BACKGROUND & AIMS: :The objective of this study was to confirm whether hemoglobin (Hb) levels during chemoradiotherapy are associated with survival in patients with locally advanced cervical carcinoma and to assess impact of the Hb level on survival according to lymph node (LN) metastasis. A retrospective review of 85 cervical carcinoma patients treated with concurrent chemoradiotherapy was conducted. The stage of disease ranged between FIGO stage IB and stage IVA. Disease-free and overall survivals were evaluated by univariate and multivariate analyses. After median follow-up of 35.7 months, 24 patients developed recurrence of disease and 14 patients died from their disease. Stage, LN metastasis, and squamous cell carcinoma antigen and Hb levels during chemoradiation were correlated significantly with survival (P < 0.05). Maintenance of Hb above 10.0 g/dL was associated with better survival (P < 0.05). However, no such benefits were observed in patients with LN metastasis by magnetic resonance imaging (MRI). Multivariate Cox regression hazard model showed that Hb levels during chemoradiation were an independent prognostic factor in patients without LN metastasis by MRI. Maintenance of Hb during chemoradiation is of benefit in cervical carcinoma patients without LN metastasis but not with LN metastasis by MRI.

背景与目标： ：本研究的目的是确定化学放疗期间血红蛋白（Hb）水平是否与局部晚期宫颈癌患者的生存相关，并根据淋巴结（LN）转移评估Hb水平对生存的影响。回顾性回顾了85例同时放化疗的宫颈癌患者。疾病的阶段在FIGO的IB阶段和IVA阶段之间。通过单因素和多因素分析评估无病生存期和总生存期。在中位随访35.7个月后，有24例患者复发疾病，有14例患者死于疾病。化学放疗期间的分期，LN转移，鳞状细胞癌抗原和血红蛋白水平与生存率显着相关（P <0.05）。维持Hb高于10.0 g / dL与更好的生存率相关（P <0.05）。但是，通过磁共振成像（MRI）在LN转移患者中未观察到此类益处。多元Cox回归风险模型显示，放化疗期间Hb水平是无LN转移的患者（通过MRI）的独立预后因素。对于没有LN转移但没有MRI的LN转移的宫颈癌患者，放化疗期间维持Hb有益。

BACKGROUND & AIMS: BACKGROUND:Ultrasonography with fine-needle aspiration cytology (FNAC) has proven to be a valuable diagnostic tool in the preoperative workup of patients with breast cancer or penile cancer eligible for sentinel lymph node biopsy. The aim of this study was to evaluate the use of this technique in the initial assessment of patients with primary cutaneous melanoma. METHODS:A total of 107 patients with cutaneous melanoma eligible for sentinel node biopsy with clinically negative nodes were studied prospectively. Patients underwent ultrasonography of potentially involved basins and FNAC in case of a suspicious lymph node. The sentinel node procedure was omitted in patients with tumour-positive lymph nodes in lieu of lymph node dissection. RESULTS:Ultrasonography with FNAC correctly identified disease preoperatively in two of the 107 patients (2%). Thirteen of the 22 patients (59%) with a suspicious node on ultrasonographic imaging but a tumour-negative fine-needle aspirate were shown to have involved nodes. Of the 85 patients with ultrasonographically normal nodes, 25 (29%) were shown to have metastases. Of the total of 43 involved basins, 16 contained metastases > 2 mm and 25 < or = 2 mm. CONCLUSIONS:In our hands, the sensitivity and specificity of preoperative ultrasonography to detect lymph node involvement in patients with melanoma are 34% and 87%, respectively. In combination with FNAC, this is 4.7% and 100%, respectively. This yield is insufficient for this technique to be used as a routine diagnostic tool in the selection of patients eligible for sentinel node biopsy.

背景与目标： 背景：超声检查结合细针穿刺细胞学检查（FNAC）已被证明是对乳腺癌或阴茎癌患者进行前哨淋巴结活检的术前检查中有价值的诊断工具。这项研究的目的是评估该技术在原发性皮肤黑素瘤患者的初步评估中的应用。
方法：前瞻性研究了107例符合临床前淋巴结活检要求的前哨淋巴结活检的皮肤黑色素瘤患者。对可疑淋巴结患者进行超声检查，包括潜在受累盆和FNAC。肿瘤阳性淋巴结代替淋巴结清扫的患者省略了前哨淋巴结清扫术。
结果：107例患者中有2例（2％）在接受FNAC的超声检查之前能正确地识别出疾病。 22例患者中有13例（59％）在超声检查中发现可疑淋巴结，但肿瘤阴性的细针抽吸物已累及淋巴结。在超声检查正常的85例患者中，有25例（29％）显示有转移。在总共43个受累盆地中，有16个包含的转移灶> 2 mm，而25个<或= 2 mm。
结论：在我们手中，术前超声检查黑色素瘤患者淋巴结受累的敏感性和特异性分别为34％和87％。与FNAC结合使用时，分别为4.7％和100％。该产量不足以将该技术用作选择适合进行前哨淋巴结活检的患者的常规诊断工具。

BACKGROUND & AIMS: :Sentinel lymph nodes (SLNs), being the first nodes to receive lymph from a primary tumour and the preferential site of initial tumour metastases, are intensively exposed to the bioactive products of tumour cells and other associated cells. This makes them ideal for studies of the factors that determine selective tissue susceptibility to metastases. We postulate that tumour-induced immune modulation of SLNs facilitates lymph-node metastases by inhibiting the generation of tumour-specific cytotoxic T cells that are active against tumour cells of primary and metastatic melanomas. Immune modulation of the lymph nodes can be reversed by granulocyte/macrophage colony-stimulating factor (GM-CSF), a finding that has implications for the future therapy of lymph-node metastases.

背景与目标： 前哨淋巴结（SLNs）作为第一个从原发肿瘤接受淋巴结和初始肿瘤转移的优先部位的淋巴结，被强烈暴露于肿瘤细胞和其他相关细胞的生物活性产物。这使它们成为研究决定选择性组织对转移的敏感性的因素的理想选择。我们推测，SLNs的肿瘤诱导免疫调节通过抑制对原发性和转移性黑素瘤的肿瘤细胞有活性的肿瘤特异性细胞毒性T细胞的产生，促进淋巴结转移。粒细胞/巨噬细胞集落刺激因子（GM-CSF）可逆转淋巴结的免疫调节作用，这一发现对未来淋巴结转移的治疗具有重要意义。

BACKGROUND & AIMS: Pollution of aquatic ecosystems poses a serious threat to aquatic organisms and ultimately the entire ecosystem. Understanding how a toxin affects embryonic development is key to determining the risk a pollutant represents to the environment. Extraembryonic membranes, such as the chorion of fish eggs, provide a protective barrier between the embryo and the environment. Although the fish chorion excludes many chemical pollutants, some noxious agents can still gain access to the aquatic embryo. Therefore a monitoring system that tests the effects directly upon the embryo must be established. Although exposure to a single toxin in the laboratory can determine the concentration at which a pollutant becomes a health or environmental hazard, embryos and adults in nature are not merely affected by a single chemical, but are exposed to mixtures of different pollutants. Zebrafish (Danio rerio) and medaka (Oryzias latipes) embryos were employed for the rapid observation of the effects of single chemicals and chemical mixtures on development. Using dechorionation and a perivitelline space microinjection system, the embryos were effective sentinels for low concentrations of aquatic pollutants. The developmental effects of small quantities of toxins were observed. Embryos treated during the late gastrula stage of development with hexachlorobenzene (HCB); 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD); toluene; benzene; or mixtures of these chemicals developed cardiovascular abnormalities. The zebrafish dechorionation exposure technique, Micro Intrachorionic Zebrafish Embryo Live Laboratory test, was especially effective in testing the pollutant mixtures. Combinations of both TCDD and benzene (as well as the toluene and benzene combinations) were tested and the mixtures acted synergistically; the combinations were more toxic than either chemical by itself. Hexachlorobenzene- and TCDD-treated embryos tested positively for expression of cytochrome P450 1A indicating that the cytochrome metabolic pathways were already functional in these early embryos, and suggested that a product of the cytochrome system may be involved in HCB and TCDD pollution associated cardiovascular defects.

背景与目标： 水生生态系统的污染严重威胁着水生生物，并最终威胁到整个生态系统。了解毒素如何影响胚胎发育是确定污染物对环境构成风险的关键。胚外膜（例如鱼卵的绒毛膜）在胚胎和环境之间提供了保护性屏障。尽管鱼绒毛膜排除了许多化学污染物，但某些有害物质仍可进入水生胚胎。因此，必须建立一个直接测试对胚胎的影响的监测系统。尽管在实验室中暴露于单一毒素可以确定污染物对健康或环境有害的浓度，但自然界中的胚胎和成年不仅受到单一化学品的影响，而且还暴露于不同污染物的混合物中。斑马鱼（Danio rerio）和medaka（Oryzias latipes）胚胎用于快速观察单一化学物质和化学混合物对发育的影响。使用去绒毛膜切开术和玻璃体周围微注射系统，胚胎是低浓度水生污染物的有效前哨。观察到少量毒素的发育影响。在发育后期的胃胚期用六氯苯（HCB）处理过的胚胎； 2,3,7,8-四氯二苯并-对二恶英（TCDD）;甲苯;苯;或这些化学物质的混合物会导致心血管异常。斑马鱼的去绒毛膜暴露技术，微内绒毛膜斑马鱼胚胎活体实验室测试，在测试污染物混合物方面特别有效。测试了TCDD和苯的组合（以及甲苯和苯的组合），并且混合物起了协同作用。这些组合物本身比任何一种化学物的毒性都大。六氯苯和TCDD处理的胚胎对细胞色素P450 1A的表达进行了阳性测试，表明这些早期胚胎中的细胞色素代谢途径已经起作用，并表明该细胞色素系统的产物可能与HCB和TCDD污染相关的心血管缺陷有关。

BACKGROUND & AIMS: BACKGROUND:A detailed appreciation of left atrial/pulmonary vein (LA/PV) anatomy may be important in improving the safety and success of catheter ablation (CA) for atrial fibrillation (AF). OBJECTIVES:The aim of this nonrandomized study was to determine the impact of computerized tomography (CT) image integration into a 3-dimensional (3D) mapping system on the clinical outcome of patients undergoing CA for AF. METHODS:Ninety-four patients (age: 56 +/- 10 years) with AF (paroxysmal 46, persistent 48) underwent wide encirclement of ipsilateral PV pairs using irrigated radiofrequency ablation with the endpoint of electrical isolation. Ablation was guided by 3D mapping alone (electroanatomic 24, noncontact 23) in 47 (3DM group) patients and by CT image integration (Cartomerge) in 47 (CT group). In persistent AF, a combination of linear ablation and targeted ablation of complex fractionated electrograms was also performed. RESULTS:Successful PV electrical isolation did not differ between the two groups. A significant reduction in fluoroscopy times was demonstrated in the CT group (49 +/- 27 minutes vs 3DM group 62 +/- 26 minutes, P = 0.03). Arrhythmia recurrence was reduced in the CT group (32% vs 51% in the 3DM group, P < 0.01). In 30 symptomatic patients (12 CT and 18 3DM), repeat procedures for AF (13 in 3DM and 5 CT, P < or = 0.10) and AT (5 in 3DM and 7 CT, P = NS) were performed. Overall success on 7-day monitor off antiarrhythmic drugs was achieved in 60% in the 3DM group when compared with 83% in the CT group (P < 0.05) at a follow-up of 25 +/- 5 weeks. CONCLUSION:CA for AF guided by CT integration was associated with reduced fluoroscopy times, arrhythmia recurrence, and increased restoration of sinus rhythm. Improved visualization of complex LA geometries might improve the safety and success of CA for AF.

背景与目标： 背景：详细了解左心房/肺静脉（LA / PV）解剖结构对于提高房颤（AF）导管消融（CA）的安全性和成功率可能很重要。
目的：这项非随机研究的目的是确定将计算机断层扫描（CT）图像集成到3维（3D）制图系统中对接受CA房颤的患者的临床结局的影响。
方法：94例房颤（阵发性46例，持续性48例）（年龄56 /-10岁）采用射频消融冲洗并以电隔离为终点，对同侧PV对进行了大包围。 47例（3DM组）患者仅通过3D映射（电解剖学24，非接触式23）进行消融，47例（CT组）通过CT图像积分（Cartomerge）进行消融。在持续性房颤中，还执行了复杂的电描记图的线性消融和靶向消融的组合。
结果：两组之间成功的PV电气隔离没有差异。在CT组中，荧光检查时间显着减少（49 /-27分钟，而3DM组62 /-26分钟，P = 0.03）。 CT组心律失常复发率降低（3DM组为32％，而51％为P <0.01）。在30例有症状的患者中（12 CT和18 3DM），重复进行AF（3DM和5 CT中13例，P <或= 0.10）和AT（3DM和7 CT中5例，P = NS）的重复手术。在25 /-5周的随访中，3DM组60％的抗心律失常药物获得了总体成功，而CT组为83％（P <0.05）。
结论：CT整合引导的房颤CA与减少的透视时间，心律失常的复发和窦性心律的恢复增加有关。改善复杂的LA几何图形的可视化效果可能会提高CA用于AF的安全性和成功性。

BACKGROUND & AIMS: OBJECTIVE:To examine the relationships between the expression of protein Nm23 and surgical stage, histologic grade, histopathologic findings, and survival in women with endometrial carcinoma. METHODS:19 patients with lymph node involvement were matched with 24 patients without lymph node involvement and the best paraffin-embedded blocks were selected for Nm23 immunohistochemical staining. The slides were evaluated semiquantitatively according to their degree of cytoplasmic staining. Statistical analysis was performed to determine whether there was a relationship between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, lymph node metastasis, and/or lymphovascular space involvement. Survival analysis was also performed. RESULTS:Slides from 15 patients (79%) with lymph node involvement and 22 patients (88%) without lymph node involvement were found to be positive for Nm23 (P=0.01). No significant relations were observed between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, or lymphovascular space involvement. Nm23 expression was found to be significantly related to lower rates of lymph node metastasis and longer survival (P=0.02). CONCLUSION:Elevated Nm23 expression is related to lower rates of lymph node metastasis and longer survival.

背景与目标： 目的：探讨Nm23蛋白的表达与子宫内膜癌女性手术分期，组织学分级，组织病理学发现及生存之间的关系。
方法：将19例淋巴结受累患者与24例无淋巴结受累患者进行配对，并选择最佳石蜡包埋块进行Nm23免疫组化染色。根据细胞质染色的程度对玻片进行半定量评估。进行统计分析以确定Nm23表达与手术分期，组织学分级，肌层浸润深度，淋巴结转移和/或淋巴管间隙受累之间是否存在关系。还进行了生存分析。
结果：发现淋巴结受累的15例患者（79％）和无淋巴结受累的22例患者（88％）的玻片Nm23呈阳性（P = 0.01）。 Nm23表达与手术分期，组织学分级，肌层浸润深度或淋巴管间隙受累之间无显着相关性。发现Nm23表达与较低的淋巴结转移率和更长的存活率显着相关（P = 0.02）。
结论：Nm23表达升高与淋巴结转移率降低和生存期延长有关。

BACKGROUND & AIMS: PURPOSE:The subareolar and periareolar injection techniques result in higher detection rates and do not require tumor localization in impalpable lesions when compared with the peritumoral technique. One of the main criticisms, however, is the widely reported inability to detect internal mammary nodes. This contrasts with our clinical experience using Tc-99m antimony sulfur colloid, in which internal mammary nodes are commonly seen. METHODS:A retrospective analysis of 241 patients over 38 months was performed to investigate the ability of our periareolar injection technique to detect internal mammary lymph node drainage in breast cancer sentinel node lymphoscintigraphy. Four injections of 5 to 10 MBq (0.14-0.27 mCi) Tc-99m antimony sulfur colloid were administered on the day of surgery followed by massage and imaging. The radioisotope was suspended in 0.1 mL with a 0.5-mL air lock. Each injection was performed over 2 seconds with a 25-gauge needle at a depth of 1.1 to 1.3 cm. Patients whose records could not be retrieved or who underwent an injection technique apart from periareolar or peritumoral were removed from the analysis. RESULTS:One hundred thirty-three patients underwent the periareolar technique, 72 patients underwent the peritumoral technique, and 36 patients were excluded from the analysis. Internal mammary drainage was seen in 24 of 133 (18.0%) patients, of which 12 (9%) were seen only in the internal mammary chain. This is much higher than previous studies quoting 0.0% to 4.3% and is similar to previously reported rates using the peritumoral technique. CONCLUSIONS:Our periareolar injection technique using Tc-99m antimony sulfur colloid is able to detect internal mammary lymph nodes in at least 18.0% of patients.

背景与目标： 目的：乳晕下和乳晕周围注射技术与肿瘤周围技术相比，具有更高的检出率，并且不需要将肿瘤定位在无法触及的病变中。然而，主要的批评之一是被广泛报道的无法检测内部乳腺淋巴结。这与我们使用Tc-99m锑硫胶体的临床经验形成了鲜明对比，在该经验中，内部乳腺淋巴结很常见。
方法：回顾性分析了241例患者，历时38个月，以探讨我们乳晕周围注射技术在乳腺癌前哨淋巴结显像术中检测内部乳腺淋巴结引流的能力。在手术当天进行四次5至10 MBq（0.14-0.27 mCi）Tc-99m锑硫胶体注射，然后进行按摩和成像。将放射性同位素悬浮在0.5 mL气闸中的0.1 mL中。每次注射都是用25号针在1.1至1.3厘米深度下进行2秒钟。无法检索记录或除了乳晕周围或肿瘤周围进行了注射技术的患者均从分析中剔除。
结果：133例患者接受了乳晕治疗，72例患者接受了肿瘤周围治疗，36例患者被排除在分析之外。 133例患者中有24例（18.0％）出现了内部乳腺引流，其中12例（9％）仅见于内部乳腺链。这比以前的研究（引用0.0％至4.3％）要高得多，并且与先前报道的使用肿瘤周围技术的比率相似。
结论：我们使用Tc-99m锑硫胶体的乳晕周围注射技术能够检测至少18.0％的患者的内部乳腺淋巴结。

BACKGROUND & AIMS: OBJECTIVE:To measure chlamydia testing and positivity rates among 16-39 year olds attending Aboriginal Community Controlled Health Services (ACCHSs). METHODS:Retrospective non-identifiable computerised records containing consultation and chlamydia testing data were collected for patients (16-39 years) attending eight ACCHSs during 2008-09 in urban, regional and remote settings for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) system. Annual chlamydia testing and positivity rates were estimated. RESULTS:Over two years, 13,809 patients aged 16-39 years (57.8% female, 82.3% Aboriginal or Torres Strait Islander) attended. The annual overall chlamydia testing rate was 13.0% (2008) and 16.0% (2009). Testing rates were higher among females (p<0.001) and among patients aged 16-29 than 30-39 years (males: p=0.01; females: p<0.001). Chlamydia positivity was 8.5% overall; similar in females (8.7%) and males (7.8%) (p=0.46); highest among 16-19 years (females: 17.4%; males: 13.0%), declining to 1.5% among females 35-39 years (p<0.001) and 4.8% among males 30-34 years (p<0.001). CONCLUSIONS:Chlamydia testing at these ACCHSs approached recommended levels among some patient groups, however, it should increase. High positivity among younger people highlights they should be targeted. IMPLICATIONS:Young people should be targeted for sexual health interventions. ACCHSs are well placed to provide enhanced sexual health services if appropriately resourced.

背景与目标： 目的：测量参加原住民社区控制健康服务（ACCHS）的16-39岁人群的衣原体检测和阳性率。
方法：收集了2008-09年间在城市，区域和偏远地区参加澳大利亚AC衣原体加强前哨监视协作组织（ACCESS）的八个ACCHS的患者（16-39岁）的回顾性，不可识别的计算机记录，其中包含咨询和衣原体检测数据系统。估计每年的衣原体检测和阳性率。
结果：两年多来，共有13809名年龄在16-39岁之间的患者（女性占57.8％，原住民或托雷斯海峡岛民占82.3％）参加了研究。每年的衣原体总检出率分别为13.0％（2008年）和16.0％（2009年）。女性的测试率较高（p <0.001），年龄在16-29岁的患者的测试率高于30-39岁的男性（男性：p = 0.01；女性：p <0.001）。衣原体阳性率为8.5％。女性（8.7％）和男性（7.8％）相似（p = 0.46）；在16-19岁之间最高（女性：17.4％；男性：13.0％），在35-39岁的女性中下降到1.5％（p <0.001），在30-34岁的男性中下降到4.8％（p <0.001）。
结论：这些ACCHS的衣原体检测在某些患者组中已达到推荐水平，但应增加。年轻人中的高度积极性凸显了他们应该成为目标。
后果：应该针对年轻人进行性健康干预。如果资源适当，ACCHS可以提供​​更好的性健康服务。

BACKGROUND & AIMS: :Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.

背景与目标： ：应用基于g的细胞外造影剂前后，可通过T1映射心血管磁共振（CMR）来测量反映弥漫性心肌纤维化的心肌细胞外体积分数（ECV）。 ECV测量所需的血液和心肌造影剂浓度之间的平衡可通过灌注造影剂（平衡造影剂CMR）获得。我们假设通过单次对比推注也可以达到平衡，以准确测量先天性心脏病（CHD）患者的弥漫性心肌纤维化。前瞻性纳入健康对照组（n = 17）；中位年龄24.0岁； CHD患者（n = 19； 25.0岁）。使用改良的Look-Locker反转恢复T1映射，在推注大剂量，之后15分钟以及在持续输注--DOTA期间，获得了左心室（LV），心室间隔（IVS）的血池和心肌的T1值，右心室（RV）在短心轴或横向方向的单个心室中平面内。仅推注和推注输注的LV，IVS和RV的ECV在CHD患者（分别为r = 0.94、0.95和0.74； p <0.01）和健康对照者（r = 0.96、0.89和0.64； p中显着相关）分别<0.05）。布兰德-奥特曼（Bland-Altman）图显示，任何被分析区域的技术之间均无明显偏差。通过仅推注T1测绘测得的LV和RV心肌的ECV与CHD患者的推注量测量非常吻合。仅推注方法的使用有助于将ECV测量值集成到现有的CMR成像协议中，从而可以在临床常规中评估CHD中弥漫性心肌纤维化。

BACKGROUND & AIMS: :Affinity zones are defined as areas within which air quality displays consistent behaviour over space and time. Constructed using multivariate statistical techniques and physiographic and landscape variables reflecting underlying sources and spatial patterns of air pollution, affinity zones provide a spatial structure suited to exploring the representativity of monitoring networks and as a basis for air pollution mapping and exposure assessment. The affinity zone method is demonstrated using European air pollution monitoring sites, and environmental data compiled within a 1 km GIS. Organised into three main stages, this method involves: (i) indicator selection, using principal components analysis, (ii) zonation by cluster analysis to classify areas into distinct types, and (iii) site allocation, to confirm similarity within affinity zones in terms of monitored air pollution concentrations. Ten interpretable and coherent air pollution affinity zones were constructed for Europe, including two rural zones and eight related to different types of densely populated and built up environments. Concentrations between affinity zones differed significantly for NO(2) background and traffic sites and for PM(10) traffic sites only. Not all zones, however, were found to be sufficiently represented by monitoring sites, illustrating the importance of affinity zones in identifying deficiencies in monitoring networks. Spatial modelling within affinity zones is also demonstrated, showing that simple kriging of background NO(2) concentrations within zones (compared to kriging ignoring zones) produced a ca. 22% reduction in errors and increased R(2) by 0.25 at reserved validation monitoring sites. The affinity zone method developed here is a robust, statistical approach that can be used for evaluating the representativity of routine monitoring networks often used in continental level environmental and health risk assessments.

背景与目标： ：亲和区域定义为空气质量在空间和时间上表现出一致行为的区域。使用多元统计技术以及反映空气污染的潜在来源和空间模式的自然和景观变量构建的亲和力区域提供了一种适合探索监测网络代表性的空间结构，并作为空气污染测绘和暴露评估的基础。使用欧洲空气污染监测站点和在1 km GIS中汇总的环境数据演示了亲和区方法。该方法分为三个主要阶段：（i）使用主成分分析进行指标选择；（ii）通过聚类分析将区域划分为不同类型；以及（iii）站点分配，以确认亲和力区域内的相似性监测的空气污染浓度。欧洲共建立了10个可解释且连贯的空气污染亲和区，其中包括2个农村区和8个与不同类型的人口稠密和密集环境相关的区域。对于NO（2）背景和交通站点以及仅PM（10）交通站点，亲和区之间的浓度差异显着。但是，并不是所有区域都能被监视站点充分代表，这说明了亲和力区域在识别监视网络缺陷中的重要性。还演示了亲和区内的空间建模，表明简单的克里格区域内背景NO（2）浓度的克里格法（与忽略区域的克里格法相比）产生了一个ca。在保留的验证监视站点上，错误减少了22％，R（2）增加了0.25。这里开发的亲和区方法是一种可靠的统计方法，可用于评估经常在大陆级环境和健康风险评估中使用的常规监测网络的代表性。

BACKGROUND & AIMS: :Lymph flow and contraction frequency were measured in popliteal efferent lymphatics. Stimulation of the ipsilateral sympathetic chain resulted in an approximate threefold increase in lymph flow, while contraction frequency increased 28% (n = 6). Occlusion of the metatarsal afferent lymphatics with a pneumatic cuff reduced efferent flow from 18 to 4 microliters/min after 25 min (n = 5), indicating that approximately 80% of popliteal efferent lymph is derived from the foot. After occlusion of the afferent lymphatics, sympathetic stimulation failed to increase efferent lymph flow significantly, while efferent contraction frequency still showed a significant rise. It is concluded that lymph formation in the popliteal node does not contribute to the rise in efferent lymph flow following sympathetic stimulation.

背景与目标： ：测定e神经传出淋巴管中的淋巴流量和收缩频率。同侧交感神经链的刺激导致淋巴流量增加约三倍，而收缩频率增加28％（n = 6）。 25分钟后（n = 5），用气动袖带阻塞meta骨传入淋巴管将传出流量从18微升/分钟降低至4微升/分钟（n = 5），这表明80出传入淋巴管中约有80％来自足部。封堵传入淋巴管后，交感刺激未能显着增加传出淋巴流量，而传出收缩频率仍显示显着升高。结论是，在交感神经刺激下，the淋巴结中的淋巴结形成对传出淋巴液流量的增加没有贡献。

BACKGROUND & AIMS: BACKGROUND:High-risk patients undergoing prophylactic mastectomy (PM) may have unsuspected cancers identified on pathology. The optimum way to identify and manage them is controversial. Magnetic resonance imaging (MRI) may identify occult cancer preoperatively. Sentinel lymph node biopsy (SLNB) allows intraoperative staging and axillary dissection during the same operation. We determined the efficacy and cost of MRI and/or SLNB in managing high-risk PM patients. METHODS:We reviewed 192 PMs in 173 patients from 1999 to 2005. Costs were estimated for MRI and SLNB during PM by the 2005 Medicare Resource-Based Relative Value Scale. We also estimated costs and procedures for the four strategies in a larger hypothetical cohort. RESULTS:A total of 19 (10%) of 192 PMs contained occult cancers, 14 ductal carcinoma-in-situ (DCIS) and 5 invasive ductal carcinoma (IDC). In 59 patients, MRI detected an IDC but missed two DCIS and an IDC. Positive MRIs generated an additional average cost of $1,207 per patient. In 56 PMs with SLNB, 6 occult cancers were found, 5 DCIS and 1 IDC, all with negative SLNBs. Adding a SLNB costs an additional average of $644. A theoretical analysis demonstrated that PM alone costs $808 per patient, PM with SLNB costs $1,420, PM with MRI and selective SLNB costs $1,774, and PM with routine MRI and SLNB costs $2,379. CONCLUSIONS:MRI adds great cost and misses most occult cancers in PMs. SLNB allows the rare patient with occult IDC to avoid axillary dissection but adds cost. Given the low rate of unsuspected invasive cancers and the costs of MRI and SLNB, neither is recommended as standard practice for PM patients.

背景与目标： 背景：进行预防性乳房切除术（PM）的高危患者可能在病理学上发现了未怀疑的癌症。识别和管理它们的最佳方法是有争议的。磁共振成像（MRI）可能会在术前识别隐匿性癌症。前哨淋巴结活检（SLNB）允许在同一手术过程中进行术中分期和腋窝淋巴结清扫术。我们确定了MRI和/或SLNB在治疗高危PM患者中的功效和成本。
方法：我们回顾了1999年至2005年间173例患者的192例PM。根据2005年Medicare基于资源的相对价值量表，对PM期间MRI和SLNB的费用进行了估算。我们还在更大的假设队列中估算了这四种策略的成本和程序。
结果：192例PM中共有19例（10％）包含隐匿性癌，14例原位导管癌和5例浸润性导管癌（IDC）。在59例患者中，MRI检测到一个IDC，但错过了两个DCIS和一个IDC。阳性MRI产生的平均额外费用为每位患者1,207美元。在56例SLNB患者中，发现了6例隐匿性癌症，其中5例DCIS和1例IDC均为SLNB阴性。添加SLNB的平均费用为644美元。理论分析表明，每人每人PM需花费808美元，SLNB的PM需1,420美元，MRI和选择性SLNB的PM需1,774美元，常规MRI和SLNB的PM需2,379美元。
结论：MRI增加了巨大的成本并且错过了PM中大多数隐匿性癌症。 SLNB可使罕见的隐匿性IDC患者避免腋窝淋巴结清扫术，但会增加成本。鉴于未预料到的浸润性癌症的发生率低以及MRI和SLNB的费用，均不建议将其作为PM患者的标准做法。

BACKGROUND & AIMS: OBJECTIVE:This study was undertaken to evaluate the deoxyribonucleic acid content and S-phase fraction in advanced epithelial ovarian carcinomas to determine whether lymph node metastases are biologically distinct from peritoneal sites of metastases.

STUDY DESIGN:Thirty-five patients with stage III or IV epithelial ovarian cancer who had undergone complete pelvic and paraaortic lymphadenectomy had representative samples from the primary ovarian tumor, peritoneal metastases, and lymph node metastases analyzed by flow cytometry for deoxyribonucleic acid nuclear content and S-phase fraction.

RESULTS:Diploid cell lines are found in metastatic lymph nodes (52%) significantly more frequently than in peritoneal metastases (25%, p < 0.02) or in primary ovarian tumors (26%, p < 0.001). The ploidy category frequency distribution of peritoneal metastases mirrors that found in the primary tumor, and both are significantly different from the ploidy category frequency distribution found in metastatic lymph nodes. Heterogeneity among sites is common, being identified in 54% of patients. Peritoneal metastases are more likely to be concordant with the primary tumor (69%) than are lymph node metastases (39%, p < 0.001). Mean S-phase fraction did not differ overall by site but was significantly different between diploid and aneuploid samples by site. Diploid lymph node metastases were found to have the lowest mean S-phase fraction (7.2% +/- 3.3%), and aneuploid lymph node metastases had the highest mean S-phase fraction (22.3% +/- 10.2%). Diploidy of the primary tumor is a positive predictor of long-term survival. Tumoral heterogeneity and lymph node metastases are not related to survival in this group of patients who underwent therapeutic pelvic and aortic lymphadenectomy.

CONCLUSIONS:A high proportion of tumor deposits found in metastatic lymph nodes are diploid with a low S-phase fraction. Therapeutic pelvic and aortic lymph node dissection removes disease that, on the basis of flow cytometric characteristics, may be predicted to be resistant to chemotherapy and radiation therapy.

背景与目标： 目的：这项研究旨在评估晚期上皮性卵巢癌中脱氧核糖核酸的含量和S期分数，以确定淋巴结转移是否在生物学上与转移的腹膜部位不同。

研究设计：35名经过完全盆腔和主动脉旁淋巴结清扫术的III或IV期上皮性卵巢癌患者的代表性样本来自原发性卵巢肿瘤，腹膜转移和淋巴结转移，并通过流式细胞术进行了分析

结果：在转移性淋巴结中发现二倍体细胞系（52％）的频率比在腹膜转移中（25％， p <0.02）或原发性卵巢肿瘤（26％，p <0.001）。腹膜转移瘤的倍性类别频率分布反映在原发性肿瘤中，并且两者均与转移性淋巴结中的倍性类别频率分布明显不同。部位之间的异质性很常见，在54％的患者中被发现。与淋巴结转移（39％，p <0.001）相比，腹膜转移更可能与原发肿瘤一致（69％）。平均S相分数在各部位之间总体上没有差异，但在二倍体和非整倍体样品之间，按部位存在显着差异。发现二倍体淋巴结转移的平均S期分数最低（7.2％/-3.3％），非整倍体淋巴结转移的平均S期分数最高（22.3％/-10.2％）。原发肿瘤的二倍体是长期生存的积极预测指标。该组接受盆腔和主动脉淋巴结清扫术的患者的肿瘤异质性和淋巴结转移与生存率无关。

结论：转移性淋巴结中发现大量肿瘤沉积物是具有低S相分数的二倍体。治疗性骨盆和主动脉淋巴结清扫术可根除流式细胞术特征可预测对化疗和放疗有抗药性的疾病。