The utility of intraoperative retroareolar margin frozen section assessment and the management of atypical epithelial proliferative lesions at the retroareolar margin in nipple-sparing mastectomies.

OBJECTIVES: Nipple-sparing mastectomy (NSM) has become more frequently utilized due to superior psychological and cosmetic outcomes. The aim of this study was to evaluate the accuracy and utility of intraoperative frozen section evaluation of the retroareolar margin (RAM) in NSM. The management of atypical epithelial proliferative lesions at the RAM was also reviewed and discussed. METHODS: A single institution, retrospective analysis was performed on all therapeutic NSM patients with intraoperative evaluation of the RAM from 2014 to 2018. Patient demographics, tumor characteristics, pathologic assessment of the RAM, surgical management, and clinical follow-up were reviewed. RESULTS: Seventy-four nipple-sparing mastectomies with intraoperative evaluation of RAMs were identified. Concordance was 95% between frozen and permanent section diagnoses with 4 cases representing false negatives and no false positives. There were no instances of nipple-areolar complex (NAC) recurrence in all cases with preserved NACs (mean follow up: 750 days). In the 9 cases where NACs were excised based on intraoperative RAM evaluation, the findings in the excised NACs were negative in 6 and ductal carcinoma in situ in 3 cases. Postoperative measurement of the tumor to nipple distance was the only statistically significant variable associated with a positive RAM by multivariable logistic regression (OR 0.475; 95% CI 0.238-0.946). CONCLUSIONS: Intraoperative RAM evaluation demonstrated high concordance with permanent histology. Negative RAM, including atypical epithelial proliferative lesions, led to NAC preservation without recurrence. Positive RAM alone did not predict NAC involvement, although pagetoid spread of ductal carcinoma in situ along nipple ducts may predict NAC positivity.

Effects of Qigong Exercise on Non-Motor Symptoms and Inflammatory Status in Parkinson's Disease: A Protocol for a Randomized Controlled Trial.

Background: Non-motor symptoms such as sleep disturbance, cognitive decline, fatigue, anxiety, and depression in Parkinson's disease (PD) impact quality of life. Increased levels of pro-inflammatory cytokines in individuals with PD have been reported, which may contribute to non-motor symptoms. A mind-body exercise, Qigong, has demonstrated benefits across different medical conditions. However, a lack of evidence causes clinicians and patients to be uncertain about the effects of Qigong in individuals with PD. This study will examine the effects of Qigong on non-motor symptoms and inflammatory status in individuals with PD. Methods: Sixty individuals with PD will be recruited. Qigong and sham Qigong group (n = 30 for each) will receive a 12-week intervention. Participants will practice their assigned exercise at home (2×/day) and attend routinely group exercise meetings. Results: Clinical questionnaires and neuropsychological tests will measure non-motor symptoms including sleep quality (primary outcome). Biomarker assays will measure inflammatory status. A two-way mixed-design analysis of variance (ANOVA) will be utilized. Conclusions: This study may generate evidence for the benefits of Qigong on non-motor symptoms of PD and the effect on inflammatory status. Findings may lead to the development of a novel, safe, and cost-effective rehabilitation approach for individuals with PD.

Socio- and Clinical Characteristics in Relation to Mammography Screening Compliance.

Use of mammography screening in the general population has been credited with improvements in the diagnosis of breast cancer. Yet, the proportion of women with invasive breast cancers who are diagnosed at later, distant stages has not been declining. Two statewide data sources were linked to compare mammography screening compliance of female Medicare beneficiaries and stage of breast cancer at diagnosis at a population level. Breast cancer diagnoses were ascertained from the Kansas Cancer Registry. Mammogram use was identified using Medicare claims files and were classified as annual, biennial, less than biennial, or never use. The study included women aged ≥69 years at the time of their primary invasive breast cancer diagnosis between 2011 and 2012 who were continuously enrolled in Medicare parts A and B for at least 4 years prior to diagnosis. This approach enabled demographic comparisons to be made at the population level, providing novel and important insights about how sociocharacteristics of residency affect mammography compliance in an invasive breast cancer population. Of the 915 female Kansans who met the eligibility criteria, 73% (672) had received at least 1 mammography screening during the 4 years prior to their primary invasive breast cancer. The percentages of these women who received annual, biennial, less than biennial, and no screening were 25.8%, 27.5%, 20.1%, and 26.6%, respectively. Women aged ≥74 years, those living in counties with a median income below $42,000, and those living in counties with a higher percentage of individuals without a college degree at the time of diagnosis had higher odds of not having had an annual screening. Linkage of data from the statewide cancer registry with Medicare claims data on mammogram screening may help to identify subgroups of older women to be targeted for promoting breast cancer screening.