Prospective, multicenter study of antimicrobial-coated, noncrosslinked, acellular porcine dermal matrix (XenMatrix™ AB Surgical Graft) for hernia repair in all centers for disease control and prevention wound classes: 24-month follow-up cohort.

Prospective, multicenter, single-arm study of antimicrobial-coated, noncrosslinked, acellular porcine dermal matrix (AC-PDM) in a cohort involving all centers for disease control and prevention wound classes in ventral/incisional midline hernia repair (VIHR). Materials and methods: Seventy-five patients (mean age 58.6±12.7 years; BMI 31.3±4.9 kg/m2) underwent ventral/incisional midline hernia repair with AC-PDM. Surgical site occurrence (SSO) was assessed in the first 45 days post-implantation. Length of stay, return to work, hernia recurrence, reoperation, quality of life, and SSO were assessed at 1, 3, 6, 12, 18, and 24 months. Results: 14.7% of patients experienced SSO requiring intervention within 45 days post-implantation, and 20.0% thereafter (>45 d post-implantation). Recurrence (5.8%), definitely device-related adverse events (4.0%), and reoperation (10.7%) were low at 24 months; all quality-of-life indicators were significantly improved compared to baseline. Conclusion: AC-PDM exhibited favourable results, including infrequent hernia recurrence and definitely device-related adverse events, with reoperation and SSO comparable to other studies, and significantly improved quality of life.

Breast MRI utilization in older patients with newly diagnosed breast cancer.

BACKGROUND: Recently, use of advanced imaging modalities, such as MRI, has increased dramatically. One novel but still evolving use for MRI is in the diagnosis and clinical staging of newly diagnosed breast cancer patients. Compared with mammography, MRI is more sensitive, but less specific, and far more expensive. The purpose of this study is to examine the prevalence and predictors of MRI use for clinical staging in older women with newly diagnosed breast cancer. MATERIALS AND METHODS: SEER-Medicare data were used to identify incident breast cancer cases between 2003 and 2005. Outpatient Medicare claims data were queried for receipt of breast MRI. Multivariate logistic regression analyses were performed to examine associations between receiving MRI and patient demographics, clinical characteristics, and SEER region. RESULTS: A total of 46,824 patients with breast cancer met inclusion criteria. MRI use increased from 3.9% of women diagnosed in 2003 to 10.1% of women diagnosed in 2005. In the bivariate analyses race, urban/rural location, SEER region, poverty level, education level, stage, surgery type, and tumor size were all significantly associated with receipt of MRI. In the multivariate analysis, those who were younger, white, living in more metropolitan areas, and living in wealthier areas were more likely to receive MRI. There was substantial variability in odds of MRI among different SEER regions. CONCLUSIONS: Breast MRI for patients with newly diagnosed breast cancer in the SEER-Medicare population is increasingly common. Ongoing examination of the dissemination of technology is critical to understanding current practice patterns and to the development and implementation of future guidelines.

Mini-and microsatellite mutations in children from Chernobyl accident cleanup workers.

Knowledge about possible genotoxic effects of low-dose radiation on the human germline is limited and relies primarily on extrapolations from high-dose exposures. To test whether ionizing radiation can cause paternal genetic mutations that are transmitted to offspring, we enrolled families of 88 Chernobyl cleanup workers exposed to ionizing radiation. We analyzed DNA isolated from lymphocytes for mutations via DNA blotting with the multi-locus minisatellite probes 33.6 and 33.15 and via PCR in a panel of six tetranucleotide repeats. Children conceived before and children conceived after their father's exposure showed no statistically significant differences in mutation frequencies. We saw an increase in germline microsatellite mutations after radiation exposure that was not statistically significant. We found no dependence of mutation rate on increasing exposure. A novel finding was that the tetranucleotide marker D7S1482 demonstrated germline hypermutability. In conclusion, our results do not support an increased level of germline minisatellite mutations but suggest a modest increase in germline mutations in tetranucleotide repeats. Small sample size, however, limited statistical power.

Analytical and statistical methods to evaluate microsatellite allelic imbalance in small amounts of DNA.

Microsatellite analysis is a powerful tool for the assessment of genetic instability and loss of heterozygosity in cancer cells. However, most human tumors harbor significant numbers of normal cells, which may contribute to false-negative results. Recent techniques based on fluorescently labeled primers and semiautomated capillary electrophoresis of polymerase chain reaction (PCR) products allow a reliable quantitative assessment of (PCR) products while requiring very small numbers of cells. We report a highly sensitive protocol for the semiautomated analysis of allelic imbalance based on time-release PCR and capillary electrophoresis. With this protocol, as few as 100 cells can be used to reliably assess allelic imbalance (AI) in DNA samples. Using a panel of seven microsatellite markers, we determined allelic variation in a large set of heterozygous lymphocyte DNA samples and examined the use of different statistical analysis techniques. Using these statistical approaches, we describe a calibration method to evaluate AI from microsatellite results. Using a simple formula, cutoff points at preset confidence levels are used to decide whether allelic imbalance exists in a given sample at the loci under investigation. Our method allows the reliable detection of AI with very small amounts of DNA, and is sufficiently quantitative to assess allelic ratios in nonclonal tissue specimens.