11 Background: Classic lobular carcinoma is characterized by a distinctive morphology, loss of E-cadherin commonly due to mutation or deletion of CDH1 on chromosome 16q, and a variable clinical course. Variants (pleomorphic, solid and alveolar) with distinct morphologies and potential differences in outcome have been described (Rosen 2009). Herein we provide an 8-year update of the patterns of quantitative gene expression as measured by the 21 gene Oncotype DX assay observed between ductal NOS (DC) and classic and variant lobular carcinomas. Methods: All tumors analyzed in the Genomic Health laboratory from 6/1/04-5/31/12 were included. Central path used WHO criteria for classification of classic lobular (CL), solid and alveolar lobular (SAL), and pleomorphic lobular (PL) carcinomas. Quantitative expression of 16 cancer related genes was measured on a scale from 2 to 15 (relative to reference genes) where a 1 unit increment is associated with an ~2-fold change in expression. Descriptive statistics for RS & individual genes [ER, PR, invasion gene group (IGG) and proliferation gene group (PGG)] among the subtypes were obtained. Comparisons of means among the subtypes were adjusted to control the overall error rate under any complete or partial null hypothesis. Results: DC accounted for 81.8% of 286,726 cases, CL 7.3%, SAL 0.4% and PL 0.4%. For all types a continuous range of RS was observed. DC had the greatest percentage of high risk RS followed by SAL, PL and CL. DC had the highest mean RS and PL and CL had the lowest RS. SAL had the highest mean ER expression and CL and PL had the lowest ER expression. These results may reflect a submission bias and are not population based. The proportion with ER+/PR- phenotype was slightly different among the subtypes: SAL (24.0%) and PL (19.4%) had a higher incidence compared to DC (14.1%) and CL (15.2%). SAL had the highest PGG expression; CL had the lowest. DC had the highest IGG; CL had the lowest. Conclusions: CL and the lobular carcinoma variants are characterized by differential patterns of gene expression. Outlier cases are not infrequent within each of the special subtypes in this large observational cohort. The variation in gene expression, noted by histologic subtype, will be presented in detail.
Background and objectives The risk of gout across CKD stages is not well described. Design, setting, participants, & measurements We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m 2 , 60–89, 45–59, 30–44, 15–29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. Results Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function ( i.e. , eGFR 15–44 ml/min per 1.73 m 2 ). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. Conclusions Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification.
From August 1996 to August 1997, we performed thoracoscopic sympathectomy for 96 cases of palmer hyperhidrosis. The patients' ages were from 22 to 58 years old (mean age: 28; gender ratio: male/female: 3/2). Most of them were students, workers or clerks. The patients were divided in two series: in 61 patients, the sympathetic chain before the 2nd to 4th ribs was removed in the lateral approach with a 3 hole procedure. In 35 patients, the 2nd portion of the sympathetic chain was destroyed (by electric cauter) in the posterior approach with a 2 hole procedure. The results were almost the same in the first series (all cases have a fair benefit), but in the second series, some advantages may be useful for therapy, i.e no need to turn the patients, severe compensation sweating is minimized (from 4% ==> 0%) and the amount of holes is reduced.
This study assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on academic productivity in oncology, measured by conference abstracts, journal publications and individual authorship trends, using a reference time frame of 2018 to 2022. To assess overall academic productivity, data was obtained on the number of abstracts and articles submitted and published from a selection of oncology conferences and journals. To assess individual authorship patterns, 200 articles were randomly selected from 2018, and for the first or last authors, publications were tracked over subsequent years. Factors assessed included gender, continent, specialty, MD vs. non-MD and career status (early vs. late). The number of submitted and published conference abstracts trended downward over time between 2018 and 2022 (p=0.11 and p=0.16 respectively). Journal submissions increased to a peak in 2020 and then declined thereafter, but this did not translate into changes in the number of papers published. For the author-level analysis, factors significantly predictive of increasing publication rates in multivariable analysis were late career status (vs. early), clinician status (vs. non-clinician), surgery or public health/epidemiology specialty, and author located in Asia. Further research is needed to help ameliorate the impact of these disparities.
