Sample records for surgical margin psm

  1. Significance and management of positive surgical margins at the time of radical prostatectomy. (United States)

    Silberstein, Jonathan L; Eastham, James A


    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

  2. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle


    OBJECTIVE: The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. MATERIAL AND METHODS: A prospective...... consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage...... positive biopsies for cancer (PPB), surgeon and surgical technique. RESULTS: The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Wald χ(2)) on PSA (p PSM...

  3. Prognostic relevance of number and bilaterality of positive surgical margins after radical prostatectomy.

    NARCIS (Netherlands)

    Somford, D.M.; Oort, I.M. van; Cosyns, J.P.; Witjes, J.A.; Kiemeney, L.A.L.M.; Tombal, B.


    PURPOSE: Positive surgical margin (PSM) status following radical prostatectomy (RP) is a well-established prognostic factor. The aim of the present study is to evaluate whether number of PSMs or bilaterality of PSMs might have prognostic significance for biochemical recurrence (BCR) in the populatio

  4. [Predictors of positive surgical margins after nephron-sparing surgery for renal cell carcinoma: retrospective analysis on 298 consecutive patients]. (United States)

    Schiavina, Riccardo; Borghesi, Marco; Chessa, Francesco; Rizzi, Simona; Martorana, Giuseppe


    Aim of our study was to evaluate the predictive factors of positive surgical margins (PSM) in a cohort of patients who underwent partial nephrectomy (PN) for renal cell carcinoma. We retrospectively evaluated our Institutional database of patients treated with open or laparoscopic PN between 200 and 2013. Categorical variables were compared using Pearson's chi-square test and linear-by-linear association. Multivariable Cox analysis was used in order to evaluate independent predictors of PSM. Surgical margins were found to be negative in 274 out of 298 patients (91.9%), and the remaining 24 (8.1%) patients had PSM at the final pathological exam. The median clinical size was significantly lower in patients with PSM than those with negative margins (2.6 vs. 3 cm, p=0.03). At univariable analysis, a shorter operative time (p=0.04), a malignant histotype (p=0.04) and higher Fuhrman grade (p=0.02) were observed in patients with positive surgical margins compared to those without PSM. At multivariable analysis, median tumor dimension (p=0.02), the malignant histotype (p=0.01) and the high Fuhrman grade (3-4) (p=0.01) were found to be independent predictive factors of PSM. The most important goal of any PN is to reach negative surgical margins. In our study, clinical tumor dimensions, malignant tumor histotype and the high Fuhrman grade demonstrated to be independent predictive factors of PSM after nephron sparing surgery for renal cell carcinoma. Other prospective, multi-institutional studies are needed in order to confirm these results.

  5. Influence of pathologist experience on positive surgical margins following radical prostatectomy. (United States)

    Tallman, Jacob E; Packiam, Vignesh T; Wroblewski, Kristen E; Paner, Gladell P; Eggener, Scott E


    A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all Pexperience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all Pexperience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Influence of positive surgical margin status after radical nephroureterectomy on upper urinary tract urothelial carcinoma survival. (United States)

    Colin, Pierre; Ouzzane, Adil; Yates, David R; Audenet, François; François, Audenet; Pignot, Géraldine; Arvin-Berod, Alexis; Merigot de Treigny, Olivier; Laurent, Guy; Valeri, Antoine; Irani, Jacques; Jacques, Irani; Saint, Fabien; Gardic, Solène; Gres, Pascal; Rozet, François; Neuzillet, Yann; Ruffion, Alain; Rouprêt, Morgan


    The influence of a positive surgical margin (PSM) on survival outcome of post radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC) is unclear. The objectives of this study were to determine the significance of PSM on cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) post RNU. From a multicenter collaborative database, data on SM status, stage, grade, lymph node status, lymphovascular invasion (LVI), tumor location, follow-up, and survival was retrieved for 472 patients. Patients underwent open RNU with bladder cuff excision. Clinicopathological features were compared using χ(2) or Fisher exact test and unpaired t test for categorical and continuous variables, respectively. Survival was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regression models were calculated. Median follow-up was 27.5 months (12.1-49.3 months). PSM was identified in 44 patients (9.3%) and correlated with pT stage (p = 0.002), grade (p < 0.001), LVI (p < 0.001), and location (p < 0.001). Univariate analyses revealed that PSM was a poor prognostic factor for CSS, RFS, and MFS (p = 0.003, 0.04, and <0.001, respectively). The 5-yr CSS and MFS for PSM was 59.1 and 51.6%, respectively, compared with 83.3 and 79.3% for patients with negative SM. Multivariate analyses revealed that SM status was an independent predictor of MFS [hazard ratio 2.7; p = 0.001). PSM after RNU is an important prognostic factor for developing UUT-UC metastases. The status of the surgical margin should be systematically reported on the pathological report and may be a useful variable to include in nomogram risk prediction tools.

  7. Optimizing Surgical Margins in Breast Conservation

    Directory of Open Access Journals (Sweden)

    Preya Ananthakrishnan


    Full Text Available Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy, include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.

  8. Non-apical positive surgical margins after radical prostatectomy for pT2 prostate cancer is associated with the highest risk of recurrence

    DEFF Research Database (Denmark)

    Roder, Martin Andreas; Kawa, Sandra; Scheike, Thomas


    BACKGROUND AND OBJECTIVE: To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). METHODS: The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The location...... of PSM was stratified into apical and non-apical. BR was defined as the first PSA ≥ 0.2 ng/ml after RP. Risk of BR was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS: Median follow-up was 3.6 years (range: 0.5-15.5 years). The overall pT2 PSM rate was 26.3%. Overall, a pT2 with PSM had...... a 3.1-fold increased risk of BR compared to margin negative patients. Patients with pT2 apical and non-apical PSM had a 5-year biochemical recurrence-free survival of 84.9% (95% CI: 77.6-92.2%) and 78.6% (95% CI: 71.3-85.9%), respectively. In multivariate analysis, pT2 apical and non-apical PSM...

  9. Incidence of positive surgical margins after robotic assisted radical prostatectomy: Does the surgeon's experience have an influence on all pathological stages? (United States)

    Villamil, A W; Costabel, J I; Billordo Peres, N; Martínez, P F; Giudice, C R; Damia, O H


    The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeon's experience in the oncological results related to pathological stage. An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeon's experience were compared and analyzed. No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeon's experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeon's experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  10. Risk of biochemical recurrence and positive surgical margins in patients with pT2 prostate cancer undergoing radical prostatectomy

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer


    BACKGROUND AND OBJECTIVE: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). METHODS: Between 1995 and 2011, 1,649 patients underwent RP...... at our institution. The study includes the 1,133 consecutive patients with pT2 tumors at final histopathology. Logistic regression analysis was used for risk of PSM. Risk of BR, defined as the first PSA ≥ 0.2 ng/ml, was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS: Median follow......-up was 3.6 years (range: 0.5-15.5 years). In logistic regression, NS surgery was independently associated with an increased risk of pT2 PSM (OR = 1.68, 95% CI: 1.3-2.0, P = 0.01) relative to non-NS surgery. NS surgery was not independently associated with BR but the interaction of PSM and NS surgery...

  11. Intraoperative ultrasound control of surgical margins during partial nephrectomy

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    Feras M Alharbi


    Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

  12. Treatment of the positive surgical margin following radical prostatectomy

    Institute of Scientific and Technical Information of China (English)


    Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China,it will be necessary to elaborate the diagnosis,clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin,prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin,prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature.By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained.Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%,and although most patients with positive surgical margins are stable for a considerable period,the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis.The risk factors of positive surgical margin include preoperative prostate specific antigen level,Gleason's score and pelvic lymph node metastasis.The most common site with positive surgical margin is in apical areas of the prostate;therefore surgical technique is also a factor resulting in positive surgical margins.From data available now it appears that as long as the surgical technique is skilled,different surgical modes do not affect the rate of surgical margin.Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy,but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that

  13. Molecular markers in the surgical margin of oral carcinomas

    DEFF Research Database (Denmark)

    Bilde, A.; Buchwald, C. von; Dabelsteen, E.;


    BACKGROUND: Local or regional lymph node recurrence is the most common pattern of treatment failure in oral squamous cell carcinoma (SCC). The local recurrence rate is 30% even when the surgical resection margin is diagnosed as tumour free. Accumulation of genetic changes in histologically normal...... epithelium in the surgical resection margin may explain the local recurrence rate. The purpose of this study is to investigate the presence of senescence markers, which may represent early malignant changes in the margin that in routine pathological evaluations are classified as histologically normal....... METHODS: Formalin-fixed, paraffin-embedded surgical specimens from 16 consecutive patients with oral SCC and a clear surgical margin were obtained. The margin was analysed by immunohistochemistry for p53, p16, Chk2, Laminin-5 and glycosylated oncofetal fibronectin. RESULTS: Two patterns of p53 expression...

  14. Molecular markers in the surgical margin of oral carcinomas

    DEFF Research Database (Denmark)

    Bilde, Anders; von Buchwald, Christian; Dabelsteen, Erik


    epithelium in the surgical resection margin may explain the local recurrence rate. The purpose of this study is to investigate the presence of senescence markers, which may represent early malignant changes in the margin that in routine pathological evaluations are classified as histologically normal...

  15. Intraoperative ultrasound control of surgical margins during partial nephrectomy. (United States)

    Alharbi, Feras M; Chahwan, Charles K; Le Gal, Sophie G; Guleryuz, Kerem M; Tillou, Xavier P; Doerfler, Arnaud P


    To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

  16. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

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    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)


    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  17. PSM: Planck Sky Model (United States)

    Ashdown, Mark; Aumont, Jonathan; Baccigalupi, Carlo; Banday, Anthony; Basak, Soumen; Bernard, Jean-Philippe; Betoule, Marc; Bouchet, François; Castex, Guillaume; Clements, Dave; Da Silva, Antonio; De Zotti, Gianfranco; Delabrouille, Jacques; Dickinson, Clive; Dodu, Fabrice; Dolag, Klaus; Elsner, Franz; Fauvet, Lauranne; Faÿ, Gilles; Giardino, Giovanna; Gonzalez-Nuevo, Joaquin; le Jeune, Maude; Leach, Samuel; Lesgourgues, Julien; Liguori, Michele; Macias, Juan; Massardi, Marcella; Matarrese, Sabino; Mazzotta, Pasquale; Melin, Jean-Baptiste; Miville-Deschênes, Marc-Antoine; Montier, Ludovic; Mottet, Sylvain; Paladini, Roberta; Partridge, Bruce; Piffaretti, Rocco; Prézeau, Gary; Prunet, Simon; Ricciardi, Sara; Roman, Matthieu; Schaefer, Bjorn; Toffolatti, Luigi


    The Planck Sky Model (PSM) is a global representation of the multi-component sky at frequencies ranging from a few GHz to a few THz. It summarizes in a synthetic way as much of our present knowledge as possible of the GHz sky. PSM is a complete and versatile set of programs and data that can be used for the simulation or the prediction of sky emission in the frequency range of typical CMB experiments, and in particular of the Planck sky mission. It was originally developed as part of the activities of Planck component separation Working Group (or "Working Group 2" - WG2), and of the ADAMIS team at APC. PSM gives users the opportunity to investigate the model in some depth: look at its parameters, visualize its predictions for all individual components in various formats, simulate sky emission compatible with a given parameter set, and observe the modeled sky with a synthetic instrument. In particular, it makes possible the simulation of sky emission maps as could be plausibly observed by Planck or other CMB experiments that can be used as inputs for the development and testing of data processing and analysis techniques.

  18. Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson. (United States)

    Bundred, N J; Thomas, J; Dixon, J M J


    The Kennedy report into the actions of the disgraced Breast Surgeon, Paterson focussed on issues of informed consent for mastectomy, management of surgical margins and raised concerns about local recurrence rates and the increasing emphasis on cosmesis after mastectomy for breast cancer. This article assesses whether Kennedy's recommendations apply to the UK as a whole and how to address these issues. New GMC advice on consent and newer nonevidenced innovations in immediate reconstruction have altered the level of informed consent required. Patients deserve a better understanding of the issues of oncological versus cosmetic outcomes on which to base their decisions. Involvement of the whole multidisciplinary team including Oncologists is necessary in surgical planning. Failure to obtain clear microscopic margins at mastectomy leads to an increased local recurrence, yet has received little attention in the UK. Whereas, other countries have used surgical quality assurance audits to reduce local recurrence; local recurrence rates are not available and the extent of variation across the UK in margin involvement after surgery, its management and relationship to local recurrence needs auditing prospectively to reduce unnecessary morbidity. To reassure public, patients and the NHS management, an accreditation system with more rigour than NHSBSP QA and peer review is now required. Resource and efforts to support its introduction will be necessary from the Royal College of Surgeons and the Association of Breast Surgeons. New innovations require careful evaluation before their backdoor introduction to the NHS. Private Hospitals need to have the same standards imposed.

  19. Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin - A multicenter study. (United States)

    Karl, Alexander; Buchner, Alexander; Tympner, Christiane; Kirchner, Thomas; Ganswindt, Ute; Belka, Claus; Ganzer, Roman; Wieland, Wolf; Eder, Fabian; Hofstädter, Ferdinand; Schilling, David; Sievert, Karl-Dietrich; Stenzl, Arnulf; Scharpf, Marcus; Fend, Falko; Vom Dorp, Frank; Rübben, Herbert; Schmid, Kurt Werner; Porres-Knoblauch, Daniel; Heidenreich, Axel; Hangarter, Birgit; Knüchel-Clarke, Ruth; Rogenhofer, Michael; Wullich, Bernd; Hartmann, Arndt; Comploj, Evi; Pycha, Armin; Hanspeter, Esther; Pehrke, Dirk; Sauter, Guido; Graefen, Markus; Gratzke, Christian; Stief, Christian; Wiegel, Thomas; Haese, Alexander


    Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis. With 48months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor (p<0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3+4=7a, 4+3=7b, and 8-10, respectively. In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. (United States)

    Thompson, James E; Egger, Sam; Böhm, Maret; Haynes, Anne-Maree; Matthews, Jayne; Rasiah, Krishan; Stricker, Phillip D


    Comparative studies suggest functional and perioperative superiority of robot-assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP). To determine whether high-volume experienced open surgeons can improve their functional and oncologic outcomes with RARP and, if so, how many cases are required to surpass ORP outcomes and reach the learning curve plateau. A prospective observational study compared two surgical techniques: 1552 consecutive men underwent RARP (866) or ORP (686) at a single Australian hospital from 2006 to 2012, by one surgeon with 3000 prior ORPs. Demographic and clinicopathologic data were collected prospectively. The Expanded Prostate Cancer Index Composite quality of life (QoL) questionnaire was administered at baseline, 1.5, 3, 6, 12, and 24 mo. Multivariate linear and logistic regression modelled the difference in QoL domains and positive surgical margin (PSM) odds ratio (OR), respectively, against case number. A total of 1511 men were included in the PSM and 609 in the QoL analysis. RARP sexual function scores surpassed ORP scores after 99 RARPs and increased to a mean difference at 861st case of 11.0 points (95% confidence interval [CI], 5.9-16.1), plateauing around 600-700 RARPs. Early urinary incontinence scores for RARP surpassed ORP after 182 RARPs and increased to a mean difference of 8.4 points (95% CI, 2.1-14.7), plateauing around 700-800 RARPs. The odds of a pT2 PSM were initially higher for RARP but became lower after 108 RARPs and were 55% lower (OR: 0.45; 95% CI, 0.22-0.92) by the 866th RARP. The odds of a pT3/4 PSM were initially higher for RARP but decreased, plateauing around 200-300 RARPs with an OR of 1.15 (0.68-1.95) at the 866th RARP. Limitations include single-surgeon data and residual confounding. RARP had a long learning curve with inferior outcomes initially, and then showed progressively superior sexual, early urinary, and pT2 PSM outcomes and similar pT3 PSM and late urinary outcomes. Learning RARP

  1. Zero positive surgical margins after radical prostatectomy: is the end in sight. (United States)

    Skarecky, Douglas W; Brenner, Mattew; Rajan, Sudhir; Rodriguez, Esequiel; Narula, Navneet; Melgoza, Frank; Ahlering, Thomas E


    Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology of the da Vinci robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

  2. The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    David González-Ballester


    Aim: One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease. However, sometimes, the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis. Faced with this dilemma, a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma (SCC).Methods: An electronic and manual search was conducted by one reviewer. A combination of controlled Medical Subjects Headings and keywords were used as search strategy. Inclusion and exclusion criteria were established.Results: Finally, after an exhaustive selection process, four articles fulfilled the inclusion criteria and were analyzed. All articles reported a decrease of surgical margin after resection. The tumor site and tumor stage seem to influence in degree of margin shrinkage.Conclusion:Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon. There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing. The highest percentage of retraction occurs at the time of resection. Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.

  3. Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee. (United States)

    Song, Wan; Lee, Dong Hyeon; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Lee, Hyun Moo; Choi, Han Yong; Kim, Jong Wook; Lee, SangChul; Byun, Seok-Soo; Jeong, Chang Wook; Kwak, Cheol; Cho, Jin Seon; Ahn, Hanjong; Jeon, Seong Soo


    Oncologic outcomes of patients with pT3aN0/Nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients. A retrospective, multicenter study was performed on 795 patients with pT3aN0/Nx PCa with PSM after RP between January 2006 and December 2014. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan-Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR. During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pT3aN0/Nx PCa with PSM (GS 6 vs. GS 7 (3 + 4), P = 0.047; vs. GS 7 (4 + 3), P = 0.007, and vs. GS 8-10, P Nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis.

  4. Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins

    Directory of Open Access Journals (Sweden)

    Upile Tahwinder


    Full Text Available Abstract Objectives The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

  5. Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome

    DEFF Research Database (Denmark)

    Amit, Moran; Na'ara, Shorook; Trejo-Leider, Leonor


    Background: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. Methods: We conducted univariate ...

  6. Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

    Directory of Open Access Journals (Sweden)

    Chiou Wen-Yen


    Full Text Available Abstract Background Most treatment failure of buccal mucosal cancer post surgery is locoregional recurrence. We tried to figure out how close the surgical margin being unsafe and needed further adjuvant treatment. Methods Between August 2000 and June 2008, a total of 110 patients with buccal mucosa carcinoma (25 with stage I, 31 with stage II, 11 with stage III, and 43 with Stage IV classified according to the American Joint Committee on Cancer 6th edition were treated with surgery alone (n = 32, surgery plus postoperative radiotherapy (n = 38 or surgery plus adjuvant concurrent chemoradiotherapy (n = 40. Main outcome measures: The primary endpoint was locoregional disease control. Results The median follow-up time at analysis was 25 months (range, 4-104 months. The 3-year locoregional control rates were significantly different when a 3-mm surgical margin (≤3 versus >3 mm, 71% versus 95%, p = 0.04 but not a 5-mm margin (75% versus 92%, p = 0.22 was used as the cut-off level. We also found a quantitative correlation between surgical margin and locoregional failure (hazard ratio, 2.16; 95% confidence interval, 1.14 - 4.11; p = 0.019. Multivariate analysis identified pN classification and surgical margin as independent factors affecting disease-free survival and locoregional control. Conclusions Narrow surgical margin ≤3 mm, but not 5 mm, is associated with high risk for locoregional recurrence of buccal mucosa carcinoma. More aggressive treatment after surgery is suggested.

  7. Surgical margins in the genomic era: The Hayes Martin Lecture, 2012. (United States)

    Wolf, Gregory T


    One of the highest honors of one's career is to be asked to address colleagues, mentors, and students who represent the world's leading health professionals dedicated to reducing the morbidity and mortality associated with head and neck cancer. Hayes Martin would certainly share this feeling of honor and humility in having a lecture given in his name on the occasion of the Eighth International Conference on Head and Neck Cancer. I am so very pleased to share with you some thoughts on the assessment, adequacy, and application of surgical resection margins in an era in which personalized surgery and molecular medicine will have a major impact on patient outcomes. My thoughts about surgical margins have evolved over nearly 40 years of performing surgical resections for cancer. A discussion of margins may seem somewhat mundane to many of you; however, I hope to provide a futuristic and somewhat theoretical view of how surgical margin issues will relate to the personalization of modern head and neck cancer treatment and how the biology of the tumor microenvironment may be instructive in the application of our surgical approaches. This is particularly relevant because of the rapid expansion of functional surgical approaches utilizing minimally invasive endoscopic resections and robotic techniques that may not achieve the same wide oncologic margins that have been emphasized historically.(1,2) Proper selection of patients for such procedures is critical if we are to improve overall treatment results.

  8. Do surgical margin and local recurrence influence survival in soft tissue sarcomas? (United States)

    Novais, Eduardo N; Demiralp, Bahtiyar; Alderete, Joseph; Larson, Melissa C; Rose, Peter S; Sim, Franklin H


    Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years). The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities.

  9. Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals. (United States)

    Shih, Ya-Chen Tina; Shen, Chan; Hu, Jim C


    The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market. The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area. As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial

    DEFF Research Database (Denmark)

    Gillgren, Peter; Drzewiecki, Krzysztof T; Niin, Marianne;


    Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin.......Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin....

  11. Surgical margins in breast-conserving therapy: current trends and future prospects. (United States)

    Sanguinetti, Alessandro; Lucchini, Roberta; Santoprete, Stefano; Bistoni, Giovanni; Avenia, Stefano; Triola, Roberto; Avenia, Nicola


    Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

  12. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma

    DEFF Research Database (Denmark)

    Lawaetz, Mads; Homøe, Preben


    OBJECTIVE: The purpose of this study was to examine which factors are associated with inadequate surgical margins and to assess the postoperative consequences. STUDY DESIGN: A retrospective cohort of 110 patients with oral squamous cell carcinoma treated with surgery during a 2-year period...

  13. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy (United States)

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin


    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  14. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Childs, Stephanie K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen Yuhui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Duggan, Margaret M. [Department of Surgery, Faulkner Hospital, Boston, Massachusetts (United States); Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Golshan, Mehra [Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Pochebit, Stephen [Department of Pathology, Faulkner Hospital, Boston, Massachusetts (United States); Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)


    Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close ({<=}2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable

  15. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial

    DEFF Research Database (Denmark)

    Gillgren, Peter; Drzewiecki, Krzysztof T; Niin, Marianne;


    Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin....

  16. Hyperspectral Imaging for Cancer Surgical Margin Delineation: Registration of Hyperspectral and Histological Images. (United States)

    Lu, Guolan; Halig, Luma; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei


    The determination of tumor margins during surgical resection remains a challenging task. A complete removal of malignant tissue and conservation of healthy tissue is important for the preservation of organ function, patient satisfaction, and quality of life. Visual inspection and palpation is not sufficient for discriminating between malignant and normal tissue types. Hyperspectral imaging (HSI) technology has the potential to noninvasively delineate surgical tumor margin and can be used as an intra-operative visual aid tool. Since histological images provide the ground truth of cancer margins, it is necessary to warp the cancer regions in ex vivo histological images back to in vivo hyperspectral images in order to validate the tumor margins detected by HSI and to optimize the imaging parameters. In this paper, principal component analysis (PCA) is utilized to extract the principle component bands of the HSI images, which is then used to register HSI images with the corresponding histological image. Affine registration is chosen to model the global transformation. A B-spline free form deformation (FFD) method is used to model the local non-rigid deformation. Registration experiment was performed on animal hyperspectral and histological images. Experimental results from animals demonstrated the feasibility of the hyperspectral imaging method for cancer margin detection.

  17. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery* (United States)

    Suzuki, Heliane Sanae; Serafini, Sérgio Zuñeda; Sato, Maurício Shigueru


    BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique. PMID:24626646

  18. Totally laparoscopic hepatectomy exposing the vessels around the tumor intended to secure the surgical margin. (United States)

    Honda, Goro; Kurata, Masanao; Okuda, Yukihiro; Kobayashi, Shin; Sakamoto, Katsunori


    Anatomical hepatectomy (AH) is basically not required for metastatic tumors in terms of oncology, but is required for hepatocellular carcinoma [1-5]; however, the surgeon cannot secure the surgical margin by palpation via a laparoscopic approach. Therefore, AH or partial hepatectomy exposing the vessels around the tumor (PHev) is often better for deep-seated or invisible lesions [6, 7] because unexpected exposure of the tumor on the cutting plane can be avoided by creating a cutting plane on the side of exposed vessels. From August 2008 to December 2012, we performed totally laparoscopic AH or PHev for 29 patients (AH in 21 patients and PHev in 8 patients) to secure the surgical margin of metastatic tumors [8, 9]. The median operative time was 329 (range 147-519) min, with median blood loss of 141 (range 5-430) g. Conversion was performed for one patient whose stump of the Glissonean branch was positive in a frozen section. Additional hepatectomy was performed via an open approach. Postoperative morbidity rate was 20.7 % (peroneal palsy in two patients, ileus in one patient, biloma in one patient, and pulmonary embolism in one patient). Mortality was zero. The median length of hospital stay after surgery was 9 (range 4-21) days. Only one patient, who underwent extended posterior sectorectomy for a 4.2-cm tumor developing close to the right main Glissonean pedicle, had a microscopically positive margin, because the tumors were exposed on the cutting plane. The embedded video demonstrates hepatectomy of the dorsal half-segment of the right anterior sector, during which the liver was divided at the anterior fissure [10] and the border between the anterior and posterior sector. Totally laparoscopic hepatectomy exposing the vessels around the tumor can be performed safely and is useful to secure the surgical margin in patients with a metastatic tumor.

  19. Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease. (United States)

    Kato, Takeshi; Fujimoto, Noriki; Fujii, Norikazu; Tanaka, Toshihiro


    It is difficult to determine the appropriate resection margin of extramammary Paget's disease (EMPD). A high recurrence rate is reported in spite of using Mohs micrographic surgery (MMS), which is performed commonly. Preoperative mapping biopsy is easier to perform than MMS. In Japan, the following method is recommended instead of MMS: well-defined border and margins histologically confirmed by mapping biopsy should be resected with 1-cm margin and ill-defined border with 3-cm margin. This study aimed to evaluate the accuracy of the Japanese guideline and to assess our mapping biopsy method compared with MMS. Preoperative mapping biopsy specimens were obtained beyond the clinical border for at least four directions in each patient. To confirm the presence of residual Paget's cells postoperatively, narrow specimens were obtained along the surgical margin. Retrospective evaluation of 17 EMPD patients was conducted concerning histological spread of Paget's cells and recurrence ratio. There were 86 directions showing a well-defined border, and in 9.3% (8/86), Paget's cells were still observed at 1-cm resection line. On the other hand, there were 21 directions showing an ill-defined border, and unnecessary radical resection was performed in 90% (19/21) of directions with 3-cm resection line. Although postoperative histological examination showed residual Paget's cells in 47% (8/17) of patients and additional resections were not performed, recurrence rate was only 5.9% (1/17). The resection line of EMPD should be based not on clinical features, but on mapping biopsy. Mapping biopsy is equivalent to MMS concerning recurrence rate and, though conventional, is useful method to treat EMPD.

  20. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy (United States)

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy


    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.

  1. [Positive surgical margin status after minimally invasive radical prostatectomy: a multicenter study]. (United States)

    Tafa, Ardit; Grasso, Angelica; Antonelli, Alessandro; Bove, Pierluigi; Celia, Antonio; Ceruti, Carlo; Crivellaro, Simone; Falsaperla, Mario; Minervini, Andrea; Parma, Paolo; Porreca, Angelo; Zaramella, Stefano; De Lorenzis, Elisa; Cozzi, Gabriele; Rocco, Bernardo


    UNLABELLED: The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50-150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients' selection can be a possible explanation.

  2. The future of the OSHA PSM standard. (United States)

    Kaelin, David E


    The significance of the proposed PSM changes could be to greatly expand coverage of processes in order to include many not currently covered by the PSM regulation. New chemicals will likely be added to Appendix A, and reactive chemicals (a definition will be needed) also may be covered. What exactly will be the definition of a reactive chemical is unclear at this time, although definitions used in New Jersey in the TCPA Act may guide OSHA. It is likely that atmospheric storage of flammable liquids will be included more specifically and the exemption of these tanks eliminated. In applying RAGAGEP, sites may be required to apply the most recent codes and standards to covered processes, perhaps at the time of PHA auditing: A narrowing of the PSM exemption for retail facilities could bring many of them under the PSM regulation at some level. Process safety management practices should be applied to all facilities that store and process hazardous materials that have fire, explosion, reactivity, and toxic properties. If changes are made to the PSM regulation, many new sites will be covered and will need to formally adopt PSM as defined in the OSHA regulation. The addition of reactive chemicals to the PSM regulation will greatly expand the number of processes covered by the regulation. Keeping up with the most current codes, standards, and legislative changes is a daunting task that may require the support of specialists. The results of the proposed legislation will be an increase in the level of process safety excellence throughout the chemical industries.

  3. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    Energy Technology Data Exchange (ETDEWEB)

    La Roca, Ricardo L.R. Felts de, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Divisao de Urologia. Dept. de Cirurgia Pelvica; Cunha, Isabela Werneck da; Bezerra, Stephania Martins, E-mail:, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia


    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA {>=} 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  4. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan. (United States)

    Tatsugami, Katsunori; Yoshioka, Kunihiko; Shiroki, Ryoichi; Eto, Masatoshi; Yoshino, Yasushi; Tozawa, Keiichi; Fukasawa, Satoshi; Fujisawa, Masato; Takenaka, Atsushi; Nasu, Yasutomo; Kashiwagi, Akira; Gotoh, Momokazu; Terachi, Toshiro


    To analyze nerve sparing performance at an early stage of robot-assisted radical prostatectomy, and the correlation between the surgeons' experience and the risk of a positive surgical margin in patients treated with robot-assisted radical prostatectomy. Patients' records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot-assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins. A total of 152 surgeons were studied, and the median number of robot-assisted radical prostatectomy cases for all surgeons was 21 (range 1-511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot-assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate-specific antigen level (P 100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins. The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot-assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  5. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer. (United States)

    Dent, O F; Chapuis, P H; Haboubi, N; Bokey, L


    Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. The study design and methodology of studies on this topic were critically examined. Features identified as affecting the efficacy of these studies were: representativeness of patients, definition of the margin assessed by MRI and by histology, lack of blinding of surgeons and pathologists to MRI results, effect of neoadjuvant treatment, and number of patients studied. Because of methodological inadequacies in studies completed to date, there is insufficient evidence of the ability of a positive MRI result to predict an involved CRM. Although MRI may be able to identify a tumour that has extended to the mesorectal fascia and/or intersphincteric plane, logically, it cannot indicate where the surgical boundary of the resection will ultimately lie, and therefore cannot validly predict an involved CRM and should not be relied upon for this purpose. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  6. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center. (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J


    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  7. Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Athanase Billis


    Full Text Available PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal and in more than 1 quadrant or section (Group 2, diffuse; and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal and in more than 2 quadrants or sections (Group 2, diffuse. The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8% patients, 39/129 (30.2% in Group 1 and 90/129 (69.8% in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2 had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4% patients, 81/160 (50.6% patients in Group 1 and 79/160 (49.4% patients in Group 2. Patients with diffuse positive surgical margins (Group 2 had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant

  8. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy. (United States)

    Sfoungaristos, S; Kavouras, A; Kanatas, P; Polimeros, N; Perimenis, P


    To compare the predictive ability of primary and secondary Gleason pattern for positive surgical margins in patients with clinically localized prostate cancer and a preoperative Gleason score ≤ 6. A retrospective analysis of the medical records of patients undergone a radical prostatectomy between January 2005 and October 2010 was conducted. Patients' age, prostate volume, preoperative PSA, biopsy Gleason score, the 1st and 2nd Gleason pattern were entered a univariate and multivariate analysis. The 1st and 2nd pattern were tested for their ability to predict positive surgical margins using receiver operating characteristic curves. Positive surgical margins were noticed in 56 cases (38.1%) out of 147 studied patients. The 2nd pattern was significantly greater in those with positive surgical margins while the 1st pattern was not significantly different between the 2 groups of patients. ROC analysis revealed that area under the curve was 0.53 (p=0.538) for the 1st pattern and 0.60 (p=0.048) for the 2nd pattern. Concerning the cases with PSA <10 ng/ml, it was also found that only the 2nd pattern had a predictive ability (p=0.050). When multiple logistic regression analysis was conducted it was found that the 2nd pattern was the only independent predictor. The second Gleason pattern was found to be of higher value than the 1st one for the prediction of positive surgical margins in patients with preoperative Gleason score ≤ 6 and this should be considered especially when a neurovascular bundle sparing radical prostatectomy is planned, in order not to harm the oncological outcome.

  9. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy:experience of a single surgeon with 500cases in Taiwan, China

    Institute of Scientific and Technical Information of China (English)

    YenChuan Ou; ChunKuang Yang; KuanghSi Chang; John Wang; SiuWan Hung; MinChe Tung; Ashutosh K Tewari; Vipul R Patel


    To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic‑assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high‑risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high‑risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3‑year, 5‑year, and 7‑year BCR‑free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high‑risk group is not suggested due to increasing PSM.

  10. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. (United States)

    Taylor, F G M; Quirke, P; Heald, R J; Moran, B; Blomqvist, L; Swift, I; St Rose, S; Sebag-Montefiore, D J; Tekkis, P; Brown, G


    A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM). Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence. Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3·90 (95 per cent confidence interval 1·99 to 7·63; P < 0·001) for a margin of 1 mm or less, 0·81 (0·36 to 1·85; P = 0·620) for a margin of more than 1 mm up to 2 mm, and 0·33 (0·10 to 1·08; P = 0·067) for a margin greater than 2 mm up to 5 mm. Multivariable analysis of the effect of MRI distance to the mesorectal fascia and preoperative treatment on local recurrence showed that a margin of 1 mm or less remained significant regardless of preoperative treatment (HR 3·72, 1·43 to 9·71; P = 0·007). For preoperative staging of rectal cancer, the best cut-off distance for predicting CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  11. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins. (United States)

    Tan, Puay Hoon; Cheng, Liang; Srigley, John R; Griffiths, David; Humphrey, Peter A; van der Kwast, Theodore H; Montironi, Rodolfo; Wheeler, Thomas M; Delahunt, Brett; Egevad, Lars; Epstein, Jonathan I


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

  12. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  13. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  14. Recognition and discrimination of tissue-marking dye color by surgical pathologists: recommendations to avoid errors in margin assessment. (United States)

    Williams, Andrew S; Hache, Kelly Dakin


    A variety of tissue-marking dye (TMD) colors can be used to indicate surgical pathology specimen margins; however, the ability of pathologists to differentiate between specific microscopic margin colors has not been assessed systematically. This study aimed to evaluate pathologists' accuracy in identifying TMD color and determine the least ambiguous combinations of colors for use in surgical pathology. Seven colors of TMD were obtained from three manufacturers and applied to excess formalin-fixed uterine tissue. Study blocks contained multiple tissue pieces, each marked with a different color from the same manufacturer. Slides were assessed by eight participants for color and color distinctness of each piece of tissue. Black, green, red, and blue TMDs were accurately identified by most participants, but participants had difficulty identifying violet, orange, and yellow TMDs. Black, green, and blue TMDs were most commonly rated as "confidently discernable." Pathologists have difficulty identifying and distinguishing certain colors of TMDs. The combined use of certain colors of TMDs (yellow/orange/red, blue/violet, and red/violet) within the same specimen should be avoided to decrease the risk of inaccurately reporting specimen margins. Copyright© by the American Society for Clinical Pathology.

  15. Postoperative irradiation of laryngeal carcinoma--the prognostic value of tumour-free surgical margins. (United States)

    Naudé, J; Dobrowsky, W


    Between 1972 and 1987, two hundred and five carcinoma patients were treated with surgery and postoperative radiotherapy. The histological confirmation of tumour-free margins was only predictive of significant differences in locoregional control in locally advanced disease. In addition, macroscopically assessed margins in advanced cases were predictive of survival probability. We suggest that the adjuvant radiotherapy was able to reduce the incidence of locoregional recurrence in the early stage microscopic positive group, hence the lack of a significant difference in the control rates. The effect on survival is therefore indirect. The advanced cases showed significantly reduced locoregional control rates and disease-specific survival times after macroscopic assessment of positive margins, possibly a sign of tumour extension beyond the margins of the radiation field. We compare our results with published reports of cases not receiving adjuvant therapy.

  16. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de


    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  17. Transferring PSM craft skills in a 2 hour session

    NARCIS (Netherlands)

    Zijderveld, E.J.A. van; Morill, N.; Shaw, D.; Belton, V.; Harvey, P.; Rouwette, E.


    Many of those involved in the Problem Structuring Methods (PSM) community have commented on the struggle that novices face in building the craft skills associated with conducting a PSM intervention. As part of this year's Operational Research Society Conference, we have three 2-hour practical

  18. {sup 18}F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Peungjesada, Silanath [University New Mexico, Department of Radiology, Albuquerque, NM (United States); Aloia, Thomas A. [University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Unit 444, Houston, TX (United States); Fox, Patricia [University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1411, Houston, TX (United States); Chasen, Beth [University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Unit 1483, Houston, TX (United States); Shin, Sooyoung; Loyer, Evelyne M. [University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States); Baiomy, Ali [Cairo University, National Cancer Center, Cairo (Egypt)


    To evaluate the patterns of {sup 18}F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUV{sub max} was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  19. The role of molecular strategies in the evaluation of surgical margins in oropharyngeal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Anastasios N. Kanatas


    Full Text Available The recurrence of a tumour at the resection margins in head and neck squamous cell carcinoma (HNSCC has profound implications on the morbidity and mortality of the patient. At present HNSCC does not undergo any form of molecular analysis to aid treatment strategy and prognosticate for those individuals at higher risk of recurrence. This article aims to review current research into molecular strategies for tumour evaluation, highlighting conflicting evidence and possible novel concepts for further exploration.

  20. The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis

    Directory of Open Access Journals (Sweden)

    Ozlem Ural


    Full Text Available Aims: To evaluate the utility of margin-reflex distance (MRD as an alternative to levator function (LF in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male, levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.

  1. Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients (United States)

    Fei, Baowei; Lu, Guolan; Wang, Xu; Zhang, Hongzheng; Little, James V.; Patel, Mihir R.; Griffith, Christopher C.; El-Diery, Mark W.; Chen, Amy Y.


    A label-free, hyperspectral imaging (HSI) approach has been proposed for tumor margin assessment. HSI data, i.e., hypercube (x,y,λ), consist of a series of high-resolution images of the same field of view that are acquired at different wavelengths. Every pixel on an HSI image has an optical spectrum. In this pilot clinical study, a pipeline of a machine-learning-based quantification method for HSI data was implemented and evaluated in patient specimens. Spectral features from HSI data were used for the classification of cancer and normal tissue. Surgical tissue specimens were collected from 16 human patients who underwent head and neck (H&N) cancer surgery. HSI, autofluorescence images, and fluorescence images with 2-deoxy-2-[(7-nitro-2,1,3-benzoxadiazol-4-yl)amino]-D-glucose (2-NBDG) and proflavine were acquired from each specimen. Digitized histologic slides were examined by an H&N pathologist. The HSI and classification method were able to distinguish between cancer and normal tissue from the oral cavity with an average accuracy of 90%±8%, sensitivity of 89%±9%, and specificity of 91%±6%. For tissue specimens from the thyroid, the method achieved an average accuracy of 94%±6%, sensitivity of 94%±6%, and specificity of 95%±6%. HSI outperformed autofluorescence imaging or fluorescence imaging with vital dye (2-NBDG or proflavine). This study demonstrated the feasibility of label-free, HSI for tumor margin assessment in surgical tissue specimens of H&N cancer patients. Further development of the HSI technology is warranted for its application in image-guided surgery.

  2. A Market Failure Perspective on Value Creation in PSM

    DEFF Research Database (Denmark)

    Berg, Christian Edelvold; Lowe, Gregory Ferrell; Lund, Anker Brink


    Public service media is present in most countries because public intervention of this kind compensates market-failure by providing merit goods that are not provided by commercial players to the public writ large. Nonetheless, PSM is often regarded as a negative for private media providers...... in electronic media. This chapter outlines the market failure thesis to consider the ways and degrees to which it is still valid for broadcasting (PSB), and important whether there are grounds for its application in broadband (PSM)....

  3. Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach. (United States)

    Rodriguez, Joseph F; Packiam, Vignesh T; Boysen, William R; Johnson, Scott C; Smith, Zachary L; Smith, Norm D; Shalhav, Arieh L; Steinberg, Gary D


    To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data. Using the National Cancer Database, we identified patients who underwent nephroureterectomy for localized upper tract urothelial carcinoma between 2010 and 2013. Demographic and clinicopathologic characteristics were compared among the three operative approaches. Multivariate regression analyses were used to determine the impact of approach on performance of lymphadenectomy (LND), positive surgical margins (PSM), and overall survival (OS). In total, there were 9401 cases identified for analysis, including 3199 ONU (34%), 2098 RNU (22%), and 4104 LNU (44%). From 2010 to 2013, utilization of RNU increased from 14% to 30%. On multivariate analysis, LND was more likely in RNU (odds ratio [OR] 1.52; p ONU. RNU was associated with decreased PSM compared with ONU (OR = 0.73; p = 0.04). After adjusting for other factors, OS was not significantly associated with surgical approach. RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

  4. Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy:a single-center 10-year report

    Institute of Scientific and Technical Information of China (English)

    LI Kin; LI Hong; YANG Yong; Ian Lap-hong; Pun Wai-hong; Ho Son-fat


    Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A

  5. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    Directory of Open Access Journals (Sweden)

    Kharidhi Laxman Vandana


    Full Text Available Background: To evaluate the gingival margin position (GMP before and after open flap debridement in different gingival thickness (GT. Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B, mesiobuccal (MB, and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin and Group 2 (thick. Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months, MB site (16 months. The gingival recession was obvious at Mi-B sites (16 months. In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically.

  6. Efektivitas Forum Komunikasi Pekerja Sosial Masyarakat terhadap Peningkatan Fungsi PSM di Kabupaten Bantul


    C. Elly Kumari Tjahya Putri


    Penelitian ini bertujuan untuk memperoleh gambaran tentang efektivitas FK-PSM (Forum Komunikasi Pekerja Sosial Masyarakat) di Kabupaten Bantul Propinsi DI. Yogyakarta sebagai wadah sarana komunikasi dan konsultasi antar PSM (Pekerja Sosial Masyarakat), maupun PSM dengan instansi terkait, serta melestarikan keputusan inovasi nilai-nilai usaha kesejahteraan sosial dan aplikasi metode pekerjaan sosial yang diadopsi oleh PSM. Melalui otoritas kewenangan FK-PSM diharapkan pelestarian inovasi terse...

  7. A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making

    NARCIS (Netherlands)

    Pleijhuis, Rick G.; Kwast, Annemiek B. G.; Jansen, Liesbeth; de Vries, J; Lanting, Rosanne; Bart, Joost; Wiggers, Theo; van Dam, Gooitzen M.; Siesling, Sabine


    BACKGROUND: Breast-conserving therapy, consisting of lumpectomy and adjuvant radiotherapy, is considered standard treatment for early-stage breast cancer. One of the most important risk factors of local recurrence is the presence of positive surgical margins following lumpectomy. We aimed to develop

  8. Development and Validation of the Poker Skills Measure (PSM). (United States)

    Leonard, Carrie A; Staples, Jaime; Williams, Robert J


    Existing research has demonstrated that poker is a game predominated by skill. Little is known about the specific characteristics of good poker players however, likely due in part to the lack of a readily available measure of poker skill. In the absence of an available and easily administered poker skill measure, laboratory studies of poker player attributes have used questionable methodologies to assess skill including peer- and self-report. The aim of the current research was to create a valid, reliable, and easily administered measure of poker playing skill. A sample of 100 University of Lethbridge undergraduate students and Lethbridge community members completed the newly created Poker Skills Measure (PSM) and an objective measure of poker playing performance (playing virtual poker). External validity of the measure was demonstrated via significant associations—expected and detected—between the PSM and the objective playing measure. Specifically, significant positive associations were found between PSM scores and hands won, pre- and post flop aggression, and a significant negative relationship was detected between PSM scores and number of hands played. Within the current sample, acceptable internal consistency (Cronbach's α = .82) and very good test re-test reliability (r = .78) was achieved with the 35 item PSM. Future directions are discussed.

  9. Risk of Local Failure in Breast Cancer Patients With Lobular Carcinoma In Situ at the Final Surgical Margins: Is Re-excision Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Sadek, Betro T.; Shenouda, Mina N.; Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Keruakous, Amany R. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)


    Purpose: To compare the outcome of patients with invasive breast cancer both with and without lobular carcinoma in situ (LCIS)-positive/close surgical margins after breast-conserving treatment. Methods and Materials: We retrospectively studied 2358 patients with T1-T2 invasive breast cancer treated with lumpectomy and radiation therapy from January 1980 to December 2009. Median age was 57 years (range, 24-91 years). There were 82 patients (3.5%) with positive/close LCIS margins (<0.2 cm) and 2232 patients (95.7%) with negative margins. A total of 1789 patients (76%) had negative lymph nodes. Patients who received neoadjuvant chemotherapy were excluded. A total of 1783 patients (76%) received adjuvant systemic therapy. Multivariable analysis (MVA) was performed using Cox's proportional hazards model. Results: The 5-year cumulative incidence of locoregional recurrence (LRR) was 3.2% (95% confidence interval [CI] 2.5%-4.1%) for the 2232 patients with LCIS-negative surgical margins (median follow-up 104 months) and 2.8% (95% CI 0.7%-10.8%) for the 82 patients with LCIS-positive/close surgical margins (median follow-up 90 months). This was not statistically significant (P=.5). On MVA, LCIS-positive margins after the final surgery were not associated with increased risk of LRR (hazard ratio [HR] 3.4, 95% CI 0.5-24.5, P=.2). Statistically significant prognostic variables on Cox's MVA for risk of LRR included systemic therapy (HR 0.5, 95% CI 0.33-0.75, P=.001), number of positive lymph nodes (HR 1.11, 95% CI 1.05-1.18, P=.001), menopausal status (HR 0.96, 95% CI 0.95-0.98, P=.001), and histopathologic grade (grade 3 vs grade 1/2) (HR 2.6, 95% CI 1.4-4.7, P=.003). Conclusion: Our results suggest that the presence of LCIS at the surgical margin after lumpectomy does not increase the risk of LRR or the final outcome. These findings suggest that re-excision or mastectomy in patients with LCIS-positive/close final surgical margins is unnecessary.

  10. TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer (United States)

    Suganya S., Annie A.; Kochurani, K. J.; Nair, Madhumathy G.; Louis, Jiss Maria; Sankaran, Santhosh; Rajagopal, R.; Kumar, K. Santhosh; Abraham, Parvin; P. G., Balagopal; Sebastian, Paul; Somananthan, Thara; Maliekal, Tessy Thomas


    Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery. PMID:27827443

  11. Clinical implications of determination of safe surgical margins by using a combination of CT and 18FDG-positron emission tomography in soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Yoshioka Takako


    Full Text Available Abstract Background To determine safe surgical margins for soft tissue sarcoma, it is essential to perform a general evaluation of the extent of tumor, responses to auxiliary therapy, and other factors preoperatively using multiple types of diagnostic imaging. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT is a tool for diagnostic imaging that has recently spread rapidly in clinical use. At present, the roles played by FDG-PET/CT in determination of margins for surgical resection of sarcoma are unclear. The present study was undertaken to explore the roles of FDG-PET/CT in determination of surgical margins for soft tissue sarcoma and to examine whether PET can serve as a standard means for setting the margins of surgical resection during reduced surgery. Methods The study involved 7 patients with sarcoma who underwent surgery in our department and in whom evaluation with FDG-PET/CT was possible. Sarcoma was histologically rated as MFH in 6 cases and leiomyosarcoma in 1 case. In all cases, sarcoma was superficial (T1a or T2a. The tumor border was defined by contrast-enhanced MRI, and SUVs were measured at intervals of 1 cm over a 5-cm long area from the tumor border. Mapping of viable tumor cells was carried out on whole-mount sections of resected tissue, and SUVs were compared with histopathological findings. Results Preoperative maximum SUVs (SUV-max of the tumor averaged 11.7 (range: 3.8-22.1. Mean SUV-max was 2.2 (range: 0.3-3.8 at 1 cm from the tumor border, 1.1 (0.85-1.47 at 2 cm, 0.83 (0.65-1.15 at 3 cm, 0.7 (0.42-0.95 at 4 cm, and 0.64 (0.45-0.82 at 5 cm. When resected tissue was mapped, tumor cells were absent in the areas where SUV-max was below 1.0. Conclusions Our findings suggest that a safe surgical margin free of viable tumor cells can be ensured if the SUV cut-off level is set at 1.0. FDG-PET/CT is promising as a diagnostic imaging technique for setting of safe minimal margins for surgical

  12. Prostate specific membrane antigen (PSM) is expressed in various human tissues: implication for the use of PSM reverse transcription polymerase chain reaction to detect hematogenous prostate cancer spread. (United States)

    Renneberg, H; Friedetzky, A; Konrad, L; Kurek, R; Weingärtner, K; Wennemuth, G; Tunn, U W; Aumüller, G


    Detection of prostate-specific membrane antigen (PSM)-mRNA expression in blood samples using reverse transcription polymerase chain reaction (RT-PCR) is discussed as a new diagnostic marker of circulating micrometastases in prostate cancer patients. We applied the RT-PCR technique to different human tissues and obtained positive signals for PSM transcripts in human genital and multiple extra-genital tissue sites. The cDNAs were prepared from different human tissues and prostatic cell lines. RT-PCR and nested RT-PCR for PSM was performed with primers derived from the published PSM cDNA. The RT-PCR fragments obtained were cloned and showed 100% sequence homology to PSM. Southern blot hybridization with labeled probes was used to confirm the specificity of the amplicons. In addition to the known PSM expression in the human brain, PSM-mRNA was detected in cDNA isolated from human testis, epididymis and seminal vesicles and in the PC-3 prostatic cancer cell line. Furthermore, we found PSM-mRNA in heart, liver, lung, kidney, spleen, and thyroid gland. The results indicate that PSM expression is not restricted to the prostate gland, but represents a more general component of genital and extra-genital human tissues. This must be considered when RT-PCR and nested RT-PCR screening for PSM expression is performed as a diagnostic measure in blood from prostate cancer patients.

  13. Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D’Amico low risk patients?

    Directory of Open Access Journals (Sweden)

    Ozgur Haki Yuksel


    Full Text Available Objectives: In this study, our aim was to estimate the value of perineural invasion (PNI in prostate needle biopsy (PNB specimens in the prediction of surgical margin positivity (SMP and its prognostic significance (upgrade Gleason Score in patients who had undergone radical retropubic prostatectomy (RRP with low risk prostate cancer according to D’Amico risk assessment. Materials and Methods: We retrospectively analyzed the data of 65 patients who were diagnosed as clinical stage T1c prostate cancer (PC and underwent RRP between January 2010 and June 2013. Pathological specimens of PNB and RRP were separately examined for the parameters of PNI, vascular invasion (VI, Gleason Score (GS and SMP. Results: The patients’ mean age was 63.65 ± 4.93 (range 47- 75 years. PNI in PNB specimens were identified in 12 of 65 patients and 11 of 12 patients showed SMP on RRP specimens. While 53 of 65 patients had not PNI on PNB, only 11 of them demonstrated SMP on RRP specimens. SMP was 30.64-fold more frequently encountered in PNB specimens obtained from PNI-positive patients relative to PNI-negative patients. In our study, PNI detected in PNB specimens was statistically significantly associated with SMP on RRP specimens (P = 0.0001. Conclusion: It is well known that higher PSA values and GS were independent predictors of SMP in clinically localized prostate cancer (CLPC. We think that PNI in PNB specimens may be a useful prognostic factor for predicting SMP in cases with CLPC.

  14. PSM design for inverse lithography with partially coherent illumination. (United States)

    Ma, Xu; Arce, Gonzalo R


    Phase-shifting masks (PSM) are resolution enhancement techniques (RET) used extensively in the semiconductor industry to improve the resolution and pattern fidelity of optical lithography. Recently, a set of gradient-based PSM optimization methods have been developed to solve for the inverse lithography problem under coherent illumination. Most practical lithography systems, however, use partially coherent illumination due to non-zero width and off-axis light sources, which introduce partial coherence factors that must be accounted for in the optimization of PSMs. This paper thus focuses on developing a framework for gradient-based PSM optimization methods which account for the inherent nonlinearities of partially coherent illumination. In particular, the singular value decomposition (SVD) is used to expand the partially coherent imaging equation by eigenfunctions into a sum of coherent systems (SOCS). The first order coherent approximation corresponding to the largest eigenvalue is used in the PSM optimization. In order to influence the solution patterns to have more desirable manufacturability properties and higher fidelity, a post-processing of the mask pattern based on the 2D discrete cosine transformation (DCT) is introduced. Furthermore, a photoresist tone reversing technique is exploited in the design of PSMs to project extremely sparse patterns.

  15. A Study of United States Army Product Support Manager (PSM) Training (United States)


    relevant policy and data associated with Product Support Manager (PSM) responsibilities, measure the current status of PSM training and selection, and...conduct an analysis of the effectiveness of that PSM training in relation to weapon system acquisition support. PRODUCT SUPPORT MANAGER (, a written survey to measure the effectiveness was sent to current PMs, Deputy PMs (DPMs), and PSMs within the Redstone Arsenal community. The

  16. Inhibition of exotoxin production by mobile genetic element SCCmec-encoded psm-mec RNA is conserved in staphylococcal species. (United States)

    Ikuo, Mariko; Nagano, Gentaro; Saito, Yuki; Mao, Han; Sekimizu, Kazuhisa; Kaito, Chikara


    Staphylococcal species acquire antibiotic resistance by incorporating the mobile-genetic element SCCmec. We previously found that SCCmec-encoded psm-mec RNA suppresses exotoxin production as a regulatory RNA, and the psm-mec translation product increases biofilm formation in Staphylococcus aureus. Here, we examined whether the regulatory role of psm-mec on host bacterial virulence properties is conserved among other staphylococcal species, S. epidermidis and S. haemolyticus, both of which are important causes of nosocomial infections. In S. epidermidis, introduction of psm-mec decreased the production of cytolytic toxins called phenol-soluble modulins (PSMs) and increased biofilm formation. Introduction of psm-mec with a stop-codon mutation that did not express PSM-mec protein but did express psm-mec RNA also decreased PSM production, but did not increase biofilm formation. Thus, the psm-mec RNA inhibits PSM production, whereas the PSM-mec protein increases biofilm formation in S. epidermidis. In S. haemolyticus, introduction of psm-mec decreased PSM production, but did not affect biofilm formation. The mutated psm-mec with a stop-codon also caused the same effect. Thus, the psm-mec RNA also inhibits PSM production in S. haemolyticus. These findings suggest that the inhibitory role of psm-mec RNA on exotoxin production is conserved among staphylococcal species, although the stimulating effect of the psm-mec gene on biofilm formation is not conserved.

  17. Detection of circulating prostate tumor cells: alternative spliced variant of PSM induced false-positive result. (United States)

    Hisatomi, Hisashi; Nagao, Kumi; Kawakita, Mutsuji; Matsuda, Tadashi; Hirata, Hiroyuki; Yamamoto, Shigeki; Nakamoto, Takaaki; Harasawa, Hiroshi; Kaneko, Noboru; Hikiji, Kazumasa; Tsukada, Yutaka


    RT-nested PCR has been introduced as a highly specific and sensitive assay method to detect the prostate-specific membrane antigen (PSM) mRNA in peripheral blood. However, appreciable percentages of false-positive cases have been reported. Additionally, primer sets reported previously could not discriminate between PSM and PSM', an alternatively spliced variant, mRNA. These isoforms can be produced from a single gene. Switches in alternative splicing patterns are often controlled with strict cell-type or developmental-stage specificity. Therefore, it is most important to discriminate between PSM mRNA and PSM' mRNA. Using our highly specific primer sets, PSM mRNA was detected in 3 of 24 peripheral blood samples of normal male volunteers (12.5%) and was not detected in peripheral blood of 11 normal female volunteers. PSM' mRNA was detected in 5 of 24 peripheral blood samples of normal male volunteers (20.8%) and in 4 of 11 of normal female volunteers (36.4%). PSM' mRNA induced false-positive results, it is important for genetic diagnosis of prostate cancer to discriminate between PSM and PSM' using our primer sets with high specificity. The advances in the uniquely designed primer sets may allow researchers to detect a real PSM mRNA without PSM' mRNA.

  18. Dual in vivo Photoacoustic and Fluorescence Imaging of HER2 Expression in Breast Tumors for Diagnosis, Margin Assessment, and Surgical Guidance

    Directory of Open Access Journals (Sweden)

    Azusa Maeda


    Full Text Available Biomarker-specific imaging probes offer ways to improve molecular diagnosis, intraoperative margin assessment, and tumor resection. Fluorescence and photoacoustic imaging probes are of particular interest for clinical applications because the combination enables deeper tissue penetration for tumor detection while maintaining imaging sensitivity compared to a single optical imaging modality. Here we describe the development of a human epidermal growth factor receptor 2 (HER2-targeting imaging probe to visualize differential levels of HER2 expression in a breast cancer model. Specifically, we labeled trastuzumab with Black Hole Quencher 3 (BHQ3 and fluorescein for photoacoustic and fluorescence imaging of HER2 overexpression, respectively. The dual-labeled trastuzumab was tested for its ability to detect HER2 overexpression in vitro and in vivo. We demonstrated an over twofold increase in the signal intensity for HER2-overexpressing tumors in vivo, compared to low–HER2-expressing tumors, using photoacoustic imaging. Furthermore, we demonstrated the feasibility of detecting tumors and positive surgical margins by fluorescence imaging. These results suggest that multimodal HER2-specific imaging of breast cancer using the BHQ3-fluorescein trastuzumab enables molecular-level detection and surgical margin assessment of breast tumors in vivo. This technique may have future clinical impact for primary lesion detection, as well as intraoperative molecular-level surgical guidance in breast cancer.

  19. Rheological Properties Study of PSM/PP Composite%PSM/PP复合材料的流变性能研究

    Institute of Scientific and Technical Information of China (English)

    彭少贤; 李龙; 赵西坡; 敖卫; 黄亚琼


    The rheological behavior of PSM/PP composite were studied by die rheometer. The influences of extrusion moulding temperature, shear rate, mass fraction of LPP and PP chain branching on the rheological behavior of PSM were investigated. The results showed that the rheological curves obeyed pseudo-plastic law during 140 ~ 170℃, 0 ~ 103s-1, and apparent viscosity descend along with the increase of temperature and shear rate and the declining rate was less. The curves transformed to Newton section when the temperature was over 170℃. The apparent viscosity of PSM/SCBPP blend was lower than that of PSM/LPP, and the apparent viscosity of PSM/LCBPP blend was higher than that of PSM/LPP. Finally, shear rate sensitivity of PSM was lower than that of PP.%应用毛细管流变仪研究了可塑性淀粉生物基材料(PSM)/聚丙烯(PP)体系的流变学性质.讨论了挤出成型温度、剪切速率、线性聚丙烯(LPP)含量和PP支链结构对PSM流动性能的影响.结果表明:140~170℃,0~103 s-1下流动曲线具假塑性流体特点;表观黏度随温度、剪切速率增加而降低,黏度随剪切速率下降逐渐减少;170℃后曲线有向牛顿型流体变化的趋势;PSM/短支链PP (SCBPP)比PSM/LPP的表观黏度低,PSM/长支链PP( LCB-PP)比PSM/LPP的表观黏度高;PSM对剪切速率的敏感性低于PP.

  20. Expression profiles of MGMT, p16, and APC genes in tumor and matching surgical margin from patients with oral squamous cell carcinoma. (United States)

    Strzelczyk, Joanna Katarzyna; Gołąbek, Karolina; Krakowczyk, Łukasz; Owczarek, Aleksander J


    The aim of the study was to assess the expression of MGMT, p16, and APC genes in tumors and matching surgical margin samples from 56 patients with primary OSCC. We also analyzed the association of the clinical variables with the expression of the studied genes. After RNA isolation and cDNA synthesis gene expression levels were assessed by quantitative reverse transcription (qRT)-PCR. Two-sided parametrical Student's t-test for independent groups with equal/unequal variances showed no statistically significant differences in genes' expression in tumor compared to margin samples. No association was found between the genes' expression and clinical parameters, except for MGMT, whose low expression was probably associated with smoking (0.87 vs 1.34, p=0.065). 'Field cancerization' is an area with genetically or epigenetically altered cells and at the same time a risk factor for cancer. Disturbances in gene expression could also be the source of damages leading to cancerization. In conclusion, it is important to mention that the field remaining after a surgery may pose an increased risk of cancer development. It may be suggested that the diagnosis and treatment of cancers should not be concentrated only on the tumor itself, but also on the cancer field effect. Therefore, further molecular analysis on surgical margins and additional research regarding their assessment are required.

  1. Performance Analysis of the IEEE 802.11s PSM

    Directory of Open Access Journals (Sweden)

    Mirza Nazrul Alam


    Full Text Available With the introduction of IEEE 802.11 power save mode (PSM, a lot of work has been done to enhance the energy saving ability of the wireless nodes. The ultimate goal of the research is to make the networking equipment carbon neutral and prolong the lifetime of the energy limited device for various applications; in some cases it is a trade-off between energy efficiency and delay. However, few studies have been made until now in the area of IEEE 802.11s based link specific power mode. The essence of this method is the ability of a node to maintain different power modes with its different peer nodes at the same time. A new peer service period (PSP mechanism is also proposed in IEEE 802.11s amendment for transmitting to a receiver operating in PSM. In this paper the performance of the link specific power mode is studied for a single- and a multilink network in terms of energy, delay throughput, and sleep duration. It is found that at small load the energy saving could be as high as eighty percent when compared with the active mode operation. A stochastic model, based on discrete time discrete state Markov chain, is developed for one peer link operation to study the system behavior closely during PSM operation.

  2. PSM-Mec-A Virulence Determinant that Connects Transcriptional Regulation, Virulence, and Antibiotic Resistance in Staphylococci. (United States)

    Qin, Li; McCausland, Joshua W; Cheung, Gordon Y C; Otto, Michael


    PSM-mec is a secreted virulence factor that belongs to the phenol-soluble modulin (PSM) family of amphipathic, alpha-helical peptide toxins produced by Staphylococcus species. All known PSMs are core genome-encoded with the exception of PSM-mec, whose gene is found in specific sub-types of SCCmec methicillin resistance mobile genetic elements present in methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci. In addition to the cytolytic translational product, PSM-mec, the psm-mec locus encodes a regulatory RNA. In S. aureus, the psm-mec locus influences cytolytic capacity, methicillin resistance, biofilm formation, cell spreading, and the expression of other virulence factors, such as other PSMs, which results in a significant impact on immune evasion and disease. However, these effects are highly strain-dependent, which is possibly due to differences in PSM-mec peptide vs. psm-mec RNA-controlled effects. Here, we summarize the functional properties of PSM-mec and the psm-mec RNA molecule and their roles in staphylococcal pathogenesis and physiology.

  3. Exploiting synteny in Cucumis for mapping of Psm: a unique locus controlling paternal mitochondrial sorting. (United States)

    Al-Faifi, Sulieman; Meyer, Jenelle D F; Garcia-Mas, Jordi; Monforte, Antonio J; Havey, Michael J


    The three genomes of cucumber show different modes of transmission, nuclear DNA bi-parentally, plastid DNA maternally, and mitochondrial DNA paternally. The mosaic (MSC) phenotype of cucumber is associated with mitochondrial DNA rearrangements and is a valuable tool for studying mitochondrial transmission. A nuclear locus (Psm) has been identified in cucumber that controls sorting of paternally transmitted mitochondrial DNA. Comparative sequencing and mapping of cucumber and melon revealed extensive synteny on the recombinational and sequence levels near Psm and placed this locus on linkage group R of cucumber and G10 of melon. However, the cucumber genomic region near Psm was surprisingly monomorphic with an average of one SNP every 25 kb, requiring that a family from a more diverse cross is produced for fine mapping and eventual cloning of Psm. The cucumber ortholog of Arabidopsis mismatch repair (MSH1) was cloned and it segregated independently of Psm, revealing that this candidate gene is not Psm.

  4. Quantitative comparison between PW-PSM and PW-TSM Doppler systems

    DEFF Research Database (Denmark)

    Wilhjelm, Jens E.


    A simulation-based quantitative comparison between pulsed-wave (PW) Doppler systems using the conventional phase-shift measurement (PSM) technique and the newer time-shift measurement (TSM) technique is presented. A PSM system applying an autocorrelator is compared with a TSM system. The performa...... the relative amount of incorrect detections as a function of velocity. Also, the variance (PW-PSM) and the cross-correlation coefficient (PW-TSM) are found...

  5. Attenuated phase-shift mask (PSM) blanks for flat panel display (United States)

    Kageyama, Kagehiro; Mochizuki, Satoru; Yamakawa, Hiroyuki; Uchida, Shigeru


    The fine pattern exposure techniques are required for Flat Panel display applications as smart phone, tablet PC recently. The attenuated phase shift masks (PSM) are being used for ArF and KrF photomask lithography technique for high end pattern Semiconductor applications. We developed CrOx based large size PSM blanks that has good uniformity on optical characteristics for FPD applications. We report the basic optical characteristics and uniformity, stability data of large sized CrOx PSM blanks.

  6. Exploring the Context Dependency of the PSM-Performance Relationship

    DEFF Research Database (Denmark)

    Lynggard, Mikkel; Pedersen, Mogens Jin; Andersen, Lotte Bøgh


    The public service motivation (PSM) of public employees matters to their performance at work. Yet research on how context factors moderate the PSM–performance relationship is sparse. This article shows how the PSM–performance relationship may depend on two context factors: (a) the extent of work...... autonomy that a public organization provides its employees and (b) the service users’ capacity to affect the organization’s service provision. We test a set of moderation hypotheses using school data (teacher survey data with administrative data on schools and student). Using within-student between-teachers...

  7. An Empirical Analysis of Odd Pricing Using PSM Data


    Okuse, Yoshiyuki


    It is evident in our daily lives that most consumer goods are not sold at the just price, but rather at the just-below price. To examine the effect of odd pricing, including just-below pricing, numerous empirical studies have been conducted. In spite of these efforts, a consistent conclusion has not been obtained so far.The goals of this research are: (1) to examine the existence of the effect of odd pricing on consumers' price acceptance using PSM analysis, and (2) to examine the mechanisms ...

  8. SCCmec-associated psm-mec mRNA promotes Staphylococcus epidermidis biofilm formation. (United States)

    Yang, Yongchang; Zhang, Xuemei; Huang, Wenfang; Yin, Yibing


    Biofilm formation is considered the major pathogenic mechanism of Staphylococcus epidermidis-associated nosocomial infections. Reports have shown that SCCmec-associated psm-mec regulated methicillin-resistant Staphylococcus aureus virulence and biofilm formation. However, the role of psm-mec in S. epidermidis remains unclear. To this purpose, we analysed 165 clinical isolates of S. epidermidis to study the distribution, mutation and expression of psm-mec and the relationship between this gene and biofilm formation. Next, we constructed three psm-mec deletion mutants, one psm-mec transgene expression strain (p221) and two psm-mec point mutant strains (pM, pAG) to explore its effects on S. epidermidis biofilm formation. Then, the amount of biofilm formation, extracellular DNA (eDNA) and Triton X-100-induced autolysis of the constructed strains was measured. Results of psm-mec deletion and transgene expression showed that the gene regulated S. epidermidis biofilm formation. Compared with the control strains, the ability to form biofilm, Triton X-100-induced autolysis and the amount of eDNA increased in the p221 strain and the two psm-mec mutants pM and pAG expressed psm-mec mRNA without its protein, whereas no differences were observed among the three constructed strains, illustrating that psm-mec mRNA promoted S. epidermidis biofilm formation through up-regulation of bacterial autolysis and the release of eDNA. Our results reveal that acquisition of psm-mec promotes S. epidermidis biofilm formation.

  9. Revisiting adoption of high transmission PSM: pros, cons and path forward (United States)

    Ma, Z. Mark; McDonald, Steve; Progler, Chris


    High transmission attenuated phase shift masks (Hi-T PSM) have been successfully applied in volume manufacturing for certain memory devices. Moreover, numerous studies have shown the potential benefits of Hi-T PSM for specific lithography applications. In this paper, the potential for extending Hi-T PSM to logic devices, is revisited with an emphasis on understanding layout, transmission, and manufacturing of Hi-T PSM versus traditional 6% embedded attenuated phase shift mask (EAPSM). Simulations on various layouts show Hi-T PSM has advantage over EAPSM in low duty cycle line patterns and high duty cycle space patterns. The overall process window can be enhanced when Hi- T PSM is combined with optimized optical proximity correction (OPC), sub-resolution assist features (SRAF), and source illumination. Therefore, Hi-T PSM may be a viable and lower cost alternative to other complex resolution enhancement technology (RET) approaches. Aerial image measurement system (AIMS) results on test masks, based on an inverse lithography technology (ILT) generated layout, confirm the simulation results. New advancement in high transmission blanks also make low topography Hi-T PSM a reality, which can minimize scattering effects in high NA lithography.

  10. PSM-Mec - A Virulence Determinant that Connects TranscriptionalRegulation, Virulence, and Antibiotic Resistance in Staphylococci


    Li Qin; Joshua McCausland; Gordon Cheung; Michael Otto


    PSM-mec is a secreted virulence factor that belongs to the phenol-soluble modulin (PSM) family of amphipathic, alpha-helical peptide toxins produced by Staphylococcus species. All known PSMs are core genome-encoded with the exception of PSM-mec, whose gene is found in specific sub-types of SCCmec methicillin resistance mobile genetic elements present in methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci. In addition to the cytolytic translational product, PSM-mec...

  11. Endocervical glandular involvement, positive endocervical surgical margin and multicentricity are more often associated with high-grade than low-grade squamous intraepithelial lesion. (United States)

    Kır, Gozde; Karabulut, Murat Hakan; Topal, Cumhur Selçuk; Yılmaz, Müberra Segmen


    The aim of this study was to compare the relative frequencies of endocervical glandular involvement (EGI), multicentricity, positive endocervical surgical margins (ESM) and positive vaginal surgical margins (VSM), and adenocarcinoma in situ of the cervix (AIS) between high-grade and low-grade squamous intraepithelial lesions (HSIL and LSIL, respectively). We identified 238 patients with squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) who were treated by loop electrocautery excision (LEEP) or conventional cold-knife conization (CKC). A total of 223 (72 [32.3%] LSIL/CIN I; 85 [38.1%] HSIL/CIN II; 66 [29.6%] HSIL/CIN III; and 151 [67.7%], HSIL/CIN II + III) LEEP/CKC slides were histologically reviewed. The frequencies of EGI, positive ESM, and multicentricity were significantly higher in the HSIL/CIN II + III group than in the LSIL/CIN I group (P = 0.001, 0.001, and 0.025, respectively). Eighteen of the 72 (25%) LSIL/CIN I patients, 44 of the 85 (51.8%) HSIL/CIN II patients, and 60 of the 66 (90.9%) HSIL/CIN III patients (P = 0.001) showed EGI. In four of the 72 (5.6%) LSIL/CIN I patients, 18 of the 85 (21.2%) HSIL/CIN II patients, and 42 of the 66 (63.6%) HSIL/CIN III patients (P = 0.001), ESM was positive. Two of the 72 (2.8%) LSIL/CIN I patients, seven of the 85 (8.2%) HSIL/CIN II patients, and 11 of the 66 (16.7%) HSIL/CIN III patients (P = 0.016) were multicentric. The current study showed that EGI, positive ESM and multicentricity were more often associated with HSIL/CIN II + III than with LSIL/CIN I. Moreover, the frequencies of EGI, multicentricity, and positive ESM increased with increasing severity of the cervical lesion. This result may influence the preference for the type of surgical procedure used for patients with cytological diagnosis of HSIL. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  12. SCCmec相关psm-mec在临床分离表皮葡萄球菌中的分布和特征分析%Distribution and Characteristics of SCCmec Associated-psm-mec in Staphylococcus Epidermidis of Clinical Isolates

    Institute of Scientific and Technical Information of China (English)

    杨永长; 陈亮; 肖代雯; 喻华; 刘华; 黄文芳


    Objective To investigate the distribution and characteristics of SCCmec-associated psm-mec in Staphylococ-cus epidermidis of clinical isolates,and to lay a foundation for further study on its function of psm-mec in Staphylococcus epidermi-dis. Methods 84 strains of Staphylococcus epidermidis were collected and identified by full automation microbiological identifica-tion system. Esp and mecA genes were amplified by PCR to differentiate methicillin-resistant Staphylococcus epidermidis ( MRSE) . Psm-mec and fudoh genes were used to determine psm-mec positive strains,and the distribution of psm-mec in MRSE i-solated from different sample type was analyzed. The regions from mecR1 to psm-mec and from psm-mec to xylR were amplified to explore the relationship between psm-mec and mecR1,xylR. Results PCR results of esp and mecA showed that there were 64 strains of MRSE with a rate of 76. 19%. 25 psm-mec positive strains mainly from blood and sputum were confirmed by the amplifi-cation results of psm-mec and fudoh genes, and the rate of psm-mec in MRSE was 39. 0%( 25/64 ) . And no psm-mec positive strains were found in methicillin-sensitive Staphylococcus epidermidis. In 25 strains of MRSE with psm-mec,all strains were posi-tive to mecR1/psm-mec,and only 16 strains positive to psm-mec/xylR. Conclusion SCCmec-associated psm-mec exists in MRSE of clinical isolates. Psm-mec connects with mecR1 in all strains,but connects with xylR only in 64% strains.%目的:分析SCCmec相关的psm-mec在临床分离表皮葡萄球菌中的分布和特征,为深入了解其在表皮葡萄球菌中的功能奠定基础。方法收集临床分离并经过全自动微生物鉴定系统准确鉴定的表皮葡萄球菌84株,PCR扩增esp和mecA基因区分耐甲氧西林表皮葡萄球菌( MRSE),PCR扩增psm-mec和fudoh基因确定携带psm-mec菌株,分析其在不同标本来源MRSE的分布,同时扩增mecR1/psm-mec与psm-mec/xylR基因间隔序列,探讨psm-mec与mecR1,xylR

  13. RT-PSM, a real-time program for peptide-spectrum matching with statistical significance. (United States)

    Wu, Fang-Xiang; Gagné, Pierre; Droit, Arnaud; Poirier, Guy G


    The analysis of complex biological peptide mixtures by tandem mass spectrometry (MS/MS) produces a huge body of collision-induced dissociation (CID) MS/MS spectra. Several methods have been developed for identifying peptide-spectrum matches (PSMs) by assigning MS/MS spectra to peptides in a database. However, most of these methods either do not give the statistical significance of PSMs (e.g., SEQUEST) or employ time-consuming computational methods to estimate the statistical significance (e.g., PeptideProphet). In this paper, we describe a new algorithm, RT-PSM, which can be used to identify PSMs and estimate their accuracy statistically in real time. RT-PSM first computes PSM scores between an MS/MS spectrum and a set of candidate peptides whose masses are within a preset tolerance of the MS/MS precursor ion mass. Then the computed PSM scores of all candidate peptides are employed to fit the expectation value distribution of the scores into a second-degree polynomial function in PSM score. The statistical significance of the best PSM is estimated by extrapolating the fitting polynomial function to the best PSM score. RT-PSM was tested on two pairs of MS/MS spectrum datasets and protein databases to investigate its performance. The MS/MS spectra were acquired using an ion trap mass spectrometer equipped with a nano-electrospray ionization source. The results show that RT-PSM has good sensitivity and specificity. Using a 55,577-entry protein database and running on a standard Pentium-4, 2.8-GHz CPU personal computer, RT-PSM can process peptide spectra on a sequential, one-by-one basis in 0.047 s on average, compared to more than 7 s per spectrum on average for Sequest and X!Tandem, in their current batch-mode processing implementations. RT-PSM is clearly shown to be fast enough for real-time PSM assignment of MS/MS spectra generated every 3 s or so by a 3D ion trap or by a QqTOF instrument.

  14. Hybridizing PSM and RSM Operator for Solving NP-Complete Problems: Application to Travelling Salesman Problem

    CERN Document Server

    Abdoun, Otman; Abouchabka, Jaafar


    In this paper, we present a new mutation operator, Hybrid Mutation (HPRM), for a genetic algorithm that generates high quality solutions to the Traveling Salesman Problem (TSP). The Hybrid Mutation operator constructs an offspring from a pair of parents by hybridizing two mutation operators, PSM and RSM. The efficiency of the HPRM is compared as against some existing mutation operators; namely, Reverse Sequence Mutation (RSM) and Partial Shuffle Mutation (PSM) for BERLIN52 as instance of TSPLIB. Experimental results show that the new mutation operator is better than the RSM and PSM.

  15. PSM, a mediator of PDGF-BB-, IGF-I-, and insulin-stimulated mitogenesis. (United States)

    Riedel, H; Yousaf, N; Zhao, Y; Dai, H; Deng, Y; Wang, J


    PSM/SH2-B has been described as a cellular partner of the FcepsilonRI receptor, insulin receptor (IR), insulin-like growth factor-I (IGF-I) receptor (IGF-IR), and nerve growth factor receptor (TrkA). A function has been proposed in neuronal differentiation and development but its role in other signaling pathways is still unclear. To further elucidate the physiologic role of PSM we have identified additional mitogenic receptor tyrosine kinases as putative PSM partners including platelet-derived growth factor (PDGF) receptor (PDGFR) beta, hepatocyte growth factor receptor (Met), and fibroblast growth factor receptor. We have mapped Y740 as a site of PDGFR beta that is involved in the association with PSM. We have further investigated the putative role of PSM in mitogenesis with three independent experimental strategies and found that all consistently suggested a role as a positive, stimulatory signaling adapter in normal NIH3T3 and baby hamster kidney fibroblasts. (1) PSM expression from cDNA using an ecdysone-regulated transient expression system stimulated PDGF-BB-, IGF-I-, and insulin- but not EGF-induced DNA synthesis in an ecdysone dose-responsive fashion; (2) Microinjection of the (dominant negative) PSM SH2 domain interfered with PDGF-BB- and insulin-induced DNA synthesis; and (3) A peptide mimetic of the PSM Pro-rich putative SH3 domain-binding region interfered with PDGF-BB-, IGF-I-, and insulin- but not with EGF-induced DNA synthesis in NIH3T3 fibroblasts. This experiment was based on cell-permeable fusion peptides with the Drosophila antennapedia homeodomain which effectively traverse the plasma membrane of cultured cells. These experimental strategies independently suggest that PSM functions as a positive, stimulatory, mitogenic signaling mediator in PDGF-BB, IGF-I, and insulin but not in EGF action. This function appears to involve the PSM SH2 domain as well as the Pro-rich putative SH3 domain binding region. Our findings support the model that PSM

  16. Prototyping 9-inch size PSM mask blanks for 450mm wafer process (2016) (United States)

    Harashima, Noriyuki; Iso, Hiroyuki; Chishima, Tatsuya


    6-inch size (known as 6025QZ) binary Cr mask is widely used in the semiconductor lithography for over 20years. Recently for the 450mm wafer process, high grade 9-inch size mask is expected. For this application, we have studied and developed prototyping 9-inch size PSM KrF and ArF mask blanks. This time we will explain these PSM mask blanks status.

  17. The psmα locus regulates production of Staphylococcus aureus alpha-toxin during infection. (United States)

    Berube, Bryan J; Sampedro, Georgia R; Otto, Michael; Bubeck Wardenburg, Juliane


    Staphylococcus aureus is a leading cause of human bacterial infection, causing a wide spectrum of disease ranging from skin and soft tissue infections to life-threatening pneumonia and sepsis. S. aureus toxins play an essential role in disease pathogenesis, contributing to both immunomodulation and host tissue injury. Prominent among these toxins are the membrane-active pore-forming cytolysin alpha-toxin (Hla) and the amphipathic α-helical phenol-soluble modulin (PSM) peptides. As deletion of either the hla or psm locus leads to a phenotypically similar virulence defect in skin and soft tissue infection, we sought to determine the relative contribution of each locus to disease pathogenesis. Here we show that production of Hla can be modulated by PSM expression. An S. aureus mutant lacking PSM expression exhibits a transcriptional delay in hla mRNA production and therefore fails to secrete normal levels of Hla at early phases of growth. This leads to attenuation of virulence in vitro and in murine skin and lung models of infection, correlating with reduced recovery of Hla from host tissues. Production of Hla and restoration of staphylococcal virulence can be achieved in the psm mutant by plasmid-driven overexpression of hla. Our study suggests the coordinated action of Hla and PSMs in host tissue during early pathogenesis, confirming a major role for Hla in epithelial injury during S. aureus infection. These findings highlight the possibility that therapeutics targeting PSM production may simultaneously prevent Hla-mediated tissue injury.

  18. Essential role of PSM/SH2-B variants in insulin receptor catalytic activation and the resulting cellular responses. (United States)

    Zhang, Manchao; Deng, Youping; Tandon, Ruchi; Bai, Cheng; Riedel, Heimo


    The positive regulatory role of PSM/SH2-B downstream of various mitogenic receptor tyrosine kinases or gene disruption experiments in mice support a role of PSM in the regulation of insulin action. Here, four alternative PSM splice variants and individual functional domains were compared for their role in the regulation of specific metabolic insulin responses. We found that individual PSM variants in 3T3-L1 adipocytes potentiated insulin-mediated glucose and amino acid transport, glycogenesis, lipogenesis, and key components in the metabolic insulin response including p70 S6 kinase, glycogen synthase, glycogen synthase kinase 3 (GSK3), Akt, Cbl, and IRS-1. Highest activity was consistently observed for PSM alpha, followed by beta, delta, and gamma with decreasing activity. In contrast, dominant-negative peptide mimetics of the PSM Pro-rich, pleckstrin homology (PH), or src homology 2 (SH2) domains inhibited any tested insulin response. Potentiation of the insulin response originated at the insulin receptor (IR) kinase level by PSM variant-specific regulation of the Km (ATP) whereas the Vmax remained unaffected. IR catalytic activation was inhibited by peptide mimetics of the PSM SH2 or dimerization domain (DD). Either peptide should disrupt the complex of a PSM dimer linked to IR via SH2 domains as proposed for PSM activation of tyrosine kinase JAK2. Either peptide abolished downstream insulin responses indistinguishable from PSM siRNA knockdown. Our results implicate an essential role of the PSM variants in the activation of the IR kinase and the resulting metabolic insulin response. PSM variants act as internal IR ligands that in addition to potentiating the insulin response stimulate IR catalytic activation even in the absence of insulin.

  19. Risk Factors Analysis for Positive Surgical Margins in Laparoscopic Radical Prostatectomy%腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    阎乙夫; 黄毅; 马潞林


    Objective:To analysis the risk factors for positive surgical margins in laparoscopic radical prostatectomy. Methods: We retrospectively analyzed the clinical and pathological data of 188 cases, who received laparoscopic radical prostatectomy from Jan. 2004 to Dec. 2010 in our hospital. The patients average 72 years old. All patients were dignosised by pathology before prostatectomy, and no metastasis was found before surgery. Univari-able analyse were used to estimate the relationship between the parameters and surgical margin status. Multivari-able logistic regression analyse were used to determine relative risk factors for positive surgical margins. Results; Except that two patients were converted to open surgery, laparoscopic radical prostatectomy was successfully applied in other 186 patients. The operating time was average 246 min, the blood loss during operation was average 309 ml. 76 cases (40. 5%) had positive surgical margin. Result from univariable analyse showed there were significance difference between positive and negtive surgical margins patients on biopsy Gleason score, number of positive biopsy cores, surgical Gleason score, and pathological stage. On multivariable logistic regression analyses, surgical Gleason score and pathological stage were independent factor of positive surgical margins. A surgical Gleason score more than 7 was associated with a 17. 1-fold higher chance of positive surgical margin than a surgical Gleason score not more than 6 (OR:17. 131, 95%CI:5. 237-56. 037,F<0. 001). A pathological stage of T3 was associated with a 9. 0-fold higher risk of positive surgical margin than a psthology stage of T2 (OR:8. 970, 95%CI: 4. 128-19. 493,P<0. 001). Conclusions; Surgical Gleason score and pathological stage were independent factors of positive surgical margins in laparoscopic radical prostatectomy. Patients with surgical Gleason score more than 7 and pathological stage of T3 had a higher rate of positive surgical margins.%目的:分析

  20. Inhibition of Exotoxin Production by Mobile Genetic Element SCCmec-Encoded psm-mec RNA Is Conserved in Staphylococcal Species


    Mariko Ikuo; Gentaro Nagano; Yuki Saito; Han Mao; Kazuhisa Sekimizu; Chikara Kaito


    Staphylococcal species acquire antibiotic resistance by incorporating the mobile-genetic element SCCmec. We previously found that SCCmec-encoded psm-mec RNA suppresses exotoxin production as a regulatory RNA, and the psm-mec translation product increases biofilm formation in Staphylococcus aureus. Here, we examined whether the regulatory role of psm-mec on host bacterial virulence properties is conserved among other staphylococcal species, S. epidermidis and S. haemolyticus, both of which are...

  1. The pyrrolidinoindoline alkaloid Psm2 inhibits platelet aggregation and thrombus formation by affecting PI3K/Akt signaling (United States)

    Su, Xing-li; Su, Wen; Wang, Ying; Wang, Yue-hu; Ming, Xin; Kong, Yi


    Aim: Psm2, one of the pyrrolidinoindoline alkaloids isolated from whole Selaginella moellendorffii plants, has shown a potent antiplatelet activity. In this study, we further evaluated the antiplatelet effects of Psm2, and elucidated the underlying mechanisms. Methods: Human platelet aggregation in vitro and rat platelet aggregation ex vivo were investigated. Agonist-induced platelet aggregation was measured using a light transmission aggregometer. The antithrombotic effects of Psm2 were evaluated in arteriovenous shunt thrombosis model in rats. To elucidate the mechanisms underlying the antiplatelet activity of Psm2, ELISAs, Western blotting and molecular docking were performed. The bleeding risk of Psm2 administration was assessed in a mouse tail cutting model, and the cytotoxicity of Psm2 was measured with MTT assay in EA.hy926 cells. Results: Psm2 dose-dependently inhibited human platelet aggregation induced by ADP, U4619, thrombin and collagen with IC50 values of 0.64, 0.37, 0.35 and 0.87 mg/mL, respectively. Psm2 (1, 3, 10 mg/kg) administered to rats significantly inhibited platelet aggregation ex vivo induced by ADP. Psm2 (1, 3, 10 mg/mL, iv) administered to rats with the A–V shunt dose-dependently decreased the thrombus formation. Psm2 inhibited platelet adhesion to fibrinogen and collagen with IC50 values of 84.5 and 96.5 mg/mL, respectively, but did not affect the binding of fibrinogen to GPIIb/IIIa. Furthermore, Psm2 inhibited AktSer473 phosphorylation, but did not affect MAPK signaling and Src kinase activation. Molecular docking showed that Psm2 bound to phosphatidylinositol 3-kinase β (PI3Kβ) with a binding free energy of −13.265 kcal/mol. In addition, Psm2 did not cause toxicity in EA.hy926 cells and produced only slight bleeding in a mouse tail cutting model. Conclusion: Psm2 inhibits platelet aggregation and thrombus formation by affecting PI3K/Akt signaling. Psm2 may be a lead compound or drug candidate that could be developed for the

  2. Mobile genetic element SCCmec-encoded psm-mec RNA suppresses translation of agrA and attenuates MRSA virulence. (United States)

    Kaito, Chikara; Saito, Yuki; Ikuo, Mariko; Omae, Yosuke; Mao, Han; Nagano, Gentaro; Fujiyuki, Tomoko; Numata, Shunsuke; Han, Xiao; Obata, Kazuaki; Hasegawa, Setsuo; Yamaguchi, Hiroki; Inokuchi, Koiti; Ito, Teruyo; Hiramatsu, Keiichi; Sekimizu, Kazuhisa


    Community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) is a socially problematic pathogen that infects healthy individuals, causing severe disease. CA-MRSA is more virulent than hospital associated-MRSA (HA-MRSA). The underlying mechanism for the high virulence of CA-MRSA is not known. The transcription product of the psm-mec gene, located in the mobile genetic element SCCmec of HA-MRSA, but not CA-MRSA, suppresses the expression of phenol-soluble modulin α (PSMα), a cytolytic toxin of S. aureus. Here we report that psm-mec RNA inhibits translation of the agrA gene encoding a positive transcription factor for the PSMα gene via specific binding to agrA mRNA. Furthermore, 25% of 325 clinical MRSA isolates had a mutation in the psm-mec promoter that attenuated transcription, and 9% of the strains had no psm-mec. In most of these psm-mec-mutated or psm-mec-deleted HA-MRSAs, PSMα expression was increased compared with strains carrying intact psm-mec, and some mutated strains produced high amounts of PSMα comparable with that of CA-MRSA. Deletion of psm-mec from HA-MRSA strains carrying intact psm-mec increased the expression of AgrA protein and PSMα, and virulence in mice. Thus, psm-mec RNA suppresses MRSA virulence via inhibition of agrA translation and the absence of psm-mec function in CA-MRSA causes its high virulence property.

  3. On the bright and dark side of public service motivation : the relationship between PSM and employee wellbeing

    NARCIS (Netherlands)

    van Loon, Nina Mari; Vandenabeele, Wouter; Leisink, Peter


    This paper reveals that the relationship between public service motivation (PSM) and employee wellbeing depends on the societal impact potential (SIP) through the job and organizational type. In people-changing organizations, PSM relates to higher burnout and lower job satisfaction when SIP is high:

  4. The Role of Explicit and Tacit Knowledge in Purchasing and Supply Management (PSM) Today and in Future

    DEFF Research Database (Denmark)

    Bals, Lydia; Kelly, Steve; Schulze, Heike

    While research has shed considerable light on the organizational-level maturity of PSM organizations, the individual competencies of PSM, especially in light of current developments in the workplace such as digitization, have received relatively less attention. Firstly, this paper identifies the ...

  5. Cholesterol effect on water permeability through DPPC and PSM lipid bilayers: a molecular dynamics study. (United States)

    Saito, Hiroaki; Shinoda, Wataru


    Water permeability of two different lipid bilayers of dipalmitoylphosphatidylcholine (DPPC) and palmitoylsphingomyelin (PSM) in the absence and presence of cholesterol (0-50 mol %) have been studied by molecular dynamics simulations to elucidate the molecular mechanism of the reduction in water leakage across the membranes by the addition of cholesterol. An enhanced free energy barrier was observed in these membranes with increased cholesterol concentration, and this was explained by the reduced cavity density around the cholesterol in the hydrophobic membrane core. There was an increase of trans conformers in the hydrophobic lipid chains adjacent to the cholesterol, which reduced the cavity density. The enhanced free energy barrier was found to be the main reason to reduce the water permeability with increased cholesterol concentration. At low cholesterol concentrations the PSM bilayer exhibited a higher free energy barrier than the DPPC bilayer for water permeation, while at greater than 30 mol % of cholesterol the difference became minor. This tendency for the PSM and DPPC bilayers to resemble each other at higher cholesterol concentrations was similar to commonly observed trends in several structural properties, such as order parameters, cross-sectional area per molecule, and cavity density profiles in the hydrophobic regions of bilayer membranes. These results demonstrate that DPPC and PSM bilayers with high cholesterol contents possess similar physical properties, which suggests that the solubility of cholesterol in these lipid bilayers has importance for an understanding of multicomponent lipid membranes with cholesterol.

  6. Spatiotemporal oscillations of Notch1, Dll1 and NICD are coordinated across the mouse PSM. (United States)

    Bone, Robert A; Bailey, Charlotte S L; Wiedermann, Guy; Ferjentsik, Zoltan; Appleton, Paul L; Murray, Philip J; Maroto, Miguel; Dale, J Kim


    During somitogenesis, epithelial somites form from the pre-somitic mesoderm (PSM) in a periodic manner. This periodicity is regulated by a molecular oscillator, known as the 'segmentation clock', that is characterised by an oscillatory pattern of gene expression that sweeps the PSM in a caudal-rostral direction. Key components of the segmentation clock are intracellular components of the Notch, Wnt and FGF pathways, and it is widely accepted that intracellular negative-feedback loops regulate oscillatory gene expression. However, an open question in the field is how intracellular oscillations are coordinated, in the form of spatiotemporal waves of expression, across the PSM. In this study, we provide a potential mechanism for this process. We show at the mRNA level that the Notch1 receptor and Delta-like 1 (Dll1) ligand vary dynamically across the PSM of both chick and mouse. Remarkably, we also demonstrate similar dynamics at the protein level; hence, the pathway components that mediate intercellular coupling themselves exhibit oscillatory dynamics. Moreover, we quantify the dynamic expression patterns of Dll1 and Notch1, and show they are highly correlated with the expression patterns of two known clock components [Lfng mRNA and the activated form of the Notch receptor (cleaved Notch intracellular domain, NICD)]. Lastly, we show that Notch1 is a target of Notch signalling, whereas Dll1 is Wnt regulated. Regulation of Dll1 and Notch1 expression thus links the activity of Wnt and Notch, the two main signalling pathways driving the clock.

  7. Distribution and expression of psm-mec in clinical isolates of Staphylococcus Epidermidis%psm-mec 在临床分离表皮葡萄球菌中的分布和表达

    Institute of Scientific and Technical Information of China (English)

    杨永长; 肖代雯; 姜伟; 陈亮; 胡洪华; 周薇; 黄文芳


    Objective To explore the distribution and expression of psm-mec in clinical isolates of Staphylococcus epidermidis and to provide foundation for its function analysis. Methods 1 65 strains of S .epidermidis identified accurately by full automation microbiological identification system were collected,and PCR was used to amplify esp and mecA gene to differentiate methicillin-resistant S .epidermidis (MRSE)and methicillin-sensitive S .epidermidis (MSSE).Strains with psm-mec were validated by amplification of psm-mec , fudoh and p221 fragments,and DNA sequence analysis was performed to determine mutation in psm-mec and its upstream sequences.psm-mec reference standard was obtained by construction of p221 recombinant plasmid.RNA of MRSE with psm-mec was extracted,and its mRNA level was measured by fluorescent quantitative RT-PCR. Results MRSE accounted for 83.64% of clinical isolated S .epidermidis ,and 29 strains were positive to psm-mec with a rate of 1 7.58%,which distributed only in MRSE.No mutation was observed in psm-mec ORF sequence,but a G to A point mutation of psm-mec in 4.34% strains.psm-mec expressed with a level ranging from 10 3 to 10 7 copies in all clinical isolates of MRSE with psm-mec ,and the G to A point mutation did not affect psm-mec transcription.Conclusion psm-mec distributes and expresses only in clinical isolates of MRSE,and G>A mutation of psm-mec has no effect on its expression.%目的:探讨 psm-mec 基因在临床分离表皮葡萄球菌中的分布和表达,为进一步分析 psm-mec 的功能奠定基础。方法收集临床分离并经过全自动微生物鉴定系统准确鉴定的表皮葡萄球菌165株,通过 PCR 扩增esp 和mecA 基因准确鉴定和区分甲氧西林敏感表皮葡萄球菌(MSSE)和甲氧西林耐药表皮葡萄球菌(MRSE)。扩增 psm-mec 、fudoh 和 p221片段确认 psm-mec 携带菌株,通过 DNA 序列比对分析 psm-mec 及其上游序列的变化。构建 p221重组质粒制备定量检测 psm-mec

  8. SCCmec 相关的 psm-mec 在血液来源人葡萄球菌中的基因定位%Genetic location of SCCmec-associated psm-mec in Staphylococcus hominis from blood culture

    Institute of Scientific and Technical Information of China (English)

    陈亮; 杨永长; 肖代雯; 喻华; 刘华; 黄文芳


    Objective To investigate the genetic location of SCCmec-associated psm-mec in Staphylococcus hominis isolated from blood culture,and to lay a foundation for further functional studies of psm-mec in Staphylococcus hominis.Methods 25 strains of Staphylococcus hominis isolated from positive blood culture were collected.mecA and psm-mec gene were amplified by PCR,and the SCCmec types were determined by the results of multiplex PCR assay.For analyzing the genetic location characteristic of psm-mec in SCCmec,three pair special PCR primers were used to measure mecR1/psm-mec,psm-mec/xylR and fudoh respectively.Results There were 21 strains of methicillin-resistant Staphylococcus hominis and 4 strains of methicillin-sensitive Staphylococcus hominis. The positive rate of psm-mec gene in methicillin-resistant Staphylococcus hominis was 47.6%,and no psm-mec gene was found in methicillin-sensitive Staphylococcus hominis.Among psm-mec positive strains,2 strains belonged to SCCmecⅢ,5 strains belonged to SCCmecⅢ-like,and 3 strains belonged to new SCCmec types.All of the 10 psm-mec positive strains were mecR1/psm-mec,psm-mec/xylR and fudoh gene positive.Conclusion SCCmec-associated psm-mec extensively exists in methicillin-resistant Staphylococ-cus hominis isolated from positive blood culture,which distributes mainly in typical SCCmecⅢ,SCCmecⅢ-like and new SCCmec types and locates between mecR1 and xylR gene.%目的:了解 SCCmec 相关的 psm-mec 基因在血液来源人葡萄球菌中的基因定位特征,为深入研究 psm-mec 基因在人葡萄球菌中的功能奠定基础。方法收集临床血培养分离的人葡萄球菌25株,通过 PCR 扩增 mecA 基因和 psm-mec 基因,多重 PCR 对耐甲氧西林人葡萄球菌 SCCmec 分型,PCR 扩增 mecR1/psm-mec 基因与 psm-mec/xylR 基因间隔序列及 fudoh 基因,探究 psm-mec 基因在 SCCmec 上的定位特点。结果 PCR 检测显示,21株为耐甲氧西林人葡萄球菌,psm-mec

  9. Antimicrobial resistance profile analysis of MRSE with psm-mec gene%携带 psm-mec 基因耐甲氧西林表皮葡萄球菌的耐药谱研究

    Institute of Scientific and Technical Information of China (English)

    杨永长; 肖代雯; 喻华; 姜伟; 陈亮; 胡洪华; 周薇; 黄文芳


    目的:比较携带与未携带psm-mec基因耐甲氧西林表皮葡萄球菌( MRSE)的耐药谱,为治疗MRSE引起的感染提供理论依据。方法收集临床分离并经过全自动微生物奠定系统准确鉴定的表皮葡萄球菌( Staphylococcus epidermidis,S. epidermidis)165株,通过PCR扩增esp和mecA基因,准确鉴定和区分甲氧西林敏感表皮葡萄球菌( MSSE)和MRSE。扩增psm-mec,fudoh和p221片段确认携带psm-mec基因的MRSE菌株,比较分析携带与未携带psm-mec 基因MRSE的耐药谱。结果83.64%的临床分离S.epidermidis为MRSE,其中29株携带psm-mec基因,携带率为17.58%,且仅分布于MRSE中。临床分离MRSE易对苯唑西林、青霉素、红霉素、复方新诺明和克林霉素耐药,未发现对利奈唑胺、呋喃妥因、普丁/达福、万古霉素和替加环素耐药菌株。携带psm-mec基因MRSE对环丙沙星、庆大霉素、利福平和复方新诺明的耐药率明显高于未携带psm-mec基因MRSE。结论携带psm-mec基因MRSE易对苯唑西林、青霉素、红霉素、克林霉素、环丙沙星、庆大霉素、利福平和复方新诺明耐药。%Objective To compare the antimicrobial resistance profiles between MRSE with and without psm-mec gene in or-der to provide foundation for treatment of MRSE infection disease.Methods One hundred and sixty five strains of S.epidermidis iden-tified accurately by full automation microbiological identification system were collected.PCR was used to amplify esp and mecA gene to differentiate methicillin-resistant S.epidermidis ( MRSE) and methicillin-sensitive S.epidermidis ( MSSE) .Strains with psm-mec gene were validated by amplification of psm-mec,fudoh and p221 fragments,and antimicrobial resistance profile of MRSE with or without psm-mec gene was analyzed.Results MRSE accounted for 83.64%of clinical isolated S.epidermidis,and 29 strains were positive for psm-mec gene with a rate of 17.58%,which were

  10. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. (United States)

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J


    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  11. Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas. (United States)

    Mizutani, Satoshi; Suzuki, Hideyuki; Aimoto, Takayuki; Yamagishi, Seiji; Mishima, Keisuke; Watanabe, Masanori; Kitayama, Yasuhiko; Motoda, Norio; Isshiki, Saiko; Uchida, Eiji


    Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy. The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results of this evaluation were used to review operation procedures and perioperative methods. We divided the MUP into 4 sections and stained each section with a different color. These sections were the pancreatic head nerve plexus margin (Area A), portal vein groove margin (Area B), superior mesenteric artery margin (Area C), and left of the superior mesenteric artery margin (Area D). The subjects evaluated were 45 patients who had carcinoma of the pancreatic head and were treated with circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Of the 45 patients, nine cases (90%) of incomplete resection showed cancer-positivity in the MUP. Among the 4 sections of the MUP, the most cases of positive results [MUP (+) ] were found in Area B, with Area A (+), 0 case; Area B (+), 6 cases; Area C (+), 2 cases; and Area D (+), 3 cases (total, 11 sites in 9 patients). Relapse occurred in 7 of the 9 patients with MUP (+). Local recurrence was observed as initial relapse in all 3 patients with Area D (+). In contrast, the most common site of recurrence other than that in patients with Area D (+) was the liver. By subclassifying the MUP with tissue marking dyes of different colors, we could confirm regional characteristics of MUP (+). As a result, circumferential superior mesenteric arterial nerve plexus-preserving pancreticoduodenectomy was able to be performed in R0 operations in selected

  12. CC-PSM: A Preference-Aware Selection Model for Cloud Service Based on Consumer Community

    Directory of Open Access Journals (Sweden)

    Yan Wang


    Full Text Available In order to give full consideration to the consumer’s personal preference in cloud service selection strategies and improve the credibility of service prediction, a preference-aware cloud service selection model based on consumer community (CC-PSM is presented in this work. The objective of CC-PSM is to select a service meeting a target consumer’s demands and preference. Firstly, the correlation between cloud consumers from a bipartite network for service selection is mined to compute the preference similarity between them. Secondly, an improved hierarchical clustering algorithm is designed to discover the consumer community with similar preferences so as to form the trusted groups for service recommendation. In the clustering process, a quantization function called community degree is given to evaluate the quality of community structure. Thirdly, a prediction model based on consumer community is built to predict a consumer’s evaluation on an unknown service. The experimental results show that CC-PSM can effectively partition the consumers based on their preferences and has good effectiveness in service selection applications.

  13. A digitally controlled PWM/PSM dual-mode DC/DC converter

    Institute of Scientific and Technical Information of China (English)

    Zhen Shaowei; Zhang Bo; Luo Ping; Hou Sijian; Ye Jingxin; Ma Xiao


    A digitally controlled pulse width modulation/pulse skip modulation (PWM/PSM) dual-mode buck DC/DC converter is proposed.Its operation mode can be automatically chosen as continuous conduction mode (CCM) or discontinuous conduction mode (DCM).The converter works in PSM at DCM and in 2 MHz PWM at CCM.Switching loss is reduced at a light load by skipping cycles.Thus high conversion efficiency is realized in a wide load current.The implementations of PWM control blocks,such as the ADC,the digital pulse width modulator (DPWM) and the loop compensator,and PSM control blocks are described in detail.The parameters of the loop compensator can be programmed for different external component values and switching frequencies,which is much more flexible than its analog rivals.The chip is manufactured in 0.13 μm CMOS technology and the chip area is 1.21 mm2.Experimental results show that the conversion efficiency is high,being 90% at 200 mA and 67% at 20 mA.Meanwhile,the measured load step response shows that the proposed dual-mode converter has good stability.

  14. A novel process simulation model (PSM) for anaerobic digestion using Aspen Plus. (United States)

    Rajendran, Karthik; Kankanala, Harshavardhan R; Lundin, Magnus; Taherzadeh, Mohammad J


    A novel process simulation model (PSM) was developed for biogas production in anaerobic digesters using Aspen Plus®. The PSM is a library model of anaerobic digestion, which predicts the biogas production from any substrate at any given process condition. A total of 46 reactions were used in the model, which include inhibitions, rate-kinetics, pH, ammonia, volume, loading rate, and retention time. The hydrolysis reactions were based on the extent of the reaction, while the acidogenic, acetogenic, and methanogenic reactions were based on the kinetics. The PSM was validated against a variety of lab and industrial data on anaerobic digestion. The P-value after statistical analysis was found to be 0.701, which showed that there was no significant difference between discrete validations and processing conditions. The sensitivity analysis for a ±10% change in composition of substrate and extent of reaction results in 5.285% higher value than the experimental value. The model is available at (Rajendran et al., 2013b).

  15. Influence of Single Base Change in Shine-Dalgarno Sequence on the Stability of B.Subtilis Plasmid PSM604

    Institute of Scientific and Technical Information of China (English)


    B.Subtilis expression plasmids generally require a stringent Shine-Dalgarno Sequence(SDS). Site-directed-mutagenesis was explored to change the Shine-Dalgarno Sequence from AAAAATGGGG (mutant type) to AAAAAGGGGG (wild type) in recombinant plasmid PSM604. The single base substitution made the plasmid with wild SDS unstable in structure and segregation. The interaction of SDS with subtilisin leader sequence of PSM604 might be responsible for the instability of plasmid.

  16. Positive Surgical Margin, HPV Persistence, and Expression of Both TPX2 and PD-L1 Are Associated with Persistence/Recurrence of Cervical Intraepithelial Neoplasia after Cervical Conization.

    Directory of Open Access Journals (Sweden)

    Hui Zhang

    Full Text Available To determine the clinicopathologic and immunohistochemical predictors of the persistence/recurrence of cervical intraepithelial neoplasia (CIN after cervical conization.Medical records of 502 patients who received cervical conization treatment of CIN between 2005 and 2012 were reviewed. The clinicopathologic parameters were analyzed using Cox hazard regression. Fifty patients with CIN persistence/recurrence were matched to 50 cases without CIN persistence/recurrence. These 100 cervical specimens were assessed for expression of insulin-like growth factor II messenger RNA (mRNA-binding protein 3 (IMP3, targeting protein for xenopus kinesin-like protein 2 (TPX2, and programmed cell death-1 ligand-1 (PD-L1 using immunohistochemical staining.Multivariate analysis found that the independent predictors of CIN persistence/recurrence were positive surgical margin (hazard ratio 5.777, 95% confidence interval 2.334-14.301, p < 0.001 and human papilloma virus persistence for 6 months (hazard ratio 20.685, 95% confidence interval 7.350-57.657, p < 0.001. Co-expression of TPX2 and PD-L1 was significantly higher in CIN persistence/recurrence group than the group without CIN persistence/recurrence (p = 0.013. The depth of glandular involvement (GI was less than 3mm in about 86.8% (59/68 CIN2-3 lesions, However, No statistically significant associations between GI and persistence/recurrence were observed (P = 0.58.Positive surgical margin, HPV persistence, and expression of both TPX2 and PD-L1 are associated with persistence/recurrence of cervical intraepithelial neoplasia after cervical conization.

  17. Predictors of circumferential resection margin involvement in surgically resected rectal cancer: A retrospective review of 23,464 patients in the US National Cancer Database (United States)

    Al-Sukhni, Eisar; Attwood, Kristopher; Gabriel, Emmanuel; Nurkin, Steven J.


    Introduction The circumferential resection margin (CRM) is a key prognostic factor after rectal cancer resection. We sought to identify factors associated with CRM involvement (CRM+). Methods A retrospective review was performed of the National Cancer Database, 2004–2011. Patients with rectal cancer who underwent radical resection and had a recorded CRM were included. Multivariable analysis of the association between clinicopathologic characteristics and CRM was performed. Tumor patients, 13.3% were CRM+. Factors associated with CRM+ were diagnosis later in the study period, lack of insurance, advanced stage, higher grade, undergoing APR, and receiving radiation. Nearly half of CRM+ patients did not receive neoadjuvant therapy. CRM+ patients who did not receive neoadjuvant therapy were more likely to be female, older, with more comorbidities, smaller tumors, earlier clinical stage, advanced pathologic stage, and CEA-negative disease compared to those who received it. Conclusions Factors associated with CRM+ include features of advanced disease, undergoing APR, and lack of health insurance. Half of CRM+ patients did not receive neoadjuvant treatment. These represent cases where CRM status may be modifiable with appropriate pre-operative selection and multidisciplinary management. PMID:26906328

  18. PSM/SH2B1 splice variants: critical role in src catalytic activation and the resulting STAT3s-mediated mitogenic response. (United States)

    Zhang, Manchao; Deng, Youping; Riedel, Heimo


    A role of PSM/SH2B1 had been shown in mitogenesis and extending to phenotypic cell transformation, however, the underlying molecular mechanism remained to be established. Here, four alternative PSM splice variants and individual functional protein domains were compared for their role in the regulation of Src activity. We found that elevated cellular levels of PSM variants resulted in phenotypic cell transformation and potentiated cell proliferation and survival in response to serum withdrawal. PSM variant activity presented a consistent signature pattern for any tested response of highest activity observed for gamma, followed by delta, alpha, and beta with decreasing activity. PSM-potentiated cell proliferation was sensitive to Src inhibitor herbimycin and PSM and Src were found in the same immune complex. PSM variants were substrates of the Src Tyr kinase and potentiated Src catalytic activity by increasing the V(max) and decreasing the K(m) for ATP with the signature pattern of variant activity. Dominant-negative PSM peptide mimetics including the SH2 or PH domains inhibited Src catalytic activity as well as Src-mediated phenotypic cell transformation. Activation of major Src substrate STAT3 was similarly potentiated by the PSM variants in a Src-dependent fashion or inhibited by PSM domain-specific peptide mimetics. Expression of a dominant-negative STAT3 mutant blocked PSM variant-mediated phenotypic cell transformation. Our results implicate an essential role of the PSM variants in the activation of the Src kinase and the resulting mitogenic response--extending to phenotypic cell transformation and involving the established Src substrate STAT3.

  19. Comparison of lithographic performance between MoSi binary mask and MoSi attenuated PSM (United States)

    Yamana, Mitsuharu; Lamantia, Matthew; Philipsen, Vicky; Wada, Shingo; Nagatomo, Tatsuya; Tonooka, Yoji


    The mask error budget continues to shrink with shrinking DRAM half pitch and MPU gate size year by year. The ITRS roadmap calls for mask CDU to be cut in half by 2014[1]. Both mask maker and mask user must take advantage of various mask properties, OPC strategies and resolution enhancement techniques to drive improvements. Mask material selection impacts both lithographic performance and mask manufacturability. In turn mask material properties and manufacturing techniques impact our ability to meet the technology roadmap. Studies have shown the advantages of polarized light[2,3] as well as the impact of various mask materials on high NA lithography[4]. In this paper we select the recently introduced binary mask material made from a MoSi absorber called Opaque MoSi On Glass (OMOG) for comparison with the conventional 6% att. PSM and 20% att. MoSi PSM. Through simulation and wafer prints, we optimized mask feature from viewpoint of MEEF and maximum exposure latitude (EL). The MoSi att. PSMs suffer from higher MEEF, which is attributed to the negative effect of TE polarization for mask duty cycle of 50% for 50 nm half pitch and below. Therefore a lower mask duty cycle is required for att. PSM to bring the MEEF performance back to acceptable levels. Experimental results confirm simulation results. As a result of the lower mask duty cycle, the att. MoSi PSMs exhibit poor Sub Resolution Assist Feature (SRAF) printability. On the contrary, the MoSi binary mask delivers both acceptable MEEF and acceptable SRAF printing performance. Moreover, we found that the mask structure impact of OMOG to wafer CD is smallest among three masks. OMOG gives the best combination of lithographic performance and delivery compared to the MoSi att. PSMs.

  20. Distribution and regulation of the mobile genetic element-encoded phenol-soluble modulin PSM-mec in methicillin-resistant Staphylococcus aureus. (United States)

    Chatterjee, Som S; Chen, Liang; Joo, Hwang-Soo; Cheung, Gordon Y C; Kreiswirth, Barry N; Otto, Michael


    The phenol-soluble modulin PSM-mec is the only known staphylococcal toxin that is encoded on a mobile antibiotic resistance determinant, namely the staphylococcal cassette chromosome (SCC) element mec encoding resistance to methicillin. Here we show that the psm-mec gene is found frequently among methicillin-resistant Staphylococcus aureus (MRSA) strains of SCCmec types II, III, and VIII, and is a conserved part of the class A mec gene complex. Controlled expression of AgrA versus RNAIII in agr mutants of all 3 psm-mec-positive SCCmec types demonstrated that expression of psm-mec, which is highly variable, is controlled by AgrA in an RNAIII-independent manner. Furthermore, psm-mec isogenic deletion mutants showed only minor changes in PSMα peptide production and unchanged (or, as previously described, diminished) virulence compared to the corresponding wild-type strains in a mouse model of skin infection. This indicates that the recently reported regulatory impact of the psm-mec locus on MRSA virulence, which is opposite to that of the PSM-mec peptide and likely mediated by a regulatory RNA, is minor when analyzed in the original strain background. Our study gives new insight in the distribution, regulation, and role in virulence of the PSM-mec peptide and the psm-mec gene locus.

  1. 耐甲氧西林表皮葡萄球菌 psm-mec 缺失突变株的构建%Construction of mutant strains of methicillin resistant Staphylococcus epidermidis with psm-mec gene deletion

    Institute of Scientific and Technical Information of China (English)

    杨永长; 胡洪华; 陈亮; 刘华; 喻华; 黄文芳


    Objective To construct mutant strains of methicillin resistant Staphylococcus epidermi-dis (MRSE) with psm-mec gene deletion and to investigate the function of psm-mec gene.Methods The drug sensitivity test and DNA sequence analysis were performed to screen out the tetracycline and chloram -phenicol sensitive clinical strains of MRSE , whose upstream and downstream sequences of psm-mec gene were identical to those of the Staphylococcus epidermidis reference strain RP62A.The recombinant plasmid pBT2-Δpsm-mec was constructed by using the fusion PCR and a temperature sensitive shuttle plasmid .After being identified , the plasmid was transformed into the Staphylococcus aureus RN4220 strain by electropora-tion, and then transformed into the selected clinical isolates of MRSE .The mutant strains of MRSE with psm-mec deletion were screened out and identified after homologous recombination .The differences in biofilm formation between the mutant and wild-type strains were analyzed for further elucidation the relationships be-tween the psm-mec gene and biofilm formation in MRSE strains .Results Three clinical MRSE isolates for the construction of mutant strains with psm-mec gene deletion were screened out and identified by using drug sensitivity test and sequence alignment analysis .The mutants constructed via homogenous recombination were screened out and identified .Compared with the corresponding wild-type strains, the three mutants with psm-mec gene deletion showed significantly decreased ability of biofilm formation , demonstrating that the psm-mec genes strains induced the biofilm formation of MRSE .Conclusion The Δpsm-mec mutant strains were successfully constructed .The psm-mec gene played an important role in the biofilm formation of Staphy-lococcus epidermdis.%目的:构建耐甲氧西林表皮葡萄球菌( MRSE)的psm-mec缺失突变株,并对psm-mec的功能进行初步研究。方法运用药敏试验、DNA序列分析技术筛选psm-mec上下游序

  2. The Psm locus controls paternal sorting of the cucumber mitochondrial genome. (United States)

    Havey, M J; Park, Y H; Bartoszewski, G


    The mitochondrial genome of cucumber shows paternal transmission and there are no reports of variation for mitochondrial transmission in cucumber. We used a mitochondrially encoded mosaic (MSC) phenotype to reveal phenotypic variation for mitochondrial-genome transmission in cucumber. At least 10 random plants from each of 71 cucumber plant introductions (PIs) were crossed as the female with an inbred line (MSC16) possessing the MSC phenotype. Nonmosaic F1 progenies were observed at high frequencies (greater than 50%) in F1 families from 10 PIs, with the greatest proportions being from PI 401734. Polymorphisms near the mitochondrial cox1 gene and JLV5 region revealed that nonmosaic hybrid progenies from crosses of PI 401734 with MSC16 as the male possessed the nonmosaic-inducing mitochondrial DNA (mtDNA) from the paternal parent. F2) F3, and backcross progenies from nonmosaic F1 plants from PI 401734 x MSC16 were testcrossed with MSC16 as the male parent to reveal segregation of a nuclear locus (Psm for Paternal sorting of mitochondria) controlling sorting of mtDNA from the paternal parent. Psm is a unique locus at which the maternal genotype affects sorting of paternally transmitted mtDNA.

  3. Investigating the lytic activity and structural properties of Staphylococcus aureus phenol soluble modulin (PSM) peptide toxins. (United States)

    Laabei, Maisem; Jamieson, W David; Yang, Yi; van den Elsen, Jean; Jenkins, A Toby A


    The ubiquitous bacterial pathogen, Staphylococcus aureus, expresses a large arsenal of virulence factors essential for pathogenesis. The phenol-soluble modulins (PSMs) are a family of cytolytic peptide toxins which have multiple roles in staphylococcal virulence. To gain an insight into which specific factors are important in PSM-mediated cell membrane disruption, the lytic activity of individual PSM peptides against phospholipid vesicles and T cells was investigated. Vesicles were most susceptible to lysis by the PSMα subclass of peptides (α1-3 in particular), when containing between 10 and 30mol% cholesterol, which for these vesicles is the mixed solid ordered (so)-liquid ordered (lo) phase. Our results show that the PSMβ class of peptides has little effect on vesicles at concentrations comparable to that of the PSMα class and exhibited no cytotoxicity. Furthermore, within the PSMα class, differences emerged with PSMα4 showing decreased vesicle and cytotoxic activity in comparison to its counterparts, in contrast to previous studies. In order to understand this, peptides were studied using helical wheel projections and circular dichroism measurements. The degree of amphipathicity, alpha-helicity and properties such as charge and hydrophobicity were calculated, allowing a structure-function relationship to be inferred. The degree of alpha-helicity of the peptides was the single most important property of the seven peptides studied in predicting their lytic activity. These results help to redefine this class of peptide toxins and also highlight certain membrane parameters required for efficient lysis.

  4. Design and Lessons Learned on the Development of a Cryogenic Pupil Select Mechanism (PSM) (United States)

    Mitchell, Alissa L.; Capon, Thomas L.; Hakun, Claef; Haney, Paul; Koca, Corina; Guzek, Jeffrey


    Calibration and testing of the instruments on the Integrated Science Instrument Module (ISIM) of the James Webb Space Telescope (JWST) is being performed by the use of a cryogenic, full-field, optical simulator that was constructed for this purpose. The Pupil Select Mechanism (PSM) assembly is one of several mechanisms and optical elements that compose the Optical Telescope Element SIMulator, or OSIM. The PSM allows for several optical elements to be inserted into the optical plane of OSIM, introducing a variety of aberrations, distortions, obscurations, and other calibration states into the pupil plane. The following discussion focuses on the details of the design evolution, analysis, build, and test of this mechanism along with the challenges associated with creating a sub arc-minute positioning mechanism operating in an extreme cryogenic environment. In addition, difficult challenges in the control system design will be discussed including the incorporation of closed-loop feedback control into a system that was designed to operate in an open-loop fashion.

  5. Transcription and translation products of the cytolysin gene psm-mec on the mobile genetic element SCCmec regulate Staphylococcus aureus virulence. (United States)

    Kaito, Chikara; Saito, Yuki; Nagano, Gentaro; Ikuo, Mariko; Omae, Yosuke; Hanada, Yuichi; Han, Xiao; Kuwahara-Arai, Kyoko; Hishinuma, Tomomi; Baba, Tadashi; Ito, Teruyo; Hiramatsu, Keiichi; Sekimizu, Kazuhisa


    The F region downstream of the mecI gene in the SCCmec element in hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) contains two bidirectionally overlapping open reading frames (ORFs), the fudoh ORF and the psm-mec ORF. The psm-mec ORF encodes a cytolysin, phenol-soluble modulin (PSM)-mec. Transformation of the F region into the Newman strain, which is a methicillin-sensitive S. aureus (MSSA) strain, or into the MW2 (USA400) and FRP3757 (USA300) strains, which are community-acquired MRSA (CA-MRSA) strains that lack the F region, attenuated their virulence in a mouse systemic infection model. Introducing the F region to these strains suppressed colony-spreading activity and PSMα production, and promoted biofilm formation. By producing mutations into the psm-mec ORF, we revealed that (i) both the transcription and translation products of the psm-mec ORF suppressed colony-spreading activity and promoted biofilm formation; and (ii) the transcription product of the psm-mec ORF, but not its translation product, decreased PSMα production. These findings suggest that both the psm-mec transcript, acting as a regulatory RNA, and the PSM-mec protein encoded by the gene on the mobile genetic element SCCmec regulate the virulence of Staphylococcus aureus.

  6. Genome-wide analysis of the regulatory function mediated by the small regulatory psm-mec RNA of methicillin-resistant Staphylococcus aureus. (United States)

    Cheung, Gordon Y C; Villaruz, Amer E; Joo, Hwang-Soo; Duong, Anthony C; Yeh, Anthony J; Nguyen, Thuan H; Sturdevant, Daniel E; Queck, S Y; Otto, M


    Several methicillin resistance (SCCmec) clusters characteristic of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) strains harbor the psm-mec locus. In addition to encoding the cytolysin, phenol-soluble modulin (PSM)-mec, this locus has been attributed gene regulatory functions. Here we employed genome-wide transcriptional profiling to define the regulatory function of the psm-mec locus. The immune evasion factor protein A emerged as the primary conserved and strongly regulated target of psm-mec, an effect we show is mediated by the psm-mec RNA. Furthermore, the psm-mec locus exerted regulatory effects that were more moderate in extent. For example, expression of PSM-mec limited expression of mecA, thereby decreasing methicillin resistance. Our study shows that the psm-mec locus has a rare dual regulatory RNA and encoded cytolysin function. Furthermore, our findings reveal a specific mechanism underscoring the recently emerging concept that S. aureus strains balance pronounced virulence and high expression of antibiotic resistance.

  7. Transcription and translation products of the cytolysin gene psm-mec on the mobile genetic element SCCmec regulate Staphylococcus aureus virulence.

    Directory of Open Access Journals (Sweden)

    Chikara Kaito

    Full Text Available The F region downstream of the mecI gene in the SCCmec element in hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA contains two bidirectionally overlapping open reading frames (ORFs, the fudoh ORF and the psm-mec ORF. The psm-mec ORF encodes a cytolysin, phenol-soluble modulin (PSM-mec. Transformation of the F region into the Newman strain, which is a methicillin-sensitive S. aureus (MSSA strain, or into the MW2 (USA400 and FRP3757 (USA300 strains, which are community-acquired MRSA (CA-MRSA strains that lack the F region, attenuated their virulence in a mouse systemic infection model. Introducing the F region to these strains suppressed colony-spreading activity and PSMα production, and promoted biofilm formation. By producing mutations into the psm-mec ORF, we revealed that (i both the transcription and translation products of the psm-mec ORF suppressed colony-spreading activity and promoted biofilm formation; and (ii the transcription product of the psm-mec ORF, but not its translation product, decreased PSMα production. These findings suggest that both the psm-mec transcript, acting as a regulatory RNA, and the PSM-mec protein encoded by the gene on the mobile genetic element SCCmec regulate the virulence of Staphylococcus aureus.

  8. Detection and related study of PSM-α gene in hospital-acquired methicillin-resistant Staphylococcus aureus%医院获得性耐甲氧西林金黄色葡萄球菌中PSM-α基因检测及相关研究

    Institute of Scientific and Technical Information of China (English)

    于淼; 赵自云; 刘成玉; 牟晓峰


    目的:了解某地区耐甲氧西林金黄色葡萄球菌(MRSA)中α型-酚溶调制蛋白(PSM-α)基因携带情况及对人外周血中性粒细胞的影响,为指导临床治疗及明确该地区 MRSA 致病机制提供理论依据。方法收集临床标本中分离并经SCCmec分型的MRSA 90株,采用聚合酶链反应(PCR)方法扩增PSM-α基因,并通过细胞形态学方法研究PSM-α对人外周血中性粒细胞的影响。结果86株医院获得性 MRSA(HA-MRSA)中,PSM-α基因阳性者78株,PSM-α阳性率为90.70%;4株社区获得性 MRSA(CA-MRSA)中,2株为PSM-α基因阳性,阳性率为50.00%;PSM-α阳性组中性粒细胞死亡率与生理盐水组、PSM-α阴性组和ATCC 25923组间比较,差异有统计学意义。PSM-α阳性组死亡率高于其他3组,而PSM-α阴性组和ATCC 25923组差异无统计学意义。结论该地区 HA-MRSA携带PSM-α基因,且PSM-α基因阳性的 MRSA菌株分泌的PSM-α具有促进中性粒细胞溶解的活性。%Objective To investigate the carriage of phenol soluble modulin-α(PSM-α)in methicillin-resistant Staphylococcus aureus(MRSA)and influence in human peripheral blood neutrophils,so as to provide theoretical ba-sis for guiding clinical treatment and identifying pathogenesis of MRSA. Methods Ninety MRSA isolates which were isolated from clinical specimens and performed SCCmec genotyping were collected,PSM-αgene was amplified by polymerase chain reaction(PCR),and the effects of PSM-αgene on hunman peripheral blood neutrophils was studied by cell morphology analysis.Results Of 86 hospital-acquired MRSA(HA-MRSA)isolates,78 were positive for PSM-αgene,the positive gene was 90.70% ;Of 4 community-acquired MRSA(CA-MRSA),2 were positive for PSM-αgene,the positive rate was 50.00% ;neutrophil death rate in PSM-αpositive group was significantly higher than normal saline group,PSM-αnegative group and ATCC 25923 group,but there was no significant

  9. Identification of presomitic mesoderm (PSM)-specific Mesp1 enhancer and generation of a PSM-specific Mesp1/Mesp2-null mouse using BAC-based rescue technology. (United States)

    Oginuma, Masayuki; Hirata, Tatsumi; Saga, Yumiko


    Bacterial artificial chromosome (BAC) modification technology is a powerful method for the identification of enhancer sequences and genetic modifications. Using this method, we have analyzed the Mesp1 and/or Mesp2 enhancers and identified P1-PSME, a PSM-specific enhancer of Mesp1, which contains a T-box binding site similar to the previously identified P2-PSME. Hence, Mesp1 and Mesp2 use different enhancers for their PSM-specific expression. In addition, we find that these two genes also use distinct enhancers for their early mesodermal expression. Based on these results, we generated a PSM-specific Mesp1/Mesp2-null mouse by introducing a BAC clone, from which only early mesodermal Mesp1 expression is possible, into the Mesp1/Mesp2 double knockout (dKO) genetic background. This successfully rescued gastrulation defects due to the lack of the early mesoderm in the dKO mouse and we thereby obtained a PSM-specific Mesp1/Mesp2-null mouse showing a lack of segmented somites.

  10. Quality of life and nutritional assessment in peritoneal surface malignancy (PSM): recommendations for care. (United States)

    McQuellon, Richard; Gavazzi, Cecilia; Piso, Pompiliu; Swain, David; Levine, Edward


    Quality of life (QOL) and nutritional status of patients treated for peritoneal surface malignancy are important areas for ongoing assessment. A working group of clinicians including a dietitian, physicians, and quality of life researchers was formed as part of the Fifth International Workshop on Peritoneal Surface Malignancy. The purpose of the group was to form a consensus statement on both quality of life and nutritional assessment in PSM. The relevant literature from the quality of life and nutritional assessment in peritoneal surface malignancy was reviewed and integrated to form a consensus statement. Baseline and ongoing assessment of both quality of life and nutritional status of patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) is recommended.

  11. 脉冲阶梯调制(PSM)原理分析

    Institute of Scientific and Technical Information of China (English)




  12. Screening of xylanase activity of Streptomyces albidoflavus PSM-3n isolated from Uttarakhand

    Directory of Open Access Journals (Sweden)

    Pushpendra Sharma


    Full Text Available Background: Awareness towards the environmental pollution had made the evolution of green technology by which enzymes got special attention in industries. The enzymes replaced chemical catalysts in manufacturing various chemicals, agricultural and pharmaceutical products. Material and methods: Actinomycetes were isolated and screened for their ability to produce xylanase. For the most promising isolate, selection of media, effect of pH, temperature, metal ions, and detergents on enzyme production and activity was studied. Results: Out of 29 isolates, 22 isolates showed xylanase activity. Out of 22 xylanase producing isolate, 05 isolates were selected for secondary screening on the basis of their clear zone size. The most promising isolate PSM-3n was identified as Streptomyces albidoflavus. It produces maximum enzyme (xylanase in media Horikoshi and Ikura having carbon and nitrogen sources as oat meal and urea respectively. The optimum pH and temperature for the enzyme production was 4.0 and 45°C respectively. The enzyme activity was found maximum at temperature 50°C and enhanced in the presence of Fe3+ ions. There was a reduction in the enzyme activity in the presence of detergents like SDS, tween-20 and tween-80. The enzyme was fairly stable at 50°C for 1 h. Conclusion: The enzyme produced by the isolate PSM-3n is fairly heat stable and highly acid stable. The activity of the enzyme was increased in presence of Fe3+ ions while decreased in presence of SDS. Therefore, further studies are required for purification of xylanase for its application potential in pulp bioleaching processes and in the functional food industry.

  13. A head-to-head hands-on comparison of ERCP mechanical simulator (EMS) and Ex-vivo Porcine Stomach Model (PSM). (United States)

    Leung, Joseph W; Wang, Dong; Hu, Bing; Lim, Brian; Leung, Felix W


    BACKGROUND: ERCP mechanical simulator (EMS) and ex-vivo porcine stomach model (PSM) have been described. No direct comparison was reported on endoscopists' perception regarding their efficacy for ERCP training OBJECTIVE: Comparative assessment of EMS and PSM. DESIGN: Questionnaire survey before and after practice. SETTING: Hands-on practice workshops. SUBJECTS: 22 endoscopists with prior experience in 111±225 (mean±SD) ERCP. INTERVENTIONS: Participants performed scope insertion, selective bile duct cannulation with guide wire and insertion of a single biliary stent. Simulated fluoroscopy with external pin-hole camera (EMS), or with additional transillumination (PSM) was used to monitor exchange of accessories. MAIN OUTCOME MEASURE: Participants rated their understanding and confidence before and after hands-on practice, and credibility of each simulator for ERCP training. Comparative efficacy of EMS and PSM for ERCP education was scored (1=not, 10=very) based on pre and post practice surveys: realism (tissue pliability, papilla anatomy, visual/cannulation realism, wire manipulation, simulated fluoroscopy, overall experience); usefulness (assessment of results, supplementing clinical experience, easy for trainees to learn new skills) and application (overall ease of use, prepare trainees to use real instrument and ease of incorporation into training). RESULTS: Before hands-on practice, both EMS and PSM received high scores. After practice, there was a significantly greater increase in confidence score for EMS than PSM (pPSM credible options for improving understanding and supplementing clinical ERCP training. EMS is more useful for basic learning.

  14. PSM/SH2-B distributes selected mitogenic receptor signals to distinct components in the PI3-kinase and MAP kinase signaling pathways. (United States)

    Deng, Youping; Xu, Hu; Riedel, Heimo


    The Pro-rich, PH, and SH2 domain containing mitogenic signaling adapter PSM/SH2-B has been implicated as a cellular partner of various mitogenic receptor tyrosine kinases and related signaling mechanisms. Here, we report in a direct comparison of three peptide hormones, that PSM participates in the assembly of distinct mitogenic signaling complexes in response to insulin or IGF-I when compared to PDGF in cultured normal fibroblasts. The complex formed in response to insulin or IGF-I involves the respective peptide hormone receptor and presumably the established components leading to MAP kinase activation. However, our data suggest an alternative link from the PDGF receptor via PSM directly to MEK1/2 and consequently also to p44/42 activation, possibly through a scaffold protein. At least two PSM domains participate, the SH2 domain anticipated to link PSM to the respective receptor and the Pro-rich region in an association with an unidentified downstream component resulting in direct MEK1/2 and p44/42 regulation. The PDGF receptor signaling complex formed in response to PDGF involves PI 3-kinase in addition to the same components and interactions as described for insulin or IGF-I. PSM associates with PI 3-kinase via p85 and in addition the PSM PH domain participates in the regulation of PI 3-kinase activity, presumably through membrane interaction. In contrast, the PSM Pro-rich region appears to participate only in the MAP kinase signal. Both pathways contribute to the mitogenic response as shown by cell proliferation, survival, and focus formation. PSM regulates p38 MAP kinase activity in a pathway unrelated to the mitogenic response.

  15. A New Surgical Technique for Ingrown Toenail


    Seyed Reza Mousavi; Jaledin Khoshnevice


    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin o...

  16. Development of a Pollination Service Measurement (PSM) method using potted plant phytometry. (United States)

    Woodcock, Thomas S; Pekkola, Laura J; Dawson, Cara; Gadallah, Fawziah L; Kevan, Peter G


    The value of pollination to human society is not limited to agricultural production, but also in the sustainability of ecosystems and the services that they provide. Seed set can be used as a comparative measure of pollination effectiveness, with minimum variability expected when other resources are not limiting. Six species of self-incompatible fall asters (Symphyotrichum) were used to evaluate pollination service at 12 sites across a spectrum of expected levels of pollination. Seed set per inflorescence was generally lower at sites with lower pollinator numbers and diversity, although as expected pollinator assemblage characteristics were highly variable within and between sites. However, rankings of sites showed consistency of response across phytometer species and between years; the summed ranks across multiple species appears to have as the greatest value in Pollination Service Measurement (PSM). Abundance, richness, and Shannon diversity of pollinator assemblages were highly autocorrelated and showed variable relationships with seed set depending on plant species and temporal scale of pollinator assemblage assessment. Use of seed set to directly measure pollination service at a site was consistent and cost effective when compared to less certain and more labour-intensive methods of pollinator collection and identification, and shows promise for implementation in pollination monitoring and bioassessment practices.

  17. Focus shift impacted by mask 3D and comparison between Att. PSM and OMOG (United States)

    Liu, Yansong; Su, Xiaojing; Dong, LiSong; Song, Zhiyang; Guo, Moran; Su, Yajuan; Wei, Yayi


    The impact of mask three dimensions (M3D) effect on lithography processes is getting more pronounced from 32 nm nodes1-2. In this paper, we report four research progresses on the M3Deffect. Firstly, the impacts of M3D effect on the best focus (BF) offset were studied with though pitch as test pattern. The M3D effect has negative impacts on the BF, generating the BF offset pattern by pattern. The BF offset strongly depends on MoSi film thickness (THK). However the impact of MoSi profile, or side wall angle (SWA) could be ignored. Secondly, M3D OPC is needed to mitigate the shift of dose and focus center. Thirdly, as long as enough shade, the thinner MoSi, the less BF shift, as electromagnetic field (EMF) effect makes space behave smaller, which leads to higher contrast but higher mask error enhancement factor(MEEF); So the trade-off between contrast and MEEF is needed. And MoSi THK 43.7 nm in production supposed to be the optimized value from this study. Finally, compared to attenuating phase shifting mask (att.PSM) mask, opaque MoSi on Glass (OMOG) mask is more robust in terms of MEEF, the normalized image logarithmic slope (NILS) etc., not obviously influenced by mask duty ratio.

  18. [Resection margins in conservative breast cancer surgery]. (United States)

    Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián


    Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  19. Mouse Nkd1, a Wnt antagonist, exhibits oscillatory gene expression in the PSM under the control of Notch signaling. (United States)

    Ishikawa, Aki; Kitajima, Satoshi; Takahashi, Yu; Kokubo, Hiroki; Kanno, Jun; Inoue, Tohru; Saga, Yumiko


    During vertebrate embryogenesis, the formation of reiterated structures along the body axis is dependent upon the generation of the somite by segmentation of the presomitic mesoderm (PSM). Notch signaling plays a crucial role in both the generation and regulation of the molecular clock that provides the spatial information for PSM cells to form somites. In a screen for novel genes involved in somitogenesis, we identified a gene encoding a Wnt antagonist, Nkd1, which is transcribed in an oscillatory manner, and may represent a new member of the molecular clock constituents. The transcription of nkd1 is extremely downregulated in the PSM of vestigial tail (vt/vt), a hypomorphic mutant of Wnt3a, whereas nkd1 oscillations have a similar phase to lunatic fringe (L-fng) transcription and they are arrested in Hes7 (a negative regulator of Notch signaling) deficient embryos. These results suggest that the transcription of nkd1 requires Wnt3a, and that its oscillation patterns depend upon the function of Hes7. Wnt signaling has been postulated to be upstream of Notch signaling but we demonstrate in this study that a Wnt-signal-related gene may also be regulated by Notch signaling. Collectively, our data suggest that the reciprocal interaction of Notch and Wnt signals, and of their respective negative feedback loops, function to organize the segmentation clock required for somitogenesis.

  20. Impact of psm-mec in Methicillin-Resistant Staphylococcus aureus (ST764) Strains Isolated from Keratitis Patients. (United States)

    Suzuki, Takashi; Yamamoto, Toshihiro; Kaito, Chikara; Miyamoto, Hitoshi; Ohashi, Yuichi


    Staphylococcus aureus is a predominant pathogen in keratitis, and the rate of methicillin-resistant S. aureus (MRSA) is increasing. In our previous study, genotypes of MRSA isolates from keratitis cases were classified into ST5 or ST764 lineage by multi-locus sequence typing. In this study, we examined the virulence properties of these MRSA keratitis isolates and its virulence determinants. There was no difference in the prevalence of virulence genes, such as adhesion and toxins, between ST5 and ST764 isolates. All ST5 isolates carried the intact psm-mec gene, which suppresses exotoxin production and colony spreading, but promotes biofilm formation. In contrast, all ST764 isolates had one point mutation in the psm-mec gene. Biofilm production in ST5 isolates was significantly higher than that in ST764 isolates, whereas colony spreading, hemolytic activity, and production of alpha-phenol-soluble modulins were higher in ST764 than in ST5 isolates. The toxicity of ST764 supernatants to corneal epithelial cells was higher than that of ST5 supernatants. These results suggest that the point mutation in the psm-mec gene contributes to the difference in virulence properties between ST5 and ST764 isolates in MRSA keratitis.

  1. Antibacterial Action of a Condensed Tannin Extracted from Astringent Persimmon as a Component of Food Addictive Pancil PS-M on Oral Polymicrobial Biofilms. (United States)

    Tomiyama, Kiyoshi; Mukai, Yoshiharu; Saito, Masahiro; Watanabe, Kiyoko; Kumada, Hidefumi; Nihei, Tomotaro; Hamada, Nobushiro; Teranaka, Toshio


    The purpose of this study was to evaluate the antibacterial activity against polymicrobial (PM) biofilms of a condensed tannin extracted from astringent persimmon (PS-M), which is contained in refreshing beverages commercially available in Japan. Salivary PM biofilms were formed anaerobically on glass coverslips for 24 and 72 h and were treated for 5 min with sterilized deionized water (DW), 0.05 and 0.2 wt% chlorhexidine digluconate (CHX), and 0.5-4.0 wt% PS-M solution. The colony forming units (CFU/mL) were determined and morphological changes of the biofilms were observed by scanning electron microscopy (SEM). The CFUs were lower in all PS-M and CHX groups compared to the DW group. PS-M exerted a dose-dependent effect. PS-M (1.53 × 10(7)) at a dose of 4.0 wt% had the same effect as 0.2 wt% CHX (2.03 × 10(7)), regardless of the culture period. SEM revealed the biofilm structures were considerably destroyed in the 4.0 wt% PS-M and 0.2 wt% CHX. These findings indicate that the antibacterial effects of PS-M, a naturally derived substance, are comparable to those of CHX. PS-M may keep the oral cavity clean and prevent dental caries and periodontal disease related to dental plaque, as well as systemic disease such as aspiration pneumonitis.

  2. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)


    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  3. Margin requirements, margin loans, and margin rates: practice and principles


    Peter Fortune


    The Board of Governors of the Federal Reserve System establishes initial margin requirements under Regulations T, U, and X. Recent margin loan increases, both in aggregate value and relative to market capitalization, have rekindled the debate about using margin requirements as an instrument to affect the prices of common stocks. Proponents of a more active margin requirement policy see the regulations as instruments for affecting the level and volatility of stock prices by influencing investo...

  4. Abortion - surgical (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  5. 重组免疫毒素scFv-psm-ETA对人前列腺癌细胞生长抑制作用的研究%Construction of scFv-psm-ETA recombinant immunotoxin and its antitumor effect on human prostate cancer cells in vitro and in vivo

    Institute of Scientific and Technical Information of China (English)

    陈凌武; 王晓波; 陈炜; 徐鸿绪; 梅骅


    目的探讨重组免疫毒素scFv-psm-ETA对人前列腺癌细胞生长的抑制作用. 方法制备具有良好器官特异性的免疫毒素scFv-psm-ETA,从抗前列腺特异膜抗原(PSM)单抗杂交瘤细胞中克隆抗PSM单抗重、轻链可变区基因,与切去细胞结合区的ETA基因相连,构建成表达scFv-psm-ETA的质粒pSW200-psm,转化E.coli株CC118,表达有生物活性的融合蛋白scFv-psm-ETA,经M1 FLAG柱纯化,检测其体外对前列腺癌细胞的细胞毒杀伤活性和在荷瘤裸鼠体内的抑瘤作用. 结果制备的 scFv-psm-ETA免疫毒素能特异性地与PSM高表达的LNCaP细胞结合,在浓度为100 ng/ml时对80%的LNCaP细胞有体外细胞毒杀伤作用;荷LNCaP前列腺癌裸鼠治疗组及对照组肿瘤大小分别为153 mm3及272 mm3(P<0.01),显示scFv-psm-ETA对荷瘤裸鼠有抑制肿瘤生长作用. 结论重组免疫毒素scFv-psm-ETA对PSM高表达的前列腺癌细胞LNCaP有体外细胞毒杀伤及体内抑瘤作用.

  6. New Frontiers in Surgical Innovation. (United States)

    Jackson, Ryan S; Schmalbach, Cecelia E


    It is an exciting time for head and neck surgical innovation with numerous advances in the perioperative planning and intraoperative management of patients with cancer, trauma patients, and individuals with congenital defects. The broad and rapidly changing realm of head and neck surgical innovation precludes a comprehensive summary. This article highlights some of the most important innovations from surgical planning with sentinel node biopsy and three-dimensional, stereolithic modeling to intraoperative innovations, such as transoral robotic surgery and intraoperative navigation. Future surgical innovations, such as intraoperative optical imaging of surgical margins, are also highlighted. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. New alternatively spliced variant of prostate-specific membrane antigen PSM-E suppresses the proliferation, migration and invasiveness of prostate cancer cells. (United States)

    Cao, Kai-Yuan; Xu, Lin; Zhang, Ding-Mei; Zhang, Xiao-Ming; Zhang, Tian; He, Xia; Wang, Zhu; Feng, Fa-Shen; Qiu, Shao-Peng; Shen, Guan-Xin


    PSM-E is a newly discovered alternatively spliced variant of prostate-specific membrane antigen (PSMA). In the current study, its role on the proliferation, invasiveness and migration in prostate cancer cell lines was analyzed. PSM-E and PSMA (as a comparison) eukaryotic expression vectors pcDNA3.0/PSM-E and pcDNA3.0/PSMA were constructed, validated by RT-PCR and Western blotting, and PSMA/PSM-E overexpression PC-3 cell models were built. Gene interference was used to block PSMA and the expression of its splice variants in LNCap cells. Three shRNA fragments were synthesized against PSMA, cloned into the vector pSilencer 2.1-U6-neo, their interference effect was evaluated by RT-PCR and Western blotting, and pSilencer 2.1-U6-neo‑shRNA3 (named p‑shRNA3) was chosen in further analyses. Growth curves were drawn to observe the proliferation change, which showed that PSM-E had the potential to suppress proliferation (PPSM-E interfering LNCap cells (P>0.05). Cross-river test showed that the migration speeds of PSM-E/PC-3 and PSMA/PC-3 were both significantly slower than the vector negative control, and faster in p-shRNA3 interfering LNCap cells compared with its vector negative control (PPSM-E/PC-3 and PSMA/PC-3 (P>0.05). Transwell assay showed that the invasive cells of both PSMA/PC-3 and PSM-E/PC-3 were fewer compared to the vector negative control (PPSM-E was weaker than PSMA (PPSM-E could suppress proliferation, migration and invasiveness of prostate cancer cells. Its suppression effect on cell proliferation is stronger compared to PSMA and the suppression effect on invasiveness is weaker than that of PSMA.

  8. Novel pattern trimming and shrink material (PTM (PTD) and PSM (NTI)) for ArF/EUV extension (United States)

    Nishita, Tokio; Sakamoto, Rikimaru


    In recent years, as next-generation lithography, various exposure techniques have been studied such as Extreme Ultraviolet Lithography (EUVL), Directed Self Assembly (DSA) and multiple patterning processes. In particular, EUVL is the most promising candidate for the high volume manufacturing below N7 node. However, there are many problems to be solved such as materials, through put of the exposure tool and mask defect. With respect to the DSA, the fine patterning with block copolymer has been studied. But the DSA process also has the several problems such as the complicated process flow in chemo process, quality of the block copolymer and defect. On the other hand, although the multiple patterning has been applied the device manufacturing for several years, there are some problems such as significant increase in cost due to increasing of the process steps and the overlay accuracy at the multiple process steps. Therefore, Pattern Trimming Materials (PTM) and Pattern Shrink Materials (PSM) were developed for miniaturization using the current exposure technology. The PTM is applied on a resist pattern produced in a Positive Tone Development (PTD) process and trim the resist pattern. It is possible to control the trimming amount by changing the formulation and the baking process. It has been confirmed that the effectiveness of PTM is not only for the L/S pattern, but also for the 2D pattern like pillar pattern. At the same time, it is confirmed that the PTM can improve the Line Width Roughness (LWR) and Local Critical Dimension Uniformity (LCDU). On the other hand, the PSM is applied on the pattern prepared in a Negative Tone Imaging (NTI) process and then it can shrink the resist pattern after baking. We adopted the new concept for pattern shrinkage process which dramatically improved LCDU with the hole shrinkage. In this paper, we demonstrated the L/S and pillar pattern trimming by PTM and the C/H shrink by PSM with ArF immersion (ArF im) condition and EUV condition

  9. A probabilistic sampling method (PSM for estimating geographic distance to health services when only the region of residence is known

    Directory of Open Access Journals (Sweden)

    Peek-Asa Corinne


    Full Text Available Abstract Background The need to estimate the distance from an individual to a service provider is common in public health research. However, estimated distances are often imprecise and, we suspect, biased due to a lack of specific residential location data. In many cases, to protect subject confidentiality, data sets contain only a ZIP Code or a county. Results This paper describes an algorithm, known as "the probabilistic sampling method" (PSM, which was used to create a distribution of estimated distances to a health facility for a person whose region of residence was known, but for which demographic details and centroids were known for smaller areas within the region. From this distribution, the median distance is the most likely distance to the facility. The algorithm, using Monte Carlo sampling methods, drew a probabilistic sample of all the smaller areas (Census blocks within each participant's reported region (ZIP Code, weighting these areas by the number of residents in the same age group as the participant. To test the PSM, we used data from a large cross-sectional study that screened women at a clinic for intimate partner violence (IPV. We had data on each woman's age and ZIP Code, but no precise residential address. We used the PSM to select a sample of census blocks, then calculated network distances from each census block's centroid to the closest IPV facility, resulting in a distribution of distances from these locations to the geocoded locations of known IPV services. We selected the median distance as the most likely distance traveled and computed confidence intervals that describe the shortest and longest distance within which any given percent of the distance estimates lie. We compared our results to those obtained using two other geocoding approaches. We show that one method overestimated the most likely distance and the other underestimated it. Neither of the alternative methods produced confidence intervals for the distance

  10. Crown lengthening: a surgical flap approach. (United States)

    Lundergan, W; Hughes, W R


    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  11. Discusses the typical fault of PSM transmitter power switch module%论述PSM发射机功率开关模块典型故障

    Institute of Scientific and Technical Information of China (English)



    This paper discusses the basic work principle of PSM transmitter power switch board,and analyzed the typical faults of the transmitter power switch module,and finally a summary of PSM transmitter switch module repair after verification method, provides the reference for the PSM transmitter power switch module fault detection and processing.%本文首先探讨了PSM发射机功率开关板的基本工作原理,并对发射机功率开关模块的典型故障进行分析,最后对PSM发射机开关模块修复后的验证方法进行总结,为PSM发射机功率开关模块故障的检测和处理提供资料参考.

  12. Surgical Assisting (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  13. Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients (United States)

    A randomized controlled trial of patients with stage IIA–C cutaneous melanoma thicker than 2-mm found that a 2-cm surgical resection margin is sufficient and is as safe for patients as a 4-cm margin.

  14. Hepatic surgical anatomy. (United States)

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros


    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  15. Simple digital PWM and PSM controlled DC-DC boost converter for luminance-regulated WLED driver

    Institute of Scientific and Technical Information of China (English)

    LIU Xin; GUO Shu-xu; CHANG Yu-chun; ZHU Shun-dong; WANG Shuai


    This article presents a control strategy based on simple digital pulse-width modulation (DPWM) and pulse-skip modulation (PSM) for a DC-DC boost converter, to drive a luminance-regulated white light emitting diodes (WLEDs). The presented control strategy not only retains most of the advantages and flexibilities of traditional digital PWM, but also reduces complexity and cost. Based on analyzing the principle of the presented control strategy, the white light emitting diode (WLED) driver is designed and simulated using the 0.6 (m CMOS process. Simulation results of the boost converter show that the power efficiency is above 76% for a full load, with a peak efficiency of 88% when supply voltage varies from 2.7 V to 5.5 V. The control strategy overcomes low efficiency for PWM mode with light load.

  16. The Development and Evaluation of Training Methods for Group 4 Personnel. II. Training Group 4 Personnel in the Operation of the Electronic Multimeter AN/PSM-4. (United States)

    Steadman, Joseph C.; And Others

    Part of continuing Navy research on training and utilizing Group 4 (low ability) personnel, this study investigated the feasibility of teaching such personnel a course in the operation of the AN/PSM-4 multimeter (an electronic measuring device), and evaluate the relative effectiveness of two different instructional methods. The course was given to…

  17. Impact of psm-mec in the mobile genetic element on the clinical characteristics and outcome of SCCmec-II methicillin-resistant Staphylococcus aureus bacteraemia in Japan. (United States)

    Aoyagi, T; Kaito, C; Sekimizu, K; Omae, Y; Saito, Y; Mao, H; Inomata, S; Hatta, M; Endo, S; Kanamori, H; Gu, Y; Tokuda, K; Yano, H; Kitagawa, M; Kaku, M


    Over-expression of alpha-phenol-soluble modulins (PSMs) results in high virulence of community-associated methicillin-resistant Staphylococcus aureus (MRSA). The psm-mec gene, located in the mobile genetic element SCCmec-II, suppresses PSMαs production. Fifty-two patients with MRSA bacteraemia were enrolled. MRSA isolates were evaluated with regard to the psm-mec gene sequence, bacterial virulence, and the minimum inhibitory concentration (MIC) of vancomycin and teicoplanin. Fifty-one MRSA isolates were classified as SCCmec-II, and 10 had one point mutation in the psm-mec promoter. We compared clinical characteristics and outcomes between mutant MRSA and wild-type MRSA. Production of PSMα3 in mutant MRSA was significantly increased, but biofilm formation was suppressed. Wild-type MRSA caused more catheter-related bloodstream infections (30/41 vs. 3/10, p 0.0028), whereas mutant MRSA formed more deep abscesses (4/10 vs. 3/41, p 0.035). Bacteraemia caused by mutant MRSA was associated with reduced 30-day mortality (1/10 vs. 13/41, p 0.25), although this difference was not significant. The MIC90 of teicoplanin was higher for wild-type MRSA (1.5 mg/L vs. 1 mg/L), but the MIC of vancomycin was not different between the two groups. The 30-day mortality of MRSA with a high MIC of teicoplanin (≥1.5 mg/L) was higher than that of strains with a lower MIC (≤0.75 mg/L) (6/10 vs. 6/33, p 0.017). Mutation of the psm-mec promoter contributes to virulence of SCCmec-II MRSA, and the product of psm-mec may determine the clinical characteristics of bacteraemia caused by SCCmec-II MRSA, but it does not affect mortality.

  18. 应用Vitek MS质谱检测PSM-mec对医院感染MRSA快速分型%Detection of PSM-mec by Vitek mass spectrometry for rapid identification of nosocomial-acquired methicillin-resistant Staphylococcus aureus

    Institute of Scientific and Technical Information of China (English)

    刘晔华; 王猛; 刘萍; 陈锦艳; 邢迎红; 张坚磊; 穆红


    Objective To evaluate the method of PSM-mec detection by Vitek MS for nosocomialacquired methicillin-resistant Staphylococcus aureus (MRSA) identification.Methods Totally 167 isolates of MRSA and 100 isolates of methicillin-sensitive Staphylococcus aureus (MSSA) used in this research were non-repetitively and prospectively collected between June 2012 and December 2013,two different SCCmec genotyping methods were applied for the MRSA strains,Vitek MS was used for identification of the isolates,the acquisition mass-spectrogram and the result mass-spectrogram at Myla system were analyzed among the different SCCmec type of MRSA.Results The 167 isolates of MRSA were classified into 5 major SCCmec types,among which SCCmec Ⅰ accounting for 3.6% (6 isolates);SCCmec Ⅱ 6.0% (10 isolates);SCCmec Ⅲ and Ⅲa 84.4% (141 isolates);SCCmec Ⅳand Ⅳ a 4.8% (8 isolates);SCCmec Ⅴ 1.2% (2 isolates),respectively.The peak adjacent to the horizontal axis of a m/z 2 500 could be visually identified between the SCCmec Ⅱ and Ⅲ MRSA,of which the delta toxin peak were presented at m/z 3 005-3 009 or m/z 3 037-3 056,while the strains without delta toxin peak and the other types of MRSA or MSSA had no characteristic peak at the same position.Conclusions Nosocomial-acquired MRSA of the drug-resistant condition could be rapidly differentiated and forecasted by Vitek MS.Vitek MS could serve as a routine clinical assistance for epidemiological investigations of nosocomial-acquired MRSA in local area.%目的 评估Vitek MS质谱快速检测PSM-mec在医院感染耐甲氧西林金黄色葡萄球菌(MRSA)分型的应用价值.方法 前瞻性研究.收集天津市第一中心医院2012年6月至2013年12月非重复分离的MRSA 167株和耐甲氧西林敏感金黄色葡萄球菌(MSSA) 100株,通过2种SCCmec分型技术检测MRSA的型别,以Vitek MS质谱对所有菌株进行常规鉴定并对菌株获取图谱和Myla结果图谱进行分析,探明不

  19. Assessment of Margins in Transoral Laser and Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Yaniv Hamzany


    Full Text Available The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM and transoral robotic surgery (TORS. Free margin status is being approached differently in vocal cord cancer (1–2 mm compared with other sites in the upper aerodigestive tract (2–5 mm. Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon’s judgment with regard to the completeness of tumor resection.

  20. Marginalization of the Youth

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal


    The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization.......The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization....

  1. Practical Marginalized Multilevel Models. (United States)

    Griswold, Michael E; Swihart, Bruce J; Caffo, Brian S; Zeger, Scott L


    Clustered data analysis is characterized by the need to describe both systematic variation in a mean model and cluster-dependent random variation in an association model. Marginalized multilevel models embrace the robustness and interpretations of a marginal mean model, while retaining the likelihood inference capabilities and flexible dependence structures of a conditional association model. Although there has been increasing recognition of the attractiveness of marginalized multilevel models, there has been a gap in their practical application arising from a lack of readily available estimation procedures. We extend the marginalized multilevel model to allow for nonlinear functions in both the mean and association aspects. We then formulate marginal models through conditional specifications to facilitate estimation with mixed model computational solutions already in place. We illustrate the MMM and approximate MMM approaches on a cerebrovascular deficiency crossover trial using SAS and an epidemiological study on race and visual impairment using R. Datasets, SAS and R code are included as supplemental materials.

  2. Multivariate Analysis on Post-conization Positive Surgical Margin in Patients with Stage Ⅲ Cervical Intraepithelial Neoplasia%宫颈上皮内瘤变Ⅲ锥切术后病理切缘阳性的多因素分析

    Institute of Scientific and Technical Information of China (English)

    郭文萍; 郭红燕; 王静


    Objective To assess the high-risk factors associated with conization margin status and management options in patients with cervical intraepithelial neoplasia Ⅲ ( CIN Ⅲ ). Methods A retrospective analysis on 442 patients with CIN Ⅲ who underwent conization between January 2004 and April 2010 in our hospital. Postoperative pathological analysis showed positive surgical margin in 41 cases ( positive group ), and negative margin in the other 401 cases ( negative group ). Results Binary logistic analysis showed that positive margin is correlated with severe cervical erosion ( OR = 3. 438, 95% CI = 1. 323 - 8. 933 ), in situ carcinoma ( OR =3. 792, 95% CI = 1. 594 -9. 022) , involvement of the glands ( OR = 3. 940, 95% CI = 1. 724 - 9. 004 ) , and > 3 lesions (OR =5. 083, 95% CI =2. 192- 11. 787 ). In our patients, the 21 cases of positive margin received a second surgery, after which the rate of residual lesion was 38.1% (8/21), which was similar to that in the negative group ( 14.8% , 8/54; Z = 1. 898, P =0.058). A follow-up was achieved in 20 of the 21 positive patients, during the follow-up, 3 patients showed recurrence or persisitence of the lesion ( 15.0% ); the rate was significantly higher than that in the negative group ( 1.7% , 3/241, Z = 2. 799, P = 0.005 ).Conclusions More than 3 lesions, glands involvement, in situ carcinoma, and cervical erosion are high-risk factors of positive surgical margin in patients with CIN Ⅲ. The positive margin is associated with recurrence/persistence. If re-conization is technically impossible, simple hysterectomy is the treatment option for the patients with positive margins. The patients with CIN Ⅲ should be followed up closely, especially for those with positive margins.%目的 探讨影响宫颈上皮内瘤变Ⅲ(cervical intraepithelial neoplasia Ⅲ,CINⅢ)锥切病理切缘阳性的高危因素及进一步处理的选择. 方法 回顾性分析我院2004年1月~2010年4月442例因CIN Ⅲ住

  3. Test of some numerical limiters for the conservative PSM scheme for 4D Drift-Kinetic simulations

    CERN Document Server

    Guterl, Jerome; Crouseilles, Nicolas; Grandgirard, Virginie; Latu, Guillaume; Mehrenberger, Michel; Sonnendrücker, Eric


    The purpose of this work is simulation of magnetised plasmas in the ITER project framework. In this context, Vlasov-Poisson like models are used to simulate core turbulence in the tokamak in a toroidal geometry. This leads to heavy simulation because a 6D dimensional problem has to be solved, 3D in space and 3D in velocity. The model is reduced to a 5D gyrokinetic model, taking advantage of the particular motion of particles due to the presence of a strong magnetic field. However, accurate schemes, parallel algorithms need to be designed to bear these simulations. This paper describes a Hermite formulation of the conservative PSM scheme which is very generic and allows to implement different semi-Lagrangian schemes. We also test and propose numerical limiters which should improve the robustness of the simulations by diminishing spurious oscillations. We only consider here the 4D drift-kinetic model which is the backbone of the 5D gyrokinetic models and relevant to build a robust and accurate numerical method.

  4. Global SH-wave propagation in a 2D whole Moon model using the parallel hybrid PSM/FDM method (United States)

    Jiang, Xianghua; Wang, Yanbin; Qin, Yanfang; Takenaka, Hiroshi


    We present numerical modeling of SH-wave propagation for the recently proposed whole Moon model and try to improve our understanding of lunar seismic wave propagation. We use a hybrid PSM/FDM method on staggered grids to solve the wave equations and implement the calculation on a parallel PC cluster to improve the computing efficiency. Features of global SH-wave propagation are firstly discussed for a 100-km shallow and 900-km deep moonquakes, respectively. Effects of frequency range and lateral variation of crust thickness are then investigated with various models. Our synthetic waveforms are finally compared with observed Apollo data to show the features of wave propagation that were produced by our model and those not reproduced by our models. Our numerical modeling show that the low-velocity upper crust plays significant role in the development of reverberating wave trains. Increasing frequency enhances the strength and duration of the reverberations. Surface multiples dominate wavefields for shallow event. Core-mantle reflections can be clearly identified for deep event at low frequency. The layered whole Moon model and the low-velocity upper crust produce the reverberating wave trains following each phases consistent with observation. However, more realistic Moon model should be considered in order to explain the strong and slow decay scattering between various phases shown on observation data.

  5. Staphylococcus aureus PSM peptides induce tolerogenic dendritic cells upon treatment with ligands of extracellular and intracellular TLRs. (United States)

    Armbruster, Nicole S; Richardson, Jennifer R; Schreiner, Jens; Klenk, Juliane; Günter, Manina; Autenrieth, Stella E


    Dendritic cells (DCs) are key players of the immune system and thus a target for immune evasion by pathogens. We recently showed that the virulence factor phenol-soluble modulin (PSM) produced by community-associated methicillin-resistant Staphylococcus aureus strains induces tolerogenic DCs upon Toll-like receptor (TLR) 2 activation via the p38-CREB-IL-10 pathway. Here, we addressed the question whether this tolerogenic phenotype of DCs induced by PSMs is specific for TLR2 activation. Therefore, bone marrow-derived DCs were treated with various ligands for extracellular and intracellular TLRs simultaneously with PSMα3. We show that PSMα3 modulates antigen uptake, maturation and cytokine production of DCs activated by TLR1/2, TLR2/6, TLR4, TLR7, and TLR9. Pre-incubation of DCs with a p38 MAP kinase inhibitor prevented the PSMα3-induced IL-10 secretion, as well as MHC class II up-regulation upon TLR activation. In consequence, the tolerogenic DCs induced by PSMα3 in response to several TLR ligands promoted priming of regulatory T cells. Thus, PSMs could be useful as inducers of tolerogenic DCs upon TLR ligand stimulation for therapeutic applications.

  6. Research of PIM to PSM Transformation Mechanism in Cloud Computing Environment%云计算环境下PIM与PSM的转化机制的研究

    Institute of Scientific and Technical Information of China (English)

    解绍词; 葛君伟


    On MDA--based cloud computing platform of software development, aiming at the problems of PIM to PSM reliability transformation, discuss and research the software development modeling process on MDA-based cloud computing environment, PIM and PSM model storage and interface form, and the PIM to PSM reliability transformation mechanism, the model of modeling software development on MDA-based cloud computing environment were presented, and the key technology search for the next step to study are mentioned.%针对基于MDA的云计算软件开发平台下,PIM到PSM之间可靠性转化问题,讨论和研究了基于MI)A的云环境软件开发建模过程、PIM与PSM模型存储与接口形式和MDA的PIM可靠准确转换成PSM的转换机制,给出了基于MDA的云环境软件开发建模模型,并对下一步需要研究的关键技术进行了展望.

  7. Insight into structure-function relationship in phenol-soluble modulins using an alanine screen of the phenol-soluble modulin (PSM) α3 peptide. (United States)

    Cheung, Gordon Y C; Kretschmer, Dorothee; Queck, Shu Y; Joo, Hwang-Soo; Wang, Rong; Duong, Anthony C; Nguyen, Thuan H; Bach, Thanh-Huy L; Porter, Adeline R; DeLeo, Frank R; Peschel, Andreas; Otto, Michael


    Phenol-soluble modulins (PSMs) are a family of peptides with multiple functions in staphylococcal pathogenesis. To gain insight into the structural features affecting PSM functions, we analyzed an alanine substitution library of PSMα3, a strongly cytolytic and proinflammatory PSM of Staphylococcus aureus with a significant contribution to S. aureus virulence. Lysine residues were essential for both receptor-dependent proinflammatory and receptor-independent cytolytic activities. Both phenotypes also required additional structural features, with the C terminus being crucial for receptor activation. Biofilm formation was affected mostly by hydrophobic amino acid positions, suggesting that the capacity to disrupt hydrophobic interactions is responsible for the effect of PSMs on biofilm structure. Antimicrobial activity, absent from natural PSMα3, could be created by the exchange of large hydrophobic side chains, indicating that PSMα3 has evolved to exhibit cytolytic rather than antimicrobial activity. In addition to gaining insight into the structure-function relationship in PSMs, our study identifies nontoxic PSMα3 derivatives for active vaccination strategies and lays the foundation for future efforts aimed to understand the biological role of PSM recognition by innate host defense.

  8. Ocean margins workshop

    Energy Technology Data Exchange (ETDEWEB)



    The Department of Energy (DOE) is announcing the refocusing of its marine research program to emphasize the study of ocean margins and their role in modulating, controlling, and driving Global Change phenomena. This is a proposal to conduct a workshop that will establish priorities and an implementation plan for a new research initiative by the Department of Energy on the ocean margins. The workshop will be attended by about 70 scientists who specialize in ocean margin research. The workshop will be held in the Norfolk, Virginia area in late June 1990.

  9. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt


    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...... argue that researchers not only need to pay attention to how certain voices are marginalized in Environmental Education research and practice, but also to how learners as agents respond to, use and negotiate the marginalization of their perspectives....

  10. Retrospective analysis of positive LEEP surgical margin and residual lesion in 246 patients with cervical high grade squamous intraepithelial lesion and micro invasive cancer after LEEP conization%宫颈高度鳞状上皮内病变和微小浸润癌环形电切术切缘阳性与病灶残余情况的246例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    高蜀君; 汪清; 郑瑞莲; 陈敏; 谢锋; 董晶; 刁雯静; 隋龙


    Objective: To evaluate the residual lesion and suitable treatment in patients with cervical high grade squamous intraepithelial lesion (HSIL) or micro invasive cancer underwent loop electrosurgical excision procedure (LEEP) conization with positive surgical margin. Methods: Two hundred and fortysix patients were included between January 2008 and December 2008 in this study for whom HSIL and micro invasive carcinoma were detected and then LEEP conizations were performed with positive surgical margin. The patients receiving conservative therapy were followed up with PAP-smear test, human papilloma virus (HPV) DNA test and cervical histological examination. The postoperative pathologic diagnosis and residual lesion were determined in patients receiving subsequent second operation.Results: Surgical margin was positive in 196 patients (16.87%, 196/1 162) of HSIL and 50 patients (43.48%, 50/115) of micro invasive cancer. The accuracy of colposcopic diagnosis and the rate of residual lesion were 90.82% (178/196) and 7.65% (15/196) for HSIL, and 8.00% (4/50) and 24.00% (12/50) for micro invasive cancer, respectively (P<0.05). The overall rate of residual lesion was 10.98% (27/246).Conclusion: Second LEEP or close monitoring are required for patients with positive surgical margin HSIL.Considered for high rates of positive surgical margin and residual disease in micro invasive cervical cancer, the active procedures should be performed on patients with positive LEEP surgical margin.%目的:探讨宫颈高度鳞状上皮内病变 (high grade squamous intraepithelial lesion,HSIL)和微小浸润癌环形电切术(loop electrosurgical excision procedure,LEEP)切缘阳性患者的病灶残留情况及其处理.方法:回顾性分析2008年1月-2008年12月因HSIL和微小浸润癌在本中心行LEEP的标本切缘阳性的246例患者的临床资料.对接受保守治疗者密切随访其宫颈细胞学、人乳头瘤病毒(human papilloma virus,HPV)感染情况

  11. Ex vivo ultrasound control of resection margins during partial nephrectomy. (United States)

    Doerfler, Arnaud; Cerantola, Yannick; Meuwly, Jean-Yves; Lhermitte, Benoît; Bensadoun, Henri; Jichlinski, Patrice


    Surgery remains the treatment of choice for localized renal neoplasms. While radical nephrectomy was long considered the gold standard, partial nephrectomy has equivalent oncological results for small tumors. The role of negative surgical margins continues to be debated. Intraoperative frozen section analysis is expensive and time-consuming. We assessed the feasibility of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy and its correlation with margin status on definitive pathological evaluation. A study was done at 2 institutions from February 2008 to March 2011. Patients undergoing partial nephrectomy for T1-T2 renal tumors were included in analysis. Partial nephrectomy was done by a standardized minimal healthy tissue margin technique. After resection the specimen was kept in saline and tumor margin status was immediately determined by ex vivo ultrasound. Sequential images were obtained to evaluate the whole tumor pseudocapsule. Results were compared with margin status on definitive pathological evaluation. A total of 19 men and 14 women with a mean ± SD age of 62 ± 11 years were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 30 cases and positive margins in 2 while it could not be done in 1. Final pathological results revealed negative margins in all except 1 case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Median ultrasound duration was 1 minute. Mean tumor and margin size was 3.6 ± 2.2 cm and 1.5 ± 0.7 mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy is feasible and efficient. Large sample studies are needed to confirm its promising accuracy to determine margin status. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Indian Ocean margins

    Digital Repository Service at National Institute of Oceanography (India)

    Naqvi, S.W.A.

    The most important biogeochemical transformations and boundary exchanges in the Indian Ocean seem to occur in the northern region, where the processes originating at the land-ocean boundary extend far beyond the continental margins. Exchanges across...

  13. Learning unbelievable marginal probabilities

    CERN Document Server

    Pitkow, Xaq; Miller, Ken D


    Loopy belief propagation performs approximate inference on graphical models with loops. One might hope to compensate for the approximation by adjusting model parameters. Learning algorithms for this purpose have been explored previously, and the claim has been made that every set of locally consistent marginals can arise from belief propagation run on a graphical model. On the contrary, here we show that many probability distributions have marginals that cannot be reached by belief propagation using any set of model parameters or any learning algorithm. We call such marginals `unbelievable.' This problem occurs whenever the Hessian of the Bethe free energy is not positive-definite at the target marginals. All learning algorithms for belief propagation necessarily fail in these cases, producing beliefs or sets of beliefs that may even be worse than the pre-learning approximation. We then show that averaging inaccurate beliefs, each obtained from belief propagation using model parameters perturbed about some le...

  14. 携带psm-mec基因的耐甲氧西林表皮葡萄球菌产细菌生物膜的能力研究

    Institute of Scientific and Technical Information of China (English)

    杨永长; 陈亮; 肖代雯; 喻华; 刘华; 黄文芳


    目的 探讨耐甲氧西林表皮葡萄球菌(MRSE)携带psm-mec基因的情况及产细菌生物膜(biofilm,Bf)的能力,为进一步分析psm-mec与Bf的关系奠定基础.方法 收集临床分离并经全自动微生物鉴定系统准确鉴定的表皮葡萄球菌84株,通过PCR扩增esp和mecA基因准确鉴定和区分甲氧西林敏感表皮葡萄球菌(MSSE)和MRSE,常规PCR检测psm-mec基因确定携带psm-mec菌株,PCR扩增fudoh基因及测序检测sm-mec上游有无基因突变,96孔培养板半定量法评估菌株产Bf的能力.结果 84株表皮葡萄球菌中esp基因均阳性,mecA基因阳性64株,故MRSE为64株(76.2%).MRSE中psm-mec基因的携带率为39.1% (25/64).Bf半定量检测发现,25株psm-mec阳性MRSE中产Bf 20株(80%),39株psm-mec阴性MRSE中产Bf13株(33.33%),差异有统计学意义(x2=13.28,P<0.05).fudoh基因序列分析发现,20株产Bf且携带psm-mec的MRSE均未发现基因突变,另有3株不产Bf的psm-mec阳性MRSE在psm-mec上游存在点突变(G>A).结论 psm-mec广泛存在于临床分离的MRSE中,绝大部分携带psm-mec的MRSE具有Bf形成能力.

  15. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan


    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  16. The Surgical Treatment of Mycetoma. (United States)

    Suleiman, Suleiman Hussein; Wadaella, El Sammani; Fahal, Ahmed Hassan


    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  17. The Surgical Treatment of Mycetoma.

    Directory of Open Access Journals (Sweden)

    Suleiman Hussein Suleiman


    Full Text Available Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  18. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup


    This article analyses how young marginalized ethnic minority men in Denmark react to the othering they are subject to in the media as well as in the social arenas of every day life. The article is based on theoretically informed ethnographic fieldwork among such young men as well as interviews an...

  19. From Borders to Margins

    DEFF Research Database (Denmark)

    Parker, Noel


    upon Deleuze's philosophy to set out an ontology in which the continual reformulation of entities in play in ‘post-international' society can be grasped.  This entails a strategic shift from speaking about the ‘borders' between sovereign states to referring instead to the ‘margins' between a plethora...

  20. Marginally Deformed Starobinsky Gravity

    DEFF Research Database (Denmark)

    Codello, A.; Joergensen, J.; Sannino, Francesco


    We show that quantum-induced marginal deformations of the Starobinsky gravitational action of the form $R^{2(1 -\\alpha)}$, with $R$ the Ricci scalar and $\\alpha$ a positive parameter, smaller than one half, can account for the recent experimental observations by BICEP2 of primordial tensor modes....

  1. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt


    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...

  2. Oncoplastic Breast Reduction: Maximizing Aesthetics and Surgical Margins

    Directory of Open Access Journals (Sweden)

    Michelle Milee Chang


    Full Text Available Oncoplastic breast reduction combines oncologically sound concepts of cancer removal with aesthetically maximized approaches for breast reduction. Numerous incision patterns and types of pedicles can be used for purposes of oncoplastic reduction, each tailored for size and location of tumor. A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer.

  3. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis (United States)


    column two. Hematoxylin has a deep blue-purple color and stains nucleic acids , which are primarily located in the cell nuclei. Eosin is pink and stains...Pietsch, H. Lanfermann, U. Pichlmeier, M. Mehdorn and -. A. R. Glioma, "Five-Aminolevulinic Acid for Fluorescence-Guided Resection of Recurrent...ed. (CRC Press, 2008). 27. C. Goutte , "Note on free lunches and cross-validation," Neural Comput 9 (6), 1245-1249 (1997). 28. H. Y. Zhu and R

  4. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis (United States)


    cancer (orange). (f) Corresponding immunohistochemical measures of percent stroma, epithelium and fat, and CD31- positive, CD105-positive vascular...density and area. A b [HbT] % O2 % H2O % Epithelium -0.06 -0.37 0.27 -0.11 -0.21 % Stroma 0.06 0.33 -0.28 0.09 0.25 % Fat -0.02 -0.01 0.21 0.02...scattering slope was observed to better localize suspicious fibro- glandular lesions. The scattering slope was likely under-valued by the limitations

  5. Tips and tricks in surgical management of maxillary sinus tumors

    Directory of Open Access Journals (Sweden)

    Ahmed Mostafa Mahmoud


    Conclusion: Fine intraoperative surgical maneuvers can obtain secured resection margin (with special attention to adenoid cystic carcinoma; avoid postoperative functional complications like trismus, nasal regurgitation of food, epiphora or double vision finally enhance esthetic results

  6. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup


    of critique although in a masculinist way. These reactions to othering represent a challenge to researchers interested in intersectionality and gender, because gender is reproduced as a hierarchical form of social differentiation at the same time as racism is both reproduced and resisted.......This article analyses how young marginalized ethnic minority men in Denmark react to the othering they are subject to in the media as well as in the social arenas of every day life. The article is based on theoretically informed ethnographic fieldwork among such young men as well as interviews...... and other types of material. Taking the concepts of othering, intersectionality and marginality as point of departure the article analyses how these young men experience othering and how they react to it. One type of reaction, described as stylization, relies on accentuating the latently positive symbolic...

  7. Actively stressed marginal networks

    CERN Document Server

    Sheinman, M; MacKintosh, F C


    We study the effects of motor-generated stresses in disordered three dimensional fiber networks using a combination of a mean-field, effective medium theory, scaling analysis and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of non-affine strain fluctuations as a susceptibility to motor stress.

  8. Actively stressed marginal networks. (United States)

    Sheinman, M; Broedersz, C P; MacKintosh, F C


    We study the effects of motor-generated stresses in disordered three-dimensional fiber networks using a combination of a mean-field theory, scaling analysis, and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of nonaffine strain fluctuations as a susceptibility to motor stress.

  9. Analysis of Ripple Effect on PSM Modulator of Short Wave Transmitter%纹波对短波发射机PSM调制器的影响分析

    Institute of Scientific and Technical Information of China (English)



    DC regulated power supply due to voltage fluctuations exist ripple. PSM short wave transmitters by PSM modulator control ladder DC and audio signal,and the signal exist ladder ripple effect of the transmitter distortion index. This paper mainly introduces the PSM modulator ripple generation and elimination of ripple method to reduce the distortion of the transmitter.%直流稳压电源由于电压波动而存在纹波,短波PSM发射机由PSM调制器控制产生阶梯状直流加音频信号,而该信号中存在阶梯纹波会影响发射机的失真指标,本文主要介绍PSM调制器纹波产生及消除纹波降低发射机失真的办法。

  10. DF100 kW PSM Transmitter Audio Path Analysis%DF100 kW PSM发射机音频通路分析

    Institute of Scientific and Technical Information of China (English)



    DF100 kW PSM transmitter as an important model of Press and Publication Administration of Radio, the radio station plays an irreplaceable role in the country’s short-covering task, while maintaining the audio path is one of the means to ensure that the transmitter normal broadcast. Actual work situation, analyzed and summarized DF100 kW PSM transmitter audio path and typical fault in order to provide a reference for future maintenance staff.%DF100 kW PSM发射机作为国家新闻出版广电总局无线局的重要机型,在全国的短波覆盖任务中起着不可替代的作用,而音频通路的维护是保证发射机正常播音的手段之一。结合实际工作情况,分析总结了DF100 kW PSM发射机的音频通路和典型故障,以期为维护人员日后的工作提供一定的参考。

  11. Phenol soluble modulin (PSM) variants of community-associated methicillin-resistant Staphylococcus aureus (MRSA) captured using mass spectrometry-based molecular networking. (United States)

    Gonzalez, David J; Vuong, Lisa; Gonzalez, Isaiah S; Keller, Nadia; McGrosso, Dominic; Hwang, John H; Hung, Jun; Zinkernagel, Annelies; Dixon, Jack E; Dorrestein, Pieter C; Nizet, Victor


    Molecular genetic analysis indicates that the problematic human bacterial pathogen methicillin-resistant Staphylococcus aureus possesses more than 2000 open reading frames in its genome. This number of potential gene products, coupled with intrinsic mechanisms of posttranslational modification, endows methicillin-resistant Staphylococcus aureus with a highly complex biochemical repertoire. Recent proteomic and metabolomic advances have provided methodologies to better understand and characterize the biosynthetic factors released by microbial organisms. Here, the emerging tool of mass spectrometry-based molecular networking was used to visualize and map the repertoire of biosynthetic factors produced by a community-associated methicillin-resistant Staphylococcus aureus strain representative of the epidemic USA300 clone. In particular, the study focused on elucidating the complexity of the recently discovered phenol soluble modulin family of peptides when placed under various antibiotic treatment stresses. Novel PSM truncated variant peptides were captured, and the type of variants that were clustered by the molecular networks platform changed in response to the different antibiotic treatment conditions. After discovery, a group of the peptides were selected for functional analysis in vitro. The peptides displayed bioactive properties including the ability to induce proinflammatory responses in human THP-1 monocytes. Additionally, the tested peptides did not display antimicrobial activity as previously reported for other phenol soluble modulin truncated variants. Our findings reveal that the PSM family of peptides are quite structurally diverse, and suggest a single phenol soluble modulin parent peptide can functionally spawn differential bioactivities in response to various external stimuli.

  12. Marginal grafts increase early mortality in liver transplantation

    Directory of Open Access Journals (Sweden)

    Telesforo Bacchella

    Full Text Available CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD, as low MELD ( 20. The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.

  13. 韩国石油化工工艺安全管理(PSM)的发展及特点%Development and features of process safety management (PSM) of petrochemical industry in Korea

    Institute of Scientific and Technical Information of China (English)



    Korea is an important country of manufacturing petrochemical products. Korean process safety management (PSM) level of petrochemical industry is in advanced one all over the world. In the paper the background for legislation of PSM system in Korea is introduced and the contents concerning PSM law are presented. Grading system is an unique feature of Korean PSM,so the evaluation procedure of the workplaces subject to the PSM regulations and grading standards are emphatically introduced. The authorities conduct an inspection or take other administrative measures taking into account the grading results. Finally,the effectiveness of KOSHA PSM is confirmed by comparison of safety situation before and after implication of PSM. The petrochemical industry in China has developed quickly in the recent two decades,especially construction of the chemical industry park. Thus,the risk management has been a key issue for Chinese government and petrochemical enterprises. Understanding the growing way of KOSHA PSM has a reference value to start and develop the process safety management for Chinese petrochemical enterprises.%韩国是世界上重要的石油化工产品生产国,其石化行业的工艺安全管理(PSM)水平处于国际先进地位。本文介绍了韩国引进美国OSHA的PSM体系的工业背景及韩国KOSHA PSM体系的主要内容;企业分级管理是韩国PSM的独有特色,本文重点介绍了韩国PSM体系的分级制度,详细说明劳动部对企业PSM实施状况的评价过程及分级标准,以分级结果为依据对不同级别的企业采取相应的管理监控措施。最后,通过对比PSM实施前后韩国石化行业安全生产状况,证实韩国PSM的效果。近二十年来中国石油化工产业快速发展,尤其是化学工业园的建设,使得风险管理成为亟待解决的问题。了解韩国PSM的发展之路对于中国石化企业开展工艺安全管理工作具有参考价值和借鉴意义。

  14. 经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的影响因素分析%Study on Factors of Positive Margins after Transperitoneal Laparoscopic Radical Prostatectomy

    Institute of Scientific and Technical Information of China (English)

    宋伟; 赵勇; 金讯波; 王慕文; 张海洋


    目的 探讨经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的相关影响因素. 方法 2009年9月至2014年5月,采用经腹腔途径行腹腔镜下前列腺癌根治术61例. 患者年龄56~74岁,平均71岁. 术前均经直肠超声引导下穿刺病理证实前列腺癌诊断. 通过回顾性研究了解术前血清前列腺特异性抗原( PSA)、穿刺后Gleason评分、穿刺针数阳性百分率,术前TNM分期对手术切缘阳性的影响. 结果 61例前列腺癌患者术后切缘阳性率19.7%(12/61),病理分期与手术切缘阳性成正相关(γ=0.311,P=0.001),且对手术切缘阳性有统计学意义(χ2 =16.32,P=0.001);对于手术切缘阳性率,术前血清PSA<20ng/ml组与血清PSA≥20ng/ml组比较,差异有统计学意义(χ2 =7.32,P=0.007);穿刺后Gleason评分<7分组与Gleason评分≥7分组差异无统计学意义了(χ2 =1.43,P=0.23);穿刺针数阳性百分率,<50%组与≥50%组差异有统计学意义(χ2 =4.32,P=0.017). 结论 穿刺后TNM分期,血清PSA水平,穿刺阳性百分率的差异对手术切缘阳性有统计学意义. 前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性.%Objective To explore the relative risk factors for positive surgical margins ( PSM) in transperito-neal laparoscopic radical prostatectomy ( LRP).Methods From September 2009 to May 2014, 61 patients ( mean age 71 years old) with prostate cancers underwent transperitoneal LRP.The retrospective study recruited 61 patients with prostate cancer underwent transperitoneal laparoscopic radical prostatectomy to access the impact of pathological stage, PSA, Gleason scores and positive percentage of the needle biopsy on positive surgical mar-gins.Results The overall margin positivity rate was 19.7% (12/61).We found positive correlation (γ=0.311, P=0.001) between positive surgical margin and pathologic staging, and the difference was statistically significant (χ2 =16.32 , P=0.001).There was significant difference

  15. Is the Longitudinal Margin of Carcinoma-Bearing Colon Resections a Neglected Parameter?

    DEFF Research Database (Denmark)

    Rørvig, Sara; Schlesinger, Nis; Mårtensson, Nina Løth;


    BACKGROUND: Resection of colon cancer with curative intent implies clear margins. An arbitrary requirement of 2 cm DtLM generally ensures surgical and pathological clearance. However, harvest of tumor-draining lymph nodes is related to DtLM. For this reason, an extended longitudinal margin become...

  16. [Surgical tactics by various ameloblastic tumors]. (United States)

    Semkin, V A; Grigor'ian, A S; Babichenko, I I; Usachev, E S; Zaretskaia, A S


    Ameloblastoma and ameloblastic fibroma are benign odontogenous tumors of the jaws with local destructive growth, prone to recurrence. They have various typical radiological and histological features. Surgical tactic generally includes partial resection of the affected jaw. Immunohistochemical study of the tumor tissues allows assessing the expression of tumor progression markers and forecasting tumor growth thus providing individual choice of surgical tactics. Our experience in treatment of ameloblastic tumors showed total biopsy with osseous surgical margins resection to be sufficient for normal bone structure remodeling in some patients.

  17. Rare Posterior Pharyngeal Mass: Atypical Marginal Zone Hyperplasia. (United States)

    Eliçora, Sultan Şevik; Güven, Mehmet; Varli, Ali F; Yilmaz, Mahmut S; Alponat, Selin


    Cases of posterior pharyngeal masses are quite rare, and are typically derived from schwannoma or encephalocele, or are of vascular or infectious origin. They are clinically significant due to their tendency to cause airway obstruction. The aim of this study was to present a rare atypical marginal hyperplasia case of a posterior pharyngeal wall mass. A 10-year-old male was admitted to our clinic with dyspnea. A plane-surfaced 4 × 3 × 3 cm mass was observed on the posterior pharyngeal wall upon physical examination. The patient underwent magnetic resonance imaging and surgical treatment. Following excision of material from the patient's mass, a pathologic diagnosis of atypical marginal zone hyperplasia was made. Atypical marginal zone hyperplasia of the posterior pharyngeal wall has not yet been reported in the literature. Marginal zone hyperplasia associated with a lymphoproliferative disease should be considered when making differential diagnoses of posterior pharyngeal wall masses.

  18. Radical prostatectomy for clinically localised prostate cancer at Rigshospitalet 1995-2011

    DEFF Research Database (Denmark)

    Røder, Martin Andreas


    of time to BR was done using Kaplan-Meier estimation and Cox regression analysis including both pre- and postoperative parameters. The association between preoperative and surgical parameters, including surgeon and nerve-sparing surgery, and PSM was analysed using logistic regression analysis. Results......: The 10-year estimated BRFS was 75%, 60% and 39% for low-, intermediate-, and high-risk patients, respectively. An in-depth analysis of high-risk patients demonstrated a 10-year metastasis-free and cancer-specific survival of 85% and 90%, respectively. A PSM was demonstrated to increase the risk of BR up...... to 3 fold. The location of PSM was found to be associated with the risk of BR, i.e. non-apical PSM had the highest risk of BR compared to margin negative and apical PSM, especially in pT2 tumours. A number of factors were found to correlate with the risk of PSM, especially preoperative PSA, surgeon...

  19. Iberian Atlantic Margins Group investigates deep structure of ocean margins (United States)

    The Iberian Atlantic Margins Group; Banda, Enric; Torne, Montserrat

    With recent seismic reflection data in hand, investigators for the Iberian Atlantic Margins project are preparing images of the deep continental and oceanic margins of Iberia. In 1993, the IAM group collected near vertical incidence seismic reflection data over a total distance of 3500 km along the North and Western Iberian Margins, Gorringe Bank Region and Gulf of Cadiz (Figure 1). When combined with data on the conjugate margin off Canada, details of the Iberian margin's deep structure should aid in distinguishing rift models and improve understanding of the processes governing the formation of margins.The North Iberian passive continental margin was formed during a Permian to Triassic phase of extension and matured during the early Cretaceous by rotation of the Iberian Peninsula with respect to Eurasia. From the late Cretaceous to the early Oligocene period, Iberia rotated in a counterclockwise direction around an axis located west of Lisbon. The plate boundary between Iberia and Eurasia, which lies along the Pyrenees, follows the north Spanish marginal trough, trends obliquely in the direction of the fossil Bay of Biscay triple junction, and continues along the Azores-Biscay Rise [Sibuet et al., 1994]. Following the NE-SW convergence of Iberia and Eurasia, the reactivation of the North Iberian continental margin resulted in the formation of a marginal trough and accretionary prism [Boillot et al., 1971].

  20. Surgical Treatment of Skin Tumors

    Directory of Open Access Journals (Sweden)



    Full Text Available When we mention about surgical treatment of any tumor residing on the skin independent of its benign or malignant nature, the first method we recall is excision. Elliptical excision is the mainstay of the dermatologic surgery. Each excision ends with a defect for which we are responsible to repair functionally and cosmetically. The diameter of the tumor we excised and the safety margin used for excision determine the diameter of the final defect. After achieving tumor free lateral and deep margins with the appropriate surgical method, we decide between the repair options of second intention healing, primary repair, flaps, full or split thickness grafts, considering the diameter and the anatomic localization of the defect, for the best functional and cosmetic result for that specific defect. This review overviews not only the most common dermatologic surgical methods, but also Mohs surgery which is a method rarely used in our country, although it is the treatment of choice for the treatment of high risk basal cell carcinoma (BCC and squamous cell carcinoma (SCC.

  1. Marginally Stable Nuclear Burning (United States)

    Strohmayer, Tod E.; Altamirano, D.


    Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high-inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi-periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.

  2. Gaussian quantum marginal problem

    CERN Document Server

    Eisert, J; Sanders, B C; Tyc, T


    The quantum marginal problem asks what local spectra are consistent with a given state of a composite quantum system. This setting, also referred to as the question of the compatibility of local spectra, has several applications in quantum information theory. Here, we introduce the analogue of this statement for Gaussian states for any number of modes, and solve it in generality, for pure and mixed states, both concerning necessary and sufficient conditions. Formally, our result can be viewed as an analogue of the Sing-Thompson Theorem (respectively Horn's Lemma), characterizing the relationship between main diagonal elements and singular values of a complex matrix: We find necessary and sufficient conditions for vectors (d1, ..., dn) and (c1, ..., cn) to be the symplectic eigenvalues and symplectic main diagonal elements of a strictly positive real matrix, respectively. More physically speaking, this result determines what local temperatures or entropies are consistent with a pure or mixed Gaussian state of ...

  3. Antiviral effect of PSM against herpes simplex virus type 2%4-苯乙烯磺酸马来酸酐共聚物抑制HSV-2感染研究

    Institute of Scientific and Technical Information of China (English)

    陈钰; 宋思维; 邱敏; 吴稚伟


    Objective: To investigate the antiviral effect of polymer of styrenesulfonic acid and maleic acid ( 4-styrenesulfonic acid-ccrmaleic acid ) ( PSM ) against herpes simplex virus type 2 ( HSV-2 ). Methods: A Vercr ICP10 cell line containing virus-controlled Luciferase as indicator was established for analyzing the effect of different concentrations of PSM on HSV-2 infection. An In cell western assay was also used for detecting intracellular viral protein expression. PSM inhibitory activity was further evaluated in a HSV- 2 vaginal challenge murine model. Results: The results of in vitro analyses showed that PSM could protect cell from HSV-2 infection, and the murine model showed that 5% PSM protected 95% of the animals from HSV-2 infection ( P <0. 001 ). Conclusion: PSM is a potential agent for the prevention of HSV-2 infection through sexual route.%目的:探索4-苯乙烯磺酸马来酸酐共聚物(PSM)对单纯疱疹病毒Ⅱ型(HSV-2)感染细胞或小鼠的抑制作用.方法:建立Vero-ICP10细胞系,通过Luciferase检测不同浓度PSM对感染细胞中HSV-2的抑制作用,并通过In cell western技术检测HSV-2 gD蛋白表达,确定不同PSM浓度对HSV-2 gD蛋白表达的抑制作用;建立HSV-2阴道感染小鼠模型,观察PSM对HSV-2经生殖道感染小鼠的抑制作用.结果:Luciferase实验和In cell western实验结果均表明PSM具有抗HSV-2感染细胞的作用;小鼠模型中,5%的PSM能有效防止小鼠感染HSV-2(P<0.001).结论:PSM在体内和体外模型中均可以抑制HSV-2感染.

  4. Surgical Innovation in Sarcoma Surgery. (United States)

    Jeys, L; Morris, G; Evans, S; Stevenson, J; Parry, M; Gregory, J


    The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  5. Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience

    Directory of Open Access Journals (Sweden)

    Clement S. Trovik


    Full Text Available Surgery remains the mainstay of soft tissue sarcoma (STS treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998–2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS.

  6. A new surgical technique for ingrown toenail. (United States)

    Mousavi, Seyed Reza; Khoshnevice, Jaledin


    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin on the toe we have done one-bite suture by Nylon 3/0 that was removed after 3 weeks. Results. All patients were operated on by our new technique and the outcome was excellent; recurrence and failure of the technique were very low. Discussion. Because with this simple technique we excise the granulation tissue and elevate margin of nail over the skin, we will have higher cure rate, shorter postoperative pain, lower risk of postoperative infection, and remarkable cosmetic result without deformity; hence this technique should be considered as an alternative method of treatment.

  7. Workers' marginal costs of commuting

    DEFF Research Database (Denmark)

    van Ommeren, Jos; Fosgerau, Mogens


    This paper applies a dynamic search model to estimate workers' marginal costs of commuting, including monetary and time costs. Using data on workers' job search activity as well as moving behaviour, for the Netherlands, we provide evidence that, on average, workers' marginal costs of one hour...

  8. A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

    Directory of Open Access Journals (Sweden)

    Hilton Becker, MD


    Full Text Available Summary: Nipple-sparing mastectomy (NSM is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

  9. Estimating Marginal Returns to Education (United States)

    Carneiro, Pedro; Heckman, James J.; Vytlacil, Edward


    This paper estimates marginal returns to college for individuals induced to enroll in college by different marginal policy changes. The recent instrumental variables literature seeks to estimate this parameter, but in general it does so only under strong assumptions that are tested and found wanting. We show how to utilize economic theory and local instrumental variables estimators to estimate the effect of marginal policy changes. Our empirical analysis shows that returns are higher for individuals with values of unobservables that make them more likely to attend college. We contrast our estimates with IV estimates of the return to schooling. PMID:25110355

  10. Marginal Solutions for the Superstring

    CERN Document Server

    Erler, Theodore


    We construct a class of analytic solutions of WZW-type open superstring field theory describing marginal deformations of a reference D-brane background. The deformations we consider are generated by on-shell vertex operators with vanishing operator products. The superstring solution exhibits an intriguing duality with the corresponding marginal solution of the {\\it bosonic} string. In particular, the superstring problem is ``dual'' to the problem of re-expressing the bosonic marginal solution in pure gauge form. This represents the first nonsingular analytic solution of open superstring field theory.

  11. Processo de Separação por Membrana (PSM: aplicação da tecnologia na indústria láctica

    Directory of Open Access Journals (Sweden)

    Jânio Sousa Santos


    Full Text Available The food industry is characterized by being a industry intensive technology , but the innovations in this area are often incremental, whose dynamics is based on new combinations of existing knowledge. Among the various sectors of the food industry, the dairy sector plays an important role in the Brazilian economy and stands out among the top four. Starting from the significant growth in this sector three points deserve more attention being: intolerance / allergy to protein (casein or lactose, coproduct whey and waste water. In order to minimize and solve these barriers industry in the processes membrane separation (PSM have been used in industry with the aim to separate, purify or concentrate determined components in the mixture of interest. The present work aims to bring to the fore the importance and the use of ultrafiltration in the dairy sector. Was delimited a qualitative approach to research, which gave through archival and bibliographic research .The ultrafiltration technology has provided great advances with regard to technology in dairy and becoming able to work with materials that were previously considered as waste in agro industries processing as whey, brine and residual water dairy others.

  12. Construction of a multiplex promoter reporter platform to monitor Staphylococcus aureus virulence gene expression and the identification of usnic acid as a potent suppressor of psm gene expression

    Directory of Open Access Journals (Sweden)

    Peng GAO


    Full Text Available As antibiotic resistance becomes phenomenal, alternative therapeutic strategies for bacterial infections such as anti-virulence treatments have been advocated. We have constructed a total of 20 gfp-luxABCDE dual-reporter plasmids with selected promoters from S. aureus virulence-associated genes. The plasmids were introduced into various S. aureus strains to establish a gfp-lux based multiplex promoter reporter platform for monitoring S. aureus virulence gene expressions in real time to identify factors or compounds that may perturb virulence of S. aureus. The gene expression profiles monitored by luminescence correlated well with qRT-PCR results and extrinsic factors including carbon dioxide and some antibiotics were shown to suppress or induce the expression of virulence factors in this platform. Using this platform, sub-inhibitory ampicillin was shown to be a potent inducer for the expression of many virulence factors in S. aureus. Bacterial adherence and invasion assays using mammalian cells were employed to measure S. aureus virulence induced by ampicillin. The platform was used for screening of natural extracts that perturb the virulence of S. aureus and usnic acid was identified to be a potent repressor for the expression of psm.

  13. Psychological Stress Measure (PSM-9): integration of an evidence-based approach to assessment, monitoring, and evaluation of stress in physical therapy practice. (United States)

    Lemyre, Louise; Lalande-Markon, Marie-Pierre


    Stress can be a primary or secondary contributor to ill health via excessive and sustained sympathetic arousal leading to ischemic heart disease, hypertension, stroke, obesity, and mental ill health, or through related behaviors such as smoking, substance abuse, and over or inappropriate eating; or as a contextual variable in terms of risk factor and lifestyle outcome. In addition, psychosocial stress can impair recovery from any pathological insult or injury. Most assessments of stress relate to life events, and both past and current life stressors, acute and chronic, play a major role. However, beyond the impact of stressors, it is the reported state of feeling stressed that is the critical predictor of ill health. This article describes stress and its correlates, discusses models of stress, and presents the nine-item Psychological Stress Measure (PSM-9). This tool is aimed directly at the state of feeling stressed, is suited for assessing stress clinically in the general population and serving as an outcome measure. The tool is valid and reliable and easy to administer in health care settings; it has a normal distribution, which makes it a very sensitive-to-change instrument in repeated measures to document progress.

  14. Construction of a Multiplex Promoter Reporter Platform to Monitor Staphylococcus aureus Virulence Gene Expression and the Identification of Usnic Acid as a Potent Suppressor of psm Gene Expression. (United States)

    Gao, Peng; Wang, Yanli; Villanueva, Iván; Ho, Pak Leung; Davies, Julian; Kao, Richard Yi Tsun


    As antibiotic resistance becomes phenomenal, alternative therapeutic strategies for bacterial infections such as anti-virulence treatments have been advocated. We have constructed a total of 20 gfp-luxABCDE dual-reporter plasmids with selected promoters from S. aureus virulence-associated genes. The plasmids were introduced into various S. aureus strains to establish a gfp-lux based multiplex promoter reporter platform for monitoring S. aureus virulence gene expressions in real time to identify factors or compounds that may perturb virulence of S. aureus. The gene expression profiles monitored by luminescence correlated well with qRT-PCR results and extrinsic factors including carbon dioxide and some antibiotics were shown to suppress or induce the expression of virulence factors in this platform. Using this platform, sub-inhibitory ampicillin was shown to be a potent inducer for the expression of many virulence factors in S. aureus. Bacterial adherence and invasion assays using mammalian cells were employed to measure S. aureus virulence induced by ampicillin. The platform was used for screening of natural extracts that perturb the virulence of S. aureus and usnic acid was identified to be a potent repressor for the expression of psm.

  15. The ClpXP protease is responsible for the degradation of the Epsilon antidote to the Zeta toxin of the streptococcal pSM19035 plasmid. (United States)

    Brzozowska, Iwona; Zielenkiewicz, Urszula


    Most bacterial genomes contain different types of toxin-antitoxin (TA) systems. The ω-ε-ζ proteinaceous type II TA cassette from the streptococcal pSM19035 plasmid is a member of the ε/ζ family, which is commonly found in multiresistance plasmids and chromosomes of various human pathogens. Regulation of type II TA systems relies on the proteolysis of antitoxin proteins. Under normal conditions, the Epsilon antidote neutralizes the Zeta toxin through the formation of a tight complex. In this study, we show, using both in vivo and in vitro analyses, that the ClpXP protease is responsible for Epsilon antitoxin degradation. Using in vivo studies, we examined the stability of the plasmids with active or inactive ω-ε-ζ TA cassettes in B. subtilis mutants that were defective for different proteases. Using in vitro assays, the degradation of purified His6-Epsilon by the His6-LonBs, ClpPBs, and ClpXBs proteases from B. subtilis was analyzed. Additionally, we showed that purified Zeta toxin protects the Epsilon protein from rapid ClpXP-catalyzed degradation.


    Directory of Open Access Journals (Sweden)

    Wahid Sri Yuliani


    Full Text Available Observasi awal di SMK PSM Randublatung Blora kelas XI Administrasi Perkantoran ditemukan bahwa keterampilan siswa dalam prosedur mengarsip menggunakan kartu kendali masih rendah. Hal ini dapat dilihat dari proses pengisian kartu kendali masih banyak yang salah dan tidak rangkap tiga, selain itu siswa dalam mengarsip banyak yang bertanya dengan temannya. Subjek penelitian ini adalah siswa kelas XI AP SMK PSM Randublatung Blora tahun ajaran 2 013/2014. Instrumen yang digunakan adalah tes dan non tes. Instrumen tes berupa tes evaluasi untuk mengetahui hasil belajar siswa. Instrumen non tes berupa lembar pengamatan keterampilan siswa. Hasil penelitian pada siklus I menunjukkan rata-rata tingkat keterampilan siswa sebesar 61,71% termasuk dalam kategori cukup. Untuk hasil penelitian siklus II menunjukkan rata -rata tingkat keterampilan siswa sebesar 85,79% termasuk dalam kategori sangat baik. Based on the first observation, is students grade XI AP SMK PSM Randublatung Blora founded that students; skill in archives procedure using control card is still low. It can be seen from t he mistake on the filling of control card and it is not triplicate. Besides, there are many students that ask to their friends in achieving. The subject of this research is students grade XI AP SMK PSM Randublatung Blora year 2013/2014. Test instrument is evaluation test to know the students’ studying result. Non test instrument is a sheet of skill observation and a sheet of students’ activity observation. Observation result on cycle I show that the average of student skill is 61,71% include in enough category. Meanwhile, the cycle II show that the average of student skill is 85,79% include in very good category. © 2014 UniversitasNegeri Semarang

  17. MRI Evaluation of Resection Margins in Bone Tumour Surgery

    Directory of Open Access Journals (Sweden)

    Simon Vandergugten


    Full Text Available In 12 patients operated on for bone sarcoma resection, a postoperative magnetic resonance imaging of the resection specimens was obtained in order to assess the surgical margins. Margins were classified according to MRI in R0, R1, and R2 by three independent observers: a radiologist and two orthopaedic surgeons. Final margin evaluation (R0, R1, and R2 was assessed by a confirmed pathologist. Agreement for margin evaluation between the pathologist and the radiologist was perfect (κ=1. Agreement between the pathologist and an experienced orthopaedic surgeon was very good while it was fair between the pathologist and a junior orthopaedic surgeon. MRI should be considered as a tool to give quick information about the adequacy of margins and to help the pathologist to focus on doubtful areas and to spare time in specimen analysis. But it may not replace the pathological evaluation that gives additional information about tumor necrosis. This study shows that MRI extemporaneous analysis of a resection specimen may be efficient in bone tumor oncologic surgery, if made by an experienced radiologist with perfect agreement with the pathologist.

  18. Micro-surgical endodontics. (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I


    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  19. Surgical innovation as sui generis surgical research. (United States)

    Lotz, Mianna


    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  20. [Sinaloa: the geography of marginalization]. (United States)

    Aguayo Hernandez, J R


    Sinaloa's State Population Program for 1993-98 contains the objective of promoting integration of demographic criteria into the planning process. The action program calls for establishing indicators of economic and social inequality so that conditions of poverty and margination can be identified. To further these goals, the State Population Council used data from the National Population Council project on regional inequality and municipal margination in Mexico to analyze margination at the state level. Nine indicators of educational status, housing conditions, spatial distribution, and income provide information that allows the definition of municipios and regions that should receive priority in economic and social development programs. The index of municipal margination (IMM) is a statistical summary of the nine indicators, which are based on information in the 1990 census. As of March 1990, 9.9% of Sinaloa's population over age 15 was illiterate and 37.4% had incomplete primary education. 91.0% had electricity, but 18.7% lacked indoor toilet facilities and 19.4% had no piped water. 23.7% of houses had dirt floors. 60% of households were crowded, defined as having more than two persons per bedroom. 43.5% of the state population lived in localities with fewer than 5000 inhabitants, where service delivery is difficult and costly. 55.6% of the economically active population was judged to earn less than the amount needed to satisfy essential needs. All except one municipio bordering the Pacific ocean had low or very low indicators of margination, while all those in the sierra had a medium or high degree of margination. Sinaloa's statewide IMM was eighteenth among Mexico's 32 federal entities, with Chiapas showing the highest degree of margination and the Federal District the lowest.

  1. Avaliação dos resultados do tratamento cirúrgico artroscópico da instabilidade anterior traumática do ombro com sutura da lesão na margem cruentizada da cavidade glenoidal Evaluation of the results from arthroscopic surgical treatment for traumatic anterior shoulder instability using suturing of the lesion at the opened margin of the glenoid cavity

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki


    Full Text Available OBJETIVO: Avaliar os resultados clínicos dos pacientes portadores de instabilidade anterior traumática do ombro tratados cirurgicamente por visualização artroscópica, utilizando âncoras bioabsorvíveis e com o uso da técnica de cruentização da margem anterior da cavidade glenoidal para a reparação da lesão de Bankart. MÉTODO: Entre março de 2006 e outubro de 2008 foram operados 27 ombros de 27 pacientes com diagnóstico de instabilidade anterior traumática do ombro, com média de idade de 28 anos e número de luxações prévias variando entre dois e 25 episódios. O sexo masculino predominou com 24 (89% pacientes. O tempo mínimo de seguimento foi de 24 meses, com uma média de 36 meses, e nenhum paciente tinha cirurgia prévia no ombro acometido ou lesão óssea significativa na margem glenoidal. A avaliação clínica pós-operatória foi realizada por meio da escala de Rowe. Para medirmos o grau de amplitude articular pré-operatória e pós-operatória, utilizamos o método descrito pela Academia Americana de Cirurgiões Ortopédicos (AAOS. RESULTADO: Pelos critérios de Rowe, 25 pacientes (93% obtiveram resultados excelentes e dois (7% resultados ruins, nenhum paciente apresentou resultado bom ou regular. Vinte e três pacientes estavam satisfeitos com o resultado obtido (85%, retornando às suas atividades sem limitações, e quatro pacientes (15% tinham algum grau de limitação. Houve recidiva da instabilidade em dois pacientes (7%. CONCLUSÃO: O tratamento da instabilidade traumática anterior do ombro por visualização artroscópica com a técnica de cruentização da margem articular anterior da cavidade glenoidal, para reparação da lesão de Bankart, proporcionou excelentes resultados em 93% dos pacientes operados.OBJECTIVE: To evaluate the clinical results from patients with traumatic anterior shoulder instability that was treated surgically through arthroscopic viewing, using bioabsorbable anchors and a technique

  2. Retroperitoneal margin involvement by adenocarcinoma of the caecum and ascending colon: what does it mean? (United States)

    Scott, N; Jamali, A; Verbeke, C; Ambrose, N S; Botterill, I D; Jayne, D G


    Circumferential margin involvement (CRM) is a powerful predictor of local recurrence, distant metastasis and patient survival in rectal cancer. In this study, we aimed to determine the frequency of retroperitoneal margin involvement in right colon cancer and describe its relationship to tumour stage and outcome of surgical treatment. Two hundred and twenty-eight consecutive resections for adenocarcinoma of the ascending colon and caecum were identified between 1998 and 2006. Tumour involvement of the posterior retroperitoneal surgical resection margin (RSRM) was recorded and correlated with tumour stage, grade and clinical outcome. RSRM positive patients were compared with CRM positive rectal tumours resected in the same surgical unit. Nineteen of 228 right hemicolectomies (8.4%) showed tumour involvement of the RSRM (defined as CRM positive rectal cancers. Retroperitoneal surgical resection margin involvement by caecal and ascending colon carcinoma is a marker of advanced tumour stage and associated with a high incidence of synchronous and metachronous distant metastasis. More aggressive surgery to obtain a clear margin or postoperative radiotherapy to the tumour bed is likely to benefit only a minority of patients.

  3. Maximum margin Bayesian network classifiers. (United States)

    Pernkopf, Franz; Wohlmayr, Michael; Tschiatschek, Sebastian


    We present a maximum margin parameter learning algorithm for Bayesian network classifiers using a conjugate gradient (CG) method for optimization. In contrast to previous approaches, we maintain the normalization constraints on the parameters of the Bayesian network during optimization, i.e., the probabilistic interpretation of the model is not lost. This enables us to handle missing features in discriminatively optimized Bayesian networks. In experiments, we compare the classification performance of maximum margin parameter learning to conditional likelihood and maximum likelihood learning approaches. Discriminative parameter learning significantly outperforms generative maximum likelihood estimation for naive Bayes and tree augmented naive Bayes structures on all considered data sets. Furthermore, maximizing the margin dominates the conditional likelihood approach in terms of classification performance in most cases. We provide results for a recently proposed maximum margin optimization approach based on convex relaxation. While the classification results are highly similar, our CG-based optimization is computationally up to orders of magnitude faster. Margin-optimized Bayesian network classifiers achieve classification performance comparable to support vector machines (SVMs) using fewer parameters. Moreover, we show that unanticipated missing feature values during classification can be easily processed by discriminatively optimized Bayesian network classifiers, a case where discriminative classifiers usually require mechanisms to complete unknown feature values in the data first.

  4. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G.; Russo, Paul; Thompson, R. Houston; Uzzo, Robert G.; Wood, Christopher G.; Gill, Inderbir S.


    Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report

  5. Aging study in advanced photomasks: impact of EFM effects on lithographic performance with MoSi binary and 6% attenuated PSM masks (United States)

    Servin, I.; Belledent, J.; Fialeyre, M. O.; Connolly, B.; Lamantia, M.; Sczyrba, M.; Jullian, M. K.; Le Gratiet, B.; Pain, L.


    As mask dimensions continue to shrink to meet the ITRS roadmap and with the extension of 193 nm immersion lithography, the masks are affected by electromagnetic field at high NA. Absorber degradation is regularly reported under long term 193 nm exposures in the subwavelength diffraction regime. The damage mechanism known as Electric Field induced Migration of chrome (EFM) partly contributes to the lifetime reduction of advanced masks. The EFM results in a progressive alteration of the Critical Dimension (CD), CD uniformity (CDU) degradation and assist features. This study evaluates the impact and the rate of absorber degradation due to an intensive ArF irradiation on assist features and its influence on the through pitch process window for sub-45 nm technology nodes. Lithographic performance is characterized after cumulative reticle aging stages. The aging test exposures are carried out directly on 193 nm scanner to duplicate the production environment. The analysis of printed wafers is correlated to advanced mask inspection (AIMSTM). This paper reports results on irradiation damage sensitivity on two types of reticles: conventional 6% attenuated PSM and new binary material OMOG (Opaque MoSi On Glass) reticle. Test patterns have been generated with and without a set of Optical Proximity Corrections (OPC) model calibration structures based on 45nm down to 28nm half-pitch design. The combination of metrology measurements used in this work between printed wafers and reticles enables to define accurately the impact of mask damage caused by EFM effects on various test patterns and CD evolution and highlight some trends about advances masks aging phenomenon.

  6. PSM Peptides of Staphylococcus aureus Activate the p38-CREB Pathway in Dendritic Cells, Thereby Modulating Cytokine Production and T Cell Priming. (United States)

    Armbruster, Nicole S; Richardson, Jennifer R; Schreiner, Jens; Klenk, Juliane; Günter, Manina; Kretschmer, Dorothee; Pöschel, Simone; Schenke-Layland, Katja; Kalbacher, Hubert; Clark, Kristopher; Autenrieth, Stella E


    The challenging human pathogen Staphylococcus aureus has highly efficient immune evasion strategies for causing a wide range of diseases, from skin and soft tissue to life-threatening infections. Phenol-soluble modulin (PSM) peptides are major pathogenicity factors of community-associated methicillin-resistant S. aureus strains. In previous work, we demonstrated that PSMs in combination with TLR2 ligand from S. aureus induce tolerogenic dendritic cells (DCs) characterized by the production of high amounts of IL-10, but no proinflammatory cytokines. This in turn promotes the activation of regulatory T cells while impairing Th1 response; however, the signaling pathways modulated by PSMs remain elusive. In this study, we analyzed the effects of PSMs on signaling pathway modulation downstream of TLR2. TLR2 stimulation in combination with PSMα3 led to increased and prolonged phosphorylation of NF-κB, ERK, p38, and CREB in mouse bone marrow-derived DCs compared with single TLR2 activation. Furthermore, inhibition of p38 and downstream MSK1 prevented IL-10 production, which in turn reduced the capacity of DCs to activate regulatory T cells. Interestingly, the modulation of the signaling pathways by PSMs was independent of the known receptor for PSMs, as shown by experiments with DCs lacking the formyl peptide receptor 2. Instead, PSMs penetrate the cell membrane most likely by transient pore formation. Moreover, colocalization of PSMs and p38 was observed near the plasma membrane in the cytosol, indicating a direct interaction. Thus, PSMs from S. aureus directly modulate the signaling pathway p38-CREB in DCs, thereby impairing cytokine production and in consequence T cell priming to increase the tolerance toward the pathogen.

  7. Hernia Surgical Mesh Implants (United States)

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  8. Urogynecologic Surgical Mesh Implants (United States)

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  9. American Pediatric Surgical Association (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  10. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin


    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  11. Abortion - surgical - aftercare (United States)

    ... this page: // Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  12. Alterations of the marginal soft tissue (gingival margin following periodontal therapy: A clinical study

    Directory of Open Access Journals (Sweden)

    Gupta Ira


    Full Text Available Background and Objectives: The evaluation of gingival margin position (GMP plays a vital role in periodontal therapy and is critical in esthetic/plastic surgical procedures revolving around restorative dentistry. Comparative evaluations of GMP measurements in various periodontal therapies are scarce. Thus, the objectives of this study are to measure the alteration in the gingival margin position following various therapies, and to compare GMP alterations among different treatment modalities from the baseline to six months after therapy. Materials and Methods: The changes in GMP were studied for MB, B, DB, ML, and L sites for SRP, curettage, and flap surgery, and for MB, B, and DB sites for crown lengthening cases at the end of one, three, and six months after therapy. The results were interpreted from baseline to one, three, and six months posttreatment. Statistical Analysis : The results were subjected to statistical analysis. Paired ′t′-test was used for intra-group comparisons and intergroup comparisons were done by one-way ANOVA. Results: The GMP changed from baseline in all the sites at different time periods following various therapies. The net results after six months were an apical shift of GMP in SRP, curettage, and flap surgery, and a coronal shift of GMP in crown lengthening. Conclusion: GMP shows various patterns of alteration after various periodontal therapies. One should wait for the GMP to become stable before attempting any restorative procedure.

  13. Profit margins in Japanese retailing

    NARCIS (Netherlands)

    J.C.A. Potjes; A.R. Thurik (Roy)


    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service

  14. Profit margins in Japanese retailing

    NARCIS (Netherlands)

    J.C.A. Potjes; A.R. Thurik (Roy)


    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service

  15. Respiration in ocean margin sediments

    NARCIS (Netherlands)

    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data. In this

  16. Respiration in ocean margin sediments

    NARCIS (Netherlands)

    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data.

  17. Comparison of margin status and lesional size between radioactive seed localized vs conventional wire localized breast lumpectomy specimens. (United States)

    Rarick, Jason; Kimler, Bruce F; Tawfik, Ossama


    Despite the known benefits of the use of radioactive seed localization (RSL), few studies have looked at the resultant pathologic marginal status of these lumpectomy specimens, especially in regard to different definitions of close/positive margins. We compared the marginal status of lumpectomy specimens removed by either RSL or conventional wire localization (CWL) techniques. A total of 106 lumpectomy specimens including 62 by CWL and 44 by RSL for invasive ductal and lobular carcinomas were compared. Data on gross and microscopic surgical margin status, tumor type and grade, and demographic information were retrospectively collected. There was no difference between the techniques in terms of tumor characteristics including size, histologic grade, lymph node positivity, or age. Although the distributions are very similar between CWL and RSL specimens for final marginal assessments (P=.69), there is a (modest) statistically significant difference in the distribution for margin classifications based on gross assessments (P=.040), specifically more RSL specimens exhibiting tumor within 1mm of the closest margin. Concordance between gross and microscopic lesion measurements is highest for invasive ductal carcinoma grade 3 for both CWL and RSL lumpectomies (78.6% and 80.0%). This study shows that there were no significant marginal status differences between RSL and CWL lumpectomy specimens with invasive carcinoma. Rather, what was relevant is whether the entire specimen could be classified as having negative/close margins. Significant workflow challenges in surgical pathology laboratories are expected with the adoption of the RSL process.

  18. Surgical Lasers In Gynecology (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.


    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  19. Surgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade

    DEFF Research Database (Denmark)

    Staehr-Rye, Anne K; Rasmussen, Lars S.; Rosenberg, Jacob;


    described, but deep neuromuscular blockade may be beneficial. We investigated if deep muscle relaxation would be associated with a higher proportion of procedures with "optimal" surgical space conditions compared with moderate relaxation during low-pressure (8 mm Hg) laparoscopic cholecystectomy. METHODS...... with surgical space conditions that were marginally better than with moderate muscle relaxation during low-pressure laparoscopic cholecystectomy....

  20. The Margins of Medieval Manuscripts

    Directory of Open Access Journals (Sweden)

    Nataša Kavčič


    Full Text Available Shortly after the mid-thirteenth century, various images began to fill the margins in both religious and secular texts. Many factors influenced the emergence of this type of manuscript decoration, but it has generally been attributed to the revived interest in nature and the Gothic inclination for humorous and anecdotic detail. After highlighting other possible reasons for the occurrence of marginal illumination, this paper introduces two manuscripts from the Archiepiscopal Archives in Ljubljana. The manuscripts show numerous facial drawings affixed to some of the letters. This article addresses how to interpret such drawings and stresses that they do not necessarily function as symbolic images or images with any specific didactic value. Quite the opposite, these drawings seem not to have any meaning and are oft en merely indications of an illuminator’s sense of humor. Because of their exaggerated facial expressions, these drawings could be perceived as the true predecessors of modern caricature.

  1. Respiration in ocean margin sediments


    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data. In this thesis the depth dependence of respiration patterns was modelled using a compiled data set of sediment oxygen consumption rates. We showed that the depth relationship can best be described by a do...

  2. A cross-sectional survey of clinicians performing periodontal surgical crown lengthening. (United States)

    Wyatt, Gillian; Grey, Nick; Deery, Chris


    The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

  3. Appositional bone formation in marginal defects at implants. (United States)

    Botticelli, Daniele; Berglundh, Tord; Buser, Daniel; Lindhe, Jan


    In a previous experiment, it was demonstrated that a wide marginal defect around an implant can heal with a high degree of osseointegration. The present experiment was performed to evaluate the degree and quality of de novo bone formation and osseointegration in marginal defects adjacent to submerged titanium implants. All mandibular premolars and 1st molars were extracted in four Labrador dogs. Four experimental sites were identified in the right side of the mandible. In two sites, custom-made implants with a sandblasted, large grit, acid-etched (SLA) surface were installed without further ostectomy (control sites). In the two remaining sites (test sites), a specially designed step drill was used to widen the marginal 5 mm of the canal. A barrier membrane was used to cover the implants in the defect sites. All implants were submerged. One month later, an identical procedure, including site preparation and implant installation, was performed in the left side of the mandible. Two months following the first implant installation procedure, biopsies were collected and prepared for sectioning. Ostectomy and implant installation in the control location resulted in a series of bone tissue alterations which eventually allowed newly formed bone to establish contact with the SLA surface. The marginal defect lateral to the implant in the test locations gradually became filled with newly formed bone. De novo bone formation started within the walls of the surgically prepared defect. Bone-to-implant contact was first established in the apical portion of the gap. This new bone tissue was in the coronal direction continuous with a dense, non-mineralized 'implant attached' soft tissue which, over time, also became mineralized to increase the height of the zone of bone-to-implant contact. The results suggest that healing of a wide marginal defect around an implant is characterized by appositional bone growth from the lateral and apical bone walls of the defect.

  4. Análise de 33 peças cirúrgicas de colectomias laparoscópicas para câncer, durante a curva de aprendizado inicial: margens oncológicas e número de linfonodos não diferem de colectomias abertas Analysis of 33 surgical specimens of laparoscopic resections for colorectal cancer in the early learning curve: margins and nodes harvest do not differ from open resections

    Directory of Open Access Journals (Sweden)

    Augusto Motta Neiva


    no início da experiência com colectomia laparoscópica, os critérios para ressecção oncológica podem ser preservados quando os procedimentos são realizados por cirurgiões especialistas trabalhando com equipe especializada em patologia gastrointestinal.INTRODUCTION: Colorectal laparoscopic surgery is considered a procedure with long learning curve. Despite surgeons with experience in laparoscopic surgery are able to achieve the same oncological results obtained in open procedures, it is important to evaluate if these good results are sustained during the learning curve. The aim of this study was to evaluate the adequacy of the margins and the lymph nodes harvest in early learning curve of laparoscopic colectomies performed by specialized surgeons compared to open colectomies. METHODS: Thirty-three surgical specimens of laparoscopic resections for colorectal cancer performed during the early learning curve were evaluated. The following data were analyzed: age, sex, tumor location, pathologic classification, lymph node harvest and proximal and distal margins. Data were compared to a control group of 45 open resections for colorectal cancer. RESULTS: Age, tumor location and Dukes classification of laparoscopic and open groups were similar. Laparoscopic group had more female patients. Distal margins were similar between the groups [mean of 7,15 cm (SD ± 9,98 for open and 8,26 cm (SD ± 11,5 for laparoscopic group, p=NS]. There was no difference in the lymph nodes harvest between the groups. The mean of lymph nodes harvest of open and laparoscopic groups were 19 (SD ± 19,41 and 21 (SD ± 14,73, respectively, (p=NS. CONCLUSION: Oncologic margins and lymph nodes harvest obtained during early learning curve of laparoscopic resections were similar to open procedures. Despite the natural difficulties faced during early learning curve, oncologic criteria can be achieved when laparoscopic colorectal resections are performed by specialized surgeons working with

  5. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría


    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  6. Margin Requirements and Equity Option Returns

    DEFF Research Database (Denmark)

    Hitzemann, Steffen; Hofmann, Michael; Uhrig-Homburg, Marliese

    In equity option markets, traders face margin requirements both for the options themselves and for hedging-related positions in the underlying stock market. We show that these requirements carry a significant margin premium in the cross-section of equity option returns. The sign of the margin pre...


    Institute of Scientific and Technical Information of China (English)

    崔萌; 史耀馨; 李宣东; 郑国梁



  8. 4-苯乙烯磺酸马来酸酐共聚物抑制HIV-1的初步研究%The preliminary research of PSM on the inhibition of HIV-1

    Institute of Scientific and Technical Information of China (English)

    张龙锋; 邱敏; 蒋丽军; 刘强; 焦志军; 吴稚伟


    目的:研究4‐苯乙烯磺酸马来酸酐共聚物(PSM)对HIV‐1的抑制作用。方法通过Luciferase检测不同浓度的PSM对易感细胞GHOST(3)X4/Hi5中HIV‐1的抑制作用,观察PSM对北美HIV‐1毒株JR‐FL、HXB2和中国临床分离株CNE6、CNE30、CNE50和CNE55的抑制作用;利用CCK8试剂盒测定PSM对VK2/E6E7生长的抑制率来观察PSM的体外细胞毒性。通过逆转录荧光实时定量PCR(qRT‐PCR)检测生殖道上皮细胞HEC‐1‐A的紧密连接蛋白ZO‐1、E‐cadherin和Occludin的表达,观察PSM对生殖道上皮细胞HEC‐1‐A表达的紧密连接蛋白的影响从而间接评价其对局部黏膜完整性的影响。结果PSM对北美HIV‐1毒株JR‐FL、HXB2以及中国常见临床分离株CNE6、CNE30、CNE50和CNE55的抑制EC50分别为5.78、0.77、1.85、3.15、1.70和2.27μg/mL,具有抗HIV‐1感染的活性;PSM对VK2/E6E7细胞具有低毒性;PSM不明显抑制ZO‐1的表达且增加了E‐cadherin和Occludin的转录水平。结论PSM可以抑制HIV‐1感染,具有作为杀微生物剂的潜能。%Objective To investigate the inhibiton effect of 4‐styrenesulfonic acid‐co‐maleic acid(PSM ) in HIV‐1 .Methods The inhibition effect of different doses of PSM on HIV‐1 in susceptible cells GHOST (3) X4/Hi5 was observed by Luciferase ,and so did the inhibitory effect of PSM on JR‐FL、HXB2、CNE6 ,CNE30 ,CNE50 ,CNE55 .The cellular toxicity of PSM on the VK2/E6E7 was also evaluated by CCK8 kit .The transcript level of tight junction proteins (ZO‐1 ,E‐cadherin and Occludin) of HEC‐1‐A were analyzed by qRT‐PCR .And then observed the effect of PSM on expression of genitourinary epithelial cells HEC‐1‐A ,so we could e‐valuated the effect of integrity of local mucosal indirectly .Results The results showed that PSM exhibited potent antiviral activity against a broad spectrum of HIV‐1 major isolates with different genotypes and biotypes

  9. Biomass energy and marginal areas

    Energy Technology Data Exchange (ETDEWEB)

    Chassany, J.P.


    The aim of this study was to analyze the conditions and effects of a possible development of the biomass energy upgrading in uneconomical or not rentable areas. The physical, social and economical characteristics of these regions (in France) are described; then the different types of biomass are presented (agricultural wastes, energetic cultures, forest and land products and residues, food processing effluents, municipal wastes) as well as the various energy process (production of alcohol, methane, thermochemical processes, vegetable oils). The development and the feasability of these processes in marginal areas are finally analyzed taking into account the accessibility of the biomass and the technical and commercial impacts.

  10. Bronchial resection margin and long-term survival in non-small-cell lung cancer. (United States)

    Poullis, Michael; McShane, James; Shaw, Mathew; Page, Richard; Woolley, Steve; Shackcloth, Michael; Mediratta, Neeraj


    Clear resection margins are necessary for long-term survival of patients undergoing surgical resection. We aimed to determine whether bronchial resection margin is a factor determining long-term survival in patients undergoing R0 resections for non-small-cell lung cancer. There were 2695 consecutive pulmonary resections performed between October 2001 and September 2011 in our institution; 1795 were R0 resections for non-small-cell lung cancer and bronchial margin length data were available. Benchmarking against the 7th International Association for the Study of Lung Cancer dataset was performed. Cox multivariate and neuronal network analysis was undertaken. Benchmarking failed to reveal any significant differences between our data and the 7th International Association for the Study of Lung Cancer dataset. Cox regression demonstrated that age (pNeuronal network analysis confirmed these findings. Bronchial resection margin length has no impact on long-term survival.

  11. Margin Analysis: Malignant Salivary Gland Neoplasms of the Head and Neck. (United States)

    Ord, Robert A; Ghazali, Naseem


    There are no established protocols for the optimum surgical margin required for salivary gland malignancies. Factors including histologic diagnosis and TNM stage have been shown to be important in prognosis and survival outcome and mandate special consideration of margin size. Salivary cancers are treated differently at different anatomic sites, and different histologic types show a propensity for major or minor glands. Low-grade malignancies are treated with soft tissue margins of 1 cm or less. The facial nerve is preserved unless infiltrated and encased. Adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma require more complex planning to obtain negative margins. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  12. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy


    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  13. Surgical ethics and the challenge of surgical innovation. (United States)

    Angelos, Peter


    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  14. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    Directory of Open Access Journals (Sweden)

    Roy Varghese


    Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  15. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.


    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  16. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.


    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  17. Investigation of platelet margination phenomena at elevated shear stress. (United States)

    Zhao, Rui; Kameneva, Marina V; Antaki, James F


    Thrombosis is a common complication following the surgical implantation of blood contacting artificial organs. Platelet transport, which is an important process of thrombosis and strongly modulated by flow dynamics, has not been investigated under the shear stress level associated with these devices, which may range from tens to several hundred Pascal.The current research investigated platelet transport within blood under supra-physiological shear stress conditions through a micro flow visualization approach. Images of platelet-sized fluorescent particles in the blood flow were recorded within microchannels (2 cm x 100 microm x 100 microm). The results successfully demonstrated the occurrence of platelet-sized particle margination under shear stresses up to 193 Pa, revealing a platelet near-wall excess up to 8.7 near the wall (within 15 microm) at the highest shear stress. The concentration of red blood cells was found to influence the stream-wise development of platelet margination which was clearly observed in the 20% Ht sample but not the 40% Ht sample. Shear stress had a less dramatic effect on the margination phenomenon than did hematocrit. The results imply that cell-cell collision is an important factor for platelet transport under supra-physiologic shear stress conditions. It is anticipated that these results will contribute to the future design and optimization of artificial organs.

  18. Dynamics of the continental margins

    Energy Technology Data Exchange (ETDEWEB)


    On 18--20 June 1990, over 70 oceanographers conducting research in the ocean margins of North America attended a workshop in Virginia Beach, Virginia. The purpose of the workshop was to provide the Department of Energy with recommendations for future research on the exchange of energy-related materials between the coastal and interior ocean and the relationship between the ocean margins and global change. The workshop was designed to optimize the interaction of scientists from specific research disciplines (biology, chemistry, physics and geology) as they developed hypotheses, research questions and topics and implementation plans. The participants were given few restraints on the research they proposed other than realistic time and monetary limits. The interdisciplinary structure of the meeting promoted lively discussion and creative research plans. The meeting was divided into four working groups based on lateral, vertical, air/sea and sediment/water processes. Working papers were prepared and distributed before the meeting. During the meeting the groups revised the papers and added recommendations that appear in this report, which was reviewed by an Executive Committee.

  19. The Case Study of Model Driven Architecture --The PIM's Establishment and Transforming PIM to RDBM PSM in Patient Observation System%模型驱动体系结构MDA的实例研究--病人观察系统的PIM模型建立和PIM到关系PSM模型转换

    Institute of Scientific and Technical Information of China (English)




  20. Increased optical magnification from 2.5x to 4.3x with technical modification lowers the positive margin rate in open radical retropubic prostatectomy. (United States)

    Magera, James S; Inman, Brant A; Slezak, Jeffrey M; Bagniewski, Stephanie M; Sebo, Thomas J; Myers, Robert P


    We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5x power loupes were used and for the subsequent 236 we used 4.3x power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3x magnification to demonstrate the surgical precision possible at 4.3x for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5x and in 12 of 236 (5.1%) at 4.3x. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5x and in 5 of 236 (2.1%) at 4.3x. On multivariate analysis 4.3x magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p technical refinements that are not possible or deemed safe at 2.5x resulted in a substantial decrease in the positive surgical margin rate.

  1. Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy. (United States)

    Bouzón, Alberto; Acea, Benigno; García, Alejandra; Iglesias, Ángela; Mosquera, Joaquín; Santiago, Paz; Seoane, Teresa


    Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. A simple method for ensuring resection margins during laparoscopic partial nephrectomy: the intracorporeal ultrasonography. (United States)

    Doerfler, Arnaud; Oitchayomi, Abeni; Tillou, Xavier


    To describe a simple method for ensuring surgical margins during laparoscopic partial nephrectomy (PN). A study was done at our institution from October 2013 to March 2014 for all patients undergoing laparoscopic PN for T1 renal tumors. Before tumor removal, intraoperative ultrasonography (US) localization was performed. The tumor was then removed with a standardized minimal healthy tissue margin technique. Immediately after removal and before performing hemostasis of the kidney, the specimen was placed into a laparoscopic endobag filled with saline solution. The laparoscopic probe was then placed into the endobag and a sequential ultrasonographic scan was performed to evaluate if the tumor's pseudocapsule was respected. Twelve patients were included in our study. Mean warm ischemia time was 19 ± 3 minutes. Mean US examination was 42 ± 9 seconds. US analysis of surgical margins was negative in all except 1 patient. The final histologic examination of all specimens confirmed US results with a 100% correlation. We describe an original, simple, and cost-effective method for ensuring surgical margins during laparoscopic PN with a moderate increase in warm time ischemia. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Surgical ethics: surgical virtue and more. (United States)

    Vercler, Christian J


    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  4. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L


    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  5. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    Energy Technology Data Exchange (ETDEWEB)

    Demirci, Senem, E-mail: [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir (Turkey); Broadwater, Gloria [Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC (United States); Cancer and Leukemia Group B Statistical Center, Duke Cancer Institute, Durham, NC (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Clough, Robert; Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)


    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  6. Guide to Surgical Specialists (United States)

    ... have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of ... and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders ...

  7. Surgical Critical Care Initiative (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  8. Ambulatory Surgical Measures - National (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  9. Ambulatory Surgical Measures - Facility (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  10. Surgical site infections

    African Journals Online (AJOL)

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...

  11. Performance Evaluation of Portfolios with Margin Requirements


    Hui Ding; Zhongbao Zhou; Helu Xiao; Chaoqun Ma; Wenbin Liu


    In financial markets, short sellers will be required to post margin to cover possible losses in case the prices of the risky assets go up. Only a few studies focus on the optimization and performance evaluation of portfolios in the presence of margin requirements. In this paper, we investigate the theoretical foundation of DEA (data envelopment analysis) approach to evaluate the performance of portfolios with margin requirements from a different perspective. Under the mean-variance framework,...

  12. Faster Algorithms for Privately Releasing Marginals


    Thaler, Justin R; Ullman, Jonathan Robert; Vadhan, Salil P.


    We study the problem of releasing $k$-way marginals of a database $D \\in (\\{0,1\\}^d)^n$, while preserving differential privacy. The answer to a $k$-way marginal query is the fraction of $D$'s records $x \\in \\{0,1\\}^d$ with a given value in each of a given set of up to $k$ columns. Marginal queries enable a rich class of statistical analyses of a dataset, and designing efficient algorithms for privately releasing marginal queries has been identified as an important open problem in private data...

  13. Assessment of seismic margin calculation methods

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.


    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs.

  14. On the evaluation of marginal expected shortfall

    DEFF Research Database (Denmark)

    Caporin, Massimiliano; Santucci de Magistris, Paolo


    In the analysis of systemic risk, Marginal Expected Shortfall may be considered to evaluate the marginal impact of a single stock on the market Expected Shortfall. These quantities are generally computed using log-returns, in particular when there is also a focus on returns conditional distribution....... In this case, the market log-return is only approximately equal to the weighed sum of equities log-returns. We show that the approximation error is large during turbulent market phases, with a subsequent impact on Marginal Expected Shortfall. We then suggest how to improve the evaluation of Marginal Expected...

  15. On the Marginal Stability of Glassy Systems (United States)

    Yan, Le; Baity-Jesi, Marco; Müller, Markus; Wyart, Matthieu


    In various glassy systems that are out of equilibrium, like spin glasses and granular packings, the dynamics appears to be critical: avalanches involving almost the whole system could happen. A recent conceptual breakthrough argues that such glassy systems sample the ensemble of marginal stable states, which inevitably results into critical dynamics. However, it is unclear how the marginal stability is dynamically guaranteed. We investigate this marginal stability assumption by studying specifically the critical athermal dynamics of the Sherrington-Kirkpatrick model. We discuss how a pseudo-gap in the density distribution of local fields characterizing the marginal stability arises dynamically.

  16. Spectrally Encoded Confocal Microscopy (SECM) for Diagnosing of Breast Cancer in Excision and Margin Specimens (United States)

    Brachtel, Elena F.; Johnson, Nicole B.; Huck, Amelia E.; Rice-Stitt, Travis L.; Vangel, Mark G.; Smith, Barbara L.; Tearney, Guillermo J.; Kang, Dongkyun


    A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intra-operatively. Spectrally-encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at sub-cellular resolution and accurately determine margin status intra-operatively. In this paper, in order to test feasibility of using SECM for intra-operative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically-removed breast specimens were imaged with a SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 µm × 500 µm) spatially-registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intra-operative margin assessment tool for guiding breast cancer excisions. PMID:26779830

  17. The Grid Failure Analysis of a Kind of 100 kW PSM Shortwave Transmitters%100kW PSM短波广播发射机栅极故障分析

    Institute of Scientific and Technical Information of China (English)



    This paper mainly analyzes the low fixed grid bias failure of 100 kW PSM short-wave transmitters,and in the process of its troubleshooting it should through the phenomenon of fault to find its key point so as to avoid detours,and reduce processing time.%主要是通过对100kW PSM短波发射机栅极固定偏压偏低故障的分析,阐明在处理短波发射机故障的过程中,要通过故障现象找出故障的本质,而不能只看故障的表面现象,这样才能少走弯路,缩短处理时间。

  18. Fibroadenomas of the breast showing an ill-defined margin on ultrasonogram: Correlation with histopathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young; Choi, Hye Young; Shim, Sung Shine; Rhee, Chung Sik; Sung, Soon Hee [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)


    To correlate the sonographic finding of ill-defined fibroadenoma with the histopathologic findings. Sonographic finding of forty nine surgically proven fibroadenomas were retrospectively correlated with histopathologic findings. We evaluated sonographic findings including the margin, shape, size and the echotexture of fibroadenoma. The histopathologic glandular structure, stromal type of fibroadenoma, type of the surrounding breast tissue and presence of interdigitation between fibroadenoma and the surrounding breast tissue were pathologically reviewed and analyzed statistically. Breast sonography of fibroadenomas demonstrated well-defined margin in 28 (57%) and ill-defined margin in 21 (43%) among 49 lesions. Histopathologically, the glandular structure and type of the surrounding breast tissue were not significantly different between well-defined and ill-defined fibroadenomas. The stromal type of fibroadenoma was sclerotic in 8 (29%) well-defined fibroadenomas while sclerotic in 15 (72%) of 21 ill-defined fibroadenomas,showing difference with a statistical significance between well-defined and ill-defined fibroadenomas (p<0.05). Twenty (71%) of 28 fibroadenomas with well-defined sonographic margins showed well-defined border between mass and the surrounding breast tissue, pathologically. Meanwhile, twenty (95%) of 21 fibroadenomas with ill-defined sonographic margins demonstrated interdigitation of the surrounding breast tissue and mass, exhibiting a statistical significance (p<0.005). Ill-defined margins of fibroadenomas on sonography represent the interdigitation of the surrounding breast tissue with a mass and is seen in the sclerotic stromal type of fibroadenomas.

  19. Effects of resection margins on local recurrence of osteosarcoma in extremity and pelvis: Systematic review and meta-analysis. (United States)

    He, Fangzhou; Zhang, Weibin; Shen, Yuhui; Yu, Pei; Bao, Qiyuan; Wen, Junxiang; Hu, Chuanzhen; Qiu, Shijing


    There are conflicting findings about the effect of resection margins on local recurrence in osteosarcoma after surgery. In this meta-analysis, we examined the association between local recurrence and resection margins for osteosarcoma in extremity and pelvis. EMBASE, PubMed and Cochrane CENTRAL were searched from January 1980 to July 2016. The quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale. The odds ratio and 95% confidence interval of local recurrence were estimated, respectively, for inadequate vs adequate margins and marginal vs wide margins using a random-effect model. Chi-square test was performed to comparing the local recurrence rate between extremity and pelvic osteosarcomas with an identical surgical margin. Thirteen articles involving 1559 patients (175 with and 1384 without local recurrence) were included in this study. The meta-analysis showed that the osteosarcoma resected with inadequate and marginal margins, whether in extremity or in pelvis, were associated with a significantly higher local recurrence rate than the osteosarcoma resected with adequate and wide margins, respectively. Chi-square test showed that, when pelvic and extremity osteosarcomas were removed with an identical resection margin, the local recurrence was significantly more frequent in pelvis osteosarcoma than in extremity osteosarcoma. This study provides level IIa evidence to support that the surgery with adequate or wide resection margin has positive effect on reducing the risk of local recurrence in osteosarcoma. In addition, the factors independent of resection margin are more likely to increase the risk of local recurrence in pelvic osteosarcoma. Level IIa, Therapeutic study. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Values and marginal preferences in international business

    NARCIS (Netherlands)

    Maseland, Robbert; van Hoorn, Andre


    In a recent paper in this journal, Maseland and van Hoorn argued that values surveys tend to conflate values and marginal preferences. This assertion has been challenged by Brewer and Venaik, who claim that the wording of most survey items does not suggest that these elicit marginal preferences. Thi

  1. Marginal Utility and Convex Indifference Curves. (United States)

    Jackson, A.A.


    Reviews discussion of the relationship between marginal utility and indifference curves which has been presented in recent issues of "Economics." Concludes that indifference analysis does not embody the assumptions of marginal utility theory and that there is no simple relationship between these concepts that does not entail unacceptable…

  2. The homogeneous marginal utility of income assumption

    NARCIS (Netherlands)

    Demuynck, T.


    We develop a test to verify if every agent from a population of heterogeneous consumers has the same marginal utility of income function. This homogeneous marginal utility of income assumption is often (implicitly) used in applied demand studies because it has nice aggregation properties and facilit

  3. Tumor margin detection using optical biopsy techniques (United States)

    Zhou, Yan; Liu, Cheng-hui; Li, Jiyou; Li, Zhongwu; Zhou, Lixin; Chen, Ke; Pu, Yang; He, Yong; Zhu, Ke; Li, Qingbo; Alfano, Robert R.


    The aim of this study is to use the Resonance Raman (RR) and fluorescence spectroscopic technique for tumor margin detection with high accuracy based on native molecular fingerprints of breast and gastrointestinal (GI) tissues. This tumor margins detection method utilizes advantages of RR spectroscopic technique in situ and in real-time to diagnose tumor changes providing powerful tools for clinical guiding intraoperative margin assessments and postoperative treatments. The tumor margin detection procedures by RR spectroscopy were taken by scanning lesion from center or around tumor region in ex-vivo to find the changes in cancerous tissues with the rim of normal tissues using the native molecular fingerprints. The specimens used to analyze tumor margins include breast and GI carcinoma and normal tissues. The sharp margin of the tumor was found by the changes of RR spectral peaks within 2 mm distance. The result was verified using fluorescence spectra with 300 nm, 320 nm and 340 nm excitation, in a typical specimen of gastric cancerous tissue within a positive margin in comparison with normal gastric tissues. This study demonstrates the potential of RR and fluorescence spectroscopy as new approaches with labeling free to determine the intraoperative margin assessment.

  4. Intraoperative Assessment of Breast Cancer Margins ex vivo using Aqueous Quantum Dot-Functionalized Molecular Probes (United States)

    Au, Giang Hoang Thuy

    Breast cancer is increasingly diagnosed at an early stage, allowing the diseased breast to be removed only partially or breast conserving surgery (BCS). Current BCS procedures have no rapid methods during surgery to assess if the surgical margin is clear of cancer, often resulting in re-excision. The current breast cancer re-excision rate is estimated to be 15% to as high as 60%. It would be desirable if there is a rapid and reliable breast cancer margin assessment tool in the operating room to help assess if the surgical margin is clean to minimize unnecessary re-excisions. In this research, we seek to develop an intraoperative, molecular probe-based breast cancer surgical margin assessment tool using aqueous quantum dots (AQDs) coupled with cancer specific biomarkers. Quantum dots (QDs) are photoluminescent semiconductor nanoparticles that do not photobleach and are brighter than organic fluorescent dyes. Aqueous quantum dots (AQDs) such as CdSe and near infrared (NIR) CdPbS developed in Shih's lab emit light longer than 600 nm. We have examined conjugating AQDs with antibodies to cancer specific biomarkers such as Tn antigen, a cancer-associated glycan antigen for epithelial cancers. We showed that AQDs could achieve ~80% antibody conjugation efficiency, i.e., 100 times less antibodies than required by commercial, making such AQD molecular probe surgical margin evaluation economically feasible. By conjugating AQDs with anti-Tn-antigen antibody, the AQDs molecular probe exhibited 94% sensitivity and 92% specificity in identifying breast cancer against normal breast tissues as well as benign breast tumors in 480 tissue blocks from 126 patients. Furthermore, mice model and clinical human studies indicated that AQDs imaging did not interfere with the following pathological staining. More interestingly, we showed that it it possible to directly conjugate one antibody to multiple AQDs, further reduces the required amount of antibodies needed, a feat that could not be

  5. 3D Surgical Simulation (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  6. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff


    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  7. Surgical bleeding in microgravity (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd


    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  8. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA


    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  9. Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention—An Institutional Experience (United States)

    Bachmann, R.; Rolinger, J.; Girotti, P.; Kopp, H. G.; Heissner, K.; Amend, B.; Königsrainer, A.; Ladurner, R.


    Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation. Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined. Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%. Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins. PMID:27190644

  10. Utility of frozen section analysis for fungal organisms in soft tissue wound debridement margin determination. (United States)

    Zimmermann, Nives; Hagen, Matthew C; Schrager, Jason J; Hebbeler-Clark, Renee S; Masineni, Sreeharsha


    Zygomycetes cause different patterns of infection in immunosuppressed individuals, including sino-orbito-cerebral, pulmonary, skin/soft tissue infection and disseminated disease. Infections with Zygomycetes have a high mortality rate, even with prompt treatment, which includes anti-fungal agents and surgical debridement. In some centers, clear margins are monitored by serial frozen sections, but there are no specific guidelines for the use of frozen sections during surgical debridement. Studies in fungal rhinosinusitis found 62.5-85 % sensitivity of frozen section analysis in margin assessment. However, the utility of frozen section analysis for margin evaluation in debridement of skin/soft tissue infection has not been published. We present a case of zygomycosis of decubitus ulcers in which we assessed statistical measures of performance of frozen section analysis for presence of fungal organisms on the margin, compared with formalin-fixed paraffin embedded (FFPE) sections as gold standard. A total of 33 specimens (94 blocks) were sectioned, stained with H&E and evaluated by both frozen and FFPE analysis. Negative interpretations were confirmed by Gomori methenamine silver stain on FFPE sections. H&E staining of frozen sections had 68.4 % sensitivity and 100 % specificity for assessing margins clear of fungal organisms. The negative and positive predictive values were 70.0 % and 100 %, respectively. Using presence of acute inflammation and necrosis as markers of fungal infection improved sensitivity (100 %) at the expense of specificity (42.9 %). Use of intraoperative assessment of skin and soft tissue margins for fungal infection is a valuable tool in the management of skin and soft tissue fungal infection treatment.

  11. Performance Evaluation of Portfolios with Margin Requirements

    Directory of Open Access Journals (Sweden)

    Hui Ding


    Full Text Available In financial markets, short sellers will be required to post margin to cover possible losses in case the prices of the risky assets go up. Only a few studies focus on the optimization and performance evaluation of portfolios in the presence of margin requirements. In this paper, we investigate the theoretical foundation of DEA (data envelopment analysis approach to evaluate the performance of portfolios with margin requirements from a different perspective. Under the mean-variance framework, we construct the optimization model and portfolio possibility set on considering margin requirements. The convexity of the portfolio possibility set is proved and the concept of efficiency in classical economics is extended to the portfolio case. The DEA models are then developed to evaluate the performance of portfolios with margin requirements. Through the simulations carried out in the end, we show that, with adequate portfolios, DEA can be used as an effective tool in computing the efficiencies of portfolios with margin requirements for the performance evaluation purpose. This study can be viewed as a justification of DEA into performance evaluation of portfolios with margin requirements.

  12. [Optimizing surgical hand disinfection]. (United States)

    Kampf, G; Kramer, A; Rotter, M; Widmer, A


    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  13. Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters



    Background: Surgical crown lengthening is needed for teeth with subgingival caries, fractured teeth, insufficient crown length, and deep subgingival margin of failed restorations. Since there is no agreement on the effects of crown lengthening surgery on gingival parameters, the purpose of this study was to evaluate periodontal parameters in patients who needed crown lengthening surgery. Methods: Twenty patients who had healthy periodontium and needed surgical crown lengthening were included ...

  14. [da Vinci surgical system]. (United States)

    Watanabe, Gou; Ishikawa, Norihiro


    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  15. 高管性别、权力结构与企业反伦理行为--基于上市公司违规操作PSM 配对样本的实证检验%Executive Gender,Power Structure and Corporate Unethical Behavior:An Empirical Test Based on PSM Data of Corporate Fraud

    Institute of Scientific and Technical Information of China (English)

    淦未宇; 徐细雄; 林丁健


    企业反伦理行为是转型期我国上市公司频繁发生的治理乱象,也是商业伦理研究的热点。本文以2006-2011年A股市场因违规操作被监管机构公开谴责、批评或处罚的327家公司及其PSM 配对样本为研究对象,采用二分类Probit回归方法实证检验了高管性别对企业伦理决策的影响效应。研究发现,高管性别是影响企业伦理决策的重要因素:当高管团队中存在女性成员或女性高管的比例上升时,公司发生反伦理性违规操作的概率显著降低。同时,女性高管抑制反伦理性违规操作的治理效果受到企业权力配置结构调节作用的影响。具体来讲,“一把手”权力强度越大(越集权),女性高管抑制反伦理性违规操作的积极作用越突出。本研究拓展了对企业反伦理行为决定因素的理论认知,也对女性高管决策与治理领域的研究文献贡献了新的知识。%Corporate unethical behavior happens frequently in Chinese stock market dur‐ing the transition period ,and also attracts much attention from scholars in the field of busi‐ness ethics .In order to investigate the impact of executive gender on corporate unethical be‐havior ,this paper estimates the bivariate Probit model with the data of 327 Chinese listed companies publicly condemned ,criticized and punished by regulatory authority owing to cor‐porate fraud and their propensity score matching companies from 2006 to 2011 .It comes to the conclusions that executive gender is the important factor affecting firm ethical decisions :higher ratio of female managers in top management team or female executives leads to the significant reduction in the possibility of corporate unethical fraud .Meanwhile ,power alloca‐tion structure plays an adjustment role in the governance effect of female executives on un‐ethical fraud .Specifically speaking ,more power possessed by chiefs results in more domi

  16. Using laser irradiation for the surgical treatment of periodontal disease (United States)

    Vieru, Rozana D.; Lefter, Agafita; Herman, Sonia


    In the marginal pr ogressive profound periodontities, we associated low level laser therapy (LLLT) to the classical surgical treatment with implant of biovitroceramics. From a total of 50 patients, 37 where irradiated with the laser. We used a diode laser, =830 nm, energy density up to 2 J cm2, in Nogier pulsed mode. The laser treatment is used in a complex of therapeutic procedures: odontal, local anti-inflammatory -- as well as in the cabinet and at home --, prosthetic, and for the morphologic and functional rebalancing. The immediate effects where: an evolution without bleeding and without post-surgical complications, as can appear at the patients who didn't benefit of laser irradiation (hematom, pain, functional alteration in the first post-surgical week). Operated tissue is recovering faster. The percentage of recurrences decreases and the success depends less on the biological potential and the immunity of each individual.

  17. Exploration of the continental margins of India

    Digital Repository Service at National Institute of Oceanography (India)

    Siddiquie, H.N.; Hashimi, N.H.; Vora, K.H.; Pathak, M.C.

    In mid 1970's the National Institute of Oceanography, Goa, India prepared a plan for systematic regional, geological and geophysical surveys of the continental margins of India. This involved over 75,000 km of underway (bathymetric, side scan sonar...

  18. Mental Depreciation and Marginal Decision Making (United States)

    Heath; Fennema


    We propose that individuals practice "mental depreciation," that is, they implicitly spread the fixed costs of their expenses over time or use. Two studies explore how people spread fixed costs on durable goods. A third study shows that depreciation can lead to two distinct errors in marginal decisions: First, people sometimes invest too much effort to get their money's worth from an expense (e.g., they may use a product a lot to spread the fixed expense across more uses). Second, people sometimes invest too little effort to get their money's worth: When people add a portion of the fixed cost to the current costs, their perceived marginal (i.e., incremental) costs exceed their true marginal costs. In response, they may stop investing because their perceived costs surpass the marginal benefits they are receiving. The latter effect is supported by two field studies that explore real board plan decisions by university students.

  19. Time Safety Margin: Theory and Practice (United States)


    safety plan as the test event approaches. Did the planners miss anything? What doesn’t make sense ? Is it too conservative or not conservative enough? The...seconds of TSM for a 10-degree dive at 150 KTAS, producing inefficiency with excessive margin. Somewhere in the middle, the restriction makes sense , but...412TW-TIH-16-01 TIME SAFETY MARGIN: THEORY AND PRACTICE WILLIAM R. GRAY, III Chief Test Pilot USAF Test Pilot School SEPTEMBER 2016

  20. Marketing margins and agricultural technology in Mozambique

    DEFF Research Database (Denmark)

    Arndt, Channing; Jensen, Henning Tarp; Robinson, Sherman


    Improvements in agricultural productivity and reductions in marketing costs in Mozambique are analysed using a computable general equilibrium (CGE) model. The model incorporates detailed marketing margins and separates household demand for marketed and home-produced goods. Individual simulations...... of improved agricultural technology and lower marketing margins yield welfare gains across the economy. In addition, a combined scenario reveals significant synergy effects, as gains exceed the sum of gains from the individual scenarios. Relative welfare improvements are higher for poor rural households...

  1. Statistical Analysis of Thermal Analysis Margin (United States)

    Garrison, Matthew B.


    NASA Goddard Space Flight Center requires that each project demonstrate a minimum of 5 C margin between temperature predictions and hot and cold flight operational limits. The bounding temperature predictions include worst-case environment and thermal optical properties. The purpose of this work is to: assess how current missions are performing against their pre-launch bounding temperature predictions and suggest any possible changes to the thermal analysis margin rules

  2. Investigating Mechanisms of Marginal Settlement Life Improvement

    Directory of Open Access Journals (Sweden)

    Hamid M. Mohammadi


    Full Text Available The main purpose of this research was to investigate mechanisms to improve marginal settlement life in Koohdasht County in Lorestan province. This research was a sort of the survey studies and a questionnaire was compiled for collection of data. Statistical population of this study was included 1560 households; also sampling method was a sort of random sampling. Number of sample size was estimated 85 households. Questionnaire's reliability was confirmed through computing Cronbach's alpha coefficient which was 0.85. Face validity of questionnaire was confirmed by some Tehran university agricultural extension and education department scientific board members. Also data analyzed by WINspss 11.5. The results of research revealed that marginal area residents had not good financial situation but they undertook great supporting burden and in point of view access to services and life conditions had not good situation. Therefore improvement of life conditions of marginal settlement life such as fundamental infrastructure include communication systems and sanitation offloading system recognized as the most important mechanisms of marginal settlement improvement according to results of priority setting of marginal settlement situation mechanisms. Also the results of factor analysis showed that 7 main mechanisms were be effective in term of marginal settlement life improvement that in order to importance were included servicing and life condition improvement, credit-economic, civil and legal, control and prevention, population and migration control, infrastructures improvement and hygiene situation.

  3. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia


    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  4. Spacecraft surgical scrub system (United States)

    Abbate, M.


    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  5. Gossypiboma—Retained Surgical Sponge

    Directory of Open Access Journals (Sweden)

    Hung-Shun Sun


    Full Text Available Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

  6. Evaluation of marginal circumference and marginal thickness changes in precrimped stainless steel crowns, after recrimping

    Directory of Open Access Journals (Sweden)

    Afshar H


    Full Text Available Background and Aim: The need for recrimping precrimped stainless steel crowns by the dentist in clinic is controversial. This study aimed to evaluate the rate of marginal circumference and marginal thickness change of precrimped stainless steel crowns after recrimping. Materials and Methods: In this experimental study, 30 primary photos were taken from margins of 30 S.S.Cs (3M, Ni-Cr related to tooth 85 with a digital camera fixed at a determined distance. Margins of crowns were crimped by 114 and 137 pliers with a controlled force (0.2 N and then 30 secondary photos were taken in the same conditions. The circumference of crown margins in primary (group A and secondary (group B photos were assessed by a digitizer system. Comparing the circumferences of crown margins in primary and secondary photos showed a significant decrease after crimping. Thickness of 30 random points on the crown margins of a crown similar to mentioned cases was measured by SEM (×150. Then similar procedures including taking a primary photo, crimping and taking a secondary photo was done for the sample crown. After significant reduction in margin circumference, thickness of 30 other random points on the crown margin were measured by SEM. Data were analyzed by paired sample t-test with p<0.05 as the limit of significance. Results: The mean marginal circumference of precrimped stainless steel crowns was reduced by 7.3% which was significant (P<0.001. On the other hand the mean marginal thickness of sample stainless steel crown showed 18µ increase. Conclusion: According to the results of this study, marginal circumference of precrimped stainless steel crowns (3M, Ni-Cr showed a significant decrease after crimping. It is concluded that crimping the stainless steel crowns even for precrimped ones seems necessary.

  7. Louis Pasteur surgical revolution. (United States)

    Toledo-Pereyra, Luis H


    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  8. Guideline implementation: Surgical attire. (United States)

    Cowperthwaite, Liz; Holm, Rebecca L


    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  9. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel


    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  10. Evaluating Surgical Margins with Optical Spectroscopy and Spectral Imaging Following Breast Cancer Resection (United States)


    parathyroid glands to prevent their accidental removal. G. Several undergraduate student s had summ er internships in m y lab, and I provided...Med (in review). Paras C, Keller MD, White L, Phay J, Mahadevan-Jansen A. “Seeing” the Parathyroid During Surgery. Nature Med (in review), 2009

  11. Debridement for surgical wounds. (United States)

    Dryburgh, Nancy; Smith, Fiona; Donaldson, Jayne; Mitchell, Melloney


    Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing. Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (Streptokinase/streptodornase) with saline-soaked dressings and reported the time to complete debridement. Four of the trials compared the effectiveness of dextranomer beads or paste with other products (different comparator

  12. Recurrence rate of basal cell carcinoma with positive histopathological margins and related risk factors* (United States)

    Lara, Fernanda; Santamaría, Jesus Rodriguez; Garbers, Luiz Eduardo Fabricio de Melo


    BACKGROUND The best way to approach surgically removed basal cell carcinoma with positive histopathological margins is a controversial issue. Some authors believe that the more appropriate treatment is an immediate reoperation while others prefer a periodic follow up. The rates of recurrence are variable in literature, between 10% and 67%. OBJECTIVE To define the recurrence rate of basal cell carcinoma with positive margins after surgery. Secondarily, identify morphological aspects that can suggest a more frequent tumoral recurrence. METHODS This was a retrospective and observational study made by analysis of medical records of 487 patients between January 2003 and December 2009 in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). From 402 basal cell carcinomas surgically treated, 41 fulfilled inclusion criteria and were evaluated for five years or more. Recurrence rate of these tumors was analyzed in all patients and clinical characteristics such as sex, age, tumor size, tumor site, ulceration, and histological type were evaluated in order to find if they were related to more common tumoral recurrence. RESULTS The rate of positive margins after surgery was 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group. Tumor size, site, histological type, ulceration and type of positive margin did not differ statistically between groups. It was not possible to consider if these factors were important in recurrence rates. STUDY LIMITATIONS Ideally, a prospective study with a larger sample would be more accurate. CONCLUSION The treatment of choice in basal cell carcinoma with positive margins must be individualized to reduce recurrence rates. PMID:28225958

  13. Reconstructing Rodinia by Fitting Neoproterozoic Continental Margins (United States)

    Stewart, John H.


    Reconstructions of Phanerozoic tectonic plates can be closely constrained by lithologic correlations across conjugate margins by paleontologic information, by correlation of orogenic belts, by paleomagnetic location of continents, and by ocean floor magmatic stripes. In contrast, Proterozoic reconstructions are hindered by the lack of some of these tools or the lack of their precision. To overcome some of these difficulties, this report focuses on a different method of reconstruction, namely the use of the shape of continents to assemble the supercontinent of Rodinia, much like a jigsaw puzzle. Compared to the vast amount of information available for Phanerozoic systems, such a limited approach for Proterozoic rocks, may seem suspect. However, using the assembly of the southern continents (South America, Africa, India, Arabia, Antarctica, and Australia) as an example, a very tight fit of the continents is apparent and illustrates the power of the jigsaw puzzle method. This report focuses on Neoproterozoic rocks, which are shown on two new detailed geologic maps that constitute the backbone of the study. The report also describes the Neoproterozoic, but younger or older rocks are not discussed or not discussed in detail. The Neoproterozoic continents and continental margins are identified based on the distribution of continental-margin sedimentary and magmatic rocks that define the break-up margins of Rodinia. These Neoproterozoic continental exposures, as well as critical Neo- and Meso-Neoproterozoic tectonic features shown on the two new map compilations, are used to reconstruct the Mesoproterozoic supercontinent of Rodinia. This approach differs from the common approach of using fold belts to define structural features deemed important in the Rodinian reconstruction. Fold belts are difficult to date, and many are significantly younger than the time frame considered here (1,200 to 850 Ma). Identifying Neoproterozoic continental margins, which are primarily

  14. Abrupt plate accelerations shape rifted continental margins (United States)

    Brune, Sascha; Williams, Simon E.; Butterworth, Nathaniel P.; Müller, R. Dietmar


    Rifted margins are formed by persistent stretching of continental lithosphere until breakup is achieved. It is well known that strain-rate-dependent processes control rift evolution, yet quantified extension histories of Earth’s major passive margins have become available only recently. Here we investigate rift kinematics globally by applying a new geotectonic analysis technique to revised global plate reconstructions. We find that rifted margins feature an initial, slow rift phase (less than ten millimetres per year, full rate) and that an abrupt increase of plate divergence introduces a fast rift phase. Plate acceleration takes place before continental rupture and considerable margin area is created during each phase. We reproduce the rapid transition from slow to fast extension using analytical and numerical modelling with constant force boundary conditions. The extension models suggest that the two-phase velocity behaviour is caused by a rift-intrinsic strength-velocity feedback, which can be robustly inferred for diverse lithosphere configurations and rheologies. Our results explain differences between proximal and distal margin areas and demonstrate that abrupt plate acceleration during continental rifting is controlled by the nonlinear decay of the resistive rift strength force. This mechanism provides an explanation for several previously unexplained rapid absolute plate motion changes, offering new insights into the balance of plate driving forces through time.

  15. Theory of margination in confined multicomponent suspensions (United States)

    Henriquez Rivera, Rafael; Sinha, Kushal; Graham, Michael


    In blood flow, leukocytes and platelets tend to segregate near the vessel walls; this is known as margination. Margination of leukocytes and platelets is important in physiological processes, medical diagnostics and drug delivery. A mechanistic theory is developed to describe flow-induced segregation in confined multicomponent suspensions of deformable particles such as blood. The theory captures the essential features of margination by describing it in terms of two key competing processes in these systems at low Reynolds number: wall-induced migration and hydrodynamic pair collisions. The theory also includes the effect of physical properties of the deformable particles and molecular diffusion. Several regimes of segregation are identified, depending on the value of a ``margination parameter'' M. Moreover, there is a critical value of M below which a sharp ``drainage transition'' occurs: one component is completely depleted from the bulk flow to the vicinity of the walls. Direct hydrodynamic simulations also display this transition in suspensions where the components differ in size or flexibility. The developed mechanistic theory leads to substantial insight into the origins of margination and will help in guiding development of new technologies involving multicomponent suspensions. This work was supported by NSF grant CBET-1436082.

  16. Collapse of modern carbonate platform margins

    Energy Technology Data Exchange (ETDEWEB)

    Mullins, H.T.; Hine, A.C.; Gardulski, A.


    Modern carbonate platform margins in the Florida-Bahama region have been viewed as depositional or constructional features. However, recent studies have shown that carbonate escarpments, such as the Blake-Bahama and West Florida Escarpments, are erosional in origin where the platform margins have a scalloped or horse-shoe shape. Seismic reflection data from one of these crescentic features along the west Florida platform margin indicate that it originated by large scale gravity collapse (slump). This collapse structure extends for at least 120 km along the margin and has removed about 350 m of strata as young as early Neogene. Although at least three generations of slope failure are recognized, catastrophic collapse appears to have occurred in the mid-Miocene. Gravitational instability due to high rates of sediment accumulation may have been the triggering mechanism. These data suggest that submarine slumping is an important process in the retreat of limestone escarpments and in the generation of carbonate megabreccia debris flows. Scalloped platform margins occur on satellite images of northern Exuma Sound and Columbus Basin in the Bahamas. The authors suggest that large-scale submarine slumping can cause elongation of structurally controlled intraplatform basins (Exuma South), and produce anomalous horse-shoe shaped basins (Columbus Basin) by mega-collapse processes.

  17. Abrupt plate accelerations shape rifted continental margins. (United States)

    Brune, Sascha; Williams, Simon E; Butterworth, Nathaniel P; Müller, R Dietmar


    Rifted margins are formed by persistent stretching of continental lithosphere until breakup is achieved. It is well known that strain-rate-dependent processes control rift evolution, yet quantified extension histories of Earth's major passive margins have become available only recently. Here we investigate rift kinematics globally by applying a new geotectonic analysis technique to revised global plate reconstructions. We find that rifted margins feature an initial, slow rift phase (less than ten millimetres per year, full rate) and that an abrupt increase of plate divergence introduces a fast rift phase. Plate acceleration takes place before continental rupture and considerable margin area is created during each phase. We reproduce the rapid transition from slow to fast extension using analytical and numerical modelling with constant force boundary conditions. The extension models suggest that the two-phase velocity behaviour is caused by a rift-intrinsic strength--velocity feedback, which can be robustly inferred for diverse lithosphere configurations and rheologies. Our results explain differences between proximal and distal margin areas and demonstrate that abrupt plate acceleration during continental rifting is controlled by the nonlinear decay of the resistive rift strength force. This mechanism provides an explanation for several previously unexplained rapid absolute plate motion changes, offering new insights into the balance of plate driving forces through time.

  18. Surgical Management of Benign and Borderline Phyllodes Tumors of the Breast. (United States)

    Moutte, Amandine; Chopin, Nicolas; Faure, Christelle; Beurrier, Frédéric; Ho Quoc, Christophe; Guinaudeau, Florence; Treilleux, Isabelle; Carrabin, Nicolas


    Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow-up was 58 months. Seventy-five patients (99%), with a mean tumor size of 27 mm, underwent a breast-conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re-excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow-up especially during this period for which patient's compliance is essential.

  19. Clinical review: surgical management of locally advanced and recurrent colorectal cancer.

    LENUS (Irish Health Repository)

    Courtney, D


    Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

  20. Computer assisted surgery in orthopaedic oncology : Indications, applications and surgical workflow

    NARCIS (Netherlands)

    Gerbers, Jasper Gerhard


    In the treatment of bone tumors surgical accuracy and precision are of vital importance to achieve an efficient but oncologically safe result. Most procedures in bone tumour surgery require intraop-erative imaging (fluoroscopy) and/or measurements for anatomical orientation and margin control. Compu

  1. New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma

    NARCIS (Netherlands)

    Cobben, DCP; Koopal, S; Tiebosch, ATMG; Jager, PL; Elsinga, PH; Wobbes, T; Hoekstra, HJ


    The emphasis of the research on the surgical treatment of melanoma has been on the resection margins, the role of elective lymph node dissection. in high risk patients and the value of adjuvant regional treatment with hyperthermic isolated lymph perfusion with melphalan. Parallel to this research,

  2. Analysis of surgical intervention populations using generic surgical process models. (United States)

    Neumuth, Thomas; Jannin, Pierre; Schlomberg, Juliane; Meixensberger, Jürgen; Wiedemann, Peter; Burgert, Oliver


    According to differences in patient characteristics, surgical performance, or used surgical technological resources, surgical interventions have high variability. No methods for the generation and comparison of statistical 'mean' surgical procedures are available. The convenience of these models is to provide increased evidence for clinical, technical, and administrative decision-making. Based on several measurements of patient individual surgical treatments, we present a method of how to calculate a statistical 'mean' intervention model, called generic Surgical Process Model (gSPM), from a number of interventions. In a proof-of-concept study, we show how statistical 'mean' procedure courses can be computed and how differences between several of these models can be quantified. Patient individual surgical treatments of 102 cataract interventions from eye surgery were allocated to an ambulatory or inpatient sample, and the gSPMs for each of the samples were computed. Both treatment strategies are exemplary compared for the interventional phase Capsulorhexis. Statistical differences between the gSPMs of ambulatory and inpatient procedures of performance times for surgical activities and activity sequences were identified. Furthermore, the work flow that corresponds to the general recommended clinical treatment was recovered out of the individual Surgical Process Models. The computation of gSPMs is a new approach in medical engineering and medical informatics. It supports increased evidence, e.g. for the application of alternative surgical strategies, investments for surgical technology, optimization protocols, or surgical education. Furthermore, this may be applicable in more technical research fields, as well, such as the development of surgical workflow management systems for the operating room of the future.

  3. Digital Margins : How spatially and socially marginalized communities deal with digital exclusion

    NARCIS (Netherlands)

    Salemink, Koen


    The increasing importance of the Internet as a means of communication has transformed economies and societies. For spatially and socially marginalized communities, this transformation has resulted in digital exclusion and further marginalization. This book presents a study of two kinds of marginaliz

  4. Surgical Management of Local Recurrences of Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Ömer Acar


    Full Text Available Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach and nonsurgical alternatives (cryoablation, radiofrequency ablation have yet to be described. In selected patients, surgical resection may have to be complemented with (neoadjuvant radiotherapy or medical treatment.

  5. Marginalization revisited: critical, postmodern, and liberation perspectives. (United States)

    Hall, J M


    Marginalization was advocated by Hall, Stevens, and Meleis in 1994 as a guiding concept for valuing diversity in knowledge development. Properties, risks, and resilience associated with the concept were detailed. This conceptualization of marginalization is reexamined here for its sociopolitical usefulness to nursing, from (1) critical theory, (2) postmodern, and (3) liberation philosophy perspectives. Additional properties are proposed to update the original conceptualization. These include: exteriority, Eurocentrism, constraint, economics, seduction, testimony, and hope. Effects of Eurocentric capitalism on all marginalized people are explored. Nursing implications include the need for interdisciplinary dialogue about the ethics of promoting and exporting Eurocentrism in nursing education and practice, and the need for integrated economic analyses of all aspects of life and health.

  6. A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification. (United States)

    Jeys, Lee M; Thorne, Chris J; Parry, Michael; Gaston, Czar Louie L; Sumathi, Vaiyapuri P; Grimer, J Robert


    Chemotherapy response and surgical margins have been shown to be associated with the risk of local recurrence in patients with osteosarcoma. However, existing surgical staging systems fail to reflect the response to chemotherapy or define an appropriate safe metric distance from the tumor that will allow complete excision and closely predict the chance of disease recurrence. We therefore sought to review a group of patients with primary high-grade osteosarcoma treated with neoadjuvant chemotherapy and surgical resection and analyzed margins and chemotherapy response in terms of local recurrence. (1) What predictor or combination of predictors available to the clinician can be assessed that more reliably predict the likelihood of local recurrence? (2) Can we determine a better predictor of local recurrence-free survival than the currently applied system of surgical margins? (3) Can we determine a better predictor of overall survival than the currently applied system of surgical margins? This retrospective study included all patients with high-grade conventional osteosarcomas without metastasis at diagnosis treated at one center between 1997 and 2012 with preoperative chemotherapy followed by resection or amputation of the primary tumor who were younger than age 50 years with minimum 24-month followup for those still alive. A total of 389 participants matched the inclusion criteria. Univariate log-rank test and multivariate Cox analyses were undertaken to identify predictors of local recurrence-free survival (LRFS). The Birmingham classification was devised on the basis of two stems: the response to chemotherapy (good response = ≥ 90% necrosis; poor response = HR], 9.9; 95% CI, 1.2-82; p = 0.03 versus radical margin HR, 1) and a poor response to neoadjuvant chemotherapy (HR, 3.8; 95% CI, 1.7-8.4; p = 0.001 versus good response HR, 1) were independent risk factors for local recurrence (LR). The best predictor of LR, however, was a combination of margins ≤ 2 mm and

  7. [Duane vertical surgical treatment]. (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G


    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  8. Diverticulitis: selective surgical management. (United States)

    Rugtiv, G M


    The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.

  9. Pathogenesis of splenic marginal zone lymphoma

    Directory of Open Access Journals (Sweden)

    Ming-Qing Du


    Full Text Available Splenic marginal zone lymphoma (SMZL is a distinct low grade B-cell lymphoma with an immunophenotype similar to that of splenic marginal zone B-cells. Like the normal splenic marginal zone B-cells, SMZLs also show variable features in somatic mutations of their rearranged immunoglobulin genes, with ∼90% of cases harbouring somatic mutations but at remarkably variable degrees, suggesting that SMZL may have multiple cell of origins, deriving from the heterogeneous B-cells of the splenic marginal zone. Notably, ∼30% of SMZLs show biased usage of IGHV1-2*04, with the expressed BCR being potentially polyreactive to autoantigens. Recent exome and targeted sequencing studies have identified a wide spectrum of somatic mutations in SMZL with the recurrent mutations targeting multiple signalling pathways that govern the development of splenic marginal zone B-cells. These recurrent mutations occur in KLF2 (20–42%, NOTCH2 (6.5–25%, NF-κB (CARD11 ∼7%, IKBKB ∼7%, TNFAIP3 7–13%, TRAF3 5%, BIRC3 6.3% and TLR (MYD88 5–13% signalling pathways. Interestingly, the majority of SMZL with KLF2 mutation have both 7q32 deletion and IGHV1-2 rearrangement, and these cases also have additional mutations in NOTCH2, or TNFAIP3, or TRAF3. There is a potential oncogenic cooperation among concurrent genetic changes, for example between the IGHV1-2 expressing BCR and KLF2 mutation in activation of the canonical NF-κB pathway, and between KLF2 and TRAF3 mutations in activation of the non-canonical NF-κB pathway. These novel genetic findings have provided considerable insights into the pathogenesis of SMZL and will stimulate the research in both normal and malignant marginal zone B-cells.

  10. Time-gated optical imaging to detect positive prostate cancer margins (United States)

    Lin, Zi-Jing; Alexandrakis, George; Patel, Nimit; Shen, Jinhui; Tang, Liping; Liu, Hanli


    Laparoscopic radical prostatectomy (LRP) has revolutionized the surgical treatment of prostate cancer. This procedure permits complete removal of the prostate and seminal vesicles while minimizing pain and recovery time. However, the laparoscopic approach greatly limits the surgeon's tactile sensation during the procedure. This is particularly true with robot-assisted LRP where no tactile feedback is available forcing the surgeon to rely solely on visual cues. The surgeon and pathologist perform intraoperative frozen section pathologic analysis of a few select tissue fragments, but this is time consuming and costly. Concrete conclusions based on such samples are unreliable as they do not reflect the entire surgical margin status. In this case a conservative approach might dictate removal of more marginal material than necessary, thereby compromising the important nerve-sparing aspects of the procedure. In this study, we demonstrate the feasibility of using multi-modal time-gated optical imaging, i.e. time-resolved light reflectance and auto-fluorescence life-time imaging performed by an ICCD (Intensified Charge-Coupled Device) imaging system to enable clinicians to detect positive tumor margins with high sensitivity and specificity over the prostate. Results from animal experiments present the potential of identifying differences in optical signals between prostate cancer and control tissues. Results also show that the use of classification algorithms can identify cancerous regions with high sensitivity and specificity.

  11. Skin cancer margin analysis within minutes with full-field OCT (Conference Presentation) (United States)

    Dalimier, Eugénie; Ogrich, Lauren; Morales, Diego; Cusack, Carrie Ann; Abdelmalek, Mark; Boccara, Claude; Durkin, John


    Non-melanoma skin cancer (NMSC) is the most common cancer. Treatment consists of surgical removal of the skin cancer. Traditional excision involves the removal of the visible skin cancer with a significant margin of normal skin. On cosmetically sensitive areas, Mohs micrographic tissue is the standard of care. Mohs uses intraoperative microscopic margin assessment which minimizes the surgical defect and can help reduce the recurrence rate by a factor of 3. The current Mohs technique relies on frozen section tissue slide preparation which significantly lengthens operative time and requires on-site trained histotechnicians. Full-Field Optical Coherence Tomography (FFOCT) is a novel optical imaging technique which provides a quick and efficient method to visualize cancerous areas in minutes, without any preparation or destruction of the tissue. This study aimed to evaluate the potential of FFOCT for the analysis of skin cancer margins during Mohs surgery. Over 150 images of Mohs specimens were acquired intraoperatively with FFOCT before frozen section analysis. The imaging procedure took less than 5 minutes for each specimen. No artifacts on histological preparation were found arising from FFOCT manipulation; however frozen section artifact was readily seen on FFOCT. An atlas was established with FFOCT images and corresponding histological slides to reveal FFOCT reading criteria of normal and cancerous structures. Blind analysis showed high concordance between FFOCT and histology. FFOCT can potentially reduce recurrence rates while maintaining short surgery times, optimize clinical workflow, and decrease healthcare costs. For the patient, this translates into smaller infection risk, decreased stress, and better comfort.

  12. Working marginal reserves using Auger technology

    Energy Technology Data Exchange (ETDEWEB)

    Celada Tamames, B.


    Following up an idea put forward at a meeting of the PEN (National Energy Plan) R and D working party held in Ponferrada in the province of Leon, Ocicarbon contracted Geocontrol SA to carry out a study on the possible use of Auger technology for working marginal coal reserves. This article summarises the most important points in the final report on this project: current state of Auger technology, inventory of marginal coal reserves in Spain and the use of Auger technology in Spain. 6 figs., 2 tabs.

  13. Algorithms for computing the multivariable stability margin (United States)

    Tekawy, Jonathan A.; Safonov, Michael G.; Chiang, Richard Y.


    Stability margin for multiloop flight control systems has become a critical issue, especially in highly maneuverable aircraft designs where there are inherent strong cross-couplings between the various feedback control loops. To cope with this issue, we have developed computer algorithms based on non-differentiable optimization theory. These algorithms have been developed for computing the Multivariable Stability Margin (MSM). The MSM of a dynamical system is the size of the smallest structured perturbation in component dynamics that will destabilize the system. These algorithms have been coded and appear to be reliable. As illustrated by examples, they provide the basis for evaluating the robustness and performance of flight control systems.

  14. Jatropha potential on marginal land in Ethiopia

    DEFF Research Database (Denmark)

    Wendimu, Mengistu Assefa

    narrative. But both the availability and suitability of “marginal” land for commercial level jatropha production is not well understood/examined, especially in Africa. Using a case study of large-scale jatropha plantation in Ethiopia, this paper examines the process of land identification for jatropha...... investments, and the agronomic performance of large-scale jatropha plantation on so-called marginal land. Although it has been argued that jatropha can be grown well on marginal land without irrigation, and thus does not compete for land and water or displace food production from agricultural land, this study...

  15. Use of marginal organs in kidney transplantation for marginal recipients: too close to the margins of safety?

    Directory of Open Access Journals (Sweden)

    Heuer M


    Full Text Available Abstract Objective Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function. Methods All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk. Results Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33% as compared to marginal recipients, of whom two-thirds received a marginal organ (p Conclusions As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.

  16. Normalized fluorescence lifetime imaging for tumor identification and margin delineation (United States)

    Sherman, Adria J.; Papour, Asael; Bhargava, Siddharth; Taylor, Zach; Grundfest, Warren S.; Stafsudd, Oscar M.


    Fluorescence lifetime imaging microscopy (FLIM) is a technique that has been proven to produce quantitative and qualitative differentiation and identification of substances with good specificity and sensitivity based on lifetime extracted information. This technique has shown the ability to also differentiate between a wide range of tissue types to identify malignant from benign tissue in vivo and ex vivo. However, the complexity, long duration and effort required to generate this information has limited the adoption of these techniques in a clinical setting. Our group has developed a time-resolved imaging system (patent pending) that does not require the extraction of lifetimes or use of complex curve fitting algorithms to display the needed information. The technique, entitled Lifetime Fluorescence Imaging (LFI, or NoFYI), converts fluorescence lifetime decay information directly into visual contrast. Initial studies using Fluorescein and Rhodamine-B demonstrated the feasibility of this approach. Subsequent studies demonstrated the ability to separate collagen and elastin powders. The technique uses nanosecond pulsed UV LEDs at 375 nm for average illumination intensities of ~4.5 μW on the tissue surface with detection by a gated CCD camera. To date, we have imaged 11 surgical head and neck squamous cell carcinoma and brain cancer biopsy specimens including 5 normal and 6 malignant samples. Images at multiple wavelengths clearly demonstrate differentiation between benign and malignant tissue, which was later confirmed by histology. Contrast was obtained between fluorophores with 35 μm spatial resolution and an SNR of ~30 dB allowing us to clearly define tumor margins in these highly invasive cancers. This method is capable of providing both anatomical and chemical information for the pathologist and the surgeon. These results suggest that this technology has a possible role in identifying tumors in tissue specimens and detecting tumor margins during procedures.

  17. A comparison of radical perineal, radical retropubic, and robot-assisted laparoscopic prostatectomies in a single surgeon series. (United States)

    Mirza, Moben; Art, Kevin; Wineland, Logan; Tawfik, Ossama; Thrasher, J Brantley


    Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  18. 17 CFR 242.405 - Withdrawal of margin. (United States)


    ...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as otherwise... account after such withdrawal is sufficient to satisfy the required margin for the security futures...

  19. On the Evolution of Glaciated Continental Margins (United States)

    Sverre Laberg, Jan; Rydningen, Tom Arne; Safronova, Polina A.; Forwick, Matthias


    Glaciated continental margins, continental margins where a grounded ice sheet repeatedly has been at or near the shelf break, are found at both northern and southern high-latitudes. Their evolution are in several aspects different from their low-latitude counterparts where eustatic sea-level variations possess a fundamental control on their evolution and where fluvial systems provide the main sediment input. From studies of the Norwegian - Barents Sea - Svalbard and NE Greenland continental margins we propose the following factors as the main control on the evolution of glaciated continental margins: 1) Pre-glacial relief controlling the accommodation space, 2) Ice sheet glaciology including the location of fast-flowing ice streams where source area morphology exerts a fundamental control, 3) Composition of the glacigenic sediments where the clay content in previous studies have been found to be important, and 4) Sea-level controlled both by eustacy and isostacy. From three case studies, 1) the western Barents Sea, 2) part of the North Norwegian (Troms), and 3) the Mid-Norwegian margin, the influence on these factors for the sea-floor morphology, sedimentary processes of the continental slope - deep sea and continental margin architecture are discussed. The pre-glacial relief of the mid-Norwegian and Troms margins relates to the onset of rifting and plate break-up from the early Cenozoic while for the SW Barents Sea, plate shear was followed by rifting. A wide zone of extended continental crust occurs offshore mid-Norway while this zone is much narrower offshore Troms leading to a more pronounced pre-glacial relief. Regarding sediment delivery and ice sheet glaciology the western Barents Sea exemplifies very high sediment input corresponding to an estimated average erosion of the source area of ~0.4 mm/yr (SW Barents Sea), much of which is related to subglacial erosion of Mesozoic - Cenozoic sedimentary rocks from large paleo-ice streams. The mid-Norwegian margin

  20. Persistence of the embryonic lateral marginal vein: report of two cases

    Directory of Open Access Journals (Sweden)

    Rojas Martinez Raúl


    Full Text Available PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

  1. Preparing and Restoring Composite Resin Restorations. The Advantage of High Magnification Loupes or the Dental Surgical Operating Microscope. (United States)

    Mamoun, John


    Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

  2. Minimally invasive surgical technique for tethered surgical drains

    Directory of Open Access Journals (Sweden)

    Shane R Hess


    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  3. Analysis the factors related to the cone marginal status of the patients with cervical intraepithelial neoplasia Ⅲ

    Institute of Scientific and Technical Information of China (English)

    Dai Zhi-qin; Pan Ling-ya; Huang Hui-fang; Lang Jing-he


    Objective:To assess the factors related to the cone marginal status of patients with cervical intraepithelial neo-plasia Ⅲ(CINⅢ)after conization.Method:A retrospective analysis of consecutive patients with CIN Ⅲ accepted conization between Jan.1st 1999 and Dec 31th 2004 was performed.To assess the relationships between the positive margin of conization of the pa-tients with cervical intraepithelial neoplasia Ⅲ and the patient's age,size of lesion and the operator.To assess the management of the positive cone margin and follow-up of the patient with CIN Ⅲ.Results:361 patients first accepted conization.Among them were 58 patients(16.1%)with positive cone mar-gin.There was no difference in the positive margin of conization in the different age groups,size of lesions and oper-ators.The rate of positive margin of conization was 14.3% with the surgeon of the gynecological oncologist,and the 20.4 % with the non-gynecological oncologist.The rate of the follow-up was 70%.According to the rate of the ab-normal cytology of follow-up,the positive margin of conization was 21.4%,and the negative margin of conization was 10.6%,there was no significant difference.Conclusion:The status of the resection margin of the conization may be related to the surgical skill.The patients with CINⅢ should be accepted a regular postoperative follow up,especially the patients with positive margin.

  4. Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

    Directory of Open Access Journals (Sweden)

    Antonio Augusto Velasco e Cruz


    Full Text Available ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men were operated on, with an age range of 44-99 years [mean ± standard deviation (SD = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months. Forty percent of the patients (24 lids had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

  5. Geological features and geophysical signatures of continental margins of India

    Digital Repository Service at National Institute of Oceanography (India)

    Krishna, K.S.

    and classification of continental margins are in general dependent on style of continental splitting, rifting, subsidence and their proximity to the tectonic plate boundaries, at times the margins undergo for modifications by sediment deposition and volcanic... by Deccan-Reunion hotspot volcanism and Bengal Fan sedimentation respectively. Volcanism has dominated on the western continental margin of India, thereby the margin had been turned into a volcanic passive continental margin, while eastern continental...


    Energy Technology Data Exchange (ETDEWEB)



    BI-OMP supports DOE's mission in Climate Change Research. The program provides the fundamental understanding of the linkages between carbon and nitrogen cycles in ocean margins. Researchers are providing a mechanistic understanding of these cycles, using the tools of modern molecular biology. The models that will allow policy makers to determine safe levels of greenhouse gases for the Earth System.

  7. Recidiva tardia de linfoma da zona marginal


    Rocha,Talita M. B.S.; Bortolheiro,Tereza C.; Costa, Eduardo; Haardt,Daniela; Roberto P. Paes; Chiattone, Carlos S.


    O linfoma de zona marginal é um linfoma de baixo grau com curso clínico indolente e potencial de recidiva.1,2 Apresentamos um caso de recidiva tardia após 25 anos de aparente remissão completa, levantando a possibilidade de recidiva de doença preexistente ou desenvolvimento de novo clone neoplásico.

  8. Large margin image set representation and classification

    KAUST Repository

    Wang, Jim Jing-Yan


    In this paper, we propose a novel image set representation and classification method by maximizing the margin of image sets. The margin of an image set is defined as the difference of the distance to its nearest image set from different classes and the distance to its nearest image set of the same class. By modeling the image sets by using both their image samples and their affine hull models, and maximizing the margins of the images sets, the image set representation parameter learning problem is formulated as an minimization problem, which is further optimized by an expectation - maximization (EM) strategy with accelerated proximal gradient (APG) optimization in an iterative algorithm. To classify a given test image set, we assign it to the class which could provide the largest margin. Experiments on two applications of video-sequence-based face recognition demonstrate that the proposed method significantly outperforms state-of-the-art image set classification methods in terms of both effectiveness and efficiency.

  9. New perceptions of continrntal margin biodiversity

    Digital Repository Service at National Institute of Oceanography (India)

    Menot, L.; Sibuet, M.; Carney, R.S.; Levin, L.A.; Rowe, G.T.; Billett, D.S.M.; Poore, G.; Kitazato, H.; Vanreusel, A.; Galeron, J.; Lavrado, H.P.; Sellanes, J.; Ingole, B.S.; Krylova, E.

    margins to major marine laboratories in developed countries. Such studies shaped our original, sometimes naïve, conceptions of what lives on these steep depth gradients even though we perceived the deep environment from afar and at a poor resolution...

  10. Sustainable biomass production on Marginal Lands (SEEMLA) (United States)

    Barbera, Federica; Baumgarten, Wibke; Pelikan, Vincent


    Sustainable biomass production on Marginal Lands (SEEMLA) The main objective of the H2020 funded EU project SEEMLA (acronym for Sustainable Exploitation of Biomass for Bioenergy from Marginal Lands in Europe) is the establishment of suitable innovative land-use strategies for a sustainable production of plant-based energy on marginal lands while improving general ecosystem services. The use of marginal lands (MagL) could contribute to the mitigation of the fast growing competition between traditional food production and production of renewable bio-resources on arable lands. SEEMLA focuses on the promotion of re-conversion of MagLs for the production of bioenergy through the direct involvement of farmers and forester, the strengthening of local small-scale supply chains, and the promotion of plantations of bioenergy plants on MagLs. Life cycle assessment is performed in order to analyse possible impacts on the environment. A soil quality rating tool is applied to define and classify MagL. Suitable perennial and woody bioenergy crops are selected to be grown in pilot areas in the partner countries Ukraine, Greece and Germany. SEEMLA is expected to contribute to an increasing demand of biomass for bioenergy production in order to meet the 2020 targets and beyond.

  11. Female Special Education Directors: Doubly Marginalized. (United States)

    Keefe, Charlotte Hendrick; Parmley, Pamela


    A qualitative study of five Texas female special education directors found that although participants achieved an administrative position, they were marginalized due to their leadership style, gender discrimination, and socialization. Participants also indicated a negative connection between being in special education administration and top-level…

  12. The marginal cost of public funds

    DEFF Research Database (Denmark)

    Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup


    This paper extends the theory and measurement of the marginal cost of public funds (MCF) to account for labor force participation responses. Our work is motivated by the emerging consensus in the empirical literature that extensive (participation) responses are more important than intensive (hours...


    Energy Technology Data Exchange (ETDEWEB)

    Nam Dinh; Ronaldo Szilard


    The concept of safety margins has served as a fundamental principle in the design and operation of commercial nuclear power plants (NPPs). Defined as the minimum distance between a system’s “loading” and its “capacity”, plant design and operation is predicated on ensuring an adequate safety margin for safety-significant parameters (e.g., fuel cladding temperature, containment pressure, etc.) is provided over the spectrum of anticipated plant operating, transient and accident conditions. To meet the anticipated challenges associated with extending the operational lifetimes of the current fleet of operating NPPs, the United States Department of Energy (USDOE), the Idaho National Laboratory (INL) and the Electric Power Research Institute (EPRI) have developed a collaboration to conduct coordinated research to identify and address the technological challenges and opportunities that likely would affect the safe and economic operation of the existing NPP fleet over the postulated long-term time horizons. In this paper we describe a framework for developing and implementing a Risk-Informed Safety Margin Characterization (RISMC) approach to evaluate and manage changes in plant safety margins over long time horizons.

  14. Marginal Strength of Collarless Metal Ceramic Crown

    Directory of Open Access Journals (Sweden)

    Sikka Swati


    fracture strength at margins of metal ceramic crowns cemented to metal tooth analogs. Crowns evaluated with different marginal configurations, shoulder and shoulder bevel with 0 mm, 0.5 mm, 1 mm, and 1.5 mm, were selected. Methods. Maxillary right canine typhodont tooth was prepared to receive a metal ceramic crown with shoulder margin. This was duplicated to get 20 metal teeth analogs. Then the same tooth was reprepared to get shoulder bevel configuration. These crowns were then cemented onmetal teeth analogs and tested for fracture strength atmargin on an Instron testing machine. A progressive compressive load was applied using 6.3 mm diameter rod with crosshead speed of 2.5 mm per minute. Statisticaly analysis was performed with ANOVA, Student's “t” test and “f” test. Results. The fracture strength of collarless metal ceramic crowns under study exceeded the normal biting force. Therefore it can be suggested that collarless metal ceramic crowns with shoulder or shoulder bevel margins up to 1.5 mm framework reduction may be indicated for anteriormetal ceramic restorations. Significance. k Collarless metal ceramic crowns have proved to be successful for anterior fixed restorations. Hence, it may be subjected to more clinical trials.

  15. Negative Stress Margins - Are They Real? (United States)

    Raju, Ivatury S.; Lee, Darlene S.; Mohaghegh, Michael


    Advances in modeling and simulation, new finite element software, modeling engines and powerful computers are providing opportunities to interrogate designs in a very different manner and in a more detailed approach than ever before. Margins of safety are also often evaluated using local stresses for various design concepts and design parameters quickly once analysis models are defined and developed. This paper suggests that not all the negative margins of safety evaluated are real. The structural areas where negative margins are frequently encountered are often near stress concentrations, point loads and load discontinuities, near locations of stress singularities, in areas having large gradients but with insufficient mesh density, in areas with modeling issues and modeling errors, and in areas with connections and interfaces, in two-dimensional (2D) and three-dimensional (3D) transitions, bolts and bolt modeling, and boundary conditions. Now, more than ever, structural analysts need to examine and interrogate their analysis results and perform basic sanity checks to determine if these negative margins are real.

  16. Mundhulens mikroflora hos patienter med marginal parodontitis

    DEFF Research Database (Denmark)

    Larsen, Tove; Fiehn, Nils-Erik


    Viden om marginal parodontitis’ mikrobiologi tog for alvor fart for ca. 40 år siden. Den tidlige viden var baseret på mikroskopiske og dyrkningsmæssige undersøgelser af den subgingivale plak. Anvendelsen af de nyere molekylærbiologiske metoder har betydet, at vor viden om de ætiologiske faktorer...

  17. Processes of marginalization in relation to participation

    DEFF Research Database (Denmark)

    Lagermann, Laila Colding


    This paper discusses processes of marginalization in relation to the participation of two students, Amir and Saad, in the school in Copenhagen, Denmark, which they attend but also across the school and different communities outside the school. In the paper I discuss the effect of some teachers...

  18. An information criterion for marginal structural models. (United States)

    Platt, Robert W; Brookhart, M Alan; Cole, Stephen R; Westreich, Daniel; Schisterman, Enrique F


    Marginal structural models were developed as a semiparametric alternative to the G-computation formula to estimate causal effects of exposures. In practice, these models are often specified using parametric regression models. As such, the usual conventions regarding regression model specification apply. This paper outlines strategies for marginal structural model specification and considerations for the functional form of the exposure metric in the final structural model. We propose a quasi-likelihood information criterion adapted from use in generalized estimating equations. We evaluate the properties of our proposed information criterion using a limited simulation study. We illustrate our approach using two empirical examples. In the first example, we use data from a randomized breastfeeding promotion trial to estimate the effect of breastfeeding duration on infant weight at 1 year. In the second example, we use data from two prospective cohorts studies to estimate the effect of highly active antiretroviral therapy on CD4 count in an observational cohort of HIV-infected men and women. The marginal structural model specified should reflect the scientific question being addressed but can also assist in exploration of other plausible and closely related questions. In marginal structural models, as in any regression setting, correct inference depends on correct model specification. Our proposed information criterion provides a formal method for comparing model fit for different specifications.

  19. Marginal adaptation of ceramic inserts after cementation

    NARCIS (Netherlands)

    Ozcan, M; Pfeiffer, P; Nergiz, [No Value


    The advantage of using ceramic inserts is to prevent major drawbacks of composite resins such as polymerization shrinkage, wear and microleakage. This in vitro study evaluated the marginal adaptation of two approximal ceramic insert systems after cementation to the cavities opened with ultrasonic ti

  20. The marginal costs of climate changing emissions

    NARCIS (Netherlands)

    Tol, R.S.J.; Downing, T.E.


    This paper presents the marginal costs of the emissions of a selected number of radiatively-active gases, three uniformly-mixed gases – carbon dioxide, methane, nitrous oxide – and two region-specific gases – nitrogen (from aircraft) and sulphur, which influence ozone and sulphate aerosol concentrat

  1. On the concept and process of marginalization

    NARCIS (Netherlands)

    J.B.W. Kuitenbrouwer (Joost)


    textabstractThe concept of marginalization has its genesis in the processes of transformation which have characterized the societies of Latin America (CEPAL). It is increasingly being used to denote similar processes in other parts of the world through which groups of the population are relegated to

  2. Early math intervention for marginalized students

    DEFF Research Database (Denmark)

    Overgaard, Steffen; Tonnesen, Pia Beck


    This study is one of more substudies in the project Early Math Intervention for Marginalized Students (TMTM2014). The paper presents the initial process of this substudy that will be carried out fall 2015. In the TMTM2014 project, 80 teachers, who completed a one week course in the idea of TMTM...

  3. Structural Marginality and the Urban Social Order. (United States)

    Kapferer, Bruce


    This article argues for a redefinition of "Marginality" in terms of the principles that influence the developing order of the urban formation as a whole. The emerging social order and the political participation of residents of two shanty areas in Kabwe, Zambia are traced over a period of 40 years. (Author/EB)

  4. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg


    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  5. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia.

    Directory of Open Access Journals (Sweden)

    In Jeong Lyu

    Full Text Available We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR recession patients with thyroid eye disease (TED-related esotropia (ET. The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044. In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064. The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET.

  6. The pre-Caledonian margin of Baltica (United States)

    Andersen, Torgeir B.; Jørgen Kjøll, Hans; Jakob, Johannes; Corfu, Fernando; Tegner, Christian


    It is well-documented that the pre-Caledonian margin of Baltica constituted a several hundred-km wide and more than 2000 km long passive margin. Its vestiges occur at low- to intermediate structural levels in the mountain belt, and are variably overprinted by the early- to end-Caledonian orogenic deformation and extension. Attempts to reconstruct the Caledonian margin of Baltica must be based on detailed maps integrated with studies of the rock-complexes that originally constituted the passive margin. The proximal parts of pre-Caledonian margin of Baltica are dominated by continental rift basins with coarse to fine-grained sediments deposited in the late Proterozoic through the Ediacaran and into the Lower Palaeozoic. The youngest dated clastic zircons probably record magmatism associated with initial contraction near or in the distal margin. The 'margin nappes' also comprise Baltican basement slivers and coarse to fine-grained sedimentary units as well as deep-marine basin deposits. A major change in the architecture of the passive margin units takes place across a transvers zone, which is sub-parallel to the present-day Gudbrandsdalen of South Norway. The transition is roughly parallel to the major basement lineament of the Sveconorwegian orogenic front in south Norway. The most important change across this transverse lineament is that the NE segment is magma-rich, characterized by abundant basaltic magmatism. The SW segment is magma-poor, and characterised by numerous (>100) solitary meta-peridotites, mostly meta-dunites and meta-harzburgites as well as a number of detrital serpentinites and soapstones. These are interpreted as fragments of exhumed mantle and their erosion products, respectively. The meta-peridotites emplaced structurally, and covered by dominantly deep-basin sediments, but also by coarser sedimentary breccias and conglomerates, as part of the rifted margin development. This mixed unit (mélange) was locally intruded by Late Cambrian to Early

  7. The Seismicity of Two Hyperextended Margins (United States)

    Redfield, Tim; Terje Osmundsen, Per


    A seismic belt marks the outermost edge of Scandinavia's proximal margin, inboard of and roughly parallel to the Taper Break. A similar near- to onshore seismic belt runs along its inner edge, roughly parallel to and outboard of the asymmetric, seaward-facing escarpment. The belts converge at both the northern and southern ends of Scandinavia, where crustal taper is sharp and the proximal margin is narrow. Very few seismic events have been recorded on the intervening, gently-tapering Trøndelag Platform. Norway's distribution of seismicity is systematically ordered with respect to 1) the structural templates of high-beta extension that shaped the thinning gradient during Late Jurassic or Early Cretaceous time, and 2) the topographically resurgent Cretaceous-Cenozoic "accommodation phase" family of escarpments that approximate the innermost limit of crustal thinning [See Redfield and Osmundsen (2012) for diagrams, definitions, discussion, and supporting citations.] Landwards from the belt of earthquake epicenters that mark the Taper Break the crust consistently thickens, and large fault arrays tend to sole out at mid crustal levels. Towards the sea the crystalline continental crust is hyperextended, pervasively faulted, and generally very thin. Also, faulting and serpentinization may have affected the uppermost parts of the distal margin's lithospheric mantle. Such contrasting structural conditions may generate a contrasting stiffness: for a given stress, more strain can be accommodated in the distal margin than in the less faulted proximal margin. By way of comparison, inboard of the Taper Break on the gently-tapered Trøndelag Platform, faulting was not penetrative. There, similar structural conditions prevail and proximal margin seismicity is negligible. Because stress concentration can occur where material properties undergo significant contrast, the necking zone may constitute a natural localization point for post-thinning phase earthquakes. In Scandinavia

  8. Leukocyte margination in a model microvessel (United States)

    Freund, Jonathan B.


    The physiological inflammation response depends upon the multibody interactions of blood cells in the microcirculation that bring leukocytes (white blood cells) to the vessel walls. We investigate the fluid mechanics of this using numerical simulations of 29 red blood cells and one leukocyte flowing in a two-dimensional microvessel, with the cells modeled as linearly elastic shell membranes. Despite its obvious simplifications, this model successfully reproduces the increasingly blunted velocity profiles and increased leukocyte margination observed at lower shear rates in actual microvessels. Red cell aggregation is shown to be unnecessary for margination. The relative stiffness of the red cells in our simulations is varied by over a factor of 10, but the margination is found to be much less correlated with this than it is to changes associated with the blunting of the mean velocity profile at lower shear rates. While velocity around the leukocyte when it is near the wall depends upon the red cell properties, it changes little for strongly versus weakly marginating cases. In the more strongly marginating cases, however, a red cell is frequently observed to be leaning on the upstream side of the leukocyte and appears to stabilize it, preventing other red cells from coming between it and the wall. A well-known feature of the microcirculation is a near-wall cell-free layer. In our simulations, it is observed that the leukocyte's most probable position is at the edge of this layer. This wall stand-off distance increases with velocity following a scaling that would be expected for a lubrication mechanism, assuming that there were a nearly constant force pushing the cells toward the wall. The leukocyte's near-wall position is observed to be less stable with increasing mean stand-off distance, but this distance would have potentially greater effect on adhesion since the range of the molecular binding is so short.

  9. Intraoperative targeted optical imaging: a guide towards tumor-free margins in cancer surgery. (United States)

    Orbay, Hakan; Bean, Jero; Zhang, Yin; Cai, Weibo


    Over the last several decades, development of various imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography greatly facilitated the early detection of cancer. Another important aspect that is closely related to the survival of cancer patients is complete tumor removal during surgical resection. The major obstacle in achieving this goal is to distinguish between tumor tissue and normal tissue during surgery. Currently, tumor margins are typically assessed by visual assessment and palpation of the tumor intraoperatively. However, the possibility of microinvasion to the surrounding tissues makes it difficult to determine an adequate tumor-free excision margin, often forcing the surgeons to perform wide excisions including the healthy tissue that may contain vital structures. It would be ideal to remove the tumor completely, with minimal safety margins, if surgeons could see precise tumor margins during the operation. Molecular imaging with optical techniques can visualize the tumors via fluorophore conjugated probes targeting tumor markers such as proteins and enzymes that are upregulated during malignant transformation. Intraoperative use of this technique may facilitate complete excision of the tumor and tumor micromasses located beyond the visual capacity of the naked eye, ultimately improving the clinical outcome and survival rates of cancer patients.

  10. A computational model for estimating tumor margins in complementary tactile and 3D ultrasound images (United States)

    Shamsil, Arefin; Escoto, Abelardo; Naish, Michael D.; Patel, Rajni V.


    Conventional surgical methods are effective for treating lung tumors; however, they impose high trauma and pain to patients. Minimally invasive surgery is a safer alternative as smaller incisions are required to reach the lung; however, it is challenging due to inadequate intraoperative tumor localization. To address this issue, a mechatronic palpation device was developed that incorporates tactile and ultrasound sensors capable of acquiring surface and cross-sectional images of palpated tissue. Initial work focused on tactile image segmentation and fusion of position-tracked tactile images, resulting in a reconstruction of the palpated surface to compute the spatial locations of underlying tumors. This paper presents a computational model capable of analyzing orthogonally-paired tactile and ultrasound images to compute the surface circumference and depth margins of a tumor. The framework also integrates an error compensation technique and an algebraic model to align all of the image pairs and to estimate the tumor depths within the tracked thickness of a palpated tissue. For validation, an ex vivo experimental study was conducted involving the complete palpation of 11 porcine liver tissues injected with iodine-agar tumors of varying sizes and shapes. The resulting tactile and ultrasound images were then processed using the proposed model to compute the tumor margins and compare them to fluoroscopy based physical measurements. The results show a good negative correlation (r = -0.783, p = 0.004) between the tumor surface margins and a good positive correlation (r = 0.743, p = 0.009) between the tumor depth margins.

  11. Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs

    Directory of Open Access Journals (Sweden)

    Marina Paini


    Full Text Available Appropriate surgical strategies for management of intraductal papillary mucinous neoplasms (IPMNs of the pancreas are a matter of debate. Preoperative and intraoperative evaluation of malignant potential of IPMN and of patient’s comorbidities is of paramount importance to balance potential complications of surgery with tumors’ risk of being or becoming malignant; the decision about the extent of pancreatic resection and the eventual total pancreatectomy needs to be determined on individual basis. The analysis of frozen-section margin of pancreas during operation is mandatory. The goal should be the complete resection of IPMN reaching negative margin, although there is still no agreed definition of “negative margin.” Of note, the presence of deepithelization is often wrongly interpreted as absence of neoplasia. Management of resection margin status and stratification of surveillance of the remnant pancreas, based on characteristics of primary tumour, are of crucial importance in the management of IPMNs in order to decrease the risk of tumor recurrence after resection. Although risk of local and distant recurrence for invasive IPMNs is increased even in case of total pancreatectomy, also local recurrence after complete resection of noninvasive IPMNs is not negligible. Therefore, a long-term/life-time follow-up monitoring is of paramount importance to detect eventual recurrences.

  12. Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins

    Directory of Open Access Journals (Sweden)

    Leonardo Hernández


    Full Text Available Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins This paper studies a simple model of financial intermediation in order to understand how the lending-borrowing spread or interest margin charged by financial intermediaries is determined in equilibrium in a monetary economy. The main conclusion of the paper concerns the effect on the spread of changes in the distribution of monetary innovations. Thus, changes in the monetary-policy-rule followed by the Central Bank which alter the volatility of inflation will have important effects on the interest margin and also on the amount of credit available to investors. A crosssection empirical analysis strongly supports our hypothesis:

  13. Tophi - surgical treatment. (United States)

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  14. Tophi – surgical treatment (United States)

    Słowińska, Iwona; Słowiński, Radosław


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly. PMID:27994273

  15. Neuronavigation. Principles. Surgical technique. (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad


    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  16. Surgical education in Mexico. (United States)

    Cervantes, Jorge


    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital.

  17. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    Institute of Scientific and Technical Information of China (English)

    Jordan M Cloyd; Elizabeth George; Brendan C Visser


    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma(DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multiinstitutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles.

  18. [Surgical complications of pancreatectomy]. (United States)

    Sauvanet, A


    The mortality for pancreatectomy has decreased to a very low level in recent years but morbidity remains high. The most frequent post-operative complications of pancreaticoduodenectomy (PD) are delayed gastric emptying (DGE) in 20% and pancreatic fistula (PF) in 10-15%. DGE is associated with other abdominal complications in half the cases; these must be delineated by CT scan and specifically treated. Isolated DGE usually resolves within three weeks with the use of nasogastric suction and pro-kinetic drugs. FP following PD may be preventable with the use of temporary trans-jejunal intubation of Wirsung's duct or by intussusception of the pancreatic margin into the jejunal lumen. FP occurring after PD will heal with conservative management (total parenteral nutrition, peripancreatic drainage, somatostatin analogues) in 80-90% of cases but secondary complications such as peritonitis, arterial erosion and pseudo-aneurysm may be life-threatening. Early hemorrhage (in the first 48-72 hours) must be treated by re-operation. Late hemorrhage (usually secondary to PF) and ischemic complications are rare (3% and 1% respectively), difficult to treat, and associated with high mortality. PF is also the main complication of distal pancreatectomy and enucleation of pancreatic tumors (10-20% and 30% respectively). These PF resolve with conservative treatment in more than 95% of cases but may justify an ERCP sphincterotomy if drainage is prolonged. After medial pancreatectomy, PF occurs in 20-30% of cases, arising from either of the two transected pancreatic surfaces.

  19. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen


    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  20. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart


    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  1. Surgical treatment of acquired tracheocele. (United States)

    Porubsky, Edward A; Gourin, Christine G


    Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

  2. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart


    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  3. Adaptive Marginal Median Filter for Colour Images

    Directory of Open Access Journals (Sweden)

    Almanzor Sapena


    Full Text Available This paper describes a new filter for impulse noise reduction in colour images which is aimed at improving the noise reduction capability of the classical vector median filter. The filter is inspired by the application of a vector marginal median filtering process over a selected group of pixels in each filtering window. This selection, which is based on the vector median, along with the application of the marginal median operation constitutes an adaptive process that leads to a more robust filter design. Also, the proposed method is able to process colour images without introducing colour artifacts. Experimental results show that the images filtered with the proposed method contain less noisy pixels than those obtained through the vector median filter.

  4. Distributions with given marginals and statistical modelling

    CERN Document Server

    Fortiana, Josep; Rodriguez-Lallena, José


    This book contains a selection of the papers presented at the meeting `Distributions with given marginals and statistical modelling', held in Barcelona (Spain), July 17-20, 2000. In 24 chapters, this book covers topics such as the theory of copulas and quasi-copulas, the theory and compatibility of distributions, models for survival distributions and other well-known distributions, time series, categorical models, definition and estimation of measures of dependence, monotonicity and stochastic ordering, shape and separability of distributions, hidden truncation models, diagonal families, orthogonal expansions, tests of independence, and goodness of fit assessment. These topics share the use and properties of distributions with given marginals, this being the fourth specialised text on this theme. The innovative aspect of the book is the inclusion of statistical aspects such as modelling, Bayesian statistics, estimation, and tests.

  5. Time Domain Stability Margin Assessment Method (United States)

    Clements, Keith


    The baseline stability margins for NASA's Space Launch System (SLS) launch vehicle were generated via the classical approach of linearizing the system equations of motion and determining the gain and phase margins from the resulting frequency domain model. To improve the fidelity of the classical methods, the linear frequency domain approach can be extended by replacing static, memoryless nonlinearities with describing functions. This technique, however, does not address the time varying nature of the dynamics of a launch vehicle in flight. An alternative technique for the evaluation of the stability of the nonlinear launch vehicle dynamics along its trajectory is to incrementally adjust the gain and/or time delay in the time domain simulation until the system exhibits unstable behavior. This technique has the added benefit of providing a direct comparison between the time domain and frequency domain tools in support of simulation validation.

  6. Rigidity of marginally outer trapped 2-spheres

    CERN Document Server

    Galloway, Gregory J


    In a matter-filled spacetime, perhaps with positive cosmological constant, a stable marginally outer trapped 2-sphere must satisfy a certain area inequality. Namely, as discussed in the paper, its area must be bounded above by $4\\pi/c$, where $c > 0$ is a lower bound on a natural energy-momentum term. We then consider the rigidity that results for stable, or weakly outermost, marginally outer trapped 2-spheres that achieve this upper bound on the area. In particular, we prove a splitting result for 3-dimensional initial data sets analogous to a result of Bray, Brendle and Neves [10] concerning area minimizing 2-spheres in Riemannian 3-manifolds with positive scalar curvature. We further show that these initial data sets locally embed as spacelike hypersurfaces into the Nariai spacetime. Connections to the Vaidya spacetime and dynamical horizons are also discussed.

  7. Passive target tracking using marginalized particle filter

    Institute of Scientific and Technical Information of China (English)


    A marginalized particle filtering(MPF)approach is proposed for target tracking under the background of passive measurement.Essentially,the MPF is a combination of particle filtering technique and Kalman filter.By making full use of marginalization,the distributions of the tractable linear part of the total state variables are updated analytically using Kalman filter,and only the lower-dimensional nonlinear state variable needs to be dealt with using particle filter.Simulation studies are performed on an illustrative example,and the results show that the MPF method leads to a significant reduction of the tracking errors when compared with the direct particle implementation.Real data test results also validate the effectiveness of the presented method.

  8. Marginal Loss Calculations for the DCOPF

    Energy Technology Data Exchange (ETDEWEB)

    Eldridge, Brent [Federal Energy Regulatory Commission, Washington, DC (United States); Johns Hopkins Univ., Baltimore, MD (United States); O' Neill, Richard P. [Federal Energy Regulatory Commission, Washington, DC (United States); Castillo, Andrea R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    The purpose of this paper is to explain some aspects of including a marginal line loss approximation in the DCOPF. The DCOPF optimizes electric generator dispatch using simplified power flow physics. Since the standard assumptions in the DCOPF include a lossless network, a number of modifications have to be added to the model. Calculating marginal losses allows the DCOPF to optimize the location of power generation, so that generators that are closer to demand centers are relatively cheaper than remote generation. The problem formulations discussed in this paper will simplify many aspects of practical electric dispatch implementations in use today, but will include sufficient detail to demonstrate a few points with regard to the handling of losses.

  9. European refiners re-adjust margins strategy

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, R.G. [ed.


    Refiners in Europe are adjusting operating strategies to reflect the volatilities of tight operating margins. From the unexpected availability of quality crudes (e.g., Brent, 0.3% sulfur), to the role of government in refinery planning, the European refining industry is positioning itself to reverse the past few years of steadily declining profitability. Unlike expected increases in US gasoline demand, European gasoline consumption is not expected to increase, and heavy fuel oil consumption is also declining. However, diesel fuel consumption is expected to increase, even though diesel processing capacity has recently decreased (i.e., more imports). Some of the possible strategies that Europeans may adapt to improve margins and reduce volatility include: Increase conversion capacity to supply growing demand for middle distillates and LPG; alleviate refinery cash flow problems with alliances; and direct discretionary investment toward retail merchandising (unless there is a clear trend toward a widening of the sweet-sour crude price differential).

  10. Justice and Surgical Innovation: The Case of Robotic Prostatectomy. (United States)

    Hutchison, Katrina; Johnson, Jane; Carter, Drew


    Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations.

  11. Marginal longitudinal semiparametric regression via penalized splines

    KAUST Repository

    Al Kadiri, M.


    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  12. Neotectonics in the northern equatorial Brazilian margin (United States)

    Rossetti, Dilce F.; Souza, Lena S. B.; Prado, Renato; Elis, Vagner R.


    An increasing volume of publications has addressed the role of tectonics in inland areas of northern Brazil during the Neogene and Quaternary, despite its location in a passive margin. Hence, northern South America plate in this time interval might have not been as passive as usually regarded. This proposal needs further support, particularly including field data. In this work, we applied an integrated approach to reveal tectonic structures in Miocene and late Quaternary strata in a coastal area of the Amazonas lowland. The investigation, undertaken in Marajó Island, mouth of the Amazonas River, consisted of shallow sub-surface geophysical data including vertical electric sounding and ground penetrating radar. These methods were combined with morphostructural analysis and sedimentological/stratigraphic data from shallow cores and a few outcrops. The results revealed two stratigraphic units, a lower one with Miocene age, and an upper one of Late Pleistocene-Holocene age. An abundance of faults and folds were recorded in the Miocene deposits and, to a minor extent, in overlying Late Pleistocene-Holocene strata. In addition to characterize these structures, we discuss their origin, considering three potential mechanisms: Andean tectonics, gravity tectonics related to sediment loading in the Amazon Fan, and rifting at the continental margin. Amongst these hypotheses, the most likely is that the faults and folds recorded in Marajó Island reflect tectonics associated with the history of continental rifting that gave rise to the South Atlantic Ocean. This study supports sediment deposition influenced by transpression and transtension associated with strike-slip divergence along the northern Equatorial Brazilian margin in the Miocene and Late Pleistocene-Holocene. This work records tectonic evidence only for the uppermost few ten of meters of this sedimentary succession. However, available geological data indicate a thickness of up to 6 km, which is remarkably thick for

  13. Negative marginal tax rates and heterogeneity


    Choné, Philippe; Laroque, Guy


    Heterogeneity is likely to be an important determinant of the shape of optimal tax schemes. This article addresses the issue in a model à la Mirrlees with a continuum of agents. The agents differ in their productivities and opportunity costs of work, but their labor supplies depend only on a unidimensional combination of their two characteristics. Conditions are given under which the standard result that marginal tax rates are everywhere non-negative holds. This is in particular the case when...

  14. Mining their own Business in the Margins

    DEFF Research Database (Denmark)

    Jensen, Lars

    Mining has long been established in Australian public discourse as an activity that has driven the Australian economy, and guaranteed Australia against the economic ills of the rest of the West. Or put slightly differently, the positive spin on mining in public discourse and the financial market,...... of speaking about margins/marginalisation in relation to the mining industry, that is, as something conducted beyond the horizon, something which defines the horizon - and as a process through which remoteness defines the (national) self....

  15. Authigenic minerals from the continental margins

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, V.P.

    phosphorites have been presumed to be sedimented plankton organic matter, fish debris, and iron-redox phosphate pump. Several workers investigated the genesis of sedimentary phosphorites occurring from Precambrian to Recent and proposed different...-phosphate sediments of the western continental margin of India showed that phosphate occurred as apatite microparticles that resembled fossilized phosphate bacteria and/or microbial filaments (Fig. 3). This established the prominence of micro- environments...


    Directory of Open Access Journals (Sweden)

    Ratnawati Tahir


    Full Text Available Abstract: Alternative Education for Marginalized Women in Rural Areas. The study aims to find alter­native forms of education for marginalized women, the process of forming study groups and gender based learning process that serves the center of the development of education, leadership and a source of economic empowerment. The study uses qualitative methods, involving a group of women who have attended an al­ternative education. Researchers and informants from community leaders. The results showed that the form of alternative education is a method of adult education or andragogy. Study groups consisted of basic literacy and functional literacy. The learning process begins with the sharing of learning, reflection on life experience and role play method. The result is 65% of participants have increased the ability of reading, writing and numeracy, and understanding of the issues of women who have confidence in the decision making of households and communities. Abstrak: Pendidikan Alternatif untuk Perempuan Marginal di Pedesaan. Penelitian ini bertujuan mengetahui bentuk pendidikan alternatif untuk perempuan marginal, proses pembentukan kelompok belajar, dan proses pembelajaran berperspektif gender yang berfungsi menjadi pusat pengembangan pendidikan, kepemimpinan, dan sumber penguatan ekonomi. Penelitian menggunakan metode kualitatif, mengambil satu kelompok perempuan yang telah mengikuti pendidikan alternatif. Informan terdiri atas tokoh masyarakat, seperti Kepala Desa, Ketua RT/RW, dan ibu rumah tangga. Hasil penelitian menunjukkan bahwa bentuk pembelajaran pendidikan alternatif adalah metode pendidikan orang dewasa atau andragogy. Pembentukan kelompok belajar terdiri atas; kelompok baca tulis dan keaksaraan fungsional. Proses pembe­lajaran dimulai dengan sharing pembelajaran, refleksi pengalaman hidup, dan metode role play. Hasilnya 65% peserta pembelajaran mengalami peningkatan kemampuan membaca, menulis, dan berhitung, serta pema

  17. Statistical Mechanics of Soft Margin Classifiers


    Risau-Gusman, Sebastian; Gordon, Mirta B.


    We study the typical learning properties of the recently introduced Soft Margin Classifiers (SMCs), learning realizable and unrealizable tasks, with the tools of Statistical Mechanics. We derive analytically the behaviour of the learning curves in the regime of very large training sets. We obtain exponential and power laws for the decay of the generalization error towards the asymptotic value, depending on the task and on general characteristics of the distribution of stabilities of the patte...

  18. Marginal Ice Zone: Biogeochemical Sampling with Gliders (United States)


    ocean and base of marine food webs, are responding to changing conditions in the Arctic Ocean . The high-level project goals are to use underwater...observing array (Fig. 1). The glider sensor suite included temperature , temperature microstructure, salinity , oxygen, chlorophyll fluorescence, optical...presented at the Arctic Science Summit Week in Toyama, Japan, in April 2015 (Direct Observations of Ocean Variability Across the Arctic Marginal Ice Zone

  19. Marginal microfiltration in amalgam restorations. Review


    Lahoud Salem, Víctor; Departamento Académico de Estomatología Rehabilitadora. Facultad de Odontología, Universidad Nacional Mayor de San Marcos, Lima. Perú.


    The present articule is review references from phenomenon of microfiltration in restorations with amalgam and yours consecuents in changes of color in the interface tooth-restorations, margin deterioted , sensitivity dentinarea postoperate, caries secondary and pulp inflamation. Besides naming the mechanicals for to reduce microfiltration, and yours effects for use of sealers dentinaries representation for the varnish cavitys and adhesive systens Conclusive indicate wath the amalgam is the ma...

  20. Marginal selenium status in northern Tasmania. (United States)

    Beckett, Jeffrey M; Ball, Madeleine J


    Se plays many important roles in humans. Marginal Se status has been associated with adverse health effects including an increased risk of chronic disease such as cancer. There are few Australian data, but the population of Tasmania, Australia, is potentially at risk of marginal Se status. A cross-sectional study of 498 men and women aged 25-84 years was undertaken to assess the Se status of the northern Tasmanian population. Se status was assessed using dietary estimates and measures of serum Se and glutathione peroxidase (GPx). Mean Se intakes were 77·4 (sd 31·3) and 65·1 (sd 23·7) μg/d for men and women, respectively; 27 % of the subjects consumed less than the Australian/New Zealand estimated average requirement. Mean serum Se concentration was 89·1 (sd 15·1) μg/l; 83 % of the study subjects had serum Se concentrations below 100 μg/l and 60 % had serum Se concentration below 90 μg/l, suggesting that Se status in many subjects was inadequate for maximal GPx activity. This was supported by the positive association between serum Se and serum GPx (P < 0·001), indicating that enzyme activity was limited by Se concentrations. The lowest mean serum Se concentrations were observed in the oldest age ranges; however, the prevalence of marginal Se status was similar across age ranges and did not appear to be influenced by sex or socio-economic status. The prevalence of marginal Se status was high in all sex and age subgroups, suggesting that the northern Tasmanian population could benefit from increasing Se intakes.

  1. Marginal longitudinal semiparametric regression via penalized splines. (United States)

    Kadiri, M Al; Carroll, R J; Wand, M P


    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  2. Clinical assessment of human breast cancer margins with wide-field optical coherence micro-elastography (Conference Presentation) (United States)

    Allen, Wes M.; Chin, Lixin; Wijesinghe, Philip; Kirk, Rodney W.; Latham, Bruce; Sampson, David D.; Saunders, Christobel M.; Kennedy, Brendan F.


    Breast cancer has the second highest mortality rate of all cancers in females. Surgical excision of malignant tissue forms a central component of breast-conserving surgery (BCS) procedures. Incomplete excision of malignant tissue is a major issue in BCS with typically 20 - 30% cases requiring a second surgical procedure due to postoperative detection of tumor in the margin. A major challenge for surgeons during BCS is the lack of effective tools to assess the surgical margin intraoperatively. Such tools would enable the surgeon to more effectively remove all tumor during the initial surgery, hence reducing re-excision rates. We report advances in the development of a new tool, optical coherence micro-elastography, which forms images, known as elastograms, based on mechanical contrast within the tissue. We demonstrate the potential of this technique to increase contrast between malignant tumor and healthy stroma in elastograms over OCT images. We demonstrate a key advance toward clinical translation by conducting wide-field imaging in intraoperative time frames with a wide-field scanning system, acquiring mosaicked elastograms with overall dimensions of 50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. We describe this wide-field imaging system, and demonstrate its operation by presenting wide-field optical coherence tomography images and elastograms of a tissue mimicking silicone phantom and a number of representative freshly excised human breast specimens. Our results demonstrate the feasibility of scanning large areas of lumpectomies, which is an important step towards practical intraoperative margin assessment.

  3. [Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair]. (United States)

    Vacher, C; Cyna-Gorse, F


    Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle.

  4. Target margins in radiotherapy of prostate cancer. (United States)

    Yartsev, Slav; Bauman, Glenn


    We reviewed the literature on the use of margins in radiotherapy of patients with prostate cancer, focusing on different options for image guidance (IG) and technical issues. The search in PubMed database was limited to include studies that involved external beam radiotherapy of the intact prostate. Post-prostatectomy studies, brachytherapy and particle therapy were excluded. Each article was characterized according to the IG strategy used: positioning on external marks using room lasers, bone anatomy and soft tissue match, usage of fiducial markers, electromagnetic tracking and adapted delivery. A lack of uniformity in margin selection among institutions was evident from the review. In general, introduction of pre- and in-treatment IG was associated with smaller planning target volume (PTV) margins, but there was a lack of definitive experimental/clinical studies providing robust information on selection of exact PTV values. In addition, there is a lack of comparative research regarding the cost-benefit ratio of the different strategies: insertion of fiducial markers or electromagnetic transponders facilitates prostate gland localization but at a price of invasive procedure; frequent pre-treatment imaging increases patient in-room time, dose and labour; online plan adaptation should improve radiation delivery accuracy but requires fast and precise computation. Finally, optimal protocols for quality assurance procedures need to be established.

  5. Ocean Margins Programs, Phase I research summaries

    Energy Technology Data Exchange (ETDEWEB)

    Verity, P. [ed.


    During FY 1992, the DOE restructured its regional coastal-ocean programs into a new Ocean Margins Program (OMP), to: Quantify the ecological and biogeochemical processes and mechanisms that affect the cycling, flux, and storage of carbon and other biogenic elements at the land/ocean interface; Define ocean-margin sources and sinks in global biogeochemical cycles, and; Determine whether continental shelves are quantitatively significant in removing carbon dioxide from the atmosphere and isolating it via burial in sediments or export to the interior ocean. Currently, the DOE Ocean Margins Program supports more than 70 principal and co-principal investigators, spanning more than 30 academic institutions. Research funded by the OMP amounted to about $6.9M in FY 1994. This document is a collection of abstracts summarizing the component projects of Phase I of the OMP. This phase included both research and technology development, and comprised projects of both two and three years duration. The attached abstracts describe the goals, methods, measurement scales, strengths and limitations, and status of each project, and level of support. Keywords are provided to index the various projects. The names, addresses, affiliations, and major areas of expertise of the investigators are provided in appendices.

  6. Origin and dynamics of depositionary subduction margins (United States)

    Vannucchi, Paola; Morgan, Jason P.; Silver, Eli; Kluesner, Jared


    Here we propose a new framework for forearc evolution that focuses on the potential feedbacks between subduction tectonics, sedimentation, and geomorphology that take place during an extreme event of subduction erosion. These feedbacks can lead to the creation of a “depositionary forearc,” a forearc structure that extends the traditional division of forearcs into accretionary or erosive subduction margins by demonstrating a mode of rapid basin accretion during an erosive event at a subduction margin. A depositionary mode of forearc evolution occurs when terrigenous sediments are deposited directly on the forearc while it is being removed from below by subduction erosion. In the most extreme case, an entire forearc can be removed by a single subduction erosion event followed by depositionary replacement without involving transfer of sediments from the incoming plate. We need to further recognize that subduction forearcs are often shaped by interactions between slow, long-term processes, and sudden extreme events reflecting the sudden influences of large-scale morphological variations in the incoming plate. Both types of processes contribute to the large-scale architecture of the forearc, with extreme events associated with a replacive depositionary mode that rapidly creates sections of a typical forearc margin. The persistent upward diversion of the megathrust is likely to affect its geometry, frictional nature, and hydrogeology. Therefore, the stresses along the fault and individual earthquake rupture characteristics are also expected to be more variable in these erosive systems than in systems with long-lived megathrust surfaces.

  7. Origin and dynamics of depositionary subduction margins (United States)

    Vannucchi, Paola; Morgan, Jason P.; Silver, Eli A.; Kluesner, Jared W.


    Here we propose a new framework for forearc evolution that focuses on the potential feedbacks between subduction tectonics, sedimentation, and geomorphology that take place during an extreme event of subduction erosion. These feedbacks can lead to the creation of a "depositionary forearc," a forearc structure that extends the traditional division of forearcs into accretionary or erosive subduction margins by demonstrating a mode of rapid basin accretion during an erosive event at a subduction margin. A depositionary mode of forearc evolution occurs when terrigenous sediments are deposited directly on the forearc while it is being removed from below by subduction erosion. In the most extreme case, an entire forearc can be removed by a single subduction erosion event followed by depositionary replacement without involving transfer of sediments from the incoming plate. We need to further recognize that subduction forearcs are often shaped by interactions between slow, long-term processes, and sudden extreme events reflecting the sudden influences of large-scale morphological variations in the incoming plate. Both types of processes contribute to the large-scale architecture of the forearc, with extreme events associated with a replacive depositionary mode that rapidly creates sections of a typical forearc margin. The persistent upward diversion of the megathrust is likely to affect its geometry, frictional nature, and hydrogeology. Therefore, the stresses along the fault and individual earthquake rupture characteristics are also expected to be more variable in these erosive systems than in systems with long-lived megathrust surfaces.

  8. Marginal historiography: on Stekel's account of things. (United States)

    Bos, Jaap


    Psychoanalytic historiography has been, and to a certain extent still is, written mainly from the victor's (Freud's) perspective. One of the first attempts to deliver an alternative account was published in 1926 by Wilhelm Stekel in a little-known paper entitled "On the History of the Analytical Movement," which he wrote in response to Freud's (1925) "An Autobiographical Study" as an attempt to supplement or even counter Freud's version. This paper offers a dialogical reading of Stekel's paper, focusing not on the question of whether or not Stekel was right, but on the problem of marginalization itself. What discursive processes contributed to the marginalization of Stekel's position, and in what sense could Stekel's paper be called an instance of self-marginalization? Analysing various intertextual links between Freud's and Stekel's accounts, the author finds that the two accounts were caught up in an antagonistic dialectic from which it was impossible to escape. Following this paper, an English translation of Stekel's 1926 account is presented here for the first time.

  9. Testing for conditional multiple marginal independence. (United States)

    Bilder, Christopher R; Loughin, Thomas M


    Survey respondents are often prompted to pick any number of responses from a set of possible responses. Categorical variables that summarize this kind of data are called pick any/c variables. Counts from surveys that contain a pick any/c variable along with a group variable (r levels) and stratification variable (q levels) can be marginally summarized into an r x c x q contingency table. A question that may naturally arise from this setup is to determine if the group and pick any/c variable are marginally independent given the stratification variable. A test for conditional multiple marginal independence (CMMI) can be used to answer this question. Since subjects may pick any number out of c possible responses, the Cochran (1954, Biometrics 10, 417-451) and Mantel and Haenszel (1959, Journal of the National Cancer Institute 22, 719-748) tests cannot be used directly because they assume that units in the contingency table are independent of each other. Therefore, new testing methods are developed. Cochran's test statistic is extended to r x 2 x q tables, and a modified version of this statistic is proposed to test CMMI. Its sampling distribution can be approximated through bootstrapping. Other CMMI testing methods discussed are bootstrap p-value combination methods and Bonferroni adjustments. Simulation findings suggest that the proposed bootstrap procedures and the Bonferroni adjustments consistently hold the correct size and provide power against various alternatives.

  10. Tumor-related markers in histologically normal margins correlate with locally recurrent oral squamous cell carcinoma: a retrospective study. (United States)

    Wang, Xinhong; Chen, Si; Chen, Xinming; Zhang, Cuicui; Liang, Xueyi


    Oral squamous cell carcinoma (OSCC) is characterized by a high rate of local recurrence (LR) even when the surgical margins are considered histopathologically 'normal'. The aim of our study was to determine the relationship between early tumor-related markers detected in histologically normal margins (HNM) and LR as well as disease-free survival in OSCC. The loss of heterozygosity (LOH) of markers on 9p21 (D9s1747, RPS6, D9s162) and 17p13 (TP53) and the immunostaining results of the corresponding mutant P53, P14, P15, and P16 proteins were assessed and correlated with LR and disease-free survival in 71 OSCC patients who had HNM. Fifteen of 71 patients with HNM developed LR. The presence of the following molecular markers in surgical margins was significantly correlated with the development of LR: LOH on chromosome 9p21 (D9s1747 + RPS6 + D9s162), any LOH, P16, and P53 (chi-square test, P tumor-related markers in histologically 'normal' resection margins may be a useful method for assessing LR in OSCC patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Surgical infection in art. (United States)

    Meakins, J L


    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

  12. Update and Review on the Surgical Management of Primary Cutaneous Melanoma

    Directory of Open Access Journals (Sweden)

    Solmaz Niknam Leilabadi


    Full Text Available The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1 Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2 Experimental use of Mohs surgery for in situ melanoma; and (3 Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2 and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

  13. Update and Review on the Surgical Management of Primary Cutaneous Melanoma (United States)

    Niknam Leilabadi, Solmaz; Chen, Amie; Tsai, Stacy; Soundararajan, Vinaya; Silberman, Howard; Wong, Alex K.


    The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits. PMID:27429273

  14. Update and Review on the Surgical Management of Primary Cutaneous Melanoma. (United States)

    Leilabadi, Solmaz Niknam; Chen, Amie; Tsai, Stacy; Soundararajan, Vinaya; Silberman, Howard; Wong, Alex K


    The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization's 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1-2 cm for melanoma thickness of 1.01-2 mm, 2 cm margins for melanoma thickness of 2.01-4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm²) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

  15. Surgical treatment for medically refractory myasthenic blepharoptosis

    Directory of Open Access Journals (Sweden)

    Shimizu Y


    Full Text Available Yusuke Shimizu,1 Shigeaki Suzuki,2 Tomohisa Nagasao,1 Hisao Ogata,1 Masaki Yazawa,1 Norihiro Suzuki,2 Kazuo Kishi1 1Department of Plastic and Reconstructive Surgery, 2Department of Neurology, Keio University School of Medicine, Tokyo, JapanPurpose: Currently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis. Patients and methods: Eight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients. Results: Seven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period. Conclusion: Our results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and

  16. The Operation for Ceramic Front Teeth Marginal Gingivitis%烤瓷前牙龈缘炎的手术治疗

    Institute of Scientific and Technical Information of China (English)

    毛小泉; 郁豆; 周婷; 李琳娜; 黄茜; 李娇云


    目的:探讨烤瓷前牙因生物学宽度不足所致龈缘炎行牙冠延长术的治疗效果.方法:选择38例烤瓷前牙因生物学宽度不足导致的龈缘炎患者,经过牙周基础治疗,炎症控制后,局麻下翻瓣,以烤瓷冠颈部边缘为未来龈沟底部,修整被炎症侵蚀的牙槽骨脊,形成3~4 mm间隙,进行牙冠延长术.随访3~4年观察龈缘炎的治疗效果.结果:38例患者治疗效果均较好,1例有轻微炎症,37例未出现炎症.结论:牙冠延长术能较好解决烤瓷前牙生物学宽度不足所致的龈缘炎.%Objective: To investigate the effect of surgical crown lengthening for ceramic front teeth marginal gingivitis because of insufficient biological width. Methods: 38 ceramic front teeth marginal gingivitis were underdone pe-riodental non- surgical treatment, and flap operation was done after inflammation of teeth were controlled. Surgical crown lengthening was done from cervical margin of porcelain crown margin to inflamed socket ridge to form a 3 - 4mm interval. Therapeutic efficacy of marginal gingivitis was followed up for 3 - 4 years respectively. Results: Therapeutic efficacy was well in all 38 cases. 1 case had light inflammation, 37 cases had no inflammation. Conclusion: Ceramic front teeth marginal gingivitis because of insufficient biological width can be controlled with surgical crown lengthening.

  17. Intraoperative radiological margin assessment in breast-conserving surgery. (United States)

    Ihrai, T; Quaranta, D; Fouche, Y; Machiavello, J-C; Raoust, I; Chapellier, C; Maestro, C; Marcy, M; Ferrero, J-M; Flipo, B


    A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed for margins assessment. Final histological data were collected and the accuracy of intraoperative specimen radiography (IOSR) for margin assessment was analyzed. IOSR allowed an evaluation of margins status in 155 cases (91.2%). After final histological examination, the positive margins rate would have been 6.5% if margin assessment had relied only on IOSR. Margin assessment with a two-dimensional X-ray device would have allowed the achievement of negative margins in 93.5% of the cases. Moreover, this procedure allows important time-saving and could have a substantial economical impact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Surgical treatment of pediatric rhinosinusitis. (United States)

    Isaacson, G


    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment.

  19. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael


    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design...... a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...

  20. Surgical Skills Beyond Scientific Management (United States)

    Whitfield, Nicholas


    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  1. Retained surgical sponge: An enigma

    Directory of Open Access Journals (Sweden)

    Gurjit Singh


    Full Text Available Retained surgical sponge in the body following a surgery is called "gossypiboma". A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation.

  2. Surgical research using national databases. (United States)

    Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael


    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

  3. Surgical education through video broadcasting. (United States)

    Nagengast, Eric S; Ramos, Margarita S; Sarma, Hiteswar; Deshpande, Gaurav; Hatcher, Kristin; Magee, William P; Campbell, Alex


    Surgical training is facing new obstacles. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more procedures. In the western world, increasing restrictions on residency work hours are adding a new hurdle to surgical training. In low-resource settings, a low attending-to-resident ratio results in limited operative experience for residents. Advances in telemedicine may offer new methods for surgical training. In this article, the authors share their unique experience using live video broadcasting of surgery for educational purposes at a comprehensive cleft care center in Guwahati, India.

  4. Surgical Templates for Dental Implant Positioning; Current ...

    African Journals Online (AJOL)

    applied scientifically based research techniques to develop an endosseous implant that forms ... KEYWORDS: Dental implants, surgical templates, surgical procedure, stent .... during the surgical stage for single implant therapy.[24] Afterward,.

  5. Evidence-based surgical wound care on surgical wound infection. (United States)

    Reilly, Jaqueline


    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  6. Visual feedback mounted on surgical tool: proof of concept (United States)

    Carter, K.; Vaughan, T.; Holden, M.; Gauvin, G.; Pezeshki, P.; Lasso, A.; Ungi, T.; Morin, E.; Rudan, J.; Engel, C. J.; Fichtinger, G.


    PURPOSE: When using surgical navigation systems in the operating room, feedback is typically displayed on a computer monitor. The surgeon's attention is usually focused on the tool and the surgical site, so the display is typically out of the direct line of sight. The purpose is to develop a visual feedback device mounted on an electromagnetically tracked electrosurgical cauterizer which will provide navigation information for the surgeon in their field of view. METHODS: A study was conducted to determine the usefulness of the visual feedback in adjunct to the navigation system currently in use. Subjects were asked to follow tumor contours with the tracked cauterizer using 3D screen navigation with the mounted visual feedback and the 3D navigation screen alone. The movements of the cauterizer were recorded. RESULTS: The study showed a significant decrease in the subjects' distance from the tumor margin, a significant increase in the subjects' confidence to avoid cutting the tumor and a statistically significant reduction in the subjects' perception of the need to look at the screen when using the visual feedback device compared to without. DISCUSSION: The LED feedback device helped the subjects feel confident in their ability to identify safe margins and minimize the amount of healthy tissue removed in the tumor resection. CONCLUSION: Good potential for the visual LED feedback has been shown. With additional training, this approach promises to lead to improved resection technique, with fewer cuts into the tumor and less healthy tissue removed.

  7. Surgical Treatment of Winged Scapula

    National Research Council Canada - National Science Library

    Galano, Gregory J; Bigliani, Louis U; Ahmad, Christopher S; Levine, William N


    .... Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles...

  8. Essential Tremor (ET): Surgical Options (United States)

    ... t respond to propranolol, primidone, or other common ET medications and whose tremor has become debilitating, there ... treatments were first introduced. Current surgical options for ET include Deep Brain Stimulation (DBS) , Focused Ultrasound Thalamotomy , ...

  9. Surgical treatment of cranial neuralgias. (United States)

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni


    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  10. Surgical trainees and trauma emergencies. (United States)

    Wybaillie, E; Broos, P L O


    An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.

  11. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    to reduce the global burden of disease (GBD), it is ... global players have supported efforts to improve access and safety of surgery ... (i) strengthening surgical services at district hospitals ... of the surrounding community and a model for other.

  12. Marginal phase correction of truncated Bessel beams (United States)



    Approximate analytic expressions are obtained for evaluating the axial intensity and the central-lobe diameter of J0 Bessel beams transmitted through a finite-aperture phase filter. A reasonable quality factor governing the axial-intensity behavior of a phase-undistorted truncated Bessel beam is found to be the inverse square root of the Fresnel number defined, for a given aperture, from the axial point of geometrical shadow. Additional drastic reduction of axial-intensity oscillations is accomplished by using marginal phase correction of the beam instead of the well-known amplitude apodization. A procedure for analytically calculating an optimal monotonic slowly varying correction phase function is described.

  13. Potentials of marginal lands - sponateous ecosystem development (United States)

    Gerwin, Werner; Schaaf, Wolfgang


    Marginal lands are often considered as unfertile and not productive. They are widely excluded from modern land use by conventional agriculture. Assessment of soil fertility usually shows very low productivity potentials at least for growing traditional crops. However, it can be frequently observed that natural succession at different types of marginal lands leads to very diverse and nonetheless productive ecosystems. Examples can be found at abandoned former industrial or transportation sites which were set aside and not further maintained - and also in post-mining landscapes. In one of the lignite open cast mines of the State of Brandenburg in Eastern Germany a landscape observatory was established in 2005 for observing this natural ecosystem development under marginal site conditions. The site of 6 ha is part of the post-mining landscapes of Lusatia which are often characterized by poor soil conditions and clearly reduced soil fertility. It is named "Hühnerwasser-Quellgebiet" (Chicken Creek Catchment) after a small stream that is restored again after destruction by the mining operations. It is planned to serve as the headwater of this stream and was left to an unrestricted primary succession. A comprehensive scientific monitoring program is carried out since the start of ecosystem development in 2005. The results offer exemplary insights into the establishment of interaction networks between the developing ecosystem compartments. After 10 years a large biodiversity, expressed by a high number of species, can be found at this site as the result of natural recovery processes. A large number of both tree species and individuals have settled here. Even if no economic use of the site and of the woody biomass produced by these trees is planned, an overall assessment of the biomass production was carried out. The results showed that the biomass production from natural succession without any application of fertilizers etc. is directly comparable with yields from

  14. Area inequalities for stable marginally trapped surfaces

    CERN Document Server

    Jaramillo, José Luis


    We discuss a family of inequalities involving the area, angular momentum and charges of stably outermost marginally trapped surfaces in generic non-vacuum dynamical spacetimes, with non-negative cosmological constant and matter sources satisfying the dominant energy condition. These inequalities provide lower bounds for the area of spatial sections of dynamical trapping horizons, namely hypersurfaces offering quasi-local models of black hole horizons. In particular, these inequalities represent particular examples of the extension to a Lorentzian setting of tools employed in the discussion of minimal surfaces in Riemannian contexts.

  15. PSM and Media Personalisation – a Conflict?

    DEFF Research Database (Denmark)

    Sørensen, Jannick Kirk


    PSBs experience currently the challenge from personalised social webservices which let their users customise web pages. BBC’s re-launched front page is one response to this, this paper examines another widget-based project, namely the Danish PSB ‘DR’s ‘MitDR’ [MyDR]. Through in-depth research......, and with a proposed concept of ‘narrative economy’. Furthermore it is discussed whether PSBs have customers and whether the management method of Customer Relation Management is relevant in relation to PSB....

  16. Formation and evolution of magma-poor margins, an example of the West Iberia margin (United States)

    Perez-Gussinye, Marta; Andres-Martinez, Miguel; Morgan, Jason P.; Ranero, Cesar R.; Reston, Tim


    The West Iberia-Newfoundland (WIM-NF) conjugate margins have been geophysically and geologically surveyed for the last 30 years and have arguably become a paradigm for magma-poor extensional margins. Here we present a coherent picture of the WIM-NF rift to drift evolution that emerges from these observations and numerical modeling, and point out important differences that may exist with other magma-poor margins world-wide. The WIM-NF is characterized by a continental crust that thins asymmetrically and a wide and symmetric continent-ocean transition (COT) interpreted to consist of exhumed and serpentinised mantle with magmatic products increasing oceanward. The architectural evolution of these margins is mainly dominated by cooling under very slow extension velocities (crust that most probably was not extremely weak at the start of rifting. These conditions lead to a system where initially deformation is distributed over a broad area and the upper, lower crust and lithosphere are decoupled. As extension progresses upper, lower, crust and mantle become tightly coupled and deformation localizes due to strengthening and cooling during rifting. Coupling leads to asymmetric asthenospheric uplift and weakening of the hanginwall of the active fault, where a new fault forms. This continued process leads to the formation of an array of sequential faults that dip and become younger oceanward. Here we show that these processes acting in concert: 1) reproduce the margin asymmetry observed at the WIM-NF, 2) explain the fault geometry evolution from planar, to listric to detachment like by having one common Andersonian framework, 3) lead to the symmetric exhumation of mantle with little magmatism, and 4) explain the younging of the syn-rift towards the basin centre and imply that unconformities separating syn- and post-rift may be diachronous and younger towards the ocean. Finally, we show that different lower crustal rheologies lead to different patterns of extension and to an

  17. Intermittent exotropia: Surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Jai Aditya Kelkar


    Full Text Available Surgical management of intermittent exotropias (IXTs is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.

  18. Aesthetic Surgical Crown Lengthening Procedure. (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria


    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  19. Aesthetic Surgical Crown Lengthening Procedure (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria


    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  20. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira


    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  1. Surgical Treatment of Facial Paralysis


    Mehta, Ritvik P.


    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (2 yr). For acute facial paralysis, the main surgi...

  2. Innovation in pediatric surgical education. (United States)

    Clifton, Matthew S; Wulkan, Mark L


    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  3. The Value of Intraoperative Frozen Section Analysis for Margin Status in Breast Conservation Surgery in a Nontertiary Institution

    Directory of Open Access Journals (Sweden)

    Mona P. Tan


    Full Text Available Introduction. Breast conservation treatment (BCT for early-stage breast malignancies requires negative margins and good cosmesis. Reoperations may be needed to achieve negative margins, which can have an adverse impact on outcomes. This study was performed to evaluate the efficacy of intraoperative frozen section analysis (IFSA for margin assessment to reduce excision rates. Methods. All patients treated at the authors’ private healthcare facility between 2009 and 2011 for breast cancer were included in the study. Those for whom BCT was intended underwent wide excision with IFSA. Six margins of the excised tissue, and the sentinel lymph node (SLN, where appropriate, were submitted for IFSA. Patient demographics, tumour characteristics, number of operations performed, and outcomes were analysed. Results. Of the 161 patients analysed, 138 (85.7% had successful breast conservation. Four patients required a reoperation for incomplete surgical extirpation. One had a false negative SLN assessment on IFSA, and was returned to the operating room for an axillary dissection. Three patients required reoperations for inadvertently missed multicentric disease. None had false negative margin evaluation with IFSA necessitating reexcision. Conclusion. The use of IFSA allows low rates of reoperation with BCT. Further research is needed to establish consistency in low reexcision rates for cost-effectiveness and optimum resource allocation.

  4. [Surgical crown lengthening procedures. Preparatory step for fixed prosthesis]. (United States)

    Parashis, A O; Tripodakis, A P


    Necessary restorative requirements for full coverage are adequate axial wall height of the preparation for retention as well as sufficient vertical width of sound tooth structure cervically for the crown margins. In cases where adequate healthy tooth structure does not exist coronally to the epithelial attachment due to various crown damages, the margins of the crown might traumatize the periodontal attachment and the periodontium will be jeopardized iatrogenically. Teeth with inadequate axial Reight of the clinical crown, subgingival caries, vertical or horizontal fractures will require surgical crown lengthening procedures before prosthetic treatment is performed. These procedures may either involve only the soft tissues or bone remodeling as well. Irrespective of the procedure, crown lengthening must be performed with the objective of at least 3 mm. of healthy tooth structure coronally to the bone. This width will permit the formation of a new dentinogingival junction and the existence of 1-2 m.m. of sound tooth structure coronally to the new attachment line for the construction of a biologically acceptable crown margin. The purpose of this article is to discuss the clinical problem and underline the importance of crown lengthening procedures as a preparatory step for prosthetic treatment in fixed partial dentures.

  5. Recidiva tardia de linfoma da zona marginal Late relapse of marginal zone lymphoma


    Rocha,Talita M. B.S.; Bortolheiro,Tereza C.; Eduardo Costa; Daniela Haardt; Roberto P. Paes; Chiattone, Carlos S.


    O linfoma de zona marginal é um linfoma de baixo grau com curso clínico indolente e potencial de recidiva.1,2 Apresentamos um caso de recidiva tardia após 25 anos de aparente remissão completa, levantando a possibilidade de recidiva de doença preexistente ou desenvolvimento de novo clone neoplásico.Marginal zone lymphoma is a low grade lymphoma with an indolent course and chance to relapse. We present a case of a patient who suffered relapse after 25 years of apparently complete remission of ...



    Kondrateva, A.


    Results of morphological research of marginal gingival tissues before surgical treatment and in process of wound healing in patients with traditional postoperative period and application of transcranial stimulation are presented. It is shown that transcranial stimulation accelerates wound healing and is an effective method of non-drug treatment of periodontal patients after surgery.

  7. Evolution of surgical skills training

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Robert L Bell; Andrew J Duffy


    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  8. Characterizing entanglement with global and marginal entropic measures

    CERN Document Server

    Adesso, G; De Siena, S; Adesso, Gerardo; Illuminati, Fabrizio; Siena, Silvio De


    We qualify the entanglement of arbitrary mixed states of bipartite quantum systems by comparing global and marginal mixednesses quantified by different entropic measures. For systems of two qubits we discriminate the class of maximally entangled states with fixed marginal mixednesses, and determine an analytical upper bound relating the entanglement of formation to the marginal linear entropies. This result partially generalizes to mixed states the quantification of entaglement with marginal mixednesses holding for pure states. We identify a class of entangled states that, for fixed marginals, are globally more mixed than product states when measured by the linear entropy. Such states cannot be discriminated by the majorization criterion.

  9. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter


    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  10. Sonographic appearance of a retained surgical sponge after thyroidectomy: report of three cases. (United States)

    Polat, Ahmet Veysel; Belet, Umit; Aydin, Ramazan; Akan, Huseyin


    Although a number of cases of retained surgical sponge (RSS) after thoracic and abdominal surgery have been reported in the literature, the occurrence of RSS after thyroidectomy is very rare. We report the imaging findings of three cases of RSS after thyroidectomy. Sonography of the three patients revealed a hyperechoic mass with marked acoustic shadow. Computed tomography showed a well-defined, circumscribed heterogeneous mass that had gas bubbles inside in two patients, whereas the mass in the third patient was hyperdense and homogenous with smooth margins. All three RSSs were surgically removed. Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company.

  11. First Danish single-institution experience with radical prostatectomy

    DEFF Research Database (Denmark)

    Vrang, Marie-Louise; Røder, Martin Andreas; Vainer, Ben


    OBJECTIVE: This study aimed to investigate the impact of positive surgical margins (PSMs), stratified by location and extension, on biochemical outcome after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: The study included data from 605 consecutive patients treated with RRP...... for localized prostate cancer. Patients with node-positive disease were excluded. Biochemical recurrence-free survival was calculated using the Kaplan-Meier method. Univariate and multivariate analysis was used to assess risk factors. RESULTS: The overall PSM rate was 35.4%. Eighty-three per cent (82.......7%) of these had a single PSM, whereas 17.3% of patients had two or more PSMs. Apical PSMs were present in 42.5% and non-apical in 57.5%. The presence of any PSM had a significant impact on the risk of biochemical recurrence (BR) [hazard ratio (HR) = 3.3, p

  12. Research priorities for zoonoses and marginalized infections. (United States)


    This report provides a review and analysis of the research landscape for zoonoses and marginalized infections which affect poor populations, and a list of research priorities to support disease control. The work is the output of the Disease Reference Group on Zoonoses and Marginalized Infectious Diseases of Poverty (DRG6), which is part of an independent think tank of international experts, established and funded by the Special Programme for Research and Training in Tropical Diseases (TDR), to identify key research priorities through review of research evidence and input from stakeholder consultations. The report covers a diverse range of diseases, including zoonotic helminth, protozoan, viral and bacterial infections considered to be neglected and associated with poverty. Disease-specific research issues are elaborated under individual disease sections and many common priorities are identified among the diseases such as the need for new and/or improved drugs and regimens, diagnostics and, where appropriate, vaccines. The disease-specific priorities are described as micro priorities compared with the macro level priorities which will drive policy-making for: improved surveillance; interaction between the health, livestock, agriculture, natural resources and wildlife sectors in tackling zoonotic diseases; and true assessment of the burden of zoonoses. This is one often disease and thematic reference group reports that have come out of the TDR Think Tank, all of which have contributed to the development of the Global Report search on Infectious Diseases of Poverty, available at:

  13. Instability and Tsunamigenic Potential at Convergent Margins (United States)

    von Huene, R.; Ranero, C. R.; Watts, P.


    Along many convergent margins multibeam echosounding navigated with GPS has revealed large slope failures that were probably tsunamigenic. Bathymetric data combined with seismic reflection imaging indicate multiple causes. The 55-km wide Nicoya Slump resulted from the steepening slope above an underthrusting seamount on the subducting oceanic plate. This slump may have generated a 27-m high wave. Several 5-7 km wide mid-slope slides off central Nicaragua probably resulted from steepening of the continental slope by tectonic erosion. They may have generated waves 6-7 m high. A 30 km wide mid-slope slump off northern Peru may have generated a 5 m high wave. Its cause will not be understood without better seismic reflection imaging but considerable fluid venting was observed across its headwall. In the Gulf of Alaska a large slide appears to have resulted from rapid sedimentation. Tsunamigenic slope failure along convergent margins is only beginning to be resolved and the causes vary. Subducted ocean floor relief, tectonically steepened slopes, and sites of rapid sedimentation can help target potential failure and possible future tsunami hazards.

  14. Large margin classifier-based ensemble tracking (United States)

    Wang, Yuru; Liu, Qiaoyuan; Yin, Minghao; Wang, ShengSheng


    In recent years, many studies consider visual tracking as a two-class classification problem. The key problem is to construct a classifier with sufficient accuracy in distinguishing the target from its background and sufficient generalize ability in handling new frames. However, the variable tracking conditions challenges the existing methods. The difficulty mainly comes from the confused boundary between the foreground and background. This paper handles this difficulty by generalizing the classifier's learning step. By introducing the distribution data of samples, the classifier learns more essential characteristics in discriminating the two classes. Specifically, the samples are represented in a multiscale visual model. For features with different scales, several large margin distribution machine (LDMs) with adaptive kernels are combined in a Baysian way as a strong classifier. Where, in order to improve the accuracy and generalization ability, not only the margin distance but also the sample distribution is optimized in the learning step. Comprehensive experiments are performed on several challenging video sequences, through parameter analysis and field comparison, the proposed LDM combined ensemble tracker is demonstrated to perform with sufficient accuracy and generalize ability in handling various typical tracking difficulties.

  15. Limit theorems for functions of marginal quantiles

    CERN Document Server

    Babu, G Jogesh; Choi, Kwok Pui; Mangalam, Vasudevan; 10.3150/10-BEJ287


    Multivariate distributions are explored using the joint distributions of marginal sample quantiles. Limit theory for the mean of a function of order statistics is presented. The results include a multivariate central limit theorem and a strong law of large numbers. A result similar to Bahadur's representation of quantiles is established for the mean of a function of the marginal quantiles. In particular, it is shown that \\[\\sqrt{n}\\Biggl(\\frac{1}{n}\\sum_{i=1}^n\\phi\\bigl(X_{n:i}^{(1)},...,X_{n:i}^{(d)}\\bigr)-\\bar{\\gamma}\\Biggr)=\\frac{1}{\\sqrt{n}}\\sum_{i=1}^nZ_{n,i}+\\mathrm{o}_P(1)\\] as $n\\rightarrow\\infty$, where $\\bar{\\gamma}$ is a constant and $Z_{n,i}$ are i.i.d. random variables for each $n$. This leads to the central limit theorem. Weak convergence to a Gaussian process using equicontinuity of functions is indicated. The results are established under very general conditions. These conditions are shown to be satisfied in many commonly occurring situations.


    Directory of Open Access Journals (Sweden)

    A. Georgescu


    Full Text Available Premises: Sexual hormones may affect the general health condition of women, as early as puberty, continuing during pregnancy and also after menopause. Variations of the hormonal levels may cause different – either local or general – pathological modifications. Sexual hormones may also affect periodontal status, favourizing gingival inflammations and reducing periodontal resistance to the action of the bacterial plaque. Scope: Establishment of the correlations between the debut or the manifestation of menopause and the modifications produced in the superficial periodontium. Materials and method: Clinical and paraclinical investigations were performed on female patients with ages between 45 and 66 years, involving macroscopic, microscopic and radiological recording of the aspect of the superificial periodontium (gingiva. Results: Analysis of the histological sections evidenced atrophic and involutive modifications in the marginal superficial periodontium of female patients at menopause. Conclusions: Sexual hormones intervene in the histological equilibrium of the marginal superficial periodontium, influencing the periodontal health status, which explains the correlation between the subjective symptomatology specific to menopause and the histopatological aspect at epithelial level.

  17. Naturally light dilatons from nearly marginal deformations

    CERN Document Server

    Megias, Eugenio


    We discuss the presence of a light dilaton in CFTs deformed by a nearly-marginal operator O, in the holographic realizations consisting of confining RG flows that end on a soft wall. Generically, the deformations induce a condensate , and the dilaton mode can be identified as the fluctuation of . We obtain a mass formula for the dilaton as a certain average along the RG flow. The dilaton is naturally light whenever i) confinement is reached fast enough (such as via the condensation of O) and ii) the beta function is small (walking) at the condensation scale. These conditions are satisfied for a class of models with a bulk pseudo-Goldstone boson whose potential is nearly flat at small field and exponential at large field values. Thus, the recent observation by Contino, Pomarol and Ratazzi holds in CFTs with a single nearly-marginal operator. We also discuss the holographic method to compute the condensate , based on solving the first-order nonlinear differential equation that the beta function satisfies.

  18. Photogrammetric monitoring of glacier margin lakes

    Directory of Open Access Journals (Sweden)

    Christian Mulsow


    Full Text Available The growing number of glacier margin lakes that have developed due to glacier retreat have caused an increase of dangerous glacier lake outburst floods (GLOFs in several regions over the last decade. This normally causes a flood wave downstream the glacier. Typically, such an event takes few to several hours. GLOF scenarios may be a significant hazard to life, property, nature and infrastructure in the affected areas. A GLOF is usually characterized by a progressive water level drop. By observing the water level of the lake, an imminent GLOF-event can be identified. Common gauging systems are often not suitable for the measurement task, as they may be affected by ice fall or landslides in the lake basin. Therefore, in our pilot study, the water level is observed by processing images of a terrestrial camera system observing a glacier margin lake. The paper presents the basic principle of an automatic single-camera-based GLOF early warning system. Challenges and approaches to solve them are discussed. First, results from processed image sequences are presented to show the feasibility of the concept. Water level changes can be determined at decimetre precision.

  19. The Role of Weight Shrinking in Large Margin Perceptron Learning

    CERN Document Server

    Panagiotakopoulos, Constantinos


    We introduce into the classical perceptron algorithm with margin a mechanism that shrinks the current weight vector as a first step of the update. If the shrinking factor is constant the resulting algorithm may be regarded as a margin-error-driven version of NORMA with constant learning rate. In this case we show that the allowed strength of shrinking depends on the value of the maximum margin. We also consider variable shrinking factors for which there is no such dependence. In both cases we obtain new generalizations of the perceptron with margin able to provably attain in a finite number of steps any desirable approximation of the maximal margin hyperplane. The new approximate maximum margin classifiers appear experimentally to be very competitive in 2-norm soft margin tasks involving linear kernels.

  20. Margins and outcome of screen-detected breast cancer with extensive in situ component. (United States)

    Kitchen, Paul R B; Cawson, Jennifer N; Moore, Suzanne E; Hill, Prue A; Barbetti, Toni M; Wilkins, Pamela A; Power, Ann-Marie; Henderson, Michael A


    In situ disease surrounding invasive tumours is an important consideration in the management of patients with early breast cancer. This study of screen-detected breast cancers assessed the influence of in situ disease including an extensive in situ component (defined as ductal carcinoma in situ involving more than 25% of the area within the invasive tumour) on surgical management, local recurrence and survival of a group of patients. A total of 595 cases of invasive breast cancer detected at St Vincent's BreastScreen were retrospectively reviewed to determine presence and extent of in situ disease, the surgical procedure and adequacy of excision. Outcome was examined in a cohort of 126 cases. A total of 438 (74%) patients had in situ foci in or around the invasive tumour and 107 (18%) were defined as extensive in situ component (EIC)-positive. The initial procedure was mastectomy in 20% of the cases and breast-conserving surgery in 80% including 18% who underwent further surgery. Re-excision (P = 0.02) or mastectomy (P = 0.01) was more often required in patients with EIC. After definitive local excision, margins were close or involved with invasive disease in 3% but the patients with EIC were more likely to have margins close or involved with in situ disease (16 vs 2%; P = 0.001). There were seven deaths and one local invasive recurrence in the follow-up group and none of the deaths were in patients who were EIC-positive. EIC predicts for a higher rate of re-excision and/or mastectomy. For patients with EIC, there is an acceptably low risk of local recurrence if margins are clear.

  1. Surgical versus non-surgical treatment of congenital hyperinsulinism. (United States)

    Mazor-Aronovitch, Kineret; Landau, Heddy; Gillis, David


    Congenital hyperinsulinism is a functional disorder of insulin secretion. In its diffuse severe form, it is traditionally treated with over 95% pancreatectomy. However, even after this procedure normoglycemia is not always achieved. Non-surgical therapy with frequent or continuous feeding, medication and close monitoring is another alternative. In this review we compare the two approaches to this condition focusing on early complications, diabetes, neurological outcome and home management issues. Early complications of pancreatectomy include mechanical, metabolic and infectious complications. Non-surgical interventions can be complicated by unwarranted effects of medications and of invasive procedures. Diabetes occurs with both approaches but much less frequently and years later with non-surgical treatment. Regarding neurodevelopmental outcome, most data come from heterogeneous groups. Nevertheless, it appears that outcome is not adversely affected by avoiding surgery. Home management is far more difficult for the non-surgical form. When the non-surgical approach is successful in achieving normoglycemia and parents are highly motivated, this mode of therapy should be considered.

  2. Continental margin radiography from a potential field and sediment thickness standpoint: the Iberian Atlantic Margin

    Energy Technology Data Exchange (ETDEWEB)

    Catalan, M.; Martos, Y. M.; Martin-Davila, J.; Munoz-Martin, A.; Carbo, A.; Druet, M.


    This study reviews the state of knowledge in the Iberian Atlantic margin. In order to do this, the margin has been divided into three provinces: the Galicia margin, the southern Iberian abyssal plain, and the Tagus abyssal plain. We have used potential field and sediment thickness data. This has allowed us to study the crust, setting limits for the continental crust domain, and the amplitude of the so-called ocean-continent transition, whose end marks the beginning of the oceanic crust. The study shows the continental crust in the Galician margin to be the widest, about 210 km in length, whilst the ocean-continent transition varies slightly in this province: between 65 km wide in the south and 56 km wide in the north. This result shows up some differences with the hypothesis of other authors. The situation in the southern Iberian abyssal plain is nearly the opposite. Its continental crust extends approximately 60 km, whilst the ocean-continent transition zone is 185 km long. The Tagus abyssal plain study shows a faster morphological evolution than the others, according with the amount of crustal thinning β, the ocean-continent transition domain spanning 100 km. These results support a transitional intermediate character for almost the whole Tagus plain, in contrary to what other authors have stated. (Author)

  3. The tragedy of the margins: land rights and marginal lands in Vietnam (c. 1800-1945)

    NARCIS (Netherlands)

    J. Kleinen


    This article deals with aspects of official land registers in pre-colonial and colonial Vietnam and their relationship with marginal lands since the eleventh century and especially since the beginning of the nineteenth century. The changing pattern of land ownership and control is studied in detail

  4. Talking (and Not Talking) about Race, Social Class and Dis/Ability: Working Margin to Margin (United States)

    Ferri, Beth A.; Connor, David J.


    In this article we examine some of the omnipresent yet unacknowledged discourses of social and economic disadvantage and dis/ability within schools in the US. First, we document ways that social class, race, and dis/ability function within schools to further disadvantage and exclude already marginalized students. Next, we show how particular ways…

  5. Mobile large area confocal scanner for imaging tumor margins: initial testing in the pathology department (United States)

    Abeytunge, Sanjee; Li, Yongbiao; Larson, Bjorg; Peterson, Gary; Toledo-Crow, Ricardo; Rajadhyaksha, Milind


    Surgical oncology is guided by examining pathology that is prepared during or after surgery. The preparation time for Mohs surgery in skin is 20-45 minutes, for head-and-neck and breast cancer surgery is hours to days. Often this results in incomplete tumor removal such that positive margins remain. However, high resolution images of excised tissue taken within few minutes can provide a way to assess the margins for residual tumor. Current high resolution imaging methods such as confocal microscopy are limited to small fields of view and require assembling a mosaic of images in two dimensions (2D) to cover a large area, which requires long acquisition times and produces artifacts. To overcome this limitation we developed a confocal microscope that scans strips of images with high aspect ratios and stitches the acquired strip-images in one dimension (1D). Our "Strip Scanner" can image a 10 x 10 mm2 area of excised tissue with sub-cellular detail in about one minute. The strip scanner was tested on 17 Mohs excisions and the mosaics were read by a Mohs surgeon blinded to the pathology. After this initial trial, we built a mobile strip scanner that can be moved into different surgical settings. A tissue fixture capable of scanning up to 6 x 6 cm2 of tissue was also built. Freshly excised breast and head-and-neck tissues were imaged in the pathology lab. The strip-images were registered and displayed simultaneously with image acquisition resulting in large, high-resolution confocal mosaics of fresh surgical tissue in a clinical setting.

  6. Echosonography and surgical therapy of facial skin tumors

    Directory of Open Access Journals (Sweden)

    Pešić Zoran U.


    Full Text Available In the second half of the 20 century, echosonography has been used in many medical specialties. In 1992 and 1993 highfrequencies echosonography was used in the examination of irritant and allergic skin lesions in order to examine the effects of different therapeuthical agents on the skin lesions [1-4]. Hoffmann used highfrequencies echosonography in the examination of healing of skin lesions [3]. By their incidence skin tumors are the largest group of newly discovered tumors, and their usual location is on the face [5-7]. By clinical examination it is not possible to precisely determine the depth of tumor border; therefore, the radically performed surgical excision is the only correct surgical treatment. The aim of this study was to estimate the results of preoperatively performed high frequencies echosonography in order to reduce the number of incorrectly performed surgical excisions of skin tumors. The group was composed of 40 patients with 45 tumors, who first underwent echosonographic diagnostic procedure (20 MHz, Hadsund electronic, Hadsund Technology, Denmark and then surgical excision; patients in control group (45 patients with 45 tumors were only subjected to surgical excision. Excised tumors were then pathohistologically analyzed, and measurements of tumor depth progression were performed. Margins of pathohistological specimen were controlled for the presence of tumor cells. Results of measurements of tumor depth obtained by echosonography and pathohistological measurements were compared. By Jate's modification of c2 test results regarding correct and incorrect surgical excision in patients and control group were compared. By linear regression analysis results of tumor depth obtained by echosonographic and pathohistologic examinations were compared. Hypoechogen zone echosonographic results were used like criteria for tumor expansion. Results of tumor depth measurements are presented in Table 1. Linear regression analysis showed (R = 0

  7. Improving Surgical Resection of Metastatic Liver Tumors With Near-Infrared Optical-Guided Fluorescence Imaging. (United States)

    Barabino, Gabriele; Porcheron, Jack; Cottier, Michèle; Cuilleron, Muriel; Coutard, Jean-Guillaume; Berger, Michel; Molliex, Serge; Beauchesne, Brigitte; Phelip, Jean Marc; Grichine, Alexei; Coll, Jean-Luc


    Objective The aim of this study was to investigate the feasibility and future clinical applications of near-infrared (NIR) fluorescence imaging to guide liver resection surgery for metastatic cancer to improve resection margins. Summary Background Data A subset of patients with metastatic hepatic tumors can be cured by surgery. The degree of long-term and disease-free survival is related to the quality of surgery, with the best resection defined as "R0" (complete removal of all tumor cells, as evidenced by microscopic examination of the margins). Although intraoperative ultrasonography can evaluate the surgical margins, surgeons need a new tool to perfect the surgical outcome. Methods A preliminary study was performed on 3 patients. We used NIR imaging postoperatively "ex vivo" on the resected liver tissue. The liver tumors were preoperatively labelled by intravenously injecting the patient with indocyanine green (ICG), a NIR fluorescent agent (24 hours before surgery, 0.25 mg/kg). Fluorescent images were obtained using a miniaturized fluorescence imaging system (FluoStic, Fluoptics, Grenoble, France). Results After liver resection, the surgical specimens from each patient were sliced into 10-mm sections in the operating room and analyzed with the FluoStic. All metastatic tumors presented rim-type fluorescence. Two specimens had incomplete rim fluorescence. The pathologist confirmed the presence of R1 margins (microscopic residual resection), even though the ultrasonographic analysis indicated that the result was R0. Conclusions Surgical liver resection guided by NIR fluorescence can help detect potentially uncertain anatomical areas that may be missed by preoperative imaging and by ultrasonography during surgery. These preliminary results will need to be confirmed in a larger prospective patient series.

  8. Surgical treatment of complex small bowel Crohn disease. (United States)

    Michelassi, Fabrizio; Sultan, Samuel


    The clinical presentations of Crohn disease of the small bowel vary from low to high complexity. Understanding the complexity of Crohn disease of the small bowel is important for the surgeon and the gastroenterologist caring for the patient and may be relevant for clinical research as a way to compare outcomes. Here, we present a categorization of complex small bowel Crohn disease and review its surgical treatment as a potential initial step toward the establishment of a definition of complex disease. The complexity of small bowel Crohn disease can be sorted into several categories: technical challenges, namely, fistulae, abscesses, bowel or ureteral obstruction, hemorrhage, cancer and thickened mesentery; extensive disease; the presence of short gut; a history of prolonged use of medications, particularly steroids, immunomodulators, and biological agents; and a high risk of recurrence. Although the principles of modern surgical treatment of Crohn disease have evolved to bowel conservation such as strictureplasty techniques and limited resection margins, such practices by themselves are often not sufficient for the management of complex small bowel Crohn disease. This manuscript reviews each category of complex small bowel Crohn disease, with special emphasis on appropriate surgical strategy.

  9. CT of lumbar disc herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Suk Yl; Lee, Dong Jin; Sung, Kyu Bo; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)


    CT from forty nine patients with 53 surgical disc explorations were reviewed and correlated with surgical findings. The results were as follows: 1. Frequent locations of HNP were in L4-5 (65%) and L5-S1 (31%). The most common type of HNP was paramidine type (71%). 2. Focal protrusion of the posterior margin of disc and obliteration of epidural fat pad were observed in all of cases (100%) and other common findings were indentation of epidural sac in 46 cases (96%) and compression of nerve root sleeve in 33 cases (69%). 3. Cephalad and caudad extension of protruded soft tissue density in the spinal canal was observed in 15 cases (31%) with variable degree. And more than 6mm extension were provided to be extruded disc in 9 cases. 4. Vacuum phenomenon was demonstrated in 5 cases (10%) and was accompanied with bulging annulus. 5. Forty eight herniated nucleus (HNP) were confirmed surgically in 44 patients. Misinterpretations were made in 4 instances (4 patients); 1 because of lumbar scoliosis, 1 because of spondylolisthesis, and the other 2 because of calcified posterior longitudinal ligament and bulging annulus. One case of true negative examination was central and foraminal stenosis in spinal CT. Thus, sensitivity, specificity and overall accuracy of lumbar spine CT in HNP were 92%, 100% and 92%, respectively.


    Directory of Open Access Journals (Sweden)

    Fernando Bray BERALDO


    Full Text Available BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19% participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P<0.001. None of the variables assessed as potential risk factors exhibited statistical significance, i.e., age, gender, distance from tumour to anal margin, neoadjuvant therapy, adjuvant therapy, type of surgery, surgical approach (laparoscopy or laparotomy, and duration of surgery.ConclusionThis study identified an incidence of 19% of moderate to severe urinary dysfuction after 6 months surveillance. No risk factor for urinary dysfunction was identified in this population.

  11. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke


    teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...... this a relatively low budget solution with a big ethical benefit....

  12. 21 CFR 878.4040 - Surgical apparel. (United States)


    ... known as scrub suits, are excluded. (b) Classification. (1) Class II (special controls) for surgical... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical apparel. 878.4040 Section 878.4040 Food... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel....

  13. Surgical treatment for male prolactinoma (United States)

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi


    Abstract A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index. Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases PMID:28079813

  14. Can we measure surgical resilience? (United States)

    Graham, David; Becerril-Martinez, Guillermo; Quinto, Lena; Zhao, Dong Fang


    Surgical resilience describes psychological resilience within a surgical setting. Within a surgical setting, psychologically resilient patients have improved recovery and wound-healing. The search for biological correlates in resilient patients has led to the hypothesis that certain endogenous biomarkers (namely neuropeptide Y (NPY), testosterone, and dehydroepiandrosterone (DHEA)) are altered in resilient patients. The concept of surgical resilience raises the question of whether enhanced recovery following surgery can be demonstrated in patients with high titres of resilience biomarkers as compared to patients with low titres of resilience biomarkers. To determine the prognostic value of resilience biomarkers in surgical recovery, a cohort of patients undergoing major surgery should initially be psychometrically tested for their resilience levels before and after surgery so that biomarker levels of NPY, testosterone and DHEA can be compared to a validated psychometric test of resilience. The primary outcome would be length of hospital stay with and without an enhanced recovery program. Secondary outcome measures such as complications, time in rehabilitation and readmission could also be included. If the hypothesis is upheld, resilience biomarkers could be used to support more individualised perioperative management and lead to more efficient and effective allocation of healthcare resources.

  15. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure. (United States)

    Ganji, Kiran Kumar; Patil, Veena Ashok; John, Jiji


    Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student "t" Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group) and 1.95 mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

  16. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

    Directory of Open Access Journals (Sweden)

    Kiran Kumar Ganji


    Full Text Available Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20 patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening and adjacent sites: Plaque and Gingival Indices (PI & (GI, Position of Gingival Margin from reference Stent (PGMRS, Probing depth (PD, and Biologic Width (BW. Statistical Analysis Used. Student “t” Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group and 1.95 mm (Ostectomy procedure B2 Group and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

  17. Evidence for Marginal Stability in Emulsions (United States)

    Lin, Jie; Jorjadze, Ivane; Pontani, Lea-Laetitia; Wyart, Matthieu; Brujic, Jasna


    We report the first measurements of the effect of pressure on vibrational modes in emulsions, which serve as a model for soft frictionless spheres at zero temperature. As a function of the applied pressure, we find that the density of states D (ω ) exhibits a low-frequency cutoff ω*, which scales linearly with the number of extra contacts per particle δ z . Moreover, for ω Soft Matter 10, 5628 (2014); S. Franz, G. Parisi, P. Urbani, and F. Zamponi, Proc. Natl. Acad. Sci. U.S.A. 112, 14539 (2015)]. Finally, the degree of localization of the softest low frequency modes increases with compression, as shown by the participation ratio as well as their spatial configurations. Overall, our observations show that emulsions are marginally stable and display non-plane-wave modes up to vanishing frequencies.

  18. Regnar -- Development of a marginal field

    Energy Technology Data Exchange (ETDEWEB)

    Thalund, K.M.; Brodersen, F.P.; Roigaard-Petersen, B. [Maersk Olie og Gas AS, Copenhagen (Denmark)


    Regnar is a small marginal field located some 13 km from the main Dan F complex and is the first subsea completion in Danish waters, operated by Maersk Olie og Gas AS. A short lifetime has been predicted for the field which therefore has been developed as a low cost project, using a combination of subsea technology and minimum topside facilities. Regnar consists of a subsea x-mas tree producing through a 6 inch pipeline with a 2 1/2 inch chemical piggyback line to Dan F. The x-mas tree and the subsea choke valve are controlled from a buoy moored nearby the well. The buoy is radio linked to Dan F. The Regnar field was brought on stream on September 26, 1993.

  19. Max-margin based Bayesian classifier

    Institute of Scientific and Technical Information of China (English)

    Tao-cheng HU‡; Jin-hui YU


    There is a tradeoff between generalization capability and computational overhead in multi-class learning. We propose a generative probabilistic multi-class classifi er, considering both the generalization capability and the learning/prediction rate. We show that the classifi er has a max-margin property. Thus, prediction on future unseen data can nearly achieve the same performance as in the training stage. In addition, local variables are eliminated, which greatly simplifi es the optimization problem. By convex and probabilistic analysis, an efficient online learning algorithm is developed. The algorithm aggregates rather than averages dualities, which is different from the classical situations. Empirical results indicate that our method has a good generalization capability and coverage rate.


    Energy Technology Data Exchange (ETDEWEB)

    Mason M. Medizade; John R. Ridgely; Donald G. Nelson


    A marginal expense oil well wireless surveillance system to monitor system performance and production from rod-pumped wells in real time from wells operated by Vaquero Energy in the Edison Field, Main Area of Kern County in California has been successfully designed and field tested. The surveillance system includes a proprietary flow sensor, a programmable transmitting unit, a base receiver and receiving antenna, and a base station computer equipped with software to interpret the data. First, the system design is presented. Second, field data obtained from three wells is shown. Results of the study show that an effective, cost competitive, real-time wireless surveillance system can be introduced to oil fields across the United States and the world.

  1. The genetics of nodal marginal zone lymphoma. (United States)

    Spina, Valeria; Khiabanian, Hossein; Messina, Monica; Monti, Sara; Cascione, Luciano; Bruscaggin, Alessio; Spaccarotella, Elisa; Holmes, Antony B; Arcaini, Luca; Lucioni, Marco; Tabbò, Fabrizio; Zairis, Sakellarios; Diop, Fary; Cerri, Michaela; Chiaretti, Sabina; Marasca, Roberto; Ponzoni, Maurilio; Deaglio, Silvia; Ramponi, Antonio; Tiacci, Enrico; Pasqualucci, Laura; Paulli, Marco; Falini, Brunangelo; Inghirami, Giorgio; Bertoni, Francesco; Foà, Robin; Rabadan, Raul; Gaidano, Gianluca; Rossi, Davide


    Nodal marginal zone lymphoma (NMZL) is a rare, indolent B-cell tumor that is distinguished from splenic marginal zone lymphoma (SMZL) by the different pattern of dissemination. NMZL still lacks distinct markers and remains orphan of specific cancer gene lesions. By combining whole-exome sequencing, targeted sequencing of tumor-related genes, whole-transcriptome sequencing, and high-resolution single nucleotide polymorphism array analysis, we aimed at disclosing the pathways that are molecularly deregulated in NMZL and we compare the molecular profile of NMZL with that of SMZL. These analyses identified a distinctive pattern of nonsilent somatic lesions in NMZL. In 35 NMZL patients, 41 genes were found recurrently affected in ≥3 (9%) cases, including highly prevalent molecular lesions of MLL2 (also known as KMT2D; 34%), PTPRD (20%), NOTCH2 (20%), and KLF2 (17%). Mutations of PTPRD, a receptor-type protein tyrosine phosphatase regulating cell growth, were enriched in NMZL across mature B-cell tumors, functionally caused the loss of the phosphatase activity of PTPRD, and were associated with cell-cycle transcriptional program deregulation and increased proliferation index in NMZL. Although NMZL shared with SMZL a common mutation profile, NMZL harbored PTPRD lesions that were otherwise absent in SMZL. Collectively, these findings provide new insights into the genetics of NMZL, identify PTPRD lesions as a novel marker for this lymphoma across mature B-cell tumors, and support the distinction of NMZL as an independent clinicopathologic entity within the current lymphoma classification. © 2016 by The American Society of Hematology.

  2. Margin Distance Does Not Influence Recurrence and Survival After Wedge Resection for Lung Cancer. (United States)

    Maurizi, Giulio; D'Andrilli, Antonio; Ciccone, Anna Maria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, Simone; Poggi, Camilla; Menna, Cecilia; Venuta, Federico; Rendina, Erino Angelo


    The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. (United States)

    Fiorelli, A I; Stolf, N A G; Pego-Fernandes, P M; Oliveira Junior, J L; Santos, R H B; Contreras, C A M; Filho, D D L; Dinkhuysen, J J; Moreira, M C V; Mejia, J A C; Castro, M C R


    The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor.

  4. Surgical treatment of facial paralysis. (United States)

    Mehta, Ritvik P


    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.


    Directory of Open Access Journals (Sweden)

    Andonovska Biljana J.


    Full Text Available The term 'malnutrition' is a broad term used to describe any imbalance in the diet. In 2009 it was confirmed that malnutrition is an urgent health problem. The reasons for which malnutrition may develop are different. Loss on cellular, physical and physiological level happens as a consequence of malnutrition. Studies show that in surgical practice there is malnutrition in 50% of patients and that there is an association between inadequate nutritional status and surgical result. It leads to prolonged treatment, increasing of the level of morbidity and mortality, increased hospital costs, etc. Sometimes malnutrition is unrecognised, untreated and worsened in hospitals. For this reason this paper will elaborate: nutrition and a surgical patient, assessment of a nutritional status, assessment of energy requirements, and enteral and parenteral nutrition in order to determine the conditions and procedures that affect the appearance, recognition and treatment of malnutrition.

  6. Surgical Complications of Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Basir Hashemi


    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  7. Nutrition support in surgical oncology. (United States)

    Huhmann, Maureen B; August, David A


    This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

  8. [Surgical adrenal approaches: learned experiences]. (United States)

    Bravo-Lázaro, Santos; Hernandis-Villalba, Juan; Meroño-Carbajosa, Emilio; Navío-Perales, Juan; Marzal-Felici, Vicente


    Laparoscopic surgery is the standard approach for surgical adrenal gland pathology. However, the open procedure still has its role. Our intention is to report our results and experience using different techniques. A retrospective study of 40 patients was carried out. Demographic and surgical data were analyzed. Thirty two patients had benign pathology and eight had malignant tumors. Laparotomy was performed in 18 patients: seven patients with malignant tumors and 11 with benign pathology. Young's approach was indicated in four patients. Laparoscopic aproach was indicated in 25 patients with seven patients requiring conversion to laparotomy. The conversion rate was 28% In most cases, the laparoscopic approach is the standard technique. Appropriate case selection is of primary importance. Other surgical techniques should be considered if necessary.

  9. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard


    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  10. Analysis of System Margins on Missions Utilizing Solar Electric Propulsion (United States)

    Oh, David Y.; Landau, Damon; Randolph, Thomas; Timmerman, Paul; Chase, James; Sims, Jon; Kowalkowski, Theresa


    NASA's Jet Propulsion Laboratory has conducted a study focused on the analysis of appropriate margins for deep space missions using solar electric propulsion (SEP). The purpose of this study is to understand the links between disparate system margins (power, mass, thermal, etc.) and their impact on overall mission performance and robustness. It is determined that the various sources of uncertainty and risk associated with electric propulsion mission design can be summarized into three relatively independent parameters 1) EP Power Margin, 2) Propellant Margin and 3) Duty Cycle Margin. The overall relationship between these parameters and other major sources of uncertainty is presented. A detailed trajectory analysis is conducted to examine the impact that various assumptions related to power, duty cycle, destination, and thruster performance including missed thrust periods have on overall performance. Recommendations are presented for system margins for deep space missions utilizing solar electric propulsion.

  11. An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

    Directory of Open Access Journals (Sweden)

    Ilaria Giovannacci


    Full Text Available Medication-Related Osteonecrosis of the Jaw (MRONJ therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT. After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.DOI: 10.14693/jdi.v22i2.486

  12. 基于PSM技术的70kV/90A高压脉冲电源的研制%Development of the 70kV/90A High-Voltage Pulse Power Supply Based on PSM Technology

    Institute of Scientific and Technical Information of China (English)

    徐伟东; 陈文光; 宣伟民; 姚列英; 王英翘


    The high microwave and neutral beam injection of the auxiliary heating systems are used to heat or drive the plasma in the controlled nuclear fusion devices. These equipment can be destroyed easily with low energy when arcing occurs. So the high-voltage power supply which supplies to the auxiliary heating systems should have many features, such as flexible control, high stability, fast response, high power factor, short protective time, very low energy discharged to these equipment when the loads are arcing. The power supply based on PSM technology is a method of controlling the total output voltage of many identical DC choppers connected in series by means of managing the work of them step by step and modulating their pulse widths in a certain sequence. This kind of power supply has some advantages which have been mentioned, especially the low energy stored in the whole system and short protective time. Such a high voltage power supply system has already been developed. Its circuit is simple and control mode is flexible. The results show that the output is about 72kV/90A and the parameters are superior to the high-voltage power supply based on thyristors.%在受控核聚变实验中,辅助加热系统采用高功率微波和高能粒子对等离子体进行加热或驱动。这些部件不仅要求为其供电的高压电源稳定度高,而且要求在它们发生打火现象时,保护时间短(〈10gs),高压电源对其释放的能量小,否则这些关键部件极易受到损坏。基于脉冲步进调制PSM技术的高压脉冲电源是许多相同的脉冲电源串联并经过特定的调制方式控制,从而实现高压大功率输出。该高压电源有控制方式灵活、输出功率高、功率因数高、稳定度高、响应速度快、保护时间短、故障时系统对负载的释能小等众多优点。尤其保护时该电源系统储能小,时间短,满足各种高功率微波管和加速器的要求。本文分析了基于

  13. Margin Requirements and Portfolio Optimization: A Geometric Approach


    Sheng Guo


    Using geometric illustrations, we investigate what implications of portfolio optimization in equilibrium can be generated by the simple mean-variance framework, under margin borrowing restrictions. First, we investigate the case of uniform marginability on all risky assets. It is shown that changing from unlimited borrowing to margin borrowing shifts the market portfolio to a riskier combination, accompanied by a higher risk premium and a lower price of risk. With the linear risk-return prefe...

  14. Marginal pricing of transmission services. An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.., Rubio, F.J. [Instituto de Investigacion Technologica, Universidad Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [Unidad de Planificacion Estrategica, Iberdrola, Madrid (Spain)


    The authors present an in-depth analysis of network revenues that are computed with marginal pricing, and investigate the reasons why marginal prices in actual power systems fail to recover total incurred network costs. The major causes of the failure are identified and illustrated with numerical examples. The paper analyzes the regulatory implications of marginal network pricing in the context of competitive electricity markets and provides suggestions for the meaningful allocation of network costs among users. 5 figs., 9 tabs., 8 refs.

  15. Convex games, clan games, and their marginal games


    Branzei , Rodica; Dimitrov, Dinko; Tijs, Stef


    We provide characterizations of convex games and total clan games by using properties of their corresponding marginal games. As it turns out, a cooperative game is convex if and only if all its marginal games are superadditive, and a monotonic game satisfying the veto player property with respect to the members of a coalition C is a total clan game (with clan C) if and only if all its C-based marginal games are subadditive.

  16. Boost invariant marginally trapped surfaces in Minkowski 4-space

    Energy Technology Data Exchange (ETDEWEB)

    Haesen, S [Department of Mathematics, Katholieke Universiteit Leuven, Celestijnenlaan 200B, 3001 Heverlee (Belgium); Ortega, M [Departamento de GeometrIa y TopologIa, Universidad de Granada, 18071 Granada (Spain)


    The extremal and partly marginally trapped surfaces in the Minkowski 4-space, which are invariant under the group of boost isometries, are classified. Moreover, it is shown that there do not exist extremal surfaces of this kind with constant Gaussian curvature. A procedure is given in order to construct a partly marginally trapped surface by gluing two marginally trapped surfaces which are invariant under the group of boost isometries. As an application, a proper star-surface is constructed.

  17. Marginal pricing of transmission services: An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.; Rubio, F.J. [Univ. Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [IBERDROLA, Bilbao (Spain). Unidad de Planificacion Estrategica


    This paper presents an in-depth analysis of network revenues computed with marginal pricing, and in particular it investigates the reasons why marginal prices fail to recover the total incurred network costs in actual power systems. The basic theoretical results are presented and the major causes of the mismatch between network costs and marginal revenues are identified and illustrated with numerical examples, some tutorial and others of realistic size. The regulatory implications of marginal network pricing in the context of competitive electricity markets are analyzed, and suggestions are provided for the meaningful allocation of the costs of the network among its users.

  18. The many ways to be marginal in a group. (United States)

    Ellemers, Naomi; Jetten, Jolanda


    Previous theory and research primarily address marginal group members on the path to achieve core membership status. The authors argue that these only represent one form of marginality and that there are many other ways to be marginal within the group. The authors develop a dynamic model in which marginality is conceptualized as resulting from group and individual negotiation about inclusion (the Marginality as Resulting From Group and Individual Negotiation About Inclusion [MARGINI] model), and where individual and group inclusion goals can converge (resulting in relatively stable forms of marginality) or diverge (resulting in less stable forms of marginality). When the marginal position is unstable, individuals can either be motivated to move toward or move further away from the group, and such changing inclusion goals are associated with different emotions and behaviors. The authors argue that one needs to understand the interplay between individual and group inclusion goals to predict and explain the full complexity and diversity of the behavior of marginal group members.

  19. Maximum-entropy distributions of correlated variables with prespecified marginals. (United States)

    Larralde, Hernán


    The problem of determining the joint probability distributions for correlated random variables with prespecified marginals is considered. When the joint distribution satisfying all the required conditions is not unique, the "most unbiased" choice corresponds to the distribution of maximum entropy. The calculation of the maximum-entropy distribution requires the solution of rather complicated nonlinear coupled integral equations, exact solutions to which are obtained for the case of Gaussian marginals; otherwise, the solution can be expressed as a perturbation around the product of the marginals if the marginal moments exist.

  20. Comparative biogeochemistry-ecosystem-human interactions on dynamic continental margins (United States)

    Levin, Lisa A.; Liu, Kon-Kee; Emeis, Kay-Christian; Breitburg, Denise L.; Cloern, James; Deutsch, Curtis; Giani, Michele; Goffart, Anne; Hofmann, Eileen E.; Lachkar, Zouhair; Limburg, Karin; Liu, Su-Mei; Montes, Enrique; Naqvi, Wajih; Ragueneau, Olivier; Rabouille, Christophe; Sarkar, Santosh Kumar; Swaney, Dennis P.; Wassman, Paul; Wishner, Karen F.


    The ocean’s continental margins face strong and rapid change, forced by a combination of direct human activity, anthropogenic CO2-induced climate change, and natural variability. Stimulated by discussions in Goa, India at the IMBER IMBIZO III, we (1) provide an overview of the drivers of biogeochemical variation and change on margins, (2) compare temporal trends in hydrographic and biogeochemical data across different margins (3) review ecosystem responses to these changes, (4) highlight the importance of margin time series for detecting and attributing change and (5) examine societal responses to changing margin biogeochemistry and ecosystems. We synthesize information over a wide range of margin settings in order to identify the commonalities and distinctions among continental margin ecosystems. Key drivers of biogeochemical variation include long-term climate cycles, CO2-induced warming, acidification, and deoxygenation, as well as sea level rise, eutrophication, hydrologic and water cycle alteration, changing land use, fishing, and species invasion. Ecosystem responses are complex and impact major margin services including primary production, fisheries production, nutrient cycling, shoreline protection, chemical buffering, and biodiversity. Despite regional differences, the societal consequences of these changes are unarguably large and mandate coherent actions to reduce, mitigate and adapt to multiple stressors on continental margins.