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BACKGROUND Multiple left ventricular pacing strategies have been suggested for improving response to cardiac resynchronization therapy (CRT). However, these programming strategies may sometimes entail accepting configurations with high pacing threshold and accelerated battery drain. We assessed the feasibility of predefined pacing programming protocols, and we evaluated their impact on device longevity and their cost-impact. METHODS We estimated battery longevity in 167 CRT-D patients based on measured pacing parameters according to multiple alternative programming strategies single-site pacing associated with lowest threshold, non-apical location, longest interventricular delay, and pacing from two electrodes. To determine the economic impact of each programming strategy, we applied the results of a model-based cost analysis using a 15-year time horizon. RESULTS Selecting the electrode with the lowest threshold resulted in a median device longevity of 11.5 years. Non-apical pacing and interventricular delay maximization were feasible in most patients and were obtained at the price of a few months of battery life. Device longevity of > 10 years was preserved in 87% of cases of non-apical pacing and in 77% on pacing at the longest interventricular delay. The mean reduction in battery life when the second electrode was activated was 1.5 years. Single-site pacing strategies increased the therapy cost by 4-6%, and multi-site pacing by 12-13%, in comparison with the lowest-cost scenario. CONCLUSIONS Modern CRT-D systems ensure effective pacing and allow multiple optimization strategies for maximizing service life or for enhancing effectiveness. Single- or multi-site pacing strategies can be implemented without compromising device service life and at an acceptable increase in therapy cost.PURPOSE To determine whether there is a correlation between the presence of peritumoral edema detected on T2-weighted sequences and pathological prognostic factors and specific biological subtypes of breast cancer. METHODS A retrospective study on 120 women with invasive breast cancer, who underwent breast MRI on a 3 T scanner over a period of 12 months, was performed. Peritumoral edema was assessed visually by two breast radiologist in consensus and patients were consequently divided into two groups. For each lesion dimensions, histology and molecular profiling were evaluated. The comparison between the two groups was performed using the χ2 test, subsequently carrying out a univariate and a multivariate logistic regression analysis. RESULTS 41 (34.2%) invasive breast cancers with perilesional edema and 79 (65.8%) without edema were identified. A significant association between the presence of perilesional edema and a larger lesion size (p = 0.0001), grade 3 (p  less then  0.001) and a higher Ki-67 index (p  less then  0.001) was found. The multivariate analysis confirmed that a larger tumor size is independently associated with peritumoral edema. A total of 101 (84.2%) luminal-like, 8 (6.7%) HER2-positive, and 11 (9.2%) triple-negative tumors were included in the study. U0126 molecular weight Peritumoral edema turned out to be less frequently associated with luminal-like lesions (p  less then  0.001), while the luminal A status was found to have a significant association with the absence of peritumoral edema in the univariate analysis. CONCLUSION The detection of peritumoral edema on T2-weighted sequences should be considered as a valid additional prognostic tool in the evaluation of breast cancer, since it is associated with biologically aggressive non-luminal breast cancers, characterized by large dimension, high tumor grade, and high Ki-67 values.PURPOSE Achieving a pathologic complete response (pCR) with neoadjuvant therapy for HER2-positive breast cancer is associated with less recurrence and improved clinical outcomes compared to having residual cancer at surgery. However, recent data have demonstrated favorable outcomes for patients with residual HER2-positive cancer who received adjuvant trastuzumab emtansine (TDM-1). Therefore, we sought to determine the optimal chemotherapy/anti-HER2 treatment strategy. METHODS We created a decision-analytic model for patients with stage II-III HER2-positive cancer that incorporated utilities based on toxicity and recurrence. We separately modeled hormone receptor-negative (HR-) and positive (HR+) disease and calculated quality-adjusted life years (QALYs) and costs through 5 years. Simulated patients received one of the following neoadjuvant treatments three 'intensive' regimens (TCHP docetaxel, carboplatin, trastuzumab, pertuzumab; THP + AC taxol, trastuzumab, pertuzumab then doxorubicin and cyclophosphamide; THP taxol, trastuzumab, pertuzumab) and two 'de-escalated' regimens (TH taxol, trastuzumab; TDM-1) followed by adjuvant treatment based on pathologic response. RESULTS Among 'intensive' neoadjuvant strategies, treatment with THP was more effective and less costly than TCHP or THP + AC. When 'de-escalated' strategies were included, TH became the most cost-effective. For HR-negative cancer, TH had 0.003 fewer quality-adjusted life years (QALYs) than THP but was less costly by $55,831, resulting in an incremental cost-effectiveness ratio of over $18M/QALY for THP, well above any threshold. For HR-positive cancer, neoadjuvant TH dominated the THP strategy. CONCLUSION An adaptive-treatment strategy beginning with neoadjuvant THP or TH followed by tailoring post-operative therapy reduces treatment costs, and spares toxicity compared to more intensive chemotherapy regimens for women with HER2-positive breast cancer.As part of the natural resource damage assessment for the Deepwater Horizon oil spill, a mathematical model was used to estimate the total number of bird carcasses deposited on shorelines based on the number of carcasses collected and adjustment factors such as detection probability and carcass persistence. Studies of carcass persistence occurred along sandy beaches and marsh edges in the northern Gulf of Mexico to obtain site-specific inputs for the model. We estimated persistence rates for these habitat types and evaluated the influence on persistence of carcass size, location of the carcass on the beach, dominant vegetation type in the marsh, carcass distance into marsh vegetation, and length of time a carcass was stranded on a shoreline. The length of time stranded had the greatest influence on persistence in both habitat types, with persistence initially relatively low and increasing logarithmically. Carcass size and position were weakly influential on sandy beaches. Carcass size had stronger influences along marsh edges, and marsh habitat type also affected persistence.