Aqueously altered igneous rocks sampled on the floor of Jezero crater, Mars.

The Perseverance rover landed in Jezero crater, Mars, to investigate ancient lake and river deposits. We report observations of the crater floor, below the crater's sedimentary delta, finding that the floor consists of igneous rocks altered by water. The lowest exposed unit, informally named Séítah, is a coarsely crystalline olivine-rich rock, which accumulated at the base of a magma body. Magnesium-iron carbonates along grain boundaries indicate reactions with carbon dioxide-rich water under water-poor conditions. Overlying Séítah is a unit informally named Máaz, which we interpret as lava flows or the chemical complement to Séítah in a layered igneous body. Voids in these rocks contain sulfates and perchlorates, likely introduced by later near-surface brine evaporation. Core samples of these rocks have been stored aboard Perseverance for potential return to Earth.

Characteristics, Origins, and Biosignature Preservation Potential of Carbonate-Bearing Rocks Within and Outside of Jezero Crater.

Carbonate minerals have been detected in Jezero crater, an ancient lake basin that is the landing site of the Mars 2020 Perseverance rover, and within the regional olivine-bearing (ROB) unit in the Nili Fossae region surrounding this crater. It has been suggested that some carbonates in the margin fractured unit, a rock unit within Jezero crater, formed in a fluviolacustrine environment, which would be conducive to preservation of biosignatures from paleolake-inhabiting lifeforms. Here, we show that carbonate-bearing rocks within and outside of Jezero crater have the same range of visible-to-near-infrared carbonate absorption strengths, carbonate absorption band positions, thermal inertias, and morphologies. Thicknesses of exposed carbonate-bearing rock cross-sections in Jezero crater are ∼75-90 m thicker than typical ROB unit cross-sections in the Nili Fossae region, but have similar thicknesses to ROB unit exposures in Libya Montes. These similarities in carbonate properties within and outside of Jezero crater is consistent with a shared origin for all of the carbonates in the Nili Fossae region. Carbonate absorption minima positions indicate that both Mg- and more Fe-rich carbonates are present in the Nili Fossae region, consistent with the expected products of olivine carbonation. These estimated carbonate chemistries are similar to those in martian meteorites and the Comanche carbonates investigated by the Spirit rover in Columbia Hills. Our results indicate that hydrothermal alteration is the most likely formation mechanism for non-deltaic carbonates within and outside of Jezero crater.

Sentinel lymph node biopsy following previous axillary surgery in recurrent breast cancer.

INTRODUCTION: Ipsilateral breast recurrence or second primary breast cancer can develop in patients who have undergone breast conserving surgery (BCS) and axillary surgery. The purpose of this study was to examine the feasibility of a reoperative sentinel lymph node biopsy (SLNB) as a repeated axillary staging procedure. PATIENTS AND METHODS: From August 2014 through January 2017 patients with locally recurrent breast cancer or with BRCA mutation requiring risk reduction mastectomy as a second surgical procedure, underwent repeat SLNB in three Hungarian Breast Units with a radiocolloid (and blue dye) technique. RESULTS: Hundred and sixty repeat SLNBs were analysed, 80 after previous SLNB and 80 after previous total or partial axillary lymph node dissection (ALND). SLN identification was successful in 106 patients (66%); 77/80 (77.5%) and 44/80 (55%) in the SLNB and ALND groups, respectively. (p < 0.003). Extra-axillary lymph drainage was more frequent in the ALND group (19/44, 43,2% versus 7/62, 11,3%; p < 0.001). Lymphatic drainage to the contralateral axilla was observed in 14 patients (11 in the ALND group, p = 0.025), isolated parasternal drainage was detected in 4 patients (p = 0.31). Only 9/106 patients with successful repeat SLNB (8,8%, all with 1 SLN removed) had SLN metastases CONCLUSIONS: Repeat SLNB is feasible in patients with ipsilateral breast tumor recurrence or new ipsilateral primary tumor after previous BCS and axillary staging. Repeat SLNB should replace routine ALND as the standard axillary restaging procedure in recurrent disease with a clinically negative axilla. Preoperative lymphoscintigraphy is important to explore extra-axillary lymphatic drainage in this restaging setting.

A multi-institutional analysis of intraoperative radiotherapy for early breast cancer: Does age matter?

BACKGROUND: Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. METHODS: A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. RESULTS: We evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative. Patients <70 were more likely to have longer operative time, oncoplastic closure, higher rates of IORT used as planned boost, and receive chemotherapy and post-operative WBRT. Wound complication rates were low and not significantly different between age groups. Median follow-up was 1.06 (range 0.51-1.9) years for < 70 and 1.01 (range 0.5-1.68) years for ≥ 70. There were 5 (0.73%) breast recurrences (4 in <70 and 1 ≥ 70, p = 0.65) and no axillary recurrences during follow-up. CONCLUSIONS: IORT was associated with a low rate of wound complication and local recurrence on short-term follow-up in this cohort.

Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study.

BACKGROUND: Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS: A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS: Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION: Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.

Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: An aesthetic and functional prospective cohort study.

BACKGROUND: Breast-conserving surgery (BCS) is considered the standard treatment for early-stage breast cancer. However, fair to poor cosmetic outcomes following conventional BCS have been observed in as many as one-third of cases. The aim of this study was to determine the critical tumor-to-breast volume ratio for each quadrant of the breast beyond which conventional BCS would no longer offer acceptable cosmetic and functional results or satisfactory quality of life for the patient. METHODS: A prospective cohort study was performed between December 2011 and December 2013 involving 350 patients younger than 70 years with early-stage unifocal (T ≤ 30 mm) breast cancer who underwent wide excision and axillary sentinel lymph node biopsy followed by whole-breast irradiation. Using validated panels and software (the Breast Cancer Treatment Outcome Scale [BCTOS], EORTC Cancer Quality of Life Questionnaire number C30-BR23, and Breast Cancer Conservative Treatment - cosmetic results [BCCT.core] software), quality of life and aesthetic and functional parameters and their changes in correlation to the percentage of breast volume excised were statistically analyzed. RESULTS: The maximum percentages of breast volume that were resectable by conventional BCS without resulting in unacceptable aesthetic and functional outcomes or decreased quality of life were 18-19% in the upper-outer quadrant (p < 0.0001), 14-15% in the lower-outer quadrant (p < 0.0001), 8-9% in the upper-inner quadrant (p < 0.0001), and 9-10% in the lower-inner quadrant (p < 0.0001). CONCLUSION: Aided by the calculated cut-off values for each breast quadrant, breast surgeons might render more objective decisions regarding performing conventional BCS, using oncoplastic techniques or choosing mastectomy with immediate reconstruction.

Does breast screening offer a survival benefit? A retrospective comparative study of oncological outcomes of screen-detected and symptomatic early stage breast cancer cases.

INTRODUCTION: Mammography screening reduces breast cancer mortality by up to 32%. However, some recent studies have questioned the impact of non-palpable breast cancer detection on mortality reduction. The aim of this study was to analyse the clinicopathological and long-term follow-up data of early stage screened and symptomatic breast cancer patients. PATIENTS AND METHOD: The institutional prospectively led database was systematically analysed for breast cancer cases diagnosed via the mammography screening program from 2002 to 2009. As a control group, symptomatic early stage breast cancer patients were collected randomly from the same database and matched for age and follow-up period. All medical records were reviewed retrospectively. RESULTS: Data from 298 breast cancer patients were collected from 47,718 mammography screenings. In addition, 331 symptomatic breast cancer patients were randomly selected. The screened group presented a significantly lower median tumour size (P < 0.00001). The incidence of negative regional lymph nodes was significantly higher in the screened group (P < 0.0006). The incidence of chemotherapy was 17% higher in the symptomatic group (P = 4*10-5). At the median follow-up of 65 and 80 months, the screened group did not exhibit better overall (P = 0.717) or disease-free survival (P = 0.081) compared to the symptomatic group. CONCLUSION: Our results do not suggest that mammography screening does not reduce breast cancer mortality but the mammography screening did not bring any significant improvement in patient overall or disease-free survival for the early stage breast cancer patients compared to the symptomatic group. The drawback of symptomatic early stage tumours compared to non-palpable tumours could be equalized by modern multimodality oncology treatments.

Association of CETP polymorphisms with the risk of vascular dementia and white matter lesions.

Cholesteryl ester transfer protein (CETP), a component of the high density lipoprotein (HDL), plays a central role in reverse cholesterol transport. We investigated the association of two putative functional CETP polymorphisms (C-629A and I405V) with the risk of vascular dementia (VD) and tested if this association is influenced by the presence of APOE4 allele. Our study included 163 VD patients (mean age: 74.25 +/- 7.9 years) and 452 cognitively healthy probands (mean age: 70.81 +/- 7.9 years). As a biological correlate, the association of CETP gene variants with white matter lesion (WML) load was investigated. Neither the C-629A (P = 0.169) nor the I405V (P = 0.840) polymorphism was associated with VD risk in the whole sample. However, in non-carriers of the APOE4 allele, homozygote carriers of the CETP C-629A A allele presented with an increased risk of VD (P = 0.01). Whereas in APOE4 carriers, no association of CETP polymorphisms with VD risk was detected. In addition, carriers of the CETP C-629A AA genotype presented with decreased WML load in the frontal brain (P = 0.009). Our results suggest that CETP gene polymorphisms might influence WML load and the risk of VD, the latter in non-carriers of the APOE4 allele.

Gene variations in GSTM3 are a risk factor for Alzheimer's disease.

Oxidative stress is a relevant pathomechanism in Alzheimer's disease (AD) and gene variations in the glutathione S-transferase M3 gene (GSTM3), involved in the detoxification of oxygen radicals, might influence the risk of AD. We investigated the effect of three polymorphisms in GSTM3: rs1332018 (C/A); rs1799735 (del/AGG); rs7483 (G/A), on the risk of AD in 363 AD patients and 358 healthy controls. Single marker association analyses revealed that the AGG/AGG genotype of the GSTM3 rs1799735 (del/AGG) polymorphism was associated with an increased risk of AD (p=0.05), especially in the group of APOE4-allele non-carriers (p=0.004; OR=2.07). Examination of the haplotypes identified a two-marker haplotype (C/AGG) consisting of rs1332018 (C/A) and rs1799735 (del/AGG) to increase the risk of AD (p=0.029), this effect was also most prevalent in APOE4-allele non-carriers (p=0.009; OR=1.95). The population attributable risk of this haplotype in APOE4-allele non-carriers was 32.2%. Our results suggest that there is a group of AD patients in which variations in metabolism of oxidative stress play an important role.

Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores.

The method most frequently used for the coverage of trochanteric pressure sores is the tensor fascia lata (TFL) flap. The authors introduce a new, hatchet-shaped incision strategy for the TFL flap, which preserves the safe blood supply of the flap and keeps the flap mobile enough. The part of the flap including the muscle is adapted to the greater trochanter. This provides a good aesthetic result without dog-ear formation at the rotation point of the flap. The donor site is closed in a V-Y fashion, and the closure does not require any skin grafting or designing a local flap. The TFL hatchet flap was used nine times on eight patients to cover trochanteric pressure sores. With one exception all patients healed. No recurrence was observed during the follow-up period, and no contour difference developed on the lateral aspect of the thigh.

The use of lymphoscintigraphy and PET in the management of head and neck melanoma.

OBJECTIVES: Lymphoscintigraphy with sentinel node dissection and 18 fluoro-2-deoxyglucose positron emission tomography (PET) are being used independently in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 1.0 mm and clinically negative regional nodes that were evaluated prospectively with PET and lymphoscintigraphy. STUDY DESIGN AND SETTING: Between July 1, 1998 and December 30, 2000 PET scans were obtained preoperatively on 18 patients undergoing resection of head and neck melanoma. Lymphoscintigraphy and sentinel node dissection was performed. Resection of the primary lesion was then carried out with adequate margins and the defects were reconstructed. RESULTS: Sentinel node(s) were found in 17/18 patients (94.4%); 5/18 (27.8%) of cases had metastases. PET detected nodal metastasis preoperatively in 3 patients (16.7%), one of which had a positive sentinel node dissection. CONCLUSION: PET and lymphoscintigraphy offer complimentary ways of evaluation for metastatic melanoma.

National practice patterns of sentinel lymph node dissection for breast carcinoma.

BACKGROUND: The sentinel node is the first regional lymph node to receive tumor cells that metastasize through the lymphatic channel from a primary tumor. The tumor status of the sentinel node should reflect the tumor status of the entire regional node basin. Sentinel lymph node dissection (SLND) has recently been investigated for use in patients with early breast carcinoma to avoid the sequelae of complete axillary lymph node dissection (ALND). Published studies of SLND in breast cancer patients identify marked variations in technique, and there are few guidelines for credentialing surgeons to perform SLND. STUDY DESIGN: The purpose of this study was to assess the current practice of SLND for breast cancer in the United States. A 27-item questionnaire was mailed to 1,000 randomly selected Fellows of the American College of Surgeons. Responses were anonymous. Statistical analysis was performed using SAS software (SAS Institute, Cary, NC). RESULTS: Response rate was 41% (n = 410), and 77% of those who responded performed SLND for breast cancer. The majority (60%) of surgeons responding routinely ordered preoperative lymphoscintigraphy. Of those who did lymphoscintigraphy, 28% removed internal mammary lymph nodes when lymphoscintigraphy showed drainage to these nodes. Ninety percent of surgeons used both blue dye and radiocolloid. Eighty percent of centers responding performed routine immunohistochemistry on sentinel lymph nodes, and 15% performed reverse transcription polymerase chain reaction. Ninety-six percent of surgeons performed SLND for primary tumors 5 cm or smaller, and 95% performed SLND for an excisional cavity 6 cm and smaller. Twenty-eight percent performed SLND for high-grade ductal carcinoma in situ, and 28% of respondents performed 10 or fewer SLND procedures with subsequent ALND before performing SLND alone. Surgeons learned SLND through courses (35%), oncology fellowships (26%), observation of other surgeons (31%), or were self-taught (26%). CONCLUSIONS: The majority of surgeons in the United States use similar technique for SLND breast cancer. But, there was marked variation in the number of SLND cases validated by an ALND before performing SLND only.

Comprehensive review of sentinel lymphadenectomy in breast cancer.

Sentinel lymph node dissection (SLND) is a minimally invasive technique to stage axillary lymph nodes in breast cancer. The complications associated with SLND are minimal, especially when compared to routine axillary lymph node dissection (ALND), and it can be performed with an overall identification rate of greater than 90% and a false-negative rate less than 5%. Despite this, SLND is not ready to replace routine axillary dissection, since we have no long-term results for these patients. What the clinical recurrence rates will be in women who undergo SLND only and how that will translate into survival rates has yet to be discovered. SLND is also a difficult technique to perform, as documented in the early SLND studies. It is imperative that each individual surgeon perform a series of cases in which SLND is combined with immediate ALND, so that identification rates and false-negative rates can be determined. Once a track record of successfully performed SLND has been established, SLND can be solely used for node-negative women. It is strongly recommended that all surgeons join one of the National Cancer Institute (NCI)-sponsored clinical trials for SLND in early breast cancer, so that many of these questions concerning SLND can finally be answered.

[The Hungarian translation of the "Dental Fear Survey" based on the Hungarian population]. / A "Dental Fear Survey" (a "Fogászati félelem kérdöív") magyar fordítása, hazai populáción végzett mérések eredményei.

Authors translated the "Dental Fear Survey" (DFS) into Hungarian. 196 persons have been investigated and the DFS values have been compared to DAS, STAI-S, STAI-T values. Mean values were: DFS: 46.27; DAS: 12.24; STAI-S: 41.58; STAI-T: 42.68. Authors found all values higher in the case of women comparing to men. Positive correlation has been found between DAS and DFS, but STAI-S and STAI-T increased only moderately comparing to the DAS and DFS values.

Lymphatic mapping and sentinel lymphadenectomy after wide local excision of primary melanoma.

BACKGROUND: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) are generally avoided in patients who have already undergone wide local excision (WLE) of a primary melanoma, because of concern that disruption of the cutaneous lymphatics might alter lymphatic flow to the sentinel node. We reviewed carefully chosen patients who had undergone LM/SL after WLE to identify circumstances that might make this approach otherwise safe and clinically accurate. STUDY DESIGN: From our melanoma database of 8,300 patients, of whom 1,015 had undergone LM/SL, we retrospectively identified 47 patients who had previously undergone WLE. Patient and tumor characteristics were collected and compared with followup data from clinic files. RESULTS: Median WLE surgical margins before LM/SL were 2.0 cm and most patients had extremity lesions. Eleven of the 47 patients (23%) had tumor-involved sentinel nodes, and 8 of these patients (73%) had a solitary nodal metastasis. With a median followup period of 36 months, 3 sentinel node-negative patients developed nodal recurrences. Two of these patients had positive sentinel nodes on pathology re-review and were not considered failures of the lymphatic mapping surgical procedure. The third patient developed in-transit metastases and delayed nodal recurrence. An additional patient, who had a primary tumor on the trunk, developed a nodal recurrence in the basin opposite that identified by lymphoscintigraphy. The overall error rate of the technique was 4 in 36 (11%). This included 2 pathology misdiagnoses (5.6%), 1 nodal recurrence associated with in-transit regional metastases (2.8%), and 1 lymphatic mapping error (2.8%). CONCLUSIONS: LM/SL can be cautiously performed in patients who have undergone previous WLE if the primary resection margin was no greater than 2.0 cm and the primary was not in a region of ambiguous drainage. Lymphatic mapping may be inaccurate when melanomas have been resected with large margins, especially if the wound was closed with rotation flaps, and when melanomas are on the head and neck or trunk regions.

Lymph node biopsy does not impair survival after therapeutic dissection for palpable melanoma metastases.

BACKGROUND: To determine the effects of disrupting a nodal basin in patients with American Joint Committee on Cancer stage III melanoma with clinically palpable lymph nodes, we studied patients who underwent therapeutic lymph node dissection after excisional lymph node biopsy, after fine-needle aspiration (FNA) biopsy, or without a preoperative biopsy. METHODS: We performed a retrospective review of our patients with American Joint Committee on Cancer stage III melanoma who were treated between January 1972 and June 1995, using data acquired from our 8200-patient database. The study group included 670 patients with melanoma, with known primary tumors, who underwent therapeutic lymph node dissection for palpable nodal metastases diagnosed by open biopsy (227 patients), by FNA (66 patients), or by clinical observation without biopsy (377 patients). Regional node recurrence, 5-year disease-free survival, and overall survival rates were calculated. RESULTS: The same-basin regional node recurrence rates were similar for the three groups (open biopsy, 4.6%; FNA, 3.2%; no biopsy, 4.6%; P = .14). The 5-year disease-free survival rates were 36.8% for the open-biopsy group, 29.6% for the FNA group, and 28.9% for the no-biopsy group (P = .08); corresponding 5-year overall survival rates were 40.6%, 43.9%, and 36.1%, respectively (P = .18). Multivariate analysis failed to identify preoperative biopsy as a significant risk factor. Matched-pair analysis using age, gender, primary tumor site, Breslow thickness, and tumor burden showed no differences in the 5-year disease-free survival rates (33% for the open-biopsy group vs. 27% for the FNA and no-biopsy groups, P = .42) and the 5-year overall survival rates (41% vs. 35%, P = .32). CONCLUSIONS: For patients with melanoma with palpable regional adenopathy, histological confirmation of clinical suspicion with either FNA or excisional lymph node biopsy does not adversely affect survival or recurrence rates.

Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms.

PURPOSE: Regional lymph node involvement is the most important prognostic indicator in patients with solid tumors. Conventional lymph node dissection has not been shown to affect survival and is often associated with considerable morbidity. Intraoperative lymphatic mapping and sentinel lymph node dissection were therefore designed as a minimally invasive alternative to routine elective lymph node dissection in patients with primary cutaneous melanoma. This study examined whether introperative lymphatic mapping and sentinel lymph node dissection were accurate in staging patients with other solid malignancies. PATIENTS AND METHODS: Between 1985 and 1998, 107 patients with breast cancer, 17 with thyroid tumors, 14 with gastrointestinal/gynecologic cancers, six with Merkel cell cancers, and five with squamous cell carcinomas of the head and neck have undergone mapping and sentinel lymph node dissection at the John Wayne Cancer Institute. RESULTS: The sentinel node was identified in 96% of patients (98% melanoma). In 36% of patients the sentinel node was the only tumor-positive node (71% melanoma). Eighteen percent of sentinel nodes were negative by hematoxylin and eosin staining but were positive by immunohistochemical staining (15% melanoma). CONCLUSION: These data suggest that many solid neoplasms have a primary lymphatic channel and lymph node to which it drains. Although sentinel lymph node dissection has been popularized in melanoma therapy, we have found it feasible for treatment of other solid malignancies. This technique may ultimately replace conventional dissection with more accurate staging.

[Introduction of the concept of Dental Anxiety Scale in Hungary. Epidemiologic studies on the Hungarian population]. / A Dental Anxiety Scale ("Fogászati szorongásskála") hazai bevezetése. Magyar populáción végzett fogászati szorongás-epidemiológia vizsgálatok.

Authors translated the Corah's "Dental Anxiety Scale" (DAS) into Hungarian. 143 dental patients, and 74 dental student's, were investigated and the DAS values were compared to the State-Trait Anxiety Invertory (STAI-S and STAI-T) values. Mean values were: DAS: 9.92, STAI-S: 39.17, STAI-T: 41.34. Authors found lower scores in the case of dental students comparing to patients (p < 0.001), and women comparing to men (p < 0.001). DAS values increased slowly with age, and decreased at 60 years old, or older patients. Married patients had higher DAS and STAI-S scores, but lower STAI-T scores comparing to the unmarried and divorced patients.