel lymph nodes. Thus far, only three cases of squamous cell carcinoma in situ of the breast have been reported in one series—none of which showed any evidence of recurrent or metastatic disease at last follow-up. In our case, treated exclusively by surgery, there was no evidence of disease 11 years after diagnosis.
Invasive lobular carcinoma (ILC) accounts for 5–15% of breast cancers. In comparison to other types of breast cancer, ILC is more likely to be associated with multifocal and contralateral breast involvement as well as a tendency to a diffuse infiltrative growth pattern which can represent a diagnostic challenge. The National Institute of Clinical Excellence guidelines in 2009 recommended the use of magnetic resonance imaging (MRI) in the preoperative assessment of ILC. This study aims to assess compliance with the guidelines in two District General Hospitals and the utility of MRI in the investigation of ILC. All cases of ILC between 2011 and 2013 were retrospectively identified from the pathology database and their breast imaging findings, pathology report, and operative intervention were reviewed. A total of 126 patients were identified with ILC, of these 46 had MRI preoperatively (36.5%). MRI upgraded mammography/ultrasound diagnoses in 10 patients (21.7%). MRI showed multicentric unilateral disease in 17 patients (37.0%) occult on ultrasound/mammogram, with these patients undergoing mastectomy and 16/17 (94.1%) confirmed multifocality on pathology. MRI showed a contralateral lesion in 9 patients (19.6%), four (8.7%) of which were malignant and had bilateral surgery, and five (10.9%) were benign on further imaging/biopsy. MRI also downgraded three patients (6.5%) to unifocal disease with reported multifocal appearances on mammography/ultrasound, and these patients underwent breast-conserving surgery. MRI adds significant additional information to mammograms/ultrasound in ILC and should be undertaken in all such cases preoperatively assuming no contraindication.
Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow-up was 58 months. Seventy-five patients (99%), with a mean tumor size of 27 mm, underwent a breast-conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re-excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow-up especially during this period for which patient's compliance is essential.
Mucinous breast carcinoma (MBC) carcinoma represents approximately 1–6% of all malignant breast carcinoma and is divided into pure (PMBC) and mixed (MMBC) subtypes. This study presents the comparison of clinical characteristics and treatment results in 70 patients with PMBC and 40 patients with MMBC, treated at a single institution during 25 years. Performed analyses showed that only nodal status was different in both subtypes. Patients with MMBC showed a significantly higher incidence of axillary nodal metastases in comparison to PMBC (25% versus 10%, respectively). Instead, the 10-year disease-free survival rate was significant higher in PMBC than MMBC (85.7% versus 65%, p < 0.02, test log rank). Authors own observations and data from literature proved that MMBC should be considered as subtypes of mucinous breast cancer.
The optimal management of patients with pathologically node-negative triple-negative breast cancer (pN0 TNBC) remains unclear. We hypothesized that lymph node irradiation (LNI; internal mammary chain/periclavicular irradiation) had an impact on outcomes of pN0 TNBC. A cohort of 126 consecutive patients with pN0 TNBC treated between 2007 and 2010 at a single institute were included. All radiotherapy (breast/chest wall, ±LNI) was delivered adjuvantly, following completion of surgery ± chemotherapy. Tumors were reviewed and histologic features were described. Tissue microarrays were constructed and tumors were assessed by immunohistochemistry using antibodies against ER, PR, HER2, Ki-67, cytokeratins 5/6, 14, epidermal growth factor receptor and androgen receptor. Patients were divided into two groups for statistical analysis: LNI (LNI+) or no LNI (LNI−). We focused on disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS). Fifty-seven and 69 patients received or not LNI, respectively. Median age was 52 (range [25–76]) and 55 (range [29–79]) in LNI+ and LNI− group (p = 0.23). LNI was associated with larger tumors (p = 0.033), central/internal tumors (33 versus 4, p < 0.01) and more chemotherapy (86% versus 59.4% p < 0.01). The median follow-up was 53.5 months. The rate of first regional relapse (associated or not with distant relapse) was low in both groups. There was no difference in 4-year DFS (82.2% versus 89.9%; p = 0.266), MFS (87.0% versus 91.1%; p = 0.286) and OS (85.8% versus 89.9%; p = 0.322) between LNI+ and LNI− group, respectively. In univariate analysis, only clinical size (T >10 mm versus ≤10 mm), histologic size (pT >10 mm versus ≤10 mm) and grade 3 (versus grade 2) were found to be significantly associated with shorter DFS. Omission of LNI in patients with pN0 TNBC does not seem to result in poorer outcome. Further studies are needed to specifically evaluate LNI in pN0 TNBC with histologic grade 3 and/or (p)T >10 mm.
Increased breast density and a history of benign breast biopsy are both considered risk factors for developing breast cancer. Understanding the specifics of these risk factors and their relationship to each other can lead to a better understanding of a patient's propensity for breast cancer development and improved surveillance strategies. We included 245 women who underwent a benign breast biopsy without atypia between October 2011 and June 2013. Biopsies were performed for suspicious calcifications as well as masses and architectural distortion. Lesions biopsied were divided into two groups: calcified and noncalcified lesions. The patient's breast density was assessed on most recent mammogram and was classified using the American College of Radiology BI-RADS density categories. Based on histologic diagnosis, each case was classified as proliferative or nonproliferative breast disease. The median age of the cohort (n = 245) was 55 years (range, 40–84 years). There were 162 (66%) postmenopausal women in the study. A core biopsy was performed for calcifications in 33.5% cases and for noncalcified lesions in 58% cases. In patients with dense breast tissue, an underlying proliferative histology was found significantly more frequently with calcifications (66.7%) as opposed to noncalcified lesions (35.9%) (RR = 2.3 (1.3–4.0); χ2 = 8.7; p = 0.003). In nondense breast patients, there was no significant difference (RR = 1.1 (0.7–1.8); χ2 = 0.1; p = 0.738). In the postmenopausal group, women with dense breasts had proliferative histology significantly more frequently than women with nondense breasts (55.3% versus 38.3%; p < 0.05), regardless of the underlying lesion type. Postmenopausal women with dense breasts who underwent a breast biopsy with benign histology had a significantly higher likelihood of having proliferative breast disease, regardless of underlying lesion type. Women with dense breasts also showed proliferative histology significantly more often for calcifications as opposed to noncalcified lesions.
Orbital metastases from breast cancer (BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0–19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options.
Collagen vascular diseases present a treatment dilemma for patients with breast cancer. Due to the potential for severe, acute, and late complications of radiation therapy, a history of collagen vascular disease (CVD) is a relative contraindication to breast-conserving treatment. We present a case of early stage breast cancer in a patient with severe scleroderma treated with breast-conserving surgery without radiation and a brief review of the published literature regarding the therapeutic approach to the patient with CVD and breast cancer.
To examine practice patterns for breast cancer patients with limited sentinel node (SN) disease in light of the ACOSOG Z0011 results. Retrospective analysis of patients with T1-2 breast cancer and positive sentinel lymph node biopsy (SLNB) admitted between January 2009 and December 2012. Patient demographics, tumor characteristics, and treatments were recorded. Eight hundred positive SLNBs were identified. A total of 452 (56.5%) proceeded to completion axillary lymph node dissection (cALND). cALND rate decreased from 65.1% to 49.7% from 2009–2010 to 2011–2012. cALND was performed for micrometastasis or isolated tumor cells in 39.3% in 2009–2010 and 22.2% in 2011–2012, whereas for macrometastases the rates were 83.1% and 68.6%, respectively. cALND rates diminished for both Z0011-eligible and -ineligible patients. The ACOSOG Z0011 trial presentation and publication coincided with a reduction in cALND for breast cancer with limited nodal disease. There appears equipoise regarding management of macrometastatic SN disease.
Breast cancer represents the most frequent cancer in female population. Nowadays breast conservative surgery (BCS) is an accepted option for breast malignancies, and its indications has been extended thanks to the advent of oncoplastic surgery, reducing both mastectomy and re-excision rate, avoiding at the same time breast deformities. From January 2008 to November 2011, 84 women underwent BCS with periareolar approach for oncoplastic volume replacement. We divided patients into four groups analyzing breast size and resection volume (Group 1: small-moderate sized breast with resection <20%; Group 2: small-moderate sized breast with resection >20%; Group 3: big sized breast with resection <20%; Group 4: big sized breast with resection >20%). We evaluated patients' satisfaction regarding final esthetic outcome using the specific module "Satisfaction with outcome" of the Breast-Q questionnaire 1 year after surgery. The mean age was 52.1 years, and the mean follow-up was 11.2 months. During the follow-up, 12 patients have been lost. We obtained high satisfaction mean value with Breast-Q questionnaire in each group: 75.8 in group 1, 63.4 in group 2, 81.1 in group 3, 69.7 in group 4. Periareolar approach as oncoplastic volume replacement technique is useful in correction of breast deformity after BCS: it is a versatile technique that can be easily adapted for any breast tumor location and for wide glandular resection.
Clinical management of breast cancer is increasingly personalized and based on molecular profiling. Often, primary tumors are used as proxies for systemic disease at the time of recurrence. However, recent studies have revealed substantial discordances between primary tumors and metastases, both with respect to traditional clinical treatment targets and on the genomic and transcriptomic level. With the increasing use of molecularly targeted therapy, discordance of actionable molecular targets between primary tumors and recurrences can result in nonoptimal treatment or unnecessary side effects. The purpose of this review is to illuminate the extent of cancer genome evolution through disease progression and the degree of molecular concordance between primary breast cancers and matched metastases. We present an overview of the most prominent studies investigating the expression of endocrine receptors, transcriptomics, and genome aberrations in primary tumors and metastases. In conclusion, biopsy of metastatic lesions at recurrence of breast cancer is encouraged to provide optimal treatment of the disease. Furthermore, molecular profiling of metastatic tissue provides invaluable mechanistic insight into the biology underlying metastatic progression and has the potential to identify novel, potentially druggable, drivers of progression.
The aim of the study was to evaluate the impact of MammaPrint on treatment decision-making in patients with breast cancer. Clinicopathologic information of all breast cancer patients referred for MammaPrint testing in South Africa was collected from 2007 until 2014. A total of 107 patients (109 tumors) with estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor-2 negative tumors were selected with tumors ≥10 mm, or when 1–3 nodes were involved without extra-nodal extension. None of the clinical indicators correlated significantly with the MammaPrint risk classification, which changed the decision for adjuvant chemotherapy in 52% of patients. Of 60 patients who were clinically high risk, 62% had a low-risk MammaPrint result and of the 47 clinically low -risk patients 40% had a high-risk MammaPrint result. This study indicates that MammaPrint could reduce the need for adjuvant chemotherapy by 17% using the selection criteria stipulated. The significant impact on treatment decisions confirmed the clinical utility of MammaPrint independent of standard clinicopathologic risk factors as supported by long-term clinical outcome studies.
Resection of biopsy-proven involved axillary lymph nodes (iALNs) is important to reduce the false-negative rates of sentinel lymph node (SLN) biopsy after neo-adjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer. Preoperative wire localization for iALNs marked with clips placed during biopsy is a technique that may help the removal of iALNs after NAC. However, ultrasound (US)-guided localization is often difficult because the clips cannot always be reliably visible on US. Computed tomography (CT)-guided wire localization can be used; however, to date there have been no reports on CT-guided wire localization for iALNs. The aim of this study was to describe a series of patients who received CT-guided wire localization for iALN removal after NAC and to evaluate the feasibility of this technique. We retrospectively analyzed five women with initially node-positive breast cancer (age, 41–52 years) who were scheduled for SLN biopsy after NAC and received preoperative CT-guided wire localization for iALNs. CT visualized all the clips that were not identified on post-NAC US. The wire tip was deployed beyond or at the target, with the shortest distance between the wire and the index clip ranging from 0 to 2.5 mm. The total procedure time was 21–38 minutes with good patient tolerance and no complications. In four of five cases, CT wire localization aided in identification and resection of iALNs that were not identified with lymphatic mapping. Residual nodal disease was confirmed in two cases: both had residual disease in wire-localized lymph nodes in addition to SLNs. Although further studies with more cases are required, our results suggest that CT-guided wire localization for iALNs is a feasible technique that facilitates identification and removal of the iALNs as part of SLN biopsy after NAC in situations where US localization is unsuccessful.
The management of women with breast cancer who wish to preserve their breasts often includes partial reconstruction at the time of tumor resection. This is referred to as the oncoplastic approach and has been shown to improve outcomes. The purpose of this review was to better understand the current surgeon mindset relative to the oncoplastic approach. A survey was designed to understand demographics and opinions on partial breast reconstruction at the time of tumor resection. This was disseminated to the registered members of the American Society of Breast Surgeons as well the American Society of Plastic Surgeons (ASPS) through an online system and comparisons were made. There were 422 responders in the ABS and 214 responders in the ASPS for a response rate of 14.8% and 9.1%, respectively. Most (69.7%) breast surgeons felt that partial breast reconstruction following lumpectomy was not limited in their practice. Fifty percent of plastic surgeons felt that it was limited because they were not getting the referrals. Both groups agreed that complex partial reconstructions were best performed using the team approach. Margin involvement was a major concern in both groups, and the groups agreed that the aesthetic benefits were a major driving force. Future adoption of these techniques will rely on increased training and increased awareness of these procedures. There tends to be general agreement surrounding the concerns and benefits of immediately reconstructing the partial mastectomy defect. Disparity does exist between the two groups in terms of delivery likely due to the system-based inadequacies in the USA. This represents an area for improvement.
Mastalgia is a distressing symptom and may be severe enough to interfere with usual daily activities. Breast pain is either cyclical or noncyclical. Currently; multiple options are available for the treatment of mastalgia including hormonal and nonhormonal agents. This study was conducted to evaluate the role of centchroman as a nonhormonal first-line treatment for moderate to severe mastalgia. To accomplish this; a prospective open-label, single-arm study was done using the Pretest–Posttest Design. A total of 100 women suffering from mastalgia were grouped according to the characteristic pattern of breast pain (cyclic and noncyclic) and received centchroman 30 mg/day for 12 weeks followed by observation for 12 weeks. The efficacy analysis of centchroman was done by comparing median Visual Analog Scale score, median pain duration and side effects over time among the two groups. Centchroman significantly alleviates mastalgia with minimal side effects. The median pain score was significantly reduced over successive visits (1, 4, 12, and 24 weeks). The median pain duration decreased remarkably over time in comparison to the baseline (p = 0.001). Overall the response rate was 88% at the end of 12 weeks and 85% at the end of 24 weeks. The drug was found more effective with a quicker response in cyclic pattern of matalgia. Complete response was observed in 66% of cyclic mastalgia and 40% of noncyclic mastalgia patients at 1 week of therapy. The response was improved over time in both groups and at completion of treatment (12 weeks) 92% patients in cyclic group and 80% patients in noncyclic group were pain free. The effect of the drug persisted till the completion (24 weeks) of the study (p = 0.001). These results imply that centchroman is very effective in treating breast pain and can be prescribed as drug of first choice for mastalgia.
Kimura disease (KD) is a rare chronic inflammatory disorder of unknown etiology, primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin E levels. We report an unusual case of a 40-year-old woman found to have KD of the breast which presented clinically as carcinoma, leading to a diagnostic dilemma. To the best of our knowledge, this is the first case of KD in the breast to be documented in the literature. The patient also had scabies, which may have provided the stimulus for hypersensitivity, which is considered to be the pathogenetic mechanism responsible for development of KD.
Mammary hypertrophy or macromastia can cause a wide range of symptoms (physical, psychosomatic or behavioral), which affect patients' quality of life. Breast reduction can, in most of the cases, solve the problem. However, certain factors could have a negative effect on the outcome of surgery. The aims of this study were to discover the degree of patient satisfaction (short- and long-term) and to evaluate results of reduction mammoplasty, and also to ascertain which factors may have a negative role on the effectiveness of breast reduction surgery. We carried out a prospective and longitudinal study of 121 patients who underwent breast reduction surgery. Quality of life, outcome of surgery (complications and sequelae) and degree of patient satisfaction were evaluated at 1 month and at 1 year after reduction mammoplasty. Mean patient age was 40.71 (SD = 12.02). Among them, 35.5% were overweight, 44.6% were obese and 34.7% were smokers. The most common symptom was pain. The mean amount of resected breast tissue was 1785 g (SD = 876). A total of 27.3% of the patients suffered complications and 30.60% suffered sequelae. Our results show an improvement in symptoms (p < 0.001) and quality of life (p < 0.001 to p = 0.002) 1 month after and 1 year after breast reduction compared with the preoperative situation. Neither age, body mass index, smoking habit nor the amount of tissue removed had a negative effect on the results of surgery. One year after surgery, the majority of patients were satisfied with the outcome (96.6%), they would recommend it to others (96.6%), and they would undergo surgery a second time (95.8%). Conclusions: Breast reduction is highly efficient in resolving symptoms and in improving quality of life. It leads to a high level of short- and long-term satisfaction irrespective of each patient's individual characteristics.
Nipple-areola reconstruction represents the completion of the breast restorative process and is associated with significant positive psychological implications. While factors such as medical comorbidities, smoking status, and radiation therapy have been shown to be associated with an increase in complications following breast reconstruction, their impact on nipple reconstruction remains largely unaddressed in the literature. An IRB-approved, retrospective review of 472 patients who underwent nipple reconstruction at Wake Forest University over a 15-year period was completed. Demographic and surgical characteristics were assessed including age, body mass index, medical comorbidities, smoking status, need for radiation, breast reconstruction type, and nipple flap used. Four hundred and seventy-two patients with 641 nipple reconstructions were included with an average follow-up of 56.5 months. Radiation prior to nipple reconstruction was required in 146 breasts (22.8%). Overall, postoperative nipple projection problems occurred in 7.6% of reconstructions with a 4.1% rate of other complications, including nipple necrosis, tip loss, wound infection and wound breakdown. Implant-based reconstruction and radiation were associated with significantly more nipple projection problems (p = 0.009 and 0.05, respectively). Higher rates of complications and nipple projection problems were seen with skate flap reconstruction compared to a star flap (p = 0.046 and 0.001, respectively). Implant-based breast reconstruction and radiotherapy are associated with higher rates of nipple reconstruction problems. Identification of patient and surgical variables associated with increased risk of poor outcomes preoperatively could help in patient counseling and selection of the most appropriate method of breast and nipple reconstruction.
Quantitative standardized uptake values (SUVs) from fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are commonly used to evaluate the extent of disease and response to treatment in breast cancer patients. Recently, PET/magnetic resonance imaging (MRI) has been shown to qualitatively detect metastases from various primary cancers with similar sensitivity to PET/CT. However, quantitative validation of PET/MRI requires assessing the reliability of SUVs from MR attenuation correction (MRAC) relative to CT attenuation correction (CTAC). The purpose of this retrospective study was to assess the utility of PET/MRI-derived SUVs in breast cancer patients by testing the hypothesis that SUVs derived from MRAC correlate well with those from CTAC. Between August 2012 and May 2013, 35 breast cancer patients (age 37–78 years, 1 man) underwent clinical 18F-FDG PET/CT followed by PET/MRI. One hundred seventy metastases were seen in 21 of 35 patients; metastases to bone in 16 patients, to liver in seven patients, and to nonaxillary lymph nodes in eight patients were sufficient for statistical analysis on an organ-specific per patient basis. SUVs in the most FDG-avid metastasis per organ per patient from PET/CT and PET/MRI were measured and compared using Pearson's correlations. Correlations between CTAC- and MRAC-derived SUVmax and SUVmean in 31 metastases to bone, liver, and nonaxillary lymph nodes were strong overall (ρ = 0.80, 0.81). SUVmax and SUVmean correlations were also strong on an organ-specific basis in 16 bone metastases (ρ = 0.76, 0.74), seven liver metastases (ρ = 0.85, 0.83), and eight nonaxillary lymph node metastases (ρ = 0.95, 0.91). These strong organ-specific correlations between SUVs from PET/CT and PET/MRI in breast cancer metastases support the use of SUVs from PET/MRI for quantitation of 18F-FDG activity.
Reported complication rates of implant-based breast reconstruction in the literature exceed 50%, with mastectomy skin flap necrosis reported to occur in up to 25% of cases. Laser-assisted indocyanine green angiography (LA-ICGA) technology allows the surgeon to optimize preservation of the mastectomy skin flap while avoiding skin necrosis. The purpose of this study was to determine if outcomes of breast reconstruction are beneficially affected by using LA-ICGA. A total 269 consecutive women (467 breast reconstructions) undergoing implant-based breast reconstruction from 2008 to 2013 were examined. The complication rates of those who underwent reconstruction prior to the implementation of LA-ICGA were compared with those who were reconstructed after implementation of LA-ICGA. A total of 254 consecutive breast reconstructions were performed prior to implementation of LA-ICGA, and 213 breasts were reconstructed with the use of LA-ICGA. After implementation of LA-ICGA System, the rate of mastectomy skin flap necrosis decreased by 86% (6.7% versus 0.9%, p = 0.02). The overall complication rate prior to LA-ICGA was 13.8% compared with 6.6% with the use of LA-ICGA (p = 0.01). After LA-ICGA was incorporated, the percentage of patients undergoing single-stage reconstruction increased from 12% to 32% (p = <0.001). Implementation of LA-ICGA provides the surgeon with an objective assessment of mastectomy flap perfusion resulting in a trend toward overall reduction in complications as well as an 86% decrease in the rate of subsequent skin necrosis. The objective assessment of mastectomy flap perfusion allows the surgeon to tailor breast reconstruction intraoperatively, in real-time, adjusting for the individual patient's mastectomy flap perfusion.
Malignant phyllodes tumor (PT) infrequently displays heterologous differentiation, and when present is most often liposarcomatous. We identified five cases of malignant PT with regions identical to well-differentiated liposarcoma (WDLS) of soft tissue and evaluated them for MDM2 and CDK4 gene expression and amplification using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), respectively. Despite indistinguishable morphology all cases of malignant PT with WDLS-like liposarcomatous differentiation were negative for MDM2 and CDK4 IHC and FISH, supporting different underlying pathogenesis.
Breast carcinoma in young women aged less than 40 years attracts a high level of mainstream media coverage, and there is a gap between societal perceptions of the disease as a growing problem and epidemiological trends. Several population studies have reported that the overall incidence of breast carcinoma in young women is stable, while one recent article suggested that the relative proportion of breast carcinoma in young women that is metastatic at diagnosis is growing. We sought to establish whether these trends were apparent at our institution. In this study, the clinical database at a breast carcinoma tertiary center was reviewed in terms of clinicopathologic data on patient age, diagnosis, clinical and pathologic stage, hormone receptor status, and HER-2 overexpression status for the period 2000–2011. Over the study period, young patients represented a decreasing proportion of all breast carcinoma cases (10.8% [2000–2003] to 8.7% [2008–2011]; p < 0.0001) treated at our institution. Young patients were more likely than patients aged 40 years or older to present with metastatic (M1) disease (5.4% versus 4.4%; p = 0.009), to be triple negative (21.6% versus 13%; p < 0.001), or to be HER-2 positive (24.3% versus 14.8%; p < 0.01). Young patients with HER-2-positive cancers were significantly more likely to present with metastatic disease (8.3% versus 4.8%; p = 0.004). This study showed no demonstrable increase in the relative proportion of breast cancer occurring in patients aged <40 years over the 12-year period 2000–2011 and no increase in the proportion of young patients presenting with metastatic disease.
In Spain, around 26,000 cases of breast cancer are diagnosed each year, representing nearly 30% of all cancers in women. The aim this study was to compare the perceptions of nonhematologic toxicities after administration of a docetaxel, epirubicin, and cyclophosphamide (TEC) regimen between breast cancer patients and oncologists. Furthermore, the relationship between such adverse events and quality of life (QOL) was evaluated. Cross-sectional study carried out among 92 breast cancer patients who received TEC as neoadjuvant or adjuvant treatment. The main nonhematologic toxicities experienced by breast cancer patients treated with the TEC regimen were asthenia, nausea, dysgeusia, arthralgia, headache, and myalgia. Patients were less likely to be affected by vomiting and peripheral neuropathy. Oncologists seemed to show greater interest in toxicities, such as asthenia, nausea, and diarrhea. Vomiting was the toxicity with the most substantial degree of agreement between oncologist and patient. Toxicities with greater disagreement were dysgeusia, arthralgia, myalgia, asthenia, and headache. Asthenia, dysgeusia, loss of appetite, skin allergies, peripheral edema, abdominal pain, and myalgia were found to significantly affect the QOL. Tolerability and QOL were more favorable in patients treated with pegfilgrastim compared with filgrastim. Oncologists tend to underestimate toxicities experienced by breast cancer patients treated with the TEC regimen. The establishment of a protocol to record these toxicities may reduce that problem.
Breast conservation therapy (BCT) has a reported incidence of positive margins ranging widely in the literature from 20% to 70%. Efforts have been made to refine standards for partial mastectomy and to predict which patients are at highest risk for incomplete excision. Most have focused on histology and demographics. We sought to further define modifiable risk factors for positive margins and residual disease. A retrospective study was conducted of 567 consecutive partial mastectomies by 21 breast and general surgeons from 2009 to 2012. Four hundred fourteen cases of neoplasm were reviewed for localization, intraoperative assessment, excision technique, rates, and results of re-excision/mastectomy. Histologic margins were positive in 23% of patients, 25% had margins 0.1–0.9 mm, and 7% had tumor within 1–1.9 mm. Residual tumor was identified at—in 61 cases: 38% (disease at margin), 21% (0.1–0.9 mm), and 14% (1–1.9 mm). Ductal carcinoma in situ (DCIS) was present in 85% of residual disease on re-excision and correlated to higher rates of re-excision (p = <0.001), residual disease, and subsequent mastectomy. The use of multiple needles to localize neoplasms was associated with 2–3 times the likelihood for positive margins than when a single needle was required. The removal of additional margins at initial surgery correlated with improved rates of complete excision when DCIS was present. Patients must have careful analysis of specimen margins at the time of surgery and may benefit from additional tissue excision or routine shaving of the cavity of resection. Surgeons should conduct careful patient selection for BCT, in the context of multifocal, and multicentric disease. Patients for whom tumor localization requires bracketing may be at higher risk for positive margins and residual disease and should be counseled accordingly.
There is limited information on the influence of a patient's comorbid status on the type of immediate breast reconstruction (IBR) selected. Our aim was to provide a population-based review of the relationship between baseline comorbid conditions and IBR subtype selected. This is a retrospective cohort study using the National Surgical Quality Improvement Program database to identify IBR recipients. Multivariable regression analyses was performed to identify the association between comorbidity and IBR subtype selection (prosthetic, pedicled, and free autologous). A total of 48,096 mastectomy patients were identified, of which 17,404 patients received IBR. IBR patients were younger (51 ± 10.4 versus 61.5 ± 13.6 years) and had a lower body mass index (27.1 ± 6.4 versus 28.9 ± 7.3) relative to patients who did not pursue IBR (p < 0.001 for all). Overall, IBR patients had a significantly lower incidence of comorbid conditions. In adjusted models, patients aged 45–64 years were more likely to pursue pedicled-autologous reconstruction (OR: 1.43, p < 0.001) and those older than 65 years were less likely to undergo free-autologous reconstruction (OR: 0.64, p = 0.02). Class I and II obesity was associated with pedicled (class I OR: 1.57, class II OR: 1.41) and free transfer (class I OR: 1.81, class II OR: 1.66) autologous IBR utilization (all p < 0.001). Also, smoking was related to increased chance of prosthetic reconstruction while preoperative radiotherapy was linked to free-autologous IBR. IBR patients were noted to be healthier than their non-IBR counterparts, and each IBR subtype was associated with a particular comorbidity profile. This has significant implications with regard to creation of an IBR-predictive model. Such a tool will improve preoperative counseling and decision making.
Neo-adjuvant chemotherapy (NAC) is used to facilitate radical surgery for initially irresectable or locally advanced breast cancer. The indication for NAC has been extended to clinically node negative (cN0) patients in whom adjuvant systemic therapy is foreseen. A population-based study was conducted to evaluate the increasing use of NAC, breast conserving surgery (BCS) after NAC and timing of the sentinel node biopsy (SNB). All female breast cancer patients, treated in 10 hospitals in the Eindhoven Cancer Registry area in the Netherlands between January 2003 and June 2012 were included (N = 18,427). In total, 1,402 patients (7.6%) received NAC. The administration increased from 2.5% in 2003 to 13.0% in 2011 (p < 0.001). Use of NAC increased from 0.5% to 2.3% for cT1 tumors, from 2.8% to 27.0% for cT2, from 30.6% to 70.9% for cT3, and from 40.5% to 58.1% for cT4 tumors (p < 0.001). In cN0 patients, use of NAC increased from 1.0% to 4.4% and in clinically node positive patients from 12.0% to 57.5% (p < 0.001). Downsizing of the tumor and BCS are achieved increasingly. In 2011, in three hospitals NAC was administered in <10% of patients, in five hospitals in 10–15% and in two hospitals the proportion of patients receiving NAC was >20% (p < 0.001). Of the 1,402 patients with NAC, 495 patients underwent SNB, 91.5% of whom prior to NAC. In the Netherlands up to one in eight patients receive NAC. The administration of NAC and the percentage of BCS increased over the past decade, especially in cT2 tumors. Considerable hospital variation in the administration of NAC exists.
Certain patients who initiate expander/implant (E/I) reconstruction following mastectomy may require radiation therapy (XRT). XRT may be delivered during the tissue expander (TE) expansion process or after exchange for a permanent implant (PI). We studied a series of women treated with E/I reconstruction and XRT to determine whether there is a difference in complication rates between those who had XRT to the TE versus PI. All two-stage E/I reconstructions at our institution from April 2005 to January 2013 were reviewed to identify patients who underwent XRT after TE placement. Our database was queried for reconstructive details, oncologic treatment, and complications. Statistical analyses were performed to establish significance of complication rate differences. Fifty-two patients underwent XRT after TE placement, 42 of which had XRT to the TE and 11 of which had XRT to the PI. The major complication rates (complications requiring emergent reoperation/readmission) were 27% versus 0% (p = 0.05) for XRT to the TE versus XRT to the PI, but there were no significant differences in minor complication rates (outpatient complications). Specifically, the rates of Grade 3/4 capsular contracture were similar between the two groups, 27% for the XRT to the TE group and 36% for the XRT to the PI group. Radiation of the PI versus radiation of the TE did not result in significant differences in overall surgical complication rates but had fewer major complications and no implant failures. Other factors must also be considered, such as patient preference, risk of cancer reoccurrence, and cosmesis. It is essential for a patient to have a team of a plastic surgeon and radiation, surgical, and medical oncologists working together to achieve each patient's goals.
Breast cancer is one of the most common cancers and causes of death in females in Tajikistan; yet less than half of the adult women in Tajikistan have heard of breast cancer. Limited access to health care contributes to late stage presentation. We developed a public–private partnership to implement a breast cancer awareness intervention in a low-resource community in Khorog, Tajikistan. We trained local health professionals in clinical breast care and conducted a breast cancer screening and treatment program. The partnership involved visiting USA-based health professionals working alongside local health care providers (HCP) in the continuum of breast care—from education to the diagnostic evaluation and management of detected breast abnormalities. Patient data were collected using a web-based program (VirtualDoc). Twenty-four HCP received didactic and clinical breast examination training. 441 women underwent clinical breast evaluation. 74 (17%) had abnormal exams and underwent additional diagnostic procedures. We identified six (1.4%) cases of breast cancer (all locally advanced) and two women had benign fibroadenomas. All women with cancer underwent modified radical mastectomy, while the fibroadenomas were treated by cosmetically appropriate lumpectomy. Five of six subjects with cancer were previously aware of their breast lump and three had recently seen a family medicine (FM) doctor. Health systems assessment revealed availability of diagnostic equipment but lack of well-trained operators and clinician interpreters. We were successful in integrating clinical breast exams into the routine care of female patients by local FM doctors and in the process, achieved a better understanding of existing risk factors and barriers to breast cancer care. This public–private partnership, leveraging the technical expertise of visiting health professionals, demonstrates how a focused onsite training and awareness program can provide sustained improvements in breast care in a low-resource environment.
Herpetic lesions most frequently occur on oral and genital areas. However, herpes simplex virus (HSV) can be a rare cause of breast infection. In few published articles, the route of transmission is predominantly from infant to mother. We report two cases about simultaneous mammary and extramammary (oral and genital) herpetic infection in nonlactating women. In both cases, HSV breast lesions were acquired by sexual contacts with partners who were asymptomatic HSV carriers. Through a review of literature, we highlight clinical signs for an early diagnosis. We also emphasize the advantage of the valacyclovir for treating this uncommon pathology.
Basal cell carcinoma (BCC) is a common skin cancer worldwide. However, BCC of the nipple and areola complex is rare. Men are more affected than women. Most of the cases were treated with simple excision. We report a case of BCC of the right nipple–areola complex in a 75-year-old man, treated with Mohs surgery and simple mastectomy.
Cases of bilateral inflammatory breast cancer (IBC) are extremely rare. Our search criteria only found one other record of metachronous bilateral IBC (1). We present the case of a patient who was treated for IBC with neoadjuvant chemotherapy, modified radical mastectomy (MRM), and whole breast radiation. Less than 1 year later, the patient had a recurrence of IBC on the left chest wall with in the radiated field, as well as a new IBC on the contralateral side. Bilateral IBC is extremely rare. This entity can present challenges for the standard treatment of IBC with neoadjuvant chemotherapy, MRM, and whole breast radiation (2). Our case study shows the importance of scheduled routine imaging, screening with physical examination after IBC management, and good patient compliance in this aggressive disease (3).


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Kukla's Korner Hockey
Rivet Ready To Play In Buffalo
by Paul on 07/31/08 at 11:19 AM ET
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from Bucky Gleason of the Buffalo News,
"I'm not going to lie. I wasn't happy about being moved," Rivet said by telephone. "It wasn't the point of me going to Buffalo. I didn't care where I would have gone. I was leaving a place that I really enjoyed. I had a great setup, and now that's done. Now, I have to start over. We've heard great things about Buffalo. We're excited."
At first, it sounded like Rivet was sincere about the trade before backing off with lip service about the town. Actually, he's been doing his homework. He sees the Sabres going in the right direction with a core of young players. Along the way, he's learning that his perception of Buffalo was actually a misperception.
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|By PR Newswire
Article Rating:
|November 27, 2012 04:30 AM EST
YODFAT, Israel, November 27, 2012 /PRNewswire/ --
Anywhere Software, a leading provider of developers' tools for the Android, Windows Mobile, and Pocket PC platforms, today announced the addition of a new service to its Basic4android development platform. Known as the "Basic4android UI Cloud," this service will allow developers to test their UI design layouts on multiple Android devices hosted by Anywhere Software. The Beta version of this service was released on November 1, 2012 and has received a very enthusiastic welcome from Basic4android's community of more than 30,000 developers.
The high level of fragmentation within the Android market makes it both expensive and time-consuming for developers to test their applications on every relevant device and OS version. In terms of the user interface, the multitude of available screen sizes and resolutions have a profound effect on the layout and are a crucial factor in UI testing. This is particularly relevant for applications that run on both smartphones and tablets.
"The Basic4android UI Cloud service is designed to simplify the testing of design layouts in a highly fragmented Android market, saving developers both time and money," said Erel Uziel, CEO of Anywhere Software. "The UI Cloud comprises a set of Android phones and tablets that cover the most common screen sizes and resolutions on the market. As all the devices are hosted and managed by Anywhere Software, developers do not have to purchase and maintain dozens of devices in order to test their layouts."
The UI Cloud works in conjunction with the Basic4android's powerful Visual Designer tool, a true WYSIWYG visual editor supporting multiple screens and resolutions. The Visual Designer allows the developer to build a layout and see the result immediately on a specific device or emulator, without the need for compilation and deployment on a device. Using the UI Cloud, developers can now view the results of their work on every device in the cloud with a single click of their mouse. The service then displays two screenshots for each device - one for portrait and one for landscape. This enables developers to see where adjustments are needed and to make the necessary corrections within a matter of minutes.
The practical advantages of the UI Cloud are already clear to Beta users, as evidenced by the positive feedback on Basic4android's online developers' forum. For example, one forum member known as PHB2 commented: "Just tested this myself and it worked like a charm. I can now see that I need to pay greater detail to the way the screens are laid out!"
Basic4android supports all Android phones and tablets (from Android 1.6 and up to Android 4.0). To date, the platform has been used to develop thousands of advanced applications including features such as: SQL databases, GPS, Serial ports (Bluetooth), Camera, XML parsing, Web services (HTTP), JSON, Animations, Network (TCP/IP), Text To Speech (TTS), Voice Recognition, WebView, AdMob (ads) , Graphics, Services (background tasks), NFC, USB and many more.
About Anywhere Software
Specializing in mobile development since 2005, Anywhere Software develops and markets developers' tools for the Android and Windows Mobile platforms. Our flagship offering - Basic4android - is a comprehensive, feature-rich Rapid Application Development toolbox that enables both novices and experts to develop high-performance native Android apps. Basic4android is used by thousands of Java developers worldwide to help them design and implement their user interfaces for Android phones and tablets. In addition, Anywhere Software offers Basic4ppc, a development platform for Windows Mobile. For more information, please visit our website at http://www.basic4ppc.com.
Contact Information:
Erel Uziel
[email protected]
SOURCE Anywhere Software
Internet of @ThingsExpo, taking place November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with the 19th International Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world and ThingsExpo Silicon Valley Call for Papers is now open.
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Machine Learning helps make complex systems more efficient. By applying advanced Machine Learning techniques such as Cognitive Fingerprinting, wind project operators can utilize these tools to learn from collected data, detect regular patterns, and optimize their own operations. In his session at 18th Cloud Expo, Stuart Gillen, Director of Business Development at SparkCognition, discussed how research has demonstrated the value of Machine Learning in delivering next generation analytics to imp...
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SYS-CON Events announced today that ReadyTalk, a leading provider of online conferencing and webinar services, has been named Vendor Presentation Sponsor at the 19th International Cloud Expo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. ReadyTalk delivers audio and web conferencing services that inspire collaboration and enable the Future of Work for today's increasingly digital and mobile workforce. By combining intuitive, innovative tec...
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Amazon has gradually rolled out parts of its IoT offerings, but these are just the tip of the iceberg. In addition to optimizing their backend AWS offerings, Amazon is laying the ground work to be a major force in IoT - especially in the connected home and office. In his session at @ThingsExpo, Chris Kocher, founder and managing director of Grey Heron, explained how Amazon is extending its reach to become a major force in IoT by building on its dominant cloud IoT platform, its Dash Button strat...
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Connected devices and the industrial internet are growing exponentially every year with Cisco expecting 50 billion devices to be in operation by 2020. In this period of growth, location-based insights are becoming invaluable to many businesses as they adopt new connected technologies. Knowing when and where these devices connect from is critical for a number of scenarios in supply chain management, disaster management, emergency response, M2M, location marketing and more. In his session at @Th...
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The cloud market growth today is largely in public clouds. While there is a lot of spend in IT departments in virtualization, these aren't yet translating into a true "cloud" experience within the enterprise. What is stopping the growth of the "private cloud" market? In his general session at 18th Cloud Expo, Nara Rajagopalan, CEO of Accelerite, explored the challenges in deploying, managing, and getting adoption for a private cloud within an enterprise. What are the key differences between wh...
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It is one thing to build single industrial IoT applications, but what will it take to build the Smart Cities and truly society changing applications of the future? The technology won't be the problem, it will be the number of parties that need to work together and be aligned in their motivation to succeed. In his Day 2 Keynote at @ThingsExpo, Henrik Kenani Dahlgren, Portfolio Marketing Manager at Ericsson, discussed how to plan to cooperate, partner, and form lasting all-star teams to change t...
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In his keynote at 18th Cloud Expo, Andrew Keys, Co-Founder of ConsenSys Enterprise, provided an overview of the evolution of the Internet and the Database and the future of their combination – the Blockchain. Andrew Keys is Co-Founder of ConsenSys Enterprise. He comes to ConsenSys Enterprise with capital markets, technology and entrepreneurial experience. Previously, he worked for UBS investment bank in equities analysis. Later, he was responsible for the creation and distribution of life sett...
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19th Cloud Expo, taking place November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, will feature technical sessions from a rock star conference faculty and the leading industry players in the world. Cloud computing is now being embraced by a majority of enterprises of all sizes. Yesterday's debate about public vs. private has transformed into the reality of hybrid cloud: a recent survey shows that 74% of enterprises have a hybrid cloud strategy. Meanwhile, 94% of enterpri...
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There are several IoTs: the Industrial Internet, Consumer Wearables, Wearables and Healthcare, Supply Chains, and the movement toward Smart Grids, Cities, Regions, and Nations. There are competing communications standards every step of the way, a bewildering array of sensors and devices, and an entire world of competing data analytics platforms. To some this appears to be chaos. In this power panel at @ThingsExpo, moderated by Conference Chair Roger Strukhoff, Bradley Holt, Developer Advocate a...
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SYS-CON Events announced today that Bsquare has been named "Silver Sponsor" of SYS-CON's @ThingsExpo, which will take place on November 1–3, 2016, at the Santa Clara Convention Center in Santa Clara, CA. For more than two decades, Bsquare has helped its customers extract business value from a broad array of physical assets by making them intelligent, connecting them, and using the data they generate to optimize business processes.
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There is little doubt that Big Data solutions will have an increasing role in the Enterprise IT mainstream over time. Big Data at Cloud Expo - to be held November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA - has announced its Call for Papers is open. Cloud computing is being adopted in one form or another by 94% of enterprises today. Tens of billions of new devices are being connected to The Internet of Things. And Big Data is driving this bus. An exponential increase is...
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Internet of @ThingsExpo, taking place November 1-3, 2016, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 19th Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The Internet of Things (IoT) is the most profound change in personal and enterprise IT since the creation of the Worldwide Web more than 20 years ago. All major researchers estimate there will be tens of billions devices - comp...
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Cloud computing is being adopted in one form or another by 94% of enterprises today. Tens of billions of new devices are being connected to The Internet of Things. And Big Data is driving this bus. An exponential increase is expected in the amount of information being processed, managed, analyzed, and acted upon by enterprise IT. This amazing is not part of some distant future - it is happening today. One report shows a 650% increase in enterprise data by 2020. Other estimates are even higher....
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industrial company for a multi-year contract initially valued at over $4.0 million. In addition to DataV software, Bsquare will also provide comprehensive systems integration, support and maintenance services. DataV leverages advanced data analytics, predictive reasoning, data-driven diagnostics, and automated orchestration of remediation actions in order to improve asset uptime while reducing service and warranty costs.
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The Brewers "Hank the Dog" at Dedication of Counsell Field at Cahill Park on May 23, 2014
The Brewers " Hank the Day" attend the pre-game and pre dedication of Counsell Field at Cahill Park on May 23, 2014. He was a very popular hit with fans of all ages and with many other dogs that attended. See video.
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Ok, I probably should check out that other "symptoms" thread that was posted here to see if anyone else mentioned this but here goes. It's a highly strange sensation that I'm noticing with more & more frequency & I have, till now, only told two People. I have the sensation of looking out of my eyes but it's like it's something I'm inside, maybe like an "Avitar", if that helps anyone picture it. Is this a sensation anyone else has experienced, this feeling of...hmmm...disconnect, for lack of a better word? It's very strange & I've stopped fighting it & being "wierded out" by it & yet I still feel/sense it. Very strange indeed.
remjr1 219210
I have had a couple of experiences where I "see" (literally) with my eyes CLOSED.
I mentioned it to my Dad a couple of weeks ago and he said the same has happened to him.
Sooo - ANYTHING is possible. Maybe we're getting to the point where we actually SEE ourselves from the outside - like an OBE - but NOT...
Hope I made some sense remjr!!
Hi 2C & Rem ~
I was just telling this to Mama Has Awakened the other day!! I also can see with my eyes closed. Not all the time but when I am really tired it happens.
Oh what awesome times we live in!!
Much Love,
Tiny Trink
Hello 2T.
What a bummer I missed that conversation! I do my best to try to read all the posts when catching up... but it seems that my "speed reading" was a bit too speedy at some point!
My favorite was the first time it happened. That's when I REALLY understood what it means to be an "energetic" or "spiritual" being. It hit home how we really don't need this body that we are in.
Interesting times ahead!
Love and hugs!
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University of Cambridge > Talks.cam > Monday Mechanics Seminars (DAMTP) > Dynamical Problems in Glaciology
Dynamical Problems in Glaciology
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Destination: Harbinger Lyrics by Lions Lions
Destination: Harbinger by Lions Lions
This is a sign,
Not strength and perceptions.
We got the open skies.
Destination: Harbinger.
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These Hitler videos crack me up….
"We must reject the idea that every time a law's broken, society is guilty rather than the lawbreaker. It is time to restore the American precept that each individual is accountable for his actions."
Ronald Reagan
I put that all over the place
FSU has beaten the SEC champ at least 9 times, and we don't even play in the SEC, lol:
1987 champs 34-6
1988 champs 13-7
1989 champs 22-14
1993 champs 33-21
1994 champs 23-17
1996 champs 24-21
2000 champs 30-7
2013 champs 34-31
2015 champs 27-2 (I am running out of room here-thanks again gator!)


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USB 3.0 PHY - GF 40LP25 x1 OTG, North/South Poly Orientation
Efficient analysis of CDC violations in a million gate SoC, part 2
Sanymi Gupta , Aniruddha Gupta & Ankush Sethi (Freescale Semiconductor)
EDN (February 03, 2014)
Reset path
One interesting topic of discussion is whether to use synchronous or asynchronous reset in design. In synchronous reset design, we use reset signal in the D path of flop. Hence, the assertion of reset will only effect or reset the state of the flop on the active edge of a clock. In some designs, the reset must be generated by a set of internal conditions. A synchronous reset is recommended for these types of designs because it will filter the logic equation glitches between clocks. But if we have some issues or failure leading to unavailability of clocks then we will not be able to reset/initialize the system. Only an asynchronous reset would work in such a condition. However, we may face metastability issues if de-assertion of this asynchronous reset is not synchronized properly.
Need of de-assertion synchronization for asynchronous reset?
If the asynchronous reset is de-asserted within the setup or hold window of clock of flop then there could be metastability at the flop's output. So we need to synchronize the de-assertion of reset.
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A Perfectly Polished 'Fit For A Dinner Date At Sūna
What's that sound you hear, coming from the general direction of Eastern Market? Oh, it's just the deafening buzz surrounding the opening of Sūna, the new restaurant from chefs Johnny Spero and Ari Gejdenson. The cozy, second-story space, located above Gejdenson's existing spot, Acqua Al 2, has only 42 seats (read: reservations are recommended). Oh-so intimate, the resto is built around an open kitchen, so you can watch chef Spero and his team craft the fresh, seasonal dishes that make up your four- or eight-course tasting menus. Likewise, the Scandinavian-inspired decor is ideal for getting cozy, and at $48 for the four-course menu, this is seriously fine dining at a price point that doesn't require for a special occasion.
To help you look appropriately chic, we've pulled together an ensemble that channels the modern (but not too fancy) flair of the food — including some chic-but-practical shoes, a perfect choice whether or not you opt for the full wine pairing. Hey, stumbling may not be classy, but this outfit sure is!
Halston Heritage Oversized Bouclé Wool-Blend Coat, $695, available at Net-A-Porter; J.Crew Martina Metallic Wedges, $238, available at J.Crew; Topshop Cap Sleeve Flippy Tunic, $40, available at Topshop; 7CHI 1252 Clutch, $58.95, available at Lori's Shoes; Bauble Bar Blue Sunburst Drops, $26, available at Bauble Bar.
Photo: Courtesy of Suna
- Fashion |
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Below is a list of confirmed Pre Season Fixtures
Karl Whymark has today agreed with manager Jimmy Gray to stay with Dynamo for the forthcoming season.
5 more players of last years squad have decided to again sign for Dynamo.
There was 1 Lucky Winner receiving £100-00.
Dynamo Manager Jimmy Gray is pleased to announce that Michael Reeve and Liam Read have both decided to stay with Shepshed Dynamo next season.
Clement Robinson joined as a club member and supporter
There were no winners this week.
Dynamo will travel to Owen St, Coalville to take on Coalville Town on July 27th.
There were no winners this week.


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A well-known gun-safety advocate who shot and killed a fellow hunter has been sentenced to home detention.
Wayne Edgerton appeared before Judge Michael Turner this afternoon in the Invercargill District Court after admitting the charge of carelessly using a 30.06 rifle, causing Adam Hill's death on April 13.
He was sentenced to seven months' home detention, 400 hours' community work, ordered to pay $10,000 emotional harm reparation to Adam Hill's partner and an order was made for the forfeiture of Edgerton's firearm.
The gallery was packed with people, some wearing fluorescent gear.
''This is to show what Adam was wearing before he was shot,'' Adam's father Dave Hill said before the sentencing.
Edgerton, a hunter and artist from Tuatapere, mistook 25-year-old Adam Hill for a deer and shot him while hunting in the Longwoods in Southland, despite Hill wearing a fluro vest.
''Do we look like deer?'' Dave Hill asked before the sentencing began.
Stephen Sycamore, Adam's cousin, was standing next to Adam when he was shot in the chest.
''We identified ourselves. We were wearing high visibility clothing,'' he said.
Adam Hill's family and friends wanted to make the point he was doing the right thing and following the rules.
They also said they wanted justice for what happened not a ''slap on the wrist''.
Hill, 25, with his partner Christine Pink, and their daughters Shikana and Maikayla, had moved to their farming post in Wairio a year before the shooting. He had been promoted to an $80,000-a-year job, with a farmhouse as part of the package, looking after 1800 cows on three properties.
Pink must now raise the girls by herself and had to leave the farmhouse in Wairio on the property where Hill worked.
"I was absolutely devastated by having to move out of that house," she told the Sunday Star-Times in May.
She first met Hill when they were students at Central Southland College in Winton. After school days they met up again, and soon became inseparable.
She described him as a hardworking, fun-loving man who worked on dairy farms and as a tree-pruner in Invercargill with older brothers Roger and Tim.
Hill's father, Dave Hill, was out hunting with his son and several others at the family's bush camp that fateful weekend when his son, who was also his best mate, was taken from him.
"My boy was such an awesome, awesome guy who was such a treasure in so many people's hearts," Dave Hill told the Southland Times three days after his son's death.
Edgerton has declined to comment since the shooting but Western Southland Deerstalkers' Association member Syd Crombie visited him after the incident and said he was devastated.
"This thing has really hit him and I don't think he will bounce back to being the good and jovial bloke he once was."
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Star Tracks
The mother-daughter duo get color-coordinated in N.Y.C. Plus: Prince William & Kate, Victoria Beckham, Brad Pitt and more
Credit: X17
Published: Tuesday Mar 08, 2011 | 05:00 PM EST
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Rookie point guard Norris Cole came up with 14 of his 20 points in the fourth quarter and the Heat defeat the Celtics. Heat-Celtics notebook By Shandel Richardson, for NBA.com Posted Wednesday December 28, 2011 12:15AM THE FACTS: The Miami Heat defeated the Boston Celtics 115-107 Tuesday at AmericanAirlines Arena, but not before holding off Boston's furious fourth-quarter rally. Heat rookie guard Norris Cole scored 20 points, 14 in the final period, to help Miami improve to 2-0. Miami's Big Three of LeBron James (26 points, six rebounds, five assists), Dwyane Wade (24 points eight assists) and Chris Bosh (18 points, 11 rebounds) led the way. They were assisted by forwards Udonis Haslem (12 points) and James Jones (nine points, 3-for-3 on 3-pointers). Boston was led by guard Ray Allen (28 points, six 3-pointers), guard Rajon Rondo (22 points, eight rebounds, 12 assists, seven turnovers), guard Keyon Dooling (18 points), center Brandon Bass (13 points) and forward Kevin Garnett (12 points). QUOTABLE: "We will get better against the zone." -- Heat coach Erik Spoelstra THE STAT: Boston committed 24 turnovers and Miami turned them into 33 points. In the first half Miami turned 15 Boston turnovers into 23 points, TURNING POINT: Miami's 39-point second quarter did the job on Boston's comeback hopes. The Celtics closed within 42-35 but the Heat went on a 15-5 run to take a 54-40 lead and take the Celtics' spirit. HOT: Heat forward James Jones, the defending Three-Point champion at All-Star weekend, is 6-for-8 on 3-pointers. COLD: Celtics center Jermaine O'Neal had no points and no rebounds through three quarters. His two-game totals are 3.0 points and 1.5 rebounds per game. NOTABLE: Boston's Chris Wilcox (left shoulder) left in the second quarter and didn't return ... Boston's Paul Pierce (heel) is likely out for tonight's game at New Orleans ... Boston went to a zone defense in the fourth quarter and it worked as his Celtics cut their deficit from 15 points to three (at 108-105). UP NEXT: For the Heat, Wednesday @ Charlotte, Friday @ Minnesota, Monday vs. Charlotte. For Boston, Wednesday @ New Orleans, Friday vs. Detroit, Monday @ Washington.


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