Superparamagnetic iron oxide nanoparticles as the sole method for sentinel node biopsy detection in patients with breast cancer.

BACKGROUND: Sentinel node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles is a novel method in breast cancer. Several studies have verified the non-inferiority of SPIO compared with the standard use of radioisotope 99m Tc with or without blue dye. The aim of the MONOS study presented here was to evaluate the use of SPIO as a sole tracer and the efficacy of tracer injection in the preoperative setting. METHODS: This prospective cohort study was carried out in two hospitals, one using 99m Tc and the other SPIO. 99m Tc was injected in the morning of the day of surgery or the day before. SPIO was either injected before surgery in the outpatient clinic or 1 h before the operation. RESULTS: A total of 338 consecutive patients with breast cancer underwent 343 procedures; SPIO nanoparticles were used in 184 procedures and 99m Tc-labelled tracer in 159. Detection rates for SPIO and 99m Tc were 95·6 and 96·9 per cent respectively (P = 0·537). All nodes with SPIO uptake were coloured brown. Fewer nodes were retrieved with SPIO (mean 1·35 versus 1·89), regardless of whether blue dye was used (P < 0·001). Preoperative SPIO injection (58·7 per cent of procedures), a median of 16 (range 2-27) days before the procedure, was associated with a better tracer-specific detection rate (95·3 versus 86 per cent; P = 0·031) and retrieval of more nodes (mean 1·43 versus 1·03; P < 0·001) than perioperative administration. Skin staining was present in 39·9 per cent of patients, and was related to breast-conserving surgery and periareolar injection. CONCLUSION: The use of SPIO alone is a safe alternative, with results comparable to those of the standard dual technique using 99m Tc and blue dye. The efficacy of injection in the preoperative setting simplifies logistics and improves performance. Skin staining can be prevented by a deeper peritumoral injection.

Clinical signs of fibrosis in small intestinal neuroendocrine tumours.

BACKGROUND: In patients with small intestinal neuroendocrine tumours (SI-NETs), serotonin and other cytokines released from tumour cells may induce fibrosis, leading to carcinoid heart disease and abdominal fibrotic reactions. The aim of this study was to assess the prevalence, clinical complications and management of this reaction in the abdomen. METHODS: This was a retrospective cohort study of patients with SI-NETs diagnosed between 1985 and 2015. Clinical data, outcomes, radiological findings, and surgical and radiological interventions were reviewed. RESULTS: A total of 824 patients were diagnosed with SI-NETs in the study interval. Clinically significant abdominal signs and symptoms of fibrosis occurred in 36 patients. Of these, 20 had critically symptomatic central mesenteric fibrosis causing obstruction of mesenteric vessels, and 16 had retroperitoneal fibrosis causing obstructive uropathy with hydronephrosis. Extensive fibrosis causing mesenteric vessel obstruction and/or obstructive uropathy was more often associated with symptomatic and advanced disease encompassing lymph node metastases in the mesenteric root, para-aortic lymph node metastases, as well as liver metastases and peritoneal carcinomatosis. Palliative intervention in terms of superior mesenteric vein stenting or resection of central mesenteric metastases and/or percutaneous nephrostomy and J stent treatment was beneficial in the majority of the patients. CONCLUSION: Extensive abdominal fibrosis associated with clinically significant symptoms of intestinal ischaemia and/or obstructive uropathy was linked to advanced disease in patients with SI-NETs. Prompt recognition and minimally invasive intervention was effective in disease palliation.

Spatial Coherence and Stability in a Disordered Organic Polariton Condensate.

Although only a handful of organic materials have shown polariton condensation, their study is rapidly becoming more accessible. The spontaneous appearance of long-range spatial coherence is often recognized as a defining feature of such condensates. In this Letter, we study the emergence of spatial coherence in an organic microcavity and demonstrate a number of unique features stemming from the peculiarities of this material set. Despite its disordered nature, we find that correlations extend over the entire spot size, and we measure g(1)(r,r') values of nearly unity at short distances and of 50% for points separated by nearly 10 µm . We show that for large spots, strong shot-to-shot fluctuations emerge as varying phase gradients and defects, including the spontaneous formation of vortices. These are consistent with the presence of modulation instabilities. Furthermore, we find that measurements with flat-top spots are significantly influenced by disorder and can, in some cases, lead to the formation of mutually incoherent localized condensates.

Nonlinear interactions in an organic polariton condensate.

Under the right conditions, cavity polaritons form a macroscopic condensate in the ground state. The fascinating nonlinear behaviour of this condensate is largely dictated by the strength of polariton-polariton interactions. In inorganic semiconductors, these result principally from the Coulomb interaction between Wannier-Mott excitons. Such interactions are considerably weaker for the tightly bound Frenkel excitons characteristic of organic semiconductors and were notably absent in the first reported demonstration of organic polariton lasing. In this work, we demonstrate the realization of an organic polariton condensate, at room temperature, in a microcavity containing a thin film of 2,7-bis[9,9-di(4-methylphenyl)-fluoren-2-yl]-9,9-di(4-methylphenyl)fluorene. On reaching threshold, we observe the spontaneous formation of a linearly polarized condensate, which exhibits a superlinear power dependence, long-range order and a power-dependent blueshift: a clear signature of Frenkel polariton interactions.

The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review.

BACKGROUND AND AIM: The aim of this study was to review the literature regarding the use of pre- and/or postoperative antibiotics in the management of appendicitis, using data obtained from PubMed and the Cochrane Library. MATERIAL AND METHODS: A literature search was conducted using the terms "appendicitis" combined with "antibiotics." Studies were selected based on relevance for the evidence on prophylactic and postoperative treatment with regard to the route and duration of drug administration and the findings of surgery. RESULTS: Patients with acute appendicitis should receive preoperative, broad-spectrum antibiotics. The use of postoperative antibiotics is only recommended in cases of perforation, and treatment should then be given intravenously, for a minimum period of 3-5 days for adult patients, until clinical signs such as fever resolve and laboratory parameters such as C-reactive protein curve and white blood cell (WBC) start to decline. CONCLUSION: Preoperative antibiotic prophylaxis is recommended in all patients with acute appendicitis, whereas postoperative antibiotics only in cases of perforation.

Disclosure of cancer diagnosis: the Greek experience.

PURPOSE: To analyze the attitude of Greek health professionals towards truth disclosure and factors that may influence it. METHODS: Through a self-completed questionnaire, we studied the attitudes over the initial disclosure of cancer diagnosis to cancer patients of 132 doctors and 123 nurses, partly involved in cancer patients' care, in 5 general hospitals of Crete, Greece. RESULTS: Eighty-nine percent of the participants considered information as patient's right and 88% as professional's ethical duty, 64% believed that the whole truth should be revealed, 90% avoided the word "cancer" in the communication and 39% disclosed cancer diagnosis at patient's direct asking. Respondents informed 1/10 of their new cancer patients, mainly due to perceived limited responsibility (23%), patient's low cognitive state (22%), fear of harming the patient (17%) and relatives' objection (15%). Sixteen percent of fellows acknowledged to themselves the responsibility to inform patients. Cooperation, compliance and arrangement of patient's personal issues were considered as benefits from accurate disclosure (88%, 83% and 75%, respectively), the latter more among doctors than nurses (p=0.01) and medical than surgical professionals (p=0.03). Thirty-six percent of the respondents considered the presence of a psychologist necessary during disclosure, nurses more than doctors (p<0.001). CONCLUSION: Despite adequate theoretical background, Greek non-cancer specialists, doctors and nurses, initially inform accurately a small part of their cancer patients. Appropriate training programs for doctors and non-medical health professionals involved in cancer patients' management are required to upgrade professional-patient communication.