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1.  Cancer Screening with Digital Mammography for Women at Average Risk for Breast Cancer, Magnetic Resonance Imaging (MRI) for Women at High Risk 
Executive Summary
Objective
The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
Research Questions
How does the sensitivity and specificity of DM compare to FM?
How does the sensitivity and specificity of MRI compare to FM?
How do the recall rates compare among these screening modalities, and what effect might this have on radiation exposure? What are the risks associated with radiation exposure?
How does the sensitivity and specificity of the combination of MRI plus FM compare to either MRI or FM alone?
What are the economic considerations?
Clinical Need
The effectiveness of FM with respect to breast cancer mortality in the screening of asymptomatic average- risk women over the age of 50 has been established. However, based on a Medical Advisory Secretariat review completed in March 2006, screening is not recommended for women between the ages of 40 and 49 years. Guidelines published by the Canadian Task Force on Preventive Care recommend mammography screening every 1 to 2 years for women aged 50 years and over, hence, the inclusion of such women in organized breast cancer screening programs. In addition to the uncertainty of the effectiveness of mammography screening from the age of 40 years, there is concern over the risks associated with mammographic screening for the 10 years between the ages of 40 and 49 years.
The lack of effectiveness of mammography screening starting at the age of 40 years (with respect to breast cancer mortality) is based on the assumption that the ability to detect cancer decreases with increased breast tissue density. As breast density is highest in the premenopausal years (approximately 23% of postmenopausal and 53% of premenopausal women having at least 50% of the breast occupied by high density), mammography screening is not promoted in Canada nor in many other countries for women under the age of 50 at average risk for breast cancer. It is important to note, however, that screening of premenopausal women (i.e., younger than 50 years of age) at high risk for breast cancer by virtue of a family history of cancer or a known genetic predisposition (e.g., having tested positive for the breast cancer genes BRCA1 and/or BRCA2) is appropriate. Thus, this review will assess the effectiveness of breast cancer screening with modalities other than film mammography, specifically DM and MRI, for both pre/perimenopausal and postmenopausal age groups.
International estimates of the epidemiology of breast cancer show that the incidence of breast cancer is increasing for all ages combined whereas mortality is decreasing, though at a slower rate. The observed decreases in mortality rates may be attributable to screening, in addition to advances in breast cancer therapy over time. Decreases in mortality attributable to screening may be a result of the earlier detection and treatment of invasive cancers, in addition to the increased detection of ductal carcinoma in situ (DCIS), of which certain subpathologies are less lethal. Evidence from the Surveillance, Epidemiology and End Results (better known as SEER) cancer registry in the United States, indicates that the age-adjusted incidence of DCIS has increased almost 10-fold over a 20 year period, from 2.7 to 25 per 100,000.
There is a 4-fold lower incidence of breast cancer in the 40 to 49 year age group than in the 50 to 69 year age group (approximately 140 per 100,000 versus 500 per 100,000 women, respectively). The sensitivity of FM is also lower among younger women (approximately 75%) than for women aged over 50 years (approximately 85%). Specificity is approximately 80% for younger women versus 90% for women over 50 years. The increased density of breast tissue in younger women is likely responsible for the decreased accuracy of FM.
Treatment options for breast cancer vary with the stage of disease (based on tumor size, involvement of surrounding tissue, and number of affected axillary lymph nodes) and its pathology, and may include a combination of surgery, chemotherapy and/or radiotherapy. Surgery is the first-line intervention for biopsy-confirmed tumors. The subsequent use of radiation, chemotherapy or hormonal treatments is dependent on the histopathologic characteristics of the tumor and the type of surgery. There is controversy regarding the optimal treatment of DCIS, which is considered a noninvasive tumour.
Women at high risk for breast cancer are defined as genetic carriers of the more commonly known breast cancer genes (BRCA1, BRCA2 TP53), first degree relatives of carriers, women with varying degrees of high risk family histories, and/or women with greater than 20% lifetime risk for breast cancer based on existing risk models. Genetic carriers for this disease, primarily women with BRCA1 or BRCA2 mutations, have a lifetime probability of approximately 85% of developing breast cancer. Preventive options for these women include surgical interventions such as prophylactic mastectomy and/or oophorectomy, i.e., removal of the breasts and/or ovaries. Therefore, it is important to evaluate the benefits and risks of different screening modalities, to identify additional options for these women.
This Medical Advisory Secretariat review is the second of 2 parts on breast cancer screening, and concentrates on the evaluation of both DM and MRI relative to FM, the standard of care. Part I of this review (March 2006) addressed the effectiveness of screening mammography in 40 to 49 year old average-risk women. The overall objective of the present review is to determine the optimal screening modality based on the evidence.
Evidence Review Strategy
The Medical Advisory Secretariat followed its standard procedures and searched the following electronic databases: Ovid MEDLINE, EMBASE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and The International Network of Agencies for Health Technology Assessment database. The subject headings and keywords searched included breast cancer, breast neoplasms, mass screening, digital mammography, magnetic resonance imaging. The detailed search strategies can be viewed in Appendix 1.
Included in this review are articles specific to screening and do not include evidence on diagnostic mammography. The search was further restricted to English-language articles published between January 1996 and April 2006. Excluded were case reports, comments, editorials, nonsystematic reviews, and letters.
Digital Mammography: In total, 224 articles specific to DM screening were identified. These were examined against the inclusion/exclusion criteria described below, resulting in the selection and review of 5 health technology assessments (HTAs) (plus 1 update) and 4 articles specific to screening with DM.
Magnetic Resonance Imaging: In total, 193 articles specific to MRI were identified. These were examined against the inclusion/exclusion criteria described below, resulting in the selection and review of 2 HTAs and 7 articles specific to screening with MRI.
The evaluation of the addition of FM to MRI in the screening of women at high risk for breast cancer was also conducted within the context of standard search procedures of the Medical Advisory Secretariat. as outlined above. The subject headings and keywords searched included the concepts of breast cancer, magnetic resonance imaging, mass screening, and high risk/predisposition to breast cancer. The search was further restricted to English-language articles published between September 2007 and January 15, 2010. Case reports, comments, editorials, nonsystematic reviews, and letters were not excluded.
MRI plus mammography: In total, 243 articles specific to MRI plus FM screening were identified. These were examined against the inclusion/exclusion criteria described below, resulting in the selection and review of 2 previous HTAs, and 1 systematic review of 11 paired design studies.
Inclusion Criteria
English-language articles, and English or French-language HTAs published from January 1996 to April 2006, inclusive.
Articles specific to screening of women with no personal history of breast cancer.
Studies in which DM or MRI were compared with FM, and where the specific outcomes of interest were reported.
Randomized controlled trials (RCTs) or paired studies only for assessment of DM.
Prospective, paired studies only for assessment of MRI.
Exclusion Criteria
Studies in which outcomes were not specific to those of interest in this report.
Studies in which women had been previously diagnosed with breast cancer.
Studies in which the intervention (DM or MRI) was not compared with FM.
Studies assessing DM with a sample size of less than 500.
Intervention
Digital mammography.
Magnetic resonance imaging.
Comparator
Screening with film mammography.
Outcomes of Interest
Breast cancer mortality (although no studies were found with such long follow-up).
Sensitivity.
Specificity.
Recall rates.
Summary of Findings
Digital Mammography
There is moderate quality evidence that DM is significantly more sensitive than FM in the screening of asymptomatic women aged less than 50 years, those who are premenopausal or perimenopausal, and those with heterogeneously or extremely dense breast tissue (regardless of age).
It is not known what effect these differences in sensitivity will have on the more important effectiveness outcome measure of breast cancer mortality, as there was no evidence of such an assessment.
Other factors have been set out to promote DM, for example, issues of recall rates and reading and examination times. Our analysis did not show that recall rates were necessarily improved in DM, though examination times were lower than for FM. Other factors including storage and retrieval of screens were not the subject of this analysis.
Magnetic Resonance Imaging
There is moderate quality evidence that the sensitivity of MRI is significantly higher than that of FM in the screening of women at high risk for breast cancer based on genetic or familial factors, regardless of age.
Radiation Risk Review
Cancer Care Ontario conducted a review of the evidence on radiation risk in screening with mammography women at high risk for breast cancer. From this review of recent literature and risk assessment that considered the potential impact of screening mammography in cohorts of women who start screening at an earlier age or who are at increased risk of developing breast cancer due to genetic susceptibility, the following conclusions can be drawn:
For women over 50 years of age, the benefits of mammography greatly outweigh the risk of radiation-induced breast cancer irrespective of the level of a woman’s inherent breast cancer risk.
Annual mammography for women aged 30 – 39 years who carry a breast cancer susceptibility gene or who have a strong family breast cancer history (defined as a first degree relative diagnosed in their thirties) has a favourable benefit:risk ratio. Mammography is estimated to detect 16 to 18 breast cancer cases for every one induced by radiation (Table 1). Initiation of screening at age 35 for this same group would increase the benefit:risk ratio to an even more favourable level of 34-50 cases detected for each one potentially induced.
Mammography for women under 30 years of age has an unfavourable benefit:risk ratio due to the challenges of detecting cancer in younger breasts, the aggressiveness of cancers at this age, the potential for radiation susceptibility at younger ages and a greater cumulative radiation exposure.
Mammography when used in combination with MRI for women who carry a strong breast cancer susceptibility (e.g., BRCA1/2 carriers), which if begun at age 35 and continued for 35 years, may confer greatly improved benefit:risk ratios which were estimated to be about 220 to one.
While there is considerable uncertainty in the risk of radiation-induced breast cancer, the risk expressed in published studies is almost certainly conservative as the radiation dose absorbed by women receiving mammography recently has been substantially reduced by newer technology.
A CCO update of the mammography radiation risk literature for 2008 and 2009 gave rise to one article by Barrington de Gonzales et al. published in 2009 (Barrington de Gonzales et al., 2009, JNCI, vol. 101: 205-209). This article focuses on estimating the risk of radiation-induced breast cancer for mammographic screening of young women at high risk for breast cancer (with BRCA gene mutations). Based on an assumption of a 15% to 25% or less reduction in mortality from mammography in these high risk women, the authors conclude that such a reduction is not substantially greater than the risk of radiation-induced breast cancer mortality when screening before the age of 34 years. That is, there would be no net benefit from annual mammographic screening of BRCA mutation carriers at ages 25-29 years; the net benefit would be zero or small if screening occurs in 30-34 year olds, and there would be some net benefit at age 35 years or older.
The Addition of Mammography to Magnetic Resonance Imaging
The effects of the addition of FM to MRI screening of high risk women was also assessed, with inclusion and exclusion criteria as follows:
Inclusion Criteria
English-language articles and English or French-language HTAs published from September 2007 to January 15, 2010.
Articles specific to screening of women at high risk for breast cancer, regardless of the definition of high risk.
Studies in which accuracy data for the combination of MRI plus FM are available to be compared to that of MRI and FM alone.
RCTs or prospective, paired studies only.
Studies in which women were previously diagnosed with breast cancer were also included.
Exclusion Criteria
Studies in which outcomes were not specific to those of interest in this report.
Studies in which there was insufficient data on the accuracy of MRI plus FM.
Intervention
Both MRI and FM.
Comparators
Screening with MRI alone and FM alone.
Outcomes of Interest
Sensitivity.
Specificity.
Summary of Findings
Magnetic Resonance Imaging Plus Mammography
Moderate GRADE Level Evidence that the sensitivity of MRI plus mammography is significantly higher than that of MRI or FM alone, although the specificity remains either unchanged or decreases in the screening of women at high risk for breast cancer based on genetic/familial factors, regardless of age.
These studies include women at high risk defined as BRCA1/2 or TP53 carriers, first degree relatives of carriers, women with varying degrees of high risk family histories, and/or >20% lifetime risk based on existing risk models. This definition of high risk accounts for approximately 2% of the female adult population in Ontario.
PMCID: PMC3377503  PMID: 23074406
2.  Asporin Is a Fibroblast-Derived TGF-β1 Inhibitor and a Tumor Suppressor Associated with Good Prognosis in Breast Cancer 
PLoS Medicine  2015;12(9):e1001871.
Background
Breast cancer is a leading malignancy affecting the female population worldwide. Most morbidity is caused by metastases that remain incurable to date. TGF-β1 has been identified as a key driving force behind metastatic breast cancer, with promising therapeutic implications.
Methods and Findings
Employing immunohistochemistry (IHC) analysis, we report, to our knowledge for the first time, that asporin is overexpressed in the stroma of most human breast cancers and is not expressed in normal breast tissue. In vitro, asporin is secreted by breast fibroblasts upon exposure to conditioned medium from some but not all human breast cancer cells. While hormone receptor (HR) positive cells cause strong asporin expression, triple-negative breast cancer (TNBC) cells suppress it. Further, our findings show that soluble IL-1β, secreted by TNBC cells, is responsible for inhibiting asporin in normal and cancer-associated fibroblasts. Using recombinant protein, as well as a synthetic peptide fragment, we demonstrate the ability of asporin to inhibit TGF-β1-mediated SMAD2 phosphorylation, epithelial to mesenchymal transition, and stemness in breast cancer cells. In two in vivo murine models of TNBC, we observed that tumors expressing asporin exhibit significantly reduced growth (2-fold; p = 0.01) and metastatic properties (3-fold; p = 0.045). A retrospective IHC study performed on human breast carcinoma (n = 180) demonstrates that asporin expression is lowest in TNBC and HER2+ tumors, while HR+ tumors have significantly higher asporin expression (4-fold; p = 0.001). Assessment of asporin expression and patient outcome (n = 60; 10-y follow-up) shows that low protein levels in the primary breast lesion significantly delineate patients with bad outcome regardless of the tumor HR status (area under the curve = 0.87; 95% CI 0.78–0.96; p = 0.0001). Survival analysis, based on gene expression (n = 375; 25-y follow-up), confirmed that low asporin levels are associated with a reduced likelihood of survival (hazard ratio = 0.58; 95% CI 0.37–0.91; p = 0.017). Although these data highlight the potential of asporin to serve as a prognostic marker, confirmation of the clinical value would require a prospective study on a much larger patient cohort.
Conclusions
Our data show that asporin is a stroma-derived inhibitor of TGF-β1 and a tumor suppressor in breast cancer. High asporin expression is significantly associated with less aggressive tumors, stratifying patients according to the clinical outcome. Future pre-clinical studies should consider options for increasing asporin expression in TNBC as a promising strategy for targeted therapy.
Andrei Turtoi and colleagues describe a mechanistic role for stroma-derived asporin in breast cancer development.
Editors' Summary
Background
Breast cancer is the most common cancer in women worldwide. Nearly 1.7 million new cases were diagnosed in 2012, and half a million women died from the disease. Breast cancer begins when cells in the breast that normally make milk (epithelial cells) acquire genetic changes that allow them to divide uncontrollably and to move around the body (metastasize). Uncontrolled cell division leads to the formation of a lump that can be detected by mammography (a breast X-ray) or by manual breast examination. Breast cancer is treated by surgical removal of the lump or, if the cancer has started to spread, by removal of the whole breast (mastectomy). After surgery, women often receive chemotherapy or radiotherapy to kill any remaining cancer cells, and women whose tumors express receptors for the female sex hormones estrogen and progesterone or for HER2, a growth factor receptor, are treated with drugs that block these receptors; estrogen, progesterone, and HER2 all control breast cell growth. Nowadays, the prognosis (outlook) for women living in high-income countries who develop breast cancer is generally good—nearly 90% of such women are still alive five years after diagnosis.
Why Was This Study Done?
The cells surrounding cancer cells—cancer-associated fibroblasts and other components of the stroma—support cancer growth and metastasis and are good targets for new cancer therapies. But, although there is mounting evidence that cancer cells actively adapt the stroma so that it produces various factors the tumor needs to grow and spread, very few molecules produced by the stroma that might serve as targets for drug development have been identified. Here, the researchers investigate whether a molecule called asporin might represent one such target. Asporin, which is highly expressed in the stroma of breast tumors, inhibits a growth factor called TGF-β1. TGF-β1 is involved in maintaining healthy joints, but is also a key molecule in the development of metastatic breast cancer. Most particularly, it modulates an important step in metastasis called the epithelial to mesenchymal transition and it regulates “stemness” in cancer cells. Stem cells are a special type of cell that can multiply indefinitely; tumor cells often look and behave very much like stem cells.
What Did the Researchers Do and Find?
Using a technique called immunohistochemistry, the researchers first showed that asporin is highly expressed in the stroma of most human breast cancers but not in normal breast tissue. Next, they showed that breast fibroblasts secrete asporin when exposed to conditioned medium from some human breast cancer cell lines (breast cancer cells adapted to grow continuously in the laboratory; conditioned medium is the solution in which cells have been grown). Specifically, conditioned medium from hormone receptor positive cells induced strong asporin expression by breast fibroblasts, whereas medium from breast cancer cells not expressing estrogen or progesterone receptors or HER2 receptors (triple-negative breast cancer cells) suppressed asporin expression. Other experiments showed that TGF-β1 secreted by breast cancer cells induces asporin expression in breast fibroblasts, and that asporin, in turn, inhibits TGF-β1-mediated induction of the epithelial to mesenchymal transition and stemness in breast cancer cells. Triple negative breast cancers appear to inhibit stromal expression of asporin at least in part via expression of the soluble signaling protein interleukin-1β. Notably, in mouse models of triple-negative breast cancer, tumors engineered to express asporin grew slower and metastasized less than tumors not expressing asporin. Finally, among women with breast cancer, asporin expression was low in triple-negative and HER2-positive tumors but significantly higher in hormone receptor positive tumors, and low asporin levels in primary breast lesions were associated with a reduced likelihood of survival independent of hormone receptor and HER2 expression.
What Do These Findings Mean?
These findings suggest that asporin is a stroma-derived inhibitor of TGF-β1 and a tumor suppressor in breast cancer. Importantly, they also provide preliminary evidence that high asporin expression is associated with less aggressive tumors (hormone receptor positive tumors), whereas low asporin expression is associated with more aggressive tumors (triple negative tumors and HER2-positive tumors). Thus, asporin expression might provide a new prognostic marker for breast cancer. However, before asporin can be used as a biomarker to predict outcomes in women with breast cancer and to identify those women in need of more aggressive treatment, these findings need to be confirmed in large prospective clinical studies. If these findings are confirmed, methods for increasing asporin expression in the stromal tissues of triple negative breast cancer could be a promising strategy for targeted therapy for this group of breast cancers, which currently have a poor prognosis.
Additional Information
This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1001871.
The US National Cancer Institute provides comprehensive information about cancer (in English and Spanish), including detailed information for patients and professionals about breast cancer and an online booklet for patients
Cancer Research UK, a not-for-profit organization, provides information about cancer; its detailed information about breast cancer includes sections on tests for hormone receptors and HER2, on treatments that target hormone receptors and treatments that target HER2, and on triple negative breast cancer
Breastcancer.org is a not-for-profit organization that provides up-to-date information about breast cancer (in English and Spanish), including information on hormone receptor status, HER2 status, and triple negative breast cancer
The UK National Health Service Choices website has information and personal stories about breast cancer; the not-for-profit organization Healthtalk.org also provides personal stories about dealing with breast cancer
doi:10.1371/journal.pmed.1001871
PMCID: PMC4556693  PMID: 26327350
3.  DEAR1 Is a Dominant Regulator of Acinar Morphogenesis and an Independent Predictor of Local Recurrence-Free Survival in Early-Onset Breast Cancer 
PLoS Medicine  2009;6(5):e1000068.
Ann Killary and colleagues describe a new gene that is genetically altered in breast tumors, and that may provide a new breast cancer prognostic marker.
Background
Breast cancer in young women tends to have a natural history of aggressive disease for which rates of recurrence are higher than in breast cancers detected later in life. Little is known about the genetic pathways that underlie early-onset breast cancer. Here we report the discovery of DEAR1 (ductal epithelium–associated RING Chromosome 1), a novel gene encoding a member of the TRIM (tripartite motif) subfamily of RING finger proteins, and provide evidence for its role as a dominant regulator of acinar morphogenesis in the mammary gland and as an independent predictor of local recurrence-free survival in early-onset breast cancer.
Methods and Findings
Suppression subtractive hybridization identified DEAR1 as a novel gene mapping to a region of high-frequency loss of heterozygosity (LOH) in a number of histologically diverse human cancers within Chromosome 1p35.1. In the breast epithelium, DEAR1 expression is limited to the ductal and glandular epithelium and is down-regulated in transition to ductal carcinoma in situ (DCIS), an early histologic stage in breast tumorigenesis. DEAR1 missense mutations and homozygous deletion (HD) were discovered in breast cancer cell lines and tumor samples. Introduction of the DEAR1 wild type and not the missense mutant alleles to complement a mutation in a breast cancer cell line, derived from a 36-year-old female with invasive breast cancer, initiated acinar morphogenesis in three-dimensional (3D) basement membrane culture and restored tissue architecture reminiscent of normal acinar structures in the mammary gland in vivo. Stable knockdown of DEAR1 in immortalized human mammary epithelial cells (HMECs) recapitulated the growth in 3D culture of breast cancer cell lines containing mutated DEAR1, in that shDEAR1 clones demonstrated disruption of tissue architecture, loss of apical basal polarity, diffuse apoptosis, and failure of lumen formation. Furthermore, immunohistochemical staining of a tissue microarray from a cohort of 123 young female breast cancer patients with a 20-year follow-up indicated that in early-onset breast cancer, DEAR1 expression serves as an independent predictor of local recurrence-free survival and correlates significantly with strong family history of breast cancer and the triple-negative phenotype (ER−, PR−, HER-2−) of breast cancers with poor prognosis.
Conclusions
Our data provide compelling evidence for the genetic alteration and loss of expression of DEAR1 in breast cancer, for the functional role of DEAR1 in the dominant regulation of acinar morphogenesis in 3D culture, and for the potential utility of an immunohistochemical assay for DEAR1 expression as an independent prognostic marker for stratification of early-onset disease.
Editors' Summary
Background
Each year, more than one million women discover that they have breast cancer. This type of cancer begins when cells in the breast that line the milk-producing glands or the tubes that take the milk to the nipples (glandular and ductal epithelial cells, respectively) acquire genetic changes that allow them to grow uncontrollably and to move around the body (metastasize). The uncontrolled division leads to the formation of a lump that can be detected by mammography (a breast X-ray) or by manual breast examination. Breast cancer is treated by surgical removal of the lump or, if the cancer has started to spread, by removal of the whole breast (mastectomy). Surgery is usually followed by radiotherapy or chemotherapy. These “adjuvant” therapies are designed to kill any remaining cancer cells but can make patients very ill. Generally speaking, the outlook for women with breast cancer is good. In the US, for example, nearly 90% of affected women are still alive five years after their diagnosis.
Why Was This Study Done?
Although breast cancer is usually diagnosed in women in their 50s or 60s, some women develop breast cancer much earlier. In these women, the disease is often very aggressive. Compared to older women, young women with breast cancer have a lower overall survival rate and their cancer is more likely to recur locally or to metastasize. It would be useful to be able to recognize those younger women at the greatest risk of cancer recurrence so that they could be offered intensive surveillance and adjuvant therapy; those women at a lower risk could have gentler treatments. To achieve this type of “stratification,” the genetic changes that underlie breast cancer in young women need to be identified. In this study, the researchers discover a gene that is genetically altered (by mutations or deletion) in early-onset breast cancer and then investigate whether its expression can predict outcomes in women with this disease.
What Did the Researchers Do and Find?
The researchers used “suppression subtractive hybridization” to identify a new gene in a region of human Chromosome 1 where loss of heterozygosity (LOH; a genetic alteration associated with cancer development) frequently occurs. They called the gene DEAR1 (ductal epithelium-associated RING Chromosome 1) to indicate that it is expressed in ductal and glandular epithelial cells and encodes a “RING finger” protein (specifically, a subtype called a TRIM protein; RING finger proteins such as BRCA1 and BRCA2 have been implicated in early cancer development and in a large fraction of inherited breast cancers). DEAR1 expression was reduced or lost in several ductal carcinomas in situ (a local abnormality that can develop into breast cancer) and advanced breast cancers, the researchers report. Furthermore, many breast tumors carried DEAR1 missense mutations (genetic changes that interfere with the normal function of the DEAR1 protein) or had lost both copies of DEAR1 (the human genome contains two copies of most genes). To determine the function of DEAR1, the researchers replaced a normal copy of DEAR1 into a breast cancer cell that had a mutation in DEAR1. They then examined the growth of these genetically manipulated cells in special three-dimensional cultures. The breast cancer cells without DEAR1 grew rapidly without an organized structure while the breast cancer cells containing the introduced copy of DEAR1 formed structures that resembled normal breast acini (sac-like structures that secrete milk). In normal human mammary epithelial cells, the researchers silenced DEAR1 expression and also showed that without DEAR1, the normal mammary cells lost their ability to form proper acini. Finally, the researchers report that DEAR1 expression (detected “immunohistochemically”) was frequently lost in women who had had early-onset breast cancer and that the loss of DEAR1 expression correlated with reduced local recurrence-free survival, a strong family history of breast cancer and with a breast cancer subtype that has a poor outcome.
What Do These Findings Mean?
These findings indicate that genetic alteration and loss of expression of DEAR1 are common in breast cancer. Although laboratory experiments may not necessarily reflect what happens in people, the results from the three-dimensional culture of breast epithelial cells suggest that DEAR1 may regulate the normal acinar structure of the breast. Consequently, loss of DEAR1 expression could be an early event in breast cancer development. Most importantly, the correlation between DEAR1 expression and both local recurrence in early-onset breast cancer and a breast cancer subtype with a poor outcome suggests that it might be possible to use DEAR1 expression to identify women with early-onset breast cancer who have an increased risk of local recurrence so that they get the most appropriate treatment for their cancer.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000068.
This study is further discussed in a PLoS Medicine Perspective by Senthil Muthuswamy
The US National Cancer Institute provides detailed information for patients and health professionals on all aspects of breast cancer, including information on genetic alterations in breast cancer (in English and Spanish)
The MedlinePlus Encyclopedia provides information for patients about breast cancer; MedlinePlus also provides links to many other breast cancer resources (in English and Spanish)
The UK charities Cancerbackup (now merged with MacMillan Cancer Support) and Cancer Research UK also provide detailed information about breast cancer
doi:10.1371/journal.pmed.1000068
PMCID: PMC2673042  PMID: 19536326
4.  Development and Implementation of a Web-Enabled 3D Consultation Tool for Breast Augmentation Surgery Based on 3D-Image Reconstruction of 2D Pictures 
Background
Producing a rich, personalized Web-based consultation tool for plastic surgeons and patients is challenging.
Objective
(1) To develop a computer tool that allows individual reconstruction and simulation of 3-dimensional (3D) soft tissue from ordinary digital photos of breasts, (2) to implement a Web-based, worldwide-accessible preoperative surgical planning platform for plastic surgeons, and (3) to validate this tool through a quality control analysis by comparing 3D laser scans of the patients with the 3D reconstructions with this tool from original 2-dimensional (2D) pictures of the same patients.
Methods
The proposed system uses well-established 2D digital photos for reconstruction into a 3D torso, which is then available to the user for interactive planning. The simulation is performed on dedicated servers, accessible via Internet. It allows the surgeon, together with the patient, to previsualize the impact of the proposed breast augmentation directly during the consultation before a surgery is decided upon. We retrospectively conduced a quality control assessment of available anonymized pre- and postoperative 2D digital photographs of patients undergoing breast augmentation procedures. The method presented above was used to reconstruct 3D pictures from 2D digital pictures. We used a laser scanner capable of generating a highly accurate surface model of the patient’s anatomy to acquire ground truth data. The quality of the computed 3D reconstructions was compared with the ground truth data used to perform both qualitative and quantitative evaluations.
Results
We evaluated the system on 11 clinical cases for surface reconstructions and 4 clinical cases of postoperative simulations, using laser surface scan technologies showing a mean reconstruction error between 2 and 4 mm and a maximum outlier error of 16 mm. Qualitative and quantitative analyses from plastic surgeons demonstrate the potential of these new emerging technologies.
Conclusions
We tested our tool for 3D, Web-based, patient-specific consultation in the clinical scenario of breast augmentation. This example shows that the current state of development allows for creation of responsive and effective Web-based, 3D medical tools, even with highly complex and time-consuming computation, by off-loading them to a dedicated high-performance data center. The efficient combination of advanced technologies, based on analysis and understanding of human anatomy and physiology, will allow the development of further Web-based reconstruction and predictive interfaces at different scales of the human body. The consultation tool presented herein exemplifies the potential of combining advancements in the core areas of computer science and biomedical engineering with the evolving areas of Web technologies. We are confident that future developments based on a multidisciplinary approach will further pave the way toward personalized Web-enabled medicine.
doi:10.2196/jmir.1903
PMCID: PMC3374529  PMID: 22306688
Medical informatics computing; computer-assisted surgery; imaging, three-dimensional
5.  Tracking the aesthetic outcomes of prosthetic breast reconstructions that have complications 
Plastic Surgery  2014;22(2):70-74.
Numerous studies have reported that successful breast reconstruction with satisfying aesthetic outcomes following mastectomy is vital to the quality of life of breast cancer patients. Although several patient factors have been shown to influence the aesthetic results of reconstructive surgery, it is unclear whether postoperative complications contribute to adverse cosmetic outcomes. Accordingly, this retrospective chart review examined a series of expander-implant breast reconstructions performed between 2004 and 2012.
BACKGROUND:
Aesthetic results following breast reconstruction have been shown to be a major contributor to patient satisfaction. While many presume that complications after reconstruction impact final aesthetic results, little data exist to substantiate this putative relationship.
OBJECTIVE:
To track and evaluate aesthetic outcomes following implant reconstructions with complications.
METHODS:
A chart review was conducted on a series of consecutive expander-implant breast reconstructions performed by the senior author between 2004 and 2012. Included patients completed their prosthetic reconstruction or converted to autologous methods and had a minimum follow-up period of 130 days. Four blinded members of the division of plastic surgery independently rated postoperative anterior photographs of patients’ breasts using a validated scoring scale with respect to five distinct aesthetic domains: breast mound volume, contour, placement, scarring and inframammary fold.
RESULTS:
Of the 172 patients who met the inclusion criteria, 36 experienced a complication. The tissue expander in one-half of these patients was salvaged and the remaining patients converted to autologous reconstruction. The average aesthetic scores for each domain did not differ significantly between patients who experienced a complication and retained their expander and those who did not experience a complication. Patients who converted to autologous tissue reconstruction after experiencing a complication had the highest aesthetic scores.
DISCUSSION:
The ability to obtain aesthetic results following a complication that were not statistically different from results in those without complications may reflect the surgeon’s refined attempt to salvage the initial implant reconstruction; in other circumstances, the improved cosmesis was achieved through conversion to an autologous tissue-based method.
CONCLUSION:
The present study quantitatively assessed the impact of complications on aesthetic outcomes following implant breast reconstruction. Continuance of prosthetic reconstruction and conversion to autologous reconstruction serve as viable options to obtain adequate aesthetic scores following a complication. Information gained from the present analysis will help manage patient expectations.
PMCID: PMC4116317  PMID: 25114615
Aesthetic; Breast reconstruction; Outcomes; Prosthetic
6.  25th Annual Computational Neuroscience Meeting: CNS-2016 
Sharpee, Tatyana O. | Destexhe, Alain | Kawato, Mitsuo | Sekulić, Vladislav | Skinner, Frances K. | Wójcik, Daniel K. | Chintaluri, Chaitanya | Cserpán, Dorottya | Somogyvári, Zoltán | Kim, Jae Kyoung | Kilpatrick, Zachary P. | Bennett, Matthew R. | Josić, Kresimir | Elices, Irene | Arroyo, David | Levi, Rafael | Rodriguez, Francisco B. | Varona, Pablo | Hwang, Eunjin | Kim, Bowon | Han, Hio-Been | Kim, Tae | McKenna, James T. | Brown, Ritchie E. | McCarley, Robert W. | Choi, Jee Hyun | Rankin, James | Popp, Pamela Osborn | Rinzel, John | Tabas, Alejandro | Rupp, André | Balaguer-Ballester, Emili | Maturana, Matias I. | Grayden, David B. | Cloherty, Shaun L. | Kameneva, Tatiana | Ibbotson, Michael R. | Meffin, Hamish | Koren, Veronika | Lochmann, Timm | Dragoi, Valentin | Obermayer, Klaus | Psarrou, Maria | Schilstra, Maria | Davey, Neil | Torben-Nielsen, Benjamin | Steuber, Volker | Ju, Huiwen | Yu, Jiao | Hines, Michael L. | Chen, Liang | Yu, Yuguo | Kim, Jimin | Leahy, Will | Shlizerman, Eli | Birgiolas, Justas | Gerkin, Richard C. | Crook, Sharon M. | Viriyopase, Atthaphon | Memmesheimer, Raoul-Martin | Gielen, Stan | Dabaghian, Yuri | DeVito, Justin | Perotti, Luca | Kim, Anmo J. | Fenk, Lisa M. | Cheng, Cheng | Maimon, Gaby | Zhao, Chang | Widmer, Yves | Sprecher, Simon | Senn, Walter | Halnes, Geir | Mäki-Marttunen, Tuomo | Keller, Daniel | Pettersen, Klas H. | Andreassen, Ole A. | Einevoll, Gaute T. | Yamada, Yasunori | Steyn-Ross, Moira L. | Alistair Steyn-Ross, D. | Mejias, Jorge F. | Murray, John D. | Kennedy, Henry | Wang, Xiao-Jing | Kruscha, Alexandra | Grewe, Jan | Benda, Jan | Lindner, Benjamin | Badel, Laurent | Ohta, Kazumi | Tsuchimoto, Yoshiko | Kazama, Hokto | Kahng, B. | Tam, Nicoladie D. | Pollonini, Luca | Zouridakis, George | Soh, Jaehyun | Kim, DaeEun | Yoo, Minsu | Palmer, S. E. | Culmone, Viviana | Bojak, Ingo | Ferrario, Andrea | Merrison-Hort, Robert | Borisyuk, Roman | Kim, Chang Sub | Tezuka, Taro | Joo, Pangyu | Rho, Young-Ah | Burton, Shawn D. | Bard Ermentrout, G. | Jeong, Jaeseung | Urban, Nathaniel N. | Marsalek, Petr | Kim, Hoon-Hee | Moon, Seok-hyun | Lee, Do-won | Lee, Sung-beom | Lee, Ji-yong | Molkov, Yaroslav I. | Hamade, Khaldoun | Teka, Wondimu | Barnett, William H. | Kim, Taegyo | Markin, Sergey | Rybak, Ilya A. | Forro, Csaba | Dermutz, Harald | Demkó, László | Vörös, János | Babichev, Andrey | Huang, Haiping | Verduzco-Flores, Sergio | Dos Santos, Filipa | Andras, Peter | Metzner, Christoph | Schweikard, Achim | Zurowski, Bartosz | Roach, James P. | Sander, Leonard M. | Zochowski, Michal R. | Skilling, Quinton M. | Ognjanovski, Nicolette | Aton, Sara J. | Zochowski, Michal | Wang, Sheng-Jun | Ouyang, Guang | Guang, Jing | Zhang, Mingsha | Michael Wong, K. Y. | Zhou, Changsong | Robinson, Peter A. | Sanz-Leon, Paula | Drysdale, Peter M. | Fung, Felix | Abeysuriya, Romesh G. | Rennie, Chris J. | Zhao, Xuelong | Choe, Yoonsuck | Yang, Huei-Fang | Mi, Yuanyuan | Lin, Xiaohan | Wu, Si | Liedtke, Joscha | Schottdorf, Manuel | Wolf, Fred | Yamamura, Yoriko | Wickens, Jeffery R. | Rumbell, Timothy | Ramsey, Julia | Reyes, Amy | Draguljić, Danel | Hof, Patrick R. | Luebke, Jennifer | Weaver, Christina M. | He, Hu | Yang, Xu | Ma, Hailin | Xu, Zhiheng | Wang, Yuzhe | Baek, Kwangyeol | Morris, Laurel S. | Kundu, Prantik | Voon, Valerie | Agnes, Everton J. | Vogels, Tim P. | Podlaski, William F. | Giese, Martin | Kuravi, Pradeep | Vogels, Rufin | Seeholzer, Alexander | Podlaski, William | Ranjan, Rajnish | Vogels, Tim | Torres, Joaquin J. | Baroni, Fabiano | Latorre, Roberto | Gips, Bart | Lowet, Eric | Roberts, Mark J. | de Weerd, Peter | Jensen, Ole | van der Eerden, Jan | Goodarzinick, Abdorreza | Niry, Mohammad D. | Valizadeh, Alireza | Pariz, Aref | Parsi, Shervin S. | Warburton, Julia M. | Marucci, Lucia | Tamagnini, Francesco | Brown, Jon | Tsaneva-Atanasova, Krasimira | Kleberg, Florence I. | Triesch, Jochen | Moezzi, Bahar | Iannella, Nicolangelo | Schaworonkow, Natalie | Plogmacher, Lukas | Goldsworthy, Mitchell R. | Hordacre, Brenton | McDonnell, Mark D. | Ridding, Michael C. | Zapotocky, Martin | Smit, Daniel | Fouquet, Coralie | Trembleau, Alain | Dasgupta, Sakyasingha | Nishikawa, Isao | Aihara, Kazuyuki | Toyoizumi, Taro | Robb, Daniel T. | Mellen, Nick | Toporikova, Natalia | Tang, Rongxiang | Tang, Yi-Yuan | Liang, Guangsheng | Kiser, Seth A. | Howard, James H. | Goncharenko, Julia | Voronenko, Sergej O. | Ahamed, Tosif | Stephens, Greg | Yger, Pierre | Lefebvre, Baptiste | Spampinato, Giulia Lia Beatrice | Esposito, Elric | et Olivier Marre, Marcel Stimberg | Choi, Hansol | Song, Min-Ho | Chung, SueYeon | Lee, Dan D. | Sompolinsky, Haim | Phillips, Ryan S. | Smith, Jeffrey | Chatzikalymniou, Alexandra Pierri | Ferguson, Katie | Alex Cayco Gajic, N. | Clopath, Claudia | Angus Silver, R. | Gleeson, Padraig | Marin, Boris | Sadeh, Sadra | Quintana, Adrian | Cantarelli, Matteo | Dura-Bernal, Salvador | Lytton, William W. | Davison, Andrew | Li, Luozheng | Zhang, Wenhao | Wang, Dahui | Song, Youngjo | Park, Sol | Choi, Ilhwan | Shin, Hee-sup | Choi, Hannah | Pasupathy, Anitha | Shea-Brown, Eric | Huh, Dongsung | Sejnowski, Terrence J. | Vogt, Simon M. | Kumar, Arvind | Schmidt, Robert | Van Wert, Stephen | Schiff, Steven J. | Veale, Richard | Scheutz, Matthias | Lee, Sang Wan | Gallinaro, Júlia | Rotter, Stefan | Rubchinsky, Leonid L. | Cheung, Chung Ching | Ratnadurai-Giridharan, Shivakeshavan | Shomali, Safura Rashid | Ahmadabadi, Majid Nili | Shimazaki, Hideaki | Nader Rasuli, S. | Zhao, Xiaochen | Rasch, Malte J. | Wilting, Jens | Priesemann, Viola | Levina, Anna | Rudelt, Lucas | Lizier, Joseph T. | Spinney, Richard E. | Rubinov, Mikail | Wibral, Michael | Bak, Ji Hyun | Pillow, Jonathan | Zaho, Yuan | Park, Il Memming | Kang, Jiyoung | Park, Hae-Jeong | Jang, Jaeson | Paik, Se-Bum | Choi, Woochul | Lee, Changju | Song, Min | Lee, Hyeonsu | Park, Youngjin | Yilmaz, Ergin | Baysal, Veli | Ozer, Mahmut | Saska, Daniel | Nowotny, Thomas | Chan, Ho Ka | Diamond, Alan | Herrmann, Christoph S. | Murray, Micah M. | Ionta, Silvio | Hutt, Axel | Lefebvre, Jérémie | Weidel, Philipp | Duarte, Renato | Morrison, Abigail | Lee, Jung H. | Iyer, Ramakrishnan | Mihalas, Stefan | Koch, Christof | Petrovici, Mihai A. | Leng, Luziwei | Breitwieser, Oliver | Stöckel, David | Bytschok, Ilja | Martel, Roman | Bill, Johannes | Schemmel, Johannes | Meier, Karlheinz | Esler, Timothy B. | Burkitt, Anthony N. | Kerr, Robert R. | Tahayori, Bahman | Nolte, Max | Reimann, Michael W. | Muller, Eilif | Markram, Henry | Parziale, Antonio | Senatore, Rosa | Marcelli, Angelo | Skiker, K. | Maouene, M. | Neymotin, Samuel A. | Seidenstein, Alexandra | Lakatos, Peter | Sanger, Terence D. | Menzies, Rosemary J. | McLauchlan, Campbell | van Albada, Sacha J. | Kedziora, David J. | Neymotin, Samuel | Kerr, Cliff C. | Suter, Benjamin A. | Shepherd, Gordon M. G. | Ryu, Juhyoung | Lee, Sang-Hun | Lee, Joonwon | Lee, Hyang Jung | Lim, Daeseob | Wang, Jisung | Lee, Heonsoo | Jung, Nam | Anh Quang, Le | Maeng, Seung Eun | Lee, Tae Ho | Lee, Jae Woo | Park, Chang-hyun | Ahn, Sora | Moon, Jangsup | Choi, Yun Seo | Kim, Juhee | Jun, Sang Beom | Lee, Seungjun | Lee, Hyang Woon | Jo, Sumin | Jun, Eunji | Yu, Suin | Goetze, Felix | Lai, Pik-Yin | Kim, Seonghyun | Kwag, Jeehyun | Jang, Hyun Jae | Filipović, Marko | Reig, Ramon | Aertsen, Ad | Silberberg, Gilad | Bachmann, Claudia | Buttler, Simone | Jacobs, Heidi | Dillen, Kim | Fink, Gereon R. | Kukolja, Juraj | Kepple, Daniel | Giaffar, Hamza | Rinberg, Dima | Shea, Steven | Koulakov, Alex | Bahuguna, Jyotika | Tetzlaff, Tom | Kotaleski, Jeanette Hellgren | Kunze, Tim | Peterson, Andre | Knösche, Thomas | Kim, Minjung | Kim, Hojeong | Park, Ji Sung | Yeon, Ji Won | Kim, Sung-Phil | Kang, Jae-Hwan | Lee, Chungho | Spiegler, Andreas | Petkoski, Spase | Palva, Matias J. | Jirsa, Viktor K. | Saggio, Maria L. | Siep, Silvan F. | Stacey, William C. | Bernar, Christophe | Choung, Oh-hyeon | Jeong, Yong | Lee, Yong-il | Kim, Su Hyun | Jeong, Mir | Lee, Jeungmin | Kwon, Jaehyung | Kralik, Jerald D. | Jahng, Jaehwan | Hwang, Dong-Uk | Kwon, Jae-Hyung | Park, Sang-Min | Kim, Seongkyun | Kim, Hyoungkyu | Kim, Pyeong Soo | Yoon, Sangsup | Lim, Sewoong | Park, Choongseok | Miller, Thomas | Clements, Katie | Ahn, Sungwoo | Ji, Eoon Hye | Issa, Fadi A. | Baek, JeongHun | Oba, Shigeyuki | Yoshimoto, Junichiro | Doya, Kenji | Ishii, Shin | Mosqueiro, Thiago S. | Strube-Bloss, Martin F. | Smith, Brian | Huerta, Ramon | Hadrava, Michal | Hlinka, Jaroslav | Bos, Hannah | Helias, Moritz | Welzig, Charles M. | Harper, Zachary J. | Kim, Won Sup | Shin, In-Seob | Baek, Hyeon-Man | Han, Seung Kee | Richter, René | Vitay, Julien | Beuth, Frederick | Hamker, Fred H. | Toppin, Kelly | Guo, Yixin | Graham, Bruce P. | Kale, Penelope J. | Gollo, Leonardo L. | Stern, Merav | Abbott, L. F. | Fedorov, Leonid A. | Giese, Martin A. | Ardestani, Mohammad Hovaidi | Faraji, Mohammad Javad | Preuschoff, Kerstin | Gerstner, Wulfram | van Gendt, Margriet J. | Briaire, Jeroen J. | Kalkman, Randy K. | Frijns, Johan H. M. | Lee, Won Hee | Frangou, Sophia | Fulcher, Ben D. | Tran, Patricia H. P. | Fornito, Alex | Gliske, Stephen V. | Lim, Eugene | Holman, Katherine A. | Fink, Christian G. | Kim, Jinseop S. | Mu, Shang | Briggman, Kevin L. | Sebastian Seung, H. | Wegener, Detlef | Bohnenkamp, Lisa | Ernst, Udo A. | Devor, Anna | Dale, Anders M. | Lines, Glenn T. | Edwards, Andy | Tveito, Aslak | Hagen, Espen | Senk, Johanna | Diesmann, Markus | Schmidt, Maximilian | Bakker, Rembrandt | Shen, Kelly | Bezgin, Gleb | Hilgetag, Claus-Christian | van Albada, Sacha Jennifer | Sun, Haoqi | Sourina, Olga | Huang, Guang-Bin | Klanner, Felix | Denk, Cornelia | Glomb, Katharina | Ponce-Alvarez, Adrián | Gilson, Matthieu | Ritter, Petra | Deco, Gustavo | Witek, Maria A. G. | Clarke, Eric F. | Hansen, Mads | Wallentin, Mikkel | Kringelbach, Morten L. | Vuust, Peter | Klingbeil, Guido | De Schutter, Erik | Chen, Weiliang | Zang, Yunliang | Hong, Sungho | Takashima, Akira | Zamora, Criseida | Gallimore, Andrew R. | Goldschmidt, Dennis | Manoonpong, Poramate | Karoly, Philippa J. | Freestone, Dean R. | Soundry, Daniel | Kuhlmann, Levin | Paninski, Liam | Cook, Mark | Lee, Jaejin | Fishman, Yonatan I. | Cohen, Yale E. | Roberts, James A. | Cocchi, Luca | Sweeney, Yann | Lee, Soohyun | Jung, Woo-Sung | Kim, Youngsoo | Jung, Younginha | Song, Yoon-Kyu | Chavane, Frédéric | Soman, Karthik | Muralidharan, Vignesh | Srinivasa Chakravarthy, V. | Shivkumar, Sabyasachi | Mandali, Alekhya | Pragathi Priyadharsini, B. | Mehta, Hima | Davey, Catherine E. | Brinkman, Braden A. W. | Kekona, Tyler | Rieke, Fred | Buice, Michael | De Pittà, Maurizio | Berry, Hugues | Brunel, Nicolas | Breakspear, Michael | Marsat, Gary | Drew, Jordan | Chapman, Phillip D. | Daly, Kevin C. | Bradle, Samual P. | Seo, Sat Byul | Su, Jianzhong | Kavalali, Ege T. | Blackwell, Justin | Shiau, LieJune | Buhry, Laure | Basnayake, Kanishka | Lee, Sue-Hyun | Levy, Brandon A. | Baker, Chris I. | Leleu, Timothée | Philips, Ryan T. | Chhabria, Karishma
BMC Neuroscience  2016;17(Suppl 1):54.
Table of contents
A1 Functional advantages of cell-type heterogeneity in neural circuits
Tatyana O. Sharpee
A2 Mesoscopic modeling of propagating waves in visual cortex
Alain Destexhe
A3 Dynamics and biomarkers of mental disorders
Mitsuo Kawato
F1 Precise recruitment of spiking output at theta frequencies requires dendritic h-channels in multi-compartment models of oriens-lacunosum/moleculare hippocampal interneurons
Vladislav Sekulić, Frances K. Skinner
F2 Kernel methods in reconstruction of current sources from extracellular potentials for single cells and the whole brains
Daniel K. Wójcik, Chaitanya Chintaluri, Dorottya Cserpán, Zoltán Somogyvári
F3 The synchronized periods depend on intracellular transcriptional repression mechanisms in circadian clocks.
Jae Kyoung Kim, Zachary P. Kilpatrick, Matthew R. Bennett, Kresimir Josić
O1 Assessing irregularity and coordination of spiking-bursting rhythms in central pattern generators
Irene Elices, David Arroyo, Rafael Levi, Francisco B. Rodriguez, Pablo Varona
O2 Regulation of top-down processing by cortically-projecting parvalbumin positive neurons in basal forebrain
Eunjin Hwang, Bowon Kim, Hio-Been Han, Tae Kim, James T. McKenna, Ritchie E. Brown, Robert W. McCarley, Jee Hyun Choi
O3 Modeling auditory stream segregation, build-up and bistability
James Rankin, Pamela Osborn Popp, John Rinzel
O4 Strong competition between tonotopic neural ensembles explains pitch-related dynamics of auditory cortex evoked fields
Alejandro Tabas, André Rupp, Emili Balaguer-Ballester
O5 A simple model of retinal response to multi-electrode stimulation
Matias I. Maturana, David B. Grayden, Shaun L. Cloherty, Tatiana Kameneva, Michael R. Ibbotson, Hamish Meffin
O6 Noise correlations in V4 area correlate with behavioral performance in visual discrimination task
Veronika Koren, Timm Lochmann, Valentin Dragoi, Klaus Obermayer
O7 Input-location dependent gain modulation in cerebellar nucleus neurons
Maria Psarrou, Maria Schilstra, Neil Davey, Benjamin Torben-Nielsen, Volker Steuber
O8 Analytic solution of cable energy function for cortical axons and dendrites
Huiwen Ju, Jiao Yu, Michael L. Hines, Liang Chen, Yuguo Yu
O9 C. elegans interactome: interactive visualization of Caenorhabditis elegans worm neuronal network
Jimin Kim, Will Leahy, Eli Shlizerman
O10 Is the model any good? Objective criteria for computational neuroscience model selection
Justas Birgiolas, Richard C. Gerkin, Sharon M. Crook
O11 Cooperation and competition of gamma oscillation mechanisms
Atthaphon Viriyopase, Raoul-Martin Memmesheimer, Stan Gielen
O12 A discrete structure of the brain waves
Yuri Dabaghian, Justin DeVito, Luca Perotti
O13 Direction-specific silencing of the Drosophila gaze stabilization system
Anmo J. Kim, Lisa M. Fenk, Cheng Lyu, Gaby Maimon
O14 What does the fruit fly think about values? A model of olfactory associative learning
Chang Zhao, Yves Widmer, Simon Sprecher,Walter Senn
O15 Effects of ionic diffusion on power spectra of local field potentials (LFP)
Geir Halnes, Tuomo Mäki-Marttunen, Daniel Keller, Klas H. Pettersen,Ole A. Andreassen, Gaute T. Einevoll
O16 Large-scale cortical models towards understanding relationship between brain structure abnormalities and cognitive deficits
Yasunori Yamada
O17 Spatial coarse-graining the brain: origin of minicolumns
Moira L. Steyn-Ross, D. Alistair Steyn-Ross
O18 Modeling large-scale cortical networks with laminar structure
Jorge F. Mejias, John D. Murray, Henry Kennedy, Xiao-Jing Wang
O19 Information filtering by partial synchronous spikes in a neural population
Alexandra Kruscha, Jan Grewe, Jan Benda, Benjamin Lindner
O20 Decoding context-dependent olfactory valence in Drosophila
Laurent Badel, Kazumi Ohta, Yoshiko Tsuchimoto, Hokto Kazama
P1 Neural network as a scale-free network: the role of a hub
B. Kahng
P2 Hemodynamic responses to emotions and decisions using near-infrared spectroscopy optical imaging
Nicoladie D. Tam
P3 Phase space analysis of hemodynamic responses to intentional movement directions using functional near-infrared spectroscopy (fNIRS) optical imaging technique
Nicoladie D.Tam, Luca Pollonini, George Zouridakis
P4 Modeling jamming avoidance of weakly electric fish
Jaehyun Soh, DaeEun Kim
P5 Synergy and redundancy of retinal ganglion cells in prediction
Minsu Yoo, S. E. Palmer
P6 A neural field model with a third dimension representing cortical depth
Viviana Culmone, Ingo Bojak
P7 Network analysis of a probabilistic connectivity model of the Xenopus tadpole spinal cord
Andrea Ferrario, Robert Merrison-Hort, Roman Borisyuk
P8 The recognition dynamics in the brain
Chang Sub Kim
P9 Multivariate spike train analysis using a positive definite kernel
Taro Tezuka
P10 Synchronization of burst periods may govern slow brain dynamics during general anesthesia
Pangyu Joo
P11 The ionic basis of heterogeneity affects stochastic synchrony
Young-Ah Rho, Shawn D. Burton, G. Bard Ermentrout, Jaeseung Jeong, Nathaniel N. Urban
P12 Circular statistics of noise in spike trains with a periodic component
Petr Marsalek
P14 Representations of directions in EEG-BCI using Gaussian readouts
Hoon-Hee Kim, Seok-hyun Moon, Do-won Lee, Sung-beom Lee, Ji-yong Lee, Jaeseung Jeong
P15 Action selection and reinforcement learning in basal ganglia during reaching movements
Yaroslav I. Molkov, Khaldoun Hamade, Wondimu Teka, William H. Barnett, Taegyo Kim, Sergey Markin, Ilya A. Rybak
P17 Axon guidance: modeling axonal growth in T-Junction assay
Csaba Forro, Harald Dermutz, László Demkó, János Vörös
P19 Transient cell assembly networks encode persistent spatial memories
Yuri Dabaghian, Andrey Babichev
P20 Theory of population coupling and applications to describe high order correlations in large populations of interacting neurons
Haiping Huang
P21 Design of biologically-realistic simulations for motor control
Sergio Verduzco-Flores
P22 Towards understanding the functional impact of the behavioural variability of neurons
Filipa Dos Santos, Peter Andras
P23 Different oscillatory dynamics underlying gamma entrainment deficits in schizophrenia
Christoph Metzner, Achim Schweikard, Bartosz Zurowski
P24 Memory recall and spike frequency adaptation
James P. Roach, Leonard M. Sander, Michal R. Zochowski
P25 Stability of neural networks and memory consolidation preferentially occur near criticality
Quinton M. Skilling, Nicolette Ognjanovski, Sara J. Aton, Michal Zochowski
P26 Stochastic Oscillation in Self-Organized Critical States of Small Systems: Sensitive Resting State in Neural Systems
Sheng-Jun Wang, Guang Ouyang, Jing Guang, Mingsha Zhang, K. Y. Michael Wong, Changsong Zhou
P27 Neurofield: a C++ library for fast simulation of 2D neural field models
Peter A. Robinson, Paula Sanz-Leon, Peter M. Drysdale, Felix Fung, Romesh G. Abeysuriya, Chris J. Rennie, Xuelong Zhao
P28 Action-based grounding: Beyond encoding/decoding in neural code
Yoonsuck Choe, Huei-Fang Yang
P29 Neural computation in a dynamical system with multiple time scales
Yuanyuan Mi, Xiaohan Lin, Si Wu
P30 Maximum entropy models for 3D layouts of orientation selectivity
Joscha Liedtke, Manuel Schottdorf, Fred Wolf
P31 A behavioral assay for probing computations underlying curiosity in rodents
Yoriko Yamamura, Jeffery R. Wickens
P32 Using statistical sampling to balance error function contributions to optimization of conductance-based models
Timothy Rumbell, Julia Ramsey, Amy Reyes, Danel Draguljić, Patrick R. Hof, Jennifer Luebke, Christina M. Weaver
P33 Exploration and implementation of a self-growing and self-organizing neuron network building algorithm
Hu He, Xu Yang, Hailin Ma, Zhiheng Xu, Yuzhe Wang
P34 Disrupted resting state brain network in obese subjects: a data-driven graph theory analysis
Kwangyeol Baek, Laurel S. Morris, Prantik Kundu, Valerie Voon
P35 Dynamics of cooperative excitatory and inhibitory plasticity
Everton J. Agnes, Tim P. Vogels
P36 Frequency-dependent oscillatory signal gating in feed-forward networks of integrate-and-fire neurons
William F. Podlaski, Tim P. Vogels
P37 Phenomenological neural model for adaptation of neurons in area IT
Martin Giese, Pradeep Kuravi, Rufin Vogels
P38 ICGenealogy: towards a common topology of neuronal ion channel function and genealogy in model and experiment
Alexander Seeholzer, William Podlaski, Rajnish Ranjan, Tim Vogels
P39 Temporal input discrimination from the interaction between dynamic synapses and neural subthreshold oscillations
Joaquin J. Torres, Fabiano Baroni, Roberto Latorre, Pablo Varona
P40 Different roles for transient and sustained activity during active visual processing
Bart Gips, Eric Lowet, Mark J. Roberts, Peter de Weerd, Ole Jensen, Jan van der Eerden
P41 Scale-free functional networks of 2D Ising model are highly robust against structural defects: neuroscience implications
Abdorreza Goodarzinick, Mohammad D. Niry, Alireza Valizadeh
P42 High frequency neuron can facilitate propagation of signal in neural networks
Aref Pariz, Shervin S. Parsi, Alireza Valizadeh
P43 Investigating the effect of Alzheimer’s disease related amyloidopathy on gamma oscillations in the CA1 region of the hippocampus
Julia M. Warburton, Lucia Marucci, Francesco Tamagnini, Jon Brown, Krasimira Tsaneva-Atanasova
P44 Long-tailed distributions of inhibitory and excitatory weights in a balanced network with eSTDP and iSTDP
Florence I. Kleberg, Jochen Triesch
P45 Simulation of EMG recording from hand muscle due to TMS of motor cortex
Bahar Moezzi, Nicolangelo Iannella, Natalie Schaworonkow, Lukas Plogmacher, Mitchell R. Goldsworthy, Brenton Hordacre, Mark D. McDonnell, Michael C. Ridding, Jochen Triesch
P46 Structure and dynamics of axon network formed in primary cell culture
Martin Zapotocky, Daniel Smit, Coralie Fouquet, Alain Trembleau
P47 Efficient signal processing and sampling in random networks that generate variability
Sakyasingha Dasgupta, Isao Nishikawa, Kazuyuki Aihara, Taro Toyoizumi
P48 Modeling the effect of riluzole on bursting in respiratory neural networks
Daniel T. Robb, Nick Mellen, Natalia Toporikova
P49 Mapping relaxation training using effective connectivity analysis
Rongxiang Tang, Yi-Yuan Tang
P50 Modeling neuron oscillation of implicit sequence learning
Guangsheng Liang, Seth A. Kiser, James H. Howard, Jr., Yi-Yuan Tang
P51 The role of cerebellar short-term synaptic plasticity in the pathology and medication of downbeat nystagmus
Julia Goncharenko, Neil Davey, Maria Schilstra, Volker Steuber
P52 Nonlinear response of noisy neurons
Sergej O. Voronenko, Benjamin Lindner
P53 Behavioral embedding suggests multiple chaotic dimensions underlie C. elegans locomotion
Tosif Ahamed, Greg Stephens
P54 Fast and scalable spike sorting for large and dense multi-electrodes recordings
Pierre Yger, Baptiste Lefebvre, Giulia Lia Beatrice Spampinato, Elric Esposito, Marcel Stimberg et Olivier Marre
P55 Sufficient sampling rates for fast hand motion tracking
Hansol Choi, Min-Ho Song
P56 Linear readout of object manifolds
SueYeon Chung, Dan D. Lee, Haim Sompolinsky
P57 Differentiating models of intrinsic bursting and rhythm generation of the respiratory pre-Bötzinger complex using phase response curves
Ryan S. Phillips, Jeffrey Smith
P58 The effect of inhibitory cell network interactions during theta rhythms on extracellular field potentials in CA1 hippocampus
Alexandra Pierri Chatzikalymniou, Katie Ferguson, Frances K. Skinner
P59 Expansion recoding through sparse sampling in the cerebellar input layer speeds learning
N. Alex Cayco Gajic, Claudia Clopath, R. Angus Silver
P60 A set of curated cortical models at multiple scales on Open Source Brain
Padraig Gleeson, Boris Marin, Sadra Sadeh, Adrian Quintana, Matteo Cantarelli, Salvador Dura-Bernal, William W. Lytton, Andrew Davison, R. Angus Silver
P61 A synaptic story of dynamical information encoding in neural adaptation
Luozheng Li, Wenhao Zhang, Yuanyuan Mi, Dahui Wang, Si Wu
P62 Physical modeling of rule-observant rodent behavior
Youngjo Song, Sol Park, Ilhwan Choi, Jaeseung Jeong, Hee-sup Shin
P64 Predictive coding in area V4 and prefrontal cortex explains dynamic discrimination of partially occluded shapes
Hannah Choi, Anitha Pasupathy, Eric Shea-Brown
P65 Stability of FORCE learning on spiking and rate-based networks
Dongsung Huh, Terrence J. Sejnowski
P66 Stabilising STDP in striatal neurons for reliable fast state recognition in noisy environments
Simon M. Vogt, Arvind Kumar, Robert Schmidt
P67 Electrodiffusion in one- and two-compartment neuron models for characterizing cellular effects of electrical stimulation
Stephen Van Wert, Steven J. Schiff
P68 STDP improves speech recognition capabilities in spiking recurrent circuits parameterized via differential evolution Markov Chain Monte Carlo
Richard Veale, Matthias Scheutz
P69 Bidirectional transformation between dominant cortical neural activities and phase difference distributions
Sang Wan Lee
P70 Maturation of sensory networks through homeostatic structural plasticity
Júlia Gallinaro, Stefan Rotter
P71 Corticothalamic dynamics: structure, number of solutions and stability of steady-state solutions in the space of synaptic couplings
Paula Sanz-Leon, Peter A. Robinson
P72 Optogenetic versus electrical stimulation of the parkinsonian basal ganglia. Computational study
Leonid L. Rubchinsky, Chung Ching Cheung, Shivakeshavan Ratnadurai-Giridharan
P73 Exact spike-timing distribution reveals higher-order interactions of neurons
Safura Rashid Shomali, Majid Nili Ahmadabadi, Hideaki Shimazaki, S. Nader Rasuli
P74 Neural mechanism of visual perceptual learning using a multi-layered neural network
Xiaochen Zhao, Malte J. Rasch
P75 Inferring collective spiking dynamics from mostly unobserved systems
Jens Wilting, Viola Priesemann
P76 How to infer distributions in the brain from subsampled observations
Anna Levina, Viola Priesemann
P77 Influences of embedding and estimation strategies on the inferred memory of single spiking neurons
Lucas Rudelt, Joseph T. Lizier, Viola Priesemann
P78 A nearest-neighbours based estimator for transfer entropy between spike trains
Joseph T. Lizier, Richard E. Spinney, Mikail Rubinov, Michael Wibral, Viola Priesemann
P79 Active learning of psychometric functions with multinomial logistic models
Ji Hyun Bak, Jonathan Pillow
P81 Inferring low-dimensional network dynamics with variational latent Gaussian process
Yuan Zaho, Il Memming Park
P82 Computational investigation of energy landscapes in the resting state subcortical brain network
Jiyoung Kang, Hae-Jeong Park
P83 Local repulsive interaction between retinal ganglion cells can generate a consistent spatial periodicity of orientation map
Jaeson Jang, Se-Bum Paik
P84 Phase duration of bistable perception reveals intrinsic time scale of perceptual decision under noisy condition
Woochul Choi, Se-Bum Paik
P85 Feedforward convergence between retina and primary visual cortex can determine the structure of orientation map
Changju Lee, Jaeson Jang, Se-Bum Paik
P86 Computational method classifying neural network activity patterns for imaging data
Min Song, Hyeonsu Lee, Se-Bum Paik
P87 Symmetry of spike-timing-dependent-plasticity kernels regulates volatility of memory
Youngjin Park, Woochul Choi, Se-Bum Paik
P88 Effects of time-periodic coupling strength on the first-spike latency dynamics of a scale-free network of stochastic Hodgkin-Huxley neurons
Ergin Yilmaz, Veli Baysal, Mahmut Ozer
P89 Spectral properties of spiking responses in V1 and V4 change within the trial and are highly relevant for behavioral performance
Veronika Koren, Klaus Obermayer
P90 Methods for building accurate models of individual neurons
Daniel Saska, Thomas Nowotny
P91 A full size mathematical model of the early olfactory system of honeybees
Ho Ka Chan, Alan Diamond, Thomas Nowotny
P92 Stimulation-induced tuning of ongoing oscillations in spiking neural networks
Christoph S. Herrmann, Micah M. Murray, Silvio Ionta, Axel Hutt, Jérémie Lefebvre
P93 Decision-specific sequences of neural activity in balanced random networks driven by structured sensory input
Philipp Weidel, Renato Duarte, Abigail Morrison
P94 Modulation of tuning induced by abrupt reduction of SST cell activity
Jung H. Lee, Ramakrishnan Iyer, Stefan Mihalas
P95 The functional role of VIP cell activation during locomotion
Jung H. Lee, Ramakrishnan Iyer, Christof Koch, Stefan Mihalas
P96 Stochastic inference with spiking neural networks
Mihai A. Petrovici, Luziwei Leng, Oliver Breitwieser, David Stöckel, Ilja Bytschok, Roman Martel, Johannes Bill, Johannes Schemmel, Karlheinz Meier
P97 Modeling orientation-selective electrical stimulation with retinal prostheses
Timothy B. Esler, Anthony N. Burkitt, David B. Grayden, Robert R. Kerr, Bahman Tahayori, Hamish Meffin
P98 Ion channel noise can explain firing correlation in auditory nerves
Bahar Moezzi, Nicolangelo Iannella, Mark D. McDonnell
P99 Limits of temporal encoding of thalamocortical inputs in a neocortical microcircuit
Max Nolte, Michael W. Reimann, Eilif Muller, Henry Markram
P100 On the representation of arm reaching movements: a computational model
Antonio Parziale, Rosa Senatore, Angelo Marcelli
P101 A computational model for investigating the role of cerebellum in acquisition and retention of motor behavior
Rosa Senatore, Antonio Parziale, Angelo Marcelli
P102 The emergence of semantic categories from a large-scale brain network of semantic knowledge
K. Skiker, M. Maouene
P103 Multiscale modeling of M1 multitarget pharmacotherapy for dystonia
Samuel A. Neymotin, Salvador Dura-Bernal, Alexandra Seidenstein, Peter Lakatos, Terence D. Sanger, William W. Lytton
P104 Effect of network size on computational capacity
Salvador Dura-Bernal, Rosemary J. Menzies, Campbell McLauchlan, Sacha J. van Albada, David J. Kedziora, Samuel Neymotin, William W. Lytton, Cliff C. Kerr
P105 NetPyNE: a Python package for NEURON to facilitate development and parallel simulation of biological neuronal networks
Salvador Dura-Bernal, Benjamin A. Suter, Samuel A. Neymotin, Cliff C. Kerr, Adrian Quintana, Padraig Gleeson, Gordon M. G. Shepherd, William W. Lytton
P107 Inter-areal and inter-regional inhomogeneity in co-axial anisotropy of Cortical Point Spread in human visual areas
Juhyoung Ryu, Sang-Hun Lee
P108 Two bayesian quanta of uncertainty explain the temporal dynamics of cortical activity in the non-sensory areas during bistable perception
Joonwon Lee, Sang-Hun Lee
P109 Optimal and suboptimal integration of sensory and value information in perceptual decision making
Hyang Jung Lee, Sang-Hun Lee
P110 A Bayesian algorithm for phoneme Perception and its neural implementation
Daeseob Lim, Sang-Hun Lee
P111 Complexity of EEG signals is reduced during unconsciousness induced by ketamine and propofol
Jisung Wang, Heonsoo Lee
P112 Self-organized criticality of neural avalanche in a neural model on complex networks
Nam Jung, Le Anh Quang, Seung Eun Maeng, Tae Ho Lee, Jae Woo Lee
P113 Dynamic alterations in connection topology of the hippocampal network during ictal-like epileptiform activity in an in vitro rat model
Chang-hyun Park, Sora Ahn, Jangsup Moon, Yun Seo Choi, Juhee Kim, Sang Beom Jun, Seungjun Lee, Hyang Woon Lee
P114 Computational model to replicate seizure suppression effect by electrical stimulation
Sora Ahn, Sumin Jo, Eunji Jun, Suin Yu, Hyang Woon Lee, Sang Beom Jun, Seungjun Lee
P115 Identifying excitatory and inhibitory synapses in neuronal networks from spike trains using sorted local transfer entropy
Felix Goetze, Pik-Yin Lai
P116 Neural network model for obstacle avoidance based on neuromorphic computational model of boundary vector cell and head direction cell
Seonghyun Kim, Jeehyun Kwag
P117 Dynamic gating of spike pattern propagation by Hebbian and anti-Hebbian spike timing-dependent plasticity in excitatory feedforward network model
Hyun Jae Jang, Jeehyun Kwag
P118 Inferring characteristics of input correlations of cells exhibiting up-down state transitions in the rat striatum
Marko Filipović, Ramon Reig, Ad Aertsen, Gilad Silberberg, Arvind Kumar
P119 Graph properties of the functional connected brain under the influence of Alzheimer’s disease
Claudia Bachmann, Simone Buttler, Heidi Jacobs, Kim Dillen, Gereon R. Fink, Juraj Kukolja, Abigail Morrison
P120 Learning sparse representations in the olfactory bulb
Daniel Kepple, Hamza Giaffar, Dima Rinberg, Steven Shea, Alex Koulakov
P121 Functional classification of homologous basal-ganglia networks
Jyotika Bahuguna,Tom Tetzlaff, Abigail Morrison, Arvind Kumar, Jeanette Hellgren Kotaleski
P122 Short term memory based on multistability
Tim Kunze, Andre Peterson, Thomas Knösche
P123 A physiologically plausible, computationally efficient model and simulation software for mammalian motor units
Minjung Kim, Hojeong Kim
P125 Decoding laser-induced somatosensory information from EEG
Ji Sung Park, Ji Won Yeon, Sung-Phil Kim
P126 Phase synchronization of alpha activity for EEG-based personal authentication
Jae-Hwan Kang, Chungho Lee, Sung-Phil Kim
P129 Investigating phase-lags in sEEG data using spatially distributed time delays in a large-scale brain network model
Andreas Spiegler, Spase Petkoski, Matias J. Palva, Viktor K. Jirsa
P130 Epileptic seizures in the unfolding of a codimension-3 singularity
Maria L. Saggio, Silvan F. Siep, Andreas Spiegler, William C. Stacey, Christophe Bernard, Viktor K. Jirsa
P131 Incremental dimensional exploratory reasoning under multi-dimensional environment
Oh-hyeon Choung, Yong Jeong
P132 A low-cost model of eye movements and memory in personal visual cognition
Yong-il Lee, Jaeseung Jeong
P133 Complex network analysis of structural connectome of autism spectrum disorder patients
Su Hyun Kim, Mir Jeong, Jaeseung Jeong
P134 Cognitive motives and the neural correlates underlying human social information transmission, gossip
Jeungmin Lee, Jaehyung Kwon, Jerald D. Kralik, Jaeseung Jeong
P135 EEG hyperscanning detects neural oscillation for the social interaction during the economic decision-making
Jaehwan Jahng, Dong-Uk Hwang, Jaeseung Jeong
P136 Detecting purchase decision based on hyperfrontality of the EEG
Jae-Hyung Kwon, Sang-Min Park, Jaeseung Jeong
P137 Vulnerability-based critical neurons, synapses, and pathways in the Caenorhabditis elegans connectome
Seongkyun Kim, Hyoungkyu Kim, Jerald D. Kralik, Jaeseung Jeong
P138 Motif analysis reveals functionally asymmetrical neurons in C. elegans
Pyeong Soo Kim, Seongkyun Kim, Hyoungkyu Kim, Jaeseung Jeong
P139 Computational approach to preference-based serial decision dynamics: do temporal discounting and working memory affect it?
Sangsup Yoon, Jaehyung Kwon, Sewoong Lim, Jaeseung Jeong
P141 Social stress induced neural network reconfiguration affects decision making and learning in zebrafish
Choongseok Park, Thomas Miller, Katie Clements, Sungwoo Ahn, Eoon Hye Ji, Fadi A. Issa
P142 Descriptive, generative, and hybrid approaches for neural connectivity inference from neural activity data
JeongHun Baek, Shigeyuki Oba, Junichiro Yoshimoto, Kenji Doya, Shin Ishii
P145 Divergent-convergent synaptic connectivities accelerate coding in multilayered sensory systems
Thiago S. Mosqueiro, Martin F. Strube-Bloss, Brian Smith, Ramon Huerta
P146 Swinging networks
Michal Hadrava, Jaroslav Hlinka
P147 Inferring dynamically relevant motifs from oscillatory stimuli: challenges, pitfalls, and solutions
Hannah Bos, Moritz Helias
P148 Spatiotemporal mapping of brain network dynamics during cognitive tasks using magnetoencephalography and deep learning
Charles M. Welzig, Zachary J. Harper
P149 Multiscale complexity analysis for the segmentation of MRI images
Won Sup Kim, In-Seob Shin, Hyeon-Man Baek, Seung Kee Han
P150 A neuro-computational model of emotional attention
René Richter, Julien Vitay, Frederick Beuth, Fred H. Hamker
P151 Multi-site delayed feedback stimulation in parkinsonian networks
Kelly Toppin, Yixin Guo
P152 Bistability in Hodgkin–Huxley-type equations
Tatiana Kameneva, Hamish Meffin, Anthony N. Burkitt, David B. Grayden
P153 Phase changes in postsynaptic spiking due to synaptic connectivity and short term plasticity: mathematical analysis of frequency dependency
Mark D. McDonnell, Bruce P. Graham
P154 Quantifying resilience patterns in brain networks: the importance of directionality
Penelope J. Kale, Leonardo L. Gollo
P155 Dynamics of rate-model networks with separate excitatory and inhibitory populations
Merav Stern, L. F. Abbott
P156 A model for multi-stable dynamics in action recognition modulated by integration of silhouette and shading cues
Leonid A. Fedorov, Martin A. Giese
P157 Spiking model for the interaction between action recognition and action execution
Mohammad Hovaidi Ardestani, Martin Giese
P158 Surprise-modulated belief update: how to learn within changing environments?
Mohammad Javad Faraji, Kerstin Preuschoff, Wulfram Gerstner
P159 A fast, stochastic and adaptive model of auditory nerve responses to cochlear implant stimulation
Margriet J. van Gendt, Jeroen J. Briaire, Randy K. Kalkman, Johan H. M. Frijns
P160 Quantitative comparison of graph theoretical measures of simulated and empirical functional brain networks
Won Hee Lee, Sophia Frangou
P161 Determining discriminative properties of fMRI signals in schizophrenia using highly comparative time-series analysis
Ben D. Fulcher, Patricia H. P. Tran, Alex Fornito
P162 Emergence of narrowband LFP oscillations from completely asynchronous activity during seizures and high-frequency oscillations
Stephen V. Gliske, William C. Stacey, Eugene Lim, Katherine A. Holman, Christian G. Fink
P163 Neuronal diversity in structure and function: cross-validation of anatomical and physiological classification of retinal ganglion cells in the mouse
Jinseop S. Kim, Shang Mu, Kevin L. Briggman, H. Sebastian Seung, the EyeWirers
P164 Analysis and modelling of transient firing rate changes in area MT in response to rapid stimulus feature changes
Detlef Wegener, Lisa Bohnenkamp, Udo A. Ernst
P165 Step-wise model fitting accounting for high-resolution spatial measurements: construction of a layer V pyramidal cell model with reduced morphology
Tuomo Mäki-Marttunen, Geir Halnes, Anna Devor, Christoph Metzner, Anders M. Dale, Ole A. Andreassen, Gaute T. Einevoll
P166 Contributions of schizophrenia-associated genes to neuron firing and cardiac pacemaking: a polygenic modeling approach
Tuomo Mäki-Marttunen, Glenn T. Lines, Andy Edwards, Aslak Tveito, Anders M. Dale, Gaute T. Einevoll, Ole A. Andreassen
P167 Local field potentials in a 4 × 4 mm2 multi-layered network model
Espen Hagen, Johanna Senk, Sacha J. van Albada, Markus Diesmann
P168 A spiking network model explains multi-scale properties of cortical dynamics
Maximilian Schmidt, Rembrandt Bakker, Kelly Shen, Gleb Bezgin, Claus-Christian Hilgetag, Markus Diesmann, Sacha Jennifer van Albada
P169 Using joint weight-delay spike-timing dependent plasticity to find polychronous neuronal groups
Haoqi Sun, Olga Sourina, Guang-Bin Huang, Felix Klanner, Cornelia Denk
P170 Tensor decomposition reveals RSNs in simulated resting state fMRI
Katharina Glomb, Adrián Ponce-Alvarez, Matthieu Gilson, Petra Ritter, Gustavo Deco
P171 Getting in the groove: testing a new model-based method for comparing task-evoked vs resting-state activity in fMRI data on music listening
Matthieu Gilson, Maria AG Witek, Eric F. Clarke, Mads Hansen, Mikkel Wallentin, Gustavo Deco, Morten L. Kringelbach, Peter Vuust
P172 STochastic engine for pathway simulation (STEPS) on massively parallel processors
Guido Klingbeil, Erik De Schutter
P173 Toolkit support for complex parallel spatial stochastic reaction–diffusion simulation in STEPS
Weiliang Chen, Erik De Schutter
P174 Modeling the generation and propagation of Purkinje cell dendritic spikes caused by parallel fiber synaptic input
Yunliang Zang, Erik De Schutter
P175 Dendritic morphology determines how dendrites are organized into functional subunits
Sungho Hong, Akira Takashima, Erik De Schutter
P176 A model of Ca2+/calmodulin-dependent protein kinase II activity in long term depression at Purkinje cells
Criseida Zamora, Andrew R. Gallimore, Erik De Schutter
P177 Reward-modulated learning of population-encoded vectors for insect-like navigation in embodied agents
Dennis Goldschmidt, Poramate Manoonpong, Sakyasingha Dasgupta
P178 Data-driven neural models part II: connectivity patterns of human seizures
Philippa J. Karoly, Dean R. Freestone, Daniel Soundry, Levin Kuhlmann, Liam Paninski, Mark Cook
P179 Data-driven neural models part I: state and parameter estimation
Dean R. Freestone, Philippa J. Karoly, Daniel Soundry, Levin Kuhlmann, Mark Cook
P180 Spectral and spatial information processing in human auditory streaming
Jaejin Lee, Yonatan I. Fishman, Yale E. Cohen
P181 A tuning curve for the global effects of local perturbations in neural activity: Mapping the systems-level susceptibility of the brain
Leonardo L. Gollo, James A. Roberts, Luca Cocchi
P182 Diverse homeostatic responses to visual deprivation mediated by neural ensembles
Yann Sweeney, Claudia Clopath
P183 Opto-EEG: a novel method for investigating functional connectome in mouse brain based on optogenetics and high density electroencephalography
Soohyun Lee, Woo-Sung Jung, Jee Hyun Choi
P184 Biphasic responses of frontal gamma network to repetitive sleep deprivation during REM sleep
Bowon Kim, Youngsoo Kim, Eunjin Hwang, Jee Hyun Choi
P185 Brain-state correlate and cortical connectivity for frontal gamma oscillations in top-down fashion assessed by auditory steady-state response
Younginha Jung, Eunjin Hwang, Yoon-Kyu Song, Jee Hyun Choi
P186 Neural field model of localized orientation selective activation in V1
James Rankin, Frédéric Chavane
P187 An oscillatory network model of Head direction and Grid cells using locomotor inputs
Karthik Soman, Vignesh Muralidharan, V. Srinivasa Chakravarthy
P188 A computational model of hippocampus inspired by the functional architecture of basal ganglia
Karthik Soman, Vignesh Muralidharan, V. Srinivasa Chakravarthy
P189 A computational architecture to model the microanatomy of the striatum and its functional properties
Sabyasachi Shivkumar, Vignesh Muralidharan, V. Srinivasa Chakravarthy
P190 A scalable cortico-basal ganglia model to understand the neural dynamics of targeted reaching
Vignesh Muralidharan, Alekhya Mandali, B. Pragathi Priyadharsini, Hima Mehta, V. Srinivasa Chakravarthy
P191 Emergence of radial orientation selectivity from synaptic plasticity
Catherine E. Davey, David B. Grayden, Anthony N. Burkitt
P192 How do hidden units shape effective connections between neurons?
Braden A. W. Brinkman, Tyler Kekona, Fred Rieke, Eric Shea-Brown, Michael Buice
P193 Characterization of neural firing in the presence of astrocyte-synapse signaling
Maurizio De Pittà, Hugues Berry, Nicolas Brunel
P194 Metastability of spatiotemporal patterns in a large-scale network model of brain dynamics
James A. Roberts, Leonardo L. Gollo, Michael Breakspear
P195 Comparison of three methods to quantify detection and discrimination capacity estimated from neural population recordings
Gary Marsat, Jordan Drew, Phillip D. Chapman, Kevin C. Daly, Samual P. Bradley
P196 Quantifying the constraints for independent evoked and spontaneous NMDA receptor mediated synaptic transmission at individual synapses
Sat Byul Seo, Jianzhong Su, Ege T. Kavalali, Justin Blackwell
P199 Gamma oscillation via adaptive exponential integrate-and-fire neurons
LieJune Shiau, Laure Buhry, Kanishka Basnayake
P200 Visual face representations during memory retrieval compared to perception
Sue-Hyun Lee, Brandon A. Levy, Chris I. Baker
P201 Top-down modulation of sequential activity within packets modeled using avalanche dynamics
Timothée Leleu, Kazuyuki Aihara
Q28 An auto-encoder network realizes sparse features under the influence of desynchronized vascular dynamics
Ryan T. Philips, Karishma Chhabria, V. Srinivasa Chakravarthy
doi:10.1186/s12868-016-0283-6
PMCID: PMC5001212  PMID: 27534393
7.  Application of threshold-bias independent analysis to eye-tracking and FROC data 
Academic radiology  2012;19(12):1474-1483.
Rationale and Objectives
Studies of medical image interpretation have focused on either assessing radiologists’ performance using, for example, the receiver operating characteristic (ROC) paradigm, or assessing the interpretive process by analyzing eye-tracking (ET) data. Analysis of ET data has not benefited from threshold-bias independent figures-of-merit (FOMs) analogous to the area under the ROC curve. The aim was to demonstrate the feasibility of such FOMs and to measure the agreement between figures-of-merit derived from free-response ROC (FROC) and ET data.
Methods
Eight expert breast radiologists interpreted a case set of 120 two-view mammograms while eye-position data and FROC data were continuously collected during the interpretation interval. Regions that attract prolonged (>800ms) visual attention were considered to be virtual marks, and ratings based on the dwell and approach-rate (inverse of time-to-hit) were assigned to them. The virtual ratings were used to define threshold-bias independent FOMs in a manner analogous to the area under the trapezoidal alternative FROC (AFROC) curve (0 = worst, 1 = best). Agreement at the case level (0.5 = chance, 1 = perfect) was measured using the jackknife and 95% confidence intervals (CI) for the FOMs and agreement were estimated using the bootstrap.
Results
The AFROC mark-ratings FOM was largest 0.734, CI = (0.65, 0.81) followed by the dwell 0.460 (0.34, 0.59) and then by the approach-rate FOM 0.336 (0.25, 0.46). The differences between the FROC mark-ratings FOM and the perceptual FOMs were significant (p < 0.05). All pairwise agreements were significantly better then chance: ratings vs. dwell 0.707 (0.63, 0.88), dwell vs. approach-rate 0.703 (0.60, 0.79) and rating vs. approach-rate 0.606 (0.53, 0.68). The ratings vs. approach-rate agreement was significantly smaller than the dwell vs. approach-rate agreement (p = 0.008).
Conclusions
Leveraging current methods developed for analyzing observer performance data could complement current ways of analyzing ET data and lead to new insights.
doi:10.1016/j.acra.2012.09.002
PMCID: PMC3489965  PMID: 23040503
8.  Mouse cursor movement and eye tracking data as an indicator of pathologists’ attention when viewing digital whole slide images 
Context:
Digital pathology has the potential to dramatically alter the way pathologists work, yet little is known about pathologists’ viewing behavior while interpreting digital whole slide images. While tracking pathologist eye movements when viewing digital slides may be the most direct method of capturing pathologists’ viewing strategies, this technique is cumbersome and technically challenging to use in remote settings. Tracking pathologist mouse cursor movements may serve as a practical method of studying digital slide interpretation, and mouse cursor data may illuminate pathologists’ viewing strategies and time expenditures in their interpretive workflow.
Aims:
To evaluate the utility of mouse cursor movement data, in addition to eye-tracking data, in studying pathologists’ attention and viewing behavior.
Settings and Design:
Pathologists (N = 7) viewed 10 digital whole slide images of breast tissue that were selected using a random stratified sampling technique to include a range of breast pathology diagnoses (benign/atypia, carcinoma in situ, and invasive breast cancer). A panel of three expert breast pathologists established a consensus diagnosis for each case using a modified Delphi approach.
Materials and Methods:
Participants’ foveal vision was tracked using SensoMotoric Instruments RED 60 Hz eye-tracking system. Mouse cursor movement was tracked using a custom MATLAB script.
Statistical Analysis Used:
Data on eye-gaze and mouse cursor position were gathered at fixed intervals and analyzed using distance comparisons and regression analyses by slide diagnosis and pathologist expertise. Pathologists’ accuracy (defined as percent agreement with the expert consensus diagnoses) and efficiency (accuracy and speed) were also analyzed.
Results:
Mean viewing time per slide was 75.2 seconds (SD = 38.42). Accuracy (percent agreement with expert consensus) by diagnosis type was: 83% (benign/atypia); 48% (carcinoma in situ); and 93% (invasive). Spatial coupling was close between eye-gaze and mouse cursor positions (highest frequency ∆x was 4.00px (SD = 16.10), and ∆y was 37.50px (SD = 28.08)). Mouse cursor position moderately predicted eye gaze patterns (Rx = 0.33 and Ry = 0.21).
Conclusions:
Data detailing mouse cursor movements may be a useful addition to future studies of pathologists’ accuracy and efficiency when using digital pathology.
doi:10.4103/2153-3539.104905
PMCID: PMC3551530  PMID: 23372984
Digital whole slide images; digital pathology; eye-tracking; interpretive behavior; visual attention
9.  Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors 
Executive Summary
In early August 2007, the Medical Advisory Secretariat began work on the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry’s newly released Aging at Home Strategy.
After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person’s transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report.
Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series.
Aging in the Community: Summary of Evidence-Based Analyses
Prevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based Analysis
Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based Analysis
Caregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based Analysis
Social Isolation in Community-Dwelling Seniors: An Evidence-Based Analysis
The Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over (FEMOR)
Objective
To assess the effectiveness of behavioural interventions for the treatment and management of urinary incontinence (UI) in community-dwelling seniors.
Clinical Need: Target Population and Condition
Urinary incontinence defined as “the complaint of any involuntary leakage of urine” was identified as 1 of the key predictors in a senior’s transition from independent community living to admission to a long-term care (LTC) home. Urinary incontinence is a health problem that affects a substantial proportion of Ontario’s community-dwelling seniors (and indirectly affects caregivers), impacting their health, functioning, well-being and quality of life. Based on Canadian studies, prevalence estimates range from 9% to 30% for senior men and nearly double from 19% to 55% for senior women. The direct and indirect costs associated with UI are substantial. It is estimated that the total annual costs in Canada are $1.5 billion (Cdn), and that each year a senior living at home will spend $1,000 to $1,500 on incontinence supplies.
Interventions to treat and manage UI can be classified into broad categories which include lifestyle modification, behavioural techniques, medications, devices (e.g., continence pessaries), surgical interventions and adjunctive measures (e.g., absorbent products).
The focus of this review is behavioural interventions, since they are commonly the first line of treatment considered in seniors given that they are the least invasive options with no reported side effects, do not limit future treatment options, and can be applied in combination with other therapies. In addition, many seniors would not be ideal candidates for other types of interventions involving more risk, such as surgical measures.
Note: It is recognized that the terms “senior” and “elderly” carry a range of meanings for different audiences; this report generally uses the former, but the terms are treated here as essentially interchangeable.
Description of Technology/Therapy
Behavioural interventions can be divided into 2 categories according to the target population: caregiver-dependent techniques and patient-directed techniques. Caregiver-dependent techniques (also known as toileting assistance) are targeted at medically complex, frail individuals living at home with the assistance of a caregiver, who tends to be a family member. These seniors may also have cognitive deficits and/or motor deficits. A health care professional trains the senior’s caregiver to deliver an intervention such as prompted voiding, habit retraining, or timed voiding. The health care professional who trains the caregiver is commonly a nurse or a nurse with advanced training in the management of UI, such as a nurse continence advisor (NCA) or a clinical nurse specialist (CNS).
The second category of behavioural interventions consists of patient-directed techniques targeted towards mobile, motivated seniors. Seniors in this population are cognitively able, free from any major physical deficits, and motivated to regain and/or improve their continence. A nurse or a nurse with advanced training in UI management, such as an NCA or CNS, delivers the patient-directed techniques. These are often provided as multicomponent interventions including a combination of bladder training techniques, pelvic floor muscle training (PFMT), education on bladder control strategies, and self-monitoring. Pelvic floor muscle training, defined as a program of repeated pelvic floor muscle contractions taught and supervised by a health care professional, may be employed as part of a multicomponent intervention or in isolation.
Education is a large component of both caregiver-dependent and patient-directed behavioural interventions, and patient and/or caregiver involvement as well as continued practice strongly affect the success of treatment. Incontinence products, which include a large variety of pads and devices for effective containment of urine, may be used in conjunction with behavioural techniques at any point in the patient’s management.
Evidence-Based Analysis Methods
A comprehensive search strategy was used to identify systematic reviews and randomized controlled trials that examined the effectiveness, safety, and cost-effectiveness of caregiver-dependent and patient-directed behavioural interventions for the treatment of UI in community-dwelling seniors (see Appendix 1).
Research Questions
Are caregiver-dependent behavioural interventions effective in improving UI in medically complex, frail community-dwelling seniors with/without cognitive deficits and/or motor deficits?
Are patient-directed behavioural interventions effective in improving UI in mobile, motivated community-dwelling seniors?
Are behavioural interventions delivered by NCAs or CNSs in a clinic setting effective in improving incontinence outcomes in community-dwelling seniors?
Assessment of Quality of Evidence
The quality of the evidence was assessed as high, moderate, low, or very low according to the GRADE methodology and GRADE Working Group. As per GRADE the following definitions apply:
Summary of Findings
Executive Summary Table 1 summarizes the results of the analysis.
The available evidence was limited by considerable variation in study populations and in the type and severity of UI for studies examining both caregiver-directed and patient-directed interventions. The UI literature frequently is limited to reporting subjective outcome measures such as patient observations and symptoms. The primary outcome of interest, admission to a LTC home, was not reported in the UI literature. The number of eligible studies was low, and there were limited data on long-term follow-up.
Summary of Evidence on Behavioural Interventions for the Treatment of Urinary Incontinence in Community-Dwelling Seniors
Prompted voiding
Habit retraining
Timed voiding
Bladder training
PFMT (with or without biofeedback)
Bladder control strategies
Education
Self-monitoring
CI refers to confidence interval; CNS, clinical nurse specialist; NCA, nurse continence advisor; PFMT, pelvic floor muscle training; RCT, randomized controlled trial; WMD, weighted mean difference; UI, urinary incontinence.
Economic Analysis
A budget impact analysis was conducted to forecast costs for caregiver-dependent and patient-directed multicomponent behavioural techniques delivered by NCAs, and PFMT alone delivered by physiotherapists. All costs are reported in 2008 Canadian dollars. Based on epidemiological data, published medical literature and clinical expert opinion, the annual cost of caregiver-dependent behavioural techniques was estimated to be $9.2 M, while the annual costs of patient-directed behavioural techniques delivered by either an NCA or physiotherapist were estimated to be $25.5 M and $36.1 M, respectively. Estimates will vary if the underlying assumptions are changed.
Currently, the province of Ontario absorbs the cost of NCAs (available through the 42 Community Care Access Centres across the province) in the home setting. The 2007 Incontinence Care in the Community Report estimated that the total cost being absorbed by the public system of providing continence care in the home is $19.5 M in Ontario. This cost estimate included resources such as personnel, communication with physicians, record keeping and product costs. Clinic costs were not included in this estimation because currently these come out of the global budget of the respective hospital and very few continence clinics actually exist in the province. The budget impact analysis factored in a cost for the clinic setting, assuming that the public system would absorb the cost with this new model of community care.
Considerations for Ontario Health System
An expert panel on aging in the community met on 3 occasions from January to May 2008, and in part, discussed treatment of UI in seniors in Ontario with a focus on caregiver-dependent and patient-directed behavioural interventions. In particular, the panel discussed how treatment for UI is made available to seniors in Ontario and who provides the service. Some of the major themes arising from the discussions included:
Services/interventions that currently exist in Ontario offering behavioural interventions to treat UI are not consistent. There is a lack of consistency in how seniors access services for treatment of UI, who manages patients and what treatment patients receive.
Help-seeking behaviours are important to consider when designing optimal service delivery methods.
There is considerable social stigma associated with UI and therefore there is a need for public education and an awareness campaign.
The cost of incontinent supplies and the availability of NCAs were highlighted.
Conclusions
There is moderate-quality evidence that the following interventions are effective in improving UI in mobile motivated seniors:
Multicomponent behavioural interventions including a combination of bladder training techniques, PFMT (with or without biofeedback), education on bladder control strategies and self-monitoring techniques.
Pelvic floor muscle training alone.
There is moderate quality evidence that when behavioural interventions are led by NCAs or CNSs in a clinic setting, they are effective in improving UI in seniors.
There is limited low-quality evidence that prompted voiding may be effective in medically complex, frail seniors with motivated caregivers.
There is insufficient evidence for the following interventions in medically complex, frail seniors with motivated caregivers:
habit retraining, and
timed voiding.
PMCID: PMC3377527  PMID: 23074508
10.  The BARD1 Cys557Ser Variant and Breast Cancer Risk in Iceland 
PLoS Medicine  2006;3(7):e217.
Background
Most, if not all, of the cellular functions of the BRCA1 protein are mediated through heterodimeric complexes composed of BRCA1 and a related protein, BARD1. Some breast-cancer-associated BRCA1 missense mutations disrupt the function of the BRCA1/BARD1 complex. It is therefore pertinent to determine whether variants of BARD1 confer susceptibility to breast cancer. Recently, a missense BARD1 variant, Cys557Ser, was reported to be at increased frequencies in breast cancer families. We investigated the role of the BARD1 Cys557Ser variant in a population-based cohort of 1,090 Icelandic patients with invasive breast cancer and 703 controls. We then used a computerized genealogy of the Icelandic population to study the relationships between the Cys557Ser variant and familial clustering of breast cancer.
Methods and Findings
The Cys557Ser allele was present at a frequency of 0.028 in patients with invasive breast cancer and 0.016 in controls (odds ratio [OR] = 1.82, 95% confidence interval [CI] 1.11–3.01, p = 0.014). The alleleic frequency was 0.037 in a high-predisposition group of cases defined by having a family history of breast cancer, early onset of breast cancer, or multiple primary breast cancers (OR = 2.41, 95% CI 1.22–4.75, p = 0.015). Carriers of the common Icelandic BRCA2 999del5 mutation were found to have their risk of breast cancer further increased if they also carried the BARD1 variant: the frequency of the BARD1 variant allele was 0.047 (OR = 3.11, 95% CI 1.16–8.40, p = 0.046) in 999del5 carriers with breast cancer. This suggests that the lifetime probability of a BARD1 Cys557Ser/BRCA2 999del5 double carrier developing breast cancer could approach certainty. Cys557Ser carriers, with or without the BRCA2 mutation, had an increased risk of subsequent primary breast tumors after the first breast cancer diagnosis compared to non-carriers. Lobular and medullary breast carcinomas were overrepresented amongst Cys557Ser carriers. We found that an excess of ancestors of contemporary carriers lived in a single county in the southeast of Iceland and that all carriers shared a SNP haplotype, which is suggestive of a founder event. Cys557Ser was found on the same SNP haplotype background in the HapMap Project CEPH sample of Utah residents.
Conclusions
Our findings suggest that BARD1 Cys557Ser is an ancient variant that confers risk of single and multiple primary breast cancers, and this risk extends to carriers of the BRCA2 999del5 mutation.
Editors' Summary
Background.
About 13% of women (one in eight women) will develop breast cancer during their lifetime, but many factors affect the likelihood of any individual woman developing this disease, for example, whether she has had children and at what age, when she started and stopped her periods, and her exposure to certain chemicals or radiation. She may also have inherited a defective gene that affects her risk of developing breast cancer. Some 5%–10% of all breast cancers are familial, or inherited. In 20% of these cases, the gene that is defective is BRCA1 or BRCA2. Inheriting a defective copy of one of these genes greatly increases a woman's risk of developing breast cancer, while researchers think that the other inherited genes that predispose to breast cancer—most of which have not been identified yet—have a much weaker effect. These are described as low-penetrance genes. Inheriting one such gene only slightly increases breast cancer risk; a woman has to inherit several to increase her lifetime risk of cancer significantly.
Why Was This Study Done?
It is important to identify these additional predisposing gene variants because they might provide insights into why breast cancer develops, how to prevent it, and how to treat it. To find low-penetrance genes, researchers do case–control association studies. They find a large group of women with breast cancer (cases) and a similar group of women without cancer (controls), and examine how often a specific gene variant occurs in the two groups. If the variant is found more often in the cases than in the controls, it might be a variant that increases a woman's risk of developing breast cancer.
What Did the Researchers Do and Find?
The researchers involved in this study recruited Icelandic women who had had breast cancer and unaffected women, and looked for a specific variant—the Cys557Ser allele—of a gene called BARD1. They chose BARD1 because the protein it encodes interacts with the protein encoded by BRCA1. Because defects in BRCA1 increase the risk of breast cancer, defects in an interacting protein might have a similar effect. In addition, the Cys557Ser allele has been implicated in breast cancer in other studies. The researchers found that the Cys557Ser allele was nearly twice as common in women with breast cancer as in control women. It was also more common (but not by much) in women who had a family history of breast cancer or who had developed breast cancer more than once. And having the Cys557Ser allele seemed to increase the already high risk of breast cancer in women who had a BRCA2 variant (known as BRCA2 999del5) that accounts for 40% of inherited breast cancer risk in Iceland.
What Do These Findings Mean?
These results indicate that inheriting the BARD1 Cys557Ser allele increases a woman's breast cancer risk but that she is unlikely to have a family history of the disease. Because carrying the Cys557Ser allele only slightly increases a woman's risk of breast cancer, for most women there is no clinical reason to test for this variant. Eventually, when all the low-penetrance genes that contribute to breast cancer risk have been identified, it might be helpful to screen women for the full set to determine whether they are at high risk of developing breast cancer. This will not happen for many years, however, since there might be tens or hundreds of these genes. For women who carry BRCA2 999del5, the situation might be different. It might be worth testing these women for the BARD1 Cys557Ser allele, the researchers explain, because the lifetime probability of developing breast cancer in women carrying both variants might approach 100%. This finding has clinical implications in terms of counseling and monitoring, as does the observation that Cys557Ser carriers have an increased risk of a second, independent breast cancer compared to non-carriers. However, all these findings need to be confirmed in other groups of patients before anyone is routinely tested for the BARD1 Cys557Ser allele.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030217.
• MedlinePlus pages about breast cancer
• Information on breast cancer from the United States National Cancer Institute
• Information on inherited breast cancer from the United States National Human Genome Research Institute
• United States National Cancer Institute information on genetic testing for BRCA1 and BRCA2 variants
• GeneTests pages on the involvement of BRCA1 and BRCA2 in hereditary breast and ovarian cancer
• Cancer Research UK's page on breast cancer statistics
In a population-based cohort of 1090 Icelandic patients, a Cys557Ser missense variant of the BARD1 gene, which interacts with BRCA1, increased the risk of single and multiple primary breast cancers.
doi:10.1371/journal.pmed.0030217
PMCID: PMC1479388  PMID: 16768547
11.  A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer 
INTRODUCTION
Breast magnetic resonance imaging (MRI) is considered a more sensitive diagnostic test for detecting invasive breast cancer than mammography or breast ultrasound. Breast MRI may be particularly useful in younger premenopausal women with higher density breast tissue for differentiating between dense fibroglandular breast tissue and breast malignancies. The main objective of this study was to determine the impact of preoperative breast MRI on surgical decision-making in young women with breast cancer.
METHODS
A retrospective review of patients with newly diagnosed invasive breast cancer and age of ≤50 years was performed. All patients underwent physical examination, preoperative mammogram, breast ultrasound, and bilateral breast MRI. Two breast cancer surgeons reviewed the preoperative mammogram report, breast ultrasound report, and physical examination summary and were asked if they would recommend a lumpectomy, a quandrantectomy, or a mastectomy. A few weeks later, the two surgeons were shown the same information with the breast MRI report and were asked what type of surgery they would now recommend. In each case, MRI was classified by two adjudicators as having affected the surgical outcome in a positive, negative, or neutral fashion. A positive impact was defined as the situation where breast MRI detected additional disease that was not found on physical examination, mammogram, or breast ultrasound and led to an appropriate change in surgical management. A negative impact was defined as the situation where breast MRI led the surgeon to recommend more extensive surgery, with less extensive disease actually found at pathology. No impact was defined as the situation where MRI findings did not alter surgical recommendations or outcomes.
RESULTS
Of 37 patients whose charts were reviewed, five patients were deemed to be ineligible due to having received neoadjuvant chemotherapy, having previous breast implants, or having had their tumor fully excised during biopsy. In total, 32 patients met the inclusion criteria of this study and were appropriate for analysis. The median age of our study patient population was 42 years. The pathologic diagnosis was invasive ductal carcinoma in 91% (29/32) of patients and invasive lobular carcinoma in 9% (3/32) of patients. For surgeon A, clinical management was altered in 21/32 (66%) patients, and for surgeon B, management was altered in 13/32 (41%) patients. The most common change in surgical decision-making after breast MRI was from breast-conserving surgery to a mastectomy. Mastectomy rates were similar between both surgeons after breast MRI. After reviewing the pathology results and comparing them with the breast MRI results, it was determined that breast MRI led to a positive outcome in 13/32 (41%) patients. Breast MRI led to no change in surgical management in 15/32 (47%) patients and resulted in a negative change in surgical management in 4/32 (13%) patients. Bilateral breast MRI detected a contralateral breast cancer in 2/32 (6%) patients.
CONCLUSIONS
Preoperative breast MRI alters surgical management in a significant proportion of younger women diagnosed with breast cancer. Prospective studies are needed to confirm these findings and to help determine if this change in surgical decision-making will result in improved local control.
doi:10.4137/BCBCR.S38432
PMCID: PMC4871200  PMID: 27226720
breast cancer; breast magnetic resonance imaging; young patients
12.  Microenvironmental Heterogeneity Parallels Breast Cancer Progression: A Histology–Genomic Integration Analysis 
PLoS Medicine  2016;13(2):e1001961.
Background
The intra-tumor diversity of cancer cells is under intense investigation; however, little is known about the heterogeneity of the tumor microenvironment that is key to cancer progression and evolution. We aimed to assess the degree of microenvironmental heterogeneity in breast cancer and correlate this with genomic and clinical parameters.
Methods and Findings
We developed a quantitative measure of microenvironmental heterogeneity along three spatial dimensions (3-D) in solid tumors, termed the tumor ecosystem diversity index (EDI), using fully automated histology image analysis coupled with statistical measures commonly used in ecology. This measure was compared with disease-specific survival, key mutations, genome-wide copy number, and expression profiling data in a retrospective study of 510 breast cancer patients as a test set and 516 breast cancer patients as an independent validation set. In high-grade (grade 3) breast cancers, we uncovered a striking link between high microenvironmental heterogeneity measured by EDI and a poor prognosis that cannot be explained by tumor size, genomics, or any other data types. However, this association was not observed in low-grade (grade 1 and 2) breast cancers. The prognostic value of EDI was superior to known prognostic factors and was enhanced with the addition of TP53 mutation status (multivariate analysis test set, p = 9 × 10−4, hazard ratio = 1.47, 95% CI 1.17–1.84; validation set, p = 0.0011, hazard ratio = 1.78, 95% CI 1.26–2.52). Integration with genome-wide profiling data identified losses of specific genes on 4p14 and 5q13 that were enriched in grade 3 tumors with high microenvironmental diversity that also substratified patients into poor prognostic groups. Limitations of this study include the number of cell types included in the model, that EDI has prognostic value only in grade 3 tumors, and that our spatial heterogeneity measure was dependent on spatial scale and tumor size.
Conclusions
To our knowledge, this is the first study to couple unbiased measures of microenvironmental heterogeneity with genomic alterations to predict breast cancer clinical outcome. We propose a clinically relevant role of microenvironmental heterogeneity for advanced breast tumors, and highlight that ecological statistics can be translated into medical advances for identifying a new type of biomarker and, furthermore, for understanding the synergistic interplay of microenvironmental heterogeneity with genomic alterations in cancer cells.
A novel approach that maps tumor microenvironment heterogeneity and couples this with genetic information to provide superior prognosis in breast cancer.
Editors' Summary
Background
The human body contains millions of cells, all of which grow, divide, and die in an orderly fashion to build tissues during early life and to replace worn-out or dying cells and repair injuries during adult life. Sometimes, however, normal cells acquire genetic changes (mutations) that allow them to divide uncontrollably and to move around the body (metastasize), resulting in cancer. Because any cell in the body can acquire the mutations needed for cancer development, there are many types of cancer. For example, breast cancer, the most common cancer in women, begins when the cells in the breast that normally make milk become altered. Moreover, different types of cancer progress and evolve differently—some cancers grow quickly and kill their “host” soon after diagnosis, whereas others can be successfully treated with drugs, surgery, or radiotherapy. The behavior of individual cancers depends both on the characteristics of the cancer cells within the tumor and on the interactions between the cancer cells and the normal stromal cells (the connective tissue cells of organs) and other cells (for example, immune cells) that surround and feed cancer cells (the tumor microenvironment).
Why Was This Study Done?
Although recent studies have highlighted the importance of the tumor microenvironment for disease-related outcomes, little is known about how the heterogeneity of the tumor microenvironment—the diversity of non-cancer cells within the tumor—affects outcomes. Mathematical modeling suggests that tumors with heterogeneous and homogeneous microenvironments have different growth patterns and that heterogeneous microenvironments are more likely to be associated with aggressive cancers than homogenous microenvironments. However, the lack of methods to quantify the spatial variability and cellular composition across solid tumors has prevented confirmation of these predictions. Here, the researchers develop a computational system for quantifying microenvironmental heterogeneity in breast cancer based on tumor morphology (shape and form) in histological sections (tissue samples taken from tumors that are examined microscopically). They then use this system to analyze the associations between clinical outcomes, molecular changes, and microenvironmental heterogeneity in breast cancer.
What Did the Researchers Do and Find?
The researchers used automated image analysis and statistical analysis to develop the ecosystem diversity index (EDI), a numerical measure of microenvironmental heterogeneity in solid tumors. They compared the EDI with prognosis (likely outcome), key mutations, genome-wide copy number (tumor cells often contain abnormal numbers of copies of specific genes), and expression profiling data (the expression of several key proteins is altered in tumors) in a test set of 510 samples from patients with breast cancer and in a validation set of 516 additional samples. Among high-grade breast cancers (grade 3 cancers; the grade of a cancer indicates what the cells look like; high-grade breast cancers have a poor prognosis), but not among low-grade breast cancers (grades 1 and 2), a high EDI (high microenvironmental heterogeneity) was associated with a poor prognosis. Specifically, patients with grade 3 tumors and a high EDI had a ten-year disease-specific survival rate of 51%, whereas the remaining patients with grade 3 tumors had a ten-year survival rate of 70%. Notably, the combination of a high EDI with specific DNA alterations—mutations in a gene called TP53 and loss of genes on Chromosomes 4p14 and 5q13—improved the accuracy of prognosis among patients with grade 3 breast cancer and stratified them into subgroups with disease-specific five-year survival rates of 35%, 9%, and 32%, respectively.
What Do These Findings Mean?
These findings establish a method for measuring the spatial heterogeneity of the microenvironment of solid tumors and suggest that the measurement of tumor microenvironmental heterogeneity can be coupled with information about genomic alterations to provide an accurate way to predict outcomes among patients with high-grade breast cancer. The association between EDI, specific genomic alterations, and outcomes needs to be confirmed in additional patients. However, these findings suggest that microenvironmental heterogeneity might provide an additional biomarker to help clinicians identify those patients with advanced breast cancer who have a particularly bad prognosis. The ability to identify these patients is important because it will help clinicians target aggressive treatments to individuals with a poor prognosis and avoid the overtreatment of patients whose prognosis is more favorable. Finally, and more generally, these findings describe a new way to investigate the interactions between the tumor microenvironment and genomic alterations in cancer cells.
Additional Information
This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at http://dx.doi.org/10.1371/journal.pmed.1001961.
The US National Cancer Institute provides comprehensive information about cancer and its development (in English and Spanish), including detailed information about breast cancer and an online booklet for patients
Cancer Research UK, a not-for-profit organization, provides information about cancer, including detailed information about breast cancer and a science blog on the tumor microenvironment
Breast Cancer Now is a not-for-profit organization that provides up-to-date information about breast cancer (in English and Spanish)
The UK National Health Service Choices website has information and personal stories about breast cancer; the not-for-profit organization Healthtalkonline also provides personal stories about dealing with breast cancer
Wikipedia has a page about the tumor microenvironment (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)
doi:10.1371/journal.pmed.1001961
PMCID: PMC4755617  PMID: 26881778
13.  Association between Melanocytic Nevi and Risk of Breast Diseases: The French E3N Prospective Cohort 
PLoS Medicine  2014;11(6):e1001660.
Using data from the French E3N prospective cohort, Marina Kvaskoff and colleagues examine the association between number of cutaneous nevi and the risk for breast cancer.
Please see later in the article for the Editors' Summary
Background
While melanocytic nevi have been associated with genetic factors and childhood sun exposure, several observations also suggest a potential hormonal influence on nevi. To test the hypothesis that nevi are associated with breast tumor risk, we explored the relationships between number of nevi and benign and malignant breast disease risk.
Methods and Findings
We prospectively analyzed data from E3N, a cohort of French women aged 40–65 y at inclusion in 1990. Number of nevi was collected at inclusion. Hazard ratios (HRs) for breast cancer and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Associations of number of nevi with personal history of benign breast disease (BBD) and family history of breast cancer were estimated using logistic regression. Over the period 15 June 1990–15 June 2008, 5,956 incident breast cancer cases (including 5,245 invasive tumors) were ascertained among 89,902 women. In models adjusted for age, education, and known breast cancer risk factors, women with “very many” nevi had a significantly higher breast cancer risk (HR = 1.13, 95% CI = 1.01–1.27 versus “none”; ptrend = 0.04), although significance was lost after adjustment for personal history of BBD or family history of breast cancer. The 10-y absolute risk of invasive breast cancer increased from 3,749 per 100,000 women without nevi to 4,124 (95% CI = 3,674–4,649) per 100,000 women with “very many” nevi. The association was restricted to premenopausal women (HR = 1.40, ptrend = 0.01), even after full adjustment (HR = 1.34, ptrend = 0.03; phomogeneity = 0.04), but did not differ according to breast cancer type or hormone receptor status. In addition, we observed significantly positive dose–response relationships between number of nevi and history of biopsy-confirmed BBD (n = 5,169; ptrend<0.0001) and family history of breast cancer in first-degree relatives (n = 7,472; ptrend = 0.0003). The main limitations of our study include self-report of number of nevi using a qualitative scale, and self-reported history of biopsied BBD.
Conclusions
Our findings suggest associations between number of nevi and the risk of premenopausal breast cancer, BBD, and family history of breast cancer. More research is warranted to elucidate these relationships and to understand their underlying mechanisms.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
In 2012, nearly 1.7 million women worldwide discovered they had breast cancer, and about half a million women died from the disease. Breast cancer begins when cells in the breast acquire genetic changes that allow them to divide uncontrollably and to move around the body (metastasize). Uncontrolled cell division leads to the formation of a lump that can be detected by mammography (a breast X-ray) or by manual breast examination. Breast cancer is treated by surgical removal of the lump, or, if the cancer has started to spread, by removal of the whole breast (mastectomy). Surgery is usually followed by radiotherapy or chemotherapy to kill any remaining cancer cells. Because the female sex hormones estrogen and progesterone stimulate the growth of some tumors, drugs that block hormone receptors are also used to treat receptor-positive breast cancer. Nowadays, the prognosis (outlook) for women with breast cancer is good, and in developed countries, nearly 90% of affected women are still alive five years after diagnosis.
Why Was This Study Done?
Several hormone-related factors affect a woman's chances of developing breast cancer. For example, women who have no children or who have them late in life have a higher breast cancer risk than women who have several children when they are young because pregnancy alters sex hormone levels. Interestingly, the development of moles (nevi)—dark skin blemishes that are risk factors for the development of melanoma, a type of skin cancer—may also be affected by estrogen and progesterone. Thus, the number of nevi might be a marker of blood hormone levels and might predict breast cancer risk. In this prospective cohort study, the researchers test this hypothesis by investigating the association between how many moles a woman has and her breast cancer risk. A prospective cohort study enrolls a group (cohort) of people, determines their baseline characteristics, and follows them over time to see which characteristics are associated with the development of specific diseases.
What Did the Researchers Do and Find?
In 1990, the E3N prospective cohort study enrolled nearly 100,000 French women (mainly school teachers) aged 40–65 years to investigate cancer risk factors. The women completed a baseline questionnaire about their lifestyle and medical history, and regular follow-up questionnaires that asked about cancer occurrence. In the initial questionnaire, the women indicated whether they had no, a few, many, or very many moles. Between 1990 and 2008, nearly 6,000 women in the cohort developed breast cancer. Using statistical methods to calculate hazard ratios (an “HR” compares how often a particular event happens in two groups with different characteristics; an HR greater than one indicates that a specific characteristic is associated with an increased risk of the event), the researchers report that women with “very many” nevi had a significantly higher breast cancer risk (a higher risk that was unlikely to have occurred by chance) than women with no nevi. Specifically, the age-adjusted HR for breast cancer among women with “very many” nevi compared to women with no nevi was 1.17. After adjustment for a personal history of benign (noncancerous) breast disease and a family history of breast cancer (two established risk factors for breast cancer), the association between nevi and breast cancer risk among the whole cohort became nonsignificant. Notably, however, the association among only premenopausal women remained significant after full adjustment (HR = 1.34), which corresponded to an increase in ten-year absolute risk of invasive breast cancer from 2,515 per 100,000 women with no nevi to 3,370 per 100,000 women with “very many” nevi.
What Do These Findings Mean?
These findings suggest that among premenopausal women there is a modest association between nevi number and breast cancer risk. This noncausal relationship may indicate that nevi and breast diseases are affected in similar ways by hormones or share common genetic factors, but the accuracy of these findings may be limited by aspects of the study design. For example, self-report of nevi numbers using a qualitative scale may have introduced some inaccuracies into the estimates of the association between nevi number and breast cancer risk. Most importantly, these findings are insufficient to support the use of nevi counts in breast cancer screening or diagnosis. Rather, together with the findings reported by Zhang et al. in an independent PLOS Medicine Research Article, they suggest that further studies into the biological mechanisms underlying the relationship between nevi and breast cancer and the association itself should be undertaken.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001660.
This study is further discussed in a PLOS Medicine Perspective by Fuhrman and Cardenas
An independent PLOS Medicine Research Article by Zhang et al. also investigates the relationship between nevi number and breast cancer risk
The US National Cancer Institute provides comprehensive information about cancer (in English and Spanish), including detailed information for patients and professionals about breast cancer; it also has a fact sheet on moles
Cancer Research UK, a not-for profit organization, provides information about cancer, including detailed information on breast cancer
The UK National Health Service Choices website has information and personal stories about breast cancer; the not-for profit organization Healthtalkonline also provides personal stories about dealing with breast cancer
More information about the E3N prospective cohort study is available; detailed information is available in French
doi:10.1371/journal.pmed.1001660
PMCID: PMC4051602  PMID: 24915306
14.  Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis 
Background
Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited.
Methods
Seven plastic surgeons were provided with pertinent medical information and preoperative photographs of patients, and were asked to assign probabilities to predict number of revisions, complications, and final aesthetic outcome using a questionnaire designed for the study. Logarithmic strictly proper scoring was used to evaluate the surgeons’ abilities to predict breast reconstruction outcomes. Surgeons’ responses were analyzed for calibration and confidence in their answers.
Results
As individuals, there was variation in surgeons’ ability to predict outcomes. For each prediction category, a different surgeon was more accurate. As a group, surgeons possessed knowledge of future events despite not being well calibrated in their probability assessments. Prediction accuracy for the group was up to six-fold greater than that of the best individual.
Conclusions
The use of individual plastic surgeon-elicited probability information is not encouraged unless the individual’s prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.
doi:10.1097/GOX.0000000000000010
PMCID: PMC4044723  PMID: 24910814
15.  Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis 
Background:
Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited.
Methods:
Seven plastic surgeons were provided with pertinent medical information and preoperative photographs of patients and were asked to assign probabilities to predict number of revisions, complications, and final aesthetic outcome using a questionnaire designed for the study. Logarithmic strictly proper scoring was used to evaluate the surgeons’ abilities to predict breast reconstruction outcomes. Surgeons’ responses were analyzed for calibration and confidence in their answers.
Results:
As individuals, there was variation in surgeons’ ability to predict outcomes. For each prediction category, a different surgeon was more accurate. As a group, surgeons possessed knowledge of future events despite not being well calibrated in their probability assessments. Prediction accuracy for the group was up to 6-fold greater than that of the best individual.
Conclusions:
The use of individual plastic surgeon–elicited probability information is not encouraged unless the individual’s prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.
doi:10.1097/GOX.0000000000000010
PMCID: PMC4044723  PMID: 24910814
16.  Contribution of breast density to the volume of the augmented breast: A preliminary study 
Breast augmentation is one of the most common procedures performed, and obtaining symmetry and the correct postoperative volume is of the utmost importance. Currently, three-dimensional analysis is used to calculate breast volume, shape, size, etc, which aids the surgeon in deciding on the correct implant size. This study used three-dimensional analysis on 38 breasts (21 women) to measure breast volume and compare it with the implant size, in addition to comparing the results with breast density on mammogram.
BACKGROUND:
Prediction of soft tissue contribution to the shape, volume and texture of the augmented breast proves to be an ever-challenging, uncontrollable variable. Similarly, the understanding of the contribution of breast density in breast augmentation has been elusive and, generally, not well studied.
OBJECTIVE:
With the aid of three-dimensional photographic analysis, the present preliminary study examined the contribution of differing breast densities to the overall volume of the augmented breast.
METHODS:
All patients undergoing primary augmentation over a six-month period were included in the study. To standardize technique and implant type, all patients received saline-filled moderate-profile implants, which were placed partially underneath the pectoralis muscle through a lower pole approach. Photographic analysis of the breast volume was completed preoperatively and, subsequently, at a minimum of six months postoperatively. Preoperatively, each breast was also assigned to one of four classes of increasing mammographic density, as judged by the mammographic radiologist (fatty, moderately dense, heterogeneously dense and extremely dense). Postoperative breast volumes were, subsequently, correlated to mammographic densities.
RESULTS:
Thirty-eight augmented breasts in 21 patients were examined. The average volume gain based on the implant size used was 92.7%. Heterogeneously dense breasts comprised 68% of the total breasts and showed an average volume gain of 100.67%, extremely dense breasts comprised 26% of the total breasts and showed an average volume gain of 97.3%, and moderately dense breasts comprised 5% of the total breasts with an average gain of 100.04%. There was no significant difference between the augmented breast volumes and the respective expected volumes (combined preaugmented breast volumes and implant volumes; P=0.3483). Additionally, no statistical difference was found between the density classes and the expected augmented volumes.
CONCLUSION:
No statistical difference was found between expected and actual augmented breast volumes among or between four different breast density classes. Thus, one would expect that the soft tissue compression or the response of the impression of the implant on the parenchyma, would not be statistically different among classes. Additionally, compressive atrophy, as seen with atrophy of the breasts over time, would be expected to be multifactorial and not uniquely independent to breast density. However, longitudinal analysis is needed to study the durability of breast shape relative to breast density.
PMCID: PMC3269329  PMID: 22942658
Breast; Breast augmentation; Breast density; Breast implant; Breast implant size; Mammographic density
17.  BRCA1 and BRCA2 mutations in central and southern Italian patients 
Breast Cancer Research : BCR  2000;2(4):307-310.
Protein truncation test (PTT) and single-strand conformation polymorphism (SSCP) assay were used to scan the BRCA1 and BRCA2 genes in 136 unrelated Italian breast/ovarian cancer patients. In the sample tested, BRCA1 and BRCA2 equally contributed to site-specific breast cancer patients who reported one to two breast cancer-affected first-/ second-degree relative(s) or who were diagnosed before age 40 years in the absence of a family history of breast/ovarian cancer. BRCA1 and BRCA2 mutations were mostly found in patients with disease diagnosis before and after age 50 years, respectively. Moreover, in cases with familial clustering of site-specific breast cancer, BRCA1 mostly accounted for tumours diagnosed before age 40 years and BRCA2 for tumours diagnosed after age 50 years. The BRCA1 and BRCA2 mutation spectrum was consistent with a lack of significant founder effects in the sample of patients studied.
Introduction:
Germline BRCA1 and BRCA2 mutations account for most hereditary breast/ovarian cancers and are associated with male breast cancer. Furthermore, constitutional mutations in these genes may occur in breast/ovarian cancer patients that do not meet stringent criteria of autosomal-dominant predisposition. The relevance of BRCA1 and BRCA2 mutations in such patients is still debated.
Objectives:
We sought to determine the impact of BRCA1 and BRCA2 mutations in a population of patients from central and southern Italy. We analyzed the BRCA1 and BRCA2 coding regions in 136 unrelated probands: 117 females with breast/ovarian cancer and 19 males with breast cancer. This population of patients was mostly representative of cases who are at risk for hereditary susceptibility, but who do not meet stringent criteria of autosomal-dominant predisposition.
Methods:
Probands, subclassified as follows, were consecutively recruited depending on informed consent from patients attending breast cancer clinics in Rome and Naples. Selection criteria for females were as follows: breast cancer with breast cancer family history [one to two first-/second-degree relative(s), n = 55]; breast cancer diagnosed before age 40 years (no breast/ovarian cancer family history, n = 28); bilateral breast cancer (regardless of age and family history, n =10); breast cancer associated with gastrointestinal, pancreatic or uterine cancers [synchronous/metachronous or in first-degree relative(s), n = 9]; breast or ovarian cancer with family history of breast-ovarian/ovarian cancer (at least 1 first-/ second-degree relative, n = 10); and ovarian cancer with no breast/ovarian cancer family history (n = 5). Males with breast cancer were recruited regardless of age and family history. BRCA1 exon 11 and BRCA2 exons 10 and 11 were screened by PTT. Coding BRCA1 exons 2, 3, 5-10 and 12-24 and BRCA2 exons 2-9 and 12-27 were screened by SSCP. Primers are listed in Table 1. In 27 cases, analyzed by PTT along the entire BRCA1 coding sequence, BRCA1 SSCP analysis was limited to exons 2, 5, 20 and 24. Mutations were verified by sequence analysis on two independent blood samples.
Results:
Deleterious germline BRCA1/BRCA2 mutations were detected in 11 out of 136 cases (8%). Only three BRCA2 mutations were novel. One BRCA2 mutation recurred in two unrelated probands. Table 2 shows the mutations and data concerning carriers and their families. Table 3 shows correlations between BRCA1/BRCA2 mutations and sex, age at disease diagnosis and familial clustering of breast/ovarian cancer in the total patient population. Table 4 shows the proportions of BRCA1 and BRCA2 mutations in females with site-specific breast and breast-ovarian/ovarian cancer. Table 5 shows the frequency of BRCA1/BRCA2 mutations in males. BRCA1 and BRCA2 mutations, respectively, accounted for four out of 68 (6%) and one out of 68 (1%) cases diagnosed before age 50 years, and for one out of 68 (1%) and five out of 68 (7%) cases diagnosed after age 50 years. BRCA1 mutations were found in five out of 117 females (4%) and in none of 19 males (0%), and BRCA2 mutations were found in four out of 117 females (3%) and in two out of 19 males (10%). The proportions of BRCA1 and BRCA2 mutations coincided in site-specific female breast cancers (four out of 102; ie 4% each). BRCA1 and BRCA2 equally contributed to female breast cancers, with no familial clustering in those diagnosed before age 40 years (one out of 28; 4% each), and to female breast cancers, all ages, with familial clustering in one to two relatives (three out of 55; ie 5% each). In the latter subset of cases, BRCA1 mostly accounted for tumours diagnosed before age 40 years (two out of eight; 25%), and BRCA2 for tumours diagnosed after age 50 years (three out of 34; 9%). Regardless of family history, the respective contributions of BRCA1 and BRCA2 to site-specific female breast cancers diagnosed before age 40 years were 8% (three out of 36) and 3% (one out of 36). One BRCA1 mutation was detected among the 15 female probands from breast-ovarian/ovarian cancer families (7%). Among male breast cancers, BRCA2 mutations were identified in one out of five (20%) cases with family history and in one out of 14 (7%) apparently sporadic cases. No BRCA1 or BRCA2 mutations were found in female probands with nonfamilial bilateral breast cancer (10 cases) or in those with breast cancer associated with gastrointestinal, pancreatic or uterine cancers, synchronous/metachronous or in first-degree relative(s) (nine cases). These cases were all diagnosed after age 40 years.
Discussion:
Our results indicate a lack of relevant founder effects for BRCA1- and BRCA2-related disease in the sample of patients studied, which is consistent with other Italian studies and with ethnical and historical data. Overall, the contribution of BRCA1 and BRCA2 to breast/ovarian cancer in Italian patients appears to be less significant than in patients from communities with founder mutations. The present study is in agreement with direct estimates on other outbred populations, indicating that 7-10% of all female breast cancers that occur in patients aged under 40 years are due to BRCA1/BRCA2.
We found that BRCA1 and BRCA2 equally contributed to site-specific breast cancers who had one/two breast cancer-affected first-/second-degree relative(s) or who were diagnosed within age 40 years in the absence of family history. This is consistent with recent data that indicated that the respective frequencies of BRCA1 and BRCA2 mutations are comparable in early onset breast cancer. Considering the total population of patients analyzed here, however, BRCA1 and BRCA2 mutations were mostly found in cases with disease diagnosis before and after age 50 years, respectively. Moreover, in cases with familial clustering of site-specific breast cancer, BRCA1 mostly accounted for tumours diagnosed before age 40 years, and BRCA2 for tumours diagnosed after age 50 years. This is in agreement with a trend, which has been observed in other populations, for the proportion of cases with BRCA2 mutations to increase, and the proportion with mutations in BRCA1 to decrease, as the age at cancer onset increases.
As in other studies, the frequency of BRCA1/BRCA2 mutations taken together was lower than the estimated frequencies at comparable ages for all susceptibility alleles derived from the Contraceptive and Steroid Hormones (CASH) study. The discrepancy between direct data deriving from BRCA1/BRCA2 mutational analysis and CASH estimates could be due to several factors, including contribution of gene(s) other than BRCA1/BRCA2, differences between populations and relative insensitivity of mutational screening. Only BRCA1 mutations were found in breast/ovarian and site-specific ovarian cancer families. BRCA2, but not BRCA1 mutations were found in the male breast cancers. The overall proportion of males with BRCA2 mutations was high when compared with data from other studies on outbred populations, but was low compared with data from populations with founder effects.
The present results should be regarded as an approximation, because the following types of mutation are predicted to escape detection by the screening strategy used: mutations in noncoding regions; missense mutations within BRCA1 exon 11 and BRCA2 exons 10 and 11; large gene deletions; and mutations within the first and last 180 nucleotides of the amplicons analyzed by PTT.
PMCID: PMC13918  PMID: 11056688
BRCA1; BRCA2; breast; carcinoma; germline mutations; Italy
18.  Analysis of Breast Contour using Rotated Catenary 
Surgical reconstruction of natural-appearing breasts is a challenging task. Currently, surgical planning is limited to the surgeon’s subjective assessment of breast morphology. Therefore, it is useful to develop objective measurements of breast contour. In this paper, a novel quantitative measure of the breast contour based on catenary theory is introduced. A catenary curve is fitted on the breast contour (lateral and inferior) and the key parameter determining the shape of the curve is extracted. The new catenary analysis was applied to pre- and post-operative clinical photographs of women who underwent tissue expander/implant (TE/Implant) reconstruction. A logistic regression model was developed to predict the probability that the observed contour is that of a TE/Implant reconstruction from the catenary parameter, patient age, and patient body mass index. It was demonstrated that the parameters contain useful information for distinguishing TE/Implant reconstructed breasts from pre-operative breasts.
PMCID: PMC3041438  PMID: 21347015
19.  Esthetic Outcomes of ADM-Assisted Expander-Implant Breast Reconstruction 
Eplasty  2012;12:e58.
Objective: Adjunct acellular dermal matrices (ADM) are thought to improve esthetic outcomes of breast reconstruction but the existing evidence is largely anecdotal. In this study, we provide comparative data on esthetic outcomes of expander-implant breast reconstruction with and without ADM. Methods: Chart review was performed on a consecutive series of expander-implant reconstructions by the senior author. Demographic, oncologic, surgical, and photographic data were obtained for each patient. Photographic data were scored using a 3-point (0-1-2) breast-specific esthetic scale by 3 blinded, independent reviewers not involved in patient care. Results: ADM-assisted breast reconstructions had significantly higher scores than the non-ADM reconstructions for breast mound volume (1.38 vs 1.11; P = .0102), breast mound placement (1.57 vs 1.39; P = .0217), and the inframammary fold (1.39 vs 1.23; P = .0458). Conclusions: ADM may improve breast volume, placement, and inframammary fold definition. These specific findings may help plastic surgeons better utilize ADM to improve outcomes for breast reconstruction.
PMCID: PMC3528352  PMID: 23308305
20.  Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study 
JMIR mHealth and uHealth  2015;3(1):e18.
Background
Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications.
Objective
The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting.
Methods
We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device.
Results
All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency.
Conclusions
The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required.
doi:10.2196/mhealth.3929
PMCID: PMC4342621  PMID: 25679749
outpatient; recovery; care; post-operative; smartphone; technology; mobile
21.  Does it matter where you go for breast surgery?: Attending Surgeon’s Influence on Variation in Receipt of Mastectomy for Breast Cancer 
Medical care  2010;48(10):892-899.
Background
Concerns about the use of mastectomy and breast reconstruction for breast cancer have motivated interest in surgeon’s influence on the variation in receipt of these procedures.
Objectives
To evaluate the influence of surgeons on variations in the receipt of mastectomy and breast reconstruction for patients recently diagnosed with breast cancer.
Methods
Attending surgeons (n=419) of a population-based sample of breast cancer patients diagnosed in Detroit and Los Angeles during 6/05 − 2/07 (n=2290) were surveyed. Respondent surgeons (n=291) and patients (n=1780) were linked. Random-effects models examined the amount of variation due to surgeon for surgical treatment. Covariates included patient clinical and demographic factors and surgeon demographics, breast cancer specialization, patient management process measures, and attitudes about treatment.
Results
Surgeons explained a modest amount of the variation in receipt of mastectomy (4%) after controlling for patient clinical and sociodemographic factors but a greater amount for reconstruction (16%). Variation in treatment rates across surgeons for a common patient case was much wider for reconstruction (median 29%, 5th–95th percentile 9%–65%) than for mastectomy (median 18%, 5th–95th percentile, 8% and 35%). Surgeon factors did not explain between-surgeon variation in receipt of treatment. For reconstruction, one surgeon factor (tendency to discuss treatment plans with a plastic surgeon prior to surgery) explained a substantial amount of the between-surgeon variation (31%).
Conclusion
Surgeons have largely adopted a consistent approach to the initial surgery options. By contrast, the wider between-surgeon variation in receipt of breast reconstruction suggests more variation in how these decisions are made in clinical practice.
doi:10.1097/MLR.0b013e3181ef97df
PMCID: PMC3176679  PMID: 20808256
22.  Receptor-Defined Subtypes of Breast Cancer in Indigenous Populations in Africa: A Systematic Review and Meta-Analysis 
PLoS Medicine  2014;11(9):e1001720.
In a systematic review and meta-analysis, Isabel dos Santos Silva and colleagues estimate the prevalence of receptor-defined subtypes of breast cancer in North Africa and sub-Saharan Africa.
Please see later in the article for the Editors' Summary
Background
Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa.
Methods and Findings
Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n = 12,284 women with breast cancer) and 26 from sub-Saharan Africa (n = 4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%–17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%–17%) lower for those with ≥40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56–0.62) and 0.21 (0.17–0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study.
Conclusions
The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Breast cancer is the commonest female tumor in Africa and death rates from the disease in some African countries are among the highest in the world. Breast cancer begins when cells in the breast acquire genetic changes that allow them to grow uncontrollably and to move around the body. When a breast lump is found (by mammography or manual examination), a few cells are collected from the lump (a biopsy) to look for abnormal cells and to test for the presence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) on the cells. The hormones estrogen and progesterone promote the growth of normal breast cells and of ER+ and PR+ breast cancer cells. HER2 also controls the growth of breast cells. The receptor status of breast cancer is a major determinant of treatment options and prognosis (likely outcome). ER+ tumors, for example, are more receptive to hormonal therapy and have a better prognosis than ER− tumors, whereas HER2+ tumors, which make large amounts of HER2, are more aggressive than HER2− tumors. Breast cancer is treated by surgically removing the lump or the whole breast (mastectomy) if the tumor has already spread, before killing any remaining cancer cells with chemotherapy or radiotherapy. In addition, ER+, PR+, and HER2+ tumors are treated with drugs that block these receptors (including tamoxifen and trastuzumab), thereby slowing breast cancer growth.
Why Was This Study Done?
ER+ tumors predominate in white women but the proportion of ER+ tumors among US-born black women is slightly lower. The frequency of different receptor-defined subtypes of breast cancer in indigenous populations in Africa is currently unclear but policy makers need this information to help them decide whether routine receptor status testing should be introduced across Africa. Because receptor status is a major determination of treatment options and outcomes, it would be more important to introduce receptor testing if all subtypes are present in breast cancers in indigenous African women and if no one subtype dominates than if most breast cancers in these women are ER+. In this systematic review (a study that uses pre-defined criteria to identify all the research on a given topic) and meta-analysis (a statistical approach that combines the results of several studies), the researchers examine the distribution of receptor-defined breast cancer subtypes in indigenous populations in Africa.
What Did the Researchers Do and Find?
The researchers identified 54 relevant studies from North Africa involving 12,284 women with breast cancer (mainly living in Egypt or Tunisia) and 26 studies from sub-Saharan Africa involving 4,737 women with breast cancer (mainly living in Nigeria or South Africa) and used the data from these studies to calculate the proportions of ER+, PR+, and HER2+ tumors (the number of receptor-positive tumors divided by the number of tumors with known receptor status) across Africa. The proportion of ER+ tumors varied markedly between studies, ranging between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Among prospectively collected samples (samples collected specifically for receptor-status testing; studies that determined the receptor status of breast cancers using stored samples reported a lower proportion of ER+ disease than studies that used prospectively collected samples), the overall pooled proportions of ER+ and triple negative tumors were 0.59 and 0.21, respectively.
What Do These Findings Mean?
Although these findings highlight the scarcity of data on hormone receptor and HER2 status in breast cancers in indigenous African populations, they provide new information about the distribution of breast cancer subtypes in Africa. Specifically, these findings suggest that although slightly more than half of breast cancers in Africa are ER+, no single subtype dominates. They also suggest that the distribution of receptor-defined breast cancer subtypes in Africa is similar to that found in Western populations. The accuracy of these findings is likely to be affected by the low methodological quality of many of the studies and the lack of standardized procedures. Thus, large well-designed studies are still needed to accurately quantify the distribution of various breast cancer subtypes across Africa. In the meantime, the current findings support the introduction of routine receptor testing across Africa, especially for young women with early stage breast cancer in whom the potential to improve survival and reduce the years of life lost by knowing the receptor status of an individual's tumor is greatest.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001720.
This study is further discussed in a PLOS Medicine Perspective by Sulma i Mohammed
The US National Cancer Institute (NCI) provides comprehensive information about cancer (in English and Spanish), including detailed information for patients and professionals about breast cancer including an online booklet for patients
Cancer Research UK, a not-for profit organization, provides information about cancer; its detailed information about breast cancer includes sections on tests for hormone receptors and HER2 and on treatments that target hormone receptors and treatments that target HER2
Breastcancer.org is a not-for-profit organization that provides up-to-date information about breast cancer (in English and Spanish), including information on hormone receptor status and HER2 status
The UK National Health Service Choices website has information and personal stories about breast cancer; the not-for profit organization Healthtalkonline also provides personal stories about dealing with breast cancer
doi:10.1371/journal.pmed.1001720
PMCID: PMC4159229  PMID: 25202974
23.  Estrogen receptor of primary breast cancers: evidence for intracellular proteolysis 
Breast Cancer Research : BCR  2000;2(6):444-454.
Iodinated oestradiol-labeled oestrogen receptor (ER) isoforms devoid of amino-terminal ABC domains represent about two-thirds of the whole receptor population detected in cytosol samples from human breast cancers. This high frequency could not be ascribed to the expression of truncated mRNAs, or to the proteolysis of the native ER peptide at the time of homogenization or assay, suggesting an intracellular proteolysis. Free amino-terminal and ligand-binding domains maintained together within oligomeric structure(s); increase of ionic strength separated them. The amino-terminal region was consistently detected in the cell nucleus by specific immunohistochemistry leading to the concept of a potential intranuclear association between ER cleavage products and/or other regulatory proteins.
Introduction:
We previously reported that about two-thirds of [125I]oestradiol-labelled cytosolic ERs from breast cancer samples eluted as low-molecular-weight isoforms (≤ 37 kDa, size-exclusion fast pressure liquid chromatography [FPLC]). These isoforms failed to adsorb strongly to hydroxylapatite at high ionic strength, a property that was ascribed to receptors devoid of amino-terminal ABC domains. In view of recent data concerning intracellular proteolysis of several transcriptional regulators, the possibility of such behaviour for ER was assessed.
The clinical significance of ER measurement in breast cancer cytosols is well established; approximately 50% of ER-positive cases respond to endocrine therapy. Whether such a poor correlation is related to a high proportion of cleaved ER is a question of prime importance. Failure of routine ER assays to discriminate between full-length and cleaved receptors led us to develop an oestradiol-binding assay based on hydroxylapatite adsorption.
The aims of the present study were to demonstrate that hydroxylapatite adsorption assay easily identifies cleaved cytosolic ER forms and to assess the origin of such ER forms.
Method:
Breast cancer cytosols classified as ER-positive according to [3H]oestradiol-binding assay (dextran-coated charcoal [DCC]) were subjected to hydroxylapatite adsorption. ER isoforms covalently labeled with [125I]tamoxifen aziridine (TAZ) released from this matrix with 0.5 mol/l KCl were subsequently immunoprecipitated with a panel of monoclonal antibodies raised against various domains of ER (H222 [E], H226 [C] or ER1D5 [AB]) before being subjected to SDS-gel electrophoresis.
Three approaches were used to identify the origins of the cleaved ER forms: potential truncated ER-α messenger RNAs that may encode ER isoforms of low molecular weights (Northern blot assay) were sought by using ER-α full-length probe; heat treatment of tumour cytosols in the absence or presence of a cocktail of protease inhibitors was performed; and the molecular weight of intracellular ER molecules was determined by in situ [125I]TAZ-labelling, which minimizes ER proteolysis.
Breast cancer samples classified as ER-positive according to both biochemical (cytosolic DCC assay) and histochemical (ER1D5 monoclonal antibody) criteria were labelled with [3H]oestradiol and were subsequently subjected to hydroxylapatite adsorption. Hydroxylapatite extraction index (EI) is defined as a ratio of the specifically bound [3H]oestradiol released from the hydroxylapatite matrix with KCl to the total amount of the specifically bound [3H]oestradiol extracted successively with KCl and ethanol: EI= ([3H]oestradiol) [KCl] × 100/([3H]oestradiol) [KCl] + ([3H]oestradiol) [EtOH]. The EI was calculated for each cytosol in order to evaluate the amount of cleaved ER forms present. Persistence of adsorption ER to hydroxylapatite in the presence of KCl (low EI) and ER1D5 positivity established by immunohistochemistry are two independent criteria for the presence of amino-terminal ABC domains. We therefore assessed whether hydroxylapatite determinations performed on cytosols are related to immuno-histochemistry data.
Results:
Cytosol pools labelled with [125I]TAZ gave different electrophoretic patterns depending on the nature of the anti-ER monoclonal antibody used in the immunoprecipitation step preceding electrophoresis. The carboxyl-terminal-specific antibody H222 precipitated all ER isoforms (full-length 67 kDa ER, and cleavage products of 50 and 37-28 kDa), whereas the amino-terminal-specific antibodies H226 and ER1D5 precipitated only the full-length and a partially truncated isoform. Adsorption of this labelled cytosol pool onto hydroxylapatite with subsequent KCl extraction yielded ER isoforms with molecular weights between 37 and 28 kDa when immunoprecipitation of the elutes was carried out using H222. The absence of these isoforms after exposure of the elutes to H226 or ER1D5 demonstrated truncation of these isoforms at a site(s) downstream of ABC domains.
Total RNA from 46 tumours was exposed to ER-α full-length probe (Northern blot). All tumours expressed a full-length 6.6-kb ER mRNA; small-sized isoforms were not recorded. A good correlation resulted when amounts of 6.6-kb ER mRNA estimated by densitometry were compared with corresponding [3H]oestradiol-binding capacities (DCC assay), thereby rejecting the concept that low-molecular-weight isoforms were encoded by truncated ER mRNA.
We next investigated whether such isoforms might be generated by proteolysis. Cytosol samples of a series of breast tumours were labelled with [125I]TAZ in the presence of a cocktail of protease inhibitors. These inhibitors failed to maintain the full-length 67 kDa ER by SDS-PAGE. In situ [125I]TAZ-labelling of receptors associated with a protein extraction procedure minimizing their proteolysis displayed multi-bands electrophoretic patterns, almost identical to those found under conventional methods. Hence, ER molecular heterogeneity appears to result from an intracellular proteolysis. ER1D5 immunostaining scores (ISs) of a series of 15 tumours were significantly correlated with ER levels, as measured by hydroxylapatite assay of corresponding cytosols (total number of binding sites). Sequential extraction of bound [3H]oestradiol from hydroxylapatite with KCl and ethanol revealed an EI of over 30% in the large majority of these cytosols, indicating a high frequency of cleaved ER isoforms. Of note, no significant correlation between IS and EI data was recorded, suggesting that ABC and E domains are separated at high ionic strength, but are apparently held together within the cell nucleus in oligomeric structures.
Discussion:
Endogenous proteolysis is a regulatory mechanism in many cellular processes, such as cell cycle progression and transcriptional regulation. The present data extend this concept to ER. Indeed, proteolysis-generated ER fragments appear to be held together within the cell in oligomeric structures. Because ER proteolysis is probably relevant to several oestrogen target tissues, we suggest that the protein environment, which differs among tissues, may be a factor of major importance in the formation of distinct oligomeric structures, which elicit specific biological responses. The possibility of heterogeneous association between cleaved ER and regulatory proteins might perhaps result in a spectrum of such transcriptional activities. In this context, we propose that a complementary hydroxylapatite extraction assay (EI assessment) should be added to the usual tests to identify ER-positive tumours. Such a complementary test would provide an estimate of the level of cleaved ER forms, which may have biological and/or clinical relevance.
PMCID: PMC13922  PMID: 11056692
estrogen receptor domains; hydroxylapatite; immunohistochemistry; primary breast cancer
24.  Oncoplastic Breast Surgery 
The Indian Journal of Surgery  2012;74(3):255-263.
Breast Surgery is now a recognized subspecialty of General Surgery abroad with structured training for designated ‘Oncoplastic Breast Surgeons’. Oncoplastic Breast surgery is probably one of the most interesting and challenging new developments over the past 20 years. The aims of Oncoplastic surgery are wide local excision of the cancer coupled with partial reconstruction of the defect to achieve a cosmetically acceptable result. Avoidance of mastectomy and consequent reduction of psychological morbidity are the principal goals in the development of various oncoplastic techniques. The use of plastic surgical techniques not only ensures good cosmetic outcome, but also allows the cancer surgeon to remove the tumour with greater volume of surrounding tissue, thus extending the boundaries of breast conserving surgery. Proper patient selection and careful planning after proper radiological and clinical assessment are the two essential prerequisites before undertaking oncoplastic breast surgery. Oncoplastic surgery involves both volume displacement and volume replacement techniques. Some commonly used volume displacement procedures are described in the article. The need for adjustment of contralateral breast should also be anticipated at the time of planning breast conserving surgery, which can be done either at the same time as breast cancer surgery or as a delayed setting.
doi:10.1007/s12262-012-0590-9
PMCID: PMC3397185  PMID: 23730053
25.  A Position Statement on Optimizing the Role of Oncoplastic Breast Surgery 
Eplasty  2012;12:e40.
Objectives: To propose initiatives and actions that could improve access to and outcomes from oncoplastic breast surgery. Methods: The author group met in May 2010 to draft position statements on key unmet needs in oncoplastic breast surgery and how these may be addressed. At a second meeting in December 2010, the statements were voted upon and adjusted as necessary to achieve unanimous agreement. Results: It was agreed that every patient undergoing breast cancer surgery should be assessed by an oncoplastic team capable of offering the full range of surgical options. However, currently, not all women are adequately informed about the surgical options available. Furthermore, levels of multidisciplinary working, standards of care, and levels of surgical training in the full range of breast oncoplastic techniques are suboptimal. Institution-specific guidelines relating to the optimal patient pathway, the definition of clinical standards, and improved education in reconstructive surgery are required. Oncoplastic breast surgery should be offered to all patients, within the context of multidisciplinary teams that include accredited surgeons who consult with each other early in the treatment pathway. These teams should be focused on achieving not just positive oncologic outcomes, but also esthetic outcomes in line with patient wishes, to achieve optimal quality of life. Conclusions: There is a desire within the surgical community to improve patient outcomes by better incorporating oncoplastic procedures into the treatment pathways for breast cancer. These position statements represent the perspectives of a group of European plastic surgeons on the key elements required to achieve this goal.
PMCID: PMC3426932  PMID: 22977675

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