Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries

BACKGROUND

The optimal management of patients with breast cancer (BC) requires the expertise of specialists from different disciplines. This has led to the evolution of multidisciplinary teams (MDTs), allowing all key professionals to jointly discuss individual patients and to contribute independently to clinical decisions. Data regarding BC MDTs in different regions and countries are scarce.

METHODS

The investigators of a large global phase III adjuvant BC trial being conducted by the Breast International Group were invited to respond to a questionnaire about the extent, structure, and function of BC MDTs.

RESULTS

One hundred and fifty-two responses from 39 countries were received, and remarkable differences were noted in different geographic regions. Sixty-five percent of the respondents from eastern Europe, 63% from western Europe, 35% from Asia, and 25% from South America declared that MDT was a mandatory part of BC care in their country. Ninety percent of the respondents from Europe stated their MDTs met weekly, compared with only half of the respondents from Asia.

CONCLUSION

This survey is perhaps the first large-scale effort to collect information regarding BC MDTs from different parts of the world and provides objective information of frequency, composition, function, and working mechanism of BC MDTs.

Liver transplantation in human immunodeficiency virus-positive patients

With the successful introduction of combined antiretroviral therapy (cART), human immunodeficiency virus (HIV) is now regarded as a chronic illness with excellent long-term outcomes. However, chronic exposure to viral etiologies (ie, chronic hepatitis B and hepatitis C) and drug-induced toxicity secondary to cART have resulted in increasing rates of mortality and morbidity due to end-stage liver disease. HIV disease is no longer considered an absolute contraindication to liver transplantation (LT) by most transplant centers worldwide. Because the burden of liver disease in this cohort is likely to increase, this review addresses the key etiologies and the management strategies available for HIV-positive patients undergoing LT.

Ulnar artery ischaemia following corticosteroid injection for carpal tunnel syndrome

A 36-year-old female with known bilateral carpal tunnel syndrome was admitted to hospital and given a steroid injection on the ulnar side in her right hand. She suffered immediate ischaemia of the 3rd, 4th, and 5th fingers. Imaging showed decreased flow in the 4th and 5th phalageal arteries. Treatment with iloprost infusion commenced 7 days after the injury, with moderate improvement and further managed with a carpal tunnel release. This case report sheds light on an unusual yet very important complication of carpal tunnel management.

Understanding the population structure of North American patients with cystic fibrosis

It is generally presumed that the cystic fibrosis (CF) population is relatively homogeneous, and predominantly of European origin. The complex ethnic make-up observed in the CF patients collected by the North American CF Modifier Gene Consortium has brought this assumption into question, and suggested the potential for population substructure in the three CF study samples collected from North America. It is well appreciated that population substructure can result in spurious genetic associations. To understand the ethnic composition of the North American CF population, and to assess the need for population structure adjustment in genetic association studies with North American CF patients, genome-wide single-nucleotide polymorphisms on 3076 unrelated North American CF patients were used to perform population structure analyses. We compared self-reported ethnicity to genotype-inferred ancestry, and also examined whether geographic distribution and cystic fibrosis transmembrane regulator (CFTR) mutation type could explain the population structure observed. Although largely Caucasian, our analyses identified a considerable number of CF patients with admixed African-Caucasian, Mexican-Caucasian and Indian-Caucasian ancestries. Population substructure was present and comparable across the three studies of the consortium. Neither geographic distribution nor CFTR mutation type explained the population structure. Given the ethnic diversity of the North American CF population, it is essential to carefully detect, estimate and adjust for population substructure to guard against potential spurious findings in CF genetic association studies. Other Mendelian diseases that are presumed to predominantly affect single ethnic groups may also benefit from careful analysis of population structure.

The development of varicosities within a free radial forearm flap used for distal-third tibial reconstruction

Reports of varicosities developing in free flaps are very rare. The presence of varicose veins in recipient sites influencing the development of varicosities in free flaps, though physiologically possible, has not been documented in literature. We encountered an unusual case of varicosities developing in a free radial forearm flap used in soft-tissue reconstruction of an open distal-third tibial fracture, which is presented here. This case report thus adds an important dimension to the assessment of a patient when planning a free flap procedure in a recipient area with pre-existing varicosities.

Group IVB Oxides as High Permittivity Gate Insulators

Increasing MOSFET performance requires scaling, the systematic reduction in device dimensions. Tunneling leakage, however, provides an absolute scaling limit for SiO2of about 1.5 nm. Power limitations and device reliability are likely to pose softer limits slightly above 2 nm. We have investigated the use of high permittivity materials such as TiO2, ZrO2, and their silicates as potential replacements for SiO2. We have synthesized titanium nitrate (Ti(NO3)4or TN), zirconium nitrate (Zr(NO3)4or ZrN), and hafnium nitrate (Hf(NO3)4or HfN) as hydrogen and carbon free deposition precursors. Several problems arise in the use of these films including the formation of an amorphous low permittivity interfacial layer. For TiO2this layer is formed by silicon up diffusion. Surface nitridation retards the formation of the interfacial layer. We discuss the effects of both thermal and remote plasma surface nitridation treatments on the properties of the film stack. ZrO2and HfO2appear to form a thermal layer of silicon oxide between the high permittivity film and the silicon and have excess oxygen in the bulk of the film.

An unusual and unsettling place for a worm

A 56-year-old man presented complaining of urinary frequency, passing urine eight times per day, urethral irritation and dysuria. Investigations showed no evidence of urinary tract infection or sexually transmitted infections. Three months later he presented, again complaining of increased urinary frequency and urethral irritation. He brought with him a urine specimen containing a small 'worm', 2 mm in length, identified as a drain fly (or moth fly) larva, of the genus Psychoda (dipterous flies). Psychoda lay eggs in organically polluted water such as sewage plants, sink drains or on decaying vegetables and fruits. Urogenital myiasis may arise from hatching of larvae near the urethral opening and ascending migration along the urethra with consequent urethritis. Following larval identification, ivermectin was prescribed and the man's symptoms improved after six weeks.

Towards BioDBcore: a community-defined information specification for biological databases

The present article proposes the adoption of a community-defined, uniform, generic description of the core attributes of biological databases, BioDBCore. The goals of these attributes are to provide a general overview of the database landscape, to encourage consistency and interoperability between resources; and to promote the use of semantic and syntactic standards. BioDBCore will make it easier for users to evaluate the scope and relevance of available resources. This new resource will increase the collective impact of the information present in biological databases.

Meeting Report from the Second "Minimum Information for Biological and Biomedical Investigations" (MIBBI) workshop

This report summarizes the proceedings of the second workshop of the 'Minimum Information for Biological and Biomedical Investigations' (MIBBI) consortium held on Dec 1-2, 2010 in Rüdesheim, Germany through the sponsorship of the Beilstein-Institute. MIBBI is an umbrella organization uniting communities developing Minimum Information (MI) checklists to standardize the description of data sets, the workflows by which they were generated and the scientific context for the work. This workshop brought together representatives of more than twenty communities to present the status of their MI checklists and plans for future development. Shared challenges and solutions were identified and the role of MIBBI in MI checklist development was discussed. The meeting featured some thirty presentations, wide-ranging discussions and breakout groups. The top outcomes of the two-day workshop as defined by the participants were: 1) the chance to share best practices and to identify areas of synergy; 2) defining a series of tasks for updating the MIBBI Portal; 3) reemphasizing the need to maintain independent MI checklists for various communities while leveraging common terms and workflow elements contained in multiple checklists; and 4) revision of the concept of the MIBBI Foundry to focus on the creation of a core set of MIBBI modules intended for reuse by individual MI checklist projects while maintaining the integrity of each MI project. Further information about MIBBI and its range of activities can be found at http://mibbi.org/.

Meeting Report: BioSharing at ISMB 2010

This report summarizes the proceedings of the one day BioSharing meeting held at the Intelligent Systems for Molecular Biology (ISMB) 2010 conference in Boston, MA, USA This inaugural BioSharing event was hosted by the Genomic Standards Consortium as part of its M3 & BioSharing special interest group (SIG) workshop. The BioSharing event included invited talks from a range of community leaders and a panel discussion at the end of the day. The panel session led to the formal agreement among community leaders to join together to promote cross-community knowledge exchange and collaborations. A key focus of the newly formed Biosharing community will be linking up resources to promote real-world data sharing (virtuous cycle of data) and supporting compliance with data policies through the creation of a one-stop-portal of information. Further information about the newly established BioSharing effort can be found at http://biosharing.org.