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Jacksonville Beach, FL, United States

Mitro S.D.,University of Michigan | Ali-Fehmi R.,Wayne State University | Bandyopadhyay S.,Wayne State University | Alosh B.,Wayne State University | And 7 more authors.
Breast Journal

Benign breast disease (BBD) is a very common condition, diagnosed in approximately half of all American women throughout their lifecourse. White women with BBD are known to be at substantially increased risk of subsequent breast cancer; however, nothing is known about breast cancer characteristics that develop after a BBD diagnosis in African-American women. Here, we compared 109 breast cancers that developed in a population of African-American women with a history of BBD to 10,601 breast cancers that developed in a general population of African-American women whose cancers were recorded by the Metropolitan Detroit Cancer Surveillance System (MDCSS population). Demographic and clinical characteristics of the BBD population were compared to the MDCSS population, using chi-squared tests, Fisher's exact tests, t-tests, and Wilcoxon tests where appropriate. Kaplan-Meier curves and Cox regression models were used to examine survival. Women in the BBD population were diagnosed with lower grade (p = 0.02), earlier stage cancers (p = 0.003) that were more likely to be hormone receptor-positive (p = 0.03) compared to the general metropolitan Detroit African-American population. In situ cancers were more common among women in the BBD cohort (36.7%) compared to the MDCSS population (22.1%, p < 0.001). Overall, women in the BBD population were less likely to die from breast cancer after 10 years of follow-up (p = 0.05), but this association was not seen when analyses were limited to invasive breast cancers. These results suggest that breast cancers occurring after a BBD diagnosis may have more favorable clinical parameters, but the majority of cancers are still invasive, with survival rates similar to the general African-American population. © 2014 Wiley Periodicals, Inc. Source

Radisky D.C.,Mayo Clinic in Jacksonville | Santisteban M.,Clinica Universitaia Of Navarra | Berman H.K.,University of Toronto | Gauthier M.L.,University of Toronto | And 7 more authors.
Cancer Prevention Research

p16, a nuclear protein encoded by the p16 INK4a gene, is a regulator of cell-cycle regulation. Previous studies haveshownthat expression ofp16in tissue biopsies of patients with ductal carcinomain situ (DCIS) is associated with increased risk of breast cancer, particularly when considered in combination with other markers such as Ki-67 and COX-2. Here, we evaluated how expression of p16 in breast tissue biopsies of women with atypical hyperplasia (AH), a putative precursor lesion to DCIS, is associated with subsequent developmentof cancer. p16expression was assessed byimmunohistochemistry in archival sections from 233 women with AH diagnosed at the Mayo Clinic. p16 expression in the atypical lesions was scored by percentage of positive cells and intensity of staining. We also studied coexpression of p16, with Ki-67 and COX-2, biomarkers of progression in AH. Risk factor and follow-up data were obtained via study questionnaire and medical records. Forty-seven patients (20%) developed breast cancer with a median follow-up of 14.5 years. Staining of p16 was increased in older patients relative to younger patients (P < 0.0025). Although risk of developing breast cancer was not associated with increased p16 expression, joint overexpressionof Ki-67andCOX-2was found to convey stronger risk of breast cancer in the first 10 years after diagnosis as compared with one negative marker (P < 0.01). However, the addition of p16 levels did not strengthen this association. p16 overexpression, either alone or in combination with COX-2 and Ki-67, does not significantly stratify breast cancer risk in women with AH. ©2011 AACR. Source

Gonzalez R.,Bariatric Surgery Guatamala | Hill S.J.,Childrens Healthcare Of Atlanta | Mattar S.G.,Indiana University | Lin E.,Emory University | And 3 more authors.
Journal of Laparoendoscopic and Advanced Surgical Techniques

Introduction: The repair of large congenital diaphragmatic hernia frequently results in patch disruption and recurrence as patients grow in size. Absorbable meshes allow for ingrowth of endogenous tissue as they are degraded, providing a more natural and durable repair. The aim of this study was to compare the characteristics of the new diaphragmatic tissue between an absorbable biologic mesh and a nonabsorbable mesh for repairing diaphragmatic hernia in a growing animal model. Methods: The left hemi-diaphragm of twenty 2-month-old Yucatan pigs was nearly completely resected. Small intestinal submucosa (SIS; Cook Biotech, Lafayette, IN) and expanded polytetrafluoroethylene (ePTFE; W.L. Gore & Associates, Flagstaff, AZ) were randomly assigned to cover the defect in 10 animals each, and were survived for 6 months. During necropsy, newly formed diaphragmatic tissue was evaluated and compared between the two groups. Results: At necropsy, the animals had tripled their weight. Patch disruption and herniation occurred in 3 animals in the ePTFE group and none in the SIS group. The SIS mesh had better integration to the chest wall (2.8±0.2 versus 1.3±0.3), more muscle growth within the newly formed diaphragmatic tissue (1.9±0.2 versus 0.4±0.2), and less fibrotic tissue (2.1±0.5 versus 3.4±0.4) than ePTFE. There was no difference between SIS and ePTFE in terms of adhesion scores to the lung (2±0.4 versus 2.4±0.4) and liver (1.8±0.3 versus 2.2±0.5). Conclusion: SIS allows for tissue ingrowth from surrounding tissue as it degrades, providing a more durable repair with 30% less incidence of herniation in a porcine model. As the diaphragm grows, SIS resulted in a more natural repair of the defect with more tissue growth, better tissue integration, and a comparable adhesion formation to ePTFE. © 2011 Mary Ann Liebert, Inc. Source

Cote M.L.,Wayne State University | Cote M.L.,Barbara Ann Karmanos Cancer Institute | Ruterbusch J.J.,Wayne State University | Ruterbusch J.J.,Barbara Ann Karmanos Cancer Institute | And 11 more authors.
Cancer Prevention Research

Benign breast disease (BBD) is an established risk factor for breast cancer among Caucasian women but less is known about BBD in African American women. As African American women suffer from disproportionate mortality due to breast cancer, special focus on pathologic characteristics that may influence disease risk is warranted. Benign breast biopsies from African American women were identified by the University Pathology Group (Detroit, MI). African American women of ages 20 to 84 years, who underwent a breast biopsy from 1997 to 2000, were eligible for the study. Subsequent breast cancers were identified through a linkage with the Detroit Surveillance Epidemiology and End Results (SEER) program. The first biopsy was reviewed by the pathologist, and lesions were classified following Dupont and Page criteria along with involution and other histologic features. Logistic regression was used to estimate the risk of developing a subsequent breast cancer with the histologic characteristics of BBD. A total of 1,406 BBD biopsies from African American women were included in this study with a median follow-up of 10.1 years. The majority (68%) showed nonproliferative disease, 29% had proliferative disease without atypia, and3%had proliferative disease with atypia. Subsequent incident breast cancers occurred in 55 women (3.9%). Women whose biopsies showed proliferative disease with atypia were more than threefold more likely to develop breast cancer as compared with women who had nonproliferative disease [relative risk (RR) 3.29, 95% confidence interval (CI) 1.21-8.93]. Better characterization of the risk of breast cancer among women with BBD, considering both ethnicity and detailed molecular findings, can lead to better surveillance, earlier diagnosis, and potentially improved survival. ©2012 AACR. Source

Thiel D.D.,Mayo Clinic in Jacksonville | Chavez M.,Mayo Clinic in Jacksonville | Brisson T.E.,South Carolina Institute for Robotic Surgery
Journal of Laparoendoscopic and Advanced Surgical Techniques

Objective: To analyze the perioperative safety and outcomes of the first 100 robotic-assisted radical prostatectomies (RARPs) performed by a resident trained surgeon entering directly into practice. Subjects and Methods: Following a mentorship-based urology residency training program, the perioperative safety and outcomes of 100 consecutive RARPs were analyzed. Intraoperative complications, surgical pathology results, hospital course, and catheter removal times were all monitored. Urinary catheter time was considered prolonged if left in place for longer than 14 days. Surgical complications were scored using the Clavien grading system. Results: The resident performed portions of 51 RARPs during the training program in resident years 2-5, including 17 as a chief resident under the guidance of a fellowship-trained robotic surgeon. One hundred RARPs were performed following residency training over a 17-month period (mean age, 60 years; mean body mass index, 29 kg/m2). Positive margin rate was 21%, and blood transfusion rate was 5%. Clavien grade 1-4 complication rates were 5%, 9%, 1%, and 1%, respectively. There was one intraoperative rectal injury and one conversion to an open operation. Five percent of patients required a urinary catheter longer than 14 days secondary to anastomotic leakage. There were no re-admissions or re-operations in the series. Conclusions: The current study serves as a benchmark for physicians entering practice directly from resident training. Mentorship-based residency programs and early console experience may be factors in contributing to perioperative safety and outcomes with newly trained physicians. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

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