Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

International Nuclear Information System (INIS)

DiBiase, Steven J.; Komarnicky, Lydia T.; Heron, Dwight E.; Schwartz, Gordon F.; Mansfield, Carl M.

2002-01-01

Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT. Methods and Materials: Between 1978 and 1994, 733 women with pathologic Stage I-II breast cancer and known surgical margin status were treated at Thomas Jefferson University Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor bed dose of 60 Gy and had documentation of their margin status; 509 had negative surgical margins, and 132 had positive surgical margins before definitive radiotherapy. Complete gross excision of the tumor and axillary lymph node sampling was obtained in all patients. The median radiation dose to the primary site was 65.0 Gy (range 60-76). Of the women with positive margins (n=132), the influence of higher doses of radiotherapy was evaluated. The median follow-up time was 52 months. Results: The local tumor control rate for patients with negative margins at 5 and 10 years was 94% and 88%, respectively, compared with 85% and 67%, respectively, for those women with positive margins (p=0.001). The disease-free survival rate for the negative margin group at 5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%, respectively, for the positive margin group (p = 0.001). The overall survival rate of women with negative margins at 5 and 10 years was 95% and 90%, respectively. By comparison, for women with positive surgical margins, the overall survival rate at 5 and 10 years was 86% and 79%, respectively (p=0.008). A comparison of the positive and negative margin groups revealed that an increased radiation dose (whether entered as a dichotomous or a continuous variable) >65.0 Gy did not improve local tumor control (p=0.776). On Cox

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.

2007-01-01

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

Attenuated phase-shift mask (PSM) blanks for flat panel display

Science.gov (United States)

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

2015-10-01

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.

Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals.

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

2017-09-01

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.

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

Science.gov (United States)

2016-03-25

you identify any additional Life Cycle training or training improvements? The theme of the responses centered on there is not one magic formula to...prepare a future PSM. One participant’s answer was: “PSMs MUST have experience in a PM shop . That experience needs to include having provided...TRAINING 33 shop only deepens an already steep learning curve for that PSM and frustrates the PMs as they don’t understand what a PSM does and CAN do

Positive Surgical Margins in Favorable-Stage Differentiated Thyroid Cancer.

Science.gov (United States)

Mercado, Catherine E; Drew, Peter A; Morris, Christopher G; Dziegielewski, Peter T; Mendenhall, William M; Amdur, Robert J

2018-04-16

The significance of positive margin in favorable-stage well-differentiated thyroid cancer is controversial. We report outcomes of positive-margin patients with a matched-pair comparison to a negative-margin group. A total of 25 patients with classic-histology papillary or follicular carcinoma, total thyroidectomy +/- node dissection, stage T1-3N0-1bM0, positive surgical margin at primary site, adjuvant radioactive iodine (I-131), and age older than 18 years were treated between 2003 and 2013. Endpoints were clinical and biochemical (thyroglobulin-only) recurrence-free survival. Matched-pair analysis involved a 1:1 match with negative-margin cases matched for overall stage and I-131 dose. Recurrence-free survival in positive-margin patients was 71% at 10 years. No patient was successfully salvaged with additional treatment. Only 1 patient died of thyroid cancer. Recurrence-free survival at 10 years was worse with a positive (71%) versus negative (90%) margin (P=0.140). Cure with a microscopically positive margin was suboptimal (71%) despite patients having classic-histology papillary and follicular carcinoma, favorable stage, and moderate-dose I-131 therapy.

Expression profiles of selected genes in tumors and matched surgical margins in oral cavity cancer: Do we have to pay attention to the molecular analysis of the surgical margins?

Science.gov (United States)

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

2018-04-24

Head and neck squamous cell carcinomas (HNSCCs) are associated with an interplay between genetics and the environment; they account for 3% of all diagnosed malignant tumors in men and 2% of those in women. The aim of the study was to analyze the significance of TIMP3, SFRP1, SFRP2, CDH1, RASSF1, RORA, and DAPK1 gene expression in head and neck squamous cell carcinoma tumors, and in matching surgical margin samples. We also analyzed the association between clinical parameters and the expression of the selected genes. Following surgical resection, 56 primary HNSCC tumors and matching surgical margin samples were collected from patients at the Clinic of Oncological and Reconstructive Surgery of Maria Skłodowska-Curie Memorial Cancer Center and the Institute of Oncology in Gliwice, Poland. The gene expression levels were analyzed by quantitative reverse transcription (qRT)-PCR. SFRP1 gene expression was statistically significantly lower in the tumor samples than in the surgical margins (0.30 ±0.36 vs 0.62 ±0.36; p < 0.01). No correlation was found between gene expression and clinical parameters, except DAPK1, where low expression correlated with alcohol abuse (0.85 ±1.19 vs 1.97 ±3.22; p = 0.074). Moreover, patients with G3 grade tumors, i.e., poorly differentiated tumors, had significantly higher values of DAPK1 gene expression than the G1 (well-differentiated tumors) and G2 (moderately differentiated) groups. There are many different reasons and concepts for altered gene expression in tumors and surgical margin tissue. Tumor heterogeneity and its microenvironment are undoubtedly linked to the biology of HNSCC. In order to understand specific tumor behavior and the microenvironment, further studies are needed. To find markers connected with cancer development and to provide insight into the earliest stages of cancer development, attention should also be focused on molecular analysis of the surgical margins.

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

Directory of Open Access Journals (Sweden)

Chiou Wen-Yen

2010-09-01

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.

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

International Nuclear Information System (INIS)

Chiou, Wen-Yen; Hung, Shih-Kai; Lin, Hon-Yi; Hsu, Feng-Chun; Lee, Moon-Sing; Ho, Hsu-Chueh; Su, Yu-Chieh; Lee, Ching-Chih; Hsieh, Chen-Hsi; Wang, Yao-Ching

2010-01-01

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. 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 6 th 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. 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. 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

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

Science.gov (United States)

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

2017-10-01

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.

Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization - A Single Center Experience.

Science.gov (United States)

Aluloski, Igor; Tanturovski, Mile; Petrusevska, Gordana; Jovanovic, Rubens; Kostadinova-Kunovska, Slavica

2017-12-01

To evaluate the factors that influence the surgical margin state in patients undergoing cold knife conization at the University Clinic of Gynecology and Obstetrics in Skopje, Republic of Macedonia Materials and methods: We have retrospectively analyzed the medical records of all patients that underwent a cold knife conization at our Clinic in 2015. We cross-referenced the surgical margin state with the histopathological diagnosis (LSIL, HSIL or micro-invasive/invasive cancer), menopausal status of the patients, number of pregnancies, surgeon experience, operating time and cone depth. The data was analyzed with the Chi square test, Fisher's exact test for categorical data and Student's T test for continuous data and univariate and multivariate logistical regressions were performed. A total of 246 medical records have neen analyzed, out of which 29 (11.79%) patients had LSIL, 194 (78.86%) had HSIL and 23 (9.34%) patients suffered micro-invasive/invasive cervical cancer. The surgical margins were positive in 78 (31.7%) of the patients. The average age of the patients was 41.13 and 35 (14.23%) of the patients were menopausal. The multivariate logistic regression identified preoperative forceps biopsy of micro-invasive SCC, HSIL or higher cone specimen histology and shorter cone depth as independent predictors of surgical margin involvement in patients undergoing cold knife conization. In the current study, we have found no association between the inherent characteristics of the patient and the surgeon and the surgical margin state after a CKC. The most important predictors for positive margins were the severity of the lesion and the cone depth.

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

2011-01-01

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....

Genome-wide analysis of the regulatory function mediated by the small regulatory psm-mec RNA of methicillin-resistant Staphylococcus aureus.

Science.gov (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

2014-07-01

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. Published by Elsevier GmbH.

General RMP Guidance - Appendix D: OSHA Guidance on PSM

Science.gov (United States)

OSHA's Process Safety Management (PSM) Guidance on providing complete and accurate written information concerning process chemicals, process technology, and process equipment; including process hazard analysis and material safety data sheets.

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

International Nuclear Information System (INIS)

Childs, Stephanie K.; Chen Yuhui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Wong, Julia S.; Bellon, Jennifer R.

2012-01-01

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 features

Robot-assisted radical prostatectomy: Multiparametric MR imaging-directed intraoperative frozen-section analysis to reduce the rate of positive surgical margins.

Science.gov (United States)

Petralia, Giuseppe; Musi, Gennaro; Padhani, Anwar R; Summers, Paul; Renne, Giuseppe; Alessi, Sarah; Raimondi, Sara; Matei, Deliu V; Renne, Salvatore L; Jereczek-Fossa, Barbara A; De Cobelli, Ottavio; Bellomi, Massimo

2015-02-01

To investigate whether use of multiparametric magnetic resonance (MR) imaging-directed intraoperative frozen-section (IFS) analysis during nerve-sparing robot-assisted radical prostatectomy reduces the rate of positive surgical margins. This retrospective analysis of prospectively acquired data was approved by an institutional ethics committee, and the requirement for informed consent was waived. Data were reviewed for 134 patients who underwent preoperative multiparametric MR imaging (T2 weighted, diffusion weighted, and dynamic contrast-material enhanced) and nerve-sparing robot-assisted radical prostatectomy, during which IFS analysis was used, and secondary resections were performed when IFS results were positive for cancer. Control patients (n = 134) matched for age, prostate-specific antigen level, and stage were selected from a pool of 322 patients who underwent nerve-sparing robot-assisted radical prostatectomy without multiparametric MR imaging and IFS analysis. Rates of positive surgical margins were compared by means of the McNemar test, and a multivariate conditional logistic regression model was used to estimate the odds ratio of positive surgical margins for patients who underwent MR imaging and IFS analysis compared with control subjects. Eighteen patients who underwent MR imaging and IFS analysis underwent secondary resections, and 13 of these patients were found to have negative surgical margins at final pathologic examination. Positive surgical margins were found less frequently in the patients who underwent MR imaging and IFS analysis than in control patients (7.5% vs 18.7%, P = .01). When the differences in risk factors are taken into account, patients who underwent MR imaging and IFS had one-seventh the risk of having positive surgical margins relative to control patients (adjusted odds ratio: 0.15; 95% confidence interval: 0.04, 0.61). The significantly lower rate of positive surgical margins compared with that in control patients provides

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.

Non-tumor enhancement at the surgical margin on CT after the removal of brain tumors

International Nuclear Information System (INIS)

Adachi, Michito; Hosoya, Takaaki; Yamaguchi, Kohichi; Yamada, Kiyotada

1992-01-01

Marginal enhancement is occasionally seen at the surgical margin on CT after the total removal of brain tumors. This enhancement disappears in due time, and therefore we call it non-tumor enhancement. It is often difficult, however, to differentiate non-tumor enhancement from tumor recurrence. In this study, we attempted to determine the characteristics of non-tumor enhancement. The subjects of the study consisted of 15 patients with astrocytoma and one with metastatic tumor in whom sequential CT scans had been performed after total removal of the tumor. Based on the observation of these sequential CT scans, the characteristics of non-tumor enhancement were presumed to be as follows: (1) In four cases, enhancement at the surgical margin persisted more than four months after surgery and then disappeared. Therefore, these cases were considered non-tumor enhancement. Prolonged duration of enhancement such as that in these cases is not necessarily due to recurrence. Marginal enhancement within 3 mm in thickness and with a well-demarcated border like that of a flax is likely to be non-tumor enhancement. (author)

Periodically Swapping Modulation (PSM) Strategy for Three-Level (TL) DC/DC Converter with Balanced Switch Currents

DEFF Research Database (Denmark)

Liu, Dong; Deng, Fujin; Zhang, Qi

2018-01-01

The asymmetrical modulation strategy is widely used in various types of three-level (TL) DC/DC converters, while the current imbalance among the power switches is one of the important issues. In this paper, a novel periodically swapping modulation (PSM) strategy is proposed for balancing the power...... switches’ currents in various types of TL DC/DC converters. In the proposed PSM strategy, the driving signals of the switch pairs are swapped periodically, which guarantees that the currents through the power switches are kept balanced in every two switching periods. Therefore, the proposed PSM...... strategy can effectively improve the reliability of the converter by balancing the power losses and thermal stresses among the power switches. The operation principle and performances of the proposed PSM strategy are analyzed in detail. Finally, the simulation and experimental results are presented...

A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy.

Science.gov (United States)

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

2011-01-01

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.

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

Science.gov (United States)

Schmidt, Brian M; McHugh, Jonathan B; Patel, Rajiv M; Wrobel, James S

2018-04-01

Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

A Market Failure Perspective on Value Creation in PSM

DEFF Research Database (Denmark)

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

2014-01-01

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...

A gene signature in histologically normal surgical margins is predictive of oral carcinoma recurrence

International Nuclear Information System (INIS)

Reis, Patricia P; Simpson, Colleen; Goldstein, David; Brown, Dale; Gilbert, Ralph; Gullane, Patrick; Irish, Jonathan; Jurisica, Igor; Kamel-Reid, Suzanne; Waldron, Levi; Perez-Ordonez, Bayardo; Pintilie, Melania; Galloni, Natalie Naranjo; Xuan, Yali; Cervigne, Nilva K; Warner, Giles C; Makitie, Antti A

2011-01-01

Oral Squamous Cell Carcinoma (OSCC) is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence. We used a meta-analysis of 199 samples (OSCCs and normal oral tissues) from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients. We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01) in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Over-expression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test) and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test). Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence

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 ...

Whipple Resection: Concordance Between Frozen Section And Permanent Section Diagnosis Of Surgical Margins.

Science.gov (United States)

Bilal, Muhammad; Tariq, Hina; Mamoon, Nadira

2018-01-01

Margin assessment is done in Whipple procedures which are usually performed to resect tumours of head of pancreas and ampullary/periampullary region. Aims and objective of the study are to determine the concordance between frozen sections (FS) and permanent sections (PS) of surgical margins in Whipple resections. It is a retrospective study, from January 2008 to January 2015 (07 years). It includes the specimen with malignancy in final report and for which FS of pancreatic and/or CBD margin(s) were requested. Data was retrieved from Laboratory information system (LIS) database. Of the 41 bile duct margins in cases of ampullary tumours, 03 were positive on FS as well as PS, 35 were negative on FS as well as on PS. Results showed 100% sensitivity, 92.1% specificity, 50% PPV and 100% NPV. Results of 36 pancreatic margins in cases of ampullary showed 100% sensitivity, 97.1% specificity, 50% PPV and 100% NPV. In pancreatic carcinoma cases, none of CBD margins were reported as positive on FS, 02 margins reported as negative were found positive on PS, while 17 were negative on FS as well as PS. Results showed 100% specificity and 89.5% NPV. Of the 27 pancreatic margins tested in pancreatic tumours 100% sensitivity, 94.1% specificity, 88.9% PPV and 100% NPV was found. Factors such as absent prior tissue diagnosis and/or inflammatory processes make margin diagnosis difficult. However, a high concordance was observed between our FS and PS diagnosis.

Surgical outcomes of patients with superficial esophageal cancer. A comparison between trans-thoracic esophagectomy and trans-hiatal esophagectomy

International Nuclear Information System (INIS)

Matsumoto, Hideo; Kubota, Hisako; Murakami, Haruaki

2010-01-01

We inspected the feasibility of minimally invasive surgery for superficial esophageal cancer, the trans-hiatal approach without thoracotomy. We examined the surgical outcomes of 33 superficial esophageal cancer whose cancer had invaded the submucosal layer and who underwent resection in our hospital between April 2003 and April 2009. The patients who had tumor invasion of within the sm1 and no metastasis to the upper and middle mediastinum lymph nodes were operated on by the trans-hiatal esophagectomy (THE). The other patients were underwent ordinary trans-thoracic esophagectomy (TTE). After the operations, we recommended adjuvant chemoradiation therapy for all patients whose tumor were histopathologically proved to involve the sm2 layer as well as the vessels and/or lymphatic duct. Of our 33 cases, nine were diagnosed as pM1 or pM2. Two were diagnosed as pM3, one of which had lymph node metastasis. Eleven cases were diagnosed as pSM1, four as pSM2, and seven as pSM3; and lymph node metastasis was observed in 4 pSM1 cases (36%), 2 pSM2 cases (50%) and 5 pSM3 cases (71.4%). The five-year survival rate in all cases was 89.6%. The five-year survival rate by operating method was 100% in THE cases or 80.9% in TTE cases. The rates by tumor depth of invasion was 100% in pM1-2 cases, 92.3% in pM3-SM1 cases and 78.8% in pSM2-3 cases. It is concluded that the surgical outcome of THE in accordance with our indication criteria is equal to that of TTE for superficial esophageal cancer. (author)

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|info:eu-repo/dai/nl/323038816; Leisink, Peter|info:eu-repo/dai/nl/071055266

2015-01-01

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:

Study on rotational bands in odd-odd nuclei 102,l04Nb by using PSM

International Nuclear Information System (INIS)

Dong Yongsheng; Hu Wentao; Feng Youliang; Wang Jinbao; Yu Shaoying; Shen Caiwan

2012-01-01

The Projected Shell Model (PSM) is used to study the low energy scheme of the neutron-rich normal-deformed isotopes of odd-odd nuclei 102,104 Nb. The quasiparticle configuration is assigned. The theoretical calculations of the energy band of 102,104 Nb could well reproduce the experimental data. It is shown that PSM is a valid method for studying the low energy scheme of heavy nuclei. (authors)

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

2011-01-01

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....

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

DEFF Research Database (Denmark)

Lawaetz, Mads; Homøe, Preben

2014-01-01

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...

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

Science.gov (United States)

Deng, Youping; Xu, Hu; Riedel, Heimo

2007-02-15

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.

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

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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: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

2013-11-15

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.

Cholesterol effect on water permeability through DPPC and PSM lipid bilayers: a molecular dynamics study.

Science.gov (United States)

Saito, Hiroaki; Shinoda, Wataru

2011-12-29

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. © 2011 American Chemical Society

Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region

International Nuclear Information System (INIS)

Ntomouchtsis, A.; Xinou, K.; Patrikidou, A.; Paraskevopoulos, K.; Kechagias, N.; Tsekos, A.; Balis, G.C.; Gerasimidou, D.; Thuau, H.; Mangoudi, D.; Vahtsevanos, K.

2013-01-01

Aim: To investigate alternative possibilities for the intraoperative evaluation of surgical margins after bone resection utilizing more conventional hospital infrastructure technologies. Materials and methods: A small pilot study was performed using digital mammograph imaging intraoperatively on 16 surgical specimens of bone tumours or malignancies with bone infiltration of the head and neck area, with the aim of evaluating the resection margins. Results: In thirteen cases the intraoperative specimen images indicated clinically complete excision. In two cases incomplete resection or close proximity of margins was detected, which required additional resection. Conclusions: The results indicated that intraoperative specimen radiography can prove useful in evaluating completeness of excision. The significance of intraoperative assessment of surgical margin is of paramount importance when immediate reconstruction is performed. This proposed method is cheap, easy to perform and fast. Its cost–benefit ratio is superior than that of any other available technique. Intraoperative analysis of specimens with digital mammography imaging can potentially become a useful tool for immediate evaluation of osseous margins after resection

[A new technique for ensuring negative surgical margins during partial nephrectomy: the ex vivo ultrasound control].

Science.gov (United States)

Desmonts, A; Tillou, X; Le Gal, S; Secco, M; Orczyk, C; Bensadoun, H; Doerfler, A

2013-10-01

To evaluate the feasibility and the efficiency of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by urologist. Patients undergoing partial nephrectomy from July 2010 to November 2012 for T1-T2 renal tumors were included in analysis. Tumor margin status was immediately determined by ex vivo ultrasound done by the surgeon himself. Results were compared with margin status on definitive pathological evaluation. A total of 26 men and 15 women with a median age of 61 (30-82) years old were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 38 cases and positive margins in two. Final pathological results revealed negative margins in all except one case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Mean ultrasound duration was 1minute±1. Mean tumor and margin sizes were 3.4±1.8cm and 2.38±1.76mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by a urologist seemed to be feasible, efficient and easy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

2011-07-01

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

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

International Nuclear Information System (INIS)

La Roca, Ricardo L.R. Felts de; Fonseca, Francisco Paula da; Cunha, Isabela Werneck da; Bezerra, Stephania Martins

2013-01-01

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

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: Ricardo@delarocaurologia.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: fpf@uol.com.br [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: iwerneck@gmail.com, E-mail: stephaniab@gmail.com [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia

2013-07-01

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

The impact of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy.

Science.gov (United States)

Pearce, Shane M; Pariser, Joseph J; Patel, Sanjay G; Anderson, Blake B; Eggener, Scott E; Zagaja, Gregory P

2016-02-01

To examine the effect of days off between cases on perioperative outcomes for robotic-assisted laparoscopic prostatectomy (RALP). We analyzed a single-surgeon series of 2036 RALP cases between 2003 and 2014. Days between cases (DBC) was calculated as the number of days elapsed since the surgeon's previous RALP with the second start cases assigned 0 DBC. Surgeon experience was assessed by dividing sequential case experience into cases 0-99, cases 100-249, cases 250-999, and cases 1000+ based on previously reported learning curve data for RALP. Outcomes included estimated blood loss (EBL), operative time (OT), and positive surgical margins (PSMs). Multiple linear regression was used to assess the impact of the DBC and surgeon experience on EBL, OT, and PSM, while controlling for patient characteristics, surgical technique, and pathologic variables. Overall median DBC was 1 day (0-3) and declined with increasing surgeon case experience. Multiple linear regression demonstrated that each additional DBC was independently associated with increased EBL [β = 3.7, 95% CI (1.3-6.2), p < 0.01] and OT [β = 2.3 (1.4-3.2), p < 0.01], but was not associated with rate of PSM [β = 0.004 (-0.003-0.010), p = 0.2]. Increased experience was also associated with reductions in EBL and OT (p < 0.01). Surgeon experience of 1000+ cases was associated with a 10% reduction in PSM rate (p = 0.03) compared to cases 0-99. In a large single-surgeon RALP series, DBC was associated with increased blood loss and operative time, but not associated with positive surgical margins, when controlling for surgeon experience.

Real Time Physiological Status Monitoring (RT-PSM): Accomplishments, Requirements, and Research Roadmap

Science.gov (United States)

2016-03-01

actionable information. With many lessons learned , the first implementation of real time physiological monitoring (RT-PSM) uses thermal-work strain... Bidirectional Inductive On-Body Network (BIONET) for WPSM Develop sensor links and processing nodes on-Soldier and non-RF links off-Soldier Elintrix...recent sleep watches (e.g., BASIS Peak, Intel Corp.) are attempting to parse sleep quality beyond duration and interruptions into deep and REM sleep

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

2015-01-01

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.

Pelatihan Bisol bagi Penyandang Tunarungu dan Tunawicara di SLB PSM Takeran sebagai Bekal Berwirausaha

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Swasti Maharani

2018-06-01

Full Text Available Impairment is something that most people do not want. There is impairment due to congenital from birth and there is also impairment caused by accidents. For example is deaf and mute. People with hearing impairment have limited hearing, whereas mute sufferers have limitations in terms of oral /voice and many also experience less hearing. Deaf people and mute need skills to maintain their survival, in SLB PSM Takeran there are lessons that teach about skills, but the skills of students in SLB PSM Takeran not well distributed, the creative craft made by SLB students are still stored neatly in school. Therefore, need to given the training bisol (Bisnis Online for the deaf and mute in SLB PSM Takeran. The training was followed by 12 deaf and mute students at SLB Takeran. The training was held for two days with demo material on how to create social media account starting from e-mail creation, facebook, twitter, instagram, bukalapak, blibli.com and so on, then how to upload photos of products to be marketed, how to send goods Through shipping services. The results of the training were analyzed by qualitative approach. The results of the qualitative analysis (based on observation and interview show that all participants feel the new knowledge and skills, namely the skills of doing business online. In addition, it can provide entrepreneurial supplies for people with deaf and mute. The future plan after this training will be the establishment of a disability community in Kecamatan Takeran, where the community will develop their skills and be able to create jobs for people with disabilities. So as to create financial independence for persons with disabilities.

Comparison of Selected Protein Levels in Tumour and Surgical Margin in a Group of Patients with Oral Cavity Cancer.

Science.gov (United States)

Strzelczyk, Joanna Katarzyna; Gołąbek, Karolina; Cuber, Piotr; Krakowczyk, Łukasz; Owczarek, Aleksander Jerzy; Fronczek, Martyna; Choręża, Piotr; Hudziec, Edyta; Ostrowska, Zofia

2017-08-01

Oral cavity cancer belongs to head-and-neck squamous cell carcinoma group. The purpose of the study was to assess the levels of certain proteins in a tumour and surgical margin in a group of patients with oral cavity cancer. The levels of DAPK1, MGMT, CDH1, SFRP1, SFRP2, RORA, TIMP3, p16, APC and RASSF1 proteins were measured by ELISA in tissue homogenates. The protein levels of DAPK1, MGMT, CDH1, SFRP2 and RASSF1 were significantly higher in tumour tissue than in the margin, contrary to TIMP3 which was lower in the tumour itself. DAPK1 level in the tumour was significantly higher in females than in males, the MGMT and p16 levels were lower in the tumours with lymph node metastasis (N1 + N2) than in N0 samples. The CDH1 expression was higher in a group with smoking habits, whereas TIMP3 was lower in this group. Changes in the levels of proteins in tumour and surgical margin may be either reflective of tumour occurrence and development, or they might be also responsible for the progress and reoccurrence of the disease. Levels of the studied proteins might be good prognostic factors; however, further studies are required.

Close or positive margins after surgical resection for the head and neck cancer patient: the addition of brachytherapy improves local control

International Nuclear Information System (INIS)

Beitler, Jonathan J.; Smith, Richard V.; Silver, Carl E.; Quish, Astrid; Deore, Shivaji M.; Mullokandov, Eduard; Fontenla, Doracy P.; Wadler, Scott; Hayes, Mary Katherine; Vikram, Bhadrasain

1998-01-01

Purpose: Microscopically positive or close margins after surgical resection results in an approximately 21-26% local failure rate despite excellent postoperative external radiation therapy. We sought to demonstrate improved local control in head and neck cancer patients who had a resection with curative intent, and had unexpected, microscopically positive or close surgical margins. Methods and Materials: Twenty-nine patients with microscopically close or positive margins after curative surgery were given definitive, adjuvant external radiation therapy and 125 I brachytherapy. All 29 patients had squamous cell cancer and tonsil was the most common subsite within the head and neck region. After external radiation therapy and thorough discussions with the attending surgeon and pathologists, the slides, gross specimens, and appropriate radiographs were reviewed and a target volume was determined. The target volume was the region of the margin in question and varied in size based on the surgery and pathologic results. Once the target volume was identified the patient was taken back to the operating room for insertion of 125 I seeds. Activity implanted (range 2.9-21.5 millicuries) was designed to administer a cumulative lifetime dose of 120-160 Gy. Results: Twenty-nine patients were followed for a median of 26 months (range 5-86 months). Two-year actuarial local control was 92%. Conclusion: 125 I, after external radiation therapy, is an excellent method to improve local control in the subset of patients with unexpectedly unsatisfactory margins

Interaction, Co-creation and Participation in PSM Literature, Policy and Strategy: A Comparative Case Study Analysis of Flanders, the Netherlands, France and the UK

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Anne-Sofie Vanhaeght

2015-12-01

Full Text Available The article critically evaluates whether there is a (mismatch between ideas on audience involvement in public service media (PSM theory and the translation thereof in public broadcasters’ policy and strategy documents. The literature section theoretically frames this discussion, first, discussing five objectives of PSM and audience involvement. Subsequently, it studies how the BBC (UK, France Télévisions (France, VRT (Flanders, and NPO (the Netherlands have to (policy and intend to (strategy involve their audiences. These cases have been selected with an eye on including both better-funded (BBC, FTV and smaller public broadcasters (VRT, NPO, as well as different media systems. For the analysis, the method of goal-means tree analysis is adopted, a type of qualitative document analysis that can be deployed to uncover goal-means relationships in policy and strategy texts. The main argument is that, rather than a mismatch, some of the questionable, normative assumptions made in theories concerning audience involvement and PSM are also present in the PSM policy and strategy texts.

Exploring the Context Dependency of the PSM-Performance Relationship

DEFF Research Database (Denmark)

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

2016-01-01

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 fixed effects regression, we find a stronger PSM–performance relationship in organizational contexts involving greater regulation of employee work autonomy for users with low to moderate user capacity....

{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)

2015-08-15

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.)

Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome

Directory of Open Access Journals (Sweden)

Ricardo L. R. Felts de La Roca

2014-06-01

Full Text Available Introduction Positive surgical margins (PSMs are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP. However, not all of these cases will evolve to biochemical (BCR or clinical (CR recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP, between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%. Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%, and CR in 10 (4.38%. Univariate analysis showed statistically significant associations (p < 0.001 between presence of PSMs with BCR, but not with CR (p = 0.05. At follow-up of the 161 patients with PSMs, only 61(37.8% presented BCR, while 100 (62.8% did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and

Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

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Berberi, Antoine N; Tehini, Georges E; Noujeim, Ziad F; Khairallah, Alexandre A; Abousehlib, Moustafa N; Salameh, Ziad A

2014-10-01

Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p sockets reduced marginal bone loss and did not compromise the success rate of the restorations. © 2014 by the American College of Prosthodontists.

Isolated port-site metastasis after surgical staging for low-risk endometrioid endometrial cancer: A case report.

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Mautone, Daniele; Dall'asta, Andrea; Monica, Michela; Galli, Letizia; Capozzi, Vito Andrea; Marchesi, Federico; Giordano, Giovanna; Berretta, Roberto

2016-07-01

Port-site metastases (PSMs) are well-known potential complications of laparoscopic surgery for gynaecologic malignancies. The present case study reports PSM following laparoscopic surgery for Stage IA Grade 1 endometrioid endometrial cancer (EEC). The recurrence developed within 7 months following primary surgery and required surgical excision followed by adjuvant chemo-radio therapy. After 9 months, the patient remains disease-free. PSMs are rare complications following laparoscopic surgery. Amongst the 23 cases of endometrial cancer PSMs reported so far, only 4 followed EEC Stage IA Grade 1-2. The present study reports a rare case of PSM after Stage IA Grade 1 EEC. The clinical and prognostic relevance of PSMs has not been identified so far; and it is not known whether PSMs represent a local recurrence or a systemic recurrence. Surgeons should be aware that even low-risk EEC may be followed by PSMs and should take steps to prevent these rare recurrences.

The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.

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Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J; Tollenaar, Rob A E M; Wouters, Michel W J M

2016-04-01

This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11). To evaluate the association between hospital volume and CRM (circumferential resection margin) involvement in rectal cancer surgery. To guarantee the quality of surgical treatment of rectal cancer, the Association of Surgeons of the Netherlands has stated a minimal annual volume standard of 20 procedures per hospital. The influence of hospital volume has been examined for different outcome variables in rectal cancer surgery. Its influence on the pathological outcome (CRM) however remains unclear. As long-term outcomes are best predicted by the CRM status, this parameter is of essential importance in the debate on the justification of minimal volume standards in rectal cancer surgery. Data from the Dutch Surgical Colorectal Audit (2011-2012) were used. Hospital volume was divided into 3 groups, and baseline characteristics were described. The influence of hospital volume on CRM involvement was analyzed, in a multivariate model, between low- and high-volume hospitals, according to the minimal volume standards. This study included 5161 patients. CRM was recorded in 86% of patients. CRM involvement was 11% in low-volume group versus 7.7% and 7.9% in the medium- and high-volume group (P≤0.001). After adjustment for relevant confounders, the influence of hospital volume on CRM involvement was still significant odds ratio (OR) = 1.54; 95% CI: 1.12-2.11). The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).

[Resection margins in conservative breast cancer surgery].

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

2013-01-01

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.

Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial.

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Nyarangi-Dix, Joanne N; Radtke, Jan Philipp; Hadaschik, Boris; Pahernik, Sascha; Hohenfellner, Markus

2013-03-01

We investigated the influence of bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy. A total of 208 men who presented for radical prostatectomy were randomized to complete bladder neck preservation with subsequent urethro-urethral anastomosis or to no preservation as controls. Patients with failed bladder neck preservation were not included in study. We documented objective continence by the 24-hour pad test, social continence by the number of pads per day and quality of life outcomes by the validated Incontinence Quality of Life questionnaire in a single blind setting. Cancer resection was assessed by surgical margin status. At 0, 3, 6 and 12 months mean urine loss in the control vs the bladder neck preservation group was 713.3 vs 237.0, 49.6 vs 15.6, 44.4 vs 5.5 and 25.4 vs 3.1 gm, respectively (each p <0.001). At 3, 6 and 12 months in the control vs the preservation group the social continence rate was 55.3% vs 84.2% (p <0.001), 74.8% vs 89.5% (p = 0.05) and 81.4% vs 94.7% (p = 0.027), and the quality of life score was 80.4 vs 90.3 (p <0.001), 85.4 vs 91.7 (p = 0.016) and 86.0 vs 93.8 (p = 0.001), respectively. We noted significantly less urine loss, higher objective and social continence rates, and higher quality of life scores after complete bladder neck preservation at all followup points. On multiple logistic regression analysis complete bladder neck preservation was an independent positive predictor of continence. No significant difference was found in surgical margin status between the control and bladder neck preservation groups (12.5% vs 14.7%, p = 0.65). In what is to our knowledge the first prospective, randomized, controlled, single blind trial complete bladder neck preservation during radical prostatectomy was associated with a significantly higher urinary continence rate and increased patient satisfaction without compromising resection margins. Copyright © 2013 American Urological

Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients

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

2017-08-01

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.

Breast surgical specimen radiographs: How reliable are they?

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Britton, P.D.; Sonoda, L.I.; Yamamoto, A.K.; Koo, B.; Soh, E.; Goud, A.

2011-01-01

Radiography of the excised surgical specimen following wire guided localisation of impalpable breast lesions is standard surgical practice. The aims of the study were to establish the reliability of the breast specimen radiograph (SR) in determining lesion excision and to determine whether the radiographic margin correlated with the histological margin. The clinical, imaging, SR and pathological details of 106 patients with a pre-operative diagnosis of breast cancer were retrospectively reviewed. The reliability of orientation was estimated and the appearance and distance from the mammographic abnormality to each radial margin were measured and correlated with surgical histological findings. The overall accuracy of the specimen radiograph in determining whether the mammographic lesion was present was 99%. The SR could be orientated 'very reliably' or 'reliably' in 80% of patients however in only 48% of patients did the closest margin on the SR correspond with the same nearest margin at final histology. A maximum measurement of 11 mm or more from the lesion to the specimen edge was associated with a 77% likelihood of having a clear final histological margin (taken as 5 mm or more) and if <11 mm a 58% chance of having involved final histological margins. There was however a wide overlap in the results with patients having an apparently wide SR margin but histologically involved margins and vice versa. The SR is reliable at determining whether the target lesion has been removed. The correlation of SR margin orientation and measurement with final histological measurement is however far less reliable.

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

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Peek-Asa Corinne

2011-01-01

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

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

Science.gov (United States)

2011-01-01

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 estimates. The algorithm

Circumferential scouting punch biopsies to delineate surgical margin for dermatofibrosarcoma protuberans

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Tsung-Mao Huang

2012-03-01

Full Text Available Dermatofibrosarcoma protuberans (DFSP is an uncommon soft-tissue tumor involving the dermis and subcutaneous tissue with a high local recurrence rate after standard excision. Mohs micrographic surgery offers a lower recurrence rate. However, the procedure requires multiple stages of excision with intraoperative histopathological mapping, which is time consuming and expensive. We report our experience of using circumferential scouting punch biopsy technique in five patients to determine in advance the resection margins for DFSP prior to wide excision. Multiple 4 mm punches, usually eight in number, were performed 1–2.5 cm around the palpable borders of DFSP to delineate the resection margins in five consecutive patients. Tumors were excised at a later date along the margin defined by these biopsies and the wounds were repaired with skin graft. The operation was completed in 2 hours in all cases excluding one that required frozen sections for deep margin. No recurrence was noted 2–10 years after the operations. The results suggest that circumferential scouting punch biopsies before wide excision may be an alternative method to define the resection margins for DFSP when Mohs surgery is not available.

Role of specimen US for predicting resection margin status in breast conserving therapy.

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Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

2015-01-01

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

Pancreatic Neuroendocrine Tumors With Involved Surgical Margins: Prognostic Factors and the Role of Adjuvant Radiotherapy

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Arvold, Nils D. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Fernandez-del Castillo, Carlos [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Clark, Jeffrey W.; Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Deshpande, Vikram [Department of Pathology, Massachusetts General Hospital, Boston, MA (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Allen, Jill N.; Kwak, Eunice L.; Wadlow, Raymond C.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Warshaw, Andrew L. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Hong, Theodore S., E-mail: Tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

2012-07-01

Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factors associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%-77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21-11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01-1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further

Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis.

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Weng, Hong; Zeng, Xian-Tao; Li, Sheng; Meng, Xiang-Yu; Shi, Ming-Jun; He, Da-Lin; Wang, Xing-Huan

2017-09-13

The present study aimed to systematically evaluate the effectiveness and safety of the intrafascial and interfascial nerve sparing (ITR-NS and ITE-NS) radical prostatectomy. PubMed, Embase, and Cochrane Library databases were searched for eligible studies. Meta-analysis with random-effects model was performed. Six comparative trials were selected and embraced in this research, including one randomized controlled trial, three prospective comparative trials, and two retrospective comparative trials. With regard to perioperative parameters, no significant association of operative time, blood loss, transfusion rates, duration of catheterization, and hospital stay existed between ITR-NS and ITE-NS. With respect to the functional results, ITR-NS had advantages in terms of both continence and potency recovery compared with ITE-NS. In reference to the oncologic results, the ITR-NS showed lower overall positive surgical margin (PSM) compared with ITE-NS but pT2 PSM and biochemical recurrence free rates were similar to the two surgical types. This study demonstrates that ITR-NS has better continence at 6 mo and 36 mo and better potency recovery at 6 mo and 12 mo postoperatively, regardless of the surgical technique. The cancer control of ITR-NS was also better than that of ITE-NS. This may be explained by the fact that patients in ITE-NS group present higher risk cancer than patients in ITR-NS group.

Effects of different abutment material and surgical insertion torque on the marginal adaptation of an internal conical interface: an in vitro study.

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Farronato, Davide; Pieroni, Stefano; Mangano, Francesco Guido; Briguglio, Francesco; Re, Dino

2014-10-01

To evaluate the marginal adaptation at implant-abutment connection of an implant featuring a conical (45° taper) internal hexagonal abutment with a connection depth of 2.5mm, comparing the performance of two identical abutments of different material (titanium grade-4 and Co-Cr-alloy). Twenty implants (3.75 mm×15 mm) were connected to non-matching abutments (5.5 mm×10 mm) of two different materials (titanium grade-4: n=10; Co-Cr-alloy: n=10). The specimens were separately embedded in epoxylite resin, inside copper cylinders, and submerged without covering the most coronal portion (5 mm) of the fixture. Five specimens per group were stressed simulating a surgical 100 Ncm insertion torque, while the others had no torque simulation. All specimens were subjected to a non-axial static load (100 N) in a universal testing machine, under an angle of 30° with respect to the implant axis. Once 100 N load was reached, low shrinkage self-curing resin was injected inside the cylinders, and load was maintained until complete resin polymerization. Specimens were cut and analyzed with optical and scanning-electron-microscope (SEM) to evaluate the marginal adaptation at the implant-abutment connection. Statistical analysis was performed using one-way ANOVA (p=0.02). None of the 20 samples failed. The implant-abutment connection was able to guarantee a good optical seal; SEM analysis confirmed the absence of microgaps. Within the limits of this study (small sample size, limited time) the marginal adaptation of the implant-abutment connection was not affected by the abutment material nor by the application of surgical insertion torque. Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: possible implications for active surveillance from the SEARCH database.

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Abern, Michael R; Aronson, William J; Terris, Martha K; Kane, Christopher J; Presti, Joseph C; Amling, Christopher L; Freedland, Stephen J

2013-03-01

Active surveillance (AS) is increasingly accepted as appropriate management for low-risk prostate cancer (PC) patients. It is unknown whether delaying radical prostatectomy (RP) is associated with increased risk of biochemical recurrence (BCR) for men with intermediate-risk PC. We performed a retrospective analysis of 1,561 low and intermediate-risk men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database treated with RP between 1988 and 2011. Patients were stratified by interval between diagnosis and RP (≤ 3, 3-6, 6-9, or >9 months) and by risk using the D'Amico classification. Cox proportional hazard models were used to analyze BCR. Logistic regression was used to analyze positive surgical margins (PSM), extracapsular extension (ECE), and pathologic upgrading. Overall, 813 (52%) men were low-risk, and 748 (48%) intermediate-risk. Median follow-up among men without recurrence was 52.9 months, during which 437 men (38.9%) recurred. For low-risk men, RP delays were unrelated to BCR, ECE, PSM, or upgrading (all P > 0.05). For intermediate-risk men, however, delays >9 months were significantly related to BCR (HR: 2.10, P = 0.01) and PSM (OR: 4.08, P 9 months were associated with BCR in subsets of intermediate-risk men with biopsy Gleason score ≤ 3 + 4 (HR: 2.51, P 9 months predicted greater BCR and PSM risk. If confirmed in future studies, this suggests delayed RP for intermediate-risk PC may compromise outcomes. Copyright © 2012 Wiley Periodicals, Inc.

PENINGKATAN KETERAMPILAN MELAKUKAN PROSEDUR KEARSIPAN MENGGUNAKAN KARTU KENDALI DENGAN METODE DEMONSTRASI MELALUI MEDIA ALAT PERAGA BAGI SISWA KELAS XI-AP SMK PSM RANDUBLATUNG BLORA TAHUN AJARAN 2013/2014

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Wahid Sri Yuliani

2013-11-01

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

Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients

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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.

Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma.

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El-Fol, Hossam Abdelkader; Noman, Samer Abduljabar; Beheiri, Mohamed Galal; Khalil, Abdalla M; Kamel, Mahmoud Mohamed

2015-05-01

Resecting oral squamous cell carcinoma (SCC) with an appropriate margin of uninvolved tissue is critical in preventing local recurrence and in making decisions regarding postoperative radiation therapy. This task can be difficult due to the discrepancy between margins measured intraoperatively and those measured microscopically by the pathologist after specimen processing. A total of 61 patients underwent resective surgery with curative intent for primary oral SCC were included in this study. All patients underwent resection of the tumor with a measured 1-cm margin. Specimens were then submitted for processing and reviewing, and histopathologic margins were measured. The closest histopathologic margin was compared with the in situ margin (1 cm) to determine the percentage discrepancy. The mean discrepancy between the in situ margins and the histopathological margins of all close and positive margins were 47.6% for the buccal mucosa (with a P value corresponding to 0.05 equaling 2.1), which is statistically significant, 4.8% for the floor of mouth, 9.5% for the mandibular alveolus, 4.8% for the retromolar trigon, and 33.3% for the tongue. There is a significant difference among resection margins based on tumor anatomical location. Margins shrinkage after resection and processing should be considered at the time of the initial resection. Tumors located in the buccal mucosa show significantly greater discrepancies than tumors at other sites. These findings suggest that it is critical to consider the oral site when outlining margins to ensure adequacy of resection. Buccal SCC is an aggressive disease, and should be considered as an aggressive subsite within the oral cavity, requiring a radical and aggressive resective approach. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

In vitro histological evaluation of the surgical margins made by different laser wavelengths in tongue tissues

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Azevedo, Ana-Salvaterra; Ferreira, Fernando; Delgado, Maria-Leonor; Garcês, Fernanda; Carreira, Sofia; Martins, Marco; Suarez-Quintanilla, Juan

2016-01-01

Background Lasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods Cuts were made in pork tongues’ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis. Key words:CO2 laser, diode laser, Er:YAG laser, laser surgery, Nd:YAG laser, oral mucosa, thermal effect. PMID:27703606

Lateral view dissection of the prostato-urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy.

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Sasaki, Hiroshi; Miki, Jun; Kimura, Takahiro; Sanuki, Kunitaro; Miki, Kenta; Takahashi, Hiroyuki; Egawa, Shin

2009-08-01

To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence. One hundred and forty-four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato-urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups. Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso-apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P Lateral view dissection of the prostato-urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.

Factors associated with a primary surgical approach for sinonasal squamous cell carcinoma.

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Cracchiolo, Jennifer R; Patel, Krupa; Migliacci, Jocelyn C; Morris, Luc T; Ganly, Ian; Roman, Benjamin R; McBride, Sean M; Tabar, Viviane S; Cohen, Marc A

2018-03-01

Primary surgery is the preferred treatment of T1-T4a sinonasal squamous cell carcinoma (SNSCC). Patients with SNSCC in the National Cancer Data Base (NCDB) were analyzed. Factors that contributed to selecting primary surgical treatment were examined. Overall survival (OS) in surgical patients was analyzed. Four-thousand seven hundred and seventy patients with SNSCC were included. In T1-T4a tumors, lymph node metastases, maxillary sinus location, and treatment at high-volume centers were associated with selecting primary surgery. When primary surgery was utilized, tumor factors and positive margin guided worse OS. Adjuvant therapy improved OS in positive margin resection and advanced T stage cases. Tumor and non-tumor factors are associated with selecting surgery for the treatment of SNSCC. When surgery is selected, tumor factors drive OS. Negative margin resection should be the goal of a primary surgical approach. When a positive margin resection ensues, adjuvant therapy may improve OS. © 2017 Wiley Periodicals, Inc.

Label-free optical imaging technologies for rapid translation and use during intraoperative surgical and tumor margin assessment

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Boppart, Stephen A.; Brown, J. Quincy; Farah, Camile S.; Kho, Esther; Marcu, Laura; Saunders, Christobel M.; Sterenborg, Henricus J. C. M.

2018-02-01

The biannual International Conference on Biophotonics was recently held on April 30 to May 1, 2017, in Fremantle, Western Australia. This continuing conference series brought together key opinion leaders in biophotonics to present their latest results and, importantly, to participate in discussions on the future of the field and what opportunities exist when we collectively work together for using biophotonics for biological discovery and medical applications. One session in this conference, entitled "Tumor Margin Identification: Critiquing Technologies," challenged invited speakers and attendees to review and critique representative label-free optical imaging technologies and their application for intraoperative assessment and guidance in surgical oncology. We are pleased to share a summary in this outlook paper, with the intent to motivate more research inquiry and investigations, to challenge these and other optical imaging modalities to evaluate and improve performance, to spur translation and adoption, and ultimately, to improve the care and outcomes of patients.

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

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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

2015-12-01

A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. 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). A literature review was conducted. 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. 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. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

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Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

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Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

2016-03-01

Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

Surgical treatment for residual or recurrent strabismus

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Tao Wang

2014-12-01

Full Text Available Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator''s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.

Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients.

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Kılıç, Suat; Kılıç, Sarah S; Baredes, Soly; Chan Woo Park, Richard; Mahmoud, Omar; Suh, Jeffrey D; Gray, Stacey T; Eloy, Jean Anderson

2018-03-01

The use of endoscopic resection as an alternative to open surgery for sinonasal malignancies has increased in the past 20 years. The National Cancer Database was queried for cases of sinonasal squamous cell carcinoma (SNSCC) without cervical or distant metastases that were treated surgically between 2010 and 2014. They were split into 2 groups based on surgical approach: open or endoscopic. Demographics, facility and insurance type, stage, tumor characteristics, postoperative treatment, 30-day readmission rate, 30- and 90-day mortality, and overall survival (OS) were compared between the 2 groups. Cox proportional hazard analysis was performed. Propensity score matching (PSM) was used to mimic a randomized, controlled trial. A total of 1,483 patients were identified: 353 (23.8%) received endoscopic and 1130 (76.2%) received open surgery. Age, gender, race, geographic region, tumor size, surgical margins, postoperative chemoradiation, and 30-day readmissions did not vary significantly between the 2 groups. Open surgery was more common in academic centers (62.8% vs 54.2%; p = 0.004), less common for tumors of the ethmoid and sphenoid sinus (p open: 5Y-OS, 56.5%; 95% confidence interval, 51.3% to 61.6%; endoscopic: 5Y-OS, 46.0%; 95% confidence interval, 33.2% to 58.8%). In the PSM cohort of 652 patients, there was also no significant difference in OS (p = 0.850). Endoscopic surgery is an effective alternative to open surgery, even after accounting for confounding factors that may favor its use over the open approach. It is also associated with a shorter hospital stay. © 2017 ARS-AAOA, LLC.

Mandibular marginal contouring in oriental aesthetic surgery: refined surgical concept and operative procedure.

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Satoh, Kaneshige; Mitsukawa, Nobuyuki

2014-05-01

In aesthetic mandibular contouring surgery, which is often conducted in Asians, the operative procedure is thought to deliver a more aesthetic mandibular shape by means of contouring conducted as a whole from the ramus to the symphysis. The authors describe the refined concept and operative procedures of mandibular marginal contouring. For the 7-year period from 2004 to 2011, mandibular marginal contouring has been used in 57 consecutive series of Japanese subjects. Patient ages ranged from 18 to 33 years, and the subjects included 15 men and 42 women. The surgery was carried out by cutting off the protruding deformed mandibular margin from the ramus to the symphysis. In 53 of 57 cases, the focus was on angle contouring. Concomitant genioplasty by horizontal osteotomy of the chin was conducted in 42 of 57 cases (recession, advancement, shortening, elongation, and correction of the shift variously). In 22 materials exhibiting bulk around the mandibular, the ramus to the body was excised sagittally and thinned. In all the patients, mandibular marginal contouring from the ramus to the symphysis was completed. Partial masseter muscle resection was conducted in 11 of 57 cases. Mandibular contouring effectively achieved a highly satisfactory result in all cases. The upper portion of the peripheral branch of the trunk of the mental nerve was dissected by an electric scalpel in 1 case but sutured immediately using an 8-0 nylon stitch. Transient palsy of the mental nerve was noticed in a few cases but subsided in 1 to 2 months. No particular complications were encountered. No secondary revision was required in this series. In mandibular angle plasty, mandibular marginal contouring from the ramus to the symphysis should be carried out by cutting off the angle keeping in mind the entire mandibular shape. This concept and the procedure can deliver greater patient satisfaction.

Multiparametric magnetic resonance imaging and frozen-section analysis efficiently predict upgrading, upstaging, and extraprostatic extension in patients undergoing nerve-sparing robotic-assisted radical prostatectomy.

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Bianchi, Roberto; Cozzi, Gabriele; Petralia, Giuseppe; Alessi, Sarah; Renne, Giuseppe; Bottero, Danilo; Brescia, Antonio; Cioffi, Antonio; Cordima, Giovanni; Ferro, Matteo; Matei, Deliu Victor; Mazzoleni, Federica; Musi, Gennaro; Mistretta, Francesco Alessandro; Serino, Alessandro; Tringali, Valeria Maria Lucia; Coman, Ioan; De Cobelli, Ottavio

2016-10-01

To evaluate the role of multiparametric magnetic resonance imaging (mpMRI) in predicting upgrading, upstaging, and extraprostatic extension in patients with low-risk prostate cancer (PCa). MpMRI may reduce positive surgical margins (PSM) and improve nerve-sparing during robotic-assisted radical prostatectomy (RARP) for localized prostate cancer PCa.This was a retrospective, monocentric, observational study. We retrieved the records of patients undergoing RARP from January 2012 to December 2013 at our Institution. Inclusion criteria were: PSA <10 ng/mL; clinical stage PSM, upgrading, upstaging, and presence of unfavorable disease.Two hundred fifty-four patients who underwent nerve-sparing RARP were included. PSM rate was 29.13% and 15.75% at FSA and final pathology respectively. Interestingly, the use of FSA reduced PSM rate in pT3 disease (25.81%). Higher PIRADS scores demonstrated to be related to high probability of upgrading and upstaging. This significativity remains even when considering PIRADS 2-3 versus 4 versus 5 and PIRADS 2-3 versus 4-5. Also PSM at FSA were associated with higher probability of upgrading and upstaging.PIRADS score and FSA resulted to be strictly related to grading and staging, thus being able to predict upgrading and/or upstaging at final pathology.

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

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Rojas Martinez Raúl

2001-01-01

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.

Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines.

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Singer, Lauren; Brown, Eric; Lanni, Thomas

2016-08-01

In this study, we compare the indications for re-excision, the findings of additional tumor in the re-excision specimen as they relate to margin status, and costs associated with re-excision based on recent new consensus statements. A retrospective analysis was performed on 462 patients with invasive breast carcinoma who underwent at least one lumpectomy between January 2011 and December 2013. Postoperative data was analyzed based on where additional disease was found, as it relates to the margin status of the initial lumpectomy and the additional direct costs associated with additional procedures. Of the 462 patients sampled, 149 underwent a re-excision surgery (32.2%). Four patients underwent mastectomy as their second operation. In the 40 patients with additional disease found on re-excision, 36 (90.0%) of them had a positive margin on their initial lumpectomy. None of the four mastectomy patients had residual disease. The mean cost of the initial lumpectomy for all 462 patients was $2118.01 plus an additional $1801.92 for those who underwent re-excision. A positive margin was most predictive of finding residual tumor on re-excision as would be expected. Using old criteria only 0.07% (4/61) of patients who had undergone re-excision with a 'clear' margin, had additional tumor found, at a total cost of $106,354.11. Thus, the new consensus guidelines will lead to less overall cost, at no clinical risk to patients while reducing a patient's surgical risk and essentially eliminating delays in adjuvant care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Minimizing surgical skin incision scars with a latex surgical glove.

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Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

2013-04-01

The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer.

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Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang, Liying; Barnes, Elizabeth

2012-08-01

To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1mm to 15 mm, with a mean of 5.3mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer

International Nuclear Information System (INIS)

Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang Liying; Barnes, Elizabeth

2012-01-01

Purpose: To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. Methods and materials: A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. Results: A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1 mm to 15 mm, with a mean of 5.3 mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10 mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Conclusions: Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions.

Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

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Thomas Fonseka

2015-03-01

Full Text Available Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC, Laparoscopic Radical Cystectomy (LRC and Robot-assisted Radical Cystectomy (RARC. RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT compared to LRC with no statistical difference between length of stay (LOS and estimated blood loss (EBL. RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY and positive surgical margins (PSM. LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

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Krammer, Julia [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Price, Elissa R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, CA (United States); Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Murray, Melissa P. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Schoenberg, Stefan O. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

2017-11-15

To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

International Nuclear Information System (INIS)

Krammer, Julia; Price, Elissa R.; Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A.; Murray, Melissa P.; Schoenberg, Stefan O.

2017-01-01

To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

Raman spectroscopy reveals biophysical markers in skin cancer surgical margins

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Feng, Xu; Moy, Austin J.; Nguyen, Hieu T. M.; Zhang, Yao; Fox, Matthew C.; Sebastian, Katherine R.; Reichenberg, Jason S.; Markey, Mia K.; Tunnell, James W.

2018-02-01

The recurrence rate of nonmelanoma skin cancer is highly related to the residual tumor after surgery. Although tissueconserving surgery, such as Mohs surgery, is a standard method for the treatment of nonmelanoma skin cancer, they are limited by lengthy and costly frozen-section histopathology. Raman spectroscopy (RS) is proving to be an objective, sensitive, and non-destructive tool for detecting skin cancer. Previous studies demonstrated the high sensitivity of RS in detecting tumor margins of basal cell carcinoma (BCC). However, those studies rely on statistical classification models and do not elucidate the skin biophysical composition. As a result, we aim to discover the biophysical differences between BCC and primary normal skin structures (including epidermis, dermis, hair follicle, sebaceous gland and fat). We obtained freshly resected ex vivo skin samples from fresh resection specimens from 14 patients undergoing Mohs surgery. Raman images were acquired from regions containing one or more structures using a custom built 830nm confocal Raman microscope. The spectra were grouped using K-means clustering analysis and annotated as either BCC or each of the five normal structures by comparing with the histopathology image of the serial section. The spectral data were then fit by a previously established biophysical model with eight primary skin constituents. Our results show that BCC has significant differences in the fit coefficients of nucleus, collagen, triolein, keratin and elastin compared with normal structures. Our study reveals RS has the potential to detect biophysical changes in resection margins, and supports the development of diagnostic algorithms for future intraoperative implementation of RS during Mohs surgery.

Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment

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Hakim Slaoui

2014-07-01

Full Text Available Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.

Evaluation of Resection Margins in Breast Conservation Therapy: The Pathology Perspective—Past, Present, and Future

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Rajyasree Emmadi

2012-01-01

Full Text Available Tumor surgical resection margin status is important for any malignant lesion. When this occurs in conjunction with efforts to preserve or conserve the afflicted organ, these margins become extremely important. With the demonstration of no difference in overall survival between mastectomy versus lumpectomy and radiation for breast carcinoma, there is a definite trend toward smaller resections combined with radiation, constituting “breast-conserving therapy.” Tumor-free margins are therefore key to the success of this treatment protocol. We discuss the various aspects of margin status in this setting, from a pathology perspective, incorporating the past and current practices with a brief glimpse of emerging future techniques.

Innovative financing for rural surgical patients: Experience in mission hospitals

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Gnanaraj Jesudian

2016-01-01

Full Text Available In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

A retrospective study comparing the accuracy of prehistology diagnosis and surgical excision of malignant melanomas by general practitioners and hospital specialists.

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Bakhai, M; Hopster, D; Wakeel, R

2010-01-01

A retrospective study was carried out to compare the overall standard of surgical excision of malignant melanomas (MMs) between general practitioners (GPs) and hospital specialists before and after the introduction of the UK melanoma guidelines between 1989 and 2006. In total, 213 melanoma excision reports were examined and surgical excision margins recorded. The results showed a significant difference in the rate of adequate surgical excision margins (at all levels of Breslow thickness) between GPs and hospital specialists, with hospital specialists excising melanomas with safe surgical excision margins at a significantly higher rate compared with GPs. Since the introduction of the guidelines in 2002, GPs showed a significant improvement in the completeness of melanoma excision but remained poor at prehistology diagnosis and in particular at taking adequate excision margins. Implementation of the guidelines has not produced significant improvements in adequacy of excision margins in both primary and secondary care. The results show that hospital specialists maintained a high standard of prehistological diagnosis and completeness of excision throughout the time of the study, performing at a significantly higher standard compared with GPs. Our conclusions concur with the UK melanoma guidelines and the National Institute for Health and Clinical Excellence guidelines, which suggest that lesions suspicious for melanoma should be urgently referred to a dermatologist or plastic surgeon for surgical excision and should not be surgically excised in primary care, particularly if lesions have a Breslow thickness > 2 mm. We suggest that the new guidelines need to be more aggressively implemented in primary care and guidance introduced to improve the accuracy of diagnosis, with better training provided for GPs.

Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

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Persing, Sarah; Jerome, Mairin A; James, Ted A; Callas, Peter; Mace, John; Sowden, Michelle; Goodwin, Andrew; Weaver, Donald L; Sprague, Brian L

2015-10-01

Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates. We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

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Fein, Douglas A; Fowble, Barbara L; Hanlon, Alexandra L; Hoffman, John P; Sigurdson, Elin R; Eisenberg, Burton L

1995-07-01

PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had {>=} 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy {+-} tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2

Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

International Nuclear Information System (INIS)

Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

1995-01-01

PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had ≥ 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy ± tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2% at

Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation?

International Nuclear Information System (INIS)

Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

1996-01-01

Purpose: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early-stage breast cancer. The clips have been useful in delineating the borders of the tangential fields, especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed, then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips, controlling for other recognized prognostic factors. Methods and Materials: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had one to three nodes, and 7% had > four nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy + tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients, while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the two groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. Results: Twenty-five and 27 patients with and without surgical clips, respectively, developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast

The influence of intraoperative radiation therapy (IORT) on outcome of surgically resectable adenocarcinoma of the pancreas

International Nuclear Information System (INIS)

Ono, Mark K.; Ahmad, Neelofur; Huq, M. Saiful; Vernick, Jerome; Rosato, Francis E.

1996-01-01

Purpose/Objective: Surgical resection offers an opportunity for long term survival for patients with cancer of the pancreas. Unfavorable pathologic prognostic factors following resection of these lesions include positive surgical margins and positive lymph nodes. The purpose of this study was to analyze the influence of IORT on survival of completely resected adenocarcinomas of the pancreas in patients with these poor pathologic features. Materials and Methods: From 1988 to 1994, 391 newly diagnosed patients with carcinoma of the pancreas were seen at Thomas Jefferson University Hospital. Pre-operative work-up identified 166 patients with clinically localized disease. These patients were evaluated by the Department of Radiation Oncology for possible treatment with IORT. These patients underwent exploratory laparotomy and 26 had a complete surgical resection (i.e. Whipple procedure or total pancreatectomy) and received IORT. Mean patient age was 66 ± 2 years (range: 43-80) with 15 male and 11 female patients. All patients had histologically proven adenocarcinoma of the pancreas. IORT was delivered to the surgical tumor bed and regional lymph nodes with a median dose of 15.0 Gy (range: 10.0-20.0 Gy). Technique, field size, and energy of the electron radiation beam varied with the clinical situation and were determined by the radiation oncologist. All 26 patients received post-operative external beam radiation therapy (EBRT) with concurrent weekly 5-FU chemotherapy. Follow-up times ranged from one to 84 months (median: 15 months). Actuarial survival rates were calculated by the Life-Table Method. Patient outcome was evaluated with respect to surgical margin and pathological lymph node status. Results: The overall actuarial 2-year survival rate was 44%. The overall median survival time (MST) was 19 months. At pathological review, five of the 26 patients (19%) were found to have positive surgical margins, four of whom also had involved lymph nodes. Thus, only one

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

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Gietelink, Lieke; Wouters, Michel W J M; Tanis, Pieter J; Deken, Marion M; Ten Berge, Martijn G; Tollenaar, Rob A E M; van Krieken, J Han; de Noo, Mirre E

2015-09-01

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 about CRM in the late 1990s, quality assurance on pathologic reporting was not available until the Dutch Surgical Colorectal Audit (DSCA) started in 2009. The present study describes the rates of CRM reporting and involvement since the start of the DSCA and analyzes whether improvement of these parameters can be attributed to the audit. Data from the DSCA (2009-2013) were analyzed. Reporting of CRM and CRM involvement was plotted for successive years, and variations of these parameters were analyzed in a funnelplot. Predictors of CRM involvement were determined in univariable analysis and the independent influence of year of registration on CRM involvement was analyzed in multivariable analysis. A total of 12,669 patients were included for analysis. The mean percentage of patients with a reported CRM increased from 52.7% to 94.2% (2009-2013) and interhospital variation decreased. The percentage of patients with CRM involvement decreased from 14.2% to 5.6%. In multivariable analysis, the year of DSCA registration remained a significant predictor of CRM involvement. After the introduction of the DSCA, a dramatic improvement in CRM reporting and a major decrease of CRM involvement after rectal cancer surgery have occurred. This study suggests that a national quality assurance program has been the driving force behind these achievements. Copyright © 2015 by the National Comprehensive Cancer Network.

The differentiation of malignant and benign human breast tissue at surgical margins and biopsy using x-ray interaction data and Bayesian classification

International Nuclear Information System (INIS)

Mersov, A.; Mersov, G.; Al-Ebraheem, A.; Cornacchi, S.; Gohla, G.; Lovrics, P.; Farquharson, M.J.

2014-01-01

Worldwide, about 1.3 million women are diagnosed with breast cancer annually with an estimated 465,000 deaths. Accordingly, there is a need for high accuracy and speed in diagnosis of lesions suspected of being cancerous. This study assesses the interaction data collected from low energy x-rays within breast tissue samples. Trace element concentrations are assessed using x-ray fluorescence, as well as electron density, and molecular structure which are examined using incoherent and coherent scatter, respectively. Our work to date has shown that such data can provide a quantitative measure of certain tissue characterising parameters and hence, through appropriate modelling, could be used to classify samples for uses such as surgical margin detection and biopsy examination. The parameters used in this study for comparing the normal and tumour tissue sample populations are: levels of elements Ca, Cu, Fe, Br, Zn, Rb, K; the area, FWHM and amplitude from peaks fitted to the coherent scatter profile that are associated with fat, fibre and water content; the ratio of the Compton and coherent scatter peak area, FWHM and amplitude from the incoherent scatter profile. The novelty of the approach to this work lies in the fact that the classification process does not rely on one source of data but combines several measurements, the data from which in this application are modelled using a method based on Bayesian classification. The reliability of the classifications was assessed by its application to diagnostically known data that was not itself included in the thresholds determination. The results of the classification of over 70 breast tissue samples will be presented in this study. Bayesian modelling was carried out using selected significant parameters for classification resulting in 71% of normal tissue samples (n=35) and 66% of tumour tissue samples (n=35) being correctly classified when using all the samples. Bayesian classification using the same variables on all

Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

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van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

2014-11-23

Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

Motion tracking to enable pre-surgical margin mapping in basal cell carcinoma using optical imaging modalities: initial feasibility study using optical coherence tomography

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Duffy, M.; Richardson, T. J.; Craythorne, E.; Mallipeddi, R.; Coleman, A. J.

2014-02-01

A system has been developed to assess the feasibility of using motion tracking to enable pre-surgical margin mapping of basal cell carcinoma (BCC) in the clinic using optical coherence tomography (OCT). This system consists of a commercial OCT imaging system (the VivoSight 1500, MDL Ltd., Orpington, UK), which has been adapted to incorporate a webcam and a single-sensor electromagnetic positional tracking module (the Flock of Birds, Ascension Technology Corp, Vermont, USA). A supporting software interface has also been developed which allows positional data to be captured and projected onto a 2D dermoscopic image in real-time. Initial results using a stationary test phantom are encouraging, with maximum errors in the projected map in the order of 1-2mm. Initial clinical results were poor due to motion artefact, despite attempts to stabilise the patient. However, the authors present several suggested modifications that are expected to reduce the effects of motion artefact and improve the overall accuracy and clinical usability of the system.

Dosimetric and motion analysis of margin-intensive therapy by stereotactic ablative radiotherapy for resectable pancreatic cancer

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Heinzerling John H

2011-10-01

Full Text Available Abstract Background The retroperitoneal margin is a common site of positive surgical margins in patients with resectable pancreatic cancer. Preoperative margin-intensive therapy (MIT involves delivery of a single high dose of ablative radiotherapy (30 Gy focused on this surgically inaccessible margin, utilizing stereotactic techniques in an effort to reduce local failure following surgery. In this study, we investigated the motion of regional organs at risk (OAR utilizing 4DCT, evaluated the dosimetric effects of abdominal compression (AC to reduce regional motion, and compared various planning techniques to optimize MIT. Methods 10 patients were evaluated with 4DCT scans. All 10 patients had scans using AC and seven of the 10 patients had scans both with and without AC. The peak respiratory abdominal organ and major vessel centroid excursion was measured. A "sub-GTV" region was defined by a radiation oncologist and surgical oncologist encompassing the retroperitoneal margin typically lateral and posterior to the superior mesenteric artery (SMA, and a 3-5 mm margin was added to constitute the PTV. Identical 3D non-coplanar SABR (3DSABR plans were designed for the average compression and non-compression scans. Compression scans were planned with 3DSABR, coplanar IMRT (IMRT, and Cyberknife (CK planning techniques. Dose volume analysis was undertaken for various endpoints, comparing OAR doses with and without AC and for different planning methods. Results The mean PTV size was 20.2 cm3. Regional vessel motion of the SMA, celiac trunk, and renal vessels was small ( 5 mm, so AC has been used in all patients enrolled thus far. AC did not significantly increase OAR dose including the stomach and traverse colon. There were several statistically significant differences in the doses to OARs as a function of the type of planning modality used. Conclusions AC does not significantly reduce the limited motion of structures in close proximity to the MIT target

Relationship between occurrence of surgical complications and hospital finances.

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Eappen, Sunil; Lane, Bennett H; Rosenberg, Barry; Lipsitz, Stuart A; Sadoff, David; Matheson, Dave; Berry, William R; Lester, Mark; Gawande, Atul A

2013-04-17

The effect of surgical complications on hospital finances is unclear. To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type. Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type. Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type. Of 34,256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39,017 (95% CI, $20,069-$50,394; P financial consequences for decreasing postsurgical complications.

Primary cutaneous marginal zone B-cell lymphoma: clinical and histological aspects.

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Khaled, A; Sassi, S; Fazaa, B; Ben Hassouna, J; Ben Romdhane, K; Kamoun, M R

2009-02-01

According to the WHO-EORTC classification of cutaneous lymphomas, primary cutaneous marginal zone B-cell lymphoma are now well characterized. We report here a case of primary cutaneous marginal zone B-cell lymphoma in a 51 year-old man in which the diagnosis was made using both histology and immunopathology. The patient had no remarkable medical history, no history of either acute inflammation or insect bite, and presented with a 5 cm solitary asymptomatic erythematous firm, multinodular and infiltrated plaque on the back for 12 months. Histological examination and immunohistochemical study of a cutaneous biopsy provided a differential diagnosis between B cell lymphoma and lymphocytoma cutis. Full body work up revealed no signs of extracutaneous dissemination. The patient underwent surgical excision of the nodule. Histological examination showed a histological and immunophenotyping profile typical of primary cutaneous marginal zone B-cell lymphoma. The lesion was completely excised with clear margins and no recurrence occurred after a 12 month-follow-up period. Primary cutaneous marginal zone B-cell lymphoma are low-grade lymphomas that have an indolent course and a high tendency to recur. They should be differentiated from lymphocytoma cutis and from the other types of cutaneous B cell lymphomas that have a different course and prognosis.

"In situ preparation": new surgical procedure indicated for soft-tissue sarcoma of a lower limb in close proximity to major neurovascular structures.

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Matsumoto, Seiichi; Kawaguchi, Noriyoshi; Manabe, Jun; Matsushita, Yasushi

2002-02-01

When soft-tissue sarcomas occur near neurovascular structures, preoperative images cannot always reveal the accurate relationship between the tumor and these structures. Therefore, in some patients, neurovascular structures are sacrificed unnecessarily. In other patients, neurovascular structures are preserved with an inappropriate margin, followed by local recurrence. The objective of this study was to evaluate a new surgical method, "in situ preparation" (ISP), which enables the preparation of neurovascular bundles and the intraoperative evaluation of the surgical margin without contamination by tumor cells. With this method, additional procedures, including pasteurization, alcohol soaking, and distilled water soaking of the preserved neurovascular bundle can also be performed to preserve the continuity of vessels. Between April 1992 and December 1998, 18 patients with soft-tissue sarcoma were operated on using ISP. The tumor and neurovascular structure were lifted en bloc from the surgical bed and separated from the field by the use of a vinyl sheet. The consistency of the neurovascular structures was preserved. The tissue block could be freely turned around and the neurovascular structure was separated from the block through the nearest approach. The margin between the tumor and neurovascular structure was evaluated, and an additional procedure, such as pasteurization, alcohol soaking or distilled water soaking, was performed, according to the safety of the surgical margin. Only one patient showed recurrence after ISP. Complications after ISP were arterial occlusion in two patients and nerve palsy in three patients. The main cause of these complications was the long period of pasteurization; modified additional procedures could prevent such complications. ISP is a useful method with which to ensure a safe surgical margin and good functional results.

Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer.

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Yang, Seung Yoon; Roh, Kun Ho; Kim, You-Na; Cho, Minah; Lim, Seung Hyun; Son, Taeil; Hyung, Woo Jin; Kim, Hyoung-Il

2017-07-01

In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy. Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes. This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor. Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.

Cost Analysis of a Surgical Consensus Guideline in Breast-Conserving Surgery.

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Yu, Jennifer; Elmore, Leisha C; Cyr, Amy E; Aft, Rebecca L; Gillanders, William E; Margenthaler, Julie A

2017-08-01

The Society of Surgical Oncology and American Society of Radiation Oncology consensus statement was the first professional guideline in breast oncology to declare "no ink on tumor" as a negative margin in patients with stages I/II breast cancer undergoing breast-conservation therapy. We sought to analyze the financial impact of this guideline at our institution using a historic cohort. We identified women undergoing re-excision after breast-conserving surgery for invasive breast cancer from 2010 through 2013 using a prospectively maintained institutional database. Clinical and billing data were extracted from the medical record and from administrative resources using CPT codes. Descriptive statistics were used in data analysis. Of 254 women in the study population, 238 (93.7%) had stage I/II disease and 182 (71.7%) had invasive disease with ductal carcinoma in situ. A subcohort of 83 patients (32.7%) who underwent breast-conservation therapy for stage I/II disease without neoadjuvant chemotherapy had negative margins after the index procedure, per the Society of Surgical Oncology and American Society of Radiation Oncology guideline. The majority had invasive ductal carcinoma (n = 70 [84.3%]) and had invasive disease (n = 45 [54.2%]), and/or ductal carcinoma in situ (n = 49 [59.0%]) within 1 mm of the specimen margin. Seventy-nine patients underwent 1 re-excision and 4 patients underwent 2 re-excisions, accounting for 81 hours of operative time. Considering facility fees and primary surgeon billing alone, the overall estimated cost reduction would have been $195,919, or $2,360 per affected patient, under the guideline recommendations. Implementation of the Society of Surgical Oncology and American Society of Radiation Oncology consensus guideline holds great potential to optimize resource use. Application of the guideline to a retrospective cohort at our institution would have decreased the overall re-excision rate by 5.6% and reduced costs by nearly $200

Surgical Stress Abrogates Pre-Existing Protective T Cell Mediated Anti-Tumor Immunity Leading to Postoperative Cancer Recurrence.

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Abhirami A Ananth

Full Text Available Anti-tumor CD8+ T cells are a key determinant for overall survival in patients following surgical resection for solid malignancies. Using a mouse model of cancer vaccination (adenovirus expressing melanoma tumor-associated antigen (TAA-dopachrome tautomerase (AdDCT and resection resulting in major surgical stress (abdominal nephrectomy, we demonstrate that surgical stress results in a reduction in the number of CD8+ T cell that produce cytokines (IFNγ, TNFα, Granzyme B in response to TAA. This effect is secondary to both reduced proliferation and impaired T cell function following antigen binding. In a prophylactic model, surgical stress completely abrogates tumor protection conferred by vaccination in the immediate postoperative period. In a clinically relevant surgical resection model, vaccinated mice undergoing a positive margin resection with surgical stress had decreased survival compared to mice with positive margin resection alone. Preoperative immunotherapy with IFNα significantly extends survival in surgically stressed mice. Importantly, myeloid derived suppressor cell (MDSC population numbers and functional impairment of TAA-specific CD8+ T cell were altered in surgically stressed mice. Our observations suggest that cancer progression may result from surgery-induced suppression of tumor-specific CD8+ T cells. Preoperative immunotherapies aimed at targeting the prometastatic effects of cancer surgery will reduce recurrence and improve survival in cancer surgery patients.

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

LENUS (Irish Health Repository)

Courtney, D

2014-01-01

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.

The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

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Tavukçu, Hasan Hüseyin; Aytaç, Ömer; Balcı, Numan Cem; Kulaksızoğlu, Haluk; Atuğ, Fatih

2017-12-01

We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.

Tumor-related markers in histologically normal margins correlate with locally recurrent oral squamous cell carcinoma: a retrospective study.

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Wang, Xinhong; Chen, Si; Chen, Xinming; Zhang, Cuicui; Liang, Xueyi

2016-02-01

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.

Limited resection for duodenal gastrointestinal stromal tumors: Surgical management and clinical outcome

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Hoeppner, Jens; Kulemann, Birte; Marjanovic, Goran; Bronsert, Peter; Hopt, Ulrich Theodor

2013-01-01

AIM: To analyze our experience in patients with duodenal gastrointestinal stromal tumors (GIST) and review the appropriate surgical approach. METHODS: We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011. Patient files, operative reports, radiological charts and pathology were analyzed. For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection (LR). For extended resection pancreatoduodenectomy was performed. Age, gender, clinical symptoms of the tumor, anatomical localization, tumor size, mitotic count, type of resection resectional status, neoadjuvant therapy, adjuvant therapy, risk classification and follow-up details were investigated in this retrospective study. RESULTS: Nine patients (5 males/4 females) with a median age of 58 years were surgically treated. The median follow-up period was 45 mo (range 6-111 mo). The initial symptom in 6 of 9 patients was gastrointestinal bleeding (67%). Tumors were found in all four parts of the duodenum, but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients (33%). Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection. In one patient, the GIST resection was done by pancreatoduodenectomy. The 8 LRs included a segmental resection of pars 4 of the duodenum, 5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy. One of these LRs was done minimally invasive; seven were done in open fashion. The median diameter of the tumors was 54 mm (14-110 mm). Using the Fletcher classification scheme, 3/9 (33%) tumors had high risk, 1/9 (11%) had intermediate risk, 4/9 (44%) had low risk, and 1/9 (11%) had very low risk for aggressive behaviour. Seven resections showed microscopically negative transsection margins (R0), two

Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: Histopathologic correlation

International Nuclear Information System (INIS)

Ishigami, Kousei; Tajima, Tsuyoshi; Fujita, Nobuhiro; Nishie, Akihiro; Asayama, Yoshiki; Kakihara, Daisuke; Nakayama, Tomohiro; Okamoto, Daisuke; Taketomi, Akinobu; Shirabe, Ken; Honda, Hiroshi

2011-01-01

Purpose: To evaluate the characteristics of hepatocellular carcinomas (HCCs) with marginal superparamagnetic iron oxide (SPIO) uptake on T2*-weighted MRI. Materials and methods: The study group consisted of 73 patients with 83 surgically resected HCCs. Preoperative SPIO-enhanced MRI studies were retrospectively reviewed. Marginal SPIO uptake was considered positive if a rim-like or band-like low intensity area was present on SPIO-enhanced T2*-weighted images. The prevalence of marginal SPIO uptake was evaluated. Pathological specimens with hematoxylin and eosin staining and immunohistochemical staining of CD68 were reviewed in HCCs with marginal SPIO uptake and 33 HCCs without marginal SPIO uptake (control group). Results: Ten of 83 (12%) HCCs showed marginal SPIO uptake. All HCCs were hypervascular, and only one nodule showed a nodule-in-nodule appearance on imaging findings. The pathology specimens suggested possible causes of marginal SPIO uptake, including marginal macrophage infiltration in moderately or poorly differentiated HCC (n = 4), residual normal hepatic tissue at the marginal area of confluent multinodular or single nodular with extranodular growth type HCC (n = 3), and a well-differentiated HCC component in nodule-in-nodule type HCC (n = 3). Marginal macrophage infiltration was not seen in the control group. Conclusion: SPIO-enhanced MRI may be able to demonstrate marginal macrophage infiltration in HCC.

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

2017-01-01

.2–6.2; p =.04) and 2.63 (95% CI, 1.1–6.3; p =.03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4–3.0; p =.12) and 1.07 (95% CI, 0.3–3.4; p =.23) for OS and DSS, respectively, relative...

Echosonography and surgical therapy of facial skin tumors

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Pešić Zoran U.

2002-01-01

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

Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery: a study of 74 primary cases.

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Serra-Guillén, C; Llombart, B; Nagore, E; Guillén, C; Requena, C; Traves, V; Kindem, S; Alcalá, R; Rivas, N; Sanmartín, O

2015-01-01

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumour with aggressive local growth. Whether DFSP should be treated with conventional surgery (CS) or Mohs micrographic surgery (MMS) has long been a topic of debate. To calculate, in a large series of DFSP treated by MMS, the minimum margin that would have been needed to achieve complete clearance by CS. Secondly, to calculate the percentage of healthy tissue that was preserved by MMS rather than CS with 2- and 3-cm margins. The minimum margin was calculated by measuring the largest distance from the visible edge of the tumour to the edge of the definitive surgical defect. Tumour and surgical defect areas for hypothetical CS with 2- and 3-cm margins were calculated using AutoCAD for Windows. A mean minimum margin of 1·34 cm was required to achieve complete clearance for the 74 tumours analysed. The mean percentages of skin spared using MMS rather than CS with 2- and 3-cm margins were 49·4% and 67·9%, respectively. MMS can achieve tumour clearance with smaller margins and greater preservation of healthy tissue than CS. © 2014 British Association of Dermatologists.

Rectal cancer: involved circumferential resection margin - a root cause analysis.

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Youssef, H; Collantes, E C; Rashid, S H; Wong, L S; Baragwanath, P

2009-06-01

An involved circumferential resection margin (CRM) following surgery for rectal cancer is the strongest predictor of local recurrence and may represent a failure of the multidisciplinary team (MDT) process. The study analyses the causes of positive CRM in patients undergoing elective surgery for rectal cancer with respect to the decision-making process of the MDT, preoperative rectal cancer staging and surgical technique. From March 2002 to September 2005, data were collected prospectively on all patients undergoing elective rectal cancer surgery with curative intent. The data on all patients identified with positive CRM were analysed. Of 158 patients (male:female = 2.2:1) who underwent potentially curative surgery, 16 (10%) patients had a positive CRM on postoperative histology. Four were due to failure of the pelvic magnetic resonance imaging (MRI) staging scans to predict an involved margin, two with an equivocal CRM on MRI did not have preoperative radiotherapy, one had an inaccurate assessment of the site of primary tumour and in one intra-operative difficulty was encountered. No failure of staging or surgery was identified in the remaining eight of the 16 patients. Abdominoperineal resection (APR) was associated with a 26% positive CRM, compared with 5% for anterior resection. No single consistent cause was found for a positive CRM. The current MDT process and/or surgical technique may be inadequate for low rectal tumours requiring APR.

Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy.

Science.gov (United States)

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

2016-01-01

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.

Skin cancer margin analysis within minutes with full-field OCT (Conference Presentation)

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

2017-02-01

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.

Surgical procedures in esophagus cancer treatment. Our experience

International Nuclear Information System (INIS)

Villena, Freddy; Carrasco, Edgar

2005-01-01

Esophagus cancer represents a very lethal neoplasm. Esophageal resection is going to be the therapeutic alternative to patients considered surgical candidates. It had been described some esophagus resection procedure. Although, there is not any agreement between surgeon about which are best procedure to patients with esophagus carcinoma. Most of patients who came advanced phase have poor prognostic and only patients, who have illness in early stage, exist expectative to improve survival with lymphadenectomy extended and neoadjuvant. We analyzes retrospectively files of 23 patients submitted to esophagectomy in hospital Solca Quito from 1985 to 2004 with the diagnostic of esophagus carcinoma, considering histology type, location, surgical proceeded, pathologic staging, surgical mortally, mobility and survival time live. Also it makes a review about proceeds of esophagus resection and adjuvant therapy to the esophagus cancer. Conclusions: Esophagectomy transhiatal has limitations in oncological resection and recommend it early lower esophagus lesions and cardiac orifice (dysplasia high grade, T is, TI, NO, MO) in patients of high risk. Right trans thoracic esophagectomy it is considered in all lesions advanced locally lower middle third, and cardias orifice with lymphadenectomy of two areas and have avoid of trans thoracic anastomotic risk. Trans operatively margins upper have been 10 cm and 5 cm distal, always freeze those margins trans operatively. Extended lymphadenectomy to three areas we have no order yet conclusive dates and the chemotherapy neoadjuvant had been a positive impact in the survival in those chemosensitive tumors with appropriate answer and could be totally remove, but randomized testing future could determine his efficacy real. (The author)

Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology.

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Witjes, Max J H; Schepers, Rutger H; Kraeima, Joep

2018-04-01

This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.

Effect of Margin Designs on the Marginal Adaptation of Zirconia Copings.

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Habib, Syed Rashid; Al Ajmi, Mohammed Ginan; Al Dhafyan, Mohammed; Jomah, Abdulrehman; Abualsaud, Haytham; Almashali, Mazen

2017-09-01

The aim of this in vitro study was to investigate the effect of Shoulder versus Chamfer margin design on the marginal adaptation of zirconia (Zr) copings. 40 extracted molar teeth were mounted in resin and prepared for zirconia crowns with two margin preparation designs (20=Shoulder and 20=Chamfer). The copings were manufactured by Cercon® (DeguDent GmbH, Germany) using the CAD/CAM system for each tooth. They were tried on each tooth, cemented, thermocycled, re-embedded in resin and were subsequently cross sectioned centrally into two equal mesial and distal halves. They were examined under electron microscope at 200 X magnification and the measurements were recorded at 5 predetermined points in micrometers (µm). The o verall mean marginal gap for the two groups was found to be 206.98+42.78µm with Shoulder margin design (Marginal Gap=199.50+40.72µm) having better adaptation compared to Chamfer (Marginal Gap=214.46+44.85µm). The independent-samples t-test showed a statistically non-significant difference (p=.113) between the means of marginal gap for Shoulder and Chamfer margin designs and the measurements were recorded at 5 predetermined points for the two groups. The Chamfer margin design appeared to offer the same adaptation results as the Shoulder margin design.

Reliability of computer designed surgical guides in six implant rehabilitations with two years follow-up.

Science.gov (United States)

Giordano, Mauro; Ausiello, Pietro; Martorelli, Massimo; Sorrentino, Roberto

2012-09-01

To evaluate the reliability and accuracy of computer-designed surgical guides in osseointegrated oral implant rehabilitation. Six implant rehabilitations, with a total of 17 implants, were completed with computer-designed surgical guides, performed with the master model developed by muco-compressive and muco-static impressions. In the first case, the surgical guide had exclusively mucosal support, in the second case exclusively dental support. For all six cases computer-aided surgical planning was performed by virtual analyses with 3D models obtained by dental scan DICOM data. The accuracy and stability of implant osseointegration over two years post surgery was then evaluated with clinical and radiographic examinations. Radiographic examination, performed with digital acquisitions (RVG - Radio Video graph) and parallel techniques, allowed two-dimensional feedback with a margin of linear error of 10%. Implant osseointegration was recorded for all the examined rehabilitations. During the clinical and radiographic post-surgical assessments, over the following two years, the peri-implant bone level was found to be stable and without appearance of any complications. The margin of error recorded between pre-operative positions assigned by virtual analysis and the post-surgical digital radiographic observations was as low as 0.2mm. Computer-guided implant surgery can be very effective in oral rehabilitations, providing an opportunity for the surgeon: (a) to avoid the necessity of muco-periosteal detachments and then (b) to perform minimally invasive interventions, whenever appropriate, with a flapless approach. Copyright © 2012 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

In search of the rainbow: Colored inks in surgical pathology

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Chandralekha Tampi

2012-01-01

Full Text Available Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children′s hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.

Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography

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Ishii, Kasumi; Aramaki, Hajime; Arai, Yasuko; Uchimura, Kanako; Okabe, Kunihiko; Nishida, Motoko; Yoda, Keiko [Tokyo Women' s Medical Coll. (Japan). Daini Hospital

2002-03-01

With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA, 19 men and 12 women, between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29{+-}5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15{+-}2 deg laterally from the midline of the incisors, and 24{+-}4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9{+-}4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31{+-}5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper

Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography

International Nuclear Information System (INIS)

Ishii, Kasumi; Aramaki, Hajime; Arai, Yasuko; Uchimura, Kanako; Okabe, Kunihiko; Nishida, Motoko; Yoda, Keiko

2002-01-01

With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA, 19 men and 12 women, between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29±5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15±2 deg laterally from the midline of the incisors, and 24±4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9±4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31±5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper posterior

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

NARCIS (Netherlands)

Gietelink, Lieke; Wouters, Michel W. J. M.; Tanis, Pieter J.; Deken, Marion M.; ten Berge, Martijn G.; Tollenaar, Rob A. E. M.; van Krieken, J. Han; de Noo, Mirre E.

2015-01-01

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

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

2015-01-01

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

Identification of predisposing factors for osteonecrosis of the jaw after marginal mandibulectomy in the surgical management of oral squamous cell carcinoma.

Science.gov (United States)

Ito, Ran; Huang, Jung-Ju; Hsieh, Wei-Chuan; Kao, Huang-Kai; Lao, William Wei-Kai; Fang, Ku-Hao; Huang, Yenlin; Chang, Yu-Liang; Cheng, Ming-Huei; Chang, Kai-Ping

2018-03-01

The aim of this study is to evaluate osteonecrosis of the jaw (ONJ) with the extent of marginal mandibulectomy. Between January 2006 and December 2012, 3087 patients undergoing ablative resection were consecutively enrolled. Among them, 345 cases undergoing marginal mandibulectomy were retrospectively reviewed. The occurrence of ONJ was 5.51% and associated with body mass index, overall stage, diabetes, concomitant mandibulotomy, and radiotherapy (P = 0.023, 0.033, 0.009, 0.016, and 0.006, respectively). As for bone parameters based on radiological measurements after marginal mandibulectomy, resected bone height, remaining bone height to original bone height ratio, and resected bone height to original bone height ratio were associated with ONJ. In multivariate logistic analyses, concomitant mandibulotomy, radiotherapy, diabetes, resected bone height of >14.5 mm, resected bone height to original bone height ratio of >49.5%, and remaining bone height to original bone height ratio of marginal mandibulectomy; more caution is necessitated in performing marginal mandibulectomy in patients with multiple risks to prevent ONJ. © 2017 Wiley Periodicals, Inc.

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

2002-01-01

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,

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

International Nuclear Information System (INIS)

Hwang, Ji Young; Choi, Hye Young; Shim, Sung Shine; Rhee, Chung Sik; Sung, Soon Hee

2002-01-01

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.

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

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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)

2002-12-15

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.

The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

Directory of Open Access Journals (Sweden)

Hasan Hüseyin Tavukçu

2015-06-01

Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.

Using laser irradiation for the surgical treatment of periodontal disease

Science.gov (United States)

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

2002-10-01

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.

Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing Mohs micrographic surgery.

Science.gov (United States)

Jambusaria-Pahlajani, Anokhi; Schmults, Chrysalyne D; Miller, Christopher J; Shin, Daniel; Williams, Jennifer; Kurd, Shanu K; Gelfand, Joel M

2009-01-01

Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm(2)). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.

Matthew and marginality

Directory of Open Access Journals (Sweden)

Denis C. Duling

1995-12-01

Full Text Available This article explores marginality theory as it was first proposed in  the social sciences, that is related to persons caught between two competing cultures (Park; Stonequist, and, then, as it was developed in sociology as related to the poor (Germani and in anthropology as it was related to involuntary marginality and voluntary marginality (Victor Turner. It then examines a (normative scheme' in antiquity that creates involuntary marginality at the macrosocial level, namely, Lenski's social stratification model in an agrarian society, and indicates how Matthean language might fit with a sample inventory  of socioreligious roles. Next, it examines some (normative schemes' in  antiquity for voluntary margi-nality at the microsocial level, namely, groups, and examines how the Matthean gospel would fit based on indications of factions and leaders. The article ,shows that the author of the Gospel of Matthew has an ideology of (voluntary marginality', but his gospel includes some hope for (involuntary  marginals' in  the  real world, though it is somewhat tempered. It also suggests that the writer of the Gospel is a (marginal man', especially in the sense defined by the early theorists (Park; Stone-quist.

Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

International Nuclear Information System (INIS)

Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

2012-01-01

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

Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

Energy Technology Data Exchange (ETDEWEB)

Demirci, Senem, E-mail: senem.demirci@ege.edu.tr [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)

2012-07-01

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

Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record.

Science.gov (United States)

Golinko, Michael S; Joffe, Renata; de Vinck, David; Chandrasekaran, Eashwar; Stojadinovic, Olivera; Barrientos, Stephan; Vukelic, Sasa; Tomic-Canic, Marjana; Brem, Harold

2009-08-01

Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.

Test characteristics of high frequency ultrasound in the pre-operative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing Mohs micrographic surgery

Science.gov (United States)

Jambusaria-Pahlajani, Anokhi; Schmults, Chrysalyne D.; Miller, Christopher J.; Shin, Daniel; Williams, Jennifer; Kurd, Shanu K; Gelfand, Joel M.

2015-01-01

Background Non-invasive techniques to assess subclinical spread of non-melanoma skin cancer (NMSC) may improve surgical precision. High frequency ultrasound (HIFU) has shown promise to evaluate the extent of NMSC. Objective To determine the accuracy of HIFU to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) prior to Mohs micrographic surgery (MMS). Methods We enrolled 100 patients with invasive SCC or BCC. Prior to the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of HIFU was subsequently tested by comparison to pathology from frozen sections. Results The test characteristics of the ultrasound were sensitivity= 32%, specificity= 88%, positive predictive value= 47%, and negative predictive value=79%. Subgroup analyses demonstrated improved test characteristics for tumors larger than the median (area >1.74 cm2). Qualitative analyses showed that HIFU was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. Conclusions HIFU requires additional refinements to improve the preoperative determination of tumor extent prior to surgical treatment of NMSC. PMID:19018815

Pre-surgical planning and MR-tractography utility in brain tumour resection

Energy Technology Data Exchange (ETDEWEB)

Romano, A.; Fantozzi, L.M.; Bozzao, A. [University Sapienza, Department of Neuroradiology, S. Andrea Hospital, Rome (Italy); D' Andrea, G.; Mastronardi, L.; Ferrante, L. [University Sapienza, Department of Neurosurgery, S. Andrea Hospital, Rome (Italy); Minniti, G. [University Sapienza, Department of Radiotherapy, S. Andrea Hospital, Rome (Italy)

2009-12-15

The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)

Pre-surgical planning and MR-tractography utility in brain tumour resection

International Nuclear Information System (INIS)

Romano, A.; Fantozzi, L.M.; Bozzao, A.; D'Andrea, G.; Mastronardi, L.; Ferrante, L.; Minniti, G.

2009-01-01

The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)

Surgical management of venous malformations.

Science.gov (United States)

Loose, D A

2007-01-01

Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit

NARCIS (Netherlands)

Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J.; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J.; Tollenaar, Rob A. E. M.; Wouters, Michel W. J. M.

2016-01-01

This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume ( <20 cases/year) was independently associated with a higher risk of CRM involvement

Marginal and happy? The need for uniqueness predicts the adjustment of marginal immigrants.

Science.gov (United States)

Debrosse, Régine; de la Sablonnière, Roxane; Rossignac-Milon, Maya

2015-12-01

Marginalization is often presented as the strategy associated with the worst adjustment for immigrants. This study identifies a critical variable that buffers marginal immigrants from the negative effects of marginalization on adjustment: The need for uniqueness. In three studies, we surveyed immigrants recruited on university campuses (n = 119, n = 116) and in the field (n = 61). Among marginal immigrants, a higher need for uniqueness predicted higher self-esteem (Study 1), affect (Study 2), and life satisfaction (Study 3), and marginally higher happiness (Study 2) and self-esteem (Study 3). No relationship between the need for uniqueness and adjustment was found among non-marginal immigrants. The adaptive value of the need for uniqueness for marginal immigrants is discussed. © 2015 The British Psychological Society.

Radionuclide bone imaging in the surgical treatment planning of odontogenic keratocysts

Energy Technology Data Exchange (ETDEWEB)

Lurie, A.G.; Puri, S.; James, R.B.; Warnich, J.T.

1976-12-01

Locally aggressive benign lesions of the jaws, such as odontogenic keratocysts and ameloblastomas, require complete excision in view of the high incidence of recurrence after incomplete surgical removal. Because of the limitations of conventional radiology as the sole technique for determining the extent of these lesions, the use of 99m-technetium-labeled bone-imaging agents is suggested. This method of defining the location of surgical margins is based on the agent's sensitivity as an indicator of subtle changes in bone metabolism. A case of an unusually large recurrent odontogenic keratocyst is presented in which the planning of the surgical procedure was predicated on the results of a bone scan of the jaws in addition to conventional radiology. This diagnostic procedure, especially when used in conjunction with conventional radiology, appears to be of considerable value in defining the extent of a variety of oral-maxillofacial bony lesions.

Radionuclide bone imaging in the surgical treatment planning of odontogenic keratocysts

International Nuclear Information System (INIS)

Lurie, A.G.; Puri, S.; James, R.B.; Warnich, J.T.

1976-01-01

Locally aggressive benign lesions of the jaws, such as odontogenic keratocysts and ameloblastomas, require complete excision in view of the high incidence of recurrence after incomplete surgical removal. Because of the limitations of conventional radiology as the sole technique for determining the extent of these lesions, the use of 99m-technetium-labeled bone-imaging agents is suggested. This method of defining the location of surgical margins is based on the agent's sensitivity as an indicator of subtle changes in bone metabolism. A case of an unusually large recurrent odontogenic keratocyst is presented in which the planning of the surgical procedure was predicated on the results of a bone scan of the jaws in addition to conventional radiology. This diagnostic procedure, especially when used in conjunction with conventional radiology, appears to be of considerable value in defining the extent of a variety of oral-maxillofacial bony lesions

Papillary type 2 versus clear cell renal cell carcinoma: Survival outcomes.

Science.gov (United States)

Simone, G; Tuderti, G; Ferriero, M; Papalia, R; Misuraca, L; Minisola, F; Costantini, M; Mastroianni, R; Sentinelli, S; Guaglianone, S; Gallucci, M

2016-11-01

To compare the cancer specific survival (CSS) between p2-RCC and a Propensity Score Matched (PSM) cohort of cc-RCC patients. Fifty-five (4.6%) patients with p2-RCC and 920 cc-RCC patients were identified within a prospectively maintained institutional dataset of 1205 histologically proved RCC patients treated with either RN or PN. Univariable and multivariable Cox regression analyses were used to identify predictors of CSS after surgical treatment. A 1:2 PSM analysis based on independent predictors of oncologic outcomes was employed and CSS was compared between PSM selected cc-RCC patients using Kaplan-Meier and Cox regression analysis. Overall, 55 (4.6%) p2-RCC and 920 (76.3%) cc-RCC patients were selected from the database; p2-RCC were significantly larger (p = 0.001), more frequently locally advanced (p p2-RCC for age (p = 0.81), tumor size (p = 0.39), pT (p = 1.00) and pN (p = 0.62) stages, cM stage (p = 0.71) and Fuhrman grade (p = 1). In this PSM cohort, 5 yr CSS was significantly lower in the p2-RCC (63% vs 72.4%; p = 0.047). At multivariable Cox analysis p2 histology was an independent predictor of CSM (HR 2.46, 95% CI 1.04-5.83; p = 0.041). We confirmed the tendency of p2-RCC to present as locally advanced and metastatic disease more frequently than cc-RCC and demonstrated p2-RCC histology as an independent predictor of worse oncologic outcomes. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

3D-printed soft-tissue physical models of renal malignancies for individualized surgical simulation: a feasibility study.

Science.gov (United States)

Maddox, Michael M; Feibus, Allison; Liu, James; Wang, Julie; Thomas, Raju; Silberstein, Jonathan L

2018-03-01

To construct patient-specific physical three-dimensional (3D) models of renal units with materials that approximates the properties of renal tissue to allow pre-operative and robotic training surgical simulation, 3D physical kidney models were created (3DSystems, Rock Hill, SC) using computerized tomography to segment structures of interest (parenchyma, vasculature, collection system, and tumor). Images were converted to a 3D surface mesh file for fabrication using a multi-jet 3D printer. A novel construction technique was employed to approximate normal renal tissue texture, printers selectively deposited photopolymer material forming the outer shell of the kidney, and subsequently, an agarose gel solution was injected into the inner cavity recreating the spongier renal parenchyma. We constructed seven models of renal units with suspected malignancies. Partial nephrectomy and renorrhaphy were performed on each of the replicas. Subsequently all patients successfully underwent robotic partial nephrectomy. Average tumor diameter was 4.4 cm, warm ischemia time was 25 min, RENAL nephrometry score was 7.4, and surgical margins were negative. A comparison was made between the seven cases and the Tulane Urology prospectively maintained robotic partial nephrectomy database. Patients with surgical models had larger tumors, higher nephrometry score, longer warm ischemic time, fewer positive surgical margins, shorter hospitalization, and fewer post-operative complications; however, the only significant finding was lower estimated blood loss (186 cc vs 236; p = 0.01). In this feasibility study, pre-operative resectable physical 3D models can be constructed and used as patient-specific surgical simulation tools; further study will need to demonstrate if this results in improvement of surgical outcomes and robotic simulation education.

Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy

International Nuclear Information System (INIS)

Lupe, Krystine; Truong, Pauline T.; Alexander, Cheryl; Lesperance, Mary; Speers, Caroline; Tyldesley, Scott

2011-01-01

Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age 10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.

Ex vivo MRI evaluation of prostate cancer: Localization and margin status prediction of prostate cancer in fresh radical prostatectomy specimens.

Science.gov (United States)

Heidkamp, Jan; Hoogenboom, Martijn; Kovacs, Iringo E; Veltien, Andor; Maat, Arie; Sedelaar, J P Michiel; Hulsbergen-van de Kaa, Christina A; Fütterer, Jurgen J

2018-02-01

To investigate the ability of high field ex vivo magnetic resonance imaging (MRI) to localize prostate cancer (PCa) and to predict the margin status in fresh radical prostatectomy (RP) specimens using histology as the reference standard. This Institutional Review Board (IRB)-approved study had written informed consent. Patients with biopsy-proved PCa and a diagnostic multiparametric 3T MRI examination of the prostate prior to undergoing RP were prospectively included. A custom-made container provided reference between the 7T ex vivo MRI obtained from fresh RP specimens and histological slicing. On ex vivo MRI, PCa was localized and the presence of positive surgical margins was determined in a double-reading session. These findings were compared with histological findings obtained from completely cut, whole-mount embedded, prostate specimens. In 12 RP specimens, histopathology revealed 36 PCa lesions, of which 17 (47%) and 20 (56%) were correlated with the ex vivo MRI in the first and second reading session, respectively. Nine of 12 (75%) index lesions were localized in the first session, in the second 10 of 12 (83%). Seven and 8 lesions of 11 lesions with Gleason score >6 and >0.5 cc were localized in the first and second session, respectively. In the first session none of the four histologically positive surgical margins (sensitivity 0%) and 9 of 13 negative margins (specificity 69%) were detected. In second session the sensitivity and specificity were 25% and 88%, respectively. Ex vivo MRI enabled accurate localization of PCa in fresh RP specimens, and the technique provided information on the margin status with high specificity. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:439-448. © 2017 International Society for Magnetic Resonance in Medicine.

Prevalence of human papilloma virus in marginal periodontium and its association with periodontitis: A cross sectional study.

Science.gov (United States)

Jacob, Anila; Janam, Presanthila; Babu Vijayamma, Janki Mohan

2014-07-01

Bacterial pathogens in dental plaque are necessary for the development of periodontitis but this etiology alone does not explain all its clinicopathologic features. Researchers have proven the role of certain viruses like herpes virus in periodontal disease which implies that other viral agents like human papilloma virus may also be involved. This cross-sectional study was conducted to determine the proportion of patients with human papilloma virus (HPV-16) in marginal periodontium by analyzing DNA from the gingival tissue sample and to understand its association with periodontitis. 102 systemically healthy patients between the age group of 15 and 70 years reporting to the Department of Periodontology who required surgical intervention (flap surgery for patients with periodontitis and crown lengthening for healthy patients) with internal bevel gingivectomy were selected. After scaling and root planning, gingival tissue was collected during the respective surgical procedure. DNA was isolated and amplified using specific primers for HPV-16 by polymerase chain reaction (PCR). The amplified products were checked by agarose gel electrophoresis. No HPV DNA was detected in the 102 samples analyzed. Marginal periodontium does not contain HPV in this study population and hence there was no association between HPV and periodontitis.

Suggestion of optimal radiation fields in rectal cancer patients after surgical resection for the development of the patterns of care study

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Hoon; Park, Jin Hong; Kim, Dae Yong [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)] [and others

2003-06-01

To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study. A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 2-3 cm distal to the anastomosis in patient whose sphincter was saved, and 2-3 cm distal to the perineal scar in patients whose anal sphincter was sacrificed; anterior margin at the posterior tip of the symphysis pubis or 2-3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.5-2 cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved by following the Korean Patterns of Care

Suggestion of optimal radiation fields in rectal cancer patients after surgical resection for the development of the patterns of care study

International Nuclear Information System (INIS)

Kim, Jong Hoon; Park, Jin Hong; Kim, Dae Yong

2003-01-01

To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study. A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 2-3 cm distal to the anastomosis in patient whose sphincter was saved, and 2-3 cm distal to the perineal scar in patients whose anal sphincter was sacrificed; anterior margin at the posterior tip of the symphysis pubis or 2-3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.5-2 cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved by following the Korean Patterns of Care Study

Five Steps to Successfully Implement and Evaluate Propensity Score Matching in Clinical Research Studies.

Science.gov (United States)

Staffa, Steven J; Zurakowski, David

2018-01-09

In clinical research, the gold standard level of evidence is the randomized controlled trial (RCT). The availability of nonrandomized retrospective data is growing; however, a primary concern of analyzing such data is comparability of the treatment groups with respect to confounding variables. Propensity score matching (PSM) aims to equate treatment groups with respect to measured baseline covariates to achieve a comparison with reduced selection bias. It is a valuable statistical methodology that mimics the RCT, and it may create an "apples to apples" comparison while reducing bias due to confounding. PSM can improve the quality of anesthesia research and broaden the range of research opportunities. PSM is not necessarily a magic bullet for poor-quality data, but rather may allow the researcher to achieve balanced treatment groups similar to a RCT when high-quality observational data are available. PSM may be more appealing than the common approach of including confounders in a regression model because it allows for a more intuitive analysis of a treatment effect between 2 comparable groups.We present 5 steps that anesthesiologists can use to successfully implement PSM in their research with an example from the 2015 Pediatric National Surgical Quality Improvement Program: a validated, annually updated surgery and anesthesia pediatric database. The first step of PSM is to identify its feasibility with regard to the data at hand and ensure availability of data on any potential confounders. The second step is to obtain the set of propensity scores from a logistic regression model with treatment group as the outcome and the balancing factors as predictors. The third step is to match patients in the 2 treatment groups with similar propensity scores, balancing all factors. The fourth step is to assess the success of the matching with balance diagnostics, graphically or analytically. The fifth step is to apply appropriate statistical methodology using the propensity

Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery

International Nuclear Information System (INIS)

Ma, Lijun; Sahgal, Arjun; Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny

2014-01-01

Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R T ) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R T , where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R 2 >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R T values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets

Portable optical fiber probe-based spectroscopic scanner for rapid cancer diagnosis: a new tool for intraoperative margin assessment.

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Niyom Lue

Full Text Available There continues to be a significant clinical need for rapid and reliable intraoperative margin assessment during cancer surgery. Here we describe a portable, quantitative, optical fiber probe-based, spectroscopic tissue scanner designed for intraoperative diagnostic imaging of surgical margins, which we tested in a proof of concept study in human tissue for breast cancer diagnosis. The tissue scanner combines both diffuse reflectance spectroscopy (DRS and intrinsic fluorescence spectroscopy (IFS, and has hyperspectral imaging capability, acquiring full DRS and IFS spectra for each scanned image pixel. Modeling of the DRS and IFS spectra yields quantitative parameters that reflect the metabolic, biochemical and morphological state of tissue, which are translated into disease diagnosis. The tissue scanner has high spatial resolution (0.25 mm over a wide field of view (10 cm × 10 cm, and both high spectral resolution (2 nm and high spectral contrast, readily distinguishing tissues with widely varying optical properties (bone, skeletal muscle, fat and connective tissue. Tissue-simulating phantom experiments confirm that the tissue scanner can quantitatively measure spectral parameters, such as hemoglobin concentration, in a physiologically relevant range with a high degree of accuracy (<5% error. Finally, studies using human breast tissues showed that the tissue scanner can detect small foci of breast cancer in a background of normal breast tissue. This tissue scanner is simpler in design, images a larger field of view at higher resolution and provides a more physically meaningful tissue diagnosis than other spectroscopic imaging systems currently reported in literatures. We believe this spectroscopic tissue scanner can provide real-time, comprehensive diagnostic imaging of surgical margins in excised tissues, overcoming the sampling limitation in current histopathology margin assessment. As such it is a significant step in the development of a

Supraglottic carcinoma: Impact of radiation therapy on outcome of patients with positive margins and extracapsular nodal disease

International Nuclear Information System (INIS)

Devineni, V.R.; Simpson, J.R.; Sessions, D.; Spector, J.G.; Hayden, R.; Fredrickson, J.; Fineberg, B.

1991-01-01

Seventy-nine patients with supraglottic carcinoma treated between 1966 and 1985 are reviewed. All patients were treated with surgery and postoperative radiation therapy. Thirty-five percent of the patients had positive margins at the site of resection of the primary tumor. Of the 25 patients who had positive nodal disease, 13 patients (52%) had either extracapsular extension or soft-tissue or adjacent organ invasion, referred to in composite as grave signs. The median follow-up of the patients was 4.9 years and all patients were followed for a minimum of 3 years. The disease-free survival for all patients was 76% at 2 years and 71% at 3 years. The locoregional control rate for all patients was 70%. This study demonstrates that there is no difference in local recurrence or disease-free survival, or time to recurrence relative to the status of the surgical margins, which may be a benefit of the postoperative radiation therapy. This study also demonstrates that there is an increase in the number of patients with grave signs with increasing nodal stage. The rate of neck recurrence in patients with grave signs was substantially higher (54%) than in patients without grave signs (8%), even though these patients also had positive lymph nodes. Interestingly, there was also a higher rate of local recurrence among patients who had grave signs. Patients receiving doses higher than 6000 cGy to the primary site had fewer local failures, although within each group of patients with positive or negative surgical margins the differences in survival were minimal

"We call ourselves marginalized"

DEFF Research Database (Denmark)

Jørgensen, Nanna Jordt

2014-01-01

of the people we refer to as marginalized. In this paper, I discuss how young secondary school graduates from a pastoralist community in Kenya use and negotiate indigeneity, marginal identity, and experiences of marginalization in social navigations aimed at broadening their current and future opportunities. I...

Patterns of intracranial glioblastoma recurrence after aggressive surgical resection and adjuvant management. Retrospective analysis of 43 cases

International Nuclear Information System (INIS)

Konishi, Yoshiyuki; Muragaki, Yoshihiro; Iseki, Hiroshi; Mitsuhashi, Norio; Okada, Yoshikazu

2012-01-01

The present retrospective study evaluated the recurrence patterns after aggressive surgical removal of intracranial glioblastomas in 43 consecutive adult patients. The resection rate of the enhanced lesion on magnetic resonance imaging was 100% and 95-99% in 22 and 21 cases, respectively. All patients received postoperative fractionated radiotherapy (60 Gy in 30 fractions) with additional chemotherapy (25 cases) or vaccine therapy (18 cases). During follow-up (median 17 months), tumor recurrence was identified in 33 patients, most frequently regional within the wall of the resection cavity (20 cases). No clinical factor differed significantly between the groups of patients with regional or marginal tumor progression (N=22) and patients with distant or multiple recurrences (N=8). Progression-free survival did not differ significantly between these two groups (p=0.27). However, overall survival was significantly longer (p=0.04) in patients with regional or marginal tumor progression, and constituted 90% and 54% at 1 and 2 years after surgery, respectively, compared to 75% and 0% in patients with distant or multiple recurrences. Aggressive surgical resection and adjuvant management of intracranial glioblastoma may change its recurrence pattern. Tumor progression appears in the wall of the resection cavity or within 2 cm from its margin in approximately half of patients. (author)

Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO research database

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Aiello Bowles Erin J

2012-04-01

Full Text Available Abstract Background Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data. Methods We included 4524 women ≥18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont. Results The CRN institutions pre-filled 30% (22 out of 72 of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years; 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma. Conclusions The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data

Lumbar posterior marginal intra-osseous cartilaginous node

Energy Technology Data Exchange (ETDEWEB)

Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

1986-03-01

This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

Lumbar posterior marginal intra-osseous cartilaginous node

International Nuclear Information System (INIS)

Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

1986-01-01

This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed. (orig.)

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

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Jânio Sousa Santos

2015-01-01

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.

Marginal Matter

Science.gov (United States)

van Hecke, Martin

2013-03-01

All around us, things are falling apart. The foam on our cappuccinos appears solid, but gentle stirring irreversibly changes its shape. Skin, a biological fiber network, is firm when you pinch it, but soft under light touch. Sand mimics a solid when we walk on the beach but a liquid when we pour it out of our shoes. Crucially, a marginal point separates the rigid or jammed state from the mechanical vacuum (freely flowing) state - at their marginal points, soft materials are neither solid nor liquid. Here I will show how the marginal point gives birth to a third sector of soft matter physics: intrinsically nonlinear mechanics. I will illustrate this with shock waves in weakly compressed granular media, the nonlinear rheology of foams, and the nonlinear mechanics of weakly connected elastic networks.

The effects of photodynamic laser therapy in the treatment of marginal chronic periodontitis

Science.gov (United States)

Chifor, Radu; Badea, Iulia; Avram, Ramona; Chifor, Ioana; Badea, Mîndra Eugenia

2016-03-01

The aim of this study was to assess the effects of the antimicrobial photodynamic laser therapy performed during the treatment of deep periodontal disease by using 40 MHz high frequency ultrasonography. The periodontal data recorded during the clinical examination before each treatment session were compared with volumetric changes of the gingiva measured on periodontal ultrasound images. The results show a significant decrease of gingival tissue inflammation proved both by a significant decrease of bleeding on probing as well as by a decrease of the gingival tissues volume on sites where the laser therapy was performed. Periodontal tissues that benefit of laser therapy besides classical non-surgical treatment showed a significant clinical improvement of periodontal status. Based on these findings we were able to conclude that the antimicrobial photodynamic laser therapy applied on marginal periodontium has important anti-inflamatory effect. The periodontal ultrasonography is a method which can provide useful data for assessing the volume changes of gingival tissues, allowing a precise monitoring of marginal periodontitis.

Marginalization of the Youth

DEFF Research Database (Denmark)

Jensen, Niels Rosendal

2009-01-01

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....

Convexity and Marginal Vectors

NARCIS (Netherlands)

van Velzen, S.; Hamers, H.J.M.; Norde, H.W.

2002-01-01

In this paper we construct sets of marginal vectors of a TU game with the property that if the marginal vectors from these sets are core elements, then the game is convex.This approach leads to new upperbounds on the number of marginal vectors needed to characterize convexity.An other result is that

Contributions to knowledge of the continental margin of Uruguay. Uruguayan continental margin: Physiographic and seismic analysis

International Nuclear Information System (INIS)

Preciozzi, F

2014-01-01

This work is about the kind of continental margins such as a )Atlantic type passive margins which can be hard or soft b) An active or Pacific margins that because of the very frequent earthquakes develop a morphology dominated by tectonic processes. The Uruguayan continental margin belongs to a soft Atlantic margin

Fixing soft margins

NARCIS (Netherlands)

P. Kofman (Paul); A. Vaal, de (Albert); C.G. de Vries (Casper)

1993-01-01

textabstractNon-parametric tolerance limits are employed to calculate soft margins such as advocated in Williamson's target zone proposal. In particular, the tradeoff between softness and zone width is quantified. This may be helpful in choosing appropriate margins. Furthermore, it offers

Cone Beam CT in Diagnosis and Surgical Planning of Dentigerous Cyst

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Naira Figueiredo Deana

2017-01-01

Full Text Available Diagnosis and preoperative planning are critical in the execution of any surgical procedure. Panoramic radiography is a routine method used in dentistry to assist clinical diagnosis; however, with this technique 3D anatomical structures are compressed into 2D images, resulting in overlapping of structures which are of interest in the diagnosis. In this study we report the case of a patient who presented with a dentigerous cyst of expressive dimensions in the body of the mandible region. The surgery was planned and executed after observing the margins of the lesion by Cone Beam Computed Tomography (CBCT. We conclude that CBCT is a precise method to help diagnosis; it provides greater accuracy in surgical treatment planning through 3D image display, allowing more effective results.

SOCIAL MARGINALIZATION AND HEALTH

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Marjana Bogdanović

2007-04-01

Full Text Available The 20th century was characterized by special improvement in health. The aim of WHO’s policy EQUITY IN HEALTH is to enable equal accessibility and equal high quality of health care for all citizens. More or less some social groups have stayed out of many social systems even out of health care system in the condition of social marginalization. Phenomenon of social marginalization is characterized by dynamics. Marginalized persons have lack of control over their life and available resources. Social marginalization stands for a stroke on health and makes the health status worse. Low socio-economic level dramatically influences people’s health status, therefore, poverty and illness work together. Characteristic marginalized groups are: Roma people, people with AIDS, prisoners, persons with development disorders, persons with mental health disorders, refugees, homosexual people, delinquents, prostitutes, drug consumers, homeless…There is a mutual responsibility of community and marginalized individuals in trying to resolve the problem. Health and other problems could be solved only by multisector approach to well-designed programs.

Pickering seismic safety margin

International Nuclear Information System (INIS)

Ghobarah, A.; Heidebrecht, A.C.; Tso, W.K.

1992-06-01

A study was conducted to recommend a methodology for the seismic safety margin review of existing Canadian CANDU nuclear generating stations such as Pickering A. The purpose of the seismic safety margin review is to determine whether the nuclear plant has sufficient seismic safety margin over its design basis to assure plant safety. In this review process, it is possible to identify the weak links which might limit the seismic performance of critical structures, systems and components. The proposed methodology is a modification the EPRI (Electric Power Research Institute) approach. The methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path, and the determination of the seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of using historical records and the regional seismo-tectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection, analysis or testing. An implementation plan for the application of the methodology to the Pickering A NGS is prepared

Surgical excision of Infantile Haemangiomas: a technical refinement to prevent bleeding complications

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F. Leone

2014-06-01

Full Text Available Purpose: The aim of the study is to improve operative speed and precision of haemangiomas excision. Methods: Case-report: haemangioma is a common affection of the 8% of the population during the neonatal period. In complicated cases and involution sequelae surgical treatment is the first choice. The Authors propose a surgical refinement to prevent intraoperative bleeding. Methods: several suture stitches were placed around the hemangioma. The edges of the lesion became more defined, thus allowing accurate excision. Results and Conclusions: Haemangiomas are characterized by rich blood supply. Surgery is often hindered by massive bleeding and Temporary placement of full-thickness sutures, surrounding the hemangioma, allowed a noticeable improvement in hemostasis precision and greater definition of the margins of the hemangioma.

Clinical implication of negative conversion of predicted circumferential resection margin status after preoperative chemoradiotherapy for locally advanced rectal cancer

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Lee, Nam Kwon [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Chul Yong, E-mail: kcyro@korea.ac.kr [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Park, Young Je; Yang, Dae Sik; Yoon, Won Sup [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Seon Hahn; Kim, Jin [Division of Colorectal Surgery, Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of)

2014-02-15

Objective: To evaluate the prognostic implication of the negative conversion of predicted circumferential resection margin status before surgery in patients with locally advanced rectal cancer with predicted circumferential resection margin involvement. Methods: Thirty-eight patients (28 men, 10 women; median age, 61 years; age range, 39–80 years) with locally advanced rectal cancer with predicted circumferential resection margin involvement who underwent preoperative chemoradiotherapy followed by radical surgery were analyzed. Involvement of the circumferential resection margin was predicted on the basis of pre- and post-chemoradiotherapy magnetic resonance imaging. The primary endpoints were 3-year local recurrence-free survival and overall survival. Results: The median follow-up time was 41.1 months (range, 13.9–85.2 months). The negative conversion rate of predicted circumferential resection margin status after preoperative chemoradiotherapy was 65.8%. Patients who experienced negative conversion of predicted circumferential resection margin status had a significantly higher 3-year local recurrence-free survival rate (100.0% vs. 76.9%; P = 0.013), disease-free survival rate (91.7% vs. 59.3%; P = 0.023), and overall survival rate (96.0% vs. 73.8%; P = 0.016) than those who had persistent circumferential resection margin involvement. Conclusions: The negative conversion of the predicted circumferential resection margin status as predicted by magnetic resonance imaging will assist in individual risk stratification as a predictive factor for treatment response and survival before surgery. These findings may help physicians determine whether to administer more intense adjuvant chemotherapy or change the surgical plan for patients displaying resistance to preoperative chemoradiotherapy.

Indian Ocean margins

Digital Repository Service at National Institute of Oceanography (India)

Naqvi, S.W.A

in the latter two areas. Some of these fluxes are expected to be substantial in the case of Indonesian continental margins and probably also across the eastern coasts of Africa not covered in this chapter. However, a dearth of information makes these margins...

Marginal kidney donor

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Ganesh Gopalakrishnan

2007-01-01

Full Text Available Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.

Prevalence of human papilloma virus in marginal periodontium and its association with periodontitis: A cross sectional study

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Anila Jacob

2014-01-01

Full Text Available Context: Bacterial pathogens in dental plaque are necessary for the development of periodontitis but this etiology alone does not explain all its clinicopathologic features. Researchers have proven the role of certain viruses like herpes virus in periodontal disease which implies that other viral agents like human papilloma virus may also be involved. Aims: This cross-sectional study was conducted to determine the proportion of patients with human papilloma virus (HPV-16 in marginal periodontium by analyzing DNA from the gingival tissue sample and to understand its association with periodontitis. Settings and Design: 102 systemically healthy patients between the age group of 15 and 70 years reporting to the Department of Periodontology who required surgical intervention (flap surgery for patients with periodontitis and crown lengthening for healthy patients with internal bevel gingivectomy were selected. Materials and Methods: After scaling and root planning, gingival tissue was collected during the respective surgical procedure. DNA was isolated and amplified using specific primers for HPV-16 by polymerase chain reaction (PCR. The amplified products were checked by agarose gel electrophoresis. Results: No HPV DNA was detected in the 102 samples analyzed. Conclusion: Marginal periodontium does not contain HPV in this study population and hence there was no association between HPV and periodontitis.

Recurrent vulvar carcinoma: complex surgical treatment via perineal excision and reconstruction with musculocutaneous flap

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Dragoș Popa

2018-04-01

Full Text Available Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3 for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable.

Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement

Energy Technology Data Exchange (ETDEWEB)

Ferris, Matthew J., E-mail: mjferri@emory.edu [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Danish, Hasan [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia (United States); Deng, Claudia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); George, Bradley A.; Goldsmith, Kelly C.; Wasilewski, Karen J.; Cash, W. Thomas [Aflac Cancer and Blood Disorders Center, Children' s Healthcare of Atlanta, Atlanta, Georgia (United States); Khan, Mohammad K.; Eaton, Bree R.; Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

2017-03-15

Purpose: To report the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution. Methods and Materials: We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May 2014. Results: At a median follow-up of 4.5 years, 26 patients (38.8%) failed distantly; 4 of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6 Gy with respect to local relapse–free survival (P=.55), disease-free survival (P=.22), or OS (P=.72). With respect to local relapse–free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly. Conclusions: Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6 Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances.

On marginal regeneration

NARCIS (Netherlands)

Stein, H.N.

1991-01-01

On applying the marginal regeneration concept to the drainage of free liquid films, problems are encountered: the films do not show a "neck" of minimum thickness at the film/border transition; and the causes of the direction dependence of the marginal regeneration are unclear. Both problems can be

Natural history and surgical treatment of chordoma: a retrospective cohort study

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Samuel Aguiar Júnior

Full Text Available CONTEXT AND OBJECTIVE: Chordoma is a rare tumor with a high risk of locoregional recurrences. The aim of this study was analyze the long-term results from treating this pathological condition.DESIGN AND SETTING: Cohort study in a single hospital in São Paulo, Brazil.METHODS: This was a retrospective cohort study on 42 patients with chordoma who were treated at Hospital A. C. Camargo between 1980 and 2006. The hospital records were reviewed and a descriptive analysis was performed on the clinical-pathological variables. Survival curves were estimated using the Kaplan-Meier method and these were compared using the log-rank test.RESULTS: Nineteen patients were men and 23 were women. Twenty-five tumors (59.5% were located in the sacrum, eleven (26.2% in the skull base and six (14.3% in the mobile spine. Surgery was performed on 28 patients (66.7%. The resection was considered to have negative margins in 14 cases and positive margins in 14 cases. The five-year overall survival (OS was 45.4%. For surgical patients, the five-year OS was 64.3% (82.2% for negative margins and 51.9% for positive margins. In the inoperable group, OS was 37.7% at 24 months and 0% at five years.CONCLUSION: Complete resection is related to local control and definitively has a positive impact on long-term survival.

Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis

International Nuclear Information System (INIS)

Heo, Eun-Young; Lee, Kyung-Won; Jheon, Sanghoon; Lee, Jae-Ho; Lee, Choon-Taek; Yoon, Ho-II

2011-01-01

The safety and efficacy of surgical resection of lung nodule without tissue diagnosis is controversial. We evaluated direct surgical resection of highly suspicious pulmonary nodules and the clinical and radiological predictors of malignancy. Retrospective analyses were performed on 113 patients who underwent surgical resection without prior tissue diagnosis for highly suspicious pulmonary nodules. Clinical and radiological characteristics were compared between histologically proven benign and malignant nodules after resection. Total costs, length of hospitalization and waiting time to surgery were compared with those of patients who had tissue diagnosis prior to surgery. Among 280 patients with pulmonary nodules suspicious for lung cancer, 113 (40.4%) underwent operation without prior tissue diagnosis. Lung nodules were diagnosed as malignant in 96 (85%) of the 113 patients. Except for forced expiratory volume in 1 s, clinical characteristics were not significantly different according to the pathologic results. Forty-five (90%) of 50 patients with ground-glass opacity nodules had a malignancy. Mixed ground-glass opacity, bubble lucency, irregular margin and larger size correlated with malignancy in ground-glass opacity nodules (P<0.05). Fifty-one (81%) of 67 patients with solid nodules had a malignancy. Spiculation, pre-contrast attenuation and contrast enhancement significantly correlated with malignancy in solid nodules (P<0.05). Surgical resection without tissue diagnosis significantly decreased total costs, hospital stay and waiting time (P<0.05). Direct surgical resection of highly suspicious pulmonary nodules can be a valid procedure. However, careful patient selection and further investigations are required to justify direct surgical resection. (author)

Indigenous women's voices: marginalization and health.

Science.gov (United States)

Dodgson, Joan E; Struthers, Roxanne

2005-10-01

Marginalization may affect health care delivery. Ways in which indigenous women experienced marginalization were examined. Data from 57 indigenous women (18 to 65 years) were analyzed for themes. Three themes emerged: historical trauma as lived marginalization, biculturalism experienced as marginalization, and interacting within a complex health care system. Experienced marginalization reflected participants' unique perspective and were congruent with previous research. It is necessary for health care providers to assess the detrimental impact of marginalization on the health status of individuals and/or communities.

Refining margins and prospects

International Nuclear Information System (INIS)

Baudouin, C.; Favennec, J.P.

1997-01-01

Refining margins throughout the world have remained low in 1996. In Europe, in spite of an improvement, particularly during the last few weeks, they are still not high enough to finance new investments. Although the demand for petroleum products is increasing, experts are still sceptical about any rapid recovery due to prevailing overcapacity and to continuing capacity growth. After a historical review of margins and an analysis of margins by regions, we analyse refining over-capacities in Europe and the unbalances between production and demand. Then we discuss the current situation concerning barriers to the rationalization, agreements between oil companies, and the consequences on the future of refining capacities and margins. (author)

Safety margins in deterministic safety analysis

International Nuclear Information System (INIS)

Viktorov, A.

2011-01-01

The concept of safety margins has acquired certain prominence in the attempts to demonstrate quantitatively the level of the nuclear power plant safety by means of deterministic analysis, especially when considering impacts from plant ageing and discovery issues. A number of international or industry publications exist that discuss various applications and interpretations of safety margins. The objective of this presentation is to bring together and examine in some detail, from the regulatory point of view, the safety margins that relate to deterministic safety analysis. In this paper, definitions of various safety margins are presented and discussed along with the regulatory expectations for them. Interrelationships of analysis input and output parameters with corresponding limits are explored. It is shown that the overall safety margin is composed of several components each having different origins and potential uses; in particular, margins associated with analysis output parameters are contrasted with margins linked to the analysis input. While these are separate, it is possible to influence output margins through the analysis input, and analysis method. Preserving safety margins is tantamount to maintaining safety. At the same time, efficiency of operation requires optimization of safety margins taking into account various technical and regulatory considerations. For this, basic definitions and rules for safety margins must be first established. (author)

Marginal Models for Categorial Data

NARCIS (Netherlands)

Bergsma, W.P.; Rudas, T.

2002-01-01

Statistical models defined by imposing restrictions on marginal distributions of contingency tables have received considerable attention recently. This paper introduces a general definition of marginal log-linear parameters and describes conditions for a marginal log-linear parameter to be a smooth

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia.

Science.gov (United States)

Bittencourt, Dulcimary Dias; Zanine, Rita Maira; Sebastião, Ana Martins; Taha, Nabiha Saadi; Speck, Neila Góis; Ribalta, Julisa Chamorro Lascasas

2012-01-01

Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). Cross-sectional study at Universidade Federal de São Paulo (Unifesp). The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

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

NARCIS (Netherlands)

Salemink, Koen

2016-01-01

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

Inserting ex vivo fluorescence confocal microscopy perioperatively in Mohs micrographic surgery expedites bedside assessment of excision margins in recurrent basal cell carcinoma.

Science.gov (United States)

Longo, Caterina; Ragazzi, Moira; Castagnetti, Fabio; Gardini, Stefano; Palmieri, Tamara; Lallas, Aimilios; Moscarella, Elvira; Piana, Simonetta; Pellacani, Giovanni; Zalaudek, Iris; Argenziano, Giuseppe

2013-01-01

Mohs micrographic surgery can be employed in recurrent basal cell carcinoma, although it is a time-consuming technique. Recently, ex vivo fluorescence confocal microscopy (FCM) has been employed to obtain a fast assessment of tumor margins at the bedside. In our case we successfully employed ex vivo FCM to assess the tumor margins and we treated the persistent tumor with intensity-modulated radiation therapy. Our case demonstrates that a multidisciplinary approach is very efficient in managing complex and recurrent tumors and highlights the benefits of FCM as a new technique that can be used in the surgical theater to speed up the entire procedure.

Definitions and general remarks on surgical pathology in the field of oncology

International Nuclear Information System (INIS)

Arnould, L.

2001-01-01

In the field of oncology, surgical pathology analysis of biopsies or surgical specimens directly determines the care program of each patient. Without going into too much detail, we report here the description of different characteristics of neoplastic lesions, necessary or useful for the establishment of the care program of the patients. These macroscopic and microscopic analyses should result in the most precise possible diagnosis and should take into account a list of other factors which allow the development of an optimal strategy for therapy, and the establishment of prognosis of the tumor. These characteristics include properties of the tumor such as the size, shape, exact location, and the grade of the lesion, etc. They also concern the relationship of the tumor to certain structures like the basal membranes, the stroma reaction, the lymphatic vessels, the nerves, and so forth. The description of local and locoregional spreading, as well as the analysis of the surgical margins gives essential information as well. Finally, in certain cases, the description of modifications induced by neo-adjuvant therapy allows the evaluation of the treatment's efficacy. (author)

Full-Thickness Skin Grafting with De-Epithelization of the Wound Margin for Finger Defects with Bone or Tendon Exposure

Directory of Open Access Journals (Sweden)

Jun Hee Lee

2015-05-01

Full Text Available BackgroundFull-thickness skin grafts (FTSGs are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs.MethodsThe surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects.ResultsMost of the grafts (15 of 16 fingers survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients.ConclusionsWe observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

Informing practice regarding marginalization: the application of the Koci Marginality Index.

Science.gov (United States)

Koci, Anne Floyd; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2012-12-01

The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on women's functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused women's health are discussed. The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al., 2002 ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached $8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a woman's health immediately and in the long-term (Breiding, Black, & Ryan, 2008 ; Campbell, 2002 ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez, 2002 ) and those without documentation are at higher risk for marginalization (Montalvo

Post spinal meningitis and asepsis.

Science.gov (United States)

Videira, Rogerio L R; Ruiz-Neto, P P; Brandao Neto, M

2002-07-01

Post spinal meningitis (PSM) is a complication still currently being reported. After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department. Cases defined as PSM comprised meningitis within a week after spinal anesthesia. Anesthesia records, anesthesia complication files and the records of the Hospital Commission for Infection Control from 1997 to 2000 were reviewed. Asepsis techniques applied were surveyed by a questionnaire answered by all our department's anesthesiologists. The equipment and procedures for spinal anesthesia were listed. Current anesthesia textbooks were reviewed for recommendations regarding asepsis techniques in conjunction with spinal anesthesia. Three cases of PSM were identified following 38,128 spinal anesthesias whereas none was observed in 12,822 patients subjected to other types of regional or general anesthesia (P>0.05). Culture of cerebrospinal fluid yielded Streptococcus in two patients and was negative in the other patient. The asepsis technique applied by the anesthesiologists varied considerably. The literature review showed that aspects on asepsis for spinal anesthesia are poorly covered. The incidence of meningitis was similar in patients subjected to spinal anesthesia and in those subjected to other anesthetic techniques. Asepsis techniques were found to differ considerably among our staff members, reflecting the lack of well-defined published standards for this procedure. We recommend that asepsis for spinal anesthesia should not be less rigorous than for surgical asepsis.

Task Group on Safety Margins Action Plan (SMAP). Safety Margins Action Plan - Final Report

International Nuclear Information System (INIS)

Hrehor, Miroslav; Gavrilas, Mirela; Belac, Josef; Sairanen, Risto; Bruna, Giovanni; Reocreux, Michel; Touboul, Francoise; Krzykacz-Hausmann, B.; Park, Jong Seuk; Prosek, Andrej; Hortal, Javier; Sandervaag, Odbjoern; Zimmerman, Martin

2007-01-01

The international nuclear community has expressed concern that some changes in existing plants could challenge safety margins while fulfilling all the regulatory requirements. In 1998, NEA published a report by the Committee on Nuclear Regulatory Activities on Future Nuclear Regulatory Challenges. The report recognized 'Safety margins during more exacting operating modes' as a technical issue with potential regulatory impact. Examples of plant changes that can cause such exacting operating modes include power up-rates, life extension or increased fuel burnup. In addition, the community recognized that the cumulative effects of simultaneous changes in a plant could be larger than the accumulation of the individual effects of each change. In response to these concerns, CSNI constituted the safety margins action plan (SMAP) task group with the following objectives: 'To agree on a framework for integrated assessments of the changes to the overall safety of the plant as a result of simultaneous changes in plant operation / condition; To develop a CSNI document which can be used by member countries to assess the effect of plant change on the overall safety of the plant; To share information and experience.' The two approaches to safety analysis, deterministic and probabilistic, use different methods and have been developed mostly independently of each other. This makes it difficult to assure consistency between them. As the trend to use information on risk (where the term risk means results of the PSA/PRA analysis) to support regulatory decisions is growing in many countries, it is necessary to develop a method of evaluating safety margin sufficiency that is applicable to both approaches and, whenever possible, integrated in a consistent way. Chapter 2 elaborates on the traditional view of safety margins and the means by which they are currently treated in deterministic analyses. This chapter also discusses the technical basis for safety limits as they are used today

Laparoscopic colectomy for transverse colon carcinoma: a surgical challenge but oncologically feasible.

Science.gov (United States)

Fernández-Cebrián, J M; Gil Yonte, P; Jimenez-Toscano, M; Vega, L; Ochando, F

2013-02-01

The aim of the study was to assess the safety and feasibility of laparoscopic surgery for transverse colon cancer and to compare the clinicopathological outcome with that of conventional open surgery. From March 1998 to December 2009, 1253 patients with colorectal tumours were operated on, 564 laparoscopically. There were 154 cases of transverse colon cancer, 86 of which were included in the study. Details were collected on age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to resume a liquid diet, postoperative length of hospital stay, complications, TNM stage, tumour size, distal resection margin, proximal resection margin, number of nodes harvested and surgical procedure. Laparoscopic and open surgical removal was compared. No significant differences were found between laparoscopic and conventional groups in age, sex, BMI, operation time or postoperative length of hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (105.9 ± 140.9 ml vs 305.7 ± 325.3 ml; P = 0.05). The time to the first flatus was shorter (2.1 ± 0.3 days vs 3.8 ± 3.0 days; P = 0.043) and diet was started earlier (3.1 ± 1.4 days vs 3.4 ± 1.5 days) in the laparoscopic group. No significant differences in tumour size, proximal resection margin or number of lymph nodes were observed. The mean distal resection margin was not statistically different (10.3 ± 4.5 cm vs 8.8 ± 4.9 cm). At a mean follow up of 33 ± 2.3 months, nonport-site metastases occurred in eight patients and locoregional recurrence occurred in three, with no significant difference between the groups. The 3-year cumulative overall survival rate was 78%, and the disease-free survival rate was 69%. There was no difference in the outcome of laparoscopic and open surgery for transverse colon cancer, including the cancer-specific outcome. © 2012 The Authors Colorectal Disease © 2012 The Association of

Surgical Management of Perineural Spread of Head and Neck Cancers.

Science.gov (United States)

Solares, C Arturo; Mason, Eric; Panizza, Benedict J

2016-04-01

The surgical management of perineural spread of head and neck cancers has become an integral part in the contemporary treatment of this pathology. We now understand that tumour spreads within the epineurium and in a continuous fashion. We also can rely on the accuracy of magnetic resonance neurography in detecting and defining the extent of disease. With modern skull base techniques and a greater understanding of the anatomy in this region, specific operations can be designed to help eradicate disease. We review the current approaches and techniques used that enable us to better obtain tumour free margins and hence improve survival.

Surgical Non-Regenerative Treatments for Peri-Implantitis: a Systematic Review

Directory of Open Access Journals (Sweden)

Ausra Ramanauskaite

2016-09-01

Full Text Available Objectives: The purposes of the present study were 1 to systematically review the literature on the surgical non-regenerative treatments of peri-implantitis and 2 to determine a predictable therapeutic option for the clinical management of peri-implantitis lesions. Material and Methods: The study search was performed on primary database MEDLINE and EMBASE from 2005 until 2016. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in probing depth (PD and/or bleeding on probing (BOP and/or radiologic marginal bone level changes after peri-implantitis surgical non-regenerative treatment at 6-month follow-up or longer were included accordingly PRISMA guidelines. Results: The first electronic and hand search resulted in 765 citations. From 16 full-text articles reviewed, 6 were included in this systematic review. Surgical non-regenerative methods were found to be efficient in reducing clinical parameters. BOP and PD values were significantly decreased following implantoplasty and systematic administration of antibacterials, but not after local application of chemical compounds or diode laser. Similarly, significant improvement in clinical and radiographic parameters was found only after implantoplasty compared with resective surgery alone. We found significant heterogeneity in study designs and treatments provided among the pooled studies. All of the studies revealed an unclear or high risk of bias. Conclusions: Surgical non-regenerative treatment of peri-implantitis was found to be effective to reduce the soft tissue inflammation and decrease probing depth. More randomized controlled clinical trials are needed to assess the efficacy of surgical non-regenerative therapy of peri-implantitis.

[Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

Science.gov (United States)

Vacher, C; Cyna-Gorse, F

2015-10-01

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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Margin improvement initiatives: realistic approaches

Energy Technology Data Exchange (ETDEWEB)

Chan, P.K.; Paquette, S. [Royal Military College of Canada, Chemistry and Chemical Engineering Dept., Kingston, ON (Canada); Cunning, T.A. [Department of National Defence, Ottawa, ON (Canada); French, C.; Bonin, H.W. [Royal Military College of Canada, Chemistry and Chemical Engineering Dept., Kingston, ON (Canada); Pandey, M. [Univ. of Waterloo, Waterloo, ON (Canada); Murchie, M. [Cameco Fuel Manufacturing, Port Hope, ON (Canada)

2014-07-01

With reactor core aging, safety margins are particularly tight. Two realistic and practical approaches are proposed here to recover margins. The first project is related to the use of a small amount of neutron absorbers in CANDU Natural Uranium (NU) fuel bundles. Preliminary results indicate that the fuelling transient and subsequent reactivity peak can be lowered to improve the reactor's operating margins, with minimal impact on burnup when less than 1000 mg of absorbers is added to a fuel bundle. The second project involves the statistical analysis of fuel manufacturing data to demonstrate safety margins. Probability distributions are fitted to actual fuel manufacturing datasets provided by Cameco Fuel Manufacturing, Inc. They are used to generate input for ELESTRES and ELOCA. It is found that the fuel response distributions are far below industrial failure limits, implying that margin exists in the current fuel design. (author)

Comparison between computed tomographic and surgical findings in nine large-breed dogs with lumbosacral stenosis

International Nuclear Information System (INIS)

Jones, J.C.; Sorjonen, D.C.; Simpson, S.T.; Coates, J.R.; Lenz, S.D.; Hathcock, J.T.; Agee, M.W.; Bartels, J.E.

1996-01-01

In a three-year prospective study, computed tomographic (CT) and surgical findings were compared for nine large breed dogs with lumbosacral stenosis. Surgically-excised tissue was examined histologically in seven dogs and additional necropsy evaluation was performed in one dog. The CT abnormalities observed at sites of confirmed cauda equina compression were: loss of epidural fat, increased soft tissue opacity, bulging of the intervertebral disc margin, spondylosis, thecal sac displacement, narrowed intervertebral foramen, narrowed vertebral canal, thickened articular process, articular process subluxation, articular process osteophyte, and telescoped sacral lamina. The CT characteristics of lumbosacral degenerative disease and discospondylitis were similar to those described in humans. In three dogs, CT findings at the site of cauda equina compression were consistent with congenital or developmental spinal stenosis, but the method of surgical exposure precluded confirmation. Epidural fibrosis (eight dogs) and multi-level CT abnormalities (six dogs) were identified but the cause(s) and significance were unknown

The marginal costs of greenhouse gas emissions

International Nuclear Information System (INIS)

Tol, R.S.J.

1999-01-01

Estimates of the marginal costs of greenhouse gas emissions are on important input to the decision how much society would want to spend on greenhouse gas emission reduction. Marginal cost estimates in the literature range between $5 and $25 per ton of carbon. Using similar assumptions, the FUND model finds marginal costs of $9--23/tC, depending on the discount rate. If the aggregation of impacts over countries accounts for inequalities in income distribution or for risk aversion, marginal costs would rise by about a factor of 3. Marginal costs per region are an order of magnitude smaller than global marginal costs. The ratios between the marginal costs of CO 2 and those of CH 4 and N 2 O are roughly equal to the global warming potentials of these gases. The uncertainty about the marginal costs is large and right-skewed. The expected value of the marginal costs lies about 35% above the best guess, the 95-percentile about 250%

Abortion - surgical

Science.gov (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. ...

Refining margins: recent trends

International Nuclear Information System (INIS)

Baudoin, C.; Favennec, J.P.

1999-01-01

Despite a business environment that was globally mediocre due primarily to the Asian crisis and to a mild winter in the northern hemisphere, the signs of improvement noted in the refining activity in 1996 were borne out in 1997. But the situation is not yet satisfactory in this sector: the low return on invested capital and the financing of environmental protection expenditure are giving cause for concern. In 1998, the drop in crude oil prices and the concomitant fall in petroleum product prices was ultimately rather favorable to margins. Two elements tended to put a damper on this relative optimism. First of all, margins continue to be extremely volatile and, secondly, the worsening of the economic and financial crisis observed during the summer made for a sharp decline in margins in all geographic regions, especially Asia. Since the beginning of 1999, refining margins are weak and utilization rates of refining capacities have decreased. (authors)

Post surgical complications from students' large animal surgical ...

African Journals Online (AJOL)

A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

Maxillary Three-Implant Overdentures Opposing Mandibular Two-Implant Overdentures: 10-Year Surgical Outcomes of a Randomized Controlled Trial.

Science.gov (United States)

Ma, Sunyoung; Tawse-Smith, Andrew; De Silva, Rohana K; Atieh, Momen A; Alsabeeha, Nabeel H M; Payne, Alan G T

2016-06-01

The surgical placement of four maxillary implants for overdentures may not be obligatory when opposing mandibular two-implant overdentures. To determine 10-year surgical outcomes and implant success of three narrow diameter implants in edentulous maxillae with conventional loading. Forty participants with mandibular two-implant overdentures were randomly allocated for surgery for maxillary overdentures. Using osteotomes, three implants of similar systems were placed with a one-stage procedure and 12-week loading with splinted and unsplinted prosthodontic designs. Marginal bone and stability measurements were done at surgery, 12 weeks, 1-, 2-, 5-, 7-, 10 years. One hundred seventeen implants were placed in 39 participants, with 35 being seen at 1 year; 29 at 2 years; 28 at 5 years; 26 at 7 years; and 23 (59%) at 10 years. Marginal bone loss was 1.35 mm between surgery and 12 weeks; 0.36 mm between 12 weeks and 1 year; 0.48 mm between 1 and 5 years; and 0.22 mm between 5 and 10 years. Implant stability quotients were 56.05, 57.54, 60.88, 58.80, 61.17 at surgery, 12 weeks, 1 year, 5 years, and 10 years. Four-field tables by implant showed success rates of 82% at 1 year; 69.2% at 2 years; 66.7% at 5 years; 61.5% at 7 years; 51.3% at 10 years. Data showed no differences between surgical technique, systems, or prosthodontic designs. Surgical placement with osteotomes of three narrow diameter implants for maxillary overdentures, opposing mandibular two-implant overdentures, is an acceptable approach, subject to strict patient selection. Implant success is independent of prosthodontic design. © 2015 Wiley Periodicals, Inc.

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...... premium depends on demand pressure: If end-users are on the long side of the market, option returns decrease with margins, while they increase otherwise. Our results are statistically and economically significant and robust to different margin specifications and various control variables. We explain our...... findings by a model of funding-constrained derivatives dealers that require compensation for satisfying end-users’ option demand....

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...... premium depends on demand pressure: If end-users are on the long side of the market, option returns decrease with margins, while they increase otherwise. Our results are statistically and economically significant and robust to different margin specifications and various control variables. We explain our...... findings by a model of funding-constrained derivatives dealers that require compensation for satisfying end-users’ option demand....

Decoding the Margins: What Can the Fractal Geometry of Basaltic Flow Margins Tell Us?

Science.gov (United States)

Schaefer, E. I.; Hamilton, C.; Neish, C.; Beard, S. P.; Bramson, A. M.; Sori, M.; Rader, E. L.

2016-12-01

Studying lava flows on other planetary bodies is essential to characterizing eruption styles and constraining the bodies' thermal evolution. Although planetary basaltic flows are common, many key features are not resolvable in orbital imagery. We are thus developing a technique to characterize basaltic flow type, sub-meter roughness, and sediment mantling from these data. We will present the results from upcoming fieldwork at Craters of the Moon National Monument and Preserve with FINESSE (August) and at Hawai'i Volcanoes National Park (September). We build on earlier work that showed that basaltic flow margins are approximately fractal [Bruno et al., 1992; Gaonac'h et al., 1992] and that their fractal dimensions (D) have distinct `a`ā and pāhoehoe ranges under simple conditions [Bruno et al., 1994]. Using a differential GPS rover, we have recently shown that the margin of Iceland's 2014 Holuhraun flow exhibits near-perfect (R2=0.9998) fractality for ≥24 km across dm to km scales [Schaefer et al., 2016]. This finding suggests that a fractal-based technique has significant potential to characterize flows at sub-resolution scales. We are simultaneously seeking to understand how margin fractality can be modified. A preliminary result for an `a'ā flow in Hawaii's Ka'ū Desert suggests that although aeolian mantling obscures the original flow margin, the apparent margin (i.e., sediment-lava interface) remains fractal [Schaefer et al., 2015]. Further, the apparent margin's D is likely significantly modified from that of the original margin. Other factors that we are exploring include erosion, transitional flow types, and topographic confinement. We will also rigorously test the intriguing possibility that margin D correlates with the sub-meter Hurst exponent H of the flow surface, a common metric of roughness scaling [e.g., Shepard et al., 2001]. This hypothesis is based on geometric arguments [Turcotte, 1997] and is qualitatively consistent with all results so far.

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: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

2014-03-01

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.

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

International Nuclear Information System (INIS)

Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Suzanne; Chavez-MacGregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica

2014-01-01

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

How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy?

International Nuclear Information System (INIS)

Kirby, Anna M.; Evans, Philip M.; Nerurkar, Ashutosh Y.; Desai, Saral S.; Krupa, Jaroslaw; Devalia, Haresh; Rovere, Guidubaldo Querci della; Harris, Emma J.; Kyriakidou, Julia; Yarnold, John R.

2010-01-01

Background and purpose: To compare partial-breast clinical target volumes generated using a standard 15 mm margin (CTV standard ) with those generated using three-dimensional surgical excision margins (CTV tailored30 ) in women who have undergone wide local excision (WLE) for breast cancer. Material and methods: Thirty-five women underwent WLE with placement of clips in the anterior, deep and coronal excision cavity walls. Distances from tumour to each of six margins were measured microscopically. Tumour bed was defined on kV-CT images using clips. CTV standard was generated by adding a uniform three-dimensional 15 mm margin, and CTV tailored30 was generated by adding 30 mm minus the excision margin in three-dimensions. Concordance between CTV standard and CTV tailored30 was quantified using conformity (CoI), geographical-miss (GMI) and normal-tissue (NTI) indices. An external-beam partial-breast irradiation (PBI) plan was generated to cover 95% of CTV standard with the 95% isodose. Percentage-volume coverage of CTV tailored30 by the 95% isodose was measured. Results: Median (range) coronal, superficial and deep excision margins were 15.0 (0.5-76.0) mm, 4.0 (0.0-60.0) mm and 4.0 (0.5-35.0) mm, respectively. Median CoI, GMI and NTI were 0.62, 0.16 and 0.20, respectively. Median coverage of CTV tailored30 by the PBI-plan was 97.7% (range 84.9-100.0%). CTV tailored30 was inadequately covered by the 95% isodose in 4/29 cases. In three cases, the excision margin in the direction of inadequate coverage was ≤2 mm. Conclusions: CTVs based on 3D excision margin data are discordant with those defined using a standard uniform 15 mm TB-CTV margin. In women with narrow excision margins, the standard TB-CTV margin could result in a geographical miss. Therefore, wider TB-CTV margins should be considered where re-excision does not occur.

Surgical management of splenic echinococcal disease

Directory of Open Access Journals (Sweden)

Meimarakis G

2009-04-01

Full Text Available Abstract Background Infection of the spleen with echinococcus is a rare clinical entity. Because the diagnosis of a splenic infestation with echinococcus is sometimes delayed, large hydatid cysts or pseudotumors may develop, demanding a differential surgical approach to cure the disease. Methods In a retrospective study 10 patients out of 250 with abdominal echinococcosis (4% were identified to have splenic infestation, either limited to the spleen (n = 4 or with synchronous involvement of the liver (n = 4, major omentum (n = 1, or the liver and lung (n = 1. Only one patient had alveolar echinococcosis whereas the others showed hydatid cysts of the spleen. Surgical therapy included splenectomy in 7 patients or partial cyst excision combined with omentoplasty in 3 patients. In case of liver involvement, pericystectomy was carried out simultaneously. Results There was no mortality. Postoperative complications were observed in 4 patients. Hospital stay and morbidity were not influenced when splenic procedures were combined with pericystectomies of the liver. Mean follow- up was 8.8 years and all of the patients are free of recurrence at this time. Conclusions Splenectomy should be the preferred treatment of hydatid cysts but partial cystectomy is suitable when the cysts are located at the margins of the spleen. Due to low morbidity rates, simultaneous treatment of splenic and liver hydatid cysts is recom mended.

EVALUATION OF OUTCOME OF VARIOUS SURGICAL PROCEDURES FOR UPPER EYELID PTOSIS

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Nagaraju

2015-02-01

Full Text Available INTRODUCTION: There are various procedures available for ptosis correction. Successful outcome not only depends on correct technique but also choosing appropriate procedure for each patient. Selection of procedure is based on available levator function and also other factors like etiology, severity, Bell’s phenomenon etc. If such varied procedure s are performed in a group of patients based on standard criteria and results are evaluated systematically we can determine what works best for a given patient . AIM : Evaluation of outcome of various surgical procedures for upper eyelid ptosis . METHODOLOGY : 25 eyelids of 20 patients who presented to a tertiary centre in south India with complaint of drooping of upper lid were considered. All subjects underwent complete ocular examination corrected visual acuity and detailed ptosis evaluation with particular emphasis on measurement of levator muscle function, MRD1 (margin reflex distance - 1, palpebral fissure width in different gazes and margin crease distance. The effect of various factors like MRD1, MCD, levator function were assessed, the amount of correction required and appropriate surgical procedure was chosen. Surgical procedure of Levator resection, frontalis sling operation, anterior levator aponeurosis advancement, o r other ptosis correction procedures under appropriate anaesthesia were performed. Post - operative evaluation in terms of visual acuity, MRD, Interpalpebral fissure height, lid symmetry, lagophthalmos and complications (if any was done. RESULTS : Levator muscle resection was done in 28% of eyelids, frontal sling surgery in 60% of eyelids, Levator muscle plication in 8% eyelids and levator muscle disinsertion with frontal sling surgery in 4% eyes. Undercorrection was seen in about 44% of eyelids in varying degrees. 56% of the eyes had optimal correction. Symmetric correction was achieved in 76% of eyelids. CONCLUSION: The influence of various preoperative factors on the

Usefulness of bone window CT images parallel to the transnasal surgical route for pituitary disorders

International Nuclear Information System (INIS)

Abe, T.; Kunii, N.; Ikeda, H.; Izumiyama, H.; Asahina, N.

2003-01-01

Before operating on 130 patients with pituitary disorders, we evaluated their bone window CT images sliced parallel to the trans nasal surgical route to assess the surgical anatomy of the nasal cavity for trans nasal surgery. High resolution bone window CT was performed in 3- to 5-mm slices parallel to the imaginary line connecting the inferior margin of the piriform aperture and the top of the sellar floor, parallel to the trans nasal surgical route. This CT angle was useful in evaluating the width and depth of the operative hold, the bony components of the nasal conchas, deviation of the nasal septum, the bony structure and mucosa in the sphenoid sinus, and the condition of the sellar floor. In patients requiring repeat surgery, the location of thin or thick nasal mucosa, residual bony septum, and inadequate sellar floor opening were easily detected. Bone window CT images sliced parallel to the trans nasal surgical route provide direct visualization of the nasal anatomy for the trans nasal approach. This method is helpful in determining how far to remove the sellar floor laterally, especially in cases requiring repeat surgery. (author)

Tessier No. 3 and No. 4 clefts: Sequential treatment in infancy by pre-surgical orthopedic skeletal contraction, comprehensive reconstruction, and novel surgical lengthening of the ala base-canthal distance.

Science.gov (United States)

Spolyar, John L; Hnatiuk, Mark; Shaheen, Kenneth W; Mertz, Jennifer K; Handler, Lawrence F; Jarial, Ravinder; Roldán, J Camilo

2015-09-01

Repair of facial clefts implies wide tissue mobilization with multi-stage surgical treatment. Authors propose pre-surgical orthopedic correction for naso-oro-ocular clefts and a novel surgical option for Tessier No. 3 cleft. Two male infants, a Tessier No. 3 cleft (age 7 months) and another Tessier No. 4 (age 3 months), were treated with a modified orthopedic Latham device with additional septo-premaxillary molding and observed to age four years. Tessier No. 3 orthopedic measurements were obtained by image corrected cephalometric analysis. Subsequent repair included tissue expansion on Tessier No. 4 and naso-frontal Rieger flap combined with myocutaneous upper lid flap on Tessier No. 3. Orthopedic movements ranged from 18.5 mm in bi-planar to 33 mm in oblique analyses. Tissue margins became aligned with platform normalization. Tissue expansion on Tessier No. 4 improved distances from ala base-lower lid and subalar base-lip. The naso-frontal flap combined with myocutaneous upper lid flap on Tessier No. 3 had similar achievement, but also sufficiently lengthened ala base-canthal distance. Repairs were facilitated by pre-surgical orthopedic correction. The naso-frontal flap combined with an upper lid myocutaneous flap seems viable as a single-stage option to lengthen ala base-canthal distance to advance repair achievement in unilateral Tessier No. 3. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Splenic marginal zone lymphoma.

Science.gov (United States)

Piris, Miguel A; Onaindía, Arantza; Mollejo, Manuela

Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning. Copyright © 2016 Elsevier Ltd. All rights reserved.

A novel single-step surgical technique for vestibular deepening using laser in conjunction with periodontal flap surgery

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Ashu Bhardwaj

2016-01-01

Full Text Available Moderate-to-severe chronic periodontitis results in clinical loss of attachment, reduced width of attached gingiva (AG, periodontal pockets beyond mucogingival junction (MGJ, gingival recession, loss of alveolar bone, and decreased vestibular depth (VD. The encroachment of frenal and muscle attachments on marginal gingiva increases the rate of progression of periodontal pockets, prevents healing, and causes their recurrence after therapy. Loss of VD and AG associated with continuous progression of pocket formation and bone loss requires two-stage surgical procedures. In this article, one-stage surgical procedure is being described for the first time, to treat the periodontal pockets extending beyond the MGJ by periodontal flap surgery along with vestibular deepening with diode laser to increase the AG. One-step surgical technique is illustrated whereby pocket therapy with reconstruction of lost periodontal tissues can be done along with gingival augmentation by vestibular deepening.

Categorical marginal models: quite extensive package for the estimation of marginal models for categorical data

OpenAIRE

Wicher Bergsma; Andries van der Ark

2015-01-01

A package accompanying the book Marginal Models for Dependent, Clustered, and Longitudinal Categorical Data by Bergsma, Croon, & Hagenaars, 2009. It’s purpose is fitting and testing of marginal models.

Characterizing Convexity of Games using Marginal Vectors

NARCIS (Netherlands)

van Velzen, S.; Hamers, H.J.M.; Norde, H.W.

2003-01-01

In this paper we study the relation between convexity of TU games and marginal vectors.We show that if specfic marginal vectors are core elements, then the game is convex.We characterize sets of marginal vectors satisfying this property, and we derive the formula for the minimum number of marginal

Surgical lighting

NARCIS (Netherlands)

Knulst, A.J.

2017-01-01

The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

Surgical smoke.

Science.gov (United States)

Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

2009-10-01

Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

12 CFR 220.4 - Margin account.

Science.gov (United States)

2010-01-01

... Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM CREDIT BY... securities. The required margin on a net long or net short commitment in a when-issued security is the margin...) Interest charged on credit maintained in the margin account; (ii) Premiums on securities borrowed in...

Stereotactic Radiosurgery of the Postoperative Resection Cavity for Brain Metastases: Prospective Evaluation of Target Margin on Tumor Control

International Nuclear Information System (INIS)

Choi, Clara Y.H.; Chang, Steven D.; Gibbs, Iris C.; Adler, John R.; Harsh, Griffith R.; Lieberson, Robert E.; Soltys, Scott G.

2012-01-01

Purpose: Given the neurocognitive toxicity associated with whole-brain irradiation (WBRT), approaches to defer or avoid WBRT after surgical resection of brain metastases are desirable. Our initial experience with stereotactic radiosurgery (SRS) targeting the resection cavity showed promising results. We examined the outcomes of postoperative resection cavity SRS to determine the effect of adding a 2-mm margin around the resection cavity on local failure (LF) and toxicity. Patients and Methods: We retrospectively evaluated 120 cavities in 112 patients treated from 1998-2009. Factors associated with LF and distant brain failure (DF) were analyzed using competing risks analysis, with death as a competing risk. The overall survival (OS) rate was calculated by the Kaplan-Meier product-limit method; variables associated with OS were evaluated using the Cox proportional hazards and log rank tests. Results: The 12-month cumulative incidence rates of LF and DF, with death as a competing risk, were 9.5% and 54%, respectively. On univariate analysis, expansion of the cavity with a 2-mm margin was associated with decreased LF; the 12-month cumulative incidence rates of LF with and without margin were 3% and 16%, respectively (P=.042). The 12-month toxicity rates with and without margin were 3% and 8%, respectively (P=.27). On multivariate analysis, melanoma histology (P=.038) and number of brain metastases (P=.0097) were associated with higher DF. The median OS time was 17 months (range, 2-114 months), with a 12-month OS rate of 62%. Overall, WBRT was avoided in 72% of the patients. Conclusion: Adjuvant SRS targeting the resection cavity of brain metastases results in excellent local control and allows WBRT to be avoided in a majority of patients. A 2-mm margin around the resection cavity improved local control without increasing toxicity compared with our prior technique with no margin.

Conference Report: The New Discovery of Margins: Theory-Based Excursions in Marginal Social Fields

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Babette Kirchner

2014-05-01

Full Text Available At this year's spring conference of the Sociology of Knowledge Section of the German Sociological Association, a diverse range of theoretical concepts and multiple empirical insights into different marginal social fields were presented. As in everyday life, drawing a line between center and margin can be seen as an important challenge that must equally be faced in sociology. The socially constructed borderline appears to be highly variable. Therefore it has to be delineated or fixed somehow. The construction of margins is necessary for society in general and smaller social groupings alike to confirm one's own "normal" identity, or one's own membership on the fringes. The different contributions exemplify what was established at the beginning of the conference: Namely that society and its margins are defined differently according to the empirical as well as conceptual focus. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1402148

A Simple and Automatic Method for Locating Surgical Guide Hole

Science.gov (United States)

Li, Xun; Chen, Ming; Tang, Kai

2017-12-01

Restoration-driven surgical guides are widely used in implant surgery. This study aims to provide a simple and valid method of automatically locating surgical guide hole, which can reduce operator's experiences and improve the design efficiency and quality of surgical guide. Few literatures can be found on this topic and the paper proposed a novel and simple method to solve this problem. In this paper, a local coordinate system for each objective tooth is geometrically constructed in CAD system. This coordinate system well represents dental anatomical features and the center axis of the objective tooth (coincide with the corresponding guide hole axis) can be quickly evaluated in this coordinate system, finishing the location of the guide hole. The proposed method has been verified by comparing two types of benchmarks: manual operation by one skilled doctor with over 15-year experiences (used in most hospitals) and automatic way using one popular commercial package Simplant (used in few hospitals).Both the benchmarks and the proposed method are analyzed in their stress distribution when chewing and biting. The stress distribution is visually shown and plotted as a graph. The results show that the proposed method has much better stress distribution than the manual operation and slightly better than Simplant, which will significantly reduce the risk of cervical margin collapse and extend the wear life of the restoration.

Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program: Safe after 40 cases, but only controlled after 140 cases.

Science.gov (United States)

Voron, T; Eveno, C; Jouvin, I; Beaugerie, A; Lo Dico, R; Dagois, S; Soyer, P; Pocard, M

2015-12-01

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), used to treat peritoneal surface malignancies (PSM), is a complex procedure with significant major morbidity (MM). To investigate the learning curve (LC) of CRS with HIPEC in a new specialized surgical unit with a fully trained senior surgeon and individualize the variables associated with morbidity and oncological results. A total of 290 consecutive patients with PSM were included. Complete CRS with HIPEC was performed in 204 patients. A risk-adjusted sequential probability ratio test was used to assess the LC on the basis of rates of incomplete cytoreduction (IC) and MM. Complete CRS, MM, and mortality rates were 70.4%, 30.4%, and 2.5%, respectively. Tumor histotype, a high peritoneal cancer index (PCI) and the invaded region were the major independent risk factors for IC, whereas previous surgery, high PCI, stomia realization and blood transfusion were predictors of MM. RA-SPRT showed that 140 and 40 cases were needed to achieve the lowest risk of IC and MM, respectively. CRS with HIPEC to treat PSM has a steep LC. Drastic selection has to be made at the beginning, excluding high PCI, rare peritoneal disease and patients previously operated on. Copyright © 2015 Elsevier Ltd. All rights reserved.

NRC Seismic Design Margins Program Plan

International Nuclear Information System (INIS)

Cummings, G.E.; Johnson, J.J.; Budnitz, R.J.

1985-08-01

Recent studies estimate that seismically induced core melt comes mainly from earthquakes in the peak ground acceleration range from 2 to 4 times the safe shutdown earthquake (SSE) acceleration used in plant design. However, from the licensing perspective of the US Nuclear Regulatory Commission, there is a continuing need for consideration of the inherent quantitative seismic margins because of, among other things, the changing perceptions of the seismic hazard. This paper discusses a Seismic Design Margins Program Plan, developed under the auspices of the US NRC, that provides the technical basis for assessing the significance of design margins in terms of overall plant safety. The Plan will also identify potential weaknesses that might have to be addressed, and will recommend technical methods for assessing margins at existing plants. For the purposes of this program, a general definition of seismic design margin is expressed in terms of how much larger that the design basis earthquake an earthquake must be to compromise plant safety. In this context, margin needs to be determined at the plant, system/function, structure, and component levels. 14 refs., 1 fig

The marginal band system in nymphalid butterfly wings.

Science.gov (United States)

Taira, Wataru; Kinjo, Seira; Otaki, Joji M

2015-01-01

Butterfly wing color patterns are highly complex and diverse, but they are believed to be derived from the nymphalid groundplan, which is composed of several color pattern systems. Among these pattern systems, the marginal band system, including marginal and submarginal bands, has rarely been studied. Here, we examined the color pattern diversity of the marginal band system among nymphalid butterflies. Marginal and submarginal bands are usually expressed as a pair of linear bands aligned with the wing margin. However, a submarginal band can be expressed as a broken band, an elongated oval, or a single dot. The marginal focus, usually a white dot at the middle of a wing compartment along the wing edge, corresponds to the pupal edge spot, one of the pupal cuticle spots that signify the locations of color pattern organizing centers. A marginal band can be expressed as a semicircle, an elongated oval, or a pair of eyespot-like structures, which suggest the organizing activity of the marginal focus. Physical damage at the pupal edge spot leads to distal dislocation of the submarginal band in Junonia almana and in Vanessa indica, suggesting that the marginal focus functions as an organizing center for the marginal band system. Taken together, we conclude that the marginal band system is developmentally equivalent to other symmetry systems. Additionally, the marginal band is likely a core element and the submarginal band a paracore element of the marginal band system, and both bands are primarily specified by the marginal focus organizing center.

Surgical Assisting

Science.gov (United States)

... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

Paediatric Abdominal Surgical Emergencies in a General Surgical ...

African Journals Online (AJOL)

... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

Outcome of Surgical Treatment of Pelvic Osteosarcoma: Hospital Universiti Sains Malaysia Experience

Directory of Open Access Journals (Sweden)

MS Ariff

2013-03-01

Full Text Available We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment.

Assessment of seismic margin calculation methods

International Nuclear Information System (INIS)

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

1989-03-01

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

MARGINS: Toward a novel science plan

Science.gov (United States)

Mutter, John C.

A science plan to study continental margins has been in the works for the past 3 years, with almost 200 Earth scientists from a wide variety of disciplines gathering at meetings and workshops. Most geological hazards and resources are found at continental margins, yet our understanding of the processes that shape the margins is meager.In formulating this MARGINS research initiative, fundamental issues concerning our understanding of basic Earth-forming processes have arisen. It is clear that a business-as-usual approach will not solve the class of problems defined by the MARGINS program; the solutions demand approaches different from those used in the past. In many cases, a different class of experiment will be required, one that is well beyond the capability of individual principle investigators to undertake on their own. In most cases, broadly based interdisciplinary studies will be needed.

A Raman spectroscopy bio-sensor for tissue discrimination in surgical robotics.

Science.gov (United States)

Ashok, Praveen C; Giardini, Mario E; Dholakia, Kishan; Sibbett, Wilson

2014-01-01

We report the development of a fiber-based Raman sensor to be used in tumour margin identification during endoluminal robotic surgery. Although this is a generic platform, the sensor we describe was adapted for the ARAKNES (Array of Robots Augmenting the KiNematics of Endoluminal Surgery) robotic platform. On such a platform, the Raman sensor is intended to identify ambiguous tissue margins during robot-assisted surgeries. To maintain sterility of the probe during surgical intervention, a disposable sleeve was specially designed. A straightforward user-compatible interface was implemented where a supervised multivariate classification algorithm was used to classify different tissue types based on specific Raman fingerprints so that it could be used without prior knowledge of spectroscopic data analysis. The protocol avoids inter-patient variability in data and the sensor system is not restricted for use in the classification of a particular tissue type. Representative tissue classification assessments were performed using this system on excised tissue. Copyright © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

International Nuclear Information System (INIS)

Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut

2011-01-01

Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually

Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

Energy Technology Data Exchange (ETDEWEB)

Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: friess@chir.med.tu-muenchen.de [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)

2011-02-14

Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

Reliabilityy and operating margins of LWR fuels

International Nuclear Information System (INIS)

Strasser, A.A.; Lindquist, K.O.

1977-01-01

The margins to fuel thermal operating limits under normal and accident conditions are key to plant operating flexibility and impact on availability and capacity factor. Fuel performance problems that do not result in clad breach, can reduce these margins. However, most have or can be solved with design changes. Regulatory changes have been major factors in eroding these margins. Various methods for regaining the margins are discussed

Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure.

Science.gov (United States)

Xiang, Shuai; Lau, Wan Yee; Chen, Xiao-ping

2015-02-01

Hilar cholangiocarcinoma is the most common malignant tumor affecting the extrahepatic bile duct. Surgical treatment offers the only possibility of cure, and it requires removal of all tumoral tissues with adequate resection margins. The aims of this review are to summarize the findings and to discuss the controversies on the extent of surgical resection aiming at cure for hilar cholangiocarcinoma. The English medical literatures on hilar cholangiocarcinoma were studied to review on the relevance of adequate resection margins, routine caudate lobe resection, extent of liver resection, and combined vascular resection on perioperative and long-term survival outcomes of patients with resectable hilar cholangiocarcinoma. Complete resection of tumor represents the most important prognostic factor of long-term survival for hilar cholangiocarcinoma. The primary aim of surgery is to achieve R0 resection. When R1 resection is shown intraoperatively, further resection is recommended. Combined hepatic resection is now generally accepted as a standard procedure even for Bismuth type I/II tumors. Routine caudate lobe resection is also advocated for cure. The extent of hepatic resection remains controversial. Most surgeons recommend major hepatic resection. However, minor hepatic resection has also been advocated in most patients. The decision to carry out right- or left-sided hepatectomy is made according to the predominant site of the lesion. Portal vein resection should be considered when its involvement by tumor is suspected. The curative treatment of hilar cholangiocarcinoma remains challenging. Advances in hepatobiliary techniques have improved the perioperative and long-term survival outcomes of this tumor.

The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia.

Science.gov (United States)

Dydykin, Sergey; Kapitonova, Marina

2015-01-01

Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

Donor Lung Procurement by Surgical Fellow with an Expectation of High Rate of Lung Utilisation.

Science.gov (United States)

Smail, Hassiba; Saxena, Pankaj; Wallinder, Andreas; Lin, Enjarn; Snell, Gregory I; Hobson, Jamie; Zimmet, Adam D; Marasco, Silvana F; McGiffin, David C

2017-12-22

There is an ever increasing demand for donor lungs in patients waiting for transplantation. Lungs of many potential donors will be rejected if the standard criteria for donor assessment are followed. We have expanded our donor lung pool by accepting marginal donors and establishing a donation after circulatory death program. We have achieved comparable results using marginal donors and accepting donor lungs following donation after circulatory death. We present our assessment and technical guidelines on lung procurement taking into consideration an increasingly complex cohort of lung donors. These guidelines form the basis of the lung procurement training program involving surgical Fellows at the Alfred Hospital in Melbourne, Australia. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature

Directory of Open Access Journals (Sweden)

Guilherme Karam Corrêa Leite

Full Text Available CONTEXT AND OBJECTIVE: The incidence of scar endometrioma ranges from 0.03 to 3.5%. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. The aim here was to identify the clinical pattern of the disease and show surgical results. The literature on this topic was reviewed. DESIGN AND SETTING: Retrospective descriptive study at Hospital Municipal Maternidade - Escola Dr. Mário de Moraes Altenfelder Silva. METHODS: Data from the medical records of patients with preoperative diagnoses of scar endometrioma who underwent operations between 2001 and 2007 were surveyed and reviewed. The postoperative diagnosis came from histopathological analysis. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size and palpation, duration of complaint, diagnosis and treatment. All patients underwent tumor excision with a safety margin. RESULTS: There were 33 patients, of mean age 30.1 ± 5.0 years (range: 18-41 years. The total incidence was 0.11%: 0.29% in cesarean sections and 0.01% in vaginal deliveries. Twenty-nine tumors (87.9% were located in cesarean scars, two (6.0% in episiotomy scars and two (6.0% in the umbilical region. The main symptom was localized cyclical pain (66.7%, of mean duration 30.5 months (± 23. Surgical treatment was successful in all cases. CONCLUSION: This is an uncommon disease. The most important diagnostic characteristic is coincidence of painful symptoms with menstruation. Patients undergoing cesarean section are at greatest risk: relative risk of 27.37 (P < 0.01. The surgical treatment of choice is excision of the endometrioma with a safety margin.

Marginal cost application in the power industry

International Nuclear Information System (INIS)

Twardy, L.; Rusak, H.

1994-01-01

Two kind of marginal costs, the short-run and the long-run, are defined. The former are applied in conditions when the load increase is not accompanied neither by the increase of the transmission capacity not the installed capacity while the latter assume new investments to expand the power system. The long-run marginal costs be used to forecast optimized development of the system. They contain two main components: the marginal costs of capacity and the marginal costs of energy. When the long-run marginal costs are calculated, each component is considered for particular voltage levels, seasons of the year, hours of the day - selected depending on the system reliability factor as well as on its load level. In the market economy countries the long-run marginal costs can be used for setting up the electric energy tariffs. (author). 7 refs, 11 figs

New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"?

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Tchernev, Georgi; Chokoeva, Anastasiya Atanasova

2017-06-15

The American Joint Committee on Cancer (AJCC's) skin melanoma surgical treatment recommendations from 2011 are characterised by a prima facie "freedom of choice" regarding how extensive should be the excisions for melanomas with tumour thickness up to 2 mm and melanoma in situ. It is unclear why the recommended surgical security margins vary between 0.5 and 1 cm for melanoma in situ, whereas for melanomas with a tumour thickness of up to 1.99 mm, the range of variation is also between 1 and 2 cm, without specifying when the surgical field should be broader and, narrower, accordingly. This "uncertainty or lack of intent" of the guilders often leads to the same surgical approach to melanomas at different stages, or to a different approach in cases of melanomas at the same stage, in contrast. Therefore, this should be defined as wrong, logically. We present 3 patients with cutaneous melanomas, treated with similar fields of surgical security. Current issues, generated within the framework of melanoma's surgery guided by the recommendations of the AJCC are also discussed. A new surgical approach in patients with melanoma is recommended, discussed for the first time in world literature. We hypothesize that the introduction of a certain recommendations for a 2 cm surgical field in all directions during the initial excision, combined with the parallel performance of a sentinel lymph node biopsy, will lead in fact to several important advantages: 1) avoiding of the secondary excision in at least 70% - 90% of the patients (depending on the tumor thickness), 2) minimizing the risk of lymphatic effusion change and misinterpretation of the sentinel lymph node biopsy's results in patients with secondary excision; 3) optimization of the surgical team's work; 4) minimizing the possibility of unprepared/uninformed personnel to take part in decisions for treating a specific disease such as skin melanoma, 4) facilitating the appropriate patients' group selection at the appropriate

Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India.

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Gandhi, K; Sahni, N; Padhy, S K; Mathew, P J

2017-10-23

The residents undergoing training at hospitals in our country face challenges in terms of infrastructure and high workload with undefined working hours. The aim of the study was to compare the stress and burnout levels in trainee doctors doing residency in surgical fields and anesthesia at a tertiary care academic center in North India. A comparative, observational study was conducted in a tertiary care teaching hospital in North India. After Ethics Committee approval, 200 residents (100 each from surgical branches and anesthesia) were required to fill a questionnaire with information about age, sex, year of residency, marital status, and the Perceived Stress Scale-10, and Burnout Clinical Subtype Questionnaire-12. Burnout and perceived stress were compared between residents of anesthesia and surgical specialties. Residents of both surgical and anesthesia branches scored high in perceived stress, namely 21 and 18, respectively. The score was significantly higher in surgical residents (P = 0.03) and increased progressively with the year of residency. The majority of residents (90% surgical, 80% anesthesia) felt that they were being overloaded with work. However, only 20%-30% of respondents felt that there was lack of development of individual skills and still fewer (<10%) reported giving up in view of difficulties. There is high level of stress and overload dimension of burnout among the residents of anesthesia and surgical branches at our tertiary care academic institution and the surgical residents score marginally higher than anesthesia residents.

Workers' marginal costs of commuting

DEFF Research Database (Denmark)

van Ommeren, Jos; Fosgerau, Mogens

2009-01-01

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...

[Evaluation of the results of surgical treatment of granuloma teleangiectodes].

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Bogdanowski, T; Rubisz-Brzezińska, J; Macura-Gina, M; Misiewicz, D

1990-01-01

In the clinic of dermatological surgery, I Department of Dermatology Silesian Medical Academy in Katowice 328 patients were treated surgically for granuloma teleangiectodes in the years 1973-1988. Two methods were used: excision of the lesion and curettage with electrocoagulation of the base of the lesion. After excision the wound was closed by approximation of its margins or local plastic procedure (285 cases) and by covering it with a free full-thickness skin graft (3 cases). Curettage and electrocoagulation was used in 43 cases, mainly due to the location of the lesion (in 90% on fingers). After granuloma excision no recurrences were observed, while after curettage and electrocoagulation recurrences developed in 20% of cases.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Science.gov (United States)

Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

2015-08-01

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

Pathology of nodal marginal zone lymphomas.

Science.gov (United States)

Pileri, Stefano; Ponzoni, Maurilio

Nodal marginal zone B cell lymphomas (NMZLs) are a rare group of lymphoid disorders part of the spectrum of marginal zone B-cell lymphomas, which encompass splenic marginal one B-cell lymphoma (SMZL) and extra nodal marginal zone of B-cell lymphoma (EMZL), often of MALT-type. Two clinicopathological forms of NMZL are recognized: adult-type and pediatric-type, respectively. NMZLs show overlapping features with other types of MZ, but distinctive features as well. In this review, we will focus on the salient distinguishing features of NMZL mostly under morphological/immunophenotypical/molecular perspectives in views of the recent acquisitions and forthcoming updated 2016 WHO classification of lymphoid malignancies. Copyright © 2016 Elsevier Ltd. All rights reserved.

Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams.

Science.gov (United States)

Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

Biodiversity and agro-ecology in field margins.

Science.gov (United States)

De Cauwer, B; Reheul, D; Nijs, I; Milbau, A

2005-01-01

This multidisciplinary study investigates agro-ecological functions (nature conservation, agriculture, environment) and implications of newly created, mown sown and unsown field margin strips installed on ex-arable land to increase biodiversity. From conservational concern, the development of species rich field margin strips was not strongly affected by the installed type of margin strip since species diversity converged over time, whether strips were sown or not. Convergence between unsown and sown margin strips occurred also in terms of species composition: unsown and sown strips became similar over time. Mowing without removal of cuttings significantly reduced species richness, yielded more grassy margin strips and delayed similarity in species composition between sown and unsown margin strips. Species richness on the longer term was not significantly affected by light regime nor by disturbance despite significant temporary effects shortly after the disturbance event. On the contrary vegetation composition in terms of importance of functional groups changed after disturbance: the share of spontaneous species within functional groups increased resulting in higher similarity between the sown and unsown vegetation. Furthermore risk of invasion was highest in the disturbed unsown community on the unshaded side of a tree lane. A positive effect of botanical diversity on insect number and diversity was found. However the effects of botanical diversity on insect number was mediated by light regime. At high light availability differences between plant communities were more pronounced compared to low light availablilty. The abundance of some insect families was dependent on the vegetation composition. Furthermore light availability significantly influenced insect diversity as well as the spatial distribution of families. From agricultural concern, installing margin strips by sowing a species mixture and a mowing regime with removal of cuttings are good practices to

Resynchronising returns to service in anoestrous dairy cows in the South Island of New Zealand.

Science.gov (United States)

Bates, A J; Kenyon, A G; Laven, R A; McDowell, J C

2016-09-01

To investigate the effect of targeted resynchronisation of cows treated for non-observed oestrus before the planned start of mating (PSM), that were not detected in oestrus or pregnant 23 days after treatment (phantom cows), on the proportion pregnant at 42 days after PSM and the end of mating. Farm staff from eight herds in two regions of the South Island of New Zealand identified 1,819 cows not showing oestrus by 10 days before PSM. These cows were treated with intravaginal progesterone for 7 days, and I/M gonadorelin 10 days and 1 day before PSM. Three days before PSM they were injected with cloprostenol and equine chorionic gonadotrophin, with fixed time artificial insemination (FTAI) at PSM. By 23 days after PSM, 1,218 cows had not returned to oestrus. Of these, 161 cows confirmed not pregnant by transrectal ultrasonography were randomly assigned to no treatment (control group; n=74) or were resynchronised 25 days after PSM using the same treatment programme as above, with FTAI 35 days after PSM (n=87). All cows that returned to oestrus were artificially inseminated until 42 days after PSM, when natural mating was used. All cows were examined using transrectal ultrasonography 80 to 90 days after PSM to confirm conception dates. Of the 1,819 anoestrous cows treated before PSM, 526 (29 (95% CI=23.1-34.0)%) had not been observed in oestrus by 23 days after PSM and had not conceived, so were diagnosed as phantoms cows. For resynchronised cows, 42/87 (48 (95% CI=37.8-58.8)%) were pregnant by 42 days after PSM compared to 21/74 (28 (95% CI=18.1-38.7)%) control cows (p=0.009). At the end of mating 58/87 (67 (95% CI=56.6-76.7)%) cows in the resynchronised group were pregnant and 46/74 (62 (95% CI=50.9-73.2)%) in the control group (p=0.554). The hazard of conception from 21 to 42 days after PSM was 1.9 (95% CI=1.07-3.12) times greater for resynchronised than control cows (p=0.026). In cows not observed in oestrus and treated before PSM, resynchronisation increased the

Surgical orthodontics.

Science.gov (United States)

Strohl, Alexis M; Vitkus, Lauren

2017-08-01

The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

Surgical and pathological outcomes of laparoscopic surgery for transverse colon cancer.

Science.gov (United States)

Lee, Y S; Lee, I K; Kang, W K; Cho, H M; Park, J K; Oh, S T; Kim, J G; Kim, Y H

2008-07-01

Several multi-institutional prospective randomized trials have demonstrated short-term benefits using laparoscopy. Now the laparoscopic approach is accepted as an alternative to open surgery for colon cancer. However, in prior trials, the transverse colon was excluded. Therefore, it has not been determined whether laparoscopy can be used in the setting of transverse colon cancer. This study evaluated the peri-operative clinical outcomes and oncological quality by pathologic outcomes of laparoscopic surgery for transverse colon cancer. Analysis of the medical records of patients who underwent laparoscopic colorectal resection from August 2004 to November 2007 was made. Computed tomography, barium enema, and colonoscopy were performed to localize the tumor preoperatively. Extended right hemicolectomy, transverse colectomy, and extended left hemicolectomy were performed for transverse colon cancer. Surgical outcomes and pathologic outcomes were compared between transverse colon cancer (TCC) and other site colon cancer (OSCC). Of the 312 colorectal cancer patients, 94 patients underwent laparoscopic surgery for OSCC, and 34 patients underwent laparoscopic surgery for TCC. Patients with TCC were similar to patients with OSCC in age, gender, body mass index, operating time, blood loss, time to pass flatus, start of diet, hospital stay, tumor size, distal resection margin, proximal resection margin, number of lymph nodes, and radial margin. One case in TCC and three cases in OSCC were converted to open surgery. Laparoscopic surgery for transverse colon cancer and OSCC had similar peri-operative clinical and acceptable pathological outcomes.

Risk insights from seismic margin reviews

International Nuclear Information System (INIS)

Budnitz, R.J.

1990-01-01

This paper discusses the information that has been derived from the three seismic-margin reviews conducted so far, and the information that is potentially available from using the seismic-margin method more generally. There are two different methodologies for conducting seismic margin reviews of nuclear power plants, one developed under NRC sponsorship and one developed under sponsorship of the Electric Power Research Institute. Both methodologies will be covered in this paper. The paper begins with a summary of the steps necessary to complete a margin review, and will then outline the key technical difficulties that need to be addressed. After this introduction, the paper covers the safety and operational insights derived from the three seismic-margin reviews already completed: the NRC-sponsored review at Maine Yankee; the EPRI-sponsored review at Catawba; and the joint EPRI/NRC/utility effort at Hatch. The emphasis is on engineering insights, with attention to the aspects of the reviews that are easiest to perform and that provide the most readily available insights

Exactly marginal deformations from exceptional generalised geometry

Energy Technology Data Exchange (ETDEWEB)

Ashmore, Anthony [Merton College, University of Oxford,Merton Street, Oxford, OX1 4JD (United Kingdom); Mathematical Institute, University of Oxford,Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG (United Kingdom); Gabella, Maxime [Institute for Advanced Study,Einstein Drive, Princeton, NJ 08540 (United States); Graña, Mariana [Institut de Physique Théorique, CEA/Saclay,91191 Gif-sur-Yvette (France); Petrini, Michela [Sorbonne Université, UPMC Paris 05, UMR 7589, LPTHE,75005 Paris (France); Waldram, Daniel [Department of Physics, Imperial College London,Prince Consort Road, London, SW7 2AZ (United Kingdom)

2017-01-27

We apply exceptional generalised geometry to the study of exactly marginal deformations of N=1 SCFTs that are dual to generic AdS{sub 5} flux backgrounds in type IIB or eleven-dimensional supergravity. In the gauge theory, marginal deformations are parametrised by the space of chiral primary operators of conformal dimension three, while exactly marginal deformations correspond to quotienting this space by the complexified global symmetry group. We show how the supergravity analysis gives a geometric interpretation of the gauge theory results. The marginal deformations arise from deformations of generalised structures that solve moment maps for the generalised diffeomorphism group and have the correct charge under the generalised Reeb vector, generating the R-symmetry. If this is the only symmetry of the background, all marginal deformations are exactly marginal. If the background possesses extra isometries, there are obstructions that come from fixed points of the moment maps. The exactly marginal deformations are then given by a further quotient by these extra isometries. Our analysis holds for any N=2 AdS{sub 5} flux background. Focussing on the particular case of type IIB Sasaki-Einstein backgrounds we recover the result that marginal deformations correspond to perturbing the solution by three-form flux at first order. In various explicit examples, we show that our expression for the three-form flux matches those in the literature and the obstruction conditions match the one-loop beta functions of the dual SCFT.

Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.

Science.gov (United States)

Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando

2016-07-01

The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols. Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest. Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels. Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when

RISK-INFORMED SAFETY MARGIN CHARACTERIZATION

International Nuclear Information System (INIS)

Dinh, Nam; Szilard, Ronaldo

2009-01-01

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

[Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study].

Science.gov (United States)

Hoch, J; Ferko, A; Bláha, M; Ryška, A; Čapov, I; Dušek, L; Feit, J; Grega, M; Hermanová, M; Hovorková, E; Chmelová, R; Kala, Z; Klos, D; Kodet, R; Langer, D; Hadži-Nikolov, D; Örhalmi, J; Páral, J; Tichý, M; Tučková, I; Vjaclovský, M; Vlček, P

Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed - total mesorectal excision (TME) - and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeons skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete. The aim of our study was to implement and standardize a new method of evaluation of the quality of the surgical procedure - TME - in rectal cancer treatment using an assessment of its circumferential margins (CRO) and completeness of the excision. The study consisted of two parts. The first, multi-centre retrospective phase with 288 patients analysed individual partial parameters of the diagnosis, operations and histological examinations of the rectal cancer. Critical points were identified and a unified follow-up protocol was prepared. In the second, prospective part of this study 600 patients were monitored parametrically focusing on the quality of the TME and its effect on the oncological treatment results. The proportion of patients with restaging following neoadjuvant therapy increased from 60.0% to 81.7% based on preoperative diagnosis. The number of specimens missing an assessment of the mesorectal excision quality decreased from 52.9% in the retrospective part of to the study to 22.8% in the prospective part. The proportion of actually complete TMEs rose from 22.6% to 26.0%, and that of nearly complete TMEs from 10.1% to 24.0%. The introduction of parametric monitoring into routine clinical practice improved the quality of pre-treatment and preoperative diagnosis, examination of

MR imaging of intramedullary tumors of the spinal cord: comparison with surgical findings

International Nuclear Information System (INIS)

Choe, Du Whan; Hwang, Hee Young; Lee, Hyeon Kyeong; Han, Moon Hee; Kim, In One; Kim, Hyen Jip; Chang, Kee Hyung

1991-01-01

To evaluate the capability of MR imaging to localize intramedullary tumors of the spinal cord and to distinguish solid from cystic components. MR images of 12 patients with surgically-proven intramedullary spinal cord tumor were retrospectively reviewed and correlated with surgical findings. Histologic diagnosis consisted of 3 astrocytomas, 4 ependymomas, 2 gangliogliomas, and one case of lipoma, lymphoma, and glioblastoma multiform each. MR scans were obtained on a 2.0T or a 0.5T with T1-and T2-weighted spin-echo pulse sequences in sagittal and axial planes. Contrast enhancement was performed with Gd-DTPA in 9 patients. All tumors expanded the spinal cord and showed an extent of involvement ranging from 2 to 5 vertebral heights, except for the gangliogliomas which involved the spinal cord more extensively. Contrast enhancement was seen in all 9 patients. Intratumoral cavities were observed in 1 out of 3 astrocytomas and 2 gangliogliomas. Peritumoral syringomyelia was seen in 2 out of 4 ependymonas and 2 gangliogliomas. In most cases, the MR findings correlated well with the surgical findings with respect to the extent, distinctness of the tumor margin, intratumoral cavity, and associated syringomyelia. It is concluded that MR imaging is a very useful diagnostic tool in the evaluation of intramedullary spinal cord tumors

Professional Commitment and Professional Marginalism in Teachers

Directory of Open Access Journals (Sweden)

Kalashnikov A.I.

2017-11-01

Full Text Available The article reviews teachers' attitudes towards the teaching profession which can be expressed both in professional commitment and in professional marginalism. The dominance of professional marginalism could affect destructively the students as well as the teacher’s personality, hence the issues related to the content of personal position of a marginal and the rate of marginalism among teachers. It was suggested that marginalism could be revealed in the study of professional commitment. The study involved 81 teachers of Sverdlovsk secondary schools aged 21—60 years with work experience ranging from 1 month to 39 years. The Professional Commitment Questionnaire was used as the study technique. The results showed that negative emotional attitude towards the profession and reluctance to leave the profession were grouped as a separate factor. The dispersion factor was 12,5%. The factor loadings ranged from 0.42 to 0.84. The study proved that professional marginalism in teachers includes dissatisfaction with work, feelings of resentment against profession and an unwillingness to leave the profession.

A quantitative analysis of transtensional margin width

Science.gov (United States)

Jeanniot, Ludovic; Buiter, Susanne J. H.

2018-06-01

Continental rifted margins show variations between a few hundred to almost a thousand kilometres in their conjugated widths from the relatively undisturbed continent to the oceanic crust. Analogue and numerical modelling results suggest that the conjugated width of rifted margins may have a relationship to their obliquity of divergence, with narrower margins occurring for higher obliquity. We here test this prediction by analysing the obliquity and rift width for 26 segments of transtensional conjugate rifted margins in the Atlantic and Indian Oceans. We use the plate reconstruction software GPlates (http://www.gplates.org) for different plate rotation models to estimate the direction and magnitude of rifting from the initial phases of continental rifting until breakup. Our rift width corresponds to the distance between the onshore maximum topography and the last identified continental crust. We find a weak positive correlation between the obliquity of rifting and rift width. Highly oblique margins are narrower than orthogonal margins, as expected from analogue and numerical models. We find no relationships between rift obliquities and rift duration nor the presence or absence of Large Igneous Provinces (LIPs).

Investigating the Structure and Meaning of Public Service Motivation across Populations

DEFF Research Database (Denmark)

Kim, Sangmook; Vandenabeele, Wouter; Wright, Bradley E.

2013-01-01

The growth in international research on public service motivation (PSM) raises a number of important questions about the degree to which the theory and research developed in one country can contribute to our understanding of PSM in other counties. To help address this issue, this study revisits...... approach by combining the efforts of international PSM scholars to develop and then test a revised measurement instrument for PSM in 12 countries. Although the resulting four dimensional 16-item measure of PSM reported here provides a better theoretical and empirical foundation for the measurement of PSM...

Synthesis of plastic scintillation microspheres: Evaluation of scintillators

International Nuclear Information System (INIS)

Santiago, L.M.; Bagán, H.; Tarancón, A.; Garcia, J.F.

2013-01-01

The use of plastic scintillation microspheres (PSm) appear to be an alternative to liquid scintillation for the quantification of alpha and beta emitters because it does not generate mixed wastes after the measurement (organic and radioactive). In addition to routine radionuclide determinations, PSm can be used for further applications, e.g. for usage in a continuous monitoring equipment, for measurements of samples with a high salt concentration and for an extractive scintillation support which permits the separation, pre-concentration and measurement of the radionuclides without additional steps of elution and sample preparation. However, only a few manufacturers provide PSm, and the low number of regular suppliers reduces its availability and restricts the compositions and sizes available. In this article, a synthesis method based on the extraction/evaporation methodology has been developed and successfully used for the synthesis of plastic scintillation microspheres. Seven different compositions of plastic scintillation microspheres have been synthesised; PSm1 with polystyrene, PSm2 with 2,5-Diphenyloxazol(PPO), PSm3 with p-terphenyl (pT), PSm4 with PPO and 1,4-bis(5-phenyloxazol-2-yl) (POPOP), PSm5 pT and (1,4-bis [2-methylstyryl] benzene) (Bis-MSB), PSm6 with PPO, POPOP and naphthalene and PSm7 with pT, Bis-MSB and naphthalene. The synthesised plastic scintillation microspheres have been characterised in terms of their morphology, detection capabilities and alpha/beta separation capacity. The microspheres had a median diameter of approximately 130 μm. Maximum detection efficiency values were obtained for the PSm4 composition as follows 1.18% for 3 H, 51.2% for 14 C, 180.6% for 90 Sr/ 90 Y and 76.7% for 241 Am. Values of the SQP(E) parameter were approximately 790 for PSm4 and PSm5. These values show that the synthesised PSm exhibit good scintillation properties and that the spectra are at channel numbers higher than in commercial PSm. Finally, the addition

On the evaluation of marginal expected shortfall

DEFF Research Database (Denmark)

Caporin, Massimiliano; Santucci de Magistris, Paolo

2012-01-01

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...

Eagle syndrome surgical treatment with piezosurgery.

Science.gov (United States)

Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

2014-05-01

Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Advancing optical imaging for breast margin assessment: an analysis of excisional time, cautery, and patent blue dye on underlying sources of contrast.

Directory of Open Access Journals (Sweden)

Torre M Bydlon

Full Text Available Breast conserving surgery (BCS is a recommended treatment for breast cancer patients where the goal is to remove the tumor and a surrounding rim of normal tissue. Unfortunately, a high percentage of patients return for additional surgeries to remove all of the cancer. Post-operative pathology is the gold standard for evaluating BCS margins but is limited due to the amount of tissue that can be sampled. Frozen section analysis and touch-preparation cytology have been proposed to address the surgical needs but also have sampling limitations. These issues represent an unmet clinical need for guidance in resecting malignant tissue intra-operatively and for pathological sampling. We have developed a quantitative spectral imaging device to examine margins intra-operatively. The context in which this technology is applied (intra-operative or post-operative setting is influenced by time after excision and surgical factors including cautery and the presence of patent blue dye (specifically Lymphazurin™, used for sentinel lymph node mapping. Optical endpoints of hemoglobin ([THb], fat ([β-carotene], and fibroglandular content via light scattering ( measurements were quantified from diffuse reflectance spectra of lumpectomy and mastectomy specimens using a Monte Carlo model. A linear longitudinal mixed-effects model was used to fit the optical endpoints for the cautery and kinetics studies. Monte Carlo simulations and tissue mimicking phantoms were used for the patent blue dye experiments. [THb], [β-carotene], and were affected by , and [β-carotene]/ was 40%. [β-carotene] and [β-carotene]/ were the only parameters not affected by cautery. This work demonstrates the importance of understanding the post-excision kinetics of ex-vivo tissue and the presence of cautery and patent blue dye for breast tumor margin assessment, to accurately interpret data and exploit underling sources of contrast.

Ferritin associates with marginal band microtubules

International Nuclear Information System (INIS)

Infante, Anthony A.; Infante, Dzintra; Chan, M.-C.; How, P.-C.; Kutschera, Waltraud; Linhartova, Irena; Muellner, Ernst W.; Wiche, Gerhard; Propst, Friedrich

2007-01-01

We characterized chicken erythrocyte and human platelet ferritin by biochemical studies and immunofluorescence. Erythrocyte ferritin was found to be a homopolymer of H-ferritin subunits, resistant to proteinase K digestion, heat stable, and contained iron. In mature chicken erythrocytes and human platelets, ferritin was localized at the marginal band, a ring-shaped peripheral microtubule bundle, and displayed properties of bona fide microtubule-associated proteins such as tau. Red blood cell ferritin association with the marginal band was confirmed by temperature-induced disassembly-reassembly of microtubules. During erythrocyte differentiation, ferritin co-localized with coalescing microtubules during marginal band formation. In addition, ferritin was found in the nuclei of mature erythrocytes, but was not detectable in those of bone marrow erythrocyte precursors. These results suggest that ferritin has a function in marginal band formation and possibly in protection of the marginal band from damaging effects of reactive oxygen species by sequestering iron in the mature erythrocyte. Moreover, our data suggest that ferritin and syncolin, a previously identified erythrocyte microtubule-associated protein, are identical. Nuclear ferritin might contribute to transcriptional silencing or, alternatively, constitute a ferritin reservoir

Methylation patterns in marginal zone lymphoma.

Science.gov (United States)

Arribas, Alberto J; Bertoni, Francesco

Promoter DNA methylation is a major regulator of gene expression and transcription. The identification of methylation changes is important for understanding disease pathogenesis, for identifying prognostic markers and can drive novel therapeutic approaches. In this review we summarize the current knowledge regarding DNA methylation in MALT lymphoma, splenic marginal zone lymphoma, nodal marginal zone lymphoma. Despite important differences in the study design for different publications and the existence of a sole large and genome-wide methylation study for splenic marginal zone lymphoma, it is clear that DNA methylation plays an important role in marginal zone lymphomas, in which it contributes to the inactivation of tumor suppressors but also to the expression of genes sustaining tumor cell survival and proliferation. Existing preclinical data provide the rationale to target the methylation machinery in these disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

Limitations of ''margin'' in qualification tests

International Nuclear Information System (INIS)

Clough, R.L.; Gillen, K.T.

1984-01-01

We have carried out investigations of polymer radiation degradation behaviors which have brought to light a number of reasons why this concept of margin can break down. First of all, we have found that dose-rate effects vary greatly in magnitude. Thus, based on high dose-rate testing, poor materials with large dose-rate effects may be selected over better materials with small effects. Also, in certain cases, material properties have been found to level out (as with PVC) or reverse trend (as with buna-n) at high doses, so that ''margin'' may be ineffective, misleading, or counterproductive. For Viton, the material properties were found to change in opposite directions at high and low dose rates, making ''margin'' inappropriate. The underlying problem with the concept of ''margin'' is that differences in aging conditions can lead to fundamental differences in degradation mechanisms

Modeling of the pliant surfaces of the thigh and leg during gait

Science.gov (United States)

Ball, Kevin A.; Pierrynowski, Michael R.

1998-05-01

Rigid Body Modeling, a 6 degree of freedom (DOF) method, provides state of the art human movement analysis, but with one critical limitation; it assumes segment rigidity. A non- rigid 12 DOF method, Pliant Surface Modeling (PSM) was developed to model the simultaneous pliant characteristics (scaling and shearing) of the human body's soft tissues. For validation, bone pins were surgically inserted into the tibia and femur of three volunteers. Infrared markers (44) were placed upon the thigh, leg, and bone pin surfaces. Two synchronized OPTOTRAK/3020TM cameras (Northern Digital Inc., Waterloo, ON) were used to record 120 seconds of treadmill gait per subject. In comparison to the 'gold standard' bone pin rotational results, PSM located the tibia, femur and tibiofemoral joint with root mean square (RMS) errors of 2.4 degrees, 4.0 degrees and 4.6 degrees, respectively. These performances met or exceeded (P less than .01) the current state of the art for surface data, Rigid Surface Modeling. The thigh's measured surface experienced uniform repeatable changes in scale: 40% mediolateral, 5% anterioposterior, 5% superioinferior, and planar shears of: 25 degrees transverse, 15 degrees sagittal, 5 degrees frontal. With the brief exception of push-off, the lower leg demonstrated much greater rigidity: less than 5% scaling and less than 5 degrees shearing. Thus, PSM offers superior 'rigid' estimates of knee motion with the ability to quantify 'pliant' surface changes.

The 'Lumbar Fusion Outcome Score' (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain.

Science.gov (United States)

Mattei, Tobias A; Rehman, Azeem A; Teles, Alisson R; Aldag, Jean C; Dinh, Dzung H; McCall, Todd D

2017-01-01

In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes - as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) - were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up. In conclusion,  LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.

Micro-surgical endodontics.

Science.gov (United States)

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

2014-02-01

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.

Prosocial Behavior and Public Service Motivation

NARCIS (Netherlands)

Esteve, Marc; Urbig, Diemo; van Witteloostuijn, Arjen; Boyne, George

2016-01-01

Although research on public service motivation (PSM) is vast, there is little evidence regarding the effects of PSM on observable behavior. This article contributes to the understanding of the behavioral implications of PSM by investigating whether PSM is associated with prosocial behavior.

Prosocial behavior and public service motivation

NARCIS (Netherlands)

Esteve, M.; Urbig, D.; van Witteloostuijn, Arjen; Boyne, George

Although research on public service motivation (PSM) is vast, there is little evidence regarding the effects of PSM on observable behavior. This article contributes to our understanding of the behavioral implications of PSM by investigating whether PSM is associated with prosocial behavior.

Mediastinal Bronchogenic Cyst With Acute Cardiac Dysfunction: Two-Stage Surgical Approach.

Science.gov (United States)

Smail, Hassiba; Baste, Jean Marc; Melki, Jean; Peillon, Christophe

2015-10-01

We describe a two-stage surgical approach in a patient with cardiac dysfunction and hemodynamic compromise resulting from a massive and compressive mediastinal bronchogenic cyst. To drain this cyst, video-assisted mediastinoscopy was performed as an emergency procedure, which immediately improved the patient's cardiac function. Five days later and under video thoracoscopy, resection of the cyst margins was impossible because the cyst was tightly adherent to the left atrium. We performed deroofing of this cyst through a right thoracotomy. The patient had an uncomplicated postoperative recovery, and no recurrence was observed at the long-term follow-up visit. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].

Science.gov (United States)

Zeng, Dong-Zhu; Shi, Yan; Lei, Xiao; Tang, Bo; Hao, Ying-Xue; Luo, Hua-Xing; Lan, Yuan-Zhi; Yu, Pei-Wu

2013-05-01

To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

Silenced, Silence, Silent: Motherhood in the Margins

Science.gov (United States)

Carpenter, Lorelei; Austin, Helena

2007-01-01

This project explores the experiences of women who mother children with ADHD. The authors use the metaphor of the text and the margin. The text is the "motherhood myth" that describes a particular sort of "good" mothering. The margin is the space beyond that text. This marginal space is inhabited by some or all of the mothers they spoke with, some…

A methodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices

International Nuclear Information System (INIS)

Prisciandaro, Joann I.; Frechette, Christina M.; Herman, Michael G.; Brown, Paul D.; Garces, Yolanda I.; Foote, Robert L.

2004-01-01

Assessment of clinic and site specific margins are essential for the effective use of three-dimensional and intensity modulated radiation therapy. An electronic portal imaging device (EPID) based methodology is introduced which allows individual and population based CTV-to-PTV margins to be determined and compared with traditional margins prescribed during treatment. This method was applied to a patient cohort receiving external beam head and neck radiotherapy under an IRB approved protocol. Although the full study involved the use of an EPID-based method to assess the impact of (1) simulation technique (2) immobilization, and (3) surgical intervention on inter- and intrafraction variations of individual and population-based CTV-to-PTV margins, the focus of the paper is on the technique. As an illustration, the methodology is utilized to examine the influence of two immobilization devices, the UON TM thermoplastic mask and the Type-S TM head/neck shoulder immobilization system on margins. Daily through port images were acquired for selected fields for each patient with an EPID. To analyze these images, simulation films or digitally reconstructed radiographs (DRR's) were imported into the EPID software. Up to five anatomical landmarks were identified and outlined by the clinician and up to three of these structures were matched for each reference image. Once the individual based errors were quantified, the patient results were grouped into populations by matched anatomical structures and immobilization device. The variation within the subgroup was quantified by calculating the systematic and random errors (Σ sub and σ sub ). Individual patient margins were approximated as 1.65 times the individual-based random error and ranged from 1.1 to 6.3 mm (A-P) and 1.1 to 12.3 mm (S-I) for fields matched on skull and cervical structures, and 1.7 to 10.2 mm (L-R) and 2.0 to 13.8 mm (S-I) for supraclavicular fields. Population-based margins ranging from 5.1 to 6.6 mm (A

Continental transform margins : state of art and future milestones

Science.gov (United States)

Basile, Christophe

2010-05-01

Transform faults were defined 45 years ago as ‘a new class of fault' (Wilson, 1965), and transform margins were consequently individualized as a new class of continental margins. While transform margins represent 20 to 25 % of the total length of continent-ocean transitions, they were poorly studied, especially when compared with the amount of data, interpretations, models and conceptual progress accumulated on divergent or convergent continental margins. The best studied examples of transform margins are located in the northern part of Norway, south of South Africa, in the gulf of California and on both sides of the Equatorial Atlantic. Here is located the Côte d'Ivoire - Ghana margin, where the more complete data set was acquired, based on numerous geological and geophysical cruises, including ODP Leg 159. The first models that encompassed the structure and evolution of transform margins were mainly driven by plate kinematic reconstructions, and evidenced the diachronic end of tectonic activity and the non-cylindrical character of these margins, with a decreasing strike-slip deformation from the convex to the concave divergent-transform intersections. Further thermo-mechanical models were more specifically designed to explain the vertical displacements along transform margins, and especially the occurrence of high-standing marginal ridges. These thermo-mechanical models involved either heat transfer from oceanic to continental lithospheres across the transform faults or tectonically- or gravity-driven mass transfer in the upper crust. These models were far from fully fit observations, and were frequently dedicated to specific example, and not easily generalizable. Future work on transform continental margins may be expected to fill some scientific gaps, and the definition of working directions can benefit from the studies dedicated to other types of margins. At regional scale the structural and sedimentological variability of transform continental margins has

Public service motivation ad fonts : Personality traits as antecedents to serve the public interest

NARCIS (Netherlands)

van Witteloostuijn, Arjen; Esteve, M.; Boyne, G.

2017-01-01

Public Service Motivation (PSM) is a topic that has generated considerable interest among Public Administration scholars. Research on PSM has mainly focused on either defining what PSM is and how this construct can be measured or on testing how PSM affects individual and organizational variables.

Public sector motivation ad fonts : Personality traits as antecedents of the motivation to serve the public interest

NARCIS (Netherlands)

Van Witteloostuijn, Arjen; Esteve, Marc; Boyne, George

2017-01-01

Public Service Motivation (PSM) is a topic that has generated considerable interest among Public Administration scholars. Research on PSM has mainly focused on either defining what PSM is and how this construct can be measured or on testing how PSM affects individual and organizational variables.

Aspects of marginal expenditures in energy sector

International Nuclear Information System (INIS)

Stojchev, D.; Kynev, K.

1994-01-01

Technical and economical problems of marginal analysis methodology, its application procedure in energy sector and marginal expenditures determination are outlined. A comparative characteristics of the application is made for different periods of time. The differences in calculation of the marginal expenditures and prices are discussed. The operational costs, investments and inflation are analyzed. The mechanism of application of this approach in different planing horizon is outlined. The role of the change in the costs in time, the time unit, volume, the scope of application, etc. are determined. The areas of transition from one to other form of marginal expenditures are shown. 4 refs. (orig.)

SU-F-J-130: Margin Determination for Hypofractionated Partial Breast Irradiation

Energy Technology Data Exchange (ETDEWEB)

Geady, C [Ryerson University (Canada); Keller, B; Hahn, E; Vesprini, D; Soliman, H; Lee, J [University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario (Canada); Ruschin, M; McCann, C [University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Makhani, N; Bosnic, S [Sunnybrook Health Sciences Center, Toronto, Ontario (Canada)

2016-06-15

Purpose: To determine the Planning Target Volume (PTV) margin for Hypofractionated Partial Breast Irradiation (HPBI) using the van Herk formalism (M=2.5∑+0.7σ). HPBI is a novel technique intended to provide local control in breast cancer patients not eligible for surgical resection, using 40 Gy in 5 fractions prescribed to the gross disease. Methods: Setup uncertainties were quantified through retrospective analysis of cone-beam computed tomography (CBCT) data sets, collected prior to (prefraction) and after (postfraction) treatment delivery. During simulation and treatment, patients were immobilized using a wing board and an evacuated bag. Prefraction CBCT was rigidly registered to planning 4-dimensional computed tomography (4DCT) using the chest wall and tumor, and translational couch shifts were applied as needed. This clinical workflow was faithfully reproduced in Pinnacle (Philips Medical Systems) to yield residual setup and intrafractional error through translational shifts and rigid registrations (ribs and sternum) of prefraction CBCT to 4DCT and postfraction CBCT to prefraction CBCT, respectively. All ten patients included in this investigation were medically inoperable; the median age was 84 (range, 52–100) years. Results: Systematic (and random) setup uncertainties (in mm) detected for the left-right, craniocaudal and anteroposterior directions were 0.4 (1.5), 0.8 (1.8) and 0.4 (1.0); net uncertainty was determined to be 0.7 (1.5). Rotations >2° in any axis occurred on 8/72 (11.1%) registrations. Conclusion: Preliminary results suggest a non-uniform setup margin (in mm) of 2.2, 3.3 and 1.7 for the left-right, craniocaudal and anteroposterior directions is required for HPBI, given its immobilization techniques and online setup verification protocol. This investigation is ongoing, though published results from similar studies are consistent with the above findings. Determination of margins in breast radiotherapy is a paradigm shift, but a necessary

Characterizing entanglement with global and marginal entropic measures

International Nuclear Information System (INIS)

Adesso, Gerardo; Illuminati, Fabrizio; De Siena, Silvio

2003-01-01

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 entanglement 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

Steel Industry Marginal Opportunity Analysis

Energy Technology Data Exchange (ETDEWEB)

none,

2005-09-01

The Steel Industry Marginal Opportunity Analysis (PDF 347 KB) identifies opportunities for developing advanced technologies and estimates both the necessary funding and the potential payoff. This analysis determines what portion of the energy bandwidth can be captured through the adoption of state-of-the-art technology and practices. R&D opportunities for addressing the remainder of the bandwidth are characterized and plotted on a marginal opportunity curve.

Pilot Study of a New Nonradioactive Surgical Guidance Technology for Locating Nonpalpable Breast Lesions.

Science.gov (United States)

Cox, Charles E; Garcia-Henriquez, Norbert; Glancy, M Jordan; Whitworth, Pat; Cox, John M; Themar-Geck, Melissa; Prati, Ronald; Jung, Michelle; Russell, Scott; Appleton, Kristie; King, Jeff; Shivers, Steven C

2016-06-01

The current technique for locating nonpalpable breast lesions is wire localization (WL). Radioactive seed localization and intraoperative ultrasound were developed to improve difficulties with WL. The SAVI SCOUT surgical guidance system was developed to improve these methods. The SCOUT system is a non-radioactive, FDA-cleared medical device that uses electromagnetic wave technology to provide real-time guidance during excisional breast procedures. Consenting patients underwent localization and excision using an implantable electromagnetic wave reflective device (reflector) and a detector handpiece with a console. Using image guidance, the reflector was placed up to 7 days before the surgical procedure. The primary end points of the study were successful reflector placement, localization, and retrieval. The secondary end points were percentage of clear margins, reexcision rates, days of placement before excision, and physician comparison with WL. This study analyzed 50 patients. The reflectors were placed under mammographic guidance (n = 18, 36 %) or ultrasound guidance (n = 32, 64 %). Of the 50 patients, 10 (20 %) underwent excisional biopsy and 40 (80 %) had a lumpectomy. The lesion and reflector were successfully removed in all 50 patients, and no adverse events occurred. Of the 41 patients who had in situ and/or invasive carcinoma identified, 38 (93 %) had clear margins and 3 (7 %) were recommended for reexcision. These data suggest that the SCOUT system is safe and effective for guiding the excision of nonpalpable breast lesions and a viable alternative to standard localization options. A larger prospective, multi-institution trial of SCOUT currently is underway to validate these findings.

Steep microbial boundstone-dominated plaform margins

NARCIS (Netherlands)

Kenter, J.A.M.; Harris, P.M.; Della Porta, G.P.

2005-01-01

Seaward progradation of several kilometers has been documented mostly for leeward margin low-angle carbonate slope systems with a dominant platform top sediment source. However, steep and high-relief margins fronting deep basins can also prograde and as such are somewhat perplexing. Characteristics

Conference Report: The New Discovery of Margins: Theory-Based Excursions in Marginal Social Fields

OpenAIRE

Kirchner, Babette; Lorenzen, Jule-Marie; Striffler, Christine

2014-01-01

At this year's spring conference of the Sociology of Knowledge Section of the German Sociological Association, a diverse range of theoretical concepts and multiple empirical insights into different marginal social fields were presented. As in everyday life, drawing a line between center and margin can be seen as an important challenge that must equally be faced in sociology. The socially constructed borderline appears to be highly variable. Therefore it has to be delineated or fixed somehow. ...

Mobile surgical skills education unit: a new concept in surgical training.

Science.gov (United States)

Shaikh, Faisal M; Hseino, Hazem; Hill, Arnold D K; Kavanagh, Eamon; Traynor, Oscar

2011-08-01

Basic surgical skills are an integral part of surgical training. Simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a nonpatient, nonstressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations. A new program is designed by the Royal College of Surgeons in Ireland (RCSI), in an approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings. In this article, authors describe the program and students response to the mobile surgical skills being delivered in the region of their training hospitals and by their own regional consultant trainers.

Evaluating the marginal utility principle for long-term hydropower scheduling

International Nuclear Information System (INIS)

Zhao, Tongtiegang; Zhao, Jianshi; Liu, Pan; Lei, Xiaohui

2015-01-01

Highlights: • Analysis of one-, two- and multi-period hydropower scheduling. • Derivation of marginal cost and marginal return of carry-over storage. • Evaluation of the marginal utility principle in a case study of the Three Gorges Reservoir. - Abstract: The conversion of the potential energy of dammed water into hydropower depends on both reservoir storage and release, which are the major difficulties in hydropower reservoir operation. This study evaluates the marginal utility principle, which determines the optimal carry-over storage between periods, for long-term hydropower scheduling. Increasing marginal cost and decreasing marginal return are two important characteristics that determine the marginal utility principle in water supply. However, the notion of decreasing marginal return is inapplicable in hydropower scheduling. Instead, the carry-over storage from one period has an increasing marginal contribution to the power generation in the next period. Although carry-over storage incurs an increasing marginal cost to the power generation in the current period, the marginal return is higher than the marginal cost. The marginal return from the carry-over storage further increases in the multi-period case. These findings suggest saving as much carry-over storage as possible, which is bounded by the operational constraints of storage capacity, environmental flow, and installed capacity in actual hydropower scheduling. The marginal utility principle is evaluated for a case study of the Three Gorges Reservoir, and the effects of the constraints are discussed. Results confirm the theoretical findings and show that the marginal return from carry-over storage is larger than the marginal cost. The operational constraints help determine the optimal carry-over storage.

MRI and pathological findings of epileptogenic lesions removed surgically

International Nuclear Information System (INIS)

Moritake, Kouzo; Kikuchi, Haruhiko; Minamikawa, Jun

1990-01-01

MRI revealed focal cerebral lesions in 19 patients, 12 males and 7 females, who had suffered from disabling seizures refractory to medical therapy for over one year; the lengths of the periods of therapy ranged from one to 17 years; mean: 8.8 years. Their ages at surgery ranged from 3 to 46 years; mean: 15.2 years. The results of other preoperative and intraoperative examinations, including mobile long-term ambulatory EEG monitoring, local CBF two-dimensional imaging by SPECT, and intraoperative cortical EEG, justified the surgical resection of those lesions revealed by MRI. These lesions were removed totally or subtotally. The pathological findings of the excised lesions were neuronal loss and gliosis in 10 cases (porencephaly, 2; arachnoid cyst, 3; post-traumatic scar, 1; nonspecific infarct, 4), hamartomatous pathology in 5 (hemartoma, 1; tuberous sclerosis, 4), and neoplasm in 4 (low-grade astrocytoma, 2; oligodendroglioma, 1; epidermoid, 1). The common pathological feature of these lesions was the proliferation of abnormal glial cells, which are sensitive to MRI imaging, especially to T 2 -weighted images. The postoperative follow-up terms of these 19 patients ranged from 6 to 23 months; mean: 15 months. Epileptic attacks had ceased in 12 of the 19 patients (63%), and there had been a marked improvement in both the frequency and severity of attacks in another 4. No permanent surgical complications or worsening of the seizures were seen in any patient. In conclusion, MRI is sensitive to epileptogenic lesions in patients with medically intractable epilepsy and is helpful in defining their configurations and margins and in planning the surgical approach. (author)

Small atrial septal defect associated with heart failure in an infant with a marginal left ventricle

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Sandra D.K. Kingma

2012-07-01

Full Text Available Atrial septal defect (ASD is usually asymptomatic in infancy, unless pulmonary hypertension or severe co-morbidity is present. We report a case of a 4-week-old infant with moderate- sized ASD, small patent ductus arteriosus (PDA, and a borderline sized left ventricle that developed heart failure. Despite the relatively small diameter of the ASD, this defect influenced the mechanism of heart failure significantly. After surgical closure of both PDA and ASD, the signs of pulmonary hypertension resolved and the patient developed a normal sized left ventricle. This report illustrates that the presence of a small ASD in combination with a marginal left ventricle may result in inadequate left ventricular filling, pulmonary hypertension and heart failure.

The surgical treatment of sacral radiation ulcer-report of 5 patients

International Nuclear Information System (INIS)

Fukuzumi, Satoshi; Ootaka, Hitoshi; Suzuki, Fumio; Nishimoto, Kazumasa; Hayashi, Satoru; Fujioka, Toshio; Minabe, Toshiharu

2007-01-01

We have treated 5 cases of sacral radiation ulcer surgically. All patients with cervical or vulval cancer were treated with external radiotherapy more than 20 years ago. Three patients have rectovaginal fistulas and four patients have osteoradionecrosis of the sacrum. Fecal and/or urinary diversion were accomplished preoperatively in four patients. After debridement of ulcers, these defects were covered by pedicled musculocutaneous flaps. In two of five, marginal necrosis was seen in a great saphenous veno-neuro accompanying artery fasciocutaneous flap and an inferior gluteus maximus musculocutaneous flap. In two of five, seroma was seen. One patient died of the sepsis from pelvic infection with rectal fistula. Among the other four patients, there was no recurrence during the follow up period. The principle for surgically treating radiation ulcer is to completely resect all radionecrotic tissues and cover these defects with well vascularized tissues. It is useful to distinguish damaged tissue from health tissue by MRI. In a case having a rectovaginal fistula, it is recommended that fecal and urinary diversion will be done at first and debridement of ulcer and reconstructive surgery will be done later. (author)

Surgical crown lengthening: a 12-month study - radiographic results

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Daniela Eleutério Diniz

2007-08-01

Full Text Available OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.

From Borders to Margins

DEFF Research Database (Denmark)

Parker, Noel

2009-01-01

of entities that are ever open to identity shifts.  The concept of the margin possesses a much wider reach than borders, and focuses continual attention on the meetings and interactions between a range of indeterminate entities whose interactions may determine both themselves and the types of entity...... 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...

Mental Depreciation and Marginal Decision Making

Science.gov (United States)

Heath; Fennema

1996-11-01

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.

Marginal and Interaction Effects in Ordered Response Models

OpenAIRE

Debdulal Mallick

2009-01-01

In discrete choice models the marginal effect of a variable of interest that is interacted with another variable differs from the marginal effect of a variable that is not interacted with any variable. The magnitude of the interaction effect is also not equal to the marginal effect of the interaction term. I present consistent estimators of both marginal and interaction effects in ordered response models. This procedure is general and can easily be extended to other discrete choice models. I ...

Output control of da Vinci surgical system's surgical graspers.

Science.gov (United States)

Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar

2014-01-01

The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of participatory community communication on HIV preventive behaviors among ethnic minority youth in central Vietnam

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Nguyen Huy V

2012-03-01

Full Text Available Abstract Background In Vietnam, socially marginalized groups such as ethnic minorities in mountainous areas are often difficult to engage in HIV research and prevention programs. This intervention study aimed to estimate the effect of participatory community communication (PCC on changing HIV preventive ideation and behavior among ethnic minority youth in a rural district from central Vietnam. Methods In a cross-sectional survey after the PCC intervention, using a structured questionnaire, 800 ethnic minority youth were approached for face-to-face interviews. Propensity score matching (PSM technique was then utilized to match these participants into two groups-intervention and control-for estimating the effect of the PCC. Results HIV preventive knowledge and ideation tended to increase as the level of recall changed accordingly. The campaign had a significant indirect effect on condom use through its effect on ideation or perceptions. When intervention and control group statistically equivalently reached in terms of individual and social characteristics by PSM, proportions of displaying HIV preventive knowledge, ideation and condom use were significantly higher in intervention group than in matched control counterparts, accounting for net differences of 7.4%, 12.7% and 5%, respectively, and can be translated into the number of 210; 361 and 142 ethnic minority youth in the population. Conclusions The study informs public health implications both theoretically and practically to guide effective HIV control programs for marginalized communities in resources-constrained settings like rural Vietnam and similar contexts of developing countries.

CRBRP structural and thermal margin beyond the design base

International Nuclear Information System (INIS)

Strawbridge, L.E.

1979-01-01

Prudent margins beyond the design base have been included in the design of Clinch River Breeder Reactor Plant to further reduce the risk to the public from highly improbable occurrences. These margins include Structural Margin Beyond the Design Base to address the energetics aspects and Thermal Margin Beyond the Design Base to address the longer term thermal and radiological consequences. The assessments that led to the specification of these margins are described, along with the experimental support for those assessments. 8 refs

Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs

Energy Technology Data Exchange (ETDEWEB)

De la Hoz Polo, Marcela [Kings College Hospital, Radiology Department, London, Brixton (United Kingdom); Dick, Elizabeth [St Mary' s Hospital, Imperial College Healthcare NHS Trust, Radiology Department, London (United Kingdom); Bhumbra, Rej [Newham and The Royal London Hospitals, Trauma and Orthopaedic Department, Barts Health Orthopaedic Centre, London, Whitechapel (United Kingdom); Pollock, Rob [Royal National Orthopaedic Hospital, Trauma and Orthopaedic Department, Stanmore (United Kingdom); Sandhu, Ranbir [University Hospitals Birmingham, Radiology Department, Queen Elizabeth Hospital, Birmingham (United Kingdom); Saifuddin, Asif [Royal National Orthopaedic Hospital, Radiology Department, Stanmore (United Kingdom)

2017-12-15

Soft tissue sarcomas (STS) are rare tumours that require prompt diagnosis and treatment at a specialist centre. Magnetic resonance imaging (MRI) has become the modality of choice for identification, characterisation, biopsy planning and staging of soft tissue masses. MRI enables both the operating surgeon and patient to be optimally prepared prior to surgery for the likelihood of margin-negative resection and to anticipate possible sacrifice of adjacent structures and consequent loss of function. The aim of this review is to aid the radiologist in performing and reporting MRI studies of soft tissue sarcomas, with particular reference to the requirements of the surgical oncologist. (orig.)

Learning Convex Inference of Marginals

OpenAIRE

Domke, Justin

2012-01-01

Graphical models trained using maximum likelihood are a common tool for probabilistic inference of marginal distributions. However, this approach suffers difficulties when either the inference process or the model is approximate. In this paper, the inference process is first defined to be the minimization of a convex function, inspired by free energy approximations. Learning is then done directly in terms of the performance of the inference process at univariate marginal prediction. The main ...

Spectrum estimation method based on marginal spectrum

International Nuclear Information System (INIS)

Cai Jianhua; Hu Weiwen; Wang Xianchun

2011-01-01

FFT method can not meet the basic requirements of power spectrum for non-stationary signal and short signal. A new spectrum estimation method based on marginal spectrum from Hilbert-Huang transform (HHT) was proposed. The procession of obtaining marginal spectrum in HHT method was given and the linear property of marginal spectrum was demonstrated. Compared with the FFT method, the physical meaning and the frequency resolution of marginal spectrum were further analyzed. Then the Hilbert spectrum estimation algorithm was discussed in detail, and the simulation results were given at last. The theory and simulation shows that under the condition of short data signal and non-stationary signal, the frequency resolution and estimation precision of HHT method is better than that of FFT method. (authors)

Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

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Jose M. Cabello

2009-04-01

Full Text Available INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

Surgical repair of a congenital sternal cleft in a cat.

Science.gov (United States)

Schwarzkopf, Ilona; Bavegems, Valerie C A; Vandekerckhove, Peter M F P; Melis, Sanne M; Cornillie, Pieter; de Rooster, Hilde

2014-07-01

To describe the clinical findings, diagnosis, and treatment of an incomplete cleft of the 5th-8th sternebra and a cranioventral abdominal wall hernia in a 2 month old Ragdoll kitten and to evaluate the short- and long-term outcome. Clinical report. Ragdoll cat (n = 1), 2 months old. Sternal cleft was confirmed by thoracic radiographs. Computed tomography (CT) was used to plan an optimal surgical approach. A ventral median incision was made, starting at the 3rd sternebra and extended into the abdomen. Ostectomy of the proximal part of the 5th left sternebra was performed. Lateral periosteal flaps were created, unfolded, and absorbable monofilament sutures preplaced to facilitate closure and the repair was reinforced by 2 peristernal sutures. A bone graft was applied, and the free margin of the omentum was sutured to the cranial aspect of the wound. No major complications occurred. At 3 weeks, CT scan confirmed approximation of the hemisternebrae and at 10 months, complete fusion of the hemisternebrae had not occurred, but a strong connection of the sternal bars was present. Sternal cleft is a rare congenital abnormality that can be corrected surgically with favorable outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

Change within Purchasing and Supply Management Organisations – Assessing the Claims from Maturity Models

DEFF Research Database (Denmark)

Holm Andreasen, Peter; Gammelgaard, Britta

2018-01-01

It is a wide-held assumption that professional development and change within purchasing and supply management (PSM) organisations can be explained and guided by a maturity model. In this paper the guidance which the maturity model concept offers to understand a PSM organisation's performance...... an organisational change framework, composing 1) movement transitions, 2) scalability of change, 3) acceptability of change, and 4) the substantive element of change. The research found that extant PSM maturity models are too rigid for PSM managers to apply, and although maturity models are commonly accepted in PSM...... is assessed. The methodology is based on the outcomes of a literature review of PSM maturity models, development of an organisational change framework and the learning from three qualitative case studies. An alternative understanding of the development of the PSM organisation is offered through...

Causes and Consequences of Public Service Motivation: Governance Interventions and Performance Implications

DEFF Research Database (Denmark)

Jensen, Ulrich Thy

are based on combinations of survey and administrative data and the dissertation employs a variety of designs such as repeated measures across time and an experiment to advance insights into the effects of organizational leadership and national policies on individuals’ PSM and the behavioral implications...... interventions as causes of PSM and the implications of PSM for public service behaviors and contributes not only to our understanding of PSM as motivational lever for public service improvements but also offers answers to the question of how PSM is shaped in organizational contexts. The empirical results...... of PSM for the provision of public services to citizens. The dissertation disentangles causes and consequences of PSM and is of interest to people who wish to understand how governance interventions (including policies and leadership) can influence employee public service motivation and how this kind...

Thermal margin model for transition core of KSNP

International Nuclear Information System (INIS)

Nahm, Kee Yil; Lim, Jong Seon; Park, Sung Kew; Chun, Chong Kuk; Hwang, Sun Tack

2004-01-01

The PLUS7 fuel was developed with mixing vane grids for KSNP. For the transition core partly loaded with the PLUS7 fuels, the procedure to set up the optimum thermal margin model of the transition core was suggested by introducing AOPM concept into the screening method which determines the limiting assembly. According to the procedure, the optimum thermal margin model of the first transition core was set up by using a part of nuclear data for the first transition and the homogeneous core with PLUS7 fuels. The generic thermal margin model of PLUS7 fuel was generated with the AOPM of 138%. The overpower penalties on the first transition core were calculated to be 1.0 and 0.98 on the limiting assembly and the generic thermal margin model, respectively. It is not usual case to impose the overpower penalty on reload cores. It is considered that the lack of channel flow due to the difference of pressure drop between PLUS7 and STD fuels results in the decrease of DNBR. The AOPM of the first transition core is evaluated to be about 135% by using the optimum generic thermal margin model which involves the generic thermal margin model and the total overpower penalty. The STD fuel is not included among limiting assembly candidates in the second transition core, because they have much lower pin power than PLUS7 fuels. The reduced number of STD fuels near the limiting assembly candidates the flow from the limiting assembly to increase the thermal margin for the second transition core. It is expected that cycle specific overpower penalties increase the thermal margin for the transition core. Using the procedure to set up the optimum thermal margin model makes sure that the enhanced thermal margin of PLUS7 fuel can be sufficiently applied to not only the homogeneous core but also the transition core

Thick tissue diffusion model with binding to optimize topical staining in fluorescence breast cancer margin imaging

Science.gov (United States)

Xu, Xiaochun; Kang, Soyoung; Navarro-Comes, Eric; Wang, Yu; Liu, Jonathan T. C.; Tichauer, Kenneth M.

2018-03-01

Intraoperative tumor/surgical margin assessment is required to achieve higher tumor resection rate in breast-conserving surgery. Though current histology provides incomparable accuracy in margin assessment, thin tissue sectioning and the limited field of view of microscopy makes histology too time-consuming for intraoperative applications. If thick tissue, wide-field imaging can provide an acceptable assessment of tumor cells at the surface of resected tissues, an intraoperative protocol can be developed to guide the surgery and provide immediate feedback for surgeons. Topical staining of margins with cancer-targeted molecular imaging agents has the potential to provide the sensitivity needed to see microscopic cancer on a wide-field image; however, diffusion and nonspecific retention of imaging agents in thick tissue can significantly diminish tumor contrast with conventional methods. Here, we present a mathematical model to accurately simulate nonspecific retention, binding, and diffusion of imaging agents in thick tissue topical staining to guide and optimize future thick tissue staining and imaging protocol. In order to verify the accuracy and applicability of the model, diffusion profiles of cancer targeted and untargeted (control) nanoparticles at different staining times in A431 tumor xenografts were acquired for model comparison and tuning. The initial findings suggest the existence of nonspecific retention in the tissue, especially at the tissue surface. The simulator can be used to compare the effect of nonspecific retention, receptor binding and diffusion under various conditions (tissue type, imaging agent) and provides optimal staining and imaging protocols for targeted and control imaging agent.

Reconstructing Rodinia by Fitting Neoproterozoic Continental Margins

Science.gov (United States)

Stewart, John H.

2009-01-01

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

Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline.

Science.gov (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

2011-01-01

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. Copyright © 2011 Elsevier Inc. All rights reserved.

Margins for treatment planning of proton therapy

International Nuclear Information System (INIS)

Thomas, Simon J

2006-01-01

For protons and other charged particles, the effect of set-up errors on the position of isodoses is considerably less in the direction of the incident beam than it is laterally. Therefore, the margins required between the clinical target volume (CTV) and planning target volume (PTV) can be less in the direction of the incident beam than laterally. Margins have been calculated for a typical head plan and a typical prostate plan, for a single field, a parallel opposed and a four-field arrangement of protons, and compared with margins calculated for photons, assuming identical geometrical uncertainties for each modality. In the head plan, where internal motion was assumed negligible, the CTV-PTV margin reduced from approximately 10 mm to 3 mm in the axial direction for the single field and parallel opposed plans. For a prostate plan, where internal motion cannot be ignored, the corresponding reduction in margin was from 11 mm to 7 mm. The planning organ at risk (PRV) margin in the axial direction reduced from 6 mm to 2 mm for the head plan, and from 7 mm to 4 mm for the prostate plan. No reduction was seen on the other axes, or for any axis of the four-field plans. Owing to the shape of proton dose distributions, there are many clinical cases in which good dose distributions can be obtained with one or two fields. When this is done, it is possible to use smaller PTV and PRV margins. This has the potential to convert untreatable cases, in which the PTV and PRV overlap, into cases with a gap between PTV and PRV of adequate size for treatment planning

Factors Affecting the Perception of Importance and Practice of Patient Safety Management among Hospital Employees in Korea.

Science.gov (United States)

Kim, In-Sook; Park, MiJeong; Park, Mi-Young; Yoo, Hana; Choi, Jihea

2013-03-01

The study was undertaken to identify factors affecting perception of the importance and practice of patient safety management (PSM) among hospital employees in Korea. This study was conducted using a descriptive design and a self-report questionnaire. Two hundred and eighty employees were recruited from three hospitals using a convenience sampling method. Measures were perception of the importance, practice, and characteristics of PSM. Data were analyzed using descriptive statistics including t test, one-way analysis of variance, Pearson's correlation analysis, and multiple regression. Factors affecting perception of the importance of PSM were whether hospital employees were in contact with patients while on duty, weekly working hours, education on PSM, and perceived adequacy of PSM system construction. Factors affecting the practice of PSM were perceived adequacy of work load, perceived adequacy of PSM system construction and perception of its importance. The findings of this study indicate a need for developing strategies to improve perception of the importance and practice of PSM among all hospital employees, and provide a reference for future experimental studies. Copyright © 2013. Published by Elsevier B.V.

Optimisation of Surgical Results in de-Quervain’s Disease

Directory of Open Access Journals (Sweden)

B Jagannath Kamath

2014-11-01

Full Text Available Background: De Quervain’s disease poses more problems with respect to management than the diagnosis. Surgery is resorted to when the conservative methods fail. There are known complications of the surgical intervention. Surgeon contemplating the surgery should be aware of these and make every attempt to optimize the results and avoid the above mentioned complication. Methods: Sixty symptomatic wrists in 57 individuals suffering from de Quervain’s disease who needed surgery were studied preoperatively with ultrasound. Number of tendons and the sub septae identified in the ultrasound examination preoperatively were confirmed on the table during the surgery. The release was brought about under local anesthesia, with magnification taking care to avoid injury to the cephalic vein and superficial branch of radial nerve, not to violate the anterior margin of the sheath, thus preventing complications. A negative post release finkelstein test was ensured before the wound closure. Results: All 60 patients who underwent release for de Quervain’s disease were symptom free, satisfied and fully functional. Conclusions: De-Quervain's disease not relieved by conservative methods needs surgical release under local anesthesia with a transverse incision with Preoperative ultrasound examination for the number of tendons and subseptae. Avoiding the violation of the volar aspect of the sheath, loupe magnification, tourniquet and post release Finkelstein’s test before wound closure, will ensure optimal results.

Open surgical simulation--a review.

Science.gov (United States)

Davies, Jennifer; Khatib, Manaf; Bello, Fernando

2013-01-01

Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

Plasticity margin recovery during annealing after cold deformation

International Nuclear Information System (INIS)

Bogatov, A.A.; Smirnov, S.V.; Kolmogorov, V.L.

1978-01-01

Restoration of the plasticity margin in steel 20 after cold deformation and annealing at 550 - 750 C and soaking for 5 - 300 min was investigated. The conditions of cold deformation under which the metal acquires microdefects unhealed by subsequent annealing were determined. It was established that if the degree of utilization of the plasticity margin is psi < 0.5, the plasticity margin in steel 20 can be completely restored by annealing. A mathematical model of restoration of the plasticity margin by annealing after cold deformation was constructed. A statistical analysis showed good agreement between model and experiment

Role of 10-Gy boost radiation after breast-conserving surgery for stage I-II breast cancer with a 5-mm negative margin

International Nuclear Information System (INIS)

Notani, Masafumi; Uchida, Nobue; Kitagaki, Hajime

2007-01-01

According to the Guidelines for breast-conserving therapy of the Japanese Breast Cancer Society, the surgical margin is ''negative'' when the minimum distance between the tumor edge and the margin of the resected specimen is more than 5 mm. The value of boost radiation for early breast cancer with a 5-mm negative margin remains unclear. A total of 137 patients with stage I-II breast cancer underwent breast-conserving surgery between July 1987 and August 2002. All of the patients had negative margins according to the Japanese guidelines. Their median age was 50 years and the median follow-up period was 62 months. The entire ipsilateral breast was irradiated to a total dose of 50 Gy (25 fractions). Then an additional 10 Gy (5 fractions) was given to 79 patients, using 6- to 12-MeV electrons (boost group), while 58 patients (no-boost group) received no further radiation. Factors influencing local recurrence were evaluated by univariate and multivariate analyses. For the entire population, the 5-year overall survival, cause-specific survival, disease-free survival, and local recurrence rates were 96.0%, 96.8%, 94.2%, and 1.67%, respectively. Boost radiation reduced local recurrence, but the improvement was not significant (P=0.070). Univariate and multivariate analyses failed to detect any factors that were significantly associated with local control. There were no severe complications in either group and there were no differences between the groups in the cosmetic outcome. Boost radiation can be performed for stage I-II breast cancer with negative margins (Japanese guidelines), and showed a tendency to decrease local recurrence. A large randomized controlled study is necessary to establish final conclusions. (author)

Anxiety in veterinary surgical students

DEFF Research Database (Denmark)

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

2012-01-01

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...

The Virtual Surgical Pelvis : Anatomy Visualization for Education and Surgical Planning

NARCIS (Netherlands)

Smit, N.N.

2016-01-01

This thesis deals with visualizing anatomical data for medical education and surgical planning purposes. To this end, we have developed a detailed virtual atlas, the Virtual Surgical Pelvis (VSP),which unifies surgically relevant knowledge on pelvic anatomy. We provide methods to share the knowledge

Deriving DICOM surgical extensions from surgical workflows

Science.gov (United States)

Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

2007-03-01

The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

Reinforcing marginality? Maternal health interventions in rural Nicaragua.

Science.gov (United States)

Kvernflaten, Birgit

2017-06-23

To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.

Tissue preservation with mass spectroscopic analysis: Implications for cancer diagnostics.

Science.gov (United States)

Hall, O Morgan; Peer, Cody J; Figg, William D

2018-05-17

Surgical intervention is a common treatment modality for localized cancer. Post-operative analysis involves evaluation of surgical margins to assess whether all malignant tissue has been resected because positive surgical margins lead to a greater likelihood of recurrence. Secondary treatments are utilized to minimize the negative effects of positive surgical margins. Recently, in Science Translational Medicine, Zhang et al describe a new mass spectroscopic technique that could potentially decrease the likelihood of positive surgical margins. Their nondestructive in vivo tissue sampling leads to a highly accurate and rapid cancer diagnosis with great precision between healthy and malignant tissue. This new tool has the potential to improve surgical margins and accelerate cancer diagnostics by analyzing biomolecular signatures of various tissues and diseases.

Retroperitoneal soft tissue sarcoma: An analysis of radiation and surgical treatment

International Nuclear Information System (INIS)

Ballo, Matthew T.; Zagars, Gunar K.; Pollock, Raphael E.; Benjamin, Robert S.; Feig, Barry W.; Cormier, Janice N.; Hunt, Kelly K.; Patel, Shreyaskumar R.; Trent, Jonathan C.; Beddar, Sam; Pisters, Peter W.T.

2007-01-01

Purpose: To evaluate the clinical outcomes of patients with localized retroperitoneal soft tissue sarcoma (STS) treated with complete surgical resection and radiation. Methods and Materials: The medical records of 83 patients were reviewed retrospectively. Sixty patients presented with primary disease and the remaining 23 had recurrence after previous surgical resection. Results: With a median follow-up of 47 months, the actuarial overall disease-specific survival (DSS), distant metastasis-free survival, and local control (LC) rates were 44%, 67%, and 40%, respectively. Of the 38 patients dying of disease, local disease progression was the sole site of recurrence for 16 patients and was a component of progression for another 11 patients. Multivariate analysis indicated that histologic grade was associated with the 5-year rates of DSS (low-grade, 92%; intermediate-grade, 51%; and high-grade, 41%, p = 0.006). Multivariate analysis also indicated an inferior 5-year LC rate for patients presenting with recurrent disease, positive or uncertain resection margins, and age greater than 65 years. The data did not suggest an improved local control with higher doses of external-beam radiation (EBRT) or with the specific use of intraoperative radiotherapy (IORT). Radiation-related complications (10% at 5 years) developed in 5 patients; all had received their EBRT postoperatively. Conclusions: Although preoperative radiation therapy and aggressive surgical resection is well tolerated in patients, local disease progression continues to be a significant component of disease death. In this small cohort of patients, the use of higher doses of EBRT or IORT did not result in clinically apparent improvements in outcomes

Effect of posterior crown margin placement on gingival health.

Science.gov (United States)

Reitemeier, Bernd; Hänsel, Kristina; Walter, Michael H; Kastner, Christian; Toutenburg, Helge

2002-02-01

The clinical impact of posterior crown margin placement on gingival health has not been thoroughly quantified. This study evaluated the effect of posterior crown margin placement with multivariate analysis. Ten general dentists reviewed 240 patients with 480 metal-ceramic crowns in a prospective clinical trial. The alloy was randomly selected from 2 high gold, 1 low gold, and 1 palladium alloy. Variables were the alloy used, oral hygiene index score before treatment, location of crown margins at baseline, and plaque index and sulcus bleeding index scores recorded for restored and control teeth after 1 year. The effect of crown margin placement on sulcular bleeding and plaque accumulation was analyzed with regression models (Prisk of bleeding at intrasulcular posterior crown margins was approximately twice that at supragingival margins. Poor oral hygiene before treatment and plaque also were associated with sulcular bleeding. Facial sites exhibited a lower probability of sulcular bleeding than lingual surfaces. Type of alloy did not influence sulcular bleeding. In this study, placement of crown margins was one of several parameters that affected gingival health.

Colorado Basin Structure and Rifting, Argentine passive margin

Science.gov (United States)

Autin, Julia; Scheck-Wenderoth, Magdalena; Loegering, Markus; Anka, Zahie; Vallejo, Eduardo; Rodriguez, Jorge; Marchal, Denis; Reichert, Christian; di Primio, Rolando

2010-05-01

The Argentine margin presents a strong segmentation with considerable strike-slip movements along the fracture zones. We focus on the volcanic segment (between the Salado and Colorado transfer zones), which is characterized by seaward dipping reflectors (SDR) all along the ocean-continent transition [e.g. Franke et al., 2006; Gladczenko et al., 1997; Hinz et al., 1999]. The segment is structured by E-W trending basins, which differs from the South African margin basins and cannot be explained by classical models of rifting. Thus the study of the relationship between the basins and the Argentine margin itself will allow the understanding of their contemporary development. Moreover the comparison of the conjugate margins suggests a particular evolution of rifting and break-up. We firstly focus on the Colorado Basin, which is thought to be the conjugate of the well studied Orange Basin [Hirsch et al., 2009] at the South African margin [e.g. Franke et al., 2006]. This work presents results of a combined approach using seismic interpretation and structural, isostatic and thermal modelling highlighting the structure of the crust. The seismic interpretation shows two rift-related discordances: one intra syn-rift and the break-up unconformity. The overlying sediments of the sag phase are less deformed (no sedimentary wedges) and accumulated before the generation of oceanic crust. The axis of the Colorado Basin trends E-W in the western part, where the deepest pre-rift series are preserved. In contrast, the basin axis turns to a NW-SE direction in its eastern part, where mainly post-rift sediments accumulated. The most distal part reaches the margin slope and opens into the oceanic basin. The general basin direction is almost orthogonal to the present-day margin trend. The most frequent hypothesis explaining this geometry is that the Colorado Basin is an aborted rift resulting from a previous RRR triple junction [e.g. Franke et al., 2002]. The structural interpretation

Disposable surgical face masks for preventing surgical wound infection in clean surgery

Directory of Open Access Journals (Sweden)

Allyson Lipp

Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

The Seismicity of Two Hyperextended Margins

Science.gov (United States)

Redfield, Tim; Terje Osmundsen, Per

2013-04-01

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

The Marginal Source of Finance

OpenAIRE

Lindhe, Tobias

2002-01-01

This paper addresses the ongoingdebate on which view of equity, traditional or new, that best describes firm behavior. According to the traditional view, the marginal source of finance is new equity, whereas under to the new view, marginal financing comes from retained earnings. In the theoretical part, we set up a model where the firm faces a cost of adjusting the dividend level because of an aggravated free cash flow problem. The existence of such a cost - which has been used in arguing the...

Comparison of five-axis milling and rapid prototyping for implant surgical templates.

Science.gov (United States)

Park, Ji-Man; Yi, Tae-Kyoung; Koak, Jai-Young; Kim, Seong-Kyoon; Park, Eun-Jin; Heo, Seong-Joo

2014-01-01

This study aims to compare and evaluate the accuracy of surgical templates fabricated using coordinate synchronization processing with five-axis milling and design-related processing with rapid prototyping (RP). Master phantoms with 10 embedded gutta-percha cylinders hidden under artificial gingiva were fabricated and imaged using cone beam computed tomography. Vectors of the hidden cylinders were extracted and transferred to those of the planned implants through reverse engineering using virtual planning software. An RP-produced template was fabricated by stereolithography in photopolymer at the RP center according to planned data. Metal sleeves were bonded after holes were bored (group RP). For the milled template, milling coordinates were synchronized using the conversion process for the coordinate synchronization platform located on the model's bottom. Metal bushings were set on holes milled on the five-axis milling machine, on which the model was fixed through the coordinate synchronization plate, and the framework was constructed on the model using orthodontic resin (group CS). A computed tomography image was taken with templates firmly fixed on models using anchor pins (RP) or anchor screws (CS). The accuracy was analyzed via reverse engineering. Differences between the two groups were compared by repeated measures two-factor analysis. From the reverse-engineered image of the template on the experimental model, RP-produced templates showed significantly larger deviations than did milled surgical guides. Maximum deviations of the group RP were 1.58 mm (horizontal), 1.68 mm (vertical), and 8.51 degrees (angular); those of the group CS were 0.68 mm (horizontal), 0.41 mm (vertical), and 3.23 degrees (angular). A comparison of milling and RP template production methods showed that a vector-milled surgical guide had significantly smaller deviations than did an RP-produced template. The accuracy of computer-guided milled surgical templates was within the safety

Polarized phase shift mask: concept, design, and potential advantages to photolithography process and physical design

Science.gov (United States)

Wang, Ruoping; Grobman, Warren D.; Reich, Alfred J.; Thompson, Matthew A.

2002-03-01

In this paper we introduce the concept and design of a novel phase shift mask technology, Polarized Phase Shift Mask (P:PSM). The P:PSM technology utilizes non-interference between orthogonally polarized light sources to avoid undesired destructive interference seen in conventional two-phase shift mask technology. Hence P:PSM solves the well-known 'phase edge' or 'phase conflict' problem. By obviating the 2nd exposure and 2nd mask in current Complementary Phase Shift Mask (C:PSM) technology, this single mask/single exposure technology offers significant advantages towards photolithography process as well as pattern design. We use examples of typical design and process difficulties associated with the C:PSM technology to illustrate the advantages of the P:PSM technology. We present preliminary aerial image simulation results that support the potential of this new reticle technology for enhanced design flexibility. We also propose possible mask structures and manufacturing methods for building a P:PSM.

Immunostimulatory Effects of Polysaccharides Isolated from Makgeolli (Traditional Korean Rice Wine

Directory of Open Access Journals (Sweden)

Chang-Won Cho

2014-04-01

Full Text Available Makgeolli is a traditional Korean rice wine, reported to have various biological functions. In this study, the immunostimulatory activity of a polysaccharide from makgeolli (PSM was investigated. The polysaccharide fraction was isolated from makgeolli by hot water extraction, ethanol precipitation, dialysis, and lyophilization. The major constituents in PSM were neutral sugars (87.3%. PSM was composed of five different sugars, glucose, mannose, galactose, xylose, and arabinose. In normal mice, PSM treatment increased the spleen index (p < 0.05 as well as splenocyte proliferation (p < 0.05 in combination with concanavalin A or lipopolysaccharide. The immunostimulatory activities of PSM were also examined in cyclophosphamide (CY-induced immunosuppressed mice. Mice treated with PSM exhibited increased splenocyte proliferation (p < 0.05, natural killer cell activity, and white blood cell counts (p < 0.01 compared with immunosuppressed mice. These results indicate that PSM can enhance immune function in normal mice and CY-induced immunosuppressed mice.

On probabilistically defined margins in radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Papiez, Lech; Langer, Mark [Department of Radiation Oncology, Indiana University, Indianapolis, IN (United States)

2006-08-21

Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

On probabilistically defined margins in radiation therapy

International Nuclear Information System (INIS)

Papiez, Lech; Langer, Mark

2006-01-01

Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision.

Science.gov (United States)

Cox, Charles E; Russell, Scott; Prowler, Vanessa; Carter, Ebonie; Beard, Abby; Mehindru, Ankur; Blumencranz, Peter; Allen, Kathleen; Portillo, Michael; Whitworth, Pat; Funk, Kristi; Barone, Julie; Norton, Denise; Schroeder, Jerome; Police, Alice; Lin, Erin; Combs, Freddie; Schnabel, Freya; Toth, Hildegard; Lee, Jiyon; Anglin, Beth; Nguyen, Minh; Canavan, Lynn; Laidley, Alison; Warden, Mary Jane; Prati, Ronald; King, Jeff; Shivers, Steven C

2016-10-01

This study was a multicenter evaluation of the SAVI SCOUT(®) breast localization and surgical guidance system using micro-impulse radar technology for the removal of nonpalpable breast lesions. The study was designed to validate the results of a recent 50-patient pilot study in a larger multi-institution trial. The primary endpoints were the rates of successful reflector placement, localization, and removal. This multicenter, prospective trial enrolled patients scheduled to have excisional biopsy or breast-conserving surgery of a nonpalpable breast lesion. From March to November 2015, 154 patients were consented and evaluated by 20 radiologists and 16 surgeons at 11 participating centers. Patients had SCOUT(®) reflectors placed up to 7 days before surgery, and placement was confirmed by mammography or ultrasonography. Implanted reflectors were detected by the SCOUT(®) handpiece and console. Presence of the reflector in the excised surgical specimen was confirmed radiographically, and specimens were sent for routine pathology. SCOUT(®) reflectors were successfully placed in 153 of 154 patients. In one case, the reflector was placed at a distance from the target that required a wire to be placed. All 154 lesions and reflectors were successfully removed during surgery. For 101 patients with a preoperative diagnosis of cancer, 86 (85.1 %) had clear margins, and 17 (16.8 %) patients required margin reexcision. SCOUT(®) provides a reliable and effective alternative method for the localization and surgical excision of nonpalpable breast lesions using no wires or radioactive materials, with excellent patient, radiologist, and surgeon acceptance.

The homogeneous marginal utility of income assumption

NARCIS (Netherlands)

Demuynck, T.

2015-01-01

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

Experimental Demonstration of Capacity-Achieving Phase-Shifted Superposition Modulation

DEFF Research Database (Denmark)

Estaran Tolosa, Jose Manuel; Zibar, Darko; Caballero Jambrina, Antonio

2013-01-01

We report on the first experimental demonstration of phase-shifted superposition modulation (PSM) for optical links. Successful demodulation and decoding is obtained after 240 km transmission for 16-, 32- and 64-PSM.......We report on the first experimental demonstration of phase-shifted superposition modulation (PSM) for optical links. Successful demodulation and decoding is obtained after 240 km transmission for 16-, 32- and 64-PSM....

Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication.

Science.gov (United States)

Swenson, David W; Pietryga, Jason A; Grand, David J; Chang, Kevin J; Murphy, Brian L; Egglin, Thomas K

2014-07-01

The purpose of this study was to compare the diagnostic performance of four radiographic signs of gastric band slippage: abnormal phi angle, the "O sign," inferior displacement of the superolateral gastric band margin, and presence of an air-fluid level above the gastric band. A search of the electronic medical record identified 21 patients with a surgically proven slipped gastric band and 63 randomly-selected asymptomatic gastric band patients who had undergone barium swallow studies. These studies were evaluated for the four signs of band slippage by two independent radiologists who were blinded to clinical data. Sensitivity, specificity, and positive and negative predictive values were calculated for each radiographic sign of band slippage. Interobserver agreement between radiologists was assessed using the Fleiss kappa statistic. In evaluating for gastric band slippage, an abnormal phi angle greater than 58° was 91-95% sensitive and 52-62% specific (κ = 0.78), the O sign was 33-48% sensitive but 97% specific (κ = 0.84), inferior displacement of the superolateral band margin by more than 2.4 cm from the diaphragm was 95% sensitive and 97-98% specific (κ = 0.97), and the presence of an air-fluid level was 95% sensitive and 100% specific (κ = 1.00). We report two previously undescribed radiographic signs of gastric band slippage that are both sensitive and specific for this important surgical complication and recommend that these signs should be incorporated into the imaging evaluation of gastric band patients.

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

Science.gov (United States)

Aydinli, Bulent; Yilmaz, Omer; Ozturk, Gurkan; Yildigan, M Ilhan; Gursan, Nesrin; Basoglu, Mahmut

2007-09-01

A marginal ulcer developing after an initial operation for gastroduodenal ulcer is a serious threat to the patient, and a challenge to surgeons. Helicobacter pylori is the primary cause of peptic ulcer disease. However, its role in ulcer recurrence, especially of marginal ulcer (MU), after peptic ulcer surgery is unclear. This study aimed to determine any association between H. pylori infection and perforated MU by comparing the prevalence of H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) use in patients with perforated (PMU) and in those with nonperforated MU (NPMU). The study retrospectively evaluated the records of 16 patients with PMU who underwent surgical treatment and 24 patients with NPMU who underwent medical treatment in Atatürk University, School of Medicine, Department of General Surgery and Gastroenterology, between January 1995 and December 2004. The rate of H. pylori in the PMU group was significantly higher than that of the NPMU group (P PMU compared with NPMU patients (P PMU (P PMU operation especially in cases with impaired hemodynamics, severe peritoneal contamination, and/or a diameter smaller than 1 cm and avoiding the use of NSAIDs will surely reduce the risk of relapsing ulcers.

Light drinking versus abstinence in pregnancy - behavioural and cognitive outcomes in 7-year-old children: a longitudinal cohort study.

Science.gov (United States)

Kelly, Y; Iacovou, M; Quigley, M A; Gray, R; Wolke, D; Kelly, J; Sacker, A

2013-10-01

To assess whether light drinking in pregnancy is linked to unfavourable developmental outcomes in children. Prospective population-based cohort. UK. Ten thousand five hundred and thirty-four 7-year-olds. Quasi-experimental using propensity score matching (PSM) to compare children born to light (up to 2 units per week) and non-drinkers. Behavioural difficulties rated by parents and teachers; cognitive test scores for reading, maths and spatial skills. Ordinary least squares (OLS) regression and PSM analyses are presented. For behavioural difficulties, unadjusted estimates for percentage standard deviation (SD) score differences ranged from 2 to 14%. On adjustment for potential confounders, differences were attenuated, with a loss of statistical significance, except for teacher-rated boys' difficulties. For boys, parent-rated behavioural difficulties: unadjusted, -11.5; OLS, -4.3; PSM, -6.8; teacher-rated behavioural difficulties: unadjusted, -13.9; OLS, -9.6; PSM, -10.8. For girls, parent-rated behavioural difficulties: unadjusted, -9.6; OLS, -2.9; PSM, -4.5; teacher-rated behavioural difficulties: unadjusted, -2.4; OLS, 4.9; PSM, 3.9. For cognitive test scores, unadjusted estimates for differences ranged between 12 and 21% of an SD score for reading, maths and spatial skills. After adjustment for potential confounders, estimates were reduced, but remained statistically significantly different for reading and for spatial skills in boys. For boys, reading: unadjusted, 20.9; OLS, 8.3; PSM, 7.3; maths: unadjusted, 14.7; OLS, 5.0; PSM, 6.5; spatial skills: unadjusted, 16.2; OLS, 7.6; PSM, 8.1. For girls, reading: unadjusted, 11.6; OLS, -0.3; PSM, -0.5; maths: unadjusted, 12.9; OLS, 4.3; PSM, 3.9; spatial skills: unadjusted, 16.2; OLS, 7.7; PSM, 6.4. The findings suggest that light drinking during pregnancy is not linked to developmental problems in mid-childhood. These findings support current UK Department of Health guidelines on drinking during pregnancy. © 2013 The

Evaluation of margining algorithms in commercial treatment planning systems

International Nuclear Information System (INIS)

Pooler, Alistair M.; Mayles, Helen M.; Naismith, Olivia F.; Sage, John P.; Dearnaley, David P.

2008-01-01

Introduction: During commissioning of the Pinnacle (Philips) treatment planning system (TPS) the margining algorithm was investigated and was found to produce larger PTVs than Plato (Nucletron) for identical GTVs. Subsequent comparison of PTV volumes resulting from the QA outlining exercise for the CHHIP (Conventional or Hypofractionated High Dose IMRT for Prostate Ca.) trial confirmed that there were differences in TPS's margining algorithms. Margining and the clinical impact of the different PTVs in seven different planning and virtual simulation systems (Pinnacle, Plato, Prosoma (MedCom), Eclipse (7.3 and 7.5) (Varian), MasterPlan (Nucletron), Xio (CMS) and Advantage Windows (AW) (GE)) is investigated, and a simple test for 3D margining consistency is proposed. Methods: Using each TPS, two different sets of prostate GTVs on 2.5 mm and 5 mm slices were margined according to the CHHIP protocol to produce PTV3 (prostate + 5 mm/0 mm post), PTV2 (PTV3 + 5 mm) and PTV1 (prostate and seminal vesicles + 10 mm). GTVs and PTVs were imported into Pinnacle for volume calculation. DVHs for 5 mm slice plans, created using the smallest PTVs, were recalculated on the largest PTV dataset and vice versa. Since adding a margin of 50 mm to a structure should give the same result as adding five margins of 10 mm, this was tested for each TPS (consistency test) using an octahedron as the GTV and CT datasets with 2.5 mm and 5 mm slices. Results: The CHHIP PTV3 and PTV1 volumes had a standard deviation, across the seven systems, of 5% and PTV2 (margined twice) 9%, on the 5 mm slices. For 2.5 mm slices the standard deviations were 4% and 6%. The ratio of the Pinnacle and the Eclipse 7.3 PTV2 volumes was 1.25. Rectal doses were significantly increased when encompassing Pinnacle PTVs (V 50 42.8%), compared to Eclipse 7.3 PTVs (V 50 = 36.4%). Conversely, fields that adequately treated an Eclipse 7.3 PTV2 were inadequate for a Pinnacle PTV2. AW and Plato PTV volumes were the most consistent

Large margin image set representation and classification

KAUST Repository

Wang, Jim Jing-Yan; Alzahrani, Majed A.; Gao, Xin

2014-01-01

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.

Large margin image set representation and classification

KAUST Repository

Wang, Jim Jing-Yan

2014-07-06

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.

Single-Center Experience Using Marginal Liver Grafts in Korea.

Science.gov (United States)

Park, P-J; Yu, Y-D; Yoon, Y-I; Kim, S-R; Kim, D-S

2018-05-01

Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called "marginal donors." We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P = .023 and P = .048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR

Marginal-cost pricing for Hydro-Quebec residential customers

International Nuclear Information System (INIS)

Paquin, C.

1994-02-01

An option available to governments and to utilities such as Hydro-Quebec for responding to objectives of energy efficiency is the adoption of marginal cost pricing. Compared to currently used price structures, marginal cost pricing will allow improvement of price signals and assure an optimal utilization of the resource. That type of pricing could be economically beneficial but may not be desirable from the point of view of revenue distribution. Taking account of Hydro-Quebec's cost structure, pure marginal cost pricing would generate an income that would be strongly contested on equity grounds. For example, it would raise prices 60% for residential customers. Faced with this possibility, an analysis is presented of the impact of a peak-offpeak pricing (or pure marginal cost pricing) on Hydro-Quebec's residential customer energy bills. The marginal costs of Hydro-Quebec are calculated by the method of Bernard and Chatel (1985) and analysis of the results is based on Friedman and Weare (1993). A sample of 28,417 residential customers from a 1989 Hydro-Quebec survey is used in the study. Two scenarios are analyzed; the first allowing comparison of the energy bill only on the basis of marginal costs and of average costs, and the second allowing comparison of the impact of marginal cost pricing on the total bill. In the first scenario, the impact translates into a 31% increase in energy bills for the entire customer class considered; in addition, this impact is inversely proportional to the revenue class. In the second scenario, the increase is 24%. 33 refs., 10 figs., 53 tabs

Quantitative Segmentation of Fluorescence Microscopy Images of Heterogeneous Tissue: Application to the Detection of Residual Disease in Tumor Margins.

Science.gov (United States)

Mueller, Jenna L; Harmany, Zachary T; Mito, Jeffrey K; Kennedy, Stephanie A; Kim, Yongbaek; Dodd, Leslie; Geradts, Joseph; Kirsch, David G; Willett, Rebecca M; Brown, J Quincy; Ramanujam, Nimmi

2013-01-01

To develop a robust tool for quantitative in situ pathology that allows visualization of heterogeneous tissue morphology and segmentation and quantification of image features. TISSUE EXCISED FROM A GENETICALLY ENGINEERED MOUSE MODEL OF SARCOMA WAS IMAGED USING A SUBCELLULAR RESOLUTION MICROENDOSCOPE AFTER TOPICAL APPLICATION OF A FLUORESCENT ANATOMICAL CONTRAST AGENT: acriflavine. An algorithm based on sparse component analysis (SCA) and the circle transform (CT) was developed for image segmentation and quantification of distinct tissue types. The accuracy of our approach was quantified through simulations of tumor and muscle images. Specifically, tumor, muscle, and tumor+muscle tissue images were simulated because these tissue types were most commonly observed in sarcoma margins. Simulations were based on tissue characteristics observed in pathology slides. The potential clinical utility of our approach was evaluated by imaging excised margins and the tumor bed in a cohort of mice after surgical resection of sarcoma. Simulation experiments revealed that SCA+CT achieved the lowest errors for larger nuclear sizes and for higher contrast ratios (nuclei intensity/background intensity). For imaging of tumor margins, SCA+CT effectively isolated nuclei from tumor, muscle, adipose, and tumor+muscle tissue types. Differences in density were correctly identified with SCA+CT in a cohort of ex vivo and in vivo images, thus illustrating the diagnostic potential of our approach. The combination of a subcellular-resolution microendoscope, acriflavine staining, and SCA+CT can be used to accurately isolate nuclei and quantify their density in anatomical images of heterogeneous tissue.

How to make offshore marginal fields work for everyone

International Nuclear Information System (INIS)

Blandford, P.R.

1995-01-01

Marginal fields make positive impact on certain oil and gas companies' financial performances. These developments are integrated into the operator's operational and philosophical mindset, so that they optimize return and establish a reasonable reserve base for the company. Having a portfolio of marginal field developments is definitely a part of the offshore business, and oil field suppliers and subcontractors will continue to develop technology and methods to ensure the fields are exploited. It goes without saying that the continued production of marginal fields helps a lot of consumers and the companies that make up the energy chain that gets it to them. There are marginal fields all over the world and the market can only grow as more and more of the resources decline and industrialization expands demand. The projections for 2020 state that fossil fuels will remain the major supply link to dependable and affordable energy, particularly as additional oil and gas infrastructures are built and installed. Likened to the commodity, oil and gas companies and the energy industry have slowly evolved to the point where they are making a difference for people worldwide. As long as there is product to produce, most companies and consumers do not really care what type of reservoir started it all. More often then not, it probably started out as a marginal prospect. The paper discusses the energy picture today, marginal field update, offshore marginal field geography, and independent and marginal field developments

Exploring the Subtleties of Inverse Probability Weighting and Marginal Structural Models.

Science.gov (United States)

Breskin, Alexander; Cole, Stephen R; Westreich, Daniel

2018-05-01

Since being introduced to epidemiology in 2000, marginal structural models have become a commonly used method for causal inference in a wide range of epidemiologic settings. In this brief report, we aim to explore three subtleties of marginal structural models. First, we distinguish marginal structural models from the inverse probability weighting estimator, and we emphasize that marginal structural models are not only for longitudinal exposures. Second, we explore the meaning of the word "marginal" in "marginal structural model." Finally, we show that the specification of a marginal structural model can have important implications for the interpretation of its parameters. Each of these concepts have important implications for the use and understanding of marginal structural models, and thus providing detailed explanations of them may lead to better practices for the field of epidemiology.

Values and marginal preferences in international business

NARCIS (Netherlands)

Maseland, Robbert; van Hoorn, Andre

2010-01-01

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.

Investigational Paradigms in Downscoring and Upscoring DCIS: Surgical Management Review

Directory of Open Access Journals (Sweden)

P. Orsaria

2012-01-01

Full Text Available Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of “downscoring” or “upscoring” patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets' score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification.

Recent progress in Pacific-Asian Marginal Seas (PAMS) studies

Science.gov (United States)

Matsuno, Takeshi; Hirose, Naoki; Zhang, Jing; Cho, Yang-Ki; Chen, Dake; Yuan, Dongliang; Hung, Chin-Chang; Jan, Sen

2017-07-01

Marginal seas which represent the buffer zones between land and the pelagic ocean are being increasingly influenced by human activity. The role of the marginal seas is important for many reasons, among which are biological resources and climate change. In East Asia, we have marginal seas between the Asian Continent and the Pacific Ocean, where various countries and areas form complicated territories and EEZ. To understand the marine environment of marginal seas, international cooperative scientific activities are necessary, and it is essential to share the latest information and knowledge.

The stability margin on EAST tokamak

International Nuclear Information System (INIS)

Jin-Ping, Qian; Bao-Nian, Wan; Biao, Shen; Bing-Jia, Xiao; Walker, M.L.; Humphreys, D.A.

2009-01-01

The experimental advanced superconducting tokamak (EAST) is the first full superconducting tokamak with a D-shaped cross-sectional plasma presently in operation. Its poloidal coils are relatively far from the plasma due to the necessary thermal isolation from the superconducting magnets, which leads to relatively weaker coupling between plasma and poloidal field. This may cause more difficulties in controlling the vertical instability by using the poloidal coils. The measured growth rates of vertical stability are compared with theoretical calculations, based on a rigid plasma model. Poloidal beta and internal inductance are varied to investigate their effects on the stability margin by changing the values of parameters α n and γ n (Howl et al 1992 Phys. Fluids B 4 1724), with plasma shape fixed to be a configuration with k = 1.9 and δ = 0.5. A number of ways of studying the stability margin are investigated. Among them, changing the values of parameters κ and l i is shown to be the most effective way to increase the stability margin. Finally, a guideline of stability margin M s (κ, l i , A) to a new discharge scenario showing whether plasmas can be stabilized is also presented in this paper

Fedme og risiko for marginal parodontitis

DEFF Research Database (Denmark)

Kongstad, Johanne; Keller, Amélie Cléo; Rohde, Jeanett Friis

2017-01-01

Oversigtsartiklen, der er af narrativ karakter, beskriver sammenhængen mellem overvægt/ fedme og marginal parodontitis. Artiklen er baseret på et udvalg af nyere engelsksproget litteratur og motiveres af den øgede forekomst af overvægtige og fede i befolkningen. Desuden er det afgørende, at tandl......Oversigtsartiklen, der er af narrativ karakter, beskriver sammenhængen mellem overvægt/ fedme og marginal parodontitis. Artiklen er baseret på et udvalg af nyere engelsksproget litteratur og motiveres af den øgede forekomst af overvægtige og fede i befolkningen. Desuden er det afgørende......, at tandlæger forholder sig kritisk til systemiske tilstandes mulige konsekvens for udvikling, forværring og behandling af marginal parodontitis. Der nævnes forskellige mål for fedme, hvor body mass index (BMI) og taljeomkreds er de mest anvendte. Problematikken vedrørende tidligere studiers anvendelse af...... forskellige kriterier for marginal parodontitis berøres. Litteraturgennemgangen tager udgangspunkt i de biologiske mekanismer, der udløses i fedtvæv ved overvægt/fedme og medfører en kronisk inflammatorisk tilstand med frigivelse af bl.a. adipokiner. Epidemiologiske tværsnitsog longitudinelle studier af...

Refining prices and margins in 1998

International Nuclear Information System (INIS)

Favennec, J.P.; Baudoin, C.

1999-01-01

Despite a business environment that was globally mediocre due primarily to the Asian crisis and to a mild winter in the northern hemisphere, the signs of improvement noted in the refining activity in 1996 were borne out in 1997. But the situation is not yet satisfactory in this sector: the low return on invested capital and the financing of environmental protection expenditure are giving cause for concern. In 1998, the drop in crude oil prices and the concomitant fall in petroleum product prices was ultimately rather favorable to margins. Two elements tended to put a damper on this relative optimism. First of all, margins continue to be extremely volatile and, secondly, the worsening of the economic and financial crisis observed during the summer made for a sharp decline in margins in all geographic regions, especially Asia

Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery?

Directory of Open Access Journals (Sweden)

Jacob Dietmar

2008-11-01

Full Text Available Abstract Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics.

Realistic respiratory motion margins for external beam partial breast irradiation

Energy Technology Data Exchange (ETDEWEB)

Conroy, Leigh; Quirk, Sarah [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Smith, Wendy L., E-mail: wendy.smith@albertahealthservices.ca [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4 (Canada)

2015-09-15

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dose profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was

Realistic respiratory motion margins for external beam partial breast irradiation

International Nuclear Information System (INIS)

Conroy, Leigh; Quirk, Sarah; Smith, Wendy L.

2015-01-01

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dose profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was

17 CFR 41.47 - Withdrawal of margin.

Science.gov (United States)

2010-04-01

... PRODUCTS Customer Accounts and Margin Requirements § 41.47 Withdrawal of margin. (a) By the customer... positions in the account under this Regulation (Subpart E, §§ 41.42 through 41.49). (b) By the security...) Interest charged on credit maintained in the account; (3) Communication or shipping charges with respect to...

Public Service Motivation Differences BetweenPermanent and Contract Employees in the Local Government

Directory of Open Access Journals (Sweden)

Wayu Eko Yudiatmaja

2017-12-01

Full Text Available This article examines the distinction of public service motivation (PSM on street-level bureaucracy in Indonesia. Focus of this study is to review the differentiation of public service motivation between permanent and contract employees in sub-districts of Tanjungpinang, Kepulauan Riau. The dimensions and indicators of Perry’s (1996 measurement of PSM is used to analyze the differentiation of public service motivation between permanent and contract employees. Independent sampel t-test has employed to 129 government employees and 74 non-government employees in Tanjungpinang. Unlike in developed countries that PSM of its civil services are higher than PSM of contract employees, the findings of this research proves that there is no differences between PSM of permanent and contract employees. The findings of this research rejects the conclusion of foreign scholars suggesting the PSM construct was viable for internationally environment.

Emotional labour strategies as mediators of the relationship between public service motivation and job satisfaction in Chinese teachers.

Science.gov (United States)

Li, Mingjun; Wang, Zhenhong

2016-06-01

The purpose of this study was to examine the relationship between teachers' public service motivation (PSM) and their job satisfaction levels and to investigate the mediating effects of surface acting (SA) and deep acting (DA) on that relationship. The teacher PSM scale, as well as emotional labour strategies and intrinsic satisfaction (IS) and extrinsic satisfaction (ES) scales, were administered to 317 primary and middle school teachers. Results indicated that PSM among Chinese teachers was significantly and positively related to both IS and ES. Furthermore, structural equation modelling analysis showed that SA and DA played mediating roles in the PSM-IS and PSM-ES relationships, respectively. These findings provide a new perspective that explains the mechanism underlying the association between PSM among teachers and their job satisfaction levels. Finally, the possible explanations and implications are discussed. © 2014 International Union of Psychological Science.

Double-sided Moral Hazard and Margin-based Royalty

OpenAIRE

NARIU, Tatsuhiko; UEDA, Kaoru; LEE, DongJoon

2009-01-01

This paper analyzes royalty modes in the franchise arrangements of convenience stores under double-sided moral hazard. In Japan, the majority of franchisors charge margin-based royalties based on net margins rather than sales-based royalties based on sales. We show that the franchisor can attain the first-best outcome by adopting margin-based royalties under double-sided moral hazard. We consider a case where a franchisee sells two kinds of goods; one is shipped from its franchisor and the ot...

Bacterial migration through punctured surgical gloves under real surgical conditions

Directory of Open Access Journals (Sweden)

Heidecke Claus-Dieter

2010-07-01

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.

Surgical experts: born or made?

Science.gov (United States)

Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

2013-01-01

The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).

Science.gov (United States)

Haider, Adil; Scott, John W; Gause, Colin D; Meheš, Mira; Hsiung, Grace; Prelvukaj, Albulena; Yanocha, Dana; Baumann, Lauren M; Ahmed, Faheem; Ahmed, Na'eem; Anderson, Sara; Angate, Herve; Arfaa, Lisa; Asbun, Horacio; Ashengo, Tigistu; Asuman, Kisembo; Ayala, Ruben; Bickler, Stephen; Billingsley, Saul; Bird, Peter; Botman, Matthijs; Butler, Marilyn; Buyske, Jo; Capozzi, Angelo; Casey, Kathleen; Clayton, Charles; Cobey, James; Cotton, Michael; Deckelbaum, Dan; Derbew, Miliard; deVries, Catherine; Dillner, Jeanne; Downham, Max; Draisin, Natalie; Echinard, David; Elneil, Sohier; ElSayed, Ahmed; Estelle, Abigail; Finley, Allen; Frenkel, Erica; Frykman, Philip K; Gheorghe, Florin; Gore-Booth, Julian; Henker, Richard; Henry, Jaymie; Henry, Orion; Hoemeke, Laura; Hoffman, David; Ibanga, Iko; Jackson, Eric V; Jani, Pankaj; Johnson, Walter; Jones, Andrew; Kassem, Zeina; Kisembo, Asuman; Kocan, Abbey; Krishnaswami, Sanjay; Lane, Robert; Latif, Asad; Levy, Barbara; Linos, Dimitrios; Linz, Peter; Listwa, Louis A; Magee, Declan; Makasa, Emmanuel; Marin, Michael L; Martin, Claude; McQueen, Kelly; Morgan, Jamie; Moser, Richard; Neighbor, Robert; Novick, William M; Ogendo, Stephen; Omigbodun, Akinyinka; Onajin-Obembe, Bisola; Parsan, Neil; Philip, Beverly K; Price, Raymond; Rasheed, Shahnawaz; Ratel, Marjorie; Reynolds, Cheri; Roser, Steven M; Rowles, Jackie; Samad, Lubna; Sampson, John; Sanghvi, Harshadkumar; Sellers, Marchelle L; Sigalet, David; Steffes, Bruce C; Stieber, Erin; Swaroop, Mamta; Tarpley, John; Varghese, Asha; Varughese, Julie; Wagner, Richard; Warf, Benjamin; Wetzig, Neil; Williamson, Susan; Wood, Joshua; Zeidan, Anne; Zirkle, Lewis; Allen, Brendan; Abdullah, Fizan

2017-10-01

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

Time Safety Margin: Theory and Practice

Science.gov (United States)

2016-09-01

Air Education and Training Command Handbook 99-107, T-38 Road to Wings, Randolph Air Force Base, Texas, July 2013. 65 This page was intentionally left...412TW-TIH-16-01 TIME SAFETY MARGIN: THEORY AND PRACTICE WILLIAM R. GRAY, III Chief Test Pilot USAF Test Pilot School SEPTEMBER 2016... Safety Margin: The01y and Practice) was submitted by the Commander, 4 I 2th Test Wing, Edwards AFB, Ca lifornia 93524-6843. Foreign announcement and

Algorithms and Public Service Media

DEFF Research Database (Denmark)

Sørensen, Jannick Kirk; Hutchinson, Jonathon

2018-01-01

When Public Service Media (PSM) organisations introduce algorithmic recommender systems to suggest media content to users, fundamental values of PSM are challenged. Beyond being confronted with ubiquitous computer ethics problems of causality and transparency, also the identity of PSM as curator...

Benefit–cost analysis of non-marginal climate and energy projects

International Nuclear Information System (INIS)

Dietz, Simon; Hepburn, Cameron

2013-01-01

Conventional benefit–cost analysis incorporates the normally reasonable assumption that the policy or project under examination is marginal. Among the assumptions this entails is that the policy or project is small, so the underlying growth rate of the economy does not change. However, this assumption may be inappropriate in some important circumstances, including in climate-change and energy policy. One example is global targets for carbon emissions, while another is a large renewable energy project in a small economy, such as a hydropower dam. This paper develops some theory on the evaluation of non-marginal projects, with empirical applications to climate change and energy. We examine the conditions under which evaluation of a non-marginal project using marginal methods may be wrong, and in our empirical examples we show that both qualitative and large quantitative errors are plausible. - Highlights: • This paper develops the theory of the evaluation of non-marginal projects. • It also includes empirical applications to climate change and energy. • We show when evaluation of a non-marginal project using marginal methods is wrong

30 CFR 204.3 - What alternatives are available for marginal properties?

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What alternatives are available for marginal... MINERALS REVENUE MANAGEMENT ALTERNATIVES FOR MARGINAL PROPERTIES General Provisions § 204.3 What alternatives are available for marginal properties? If you have production from a marginal property, MMS and...

Margination of Stiffened Red Blood Cells Regulated By Vessel Geometry.

Science.gov (United States)

Chen, Yuanyuan; Li, Donghai; Li, Yongjian; Wan, Jiandi; Li, Jiang; Chen, Haosheng

2017-11-10

Margination of stiffened red blood cells has been implicated in many vascular diseases. Here, we report the margination of stiffened RBCs in vivo, and reveal the crucial role of the vessel geometry in the margination by calculations when the blood is seen as viscoelastic fluid. The vessel-geometry-regulated margination is then confirmed by in vitro experiments in microfluidic devices, and it establishes new insights to cell sorting technology and artificial blood vessel fabrication.

Global curriculum in surgical oncology.

Science.gov (United States)

Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A

2016-06-01

The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

Criticality safety margins for mixtures of fissionable materials

International Nuclear Information System (INIS)

Williamson, T.G.; Mincey, J.F.

1992-01-01

In the determination of criticality safety margins, approximations for combinations of fissile and fissionable isotopes are sometimes used that go by names such as the rule of fractions or equivalency relations. Use of the rule of fractions to ensure criticality safety margins was discussed in an earlier paper. The purpose of this paper is to correct errors and to clarify some of the implications. Deviations of safety margins from those calculated by the rule of fractions are still noted; however, the deviations are less severe. Caution in applying such rules is still urged. In general, these approximations are based on American National Standard ANSI/ANS-8.15, Sec. 5.2. This section allows that ratios of material masses to their limits may be summed for fissile nuclides in aqueous solutions. It also allows the addition of nonfissile nuclides if an aqueous moderator is present and addresses the effects of infinite water or equivalent reflector. Water-reflected binary combinations of aqueous solutions of fissile materials, as well as binary combinations of fissile and fissionable metals, were considered. Some combinations were shown to significantly decrease the margin of subcriticality compared to the single-unit margins. In this study, it is confirmed that some combinations of metal units in an optimum geometry may significantly decrease the margin of subcriticality. For some combinations of aqueous solutions of fissile materials, the margin of subcriticality may also be reduced by very small amounts. The conclusion of Ref. 1 that analysts should be careful in applying equivalency relations for combining materials remains valid and sound advice. The ANSI/ANS standard, which allows the use of ratios of masses to their limits, applies to aqueous, fully water-reflected, single-unit solutions. Extensions to other situations should be considered with extreme care

Evaluation of motion management strategies based on required margins

International Nuclear Information System (INIS)

Sawkey, D; Svatos, M; Zankowski, C

2012-01-01

Strategies for delivering radiation to a moving lesion each require a margin to compensate for uncertainties in treatment. These motion margins have been determined here by separating the total uncertainty into components. Probability density functions for the individual sources of uncertainty were calculated for ten motion traces obtained from the literature. Motion margins required to compensate for the center of mass motion of the clinical treatment volume were found by convolving the individual sources of uncertainty. For measurements of position at a frequency of 33 Hz, system latency was the dominant source of positional uncertainty. Averaged over the ten motion traces, the motion margin for tracking with a latency of 200 ms was 4.6 mm. Gating with a duty cycle of 33% required a mean motion margin of 3.2–3.4 mm, and tracking with a latency of 100 ms required a motion margin of 3.1 mm. Feasible reductions in the effects of the sources of uncertainty, for example by using a simple prediction algorithm to anticipate the lesion position at the end of the latency period, resulted in a mean motion margin of 1.7 mm for tracking with a latency of 100 ms, 2.4 mm for tracking with a latency of 200 ms, and 2.1–2.2 mm for the gating strategies with duty cycles of 33%. A crossover tracking latency of 150 ms was found, below which tracking strategies could take advantage of narrower motion margins than gating strategies. The methods described here provide a means to guide selection of a motion management strategy for a given patient. (paper)

Sustainable food production in marginal lands—Case of GDLA member countries

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Shabbir A. Shahid

2013-06-01

Full Text Available Sustainable food production in the changing climate and dwindling water resources in the Global Dry Land Alliance (GDLA member countries is a real challenge, especially when considering marginal lands in dryland systems. The definition of marginal land is very vague and defined from different perspectives (pragmatism about marginal lands. Dryland itself indicates "marginality" due to water stress. In general, the abandoned agriculture land where food production is not economical, and has low inherent productivity potential is considered marginal; however, a land may be marginal for agriculture but vital for grazing. In this paper attempts have been made to give review of literature (water stress, extent of marginal saline lands, marginality. Policy matters (development of soil, water and agriculture strategies that GDLA and member countries should consider for future sustainable food production in their countries, including but not limited to, assessment of land resources for agriculture potential, defining, mapping and characterizing marginal lands, and use of innovative technologies (conservation agriculture, climate smart agriculture, integrated soil reclamation program and capacity building for food production, are discussed. The international perception (FAO, UNEP, CGIAR on marginal lands is also described. An innovative approach of using national biocapacity and ecological footprint is used to assess marginality of GDLA member countries. Ecological overshoot (using 1.5 earth planets and biocapacity debtor and creditor countries are highlighted. Challenges and best management practices for food production in marginal lands are included. Other important issues, like leasing land abroad, GDLA strategic food reserves and best management practices, innovative ideas for food production are shared. Finally recommendations are drafted for actions by GDLA, its member countries and the partners.

Capping of the radicular exposed surface (part II). Surgical and not surgical treatment

OpenAIRE

Grados Pomarino, Sixto; Estrada, Andrew Alejandro; Maetahara Rubio, Denis Miguel; Guzmán Vera, Yanina Sara; Tello Barbarán, Javier

2014-01-01

The gingival recession treatment can be made surgical1y with a high predictability of success due to the great advance during the last ones of the mucogingival surgical techniques. The use of connective grafts in coverage of recessions has obtained high rates of success reason why these procedures are common within the modern periodontal surgical practice. Knowing that all patients do not accept the surgical treatment, many investigators have come studying the possibility of treating non-surg...

Identifying technology innovations for marginalized smallholders-A conceptual approach.

Science.gov (United States)

Malek, Mohammad Abdul; Gatzweiler, Franz W; Von Braun, Joachim

2017-05-01

This paper adds a contribution in the existing literature in terms of theoretical and conceptual background for the identification of idle potentials of marginal rural areas and people by means of technological and institutional innovations. The approach follows ex-ante assessment for identifying suitable technology and institutional innovations for marginalized smallholders in marginal areas-divided into three main parts (mapping, surveying and evaluating) and several steps. Finally, it contributes to the inclusion of marginalized smallholders by an improved way of understanding the interactions between technology needs, farming systems, ecological resources and poverty characteristics in the different segments of the poor, and to link these insights with productivity enhancing technologies.

The natural history of perforated marginal ulcers after gastric bypass surgery.

Science.gov (United States)

Altieri, Maria S; Pryor, Aurora; Yang, Jie; Yin, Donglei; Docimo, Salvatore; Bates, Andrew; Talamini, Mark; Spaniolas, Konstantinos

2018-03-01

Although perforated marginal ulcers (pMU) following Roux-en-Y Gastric Bypass (RYGB) represent a surgical emergency, the epidemiology and outcome of this condition is not well understood. The purpose of this study was to evaluate incidence of pMU following RYGB and assess the natural history of this complication. The SPARCS administrative database was used to identify patients undergoing RYGB between 2005 and 2010. With the use of a unique identifier, we followed patients up to 2014 for subsequent admission and re-intervention (repair or revision) for perforated MU. Groups were compared using Chi square tests with exact p values based on Monte Carlo simulation, t test with unequal variances, and the Wilcoxon rank-sum test when appropriate. We identified 35,080 RYGB patients; 292 patients (0.83%) developed pMU 937 (443-1546) days following RYGB [Median (Q1-Q3)]. Among these 292 patients, tobacco use was present in one-third of patients. Repair of the perforation was performed in 115 patients, while anastomotic revision was reported in 64. Patients who underwent revision were more likely to have respiratory complications. Hospital length of stay was significantly longer for patients managed with RYGB revision (Median, Q1-Q3:7, 5-14, vs 6, 4-7, days, p = 0.001). Recurrence of marginal ulcer was common after either intervention (26.09% for repair and 29.69% for revision, p = 0.726). Following RYGB, the incidence of pMU is small. Anastomotic revision for pMU is associated with prolonged length of stay compared to repair alone. Importantly, recurrence after intervention of pMU is common, suggesting possible value of a routine surveillance program for patients following pMU.

Evaluation of the marginal fit of metal copings fabricated on three different marginal designs using conventional and accelerated casting techniques: An in vitro study

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Sharad Vaidya

2014-01-01

Conclusion: Among the three marginal designs studied, shoulder with bevel showed the best marginal fit with conventional as well as accelerated casting techniques. Accelerated casting technique could be a vital alternative to the time-consuming conventional casting technique. The marginal fit between the two casting techniques showed no statistical difference.

Porovnání efektivnosti měření cenové citlivosti u nových a zavedených značek

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Elena Salamandic

2015-03-01

Full Text Available Purpose of the article: The Price Sensitivity Measurement (PSM evaluates consumers’ expectations to set the optimal price. Applied to a brand’s different lifecycle stages, it can show different feasibility. The aim of this paper is showing that PSM is more effective for newly introduced brand products compared to established ones. Methodology: The difference in PSM effectiveness is tested for a newly introduced Lithuanian cosmetics brand, Ziede, and a well-known vitamin distributor brand, Jamieson. The authors selected 3 products, based on product category, consumer segment and product lifecycle stage. PSM was applied for different consumer categories by differentiating respondents who were familiar with the brands from those who weren’t. Scientific aim: Empirical results show that optimal prices are higher for brand-familiar consumers, since they incorporate the brand value in their perception of optimal price (Salamandic, Alijosiene, Gudonaviciene, 2014. However, as the brand moves along the lifecycle stages, the price perceived by consumers as optimal moves closer to the actual market price. The scientific problem is to find how to reach maximum effectiveness of PSM when setting the optimal price. Findings: Empirical research confirmed two important recommendations for PSM applications. Firstly, since price sensitivity decreases with increasing brand awareness, PSM should be applied for different consumer categories. Secondly, product lifecycle advances together with brand awareness; therefore, PSM is more effective for newly introduced brand products. Conclusions: By comparing PSM feasibility for new vs. established brands, it was obtained that PSM is more effective when applied at the early stage of a brand’s lifecycle. Mispricing is detected more accurately when information is collected from more respondents who are unfamiliar with the brand, which happens more often when the brand is newly introduced. To avoid future losses, price

Surgical removal of infraauriculer recurrent dermatofibrosarcoma protuberans and reconstruction with bilobed flap

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Fuat Bulut

2014-06-01

Full Text Available Dermatofibrosarcoma protuberance is a rare skin tumor which has slowly growing, low metastasis capacity but can be locally agressive. This is a case report about a patient who was operated in an other medical center for dermatofibrosarkom protüberans and the tumor recurred after a short time. The tumor was reexcised with free surgical 2 cm margin with also superficial parotidektomy was done. Skin defect was covered by bilobed flap. The pathological specimen was reported as dermatofibrosarcoma protuberance. There is no recurrence or metastasis for 12 months follow-up of patient. A rare is use of the bilobed flap in the head and neck region after large tumoral lesion excision. In our opinion, the revised reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.

Surgical Regenerative Treatments for Peri-Implantitis: Meta-analysis of Recent Findings in a Systematic Literature Review

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Povilas Daugela

2016-09-01

Full Text Available Objectives: The purpose of the present study was to systematically review the literature on the surgical regenerative treatment of the peri-implantitis and to determine an effective therapeutic predictable option for their clinical management. Material and Methods: The study searched MEDLINE and EMBASE databases from 2006 to 2016. Clinical human studies that had reported changes in probing depth (PD and/or bleeding on probing (BOP and/or radiologic marginal bone level (RBL changes after peri-implantitis surgical treatment at 12-month follow-up or longer were included accordingly to PRISMA guidelines. Results: The initial search obtained 883 citations. After screening and determination of eligibility, 18 articles were included in the review. The meta-analysis of selected studies revealed that the weighted mean RBL fill was 1.97 mm (95% confidence interval [CI] = 1.58 to 2.35 mm, PD reduction was 2.78 mm (95% CI = 2.31 to 3.25 mm, and BOP reduced by 52.5% (95% CI = 41.6 to 63.1%. Defect fill in studies using and not using barrier membranes for graft coverage was 1.86 mm (95% CI = 1.36 to 2.36 mm and 2.12 mm (95% CI = 1.46 to 2.78 mm correspondingly. High heterogeneity among the studies regarding defects morphology, surgical protocols, and selection of biomaterials were found. Conclusions: All included studies underlined an improvement of clinical conditions after the surgical regenerative treatment of peri-implantitis, however, there is a lack of scientific evidence in the literature regarding the superiority of the regenerative versus non-regenerative surgical treatment. The presence of a barrier membrane or submergence in the regenerative procedure does not seem to be fundamental in order to obtain clinical success of the surgery.

Abortion - surgical - aftercare

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000658.htm 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 ...

Marginal Accuracy of Castings Produced with Different Investment Systems.

Science.gov (United States)

Yadav, R K

2009-04-01

The use of casting ring to produce accurate castings has been challenged with the introduction of a ringless casting technique. This study compared the marginal accuracy of all - metal complete coverage crowns fabricated with ringless, split plastic ring and metal ring investment systems. A total of 40 all- metal complete coverage crowns were fabricated on a metal die. The crowns were divided in 4 groups (Group A, B, C and D) of 10 patterns each. A ringless system of investing and casting was used for group A whereas a split plastic ring system was used for group B. Groups C and D utilized metal ring with single and double layers of asbestos free cellulose acetate liner respectively for investing and casting procedures. The restorations were seated on the metal die and the vertical marginal discrepancy was evaluated by measuring the gap between the finish line on the die and the margins of the crown on four specific sites with an optical microscope. Statistical analysis was carried out using ANOVA and multiple comparison "t" test. The mean vertical marginal discrepancy for groups A, B, C and D was 95μm, 136μm, 128μm and 104μm respectively. Vertical marginal discrepancy on each surface was compared among the four groups. Difference of vertical marginal discrepancy on buccal surface (p0.05). Accurate castings with better marginal fit can be produced with ringless casting technique.

Influence of Crack Morphology on Leak Before Break Margins

International Nuclear Information System (INIS)

Weilin Zang

2007-11-01

The purpose of the project is to evaluate the deterministic LBB-margins for different pipe systems in a Swedish PWR-plant and using different crack morphology parameters. Results: - The influence of crack morphology on Leak Before Break (LBB) margins is studied. The subject of the report is a number of LBB-submittals to SKI where deterministic LBB-margins are reported. These submittals typically uses a surface roughness of 0.0762 mm (300 microinch) and number of turns equal to zero and an in-house code for the leak rate evaluations. The present report has shown that these conditions give the largest LBB-margins both in terms of the quotient between the critical crack length and the leakage crack size and for the leak rate margin. - Crack morphology parameters have a strong influence on the leak rate evaluations. Using the SQUIRT code and more recent recommendations for crack morphology parameters, it is shown that in many cases the evaluated margins, using 1 gpm as the reference leak rate detection limit, are below the safety factor of 2 on crack size and 10 on leak rate, which is generally required for LBB approval. - The effect of including weld residual stresses on the LBB margins is also investigated. It is shown that for the two examples studied, weld residual stresses were important for the small diameter thin wall pipe whereas it was negligible for the large diameter thick wall pipe which had a self-balanced weld residual stress distribution

Marginal adaptation of composite resins under two adhesive techniques.

Science.gov (United States)

Dačić, Stefan; Veselinović, Aleksandar M; Mitić, Aleksandar; Nikolić, Marija; Cenić, Milica; Dačić-Simonović, Dragica

2016-11-01

In the present research, different adhesive techniques were used to set up fillings with composite resins. After the application of etch and rinse or self etch adhesive technique, marginal adaptation of composite fillings was estimated by the length of margins without gaps, and by the microretention of resin in enamel and dentin. The study material consisted of 40 extracted teeth. Twenty Class V cavities were treated with 35% phosphorous acid and restored after rinsing by Adper Single Bond 2 and Filtek Ultimate-ASB/FU 3M ESPE composite system. The remaining 20 cavities were restored by Adper Easy One-AEO/FU 3M ESPE composite system. Marginal adaptation of composite fillings was examined using a scanning electron microscope (SEM). The etch and rinse adhesive technique showed a significantly higher percentage of margin length without gaps (in enamel: 92.5%, in dentin: 57.3%), compared with the self-etch technique with lower percentage of margin length without gaps, in enamel 70.4% (p resin tugs in interprismatic spaces of enamel, while the dentin microretention was composed of adhesive and hybrid layers with resin tugs in dentin canals. In the second technique, resin tugs were rarely seen and a microgap was dominant along the border of restoration margins. The SEM analysis showed a better marginal adaptation of composite resin to enamel and dentin with better microretention when the etch and rinse adhesive procedure was applied. © 2016 Wiley Periodicals, Inc.

Technical specification improvement through safety margin considerations

International Nuclear Information System (INIS)

Howard, R.C.; Jansen, R.L.

1986-01-01

Westinghouse has developed an approach for utilizing safety analysis margin considerations to improve plant operability through technical specification revision. This approach relies on the identification and use of parameter interrelations and sensitivities to identify acceptable operating envelopes. This paper summarizes technical specification activities to date and presents the use of safety margin considerations as another viable method to obtain technical specification improvement

The strong anti-glioblastoma capacity of the plasma-stimulated lysine-rich medium

International Nuclear Information System (INIS)

Yan, Dayun; Keidar, Michael; Nourmohammadi, Niki; Talbot, Annie; Sherman, Jonathan H

2016-01-01

Plasma-stimulated medium (PSM) shows a remarkable anti-cancer capacity as strong as the direct cold atmospheric plasma (CAP) treatment of cancer cells. PSM is able to effectively resist the growth of several cancer cell lines. To date, the sole approach to strengthen the anti-cancer capacity of PSM is extending the plasma treatment time. In this study, we demonstrated that the anti-glioblastoma capacity of PSM could be significantly increased by adding 20 mM lysine in Dulbecco’s modified Eagle’s medium (DMEM). This study provides clear evidence that the anti-glioblastoma capacity of PSM could be noticeably enhanced by modifying the composition of medium without increasing the CAP treatment time. (paper)

Pattern of Failure After Limited Margin Radiotherapy and Temozolomide for Glioblastoma

International Nuclear Information System (INIS)

McDonald, Mark W.; Shu, Hui-Kuo G.; Curran, Walter J.; Crocker, Ian R.

2011-01-01

Purpose: To evaluate the pattern of failure after limited margin radiotherapy for glioblastoma. Methods and Materials: We analyzed 62 consecutive patients with newly diagnosed glioblastoma treated between 2006 and 2008 with standard fractionation to a total dose of 60Gy with concurrent temozolomide (97%) or arsenic trioxide (3%). The initial clinical target volume included postoperative T2 abnormality with a median margin of 0.7cm. The boost clinical target volume included residual T1-enhancing tumor and resection cavity with a median margin of 0.5cm. Planning target volumes added a 0.3- or 0.5-cm margin to clinical target volumes. The total boost planning target volume (PTV boost ) margin was 1cm or less in 92% of patients. The volume of recurrent tumor (new T1 enhancement) was categorized by the percent within the 60-Gy isodose line as central (>95%), infield (81-95%), marginal (20-80%), or distant ( boost with a 2.5-cm margin were created for each patient. Results: With a median follow-up of 12 months, radiographic tumor progression developed in 43 of 62 patients. Imaging was available for analysis in 41: 38 (93%) had central or infield failure, 2 (5%) had marginal failure, and 1 (2%) had distant failure relative to the 60-Gy isodose line. The treated PTV boost (median, 140cm 3 ) was, on average, 70% less than the PTV boost with a 2.5-cm margin (median, 477cm 3 ) (p boost margin of 1cm or less did not appear to increase the risk of marginal and/or distant tumor failures compared with other published series. With careful radiation planning and delivery, it appears that treatment margins for glioblastoma can be reduced.

Stroke: a Hidden Danger of Margin Trading in Stock Markets.

Science.gov (United States)

Lin, Shu-Hui; Wang, Chien-Ho; Liu, Tsai-Ching; Chen, Chin-Shyan

2015-10-01

Using 10-year population data from 2000 through 2009 in Taiwan, this is the first paper to analyze the relationship between margin trading in stock markets and stroke hospitalizations. The results show that 3 and 6 days after an increase of margin trading in the Taiwan stock markets are associated with greater stoke hospitalizations. In general, a 1 % increase in total margin trading positions is associated with an increment of 2.5 in the total number of stroke hospitalizations, where the mean number of hospital admissions is 233 cases a day. We further examine the effects of margin trading by gender and age groups and find that the effects of margin trading are significant for males and those who are 45-74 years old only. In summary, buying stocks with money you do not have is quite risky, especially if the prices of those stocks fall past a certain level or if there is a sudden and severe drop in the stock market. There is also a hidden danger to one's health from margin trading. A person should be cautious before conducting margin trading, because while it can be quite profitable, danger always lurks just around the corner.

Studying media at The Margins: learning from the field

Directory of Open Access Journals (Sweden)

Clemencia Rodríguez

2016-07-01

Full Text Available This article, informed by ethnographic research on media at the margins, proposes a shift in perspective at several different levels: 1 instead of focusing on individual technologies, our research should examine how grassroots communicators operating at the margins exist in a media ecology that offers different potentialities in each historical situation; 2 instead of trying to determine if the media technologies used at the margin are old or new, digital or not digital, we need to explore how embedded community communicators detect local information or communication needs and use available technologies to address these needs; 3 our research on media at the margins should shed light on how grassroots communicators re-invent, hybridize, converge, and bridge technologies from one platform to another. In sum, understanding media at the margins is about embracing complexity, maintaining the notion of media ecologies, and understanding how grassroots communicators, deeply embedded in local contexts, wedge media technologies into everyday life.

Uplift history of a transform continental margin revealed by the stratigraphic record: The case of the Agulhas transform margin along the Southern African Plateau

Science.gov (United States)

Baby, Guillaume; Guillocheau, François; Boulogne, Carl; Robin, Cécile; Dall'Asta, Massimo

2018-04-01

The south and southeast coast of southern Africa (from 28°S to 33°S) forms a high-elevated transform passive margin bounded to the east by the Agulhas-Falkland Fracture Zone (AFFZ). We analysed the stratigraphic record of the Outeniqua and Durban (Thekwini) Basins, located on the African side of the AFFZ, to determine the evolution of these margins from the rifting stage to present-day. The goal was to reconstruct the strike-slip evolution of the Agulhas Margin and the uplift of the inland high-elevation South African Plateau. The Agulhas transform passive margin results from four successive stages: Rifting stage, from Late Triassic to Early Cretaceous ( 200?-134 Ma), punctuated by three successive rifting episodes related to the Gondwana breakup; Wrench stage (134-131 Ma), evidenced by strike- and dip-slip deformations increasing toward the AFFZ; Active transform margin stage (131-92 Ma), during which the Falkland/Malvinas Plateau drifts away along the AFFZ, with an uplift of the northeastern part of the Outeniqua Basin progressively migrating toward the west; Thermal subsidence stage (92-0 Ma), marked by a major change in the configuration of the margin (onset of the shelf-break passive margin morphology). Two main periods of uplift were documented during the thermal subsidence stage of the Agulhas Margin: (1) a 92 Ma short-lived margin-scale uplift, followed by a second one at 76 Ma located along the Outeniqua Basin and; (2) a long-lasting uplift from 40 to 15 Ma limited to the Durban (Thekwini) Basin. This suggests that the South African Plateau is an old Upper Cretaceous relief (90-70 Ma) reactivated during Late Eocene to Early Miocene times (40-15 Ma).

Preoperative CT assessment of esophageal carcinoma : comparison between the patients with and without recurrence of esophageal carcinoma after surgical resection

International Nuclear Information System (INIS)

Lee, Young Hen; Oh, Yu Whan; Cho, Kyu Ran; Park, Bum Jin; Lee, Nam Jun; Chung, Kyoo Byung

2001-01-01

To determine whether preoperative CT is helpful in predicting the development of recurrent tumor following surgical resection in patients with esophageal cancer. Thirty patients with esophageal cancer in whom preoperative CT of the chest had been performed were included in the study. All had undergone esophagectomy, esophagogastrostomy and lymph node dissection at our institution between 1995 and 1997. They were divided into two groups according to the development of tumor recurrence during the follow-up period of three years. Sixteen patients (group I) suffered tumor recurrence, while the other 14 (group II) remained tumor-free after surgery. In each group, a review of the preoperative CT scans indicated the length, thickness, location and margin of the tumor, and the presence or absence of lymphadenopathy in the mediastinum and/or upper abdomen. Differences in preoperative CT findings between the two groups were assessed by statistical testing. Lymphadenopathy of the mediastinum and/or upper abdomen was seen in 11 (69%) of 16 patients in group I and three (21%) of 14 in group II (p .05). In group I, five esophageal tumors were located in the middle esophagus and eleven in the lower esophagus. In group II, such tumor was located one in the upper esophagus, six in the middle esophagus, and seven in the lower esophagus (p>.05). Patients with preoperative CT findings of lymphadenopathy and/or and indistinct primary tumor margin are more likely to develop tumor recurrence following surgical resection than those without these findings

Ex vivo fluorescence confocal microscopy for fast evaluation of tumour margins during Mohs surgery.

Science.gov (United States)

Bennàssar, A; Vilata, A; Puig, S; Malvehy, J

2014-02-01

Ex vivo fluorescence confocal microscopy (FCM) enables real-time imaging of skin morphology directly in freshly excised tissue. FCM displays wide field-of-view mosaics with cellular resolution, thus enabling a rapid bedside pathology. An application of interest is rapid detection of residual basal cell carcinoma (BCC) in skin excisions during Mohs surgery. We sought to evaluate the sensitivity and specificity of ex vivo imaging with FCM for the detection of residual BCC in Mohs tissue excisions, and to calculate the time invested up to the diagnosis for both FCM and frozen sections. Eighty consecutive BCCs were prospectively collected and the margins scanned with ex vivo FCM, including excisions with and without residual BCC of all major subtypes. Each mosaic was divided into two or four, resulting in 480 submosaics for study. Every confocal submosaic was assessed for the presence or absence of BCC and compared with standard frozen sections as the gold standard. Furthermore, the time spent for each technique was calculated and compared. The overall sensitivity and specificity of detecting residual BCC were 88% and 99%, respectively. Moreover, the new technique reduced by almost two-thirds the time invested when compared with the processing of a frozen section (P confocal mosaicing microscopy in fresh tissue for rapid surgical pathology, potentially to expedite and guide Mohs surgery with high accuracy. This observation is an important step towards the goal of using real-time surgical pathology for skin tumours. © 2013 British Association of Dermatologists.

Surgical competence.

Science.gov (United States)

Patil, Nivritti G; Cheng, Stephen W K; Wong, John

2003-08-01

Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

Quantitative Segmentation of Fluorescence Microscopy Images of Heterogeneous Tissue: Application to the Detection of Residual Disease in Tumor Margins.

Directory of Open Access Journals (Sweden)

Jenna L Mueller

Full Text Available To develop a robust tool for quantitative in situ pathology that allows visualization of heterogeneous tissue morphology and segmentation and quantification of image features.TISSUE EXCISED FROM A GENETICALLY ENGINEERED MOUSE MODEL OF SARCOMA WAS IMAGED USING A SUBCELLULAR RESOLUTION MICROENDOSCOPE AFTER TOPICAL APPLICATION OF A FLUORESCENT ANATOMICAL CONTRAST AGENT: acriflavine. An algorithm based on sparse component analysis (SCA and the circle transform (CT was developed for image segmentation and quantification of distinct tissue types. The accuracy of our approach was quantified through simulations of tumor and muscle images. Specifically, tumor, muscle, and tumor+muscle tissue images were simulated because these tissue types were most commonly observed in sarcoma margins. Simulations were based on tissue characteristics observed in pathology slides. The potential clinical utility of our approach was evaluated by imaging excised margins and the tumor bed in a cohort of mice after surgical resection of sarcoma.Simulation experiments revealed that SCA+CT achieved the lowest errors for larger nuclear sizes and for higher contrast ratios (nuclei intensity/background intensity. For imaging of tumor margins, SCA+CT effectively isolated nuclei from tumor, muscle, adipose, and tumor+muscle tissue types. Differences in density were correctly identified with SCA+CT in a cohort of ex vivo and in vivo images, thus illustrating the diagnostic potential of our approach.The combination of a subcellular-resolution microendoscope, acriflavine staining, and SCA+CT can be used to accurately isolate nuclei and quantify their density in anatomical images of heterogeneous tissue.

The determinants of intermediaries’ power over farmers’ margin-related activities

DEFF Research Database (Denmark)

Xhoxhi, Orjon; Pedersen, Søren Marcus; Lind, Kim Martin Hjorth

2014-01-01

This paper investigates the determinants of intermediaries’ power over farmers’ margin-related activities in Adana, Turkey. In doing so, a holistic model of intermediaries’ power over farmers’ margin-related activities is proposed. The objective of this model is to contribute to a better understa......This paper investigates the determinants of intermediaries’ power over farmers’ margin-related activities in Adana, Turkey. In doing so, a holistic model of intermediaries’ power over farmers’ margin-related activities is proposed. The objective of this model is to contribute to a better...

Volcanic passive margins: another way to break up continents.

Science.gov (United States)

Geoffroy, L; Burov, E B; Werner, P

2015-10-07

Two major types of passive margins are recognized, i.e. volcanic and non-volcanic, without proposing distinctive mechanisms for their formation. Volcanic passive margins are associated with the extrusion and intrusion of large volumes of magma, predominantly mafic, and represent distinctive features of Larges Igneous Provinces, in which regional fissural volcanism predates localized syn-magmatic break-up of the lithosphere. In contrast with non-volcanic margins, continentward-dipping detachment faults accommodate crustal necking at both conjugate volcanic margins. These faults root on a two-layer deformed ductile crust that appears to be partly of igneous nature. This lower crust is exhumed up to the bottom of the syn-extension extrusives at the outer parts of the margin. Our numerical modelling suggests that strengthening of deep continental crust during early magmatic stages provokes a divergent flow of the ductile lithosphere away from a central continental block, which becomes thinner with time due to the flow-induced mechanical erosion acting at its base. Crustal-scale faults dipping continentward are rooted over this flowing material, thus isolating micro-continents within the future oceanic domain. Pure-shear type deformation affects the bulk lithosphere at VPMs until continental breakup, and the geometry of the margin is closely related to the dynamics of an active and melting mantle.

Effect of post-implant edema on prostate brachytherapy treatment margins

International Nuclear Information System (INIS)

Reed, Daniel R.; Wallner, Kent; Ford, Eric; Mueller, Amy; Merrick, Gregory; Maki, Jeffrey; Sutlief, Steven; Butler, Wayne

2005-01-01

Purpose: To determine if postimplant prostate brachytherapy treatment margins calculated on Day 0 differ substantially from those calculated on Day 30. Methods: Thirty patients with 1997 American Joint Commission on Cancer clinical stage T1-T2 prostatic carcinoma underwent prostate brachytherapy with I-125 prescribed to 144 Gy. Treatment planning methods included using loose seeds in a modified peripheral loading pattern and treatment margins (TMs) of 5-8 mm. Postimplant plain radiographs, computed tomography scans, and magnetic resonance scans were obtained 1-4 hours after implantation (Day 0). A second set of imaging studies was obtained at 30 days after implantation (Day 30) and similarly analyzed. Treatment margins were measured as the radial distance in millimeters from the prostate edge to the 100% isodose line. The TMs were measured and tabulated at 90 o intervals around the prostate periphery at 0.6-cm intervals. Each direction was averaged to obtain the mean anterior, posterior, left, and right margins. Results: The mean overall TM increased from 2.6 mm (±2.3) on Day 0 to 3.5 mm (±2.4) on Day 30. The mean anterior margin increased from 1.2 mm on Day 0 to 1.8 mm on Day 30. The posterior margin increased from 1.2 mm on Day 0 to 2.8 mm on Day 30. The lateral treatment margins increased most over time, with mean right treatment margin increasing from 3.9 mm on Day 0 to 4.7 mm on Day 30. Conclusion: Treatment margins appear to be durable in the postimplant period, with a clinically insignificant increase from Day 0 to Day 30

STUDI PERBANDINGAN ANTARA ALGORITMA BIVARIATE MARGINAL DISTRIBUTION DENGAN ALGORITMA GENETIKA

Directory of Open Access Journals (Sweden)

Chastine Fatichah

2006-01-01

Full Text Available Bivariate Marginal Distribution Algorithm is extended from Estimation of Distribution Algorithm. This heuristic algorithm proposes the new approach for recombination of generate new individual that without crossover and mutation process such as genetic algorithm. Bivariate Marginal Distribution Algorithm uses connectivity variable the pair gene for recombination of generate new individual. Connectivity between variable is doing along optimization process. In this research, genetic algorithm performance with one point crossover is compared with Bivariate Marginal Distribution Algorithm performance in case Onemax, De Jong F2 function, and Traveling Salesman Problem. In this research, experimental results have shown performance the both algorithm is dependence of parameter respectively and also population size that used. For Onemax case with size small problem, Genetic Algorithm perform better with small number of iteration and more fast for get optimum result. However, Bivariate Marginal Distribution Algorithm perform better of result optimization for case Onemax with huge size problem. For De Jong F2 function, Genetic Algorithm perform better from Bivariate Marginal Distribution Algorithm of a number of iteration and time. For case Traveling Salesman Problem, Bivariate Marginal Distribution Algorithm have shown perform better from Genetic Algorithm of optimization result. Abstract in Bahasa Indonesia : Bivariate Marginal Distribution Algorithm merupakan perkembangan lebih lanjut dari Estimation of Distribution Algorithm. Algoritma heuristik ini mengenalkan pendekatan baru dalam melakukan rekombinasi untuk membentuk individu baru, yaitu tidak menggunakan proses crossover dan mutasi seperti pada Genetic Algorithm. Bivariate Marginal Distribution Algorithm menggunakan keterkaitan pasangan variabel dalam melakukan rekombinasi untuk membentuk individu baru. Keterkaitan antar variabel tersebut ditemukan selama proses optimasi berlangsung. Aplikasi yang

Consideration of margins for hypo fractionated radiotherapy

International Nuclear Information System (INIS)

Herschtal, A.; Foroudi, F.; Kron, T.

2010-01-01

Full text: Geographical misses of the tumour are of concern in radiotherapy and are typically accommodated by introducing margins around the target. However, there is a trade-off between ensuring the target receives sufficient dose and minimising the dose to surrounding normal structures. Several methods of determining margin width have been developed with the most commonly used one proposed by M. VanHerk (VanHerk UROBP 52: 1407, 2002). VanHerk's model sets margins to achieve 95% of dose coverage for the target in 90% of patients. However, this model was derived assuming an infinite number of fractions. The aim of the present work is to estimate the modifications necessary to the model if a finite number of fractions are given. Software simulations were used to determine the true probability of a patient achieving 95% target coverage if different fraction numbers are used for a given margin width. Model parameters were informed by a large data set recently acquired at our institution using daily image guidance for prostate cancer patients with implanted fiducial markers. Assuming a 3 mm penumbral width it was found that using the VanHerk model only 74 or 54% of patients receive 95% of the prescription dose if 20 or 6 fractions are given, respectively. The steep dose gradients afforded by IMRT are likely to make consideration of the effects of hypofractionation more important. It is necessary to increase the margins around the target to ensure adequate tumour coverage if hypofractionated radiotherapy is to be used for cancer treatment. (author)

Influence of Different Ceramic Systems on Marginal Misfit.

Science.gov (United States)

Vargas, S P; Neves, A C C; Vitti, R; Amaral, M; Henrique, M N; Silva-Concílio, L R

2017-09-01

the aim of this study was to evaluate the marginal misfit at the interface between a ceramic coping and its abutment. Twenty-four specimens were made with solid abutments. The specimens were divided into 3 groups according to the ceramic system (n = 8): Lava (zirconia), IPS e.max Press (lithium disilicate), and IPS Empress Esthetic (leucite). All copings were cemented with resin luting agent (RelyX U200) and the marginal misfit were evaluated at 3 different times: initial, after cementation, and after mechanical cycling using a linear measuring microscope (Measuring Microscope STM-Olympus) at a magnification of 40x. All specimens were subjected to mechanical cycling (1 million cycles) by an universal testing machine (Instron 8800). The results were statistically analyzed using Analysis of Variance and Student's t-test (α = 0.05). all groups showed an increase in the marginal misfit after cementation. The lithium disilicate group demonstrated the lowest interacial gap values at each evaluation (p = 0.001). The zirconia and leucite groups showed similar interfacial gap values (initial, p = 0.244; and post cementation, p = 0.751). the cementation increase the marginal misfit, but the mechanical cycling did not influence the marginal misfit of the ceramics systems evaluated. Copyright© 2017 Dennis Barber Ltd.

SAGES TAVAC safety and effectiveness analysis: da Vinci ® Surgical System (Intuitive Surgical, Sunnyvale, CA).

Science.gov (United States)

Tsuda, Shawn; Oleynikov, Dmitry; Gould, Jon; Azagury, Dan; Sandler, Bryan; Hutter, Matthew; Ross, Sharona; Haas, Eric; Brody, Fred; Satava, Richard

2015-10-01

The da Vinci(®) Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is a computer-assisted (robotic) surgical system designed to enable and enhance minimally invasive surgery. The Food and Drug Administration (FDA) has cleared computer-assisted surgical systems for use by trained physicians in an operating room environment for laparoscopic surgical procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgical procedures. There are substantial numbers of peer-reviewed papers regarding the da Vinci(®) Surgical System, and a thoughtful assessment of evidence framed by clinical opinion is warranted. The SAGES da Vinci(®) TAVAC sub-committee performed a literature review of the da Vinci(®) Surgical System regarding gastrointestinal surgery. Conclusions by the sub-committee were vetted by the SAGES TAVAC Committee and SAGES Executive Board. Following revisions, the document was evaluated by the TAVAC Committee and Executive Board again for final approval. Several conclusions were drawn based on expert opinion organized by safety, efficacy, and cost for robotic foregut, bariatric, hepatobiliary/pancreatic, colorectal surgery, and single-incision cholecystectomy. Gastrointestinal surgery with the da Vinci(®) Surgical System is safe and comparable, but not superior to standard laparoscopic approaches. Although clinically acceptable, its use may be costly for select gastrointestinal procedures. Current data are limited to the da Vinci(®) Surgical System; further analyses are needed.

Determinants of banks’ net interest margins in Central and Eastern Europe

Directory of Open Access Journals (Sweden)

Tomislav Rizdak

2013-03-01

Full Text Available This research analyzes the main determinants of the net interest margin of banks operating in Central and Eastern European (CEE countries in the period from 1999 to 2010. The results reveal several main drivers of net interest margins in the CEE. Prior to 2008 the net interest margins declined primarily due to strong capital inflows and stable macroeconomic environment. In the crisis period, significant rise in government debt accompanied by the increase in macroeconomic risks and abating capital inflows were pushing margins up while other factors such as low credit demand, higher capitalization and significantly increased share of non-performing loans pressured banks’ margins down. The results also confirm the important contribution of higher efficiency to lowering banks’ margins.

Marginal Assessment of Crowns by the Aid of Parallel Radiography

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Farnaz Fattahi

2015-03-01

Full Text Available Introduction: Marginal adaptation is the most critical item in long-term prognosis of single crowns. This study aimed to assess the marginal quality as well asthe discrepancies in marginal integrity of some PFM single crowns of posterior teeth by employing parallel radiography in Shiraz Dental School, Shiraz, Iran. Methods: In this descriptive study, parallel radiographies were taken from 200 fabricated PFM single crowns of posterior teeth after cementation and before discharging the patient. To calculate the magnification of the images, a metallic sphere with the thickness of 4 mm was placed in the direction of the crown margin on the occlusal surface. Thereafter, the horizontal and vertical space between the crown margins, the margin of preparations and also the vertical space between the crown margin and the bone crest were measured by using digital radiological software. Results: Analysis of data by descriptive statistics revealed that 75.5% and 60% of the cases had more than the acceptable space (50µm in the vertical (130±20µm and horizontal (90±15µm dimensions, respectively. Moreover, 85% of patients were found to have either horizontal or vertical gap. In 77% of cases, the margins of crowns invaded the biologic width in the mesial and 70% in distal surfaces. Conclusion: Parallel radiography can be expedient in the stage of framework try-in to yield some important information that cannot be obtained by routine clinical evaluations and may improve the treatment prognosis

Supervised linear dimensionality reduction with robust margins for object recognition

Science.gov (United States)

Dornaika, F.; Assoum, A.

2013-01-01

Linear Dimensionality Reduction (LDR) techniques have been increasingly important in computer vision and pattern recognition since they permit a relatively simple mapping of data onto a lower dimensional subspace, leading to simple and computationally efficient classification strategies. Recently, many linear discriminant methods have been developed in order to reduce the dimensionality of visual data and to enhance the discrimination between different groups or classes. Many existing linear embedding techniques relied on the use of local margins in order to get a good discrimination performance. However, dealing with outliers and within-class diversity has not been addressed by margin-based embedding method. In this paper, we explored the use of different margin-based linear embedding methods. More precisely, we propose to use the concepts of Median miss and Median hit for building robust margin-based criteria. Based on such margins, we seek the projection directions (linear embedding) such that the sum of local margins is maximized. Our proposed approach has been applied to the problem of appearance-based face recognition. Experiments performed on four public face databases show that the proposed approach can give better generalization performance than the classic Average Neighborhood Margin Maximization (ANMM). Moreover, thanks to the use of robust margins, the proposed method down-grades gracefully when label outliers contaminate the training data set. In particular, we show that the concept of Median hit was crucial in order to get robust performance in the presence of outliers.

Influence of margin segmentation and anomalous volcanism upon the break-up of the Hatton Bank rifted margin, west of the UK

Science.gov (United States)

Elliott, G. M.; Parson, L. M.

2007-12-01

The Hatton Bank margin, flanking the Iceland Basin is a widely cited example of a volcanic rifted margin. Prior to this study insights into the break-up history of the margin have been limited to profiles in the north and south, yet whilst valuable, the along margin tectono-magmatic variability has not been revealed. Over 5660 line km of high quality reflection seismic profiles with supplementary multibeam bathymetry were collected to support the UK's claim to Hatton region under the United Nations Convention on Law of the Sea (UNCLOS). Integration of this new data with existing profiles, allowed the margin to be divided into three segments, each of which are flanked by oceanic crust with a smooth upper surface and internal dipping reflectors. The southernmost segment is characterised by a series of inner and outer seaward dipping reflector (SDR) packages, which are separated by an outer high feature. The outer SDR are truncated by Endymion Spur, a chain of steep sided, late stage volcanic cones linked with necks. The central sector has no inner SDR package and is characterised by the presence of a highly intruded continental block, the Hatton Bank Block (HBB). The northern sector is adjacent to Lousy Bank, with a wider region of SDR recognised than to the south and a high amount of volcanic cones imaged. The variations in the distribution of the SDR's along the margin, the presence of the HBB and Endymion Spur all suggest that the break-up process was not uniform alongstrike. The division of the margin into three sectors reveals that structural segmentation played an important role in producing the variations along the margin. Break- up initiated in the south and progressed north producing the SDR packages witnessed, when the HBB was encountered the focus of break-up moved seaward of the block. The northern sector was closer to the Iceland Hotspot and hence a greater amount of volcanism is encountered. The smooth oceanic basement also indicates a high thermal flux

Slope failure of chalk channel margins

DEFF Research Database (Denmark)

Gale, A.; Anderskouv, Kresten; Surlyk, Finn

2015-01-01

provide evidence for recurring margin collapse of a long-lived Campanian channel. Compressionally deformed and thrust chalk hardgrounds are correlated to thicker, non-cemented chalk beds that form a broad, gentle anticline. These chalks represent a slump complex with a roll-over anticline of expanded, non......-cemented chalk in the head region and a culmination of condensed hardgrounds in the toe region. Observations strongly suggest that the slumping represents collapse of a channel margin. Farther northwards, the contemporaneous succession shows evidence of small-scale penecontemporaneous normal faulting towards...

Perennial Grass Bioenergy Cropping on Wet Marginal Land

NARCIS (Netherlands)

Das, Srabani; Teuffer, Karin; Stoof, Cathelijne R.; Walter, Michael F.; Walter, M.T.; Steenhuis, Tammo S.; Richards, Brian K.

2018-01-01

The control of soil moisture, vegetation type, and prior land use on soil health parameters of perennial grass cropping systems on marginal lands is not well known. A fallow wetness-prone marginal site in New York (USA) was converted to perennial grass bioenergy feedstock production. Quadruplicate

Helping Students on the Margin Succeed in Schools.

Science.gov (United States)

Langenfeld, Michelle Schoen; Cumming, Brenda

1996-01-01

Addresses how Apple Valley High School (Minnesota) has been able to help marginal students succeed in school. The fundamental actions that contributed to the effectiveness of study-team efforts to help marginal students are discussed, and what has been learned through these efforts is considered. (GR)

Principals' Perceived Supervisory Behaviors Regarding Marginal Teachers in Two States

Science.gov (United States)

Range, Bret; Hewitt, Paul; Young, Suzie

2014-01-01

This descriptive study used an online survey to determine how principals in two states viewed the supervision of marginal teachers. Principals ranked their own evaluation of the teacher as the most important factor when identifying marginal teachers and relied on informal methods to diagnose marginal teaching. Female principals rated a majority of…

Recognizing surgical patterns

NARCIS (Netherlands)

Bouarfa, L.

2012-01-01

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

Quantifying Safety Margin Using the Risk-Informed Safety Margin Characterization (RISMC)

Energy Technology Data Exchange (ETDEWEB)

Grabaskas, David; Bucknor, Matthew; Brunett, Acacia; Nakayama, Marvin

2015-04-26

The Risk-Informed Safety Margin Characterization (RISMC), developed by Idaho National Laboratory as part of the Light-Water Reactor Sustainability Project, utilizes a probabilistic safety margin comparison between a load and capacity distribution, rather than a deterministic comparison between two values, as is usually done in best-estimate plus uncertainty analyses. The goal is to determine the failure probability, or in other words, the probability of the system load equaling or exceeding the system capacity. While this method has been used in pilot studies, there has been little work conducted investigating the statistical significance of the resulting failure probability. In particular, it is difficult to determine how many simulations are necessary to properly characterize the failure probability. This work uses classical (frequentist) statistics and confidence intervals to examine the impact in statistical accuracy when the number of simulations is varied. Two methods are proposed to establish confidence intervals related to the failure probability established using a RISMC analysis. The confidence interval provides information about the statistical accuracy of the method utilized to explore the uncertainty space, and offers a quantitative method to gauge the increase in statistical accuracy due to performing additional simulations.

Development and function of the splenic marginal zone

NARCIS (Netherlands)

Mebius, Reina E.; Nolte, Martijn A.; Kraal, Georg

2004-01-01

The marginal zone of the spleen is a crucial region where blood-borne pathogens are sequestered by macrophages with unique arrays of scavenger molecules. In addition, a special population of B cells, which is capable of rapid activation, resides in this region. Marginal zone B cells and macrophages

Marginal Leakage of Class V Composite Resin Restorations

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Maryam Khoroushi

2018-01-01

Full Text Available >Introduction: Marginal leakage is one of the significant causes of restoration failure. This in-vitro study was conducted to compare cone beam computed tomography (CBCT and dye-penetration methods for determining marginal leakage at gingival surface of class V resin composite restorations.Materials and Methods: Class V cavities were prepared on the buccal surfaces of nineteen caries-free extracted human molar teeth. Cavities were conditioned and filled. The teeth were immersed in a 50% w/w aqueous silver nitrate solution for 24 h and were taken out and rinsed with distilled water. Then, they were put into a developing solution. Whole specimens were first viewed with CBCT and were then sectioned and evaluated by stereomicroscope.Results: Measurement of agreement between CBCT and stereomicroscope revealed that 15 (78.9% teeth had score 0, 1 (5.3% tooth had score 1, and 1 (5.3% tooth had score 2 in both techniques. Measurement of agreement between CBCT and stereomicroscope techniques, in the detection of marginal leakage, was 89.5% (Kappa coefficient = 0.627, P = 0.00. The Wilcoxon paired rank test revealed no significant difference between the results of CBCT and stereomicroscope in measuring the leakage at gingival margin (P = 0.157.Conclusion: Considering the limitations of the study, there was no significant difference between the results of CBCT and stereomicroscope in measuring the leakage at gingival margin of class V composite restorations. CBCT can be used noninvasively to detect the marginal leakage of gingival wall of class V composite restorations using aqueous silver nitrate solution as a tracer.

Marginally Deformed Starobinsky Gravity

DEFF Research Database (Denmark)

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

2015-01-01

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....

Komorbiditet ved marginal parodontitis

DEFF Research Database (Denmark)

Holmstrup, Palle; Damgaard, Christian; Olsen, Ingar

2017-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende væsentligste viden om sammenhængen mellem marginal parodontitis og en række medicinske sygdomme, herunder hjerte-kar-sygdomme, diabetes mellitus, reumatoid arthritis, osteoporose, Parkinsons sygdom, Alzheimers sygdom, psoriasis og...

From marginality to further marginalization: Experiences from the victims of the July 2000 Payatas trashslide in the Philippines

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JC Gaillard

2009-04-01

Full Text Available Victims of disasters are disproportionately drawn from the marginalized segments of society. Disaster victims are marginalized geographically because they live in hazardous places, socially because they are members of minority groups, economically because they are poor, and marginalized politically because their voice is disregarded by those with political power. #e victims of the July 2000 Payatas trash slide in the Philippines show all these characteristics. Most of the victims of the disaster were urban migrants who came all the way from their poor provinces to settle on the lower slopes of the largest dumpsite of the country. #ey scavenged recyclable materials to sell as a way to make a living, but their limited incomes did not allow them to a$ord safer locations for their homes, farther removed from the slopes of the dumpsite. On the morning of 10 July 2000, 300 of them lost their lives when a large section of the dumpsite collapsed in a massive debris %ow which buried their houses. In the aftermath of the disaster, the survivors who used to live on the dumpsite, and who were the poorest victims, were also those who were relocated by the Philippine government. In the present case, the most vulnerable families in the face of the trash slide were eventually those who had to su#er again from life-disrupting relocation while being the less able to recover quickly from the disaster. Daily incomes of relocated families are today much lower than those who remained in the vicinity of the dumpsite. For the victims of the July 2000 Payatas tragedy, poverty thus acted as a vicious, worsening circle which ranged from vulnerability to poor recovery, or from marginality to further marginalization.

Intraoperative monitoring of marginal mandibular nerve during neck dissection.

Science.gov (United States)

Tirelli, Giancarlo; Bergamini, Pier Riccardo; Scardoni, Alessandro; Gatto, Annalisa; Boscolo Nata, Francesca; Marcuzzo, Alberto Vito

2018-05-01

The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection. This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor. The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy. In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection. © 2018 Wiley Periodicals, Inc.

[Comparative effectiveness of surgical and non-surgical treatment for pediatric mandibular condylar fractures].

Science.gov (United States)

Hu, Min; Wang, Yanyi; Zhang, Lihai; Yao, Jun

2010-12-01

To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy. The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture). Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible

Radiotherapy Results of Carcinoma of Cervix with positive Resection Margin

International Nuclear Information System (INIS)

Huh, Seung Jae; Kim, Dae Yong; Ahn, Yong Chan; Kim, Won Dong; Wu, Hong Gyun; Ha, Sung Whan; Kim, Il Han; Park, Charn Il

1996-01-01

Purpose : Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluated the role of radiotherapy. Materials and Methods : Between 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy because of positive vaginal(48 patients) or parametrial resection margins(12 patients). Patients were treated with external beam radiation therapy(EBRT) alone (12 patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 5 months. Results : The 5-year actuarial disease free and overall survival rates for all patients were 75.2%, 84.1%, respectively. The overall recurrence rate was 23%(14/60). In 48 patients with positive vaginal resection margins, the pelvic recurrence was 8%(4/48). Distant metastasis was 15%(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was 21%(9/43), while recurrence rate was 40%(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32%(19/60) and grade III complications occurred in three patients (5%). Conclusion : Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and BOI is recommended

Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

Science.gov (United States)

Beets-Tan, R G H; Lettinga, T; Beets, G L

2005-08-01

To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

Manipulation in political stock markets: Preconditions and evidence

OpenAIRE

Hansen, Jan; Schmidt, Carsten; Strobel, Martin

2001-01-01

Political stock markets (PSM) are sometimes seen as substitutes for opinion polls. On the bases of a behavioral model, specific preconditions were drawn out under which manipulation in PSM can weaken this argument. Evidence for manipulation is reported from the data of two separate PSM during the Berlin 99 state elections.

A fluorescent colorimetric pH sensor and the influences of matrices on sensing performances

Science.gov (United States)

Tian, Yanqing; Fuller, Emily; Klug, Summer; Lee, Fred; Su, Fengyu; Zhang, Liqiang; Chao, Shih-hui; Meldrum, Deirdre R.

2013-01-01

A fluorescent colorimetric pH sensor was developed by a polymerization of a monomeric fluorescein based green emitter (SM1) with a monomeric 2-dicyanomethylene-3-cyano-4,5,5-trimethyl-2,5-dihydrofuran derived red emitter (SM2) in poly(2-hydroxyethyl methacrylate)-co-polyacrylamide (PHEMA-co-PAM) matrices. Polymerized SM1 (PSM1) in the polymer matrices showed bright emissions at basic conditions and weak emissions at acidic conditions. Polymerized SM2 (PSM2) in the polymer matrices exhibited a vastly different response when compared to PSM1. The emissions of PSM2 are stronger under acidic conditions than those under basic conditions. When SM1 and SM2 were polymerized in the same polymer matrix, a dual emission sensor acting as a ratiometric pH sensor (PSM1,2) was successfully developed. Because the PSM1 and PSM2 exhibited different pH responses and separated emission windows, the changes in the emission colors were clearly observed in their dual color sensor of PSM1,2, which changed emission colors dramatically from green at pH 7 to red at pH 4, which was detected visually and/or by using a color camera under an excitation of 488 nm. In addition to the development of the dual color ratiometric pH sensor, we also studied the effects of different matrix compositions, crosslinkers, and charges on the reporting capabilities of the sensors (sensitivity and pKa). PMID:24078772

A fluorescent colorimetric pH sensor and the influences of matrices on sensing performances.

Science.gov (United States)

Tian, Yanqing; Fuller, Emily; Klug, Summer; Lee, Fred; Su, Fengyu; Zhang, Liqiang; Chao, Shih-Hui; Meldrum, Deirdre R

2013-10-01

A fluorescent colorimetric pH sensor was developed by a polymerization of a monomeric fluorescein based green emitter ( SM1 ) with a monomeric 2-dicyanomethylene-3-cyano-4,5,5-trimethyl-2,5-dihydrofuran derived red emitter ( SM2 ) in poly(2-hydroxyethyl methacrylate)- co -polyacrylamide (PHEMA-co-PAM) matrices. Polymerized SM1 ( PSM1 ) in the polymer matrices showed bright emissions at basic conditions and weak emissions at acidic conditions. Polymerized SM2 ( PSM2 ) in the polymer matrices exhibited a vastly different response when compared to PSM1 . The emissions of PSM2 are stronger under acidic conditions than those under basic conditions. When SM1 and SM2 were polymerized in the same polymer matrix, a dual emission sensor acting as a ratiometric pH sensor ( PSM1,2 ) was successfully developed. Because the PSM1 and PSM2 exhibited different pH responses and separated emission windows, the changes in the emission colors were clearly observed in their dual color sensor of PSM1,2 , which changed emission colors dramatically from green at pH 7 to red at pH 4, which was detected visually and/or by using a color camera under an excitation of 488 nm. In addition to the development of the dual color ratiometric pH sensor, we also studied the effects of different matrix compositions, crosslinkers, and charges on the reporting capabilities of the sensors (sensitivity and p K a ).