Proton Shell Gaps in N=28 Nuclei from the First Complete Spectroscopy Study with FRIB Decay Station Initiator

The first complete measurement of the β-decay strength distribution of _{17}^{45}Cl_{28} was performed at the Facility for Rare Isotope Beams (FRIB) with the FRIB Decay Station Initiator during the second FRIB experiment. The measurement involved the detection of neutrons and γ rays in two focal planes of the FRIB Decay Station Initiator in a single experiment for the first time. This enabled an analytical consistency in extracting the β-decay strength distribution over the large range of excitation energies, including neutron unbound states. We observe a rapid increase in the β-decay strength distribution above the neutron separation energy in _{18}^{45}Ar_{27}. This was interpreted to be caused by the transitioning of neutrons into protons excited across the Z=20 shell gap. The SDPF-MU interaction with reduced shell gap best reproduced the data. The measurement demonstrates a new approach that is sensitive to the proton shell gap in neutron rich nuclei according to SDPF-MU calculations.

Microsecond Isomer at the N=20 Island of Shape Inversion Observed at FRIB

Excited-state spectroscopy from the first experiment at the Facility for Rare Isotope Beams (FRIB) is reported. A 24(2)-μs isomer was observed with the FRIB Decay Station initiator (FDSi) through a cascade of 224- and 401-keV γ rays in coincidence with ^{32}Na nuclei. This is the only known microsecond isomer (1  μs≤T_{1/2}<1  ms) in the region. This nucleus is at the heart of the N=20 island of shape inversion and is at the crossroads of the spherical shell-model, deformed shell-model, and ab initio theories. It can be represented as the coupling of a proton hole and neutron particle to ^{32}Mg, ^{32}Mg+π^{-1}+ν^{+1}. This odd-odd coupling and isomer formation provides a sensitive measure of the underlying shape degrees of freedom of ^{32}Mg, where the onset of spherical-to-deformed shape inversion begins with a low-lying deformed 2^{+} state at 885 keV and a low-lying shape-coexisting 0_{2}^{+} state at 1058 keV. We suggest two possible explanations for the 625-keV isomer in ^{32}Na: a 6^{-} spherical shape isomer that decays by E2 or a 0^{+} deformed spin isomer that decays by M2. The present results and calculations are most consistent with the latter, indicating that the low-lying states are dominated by deformation.

Crossing N=28 Toward the Neutron Drip Line: First Measurement of Half-Lives at FRIB

New half-lives for exotic isotopes approaching the neutron drip-line in the vicinity of N∼28 for Z=12-15 were measured at the Facility for Rare Isotope Beams (FRIB) with the FRIB decay station initiator. The first experimental results are compared to the latest quasiparticle random phase approximation and shell-model calculations. Overall, the measured half-lives are consistent with the available theoretical descriptions and suggest a well-developed region of deformation below ^{48}Ca in the N=28 isotones. The erosion of the Z=14 subshell closure in Si is experimentally confirmed at N=28, and a reduction in the ^{38}Mg half-life is observed as compared with its isotopic neighbors, which does not seem to be predicted well based on the decay energy and deformation trends. This highlights the need for both additional data in this very exotic region, and for more advanced theoretical efforts.

The Fetus with Ganglionic Eminence Abnormality: Head Size and Extracranial Sonographic Findings Predict Genetic Diagnoses and Postnatal Outcomes

BACKGROUND AND PURPOSE

Ganglionic eminence abnormalities on fetal MR imaging are associated with cerebral malformations. Their presumed genetic basis and associated postnatal outcomes remain largely unknown. We aimed to elucidate these through a multicenter study.

MATERIALS AND METHODS

Between January 2010 and June 2020, seven hospitals in 2 countries performing fetal MR imaging examinations identified fetal MR imaging studies demonstrating ganglionic eminence enlargement, cavitation, or both. Cases with no genetic diagnosis, no whole exome sequencing, or no outcome of a liveborn child were excluded. Head size was classified as large (fronto-occipital diameter > 95th centile), small (fronto-occipital diameter <5th centile), or normal.

RESULTS

Twenty-two fetuses with ganglionic eminence abnormalities were identified. Of 8 with large heads, 2 were diagnosed with MTOR mutations; 1 with PIK3CA mutation-producing megalencephaly, polymicrogyria, polydactyly, hydrocephalus (MPPH) syndrome; 3 with TSC mutations; 1 with megalencephaly capillary malformation syndrome; and 1 with hemimegalencephaly. Cardiac rhabdomyoma was present prenatally in all cases of TSC; mutation postaxial polydactyly accompanied megalencephaly capillary malformation and MPPH. Of 12 fetuses with small heads, 7 had TUBA1A mutations, 1 had a TUBB3 mutation, 2 had cobblestone lissencephaly postnatally with no genetic diagnosis, 1 had a PDHA1 mutation, and 1 had a fetal akinesia dyskinesia sequence with no pathogenic mutation on trio whole exome sequencing. One of the fetuses with a normal head size had an OPHN1 mutation with postnatal febrile seizures, and the other had peri-Sylvian polymicrogyria, seizures, and severe developmental delay but no explanatory mutation on whole exome sequencing.

CONCLUSIONS

Fetal head size and extracranial prenatal sonographic findings can refine the phenotype and facilitate genetic diagnosis when ganglionic eminence abnormality is diagnosed with MR imaging.

Autologous Transplantation Using Donor Leukocytes Loaded Ex Vivo with Oncolytic Myxoma Virus Can Eliminate Residual Multiple Myeloma

Multiple myeloma (MM) is a hematological malignancy of monoclonal plasma cells that remains incurable. Standard treatments for MM include myeloablative regimens and autologous cell transplantation for eligible patients. A major challenge of these treatments is the relapse of the disease due to residual MM in niches that become refractory to treatments. Therefore, novel therapies are needed in order to eliminate minimal residual disease (MRD). Recently, our laboratory reported that virotherapy with oncolytic myxoma virus (MYXV) improved MM-free survival in an allogeneic transplant mouse model. In this study, we demonstrate the capacity of donor autologous murine leukocytes, pre-armed with MYXV, to eliminate MRD in a BALB/c MM model. We report that MYXV-armed bone marrow (BM) carrier leukocytes are therapeutically superior to MYXV-armed peripheral blood mononuclear cells (PBMCs) or free virus. Importantly, when cured survivor mice were re-challenged with fresh myeloma cells, they developed immunity to the same MM that had comprised MRD. In vivo imaging demonstrated that autologous carrier cells armed with MYXV were very efficient at delivery of MYXV into the recipient tumor microenvironment. Finally, we demonstrate that treatment with MYXV activates the secretion of pro-immune molecules from the tumor bed. These results highlight the utility of exploiting autologous leukocytes to enhance tumor delivery of MYXV to treat MRD in vivo.

Characterizing unconventional T cells in the tumor microenvironment of metastatic osteosarcoma

Osteosarcoma is the most common bone cancer and typically affects patients in the second decade of life. Current treatment methods have not proven effective for treating reoccurring or metastatic osteosarcoma (mOS) given the 5-year survival rate of 15–30%. Previous work has shown anti-PD-L1 combined with anti-CTLA-4 improves survival of mOS in mice from 0% in no treatment mice to 60% in treated mice. To further improve survival, we analyzed tumor infiltrating lymphocytes (TILs) in mice over time and discovered CD4hiCD8hiPD-1hi T cells consistently appeared in the tumor microenvironment (TME) after approximately two months. To determine whether these CD4hiCD8hi, or double positive (DP) cells, were candidates for immune therapy, TILs from mice with long-term cancer were stained for CD3 to confirm T cell lineage, CD44 to verify activation, and Qa-2, which is first expressed during the stage IV single positive phase of T cell maturation and is therefore a marker to distinguish mature from immature T cells. The DP TILs were found to be activated, mature T cells that are distinct from DP immature thymocytes. The DP TILs were further compared to splenocytes and were determined to be concentrated in the TME rather than resulting from a systemic change in the immune system. Finally, the presence of DP T cells in the lungs was found to be unique to long-term lung metastases when lung tissues from age-matched healthy mice were obtained and processed alongside experimental lung metastases. Overall, mature and activated DP T cells concentrate in the TME of long-term lung metastases of mOS.

Methods for the evaluation of biomarkers in patients with kidney and liver diseases: multicentre research programme including ELUCIDATE RCT

Background

Protein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expensive tests. However, their potential is not yet being realised.

Design and methods

The study consisted of three workstreams to create a framework for research: workstream 1, methodology – to define current practice and explore methodology innovations for biomarkers for monitoring disease; workstream 2, clinical translation – to create a framework of research practice, high-quality samples and related clinical data to evaluate the validity and clinical utility of protein biomarkers; and workstream 3, the ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Event (ELUCIDATE) randomised controlled trial (RCT) – an exemplar RCT of an established test, the ADVIA Centaur® Enhanced Liver Fibrosis (ELF) test (Siemens Healthcare Diagnostics Ltd, Camberley, UK) [consisting of a panel of three markers – (1) serum hyaluronic acid, (2) amino-terminal propeptide of type III procollagen and (3) tissue inhibitor of metalloproteinase 1], for liver cirrhosis to determine its impact on diagnostic timing and the management of cirrhosis and the process of care and improving outcomes.

Results

The methodology workstream evaluated the quality of recommendations for using prostate-specific antigen to monitor patients, systematically reviewed RCTs of monitoring strategies and reviewed the monitoring biomarker literature and how monitoring can have an impact on outcomes. Simulation studies were conducted to evaluate monitoring and improve the merits of health care. The monitoring biomarker literature is modest and robust conclusions are infrequent. We recommend improvements in research practice. Patients strongly endorsed the need for robust and conclusive research in this area. The clinical translation workstream focused on analytical and clinical validity. Cohorts were established for renal cell carcinoma (RCC) and renal transplantation (RT), with samples and patient data from multiple centres, as a rapid-access resource to evaluate the validity of biomarkers. Candidate biomarkers for RCC and RT were identified from the literature and their quality was evaluated and selected biomarkers were prioritised. The duration of follow-up was a limitation but biomarkers were identified that may be taken forward for clinical utility. In the third workstream, the ELUCIDATE trial registered 1303 patients and randomised 878 patients out of a target of 1000. The trial started late and recruited slowly initially but ultimately recruited with good statistical power to answer the key questions. ELF monitoring altered the patient process of care and may show benefits from the early introduction of interventions with further follow-up. The ELUCIDATE trial was an ‘exemplar’ trial that has demonstrated the challenges of evaluating biomarker strategies in ‘end-to-end’ RCTs and will inform future study designs.

Conclusions

The limitations in the programme were principally that, during the collection and curation of the cohorts of patients with RCC and RT, the pace of discovery of new biomarkers in commercial and non-commercial research was slower than anticipated and so conclusive evaluations using the cohorts are few; however, access to the cohorts will be sustained for future new biomarkers. The ELUCIDATE trial was slow to start and recruit to, with a late surge of recruitment, and so final conclusions about the impact of the ELF test on long-term outcomes await further follow-up. The findings from the three workstreams were used to synthesise a strategy and framework for future biomarker evaluations incorporating innovations in study design, health economics and health informatics.

Trial registration

Current Controlled Trials ISRCTN74815110, UKCRN ID 9954 and UKCRN ID 11930.

Funding

This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 3. See the NIHR Journals Library website for further project information.

Placeholders dissociate two forms of inhibition of return

Decades of research using Posner's classic spatial cueing paradigm has uncovered at least two forms of inhibition of return (IOR) in the aftermath of an exogenous, peripheral orienting cue. One prominent dissociation concerns the role of covert and overt orienting in generating IOR effects that relate to perception- and action-oriented processes, respectively. Another prominent dissociation concerns the role of covert and overt orienting in generating IOR effects that depend on object- and space-based representation, respectively. Our objective was to evaluate whether these dichotomies are functionally equivalent by manipulating placeholder object presence in the cueing paradigm. By discouraging eye movements throughout, Experiments 1A and 1B validated a perception-oriented form of IOR that depended critically on placeholders. Experiment 2A demonstrated that IOR was robust without placeholders when eye movements went to the cue and back to fixation before the manual response target. In Experiment 2B, we replicated Experiment 2A's procedures except we discouraged eye movements. IOR was observed, albeit only weakly and significantly diminished relative to when eye movements were involved. We conclude that action-oriented IOR is robust against placeholders but that the magnitude of perception-oriented IOR is critically sensitive to placeholder presence when unwanted oculomotor activity can be ruled out.

Familiarity seekers are fast and novelty seekers are slow

Christie and Klein (1995) demonstrated that a familiar item (word) rapidly attracts attention when presented simultaneously with an unfamiliar item (nonword). However, this finding has never been replicated. The current study is an attempt at such a replication. Participants were presented a familiar word and unfamiliar nonword in the experimental condition. At varying times after stimulus onset one of the items moved, and the participant reported the direction of the movement. A replication of Christie and Klein would be obtained if performance was better for movement discrimination of the familiar item shortly after onset but not at later intervals. The original finding was replicated in fast participants while slower participants show a different effect. A potential individual difference variable is suggested to explain this difference between the fast and slow participants.

Neuroprotective Strategies in Glaucoma

BACKGROUND

Glaucoma is characterized as a neuropathic disease that causes progressive degeneration of retinal ganglion cells (RGCs) in the retina, resulting in irreversible loss of vision. All conventional treatments for glaucoma are focused on reducing intraocular pressure (IOP) in the anterior chamber of the eye. However, these treatments alone are insufficient to halt the progression of the disease. As a result, neuroprotective strategies have been developed that prevent retinal neuron loss and disease progression.

METHODS

The goal of this review is to summarize and discuss neuroprotective strategies in glaucoma at the level of the retina and the ganglion cell layer instead of treatments targeting IOP. Recent and past neuroprotective therapies used to prevent the loss of retinal ganglion cells, the loss of axons in the optic nerve and the loss of vision and function associated with glaucoma are presented.

RESULTS

Pharmacological approaches have targeted specific receptors, signaling cascades and neurotrophic factors to induce neuroprotection in the retina, while others have focused on the mechanism of cellular loss associated with glaucoma, including excitotoxicity, oxidative stress and apoptotic processes. In addition to neuroprotective pharmacological treatments, stem cell, gene therapy and viral research have demonstrated neuroprotection against the loss of RGCs in glaucomatous conditions.

CONCLUSION

It is likely that future development for glaucoma treatment will include a combination of these treatments to prevent the pathophysiology of glaucoma.

T-independent response mediated by oncolytic tanapoxvirus recombinants expressing interleukin-2 and monocyte chemoattractant protein-1 suppresses human triple negative breast tumors

Human triple negative breast cancer (TNBC) is an aggressive disease, associated with a high rate of recurrence and metastasis. Current therapeutics for TNBC are limited, highly toxic and show inconsistent efficacy due to a high degree of intra-tumoral and inter-tumoral heterogeneity. Oncolytic viruses (OVs) are an emerging treatment option for cancers. Several OVs are currently under investigation in preclinical and clinical settings. Here, we examine the oncolytic potential of two tanapoxvirus (TPV) recombinants expressing mouse monocyte chemoattractant protein (mMCP)-1 [also known as mCCL2] and mouse interleukin (mIL)-2, in human TNBC, in vitro and in vivo. Both wild-type (wt) TPV and TPV recombinants demonstrated efficient replicability in human TNBC cells and killed cancer cell efficiently in a dose-dependent manner in vitro. TPV/∆66R/mCCL2 and TPV/∆66R/mIL-2 expressing mCCL2 and mIL-2, respectively, suppressed the growth of MDA-MB-231 tumor xenografts in nude mice significantly, as compared to the mock-injected tumors. Histological analysis of tumors showed areas of viable tumor cells, necrotic foci and immune cell accumulation in virus-treated tumors. Moreover, TPV/∆66R/mIL-2-treated tumors showed a deep infiltration of mononuclear immune cells into the tumor capsule and focal cell death in tumors. In conclusion, TPV recombinants expressing mCCL2 and mIL-2 showed a significant therapeutic effect in MDA-MB-231 tumor xenografts, in nude mice through induction of potent antitumor immune responses. Considering the oncolytic potency of armed oncolytic TPV recombinants expressing mCCL2 and mIL-2 in an experimental nude mouse model, these viruses merit further investigation as alternative treatment options for human breast cancer.

Does multilingualism affect the incidence of Alzheimer's disease?: A worldwide analysis by country

It has been suggested that the cognitive requirements associated with bi- and multilingual processing provide a form of mental exercise that, through increases in cognitive reserve and brain fitness, may delay the symptoms of cognitive failure associated with Alzheimer′s disease and other forms of dementia. We collected data on a country-by-country basis that might shed light on this suggestion. Using the best available evidence we could find, the somewhat mixed results we obtained provide tentative support for the protective benefits of multilingualism against cognitive decline. But more importantly, this study exposes a critical issue, which is the need for more comprehensive and more appropriate data on the subject.

The Missing-Phoneme Effect in Aural Prose Comprehension

When participants search for a target letter while reading for comprehension, they miss more instances if the target letter is embedded in frequent function words than in less frequent content words. This phenomenon, called the missing-letter effect, has been considered a window on the cognitive mechanisms involved in the visual processing of written language. In the present study, one group of participants read two texts for comprehension while searching for a target letter, and another group listened to a narration of the same two texts while listening for the target letter's corresponding phoneme. The ubiquitous missing-letter effect was replicated and extended to a missing-phoneme effect Item-based correlations between the reading and listening tasks were high, which led us to conclude that both tasks involve cognitive processes that reading and listening have in common and that both processes are rooted in psycholinguistically driven allocation of attention.

Awareness of distractors is necessary to generate a strategy to avoid responding to them: A commentary on Lin and Murray (2015)

Lin and Murray published in the 2015 January Issue of Psychological Science a study that claims to have made the surprising discovery of unconscious effects that are stronger than equivalent conscious effects. Specifically, the authors claim to have uncovered dissociable components of aware and unaware orienting and inhibition in exogenous cueing. They suggest an awareness-dependent location-based inhibition mechanism referred to as a negative attentional aftereffect. Here we argue for a simpler explanation, based on established literature, that all they have shown is response inhibition to a consciously perceived cue presented at a fixed location.

Outbreak of Mycobacterium mucogenicum Bloodstream Infections among Patients with Sickle Cell Disease in an Outpatient Setting

Objective.

To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting.

Design.

Outbreak investigation and retrospective chart review.

Setting.

University outpatient clinic.

Patients.

Patients whose blood cultures tested positive for M. mucogenicum in May or June 2008.

Methods.

An outbreak investigation and a review of infection control practices were conducted. During the process, environmental culture samples were obtained. Isolates from patients and the environment were genotyped with the DiversiLab typing system to identify the source. Chart reviews were conducted to study the management and outcomes of the patients.

Results.

Four patients with sickle cell disease and implanted ports followed in the same hematology outpatient clinic developed blood cultures positive for M. mucogenicum. A nurse in the clinic had prepared intravenous port flushes on the sink counter, using a saline bag that was hanging over the sink throughout the shift. None of the environmental cultures grew M. mucogenicum except for the tap water from 2 rooms, 1 of which had a faucet aerator. The 4 patient isolates and the tap water isolate from the room with the aerator were found to have greater than 98.5% similarity. The subcutaneous ports were removed, and patients cleared their infections after a course of antibiotic therapy.

Conclusion.

The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.

Illusory line motion is not caused by object-differentiating mechanisms or endogenous attention

Christie and Klein [2005. Does attention cause illusory line motion? Perception & Psychophysics, 67(6), 1032-1043] published line motion ratings consistent with illusory line motion (ILM) after peripheral endogenous cues but not central arrow cues. When attention was directed endogenously on the basis of the shape of one of two peripherally presented objects, participants reported small, but significant motion away from the attended object, and this was attributed to participant bias, or to a peripherally directed object-based attention system endogenously recruited to differentiate the peripheral shapes. By using a unique cueing method with identical peripheral markers, but still allowing them to act as cues, the findings of Christie and Klein Experiment 4 were replicated. This reduces the likelihood that object discrimination or object attention mechanisms are responsible for the reported ILM-like effects.

Patient education in allogeneic hematopoietic cell transplant: what patients wish they had known about quality of life

Quality of life (QOL) is increasingly recognized as an important clinical outcome of hematopoietic cell transplantation (HCT), but patient education is often overlooked. The goal of the current qualitative study was to examine education regarding post-HCT QOL from the patient’s perspective. Allogeneic HCT recipients participated in one of four focus groups. Participants were asked to recall what they had been told about post-HCT QOL as they were preparing for transplant, how their QOL differed from what they expected, and how to educate future patients about post-HCT QOL. Verbatim transcripts were coded for both a priori and emergent themes using content analysis. A total of 24 patients participated (54% female, mean age 51, range 23-73). Participants frequently expressed the desire for additional education regarding post-HCT QOL, particularly late complications. They noted that late complications were often unexpected, had a profound impact on their QOL, and threatened their ongoing sense of recovery. They emphasized that the timing, content, and format of education regarding QOL should be flexible to meet their diverse needs. Findings from the current study draw attention to the importance of patient education regarding post-HCT QOL as well as additional QOL research designed with patient education in mind.

Vector averaging of inhibition of return

Observers detected targets presented 400 msec after a display containing one cue or two to four cues displayed simultaneously in randomly selected locations on a virtual circle around fixation. The cue arrangement was completely uninformative about the upcoming target's location, and eye position was monitored to ensure that the participants maintained fixation between the cue and their manual detection response. Reflecting inhibition of return (IOR), there was a gradient of performance following single cues, with reaction time decreasing monotonically as the target's angular distance from the cued direction increased. An equivalent gradient of IOR was found following multiple cues whose center of gravity fell outside the parafoveal region and, thus, whose net vector would activate an orienting response. Moreover, on these trials, whether or not the targeted location had been stimulated by a cue had little effect on this gradient. Finally, when the array of cues was balanced so that its center of gravity was at fixation, there was no IOR. These findings, which suggest that IOR is an aftermath of orienting elicited by the cue, are compatible with population coding of the entire cue (as a grouped array for multiple cues) as the generator of IOR.

Not hysteria: ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis

We report a case of a 33-year-old nulliparous woman who, following a short prodromal illness, experienced a series of psychiatric and behavioural symptoms. These included states of terror, insomnia, delirium, self-harm and suicidal ideation, facial dyskinesias, verbigeration, cognitive impairment, reduced responsiveness, violence and paranoia. A diagnosis of anti-N-methyl-d-aspartate (NMDAR) encephalitis was made 50 days after symptom onset. Early tumour removal is associated with an improved prognosis and a laparoscopic oophorectomy was performed following detection of a dermoid cyst. Within 24 hours of the operation there was marked improvement in cognitive function and appetite.

Global versus local processing: seeing the left side of the forest and the right side of the trees

Previous studies using hierarchical figures (where a large global shape is composed of a series of smaller local shapes) suggest that performance is better for local features presented in the right relative to left visual field, whereas the opposite pattern is observed for global features. However, these previous studies have focused on effects between hemifields. Recent data from patients with neurological damage suggest that local deficits can be allocentric (e.g., following left hemisphere injury, individuals are relatively slow to detect features on the right side of an object, regardless of visual field). Therefore, we decided to extend previous global versus local research by also observing local performance within hemifields. Specifically, on each trial we presented two hierarchical figures (one in each hemifield), but crucially the left and right side of each item were composed of different local features. In this task, the participant simply reports if a circle is present, regardless of location or whether this is a local or global feature. We observed that both neurologically healthy individuals, as well as an individual with brain injury, were relatively better detecting local information on the right side of objects, regardless of spatial location, while both showed better performance for global stimuli in the left visual field. This work is consistent with recent work in patients with neurological damage, and provides a new paradigm for exploring hemispheric specialization.

Can locoregional treatment of the primary tumor improve outcomes for women with stage IV breast cancer at diagnosis?

89

Background: To determine whether locoregional treatment (LRT) of the primary tumor improves outcomes in patients with stage IV breast cancer at diagnosis.

Methods: The study cohort comprised 733 women referred from 1996 to 2005 to a population-based cancer institution with clinical or pathologic M1 breast cancer at diagnosis. Patient, tumor, and treatment characteristics were compared between women who were treated with (n=378) and without LRT (n=355) of the primary tumor. Five-year Kaplan-Meier overall survival (OS) and locoregional progression-free survival (LRPFS) were compared between groups. Multivariable analysis to control for potential confounding factors was performed using Cox regression modeling.

Results: LRT consisted of surgery alone in 67%, radiotherapy alone in 22%, and both in 11% of patients. LRT use was significantly associated with age <50 years, ECOG performance status 0-1, T1-2 tumors, and N0-1 disease, (all p<0.05). Subjects with less metastatic disease burden and those asymptomatic from the M1 disease were more likely to undergo LRT (p<0.001). Systemic therapy was used in 92% and 85% of patients treated with vs. without LRT, respectively. Five-year OS rates in the LRT and no LRT cohorts were 21% vs 14% (p<0.001). The 5-year LRPFS rates were 72% vs 46% (p<0.001). Among 378 patients who underwent LRT, 5-year OS rates were higher in patients with age <50, ECOG 0-1, ER positive disease, clear surgical margins, single M1 subsite, bone only metastases, and 1-3 metastatic lesions (all p<0.003). Type of LRT (surgery vs radiotherapy vs both) and type of surgery (lumpectomy vs mastectomy) were not associated with 5-year OS (all p>0.05). On multivariable analysis, LRT was associated with improved OS (hazard ratio 0.78, 95% confidence interval 0.64-0.94, p=0.009).

Conclusions: LRT of the primary disease was associated with improved survival in women with stage IV breast cancer at diagnosis. Among subjects treated with LRT, the most favorable survival rates were observed in patients with young age, good performance status, ER-positive disease, clear resection margins and in those with distant disease limited to one subsite, bone only, or fewer than 4 metastatic lesions.

The sensitivity of direct faecal examination, direct faecal flotation, modified centrifugal faecal flotation and centrifugal sedimentation/flotation in the diagnosis of canine spirocercosis

Several faecal examination techniques have shown variable sensitivity in demonstrating Spirocerca lupi (S. lupi) eggs. The objective of this study was to determine which faecal examination technique, including a novel modified centrifugal flotation technique, was most sensitive to diagnose spirocercosis. Ten coproscopic examinations were performed on faeces collected from 33 dogs confirmed endoscopically to have spirocercosis. The tests included a direct faecal examination, a faecal sedimentation/flotation test, 4 direct faecal flotations and 4 modified faecal centrifugal flotations. These latter 2 flotation tests utilised 4 different faecal flotation solutions:NaNO3 (SG 1.22),MgSO4 (SG 1.29),ZnSO4 (SG 1.30) and sugar (SG 1.27). The sensitivity of the tests ranged between 42 %and 67 %, with theNaNO3 solution showing the highest sensitivity in both the direct and modified-centrifugal flotations. The modified NaNO3 centrifugal method ranked 1st with the highest mean egg count (45.24±83), and was superior (i.e. higher egg count) and significantly different (P 0.05) compared with the routine saturated sugar,ZnSO4 andMgSO4 flotation methods. The routine NaNO3 flotation method was also superior and significantly different (P 0.05) compared with the routine ZnSO4 andMgSO4 flotation methods. Fifteen per cent (n=5) of dogs had neoplastic oesophageal nodules and a further 18 % (n = 6) had both neoplastic and non-neoplastic nodules. S. lupi eggs were demonstrated in 40%of dogs with neoplastic nodules only and 72.9 % of the dogs with non-neoplastic nodules. The mean egg count in the non-neoplastic group (61) was statistically greater (P = 0.02) than that of the neoplastic group (1). The results show that faecal examination using a NaNO3 solution is the most sensitive in the diagnosis of spirocercosis. The modified centrifugal flotation faecal method using this solution has the highest egg count. The study also found that dogs with neoplastic nodules shed significantly fewer eggs than dogs with non-neoplastic nodules.

Cognitive function and cerebral emboli after primary hip arthroplasty

Transcranial Doppler ultrasound has been used to detect cerebral emboli after hip arthroplasty. The cognitive effects of these embolic events are unclear. The aim of this study was to assess cognitive change after primary cemented hip arthroplasty using a range of neuropsychological tests and to measure intraoperative cerebral embolic load. Twenty primary cemented total hip arthroplasties underwent a series of cognitive tests before and at four days after surgery. A range of validated tests assessed: global cognitive function; verbal fluency and speed; immediate and delayed memory recall; attention and mental processing speeds. Intra-operative transcranial Doppler ultrasound monitoring of the middle cerebral artery for embolic signals was also performed. A one-sample Wilcoxon signed-rank test compared median cognitive results post-pre surgery and a Mann-Whitney U test established if there was a cognitive difference between those patients who had detectable cerebral emboli and those who did not. Scatter plot graphs were also used to establish any correlation between the embolic load and clinical cognitive dysfunction. A significant (p<0.01) difference was noted in specific tests assessing mental processing speed, visual searching and sustained and divided attention following surgery. Intra-operative cerebral embolic signals were detected in 11 out of 20 patients and the majority occurred with femoral component cementation and hip reduction. There was no difference in cognitive dysfunction between those patients who had detectable cerebral embolic signals and those who did not and there appeared to be no direct correlation between the size of the embolic load and the level of cognitive dysfunction.

On the uniqueness of attentional capture by uninformative gaze cues: facilitation interacts with the Simon effect and is rarely followed by IOR

Orienting to an uninformative peripheral cue is characterized by a brief facilitation followed by a long-lasting inhibition once attention is removed from the cued location. Although central gaze cues cause reflexive orienting, the inhibitory effect that is relatively ubiquitous following exogenous orienting to uninformative peripheral cues has been relatively rare. We hypothesized that IOR might be seen following gaze-induced orienting if attention were effectively returned to centre by a return gaze or return flash. The timecourse of gaze-directed orienting was measured by varying the interval between the gaze cue and a peripheral target requiring an orientation discrimination (permitting measurement of the Simon effect). Significant facilitation was observed at all but the longest SOA tested, 2,880 ms, by which time the facilitation had disappeared with no evidence of IOR. Gaze-induced cuing (which was unaffected by return cue condition) interacted with the Simon effect, decreasing it at the gazed-at location, a pattern that is not seen with more typical endogenous and exogenous cuing.

Warfarin response and vitamin K epoxide reductase complex 1 in African Americans and Caucasians

The objective of this study was to determine whether two vitamin K epoxide reductase complex 1 (VKORC1) polymorphisms contribute to the variability in warfarin response, particularly in African Americans. The effect of the VKORC1 1173C/T and -1639G/A polymorphisms was examined in a prospective cohort study of 338 warfarin users. Subjects carrying an 1173T allele had a lower warfarin maintenance dose compared with subjects with the CC genotype in African Americans (-12.10 mg/week+/-4.93; P=0.02) and Caucasians (-14.41 mg/week+/-3.28; P<0.001). Before reaching maintenance dose, only Caucasians with the T allele had significantly increased risk of international normalized ratio >3 (odds ratio=3.10; 95% confidence interval: 1.73-5.55) compared with Caucasians with the CC genotype. Polymorphisms in the VKORC1 gene are associated with warfarin maintenance dose requirements among both African Americans and Caucasians. However, these polymorphisms may not be as useful in predicting over-anticoagulation among African Americans.