Ipsilateral breast tumor recurrence in early stage breast cancer patients treated with breast conserving surgery and adjuvant radiation therapy: Concordance of biomarkers and tumor location from primary tumor to in-breast tumor recurrence

BACKGROUND Patients with an in-breast tumor recurrence(IBTR)after breast-conserving therapy have a high risk of distant metastasis and disease-related mortality.Classifying clinical parameters that increase risk for recurrence after IBTR remains a challenge.AIM To describe primary and recurrent tumor characteristics in patients who experience an IBTR and understand the relationship between these characteristics and disease outcomes.METHODS Patients with stage 0-II breast cancer treated with lumpectomy and adjuvant radiation were identified from institutional databases of patients treated from 2003-2017 at our institution.Overall survival(OS),disease-free survival,and local recurrence-free survival(LRFS)were estimated using the Kaplan Meier method.We identified patients who experienced an isolated IBTR.Concordance of hormone receptor status and location of tumor from primary to recurrence was evaluated.The effect of clinical and treatment parameters on disease outcomes was also evaluated.RESULTS We identified 2164 patients who met the eligibility criteria.The median follow-up for all patients was 3.73[interquartile range(IQR)2.27-6.07]years.Five-year OS was 97.7%(95%CI:96.8%-98.6%)with 28 deaths;5-year LRFS was 98.0%(97.2-98.8)with 31 IBTRs.We identified 37 patients with isolated IBTR,19(51.4%)as ductal carcinoma in situ and 18(48.6%)as invasive disease,of whom 83.3%had an in situ component.Median time from initial diagnosis to IBTR was 1.97(IQR:1.03-3.5)years.Radiotherapy information was available for 30 of 37 patients.Median whole-breast dose was 40.5 Gy and 23 patients received a boost to the tumor bed.Twenty-five of thirty-two(78.1%)patients had concordant hormone receptor status,HER-2 receptor status,and estrogen receptor(ER)(P=0.006)and progesterone receptor(PR)(P=0.001)status from primary to IBTR were significantly associated.There were no observed changes in HER-2 status from primary to IBTR.The concordance between quadrant of primary to IBTR was 10/19[(62.2%),P=0.008].Tumor size greater than 1.5 cm(HR=0.44,95%CI:0.22-0.90,P=0.02)and use of endocrine therapy upfront(HR=0.36,95%CI:0.18-0.73,P=0.004)decreased the risk of IBTR.CONCLUSION Among patients with early stage breast cancer who had breast conserving surgery treated with adjuvant RT,ER/PR status and quadrant were highly concordant from primary to IBTR.Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy were significantly associated with decreased risk of IBTR.

Ipsilateral Lymphadenectomy to Inhibit Corneal Allograft Rejection in Rats

In order to investigate the ipsilateral lymphadenectomy for inhibiting rejection in rat corneal transplantation, corneal allogenic transplantation models were established in rats. Eighteen female Wister rats were used as donors, and 36 Sprague Dawley rats as recipients. After penetrating corneal transplantation, recipients were randomly divided into 3 groups: group A (control group); group B, the ipsilateral lymphadenectomy group; group C, the bilateral lymphadenectomy group. Among 12 rats in each group, the corneas of 2 rats in each group were used for pathological study at day 14 after the transplantation, and the remaining 10 rats were used for studying corneal rejection by a slit lamp. The time points when allograft rejection occurred were recorded and mean survival time (MST) was compared. The results showed that MST in groups B and C was 46 30±9 464 days and 44 43±7 604 days, respectively, which was significantly prolonged as compared with that in group A (10 71±1 567 days, P<0.01). There was no significant difference in MST between groups B and C (P>0.05). It was concluded that both bilateral and ipsilateral lymphadenectomy therapies could effectively inhibit the corneal allograft rejection. Ipsilateral lymphadenectomy is a less complex surgical procedure and is just as effective in preventing rejection.

Hemichorea due to ipsilateral thalamic infarction: A case report

BACKGROUND Hemichorea usually results from vascular lesions of the basal ganglia.Most often,the lesion is contralateral to the affected limb but rarely,it may be ipsilateral.The pathophysiology of ipsilateral hemichorea is still poorly understood.We review the literature on hemichorea due to ipsilateral cerebral infarction and explore possible mechanisms for its occurrence.CASE SUMMARY A 72-year-old woman presented with complaints of involuntary movements of the muscles of the left side of the face and mild weakness of the right limbs.Her symptoms had started suddenly 1 d earlier.After admission to the hospital,the involuntary movements spread to involve the left limbs also.Magnetic resonance imaging revealed a left thalamic infarction.The patient’s hemichorea subsided after treatment with haloperidol(2 mg per time,3 times/d)for 3 d;the hemiparesis resolved with rehabilitation physiotherapy.She is presently symptom free and on treatment for prevention of secondary stroke.We review the literature on the occurrence of ipsilateral hemichorea following thalamic infarction and discuss the possible pathomechanisms of this unusual presentation.CONCLUSION Ipsilateral hemichorea following a thalamic stroke is rare but it can be explained by structure of the extrapyramidal system.The thalamus is a relay station that exerts a bilateral control of motor function.

Ipsilateral motor evoked potentials in a patient with unihemispheric cortical atrophy due to Rasmussen encephalitis

The role of the ipsilaterally descending motor pathways in the recovery mechanisms after unilateral hemispheric damage is still poorly understood. Motor output reorganization was investigated in a 56-year-old male patient with acquired unilateral hemispheric atrophy due to Rasmussen encephalitis. In particular,the ipsilateral corticospinal pathways were explored using focal transcranial magnetic stimulation. In the first dorsal interosseous and wrist extensors muscles, the median amplitudes of the ipsilateral motor evoked potentials induced by transcranial magnetic stimulation in the patient were higher than those of 10 age-matched healthy control subjects. In the biceps brachii muscle, the median amplitudes of the ipsilateral motor evoked potentials were the second largest in the patient compared to the controls. This study demonstrated a reinforcement of ipsilateral motor projections from the unaffected motor cortex to the hemiparetic hand in a subject with acquired unihemispheric cortical damage.

Performance and Implementations of Vibrotactile Brain-Computer Interface with Ipsilateral and Bilateral Stimuli

The tactile P300 brain-computer interface( BCI) is related to the somatosensory perception and response of the human brain,and is different from visual or audio BCIs. Recently,several studies focused on the tactile stimuli delivered to different parts of the human body. Most of these stimuli were symmetrically bilateral.Only a fewstudies explored the influence of tactile stimuli laterality.In the current study,we extensively tested the performance of a vibrotactile BCI system using ipsilateral stimuli and bilateral stimuli.Two vibrotactile P300-based paradigms were tested. The target stimuli were located on the left and right forearms for the left forearm and right forearm( LFRF) paradigm,and on the left forearm and calf for the left forearm and left calf( LFLC)paradigm. Ten healthy subjects participated in this study. Our experiments and analysis showed that the bilateral paradigm( LFRF) elicited larger P300 amplitude and achieved significantly higher classification accuracy than the ipsilateral paradigm( LFLC). However, both paradigms achieved classification accuracies higher than 70% after the completion of several trials on average,which was usually regarded as the minimum accuracy level required for BCI system to be deemed useful.

Ipsilateral synchronous papillary and clear renal cell carcinoma:A case report and review of literature

BACKGROUND There is limited information on ipsilateral synchronous papillary renal cell carcinoma(PRCC)and clear cell renal cell carcinoma(CCRCC).Therefore,these rare tumors are often misdiagnosed preoperatively as a single tumor with intrarenal metastasis or some other diseases.Effective management and long-term overall survival might be affected because the prognosis of the two tumors differs.CASE SUMMARY We describe a case of ipsilateral synchronous PRCC and CCRCC with two histological variants in a 72-year-old man,whose mass was found incidentally,with no other chief complaints and vital signs were normal.Initial ultrasound revealed a hypoechoic lobular mass with a volume of 7.8 cm×4.8 cm×2.8 cm in the middle to lower pole of the left kidney.A subsequent contrast-enhanced computed tomography scan showed a single endophytic mass of 7.5 cm in diameter.The patient underwent laparoscopic left radical nephrectomy.A final diagnosis of ipsilateral synchronous PRCC and CCRCC was confirmed by pathological examination.There was no recurrence or metastasis after 25 mo follow-up.CONCLUSION We report a case of ipsilateral synchronous PRCC and CCRCC,and review related literature to estimate the prevalence of similar cases.The above descriptions may be expected to help understand the disease,and improve diagnosis in the future.

Transient Ipsilateral Lower Limb Paresis after Interscalene Brachial Plexus Block

We describe a partial motor block of ipsilateral lower limb after interscalene block with the injection of 40 ml of 0.5% bupivacaine and 2% lignocaine with adrenaline. Immediately after the block, patient reported a right motor hemi syndrome which was transient. We concluded that the neurological symptom was caused by the technique of interscalene brachial plexus block may be as a result of excessive lateral deviation of the neck with a compromised collateral circulation.

A Case of Harvesting Anterolateral Thigh Flaps Twice from the Ipsilateral Thigh of a Single Patient in Separate Operations

Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.

Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first?

Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an an atomical lock ing plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.

Development and validation of a nomogram for predicting survival of breast cancer patients with ipsilateral supraclavicular lymph node metastasis

Background:Breast cancer patients with ipsilateral supraclavicular lymph node metastasis(ISLNM)but without distant metastasis are considered to have a poor prognosis.This study aimed to develop a nomogram to predict the overall survival(OS)of breast cancer patients with ISLNM but without distant metastasis.Methods:Medical records of breast cancer patients who received surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University,Jiyuan People’s Hospital and Huaxian People’s Hospital between December 21,2012 and June 30,2020 were reviewed retrospectively.Overall,345 patients with pathologically confirmed ISLNM and without evidence of distant metastasis were identified.They were further randomized 2:1 and divided into training(n=231)and validation(n=114)cohorts.A nomogram to predict the probability of OS was constructed based on clinicopathologic variables identified by the univariable and multivariable analyses.The predictive accuracy and discriminative ability were measured by calibration plots,concordance index(C-index),and risk group stratification.Results:Univariable analysis showed that estrogen receptor-positive(ER+),progesterone receptor-positive(PR+),human epidermal growth factor receptor 2-positive(HER2+)with Herceptin treatment,and a low axillary lymph node ratio(ALNR)were prognostic factors for better OS.PR+,HER2+with Herceptin treatment,and a low ALNR remained independent prognostic factors for better OS on multivariable analysis.These variables were incorporated into a nomogram to predict the 1-,3-,and 5-year OS of breast cancer patients with ISLNM.The C-indexes of the nomogram were 0.737(95%confidence interval[CI]:0.660–0.813)and 0.759(95%CI:0.636–0.881)for the training and the validation cohorts,respectively.The calibration plots presented excellent agreement between the nomogram prediction and actual observation for 3 and 5 years,but not 1 year,OS in both the cohorts.The nomogram was also able to stratify patients into different risk groups.Conclusions:In this study,we established and validated a novel nomogram for predicting survival of patients with ISLNM.This nomogram may,to some extent,allow clinicians to more accurately estimate prognosis and to make personalized therapeutic decisions for individual patients with ISLNM.

Comparison of breast reconstruction using ipsilateral and contralateral pedicle transverse rectus abdominis musculocutaneous flaps

Aim: Breast reconstruction has several beneficial effects on psychosocial well-being and quality of life. The ultimate goal has always been to create the most natural breast mound. Thus in many centers, the unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains the most common technique for breast reconstruction. Our objective was to retrospectively compare the outcomes of ipsilateral and contralateral pedicle TRAM flaps. Methods: The total of 110 patients underwent unilateral breast reconstruction with pedicle TRAM flap at Cancer Institute of Tehran University of Medical Science from January 1996 to June 2011. Premorbid risk factors, postoperative outcomes and demographic data were assessed. The analysis of the recordings was done by SPSS 20. Results: Out of 110 patients who were included in the study, 87 had ipsilateral and 23 contralateral pedicle TRAM flaps. The incidence of flap complications that did not require surgical intervention was 19.7% in ipsilateral and 30.4% in contralateral pedicle TRAM flap. The incidence of flap loss requiring revision was significantly higher in contralateral group (P = 0.001). Major complications were noted in 11.5% of the ipsilateral pedicle TRAM patients and 26.1% of the contralateral group (P < 0.001). Minor complications were noted in 17.2% of the ipsilateral pedicle TRAM patients and in 34.8% of the contralateral group (P < 0.001). Total early hospital stay was longer in contralateral pedicle TRAM flaps (7.66 days vs. 10.68 days, P = 0.83). H igher c omplications were e ncountered i n c ontralateral p edicle T RAM flaps compared to ipsilateral pedicle TRAM patients (39.1% vs. 19.5%, P = 0.001). The type of pedicled TRAM flap (ipsilateral vs. contralateral), had significant effect on complications (odds ratio = 0.007, P = 0.002) while other variables had no significant effect on the incidence of complications. Conclusion: This study indicates that the overall outcome and mid-term morbidity-free survivals of ipsilateral pedicle TRAM flap breast reconstruction are statistically superior to contralateral pedicle TRAM flap breast reconstruction. Both of these procedures are reasonably feasible and safe. These findings lead us to discourage the use of contralateral pedicle TRAM flap when an ipsilateral option is feasible.

Floating Knee with Vascular Compression Treated Non-Operatively in a Context of Limited Resources: A Case Report

Lower limb fractures like floating knees are more common in urban areas of low-income countries. In addition, associated complex lesions are manifestations of polytrauma requiring correct and appropriate management. The treatment is mostly surgical. We present a 19-year-old patient with a floating knee due to ipsilateral femoral and tibial fractures and vascular compression treated with femoral and calcaneus traction followed by a long limb cast. For our patient, the management of the concomitant vascular compression threatening vital and functional prognosis was in focus aiming at avoiding a radical decision such as limb amputation. The non-operative treatment managed to restore the blood supply and save the limb. At the follow-up after 10 months the fractures were clinically healed and radiologically consolidated and the walking capacity was almost restored. Non-surgical treatment accompanied by daily monitoring can prevent the radical solution of amputation in the context of a floating knee with vascular compression. We want to draw attention to the weakness of the existing classifications because they do not take into account vascular lesions as well as the presence of open fractures to define the severity and evaluate the prognosis.

Paired associated magnetic stimulation promotes neural repair in the rat middle cerebral artery occlusion model of stroke

Paired associative stimulation has been used in stroke patients as an innovative recovery treatment.However,the mechanisms underlying the therapeutic effectiveness of paired associative stimulation on neurological function remain unclear.In this study,rats were randomly divided into middle cerebral occlusion model(MCAO)and paired associated magnetic stimulation(PAMS)groups.The MCAO rat model was produced by middle cerebral artery embolization.The PAMS group received PAMS on days 3 to 20 post MCAO.The MCAO group received sham stimulation,three times every week.Within 18 days after ischemia,rats were subjected to behavioral experiments—the foot-fault test,the balance beam walking test,and the ladder walking test.Balance ability was improved on days 15 and 17,and the footfault rate was less in their affected limb on day 15 in the PAMS group compared with the MCAO group.Western blot assay showed that the expression levels of brain derived neurotrophic factor,glutamate receptor 2/3,postsynaptic density protein 95 and synapsin-1 were significantly increased in the PAMS group compared with the MCAO group in the ipsilateral sensorimotor cortex on day 21.Resting-state functional magnetic resonance imaging revealed that regional brain activities in the sensorimotor cortex were increased in the ipsilateral hemisphere,but decreased in the contralateral hemisphere on day 20.By finite element simulation,the electric field distribution showed a higher intensity,of approximately 0.4 A/m^2,in the ischemic cortex compared with the contralateral cortex in the template.Together,our findings show that PAMS upregulates neuroplasticity-related proteins,increases regional brain activity,and promotes functional recovery in the affected sensorimotor cortex in the rat MCAO model.The experiments were approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.201802173 S)on March 3,2018.

Role of Radiotherapy-Induced Malignancies in Patients with Both Breast and Lung Cancer Diagnoses

Background:Breast and lung cancer are two of the most commonly diagnosed cancers in North America. While patients are living longer with advances in treatment and supportive care, some patients are being diagnosed with a second malignancy. The primary objective in this study was to assess the correlation between the development of an ipsilateral lung cancer or breast cancer, and prior radiation therapy. In addition, we sought to report the survival outcomes of patients in these clinical scenarios. Methods: We conducted a single institution (the Ottawa Hospital Cancer Centre) retrospective review of patients with the diagnoses of both breast and lung cancer treated between 1995 and 2013. Patients were included if they received radiation for a breast primary, and subsequently developed an ipsilateral lung primary, or vice-versa. Data included patient demographics, lifestyle factors, tumor location and subtype, cancer stages, treatment modalities, and survival outcomes. Results: Of 252 patients included in the study, 217 patients developed a breast primary first, with 35 patients developing a lung primary first. Median disease-free survival from the second primary diagnosis was 36 months in breast primary first patients, and 59 months in the lung primary first cohort. There was no significant correlation between the laterality of radiation treatment and side of second primary based on Fisher’s exact test. Conclusions: Our data reveal no association between side of radiation treatment and subsequent cancer development. The benefits of radiotherapy outweigh the risk of radiation-induced primaries. Longer term studies with matched patient cohorts are required to further assess treatment and lifestyle factors that may contribute towards the development of second malignancies.

Homolateral Combined Fracture of Monteggia and Galeazzi. Case Report and Review of the Literature

Introduction: Homolateral combined fractures of Monteggia and Galeazzi are very rare. Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial skeleton, pronosupination, and the flexion-extension of the elbow and wrist. Observation: We reported the case of a 45-year-old woman who presented a homolateral fracture of Monteggia and Galeazzi following a road accident. This combination of fractures posed a problem of diagnosis and management. Surgical follow-up presented functional issues. Conclusion: The association of Monteggia and Galeazzi fracture is very rare and poorly reported in the literature. This observation reminds us of the importance of performing a complete clinical and paraclinical assessment before any therapeutic decision.

Restoring After Central Nervous System Injuries:Neural Mechanisms and Translational Applications of Motor Recovery

Central nervous system(CNS)injuries,including stroke,traumatic brain injury,and spinal cord injury,are leading causes of long-term disability.It is estimated that more than half of the survivors of severe unilateral injury are unable to use the denervated limb.Previous studies have focused on neuroprotective interventions in the affected hemisphere to limit brain lesions and neurorepair measures to promote recovery.However,the ability to increase plasticity in the injured brain is restricted and difficult to improve.Therefore,over several decades,researchers have been prompted to enhance the compensation by the unaffected hemisphere.Animal experiments have revealed that regrowth of ipsilateral descending fibers from the unaffected hemisphere to denervated motor neurons plays a significant role in the restoration of motor function.In addition,several clinical treatments have been designed to restore ipsilateral motor control,including brain stimulation,nerve transfer surgery,and brain–computer interface systems.Here,we comprehensively review the neural mechanisms as well as translational applications of ipsilateral motor control upon rehabilitation after CNS injuries.