Breast surgery after neoadjuvant chemotherapy in patients with lobular carcinoma: surgical and oncologic outcome.

INTRODUCTION: Breast cancer patients with invasive lobular carcinoma (ILC) have an increased risk of positive margins after surgery and often show little response to neoadjuvant chemotherapy (NAC). We aimed to investigate surgical outcomes in patients with ILC treated with NAC. METHODS: In this retrospective cohort study, all breast cancer patients with ILC treated with NAC who underwent surgery at the Netherlands Cancer Institute from 2010 to 2019 were selected. Patients with mixed type ILC in pre-NAC biopsies were excluded if the lobular component was not confirmed in the surgical specimen. Main outcomes were tumor-positive margins and re-excision rate. Associations between baseline characteristics and tumor-positive margins were assessed, as were complications, locoregional recurrence rate (LRR), recurrence-free survival (RFS), and overall survival (OS). RESULTS: We included 191 patients. After NAC, 107 (56%) patients had breast conserving surgery (BCS) and 84 (44%) patients underwent mastectomy. Tumor-positive margins were observed in 67 (35%) patients. Fifty five (51%) had BCS and 12 (14%) underwent mastectomy (p value < 0.001). Re-excision was performed in 35 (33%) patients with BCS and in 4 (5%) patients with mastectomy. Definitive surgery was mastectomy in 107 (56%) patients and BCS in 84 (44%) patients. Tumor-positive margins were associated with cT ≥ 3 status (OR 4.62, 95% CI 1.26-16.98, p value 0.021) in the BCS group. Five-year LRR (4.7%), RFS (81%), and OS (93%) were not affected by type of surgery after NAC. CONCLUSION: Although 33% of ILC breast cancer patients undergoing BCS after NAC required re-excision for positive resection margins, it is considered safe given that five-year RFS remained excellent and LRR and OS did not differ by extent of surgery.

Clinical impact of MRI-detected additional lesions in breast cancer patients with neoadjuvant systemic therapy at the Netherlands cancer institute.

BACKGROUND: In breast cancer patients treated with neoadjuvant systemic therapy (NST), MRI is used pre- and post-NST for response monitoring. The relevance of additional MRI-detected lesions in these patients is unclear. Therefore, we aimed to assess the impact of pre-NST MRI-detected additional lesions on surgical treatment and outcome. METHODS: We retrospectively selected all early-stage breast cancer patients with MRI pre-NST at our institute from January 2010-2015. MRI-detected lesions were defined as separated from the index tumor and occult at conventional mammography and ultrasound. Outcomes were change in surgical treatment and five-year recurrence-free and overall survival. RESULTS: Overall, MRI detected additional lesions in 206 (31%) of 656 patients: in 160 patients in the ipsilateral breast and in 78 contralateral breasts, including 32 bilateral cases. Ipsilateral lesions were mostly categorized BI-RADS 5 (54 %) and contralateral lesions BI-RADS 3 (64%). Targeted ultrasound was performed in 115 (56%) patients: in 70 ipsilateral and in 64 contralateral cases. Biopsy was obtained in 44 (28% of 160) ipsilateral and 50 (64% of 78) contralateral breasts, containing tumor foci in 20 (13% of 160) and 11 (14% of 78) cases, respectively. Surgical treatment changed in 54 (26% of 206) patients: 19 (9%) had mastectomy, 24 (12%) had wider local excision and 11 (5%) underwent contralateral surgery. Five-year recurrence-free and overall survival did not differ for patients with local excision or mastectomy. CONCLUSION: Pre-NST MRI-detected additional lesions in 31% of patients, resulting in more extensive surgery in 26% of these patients, including 5% contralateral surgeries.

Immediate or delayed oncoplastic surgery after breast conserving surgery at the Netherlands Cancer Institute: a cohort study of 251 cases.

PURPOSE: Oncoplastic surgery (OPS) after breast conserving surgery is preferably performed during the same operation. Offering delayed OPS instead of mastectomy to patients with a high risk of tumor-positive margins allows breast conservation with the option of margin re-excision during OPS, without having to dismantle the reconstruction. We aimed to evaluate surgical outcomes after immediate and delayed OPS. METHODS: We included early-stage breast cancer patients who underwent OPS at the Netherlands Cancer Institute between 2016 and 2019. Patients were selected for delayed OPS after multidisciplinary consultation if the risk of tumor-positive margins with immediate OPS was considered significant (> 30%). Groups were compared on baseline characteristics and short-term surgical outcomes. RESULTS: Of 242 patients with 251 OPS, 130 (52%) OPS had neoadjuvant chemotherapy. Immediate OPS was performed in 176 (70%) cases and delayed OPS in 76 (30%). Selection for delayed OPS was associated with tumor size (OR 1.03, 95% CI 1.01-1.04), ILC (OR 2.61, 95% CI 1.10-6.20), DCIS (OR 3.45, 95% CI 1.42-8.34) and bra size (OR 0.76, 95% CI 0.62-0.94). Delayed and immediate OPS differed in tissue weight (54 vs. 67 g, p = 0.034), tissue replacement (51% vs. 26%, p < .001) and tumor-positive margins (66% vs. 18%, p < .001). Re-excision was performed in 48 (63%) delayed OPS and in 11 (6%) immediate OPS. Groups did not differ in complications (21% vs. 18%, p = 0.333). Breast conservation after immediate and delayed OPS was 98% and 93%, respectively. CONCLUSION: Performing delayed OPS in selected cases facilitated simultaneous margin re-excision without increasing complications, and resulted in an excellent breast conservation rate.

Biopsy-Guided Pathological Response Assessment in Breast Cancer is Insufficient: Additional Pathology Findings of the MICRA Trial.

BACKGROUND: Neoadjuvant systemic treatment (NST) leads to pathologic complete response (pCR) in 10-89% of breast cancer patients depending on subtype. The added value of surgery is uncertain in patients who reach pCR; however, current imaging and biopsy techniques aiming to predict pCR are not accurate enough. This study aims to quantify the residual disease remaining after NST in patients with a favorable response on MRI and residual disease missed with biopsies. METHODS: In the MICRA trial, patients with a favorable response to NST on MRI underwent ultrasound-guided post-NST 14G biopsies followed by surgery. We analyzed pathology reports of the biopsies and the surgical specimens. Primary outcome was the extent of residual invasive disease among molecular subtypes, and secondary outcome was the extent of missed residual invasive disease. RESULTS: We included 167 patients. Surgical specimen showed residual invasive disease in 69 (41%) patients. The median size of residual invasive disease was 18 mm (interquartile range [IQR] 12-30) in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) patients, 8 mm (IQR 3-15) in HR+/HER2-positive (HER2+) patients, 4 mm (IQR 2-9) in HR-negative (HR-)/HER2+ patients, and 5 mm (IQR 2-11) in triple-negative (TN) patients. Residual invasive disease was missed in all subtypes varying from 4 to 7 mm. CONCLUSION: Although the extent of residual invasive disease is small in TN and HER2+ subtypes, substantial residual invasive disease is left behind in all subtypes with 14G biopsies. This may hamper local control and limits adjuvant systemic treatment options. Therefore, surgical excision remains obligatory until accuracy of imaging and biopsy techniques improve.

Three-year follow-up of de-escalated axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer: the MARI-protocol.

PURPOSE: In clinically node-positive (cN+) breast cancer patients, evidence supporting response-guided treatment after neoadjuvant systemic therapy (NST) instead of axillary lymph node dissection (ALND) is increasing, but follow-up results are lacking. We assessed three-year axillary recurrence-free interval (aRFI) in cN+ patients with response-adjusted axillary treatment according to the 'Marking Axillary lymph nodes with Radioactive Iodine seeds' (MARI)-protocol. METHODS: We retrospectively assessed all stage II-III cytologically proven cN+ breast cancer patients who underwent the MARI-protocol between July 2014 and November 2018. Pre-NST axillary staging with FDG-PET/CT (less- or more than four suspicious axillary nodes; cALN < 4 or cALN ≥ 4) and post-NST pathological axillary response measured in the pre-NST largest tumor-positive axillary lymph node marked with an iodine seed (MARI-node; ypMARI-neg or ypMARI-pos) determined axillary treatment: no further treatment (cALN < 4, ypMARI-neg), axillary radiotherapy (ART) (cALN < 4, ypMARI-pos and cALN ≥ 4, ypMARI-neg) or ALND plus ART (cALN ≥ 4, ypMARI-pos). RESULTS: Of 272 women included, the MARI-node was tumor-negative in 56 (32%) of 174 cALN < 4 patients and 43 (44%) of 98 cALN ≥ 4 patients. According to protocol, 56 (21%) patients received no further axillary treatment, 161 (59%) received ART and 55 (20%) received ALND plus ART. Median follow-up was 3.0 years (IQR 1.9-4.1). Five patients (one no further treatment, four ART) had axillary metastases. Three-year aRFI was 98% (95% CI 96-100). The overall recurrence risk remained highest for patients with ALND (HR 4.36; 95% CI 0.95-20.04, p = 0.059). CONCLUSIONS: De-escalation of axillary treatment according to the MARI-protocol prevented ALND in 80% of cN+ patients with an excellent three-year aRFI of 98%.

Cerrado deforestation threatens regional climate and water availability for agriculture and ecosystems.

The Brazilian Cerrado is one of the most biodiverse savannas in the world, yet 46% of its original cover has been cleared to make way for crops and pastures. These extensive land-use transitions (LUTs) are expected to influence regional climate by reducing evapotranspiration (ET), increasing land surface temperature (LST), and ultimately reducing precipitation. Here, we quantify the impacts of LUTs on ET and LST in the Cerrado by combining MODIS satellite data with annual land use and land cover maps from 2006 to 2019. We performed regression analyses to quantify the effects of six common LUTs on ET and LST across the entire gradient of Cerrado landscapes. Results indicate that clearing forests for cropland or pasture increased average LST by ~3.5°C and reduced mean annual ET by 44% and 39%, respectively. Transitions from woody savannas to cropland or pasture increased average LST by 1.9°C and reduced mean annual ET by 27% and 21%, respectively. Converting native grasslands to cropland or pasture increased average LST by 0.9 and 0.6°C, respectively. Conversely, grassland-to-pasture transitions increased mean annual ET by 15%. To date, land changes have caused a 10% reduction in water recycled to the atmosphere annually and a 0.9°C increase in average LST across the biome, compared to the historic baseline under native vegetation. Global climate changes from increased atmospheric greenhouse gas concentrations will only exacerbate these effects. Considering potential future scenarios, we found that abandoning deforestation control policies or allowing legal deforestation to continue (at least 28.4 Mha) would further reduce yearly ET (by -9% and -3%, respectively) and increase average LST (by +0.7 and +0.3°C, respectively) by 2050. In contrast, policies encouraging zero deforestation and restoration of the 5.2 Mha of illegally deforested areas would partially offset the warming and drying impacts of land-use change.

O Cerrado brasileiro é uma das savanas mais biodiversas do mundo. Apesar disso, 46% da sua cobertura original foi desmatada para dar lugar a cultivos agrícolas e pastos. Estas extensas transições de uso do solo (LUT) têm o potencial de influenciar o clima regional, reduzindo a evapotranspiração (ET), aumentando a temperatura da superfície terrestre (LST) e por fim reduzindo a precipitação. O objetivo deste estudo foi quantificar os impactos de LUTs sobre ET e LST no Cerrado, combinando dados do satélite MODIS com mapas anuais de uso e cobertura do solo de 2006-2019. Foram realizadas análises de regressão para quantificar os efeitos de seis LUTs usuais sobre ET e LST, ao longo de todo o gradiente de paisagens do Cerrado. Os resultados indicaram que a retirada de florestas para dar lugar à agricultura ou pastagem aumentou a LST média em ~3.5°C e reduziu a ET média anual em 44% e 39%, respectivamente. Transições de formações savânicas para agricultura ou pastagem aumentaram a LST média em 1.9°C e reduziram a ET média anual em 27% e 21%, respectivamente. A conversão de campos nativos para agricultura ou pastagem aumentou a LST média em 0.9 e 0.6°C, respectivamente. Em contrapartida, transições de formações campestres nativas para pastagens aumentaram a ET média anual em 15%. Até o momento, as mudanças de uso do solo causaram redução de 10% da água reciclada para a atmosfera anualmente e aumento de 0.9°C da LST média ao longo do bioma, em comparação com a linha de base histórica sob vegetação nativa. As mudanças climáticas globais decorrentes do aumento das concentrações atmosféricas de gases do efeito estufa irão exacerbar esses efeitos. Considerando potenciais cenários futuros, observou-se que o abandono das políticas de controle do desmatamento ou o avanço do desmatamento legal (ao menos 28.4 Mha) reduziriam a ET anual (em −9% e −3%, respectivamente) e aumentariam a LST média (em +0.7 e +0.3ºC, respectivamente) até 2050. Por outro lado, políticas que promovam desmatamento zero e restauração dos 5.2 Mha de áreas ilegalmente desmatadas compensariam parte dos impactos de aquecimento e seca causados por alterações de uso do solo.

Minimally Invasive Complete Response Assessment of the Breast After Neoadjuvant Systemic Therapy for Early Breast Cancer (MICRA trial): Interim Analysis of a Multicenter Observational Cohort Study.

BACKGROUND: The added value of surgery in breast cancer patients with pathological complete response (pCR) after neoadjuvant systemic therapy (NST) is uncertain. The accuracy of imaging identifying pCR for omission of surgery, however, is insufficient. We investigated the accuracy of ultrasound-guided biopsies identifying breast pCR (ypT0) after NST in patients with radiological partial (rPR) or complete response (rCR) on MRI. METHODS: We performed a multicenter, prospective single-arm study in three Dutch hospitals. Patients with T1-4(N0 or N +) breast cancer with MRI rPR and enhancement ≤ 2.0 cm or MRI rCR after NST were enrolled. Eight ultrasound-guided 14-G core biopsies were obtained in the operating room before surgery close to the marker placed centrally in the tumor area at diagnosis (no attempt was made to remove the marker), and compared with the surgical specimen of the breast. Primary outcome was the false-negative rate (FNR). RESULTS: Between April 2016 and June 2019, 202 patients fulfilled eligibility criteria. Pre-surgical biopsies were obtained in 167 patients, of whom 136 had rCR and 31 had rPR on MRI. Forty-three (26%) tumors were hormone receptor (HR)-positive/HER2-negative, 64 (38%) were HER2-positive, and 60 (36%) were triple-negative. Eighty-nine patients had pCR (53%; 95% CI 45-61) and 78 had residual disease. Biopsies were false-negative in 29 (37%; 95% CI 27-49) of 78 patients. The multivariable associated with false-negative biopsies was rCR (FNR 47%; OR 9.81, 95% CI 1.72-55.89; p = 0.01); a trend was observed for HR-negative tumors (FNR 71% in HER2-positive and 55% in triple-negative tumors; OR 4.55, 95% CI 0.95-21.73; p = 0.058) and smaller pathological lesions (6 mm vs 15 mm; OR 0.93, 95% CI 0.87-1.00; p = 0.051). CONCLUSION: The MICRA trial showed that ultrasound-guided core biopsies are not accurate enough to identify breast pCR in patients with good response on MRI after NST. Therefore, breast surgery cannot safely be omitted relying on the results of core biopsies in these patients.

Internal Mammary Chain Sentinel Nodes in Early-Stage Breast Cancer Patients: Toward Selective Removal.

BACKGROUND: Removal of internal mammary chain sentinel nodes (IMCSNs) affects prognosis and treatment of breast cancer, and internal mammary chain radiotherapy (IMCRT) can improve survival for selected patients. This study aimed to determine the effect of IMCSN biopsy on recurrence-free survival (RFS) and overall survival (OS) and to identify predictive factors for IMCSN and distant metastasis. METHODS: Patients with IMCSNs were selected from a prospective database for the period 1999-2007. Lymphoscintigraphy was performed after intratumoral technetium-99 m injection, and all sentinel nodes were removed. Both RFS and OS were calculated for subgroups with tumor-positive, tumor-negative, or non-removed IMCSNs. Predictive factors were identified for tumor-positive IMCSNs and distant metastasis by regression analysis. RESULTS: For 287 (85%) of 336 patients, IMCSN biopsy was performed, and metastasis was detected in 38 patients (13%). The patients with tumor-positive IMCSNs had poorer OS than the patients with no IMCSN metastasis or non-removed IMCSNs (p = 0.002). These patients also had worse RFS due to distant metastasis (p = 0.002). Axillary metastasis was predictive for tumor-positive IMCSNs (positive predictive value, 38.5%). The predictive factors for distant metastasis were tumor-positive IMCSNs (hazard ratio [HR], 2.5), non-removed IMCSNs (HR, 2.3), tumor diameter greater than 1.5 cm (HR, 3.5), and age older than 65 years (HR, 3.1; reference, < 50 years). CONCLUSIONS: Patients with IMCSNs have worse survival due to distant metastasis. The clinically relevant predictive factor for distant metastasis is tumor larger than 1.5 cm. According to the authors' current protocol, IMCSN biopsy is performed for patients younger than 70 years who have a tumor larger than 1.5 cm, with the cardiotoxicity of the adjuvant IMCRT weighed against the survival benefit.

Cerrado ecoregions: A spatial framework to assess and prioritize Brazilian savanna environmental diversity for conservation.

The Brazilian Cerrado is the second largest biome in Latin America, extending over more than 200 million ha and hosts some of the most intensive agricultural activities for grain and beef production in the world. Because of the biodiversity richness and high levels of endemism, Cerrado is considered one of world's hotspot for biodiversity conservation. The objectives of this study are three-fold: to present a comprehensive division of Cerrado into different ecoregions that reflect the environmental heterogeneity within the biome; to analyze the ecoregions in terms of biophysical characteristics, protected areas, environmental liability in riparian permanent protection areas along watercourses, and priorities for biodiversity conservation; and to rank the ecoregions in terms of endangerment for biodiversity conservation and restoration. A previous study that delineated 22 ecoregions using geomorphology, vegetation, soil, geology, and plant diversity maps was revised using topography, vegetation, precipitation, and soil maps. Our new ecoregion map consists of 19 units that are unique in terms of landscape characteristics and has been adjusted to the current official boundary map of Cerrado. Some of the ecoregions consist of only one geomorphological compartment, whereas others are heterogeneous, consisting of up to eight compartments. Ferralsols comprise the dominant soil type in 14 of the ecoregions. The percentage of protected areas within ecoregions ranges from 1.7% to 51.5%. The most endangered ecoregion, where land use change critically threatens habitat integrity, is the Depressão Cárstica do São Francisco (states of Bahia, Minas Gerais, and Piauí), where environmental liability along riparian permanent protection areas amounts to 85.6% of the total area. Our proposed ecoregion map provides a spatial framework for regional and local assessments to improve decision-making processes to reconcile conservation and restoration planning, sustainable agriculture, and provision of ecosystem services. Besides de adjustment of the previous Cerrado's ecoregion map to the official biome boundary (relevant for the implementation of public policies of conservation as those regulated by the Brazilian Forest Code), the new analyses of the ecoregion map represent a substantial improvement in comparison to the ones conducted by the previous study in 2003. In addition, current web resources allow us to make all the information used or derived from this study available to other users. This opens the possibility of additional improvements of our findings by the scientific community or to be used effectively by decision makers.

The Need for a New Cut-off Value to Increase Diagnostic Performance of Bioelectrical Impedance Analysis Compared with Dual-Energy X-ray Absorptiometry to Measure Muscle Mass in Indonesian Elderly.

BACKGROUND: the use of bioelectrical impedance analysis (BIA) is affected by the population setting, the type of BIA, and the cut-off point being used. The aim of this study was to determine the diagnostic performance of BIA to measure muscle mass in Indonesian elderly outpatients aged 60 years or more. METHODS: a cross-sectional study was conducted at the Geriatric Clinic of Cipto Mangunkusumo Hospital from April to June 2018. The muscle mass was measured using BIA Tanita MC-780MA (Tokyo, Japan) with dual-energy x-ray absorptiometry (DXA) as the reference test. Analysis on the cut-off point was performed based on the Asian Working Group of Sarcopenia (AWGS) criteria and the new cut-off point. RESULTS: from 120 subjects, 74 were female (61.7%). The diagnostic performance of BIA based on AWGS criteria only showed sensitivity and specificity of 79.2% and 66.7%. The diagnostic performance of BIA based on the new cut-off point showed sensitivity and specificity of 75% and 92.7%. The new cut-off point using BIA was found to be <6.9 kg/m2 in males (sensitivity 70.6%; specificity 82.8%) and <5 kg/m2 in females (sensitivity 85.7%; specificity 97%). CONCLUSION: the diagnostic performance of BIA Tanita MC-780MA (Tokyo, Japan) was good to measure muscle mass in Indonesian elderly outpatients using a new cut-off point of <6.9 kg/m2 for males and <5 kg/m2 for females.

Diagnostic Performance of Calf Circumference, Thigh Circumference, and SARC-F Questionnaire to Identify Sarcopenia in Elderly Compared to Asian Working Group for Sarcopenia's Diagnostic Standard.

BACKGROUND: sarcopenia is one of many geriatric problems that may lead to major clinical outcomes. Calf and thigh circumference have good correlation with muscle mass, whereas SARC-F questionnaire is very predictive of muscle function. There has not been a study that evaluates the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire in detecting sarcopenia. The aim of this study was to investigate the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire compared to standard diagnostic methods of sarcopenia according to the Asian Working Group for Sarcopenia (AWGS) to predict sarcopenia in patient aged 60 years or older. METHODS: this cross-sectional study was conducted in Geriatric Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia during April-June 2018. Analysis was performed using receiver operating characteristic (ROC) curve to determine the cut-off point as well as sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR+ and LR-) of calf and thigh circumference as an indicator of low muscle mass, and SARC-F questionnaire score to detect decreased muscle function. RESULTS: from 120 participants, there were 46 men (38.3%) and 74 women (61.7%). The combination of calf circumference with cut-off point below 34 cm in men and below 29 cm in women, thigh circumference below 49 cm in men and below 44 cm in women with SARC-F questionnaire score of ≥4 have Sn, Sp, PPV, NPV, LR+, and LR- of 15.79%; 99.01%; 75.00%; 86.21%; 15.95; and 0.85 respectively. CONCLUSION: combination of calf and thigh circumference with SARC-F questionnaire showed good diagnostic accuracy in predicting sarcopenia in elderly outpatients.

Digestion in adult females of the leaf-footed bug Leptoglossus zonatus (Hemiptera: Coreidae) with emphasis on the glycoside hydrolases α-amylase, α-galactosidase, and α-glucosidase.

The leaffooted bug, Leptoglossus zonatus (Hemiptera: Coreidae) is an emerging pest of several crops around the World and up to now very little is known of its digestive system. In this article, glycoside hydrolase (carbohydrase) activities in the adult midgut cells and in the luminal contents of L. zonatus adult females were studied. The results showed the distribution of digestive carbohydrases in adults of this heteropteran species in the different intestinal compartments. Determination of the spatial distribution of α-glucosidase activity in L. zonatus midgut showed only one major molecular form, which was not equally distributed between soluble and membrane-bound isoforms, being more abundant as a membrane-bound enzyme. The majority of digestive carbohydrases were found in the soluble fractions. Activities against starch, maltose and the synthetic substrate NPαGlu were found to show the highest levels of activity, followed by enzymes active against galactosyl oligosaccharides. Based on ion-exchange chromatography elution profiles and banding patterns in mildly denaturing electrophoresis, both midgut α-amylases and α-galactosidases showed at least two isoforms. The data suggested that the majority of carbohydrases involved in initial digestion were present in the midgut lumen, whereas final digestion of starch and of galactosyl oligosaccharides takes place partially within the lumen and partially at the cell surface. The complex of carbohydrases here described was qualitatively appropriate for the digestion of free oligosaccharides and oligomaltodextrins released by α-amylases acting on maize seed starch granules.

Synthesis of lignin-based carbon/graphene oxide foam and its application as sensors for ammonia gas detection.

The present study highlights the integration of lignin with graphene oxide (GO) and its reduced form (rGO) as a significant advancement within the bio-based products industry. Lignin-phenol-formaldehyde (LPF) resin is used as a carbon source in polyurethane foams, with the addition of 1 %, 2 %, and 4 % of GO and rGO to produce carbon structures thus producing carbon foams (CFs). Two conversion routes are assessed: (i) direct addition with rGO solution, and (ii) GO reduction by heat treatment. Carbon foams are characterized by thermal, structural, and morphological analysis, alongside an assessment of their electrochemical behavior. The thermal decomposition of samples with GO is like those having rGO, indicating the effective removal of oxygen groups in GO by carbonization. The addition of GO and rGO significantly improved the electrochemical properties of CF, with the GO2% sensors displaying 39 % and 62 % larger electroactive area than control and rGO2% sensors, respectively. Furthermore, there is a significant electron transfer improvement in GO sensors, demonstrating a promising potential for ammonia detection. Detailed structural and performance analysis highlights the significant enhancement in electrochemical properties, paving the way for the development of advanced sensors for gas detection, particularly ammonia, with the prospective market demands for durable, simple, cost-effective, and efficient devices.

Improvement of UV stability of thermoplastic starch matrix by addition of selected lignin fraction - Photooxidative degradation.

This paper examines the additivation of thermoplastic starch (TPS) matrix by selected fractions of kraft lignin (KL) and correlates its structure-performance when exposed to photooxidative degradation. KL from Eucalyptus urograndis wood was refined by a sequential fractionation process in ethyl acetate (EtOAc). Films were prepared by mixing lignin fractions as additive in TPS matrix by casting and pressing. The lignin employed were KL, fraction of KL insoluble in EtOAc (INS) and fraction of KL soluble in EtOAc (SOL). The samples were exposed to accelerated aging with Ultraviolet-C light (UV-C) for 432 h. Structural changes were measured by FTIR (Fourier-Transform Infrared) spectra. Thermal properties, such as melting enthalpy, glass transition temperature and thermal decomposition, were evaluated by DSC (Differential Scanning Calorimetry) and TG (Thermogravimetry). Morphology of the films was obtained by SEM (Scanning Electron Microscopy). Surface property of wettability was measured by contact angle. Mechanical properties were explored before and after exposure to UV-C light. It was observed that the least photodegraded films were those resulting from the addition of the lignin fraction with higher phenolic hydroxyl group content. According to structural and morphological observations, the soluble fraction (TSOL) presented the highest photoprotection and stabilizing effect as an UV-C light blocker additive on TPS matrix.

Clinical impact of molecular breast imaging as adjunct diagnostic modality in evaluation of indeterminate breast abnormalities and unresolved diagnostic concerns.

PURPOSE: Improvements in molecular breast imaging (MBI) have increased the use of MBI as adjunct diagnostic modality and alternative to MRI. We aimed to assess the value of MBI in patients with equivocal breast lesions on conventional imaging, especially in terms of its ability to rule out malignancy. METHODS: We selected patients who underwent MBI in addition to conventional diagnostics due to equivocal breast lesions between 2012 and 2015. All patients underwent digital mammography, target ultrasound and MBI. MBI was performed using a single-head Dilon 6800 gamma camera after administration of 600 MBq 99m Tc-sestamibi. Imaging was reported according to BI-RADS classification and compared with pathology or follow-up of ≥6 months. RESULTS: Of 226 women included, pathology was obtained in 106 (47%) and (pre)malignant lesions were found in 25 (11%). Median follow-up was 5.4 years (IQR 3.9-7.1). Sensitivity was higher for MBI compared to conventional diagnostics (84% vs. 32%; P = 0.002), identifying malignancy in 21 and 6 patients, respectively, but specificity did not differ (86% vs. 81%; P = 0.161). Positive and negative predictive value were 43% and 98% for MBI and 17% and 91% for conventional diagnostics. MBI was discordant with conventional diagnostics in 68 (30%) patients and correctly changed diagnosis in 46 (20%) patients, identifying 15 malignant lesions. In subgroups with nipple discharge ( N = 42) and BI-RADS 3 lesions ( N = 113) MBI detected 7 of 8 occult malignancies. CONCLUSION: MBI correctly adjusted treatment in 20% of patients with diagnostic concerns after conventional work-up, and could rule out malignancy with a high negative predictive value of 98%.

[18F]FDG-PET/CT in prone compared to supine position for optimal axillary staging and treatment in clinically node-positive breast cancer patients with neoadjuvant systemic therapy.

PURPOSE: Axillary staging before neoadjuvant systemic therapy in clinically node-positive breast cancer patients with tailored axillary treatment according to the Marking Axillary lymph nodes with radioactive iodine seeds (MARI)-protocol, a protocol developed at the Netherlands Cancer Institute, is performed with [18F] fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT). We aimed to assess the value of FDG-PET/CT in prone compared to standard supine position for axillary staging. METHODS: We selected patients with FDG-PET/CT in supine and prone position who underwent the MARI-protocol. One hour after administration of 3.5 MBq/kg, [18F]FDG-PET was performed with a low-dose prone position CT-thorax followed by a supine whole-body scan. Scans were separately reviewed by two nuclear medicine physicians and categorized by number of FDG-positive axillary lymph nodes (ALNs; cALN<4 or cALN≥4). Main outcome was axillary up- or downstaging. RESULTS: Of 153 patients included, 24 (16%) patients were up- or downstaged at evaluation of prone images: One observer upstaged 14 patients, downstaged 3  patients and reported a higher number of ALNs (3.6 vs. 3.2, p < 0.001), while staging (4 up- and 5 downstaged) and number of ALNs (2.8 vs. 2.8) did not differ for the other. Observers agreed on up- or downstaging in only 1 (1%) patient. Irrespective of supine or prone position scanning, observers agreed on axillary staging in 124 (81%) patients and disagreed in 5 (3%). Interobserver agreement was lower with prone assessments (86%, K = 0.67) than supine (92%, K = 0.80). CONCLUSIONS: Axillary staging with FDG-PET/CT in prone compared to supine position did not result in concordant up- or downstaging. Therefore, FDG-PET/CT in supine position only can be considered sufficient for axillary staging.

Improvements in thermal and mechanical properties of composites based on thermoplastic starch and Kraft Lignin.

Thermoplastic starch (TPS) is a widely studied biopolymer as an alternative to the use of conventional polymers. In this sense, the incorporation of fillers or reinforcements coming preferably from other substances of natural origin, can be an alternative to try to improve some mechanical and thermal properties of starch polymers. Thus, Kraft Lignin (KL), can be an excellent filler to be incorporated, since it presents mechanical and thermal properties and reduces the cost and weight of the final compounds. TPS films were prepared by casting using dimethyl sulfoxide (DMSO) as solvent and additives with 2, 4 and 8% KL. Characterization of TPS films and compositions with KL were carried out by Fourier-Transform Infrared Spectroscopy (FT-IR), Scanning Electron Microscope (SEM), Thermogravimetric Analysis (TGA), Dynamic Thermomechanical Analysis (DMTA), tensile testing and contact angle. Samples were also analyzed for biodegradation and for the ability to remove contaminants in water, Metil Orange (MO), by Ultraviolet-Visible Spectroscopy (UV-Vis). The FT-IR spectra of the films showed bands typical of functional groups derived from starch and lignin, with the intensity of these bands varying among the samples studied. Micrographs revealed slightly different morphologies among the films, but all showed irregular shapes with structures that appeared as plots. Increasing the percentage of KL led to an increase in contact angle values, showing a more hydrophobic behavior. In the TGA analysis, it was possible to observe a change in the main degradation event of the films for lower temperatures, especially of TPS - 4 and 8% KL compared to the TPS film. Films with KL had the peak of maximum degradation shifted to temperatures below the starch film, where the decrease in intensity of the main peak in the TPS - 4% KL and TPS - 8% KL samples demonstrates that there was less mass loss in the event. There was also in the percentage of residue as the addition of KL was increased The DMTA analyses allowed for the conclusion that presence of KL in TPS film allowed for an increase in its energy storage property, and that the loss modulus followed a decreasing order of storage modulus values to TPS - 8% KL from TPS. For the tensile strength property only TPS - 4% KL has significant improvement, and the elongation at break showed an increase for TPS - 4 and 8% KL compared to TPS. Samples showed a continuous and progressive biodegradation process, being completely biodegraded within 10 days. The monitoring of the ability to remove contaminants from water by UV-Vis, also showed promising results of compounds for this application. The best results were obtained, in most tests, for the TPS- 4% KL films.