Let X be a scheme of finite type over a finite field k, and let ℒX denote its arc space; in particular, ℒX(k) = X(kt). Using the theory of Grinberg, Kazhdan, and Drinfeld on the finite-dimensionality ...of singularities of ℒX in the neighborhood of non-degenerate arcs, we show that a canonical "basic function" can be defined on the non-degenerate locus of ℒX(k), which corresponds to the trace of Frobenius on the stalks of the intersection complex of any finite-dimensional model. We then proceed to compute this function when X is an affine toric variety or an "L-monoid". Our computation confirms the expectation that the basic function is a generating function for a local unramified L-function; in particular, in the case of an L-monoid we prove a conjecture formulated by the second author.
The objective of this study was to determine clinical, tumoral and surgical factors associated with successful bilateral sentinel lymph node mapping (SBM) in early-stage cervical cancer.
We performed ...an ancillary work on the data of two prospective trials on SLN biopsy for FIGO IA-IIA cervical cancer (SENTICOL I & II). Patients having Sentinel lymph node (SLN) mapping for early-stage cervical cancer were included between 2005 and 2012 from 28 French oncologic centers. SLN was detected by a combined labeling technique (blue and isotopic).
405 patients were included for analysis: SLNs were identified on at least one side of the pelvis in 381 patients (94.1%) and bilaterally in 326 patients (80.5%). The mean age was 45.4 years 22–85 years. Most patients had IB1 pathologic FIGO 2018 stage (81.3%) and squamous cell carcinoma (71%). Surgeries were mainly performed by minimally invasive approach (368 patients – 90.9%). By multivariate analysis, lower SBM rate was significantly associated with Age ≥70 years (ORa = 0.02, 95%CI = 0.001–0.28, p = 0.004), tumor size larger than 20 mm (ORa = 0.46,95%CI = 0.21–0.99, p = 0.048) and Body-mass index higher than 30 kg/m2 (ORa = 0.28, 95%CI = 0.12–0.65, p = 0.003). SBM rate was significantly higher in high skills centers (>5patients/year) (ORa = 8.05, 95%CI = 2.06–31.50, p = 0.003) and in SENTICOL II (2009–2012) compared to SENTICOL I (2005–2007) (ORa = 2.6, 95%CI = 1.23–5.51, p = 0.01).
In early-stage cervical cancer, bilateral SLN detection rates is lower in patients aged more than 70years, patients with BMI≥30 kg/m2 and larger tumor ≥20 mm whereas stronger experience of SLN biopsy technique improves bilateral SLN detection.
•Bilateral detection is required to increase sensitivity and decrease false-negative rate of sentinel lymph node biopsy.•Obesity may decrease bilateral detection of sentinel lymph nodes.•Bilateral detection of sentinel lymph nodes is lower in patients aged more than 70 years.•Failure of bilateral detection of sentinel lymph nodes is more frequent with tumor size larger than 20 mm.•Experience and higher surgical skills improved sentinel lymph nodes detection.
The purpose of this study was to describe sentinel lymph nodes (SLN) topography in patients with early-stage cervical cancer and to determine factors associated with atypical lymphatic drainage ...pathway (LDP).
We analyzed the data of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) in women undergoing surgery for early-stage cervical cancer. SLN detection was realized with a combined labeling technique (Patent blue and radioactive tracer). Patients having bilateral SLN detection were included. Univariate and Multivariate analysis were performed by patients and by side to assess clinical and pathologic factors that may predict atypical LDP.
Between January 2005 and July 2012, 326 patients with 1104 intraoperative detected SLNs fulfilled the inclusion criteria. The SLNs were mainly located in the interiliac or external iliac area in 83.2%. The other localizations were: 9.2% in the common iliac area, 3.9% in the parametrium, 1.6% in the promontory area, 1.5% in the paraaortic area and 0.5% in other areas. Thirty-five patients (10.7%) had atypical SLN without SLN in typical area on one or both sides. In multivariate analysis, tumor size ≥20 mm appeared as an independent factor of having at least one exclusive atypical LDP (ORa = 3.95 95%CI = 1.60–9.78, p = 0.003). Multiparity decreased significantly the probability of having at least one exclusive atypical LDP (ORa = 0.16 95%CI = 0.07–0.39, p < 0.0001).
Tumor size larger than 20 mm and nulliparity increase the risk of having exclusive atypical LDP in early-stage cervical cancer.
•Sentinel lymph nodes are mostly found in the interiliac and external iliac area.•Atypical topography of sentinel lymph nodes concerns up to 24.5% of patients.•Sentinel lymph nodes in atypical areas are more frequent with tumor size ≥20 mm.•Multiparity may have an impact on uterine lymphatic drainage.•Sentinel lymph node biopsy may detect metastatic nodes in aberrant topography.
We aimed to assess the diagnostic value of frozen-section pathologic examination (FSE) of sentinel lymph nodes (SLN) in patients with early-stage cervical cancer.
Two French prospective multicentric ...database on SLN biopsy for cervical cancer (SENTICOL I and II) were analysed. Patients with IA to IIA1 2018 FIGO stage, who underwent SLN biopsy with both FSE and ultrastaging examination were included.
Between 2005 and 2012, 313 patients from 25 centers fulfilled the inclusion criteria. Metastatic involvement of SLN was diagnosed in 52 patients (16.6%). Macrometastases, micrometastases and isolated tumor cells (ITCs) were found in 27, 12 and 13 patients respectively. Among the 928 SLNs analysed, FSE identified 23 SLNs with macrometastases in 20 patients and 5 SLNs with micrometastases in 2 patients whereas no ITCs were identified. Ultrastaging of negative SLNs by FSE found macrometastases, micrometastases and ITCs in additional 7, 11 and 17 SLNs. Ultrastaging increased significantly the rate of patients with positive SLN from 7% to 16.6% (p < 0.0001).
The sensitivity and the negative predictive value of FSE were 42.3% and 89.7% respectively or 56.4% and 94.1% if ITCs were excluded. False-negative cases were more frequent with tumor size ≥ 20 mm (OR = 4.46, 95%IC = 1.45–13.66, p = 0.01) and preoperative brachytherapy (OR = 4.47, 95%IC = 1.37–14.63, p = 0.01) and less frequent with patients included in higher volume center (>5 patients/year) (OR = 0.09, 95%IC = 0.02–0.51, p = 0.01).
FSE of SLN had a low sensitivity for detecting micrometastases and ITCs and a high negative predictive value for SLN status. Clinical impact of false-negative cases has to be assessed by further studies.
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•Intraoperative sentinel lymph node assessment is crucial to determine the treatment strategy in cervical cancer.•Frozen section examination has a low sensitivity for detecting micrometastases.•False-negativity of frozen section analysis is more frequent with tumor size larger than 20 mm.•Accuracy of frozen section analysis of sentinel lymph node is better in high-volume centers.
The purpose of this study was to assess the postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer and to determine risk factors of severe perioperative morbidity.
...Data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II) were analysed. Patients having a radical hysterectomy were included between 2005 and 2012 from 25 French oncologic centers. Postoperative complications were prospectively recorded in a pre-specified analysis.
248 patients met the inclusion criteria. The median age was 44.5 years 25–85. 88.7% of patients had a stage IB1 disease. There were 71.4% epidermoid carcinomas and 25% adenocarcinomas. 125 patients (50.4%) had a laparoscopic-assisted vaginal RH, 88 patients (35.5%) had a total laparoscopic RH, 26 patients (10.5%) had an open RH and 9 patients (3.6%) had a robotic-assisted RH. Sixteen patients (6.4%) had intraoperative complications. On a multivariate analysis, intraoperative complications were significantly associated with BMI >30 kg/m2. The urinary, lymphovascular and neurologic complications rates were respectively 34.3%, 20.6% and 19.8%. 31 patients (12.5%) had severe postoperative complications (Clavien-Dindo ≥ 3 or CTCAE ≥ 3). On multivariate analysis, severe postoperative complications were associated with parametrial involvement, preoperative brachytherapy and inclusion in low surgical skills center.
This study based on prospective data showed that RH has low severe postoperative complications. The main complications were urinary infections and lower limb lymphedema. Patients with early-stage cervical cancer should be referred to expert center to ensure best surgical outcomes.
Abstract Objective To describe pregnancy outcomes for pregnant women with sickle cell disease (SCD) receiving prophylactic transfusions. Study design This retrospective case–control study compared ...pregnancy outcomes among women with SCD receiving prophylactic transfusions and women without any hemoglobinopathy, matched for ethnicity, parity, age and hospital. Results The study included two groups of pregnancies: 128 in women with SCD (95 with SS phenotype and 33 with SC) and 128 in women with AA phenotype. No woman died. Two perinatal deaths (2.1%) and five alloimmunizations (5.3%) occurred, all in the SS group. Compared with the control group, HbSS disease was more often associated with pre-eclampsia (9.4% versus 2.3%, p = .03), preterm delivery (15.8% versus 6.2%, p = .01), birth weight <10th percentile (13.7% versus 3.9%, p = .008) and caesarean delivery (73.6% versus 26.4%, p < .01). Conclusion Despite prophylactic blood transfusions, SCD remains a severe complicating factor in pregnancy. The policy of systematic transfusions should be analyzed in a sufficiently large randomized trial.
Deep diving air-breathing species by necessity must balance submergence time and level of exercise during breath-holding: a low activity level preserves oxygen stores and allows longer duration ...submergence whereas high activity levels consume oxygen quickly and shorten submergence time. In this study, we combined high-resolution multi sensor animal-borne tag data to investigate diving behavior and locomotion styles of the narwhal (Monodon monoceros) (
n
= 13, mean record length 91 h)–a deep diving Arctic species. Narwhals in this study dove down to >800 m but despite the deep diving abilities, one-third of the dives (33%) were shallow (>100 m) and short in duration (<5 min). Narwhals utilized energy saving measures such as prolonged gliding during descent with increasing target depth but stroked actively throughout the ascent indicating excess oxygen storages. Foraging behavior, as detected by the presence of buzzes, was a key factor influencing dive depth and spinning behavior—the rolling movement of the animal along its longitudinal axes. Narwhals in East Greenland utilized two foraging strategies, while transiting and while stationary, with different target depths and buzzing rates. The first targeted deep-dwelling, possibly solitary prey items and the latter, more schooling prey closer to the surface. The buzzing rate during stationary foraging was on average twice as high as during transiting foraging. Spinning was an integrated part of narwhal swimming behavior but the amount of spinning was correlated with foraging behavior. The odds for spinning during all dive phases were 2–3 times higher during foraging than non-foraging. Due to the spinning behavior, stroking rate might be better suited for estimating energy consumption in narwhals than ODBA (overall dynamic body acceleration). The narwhal is considered as one of the most sensitive species to climate change–the results from this study can act as a baseline essential for evaluating changes in the behavior and energy usage of narwhals caused by stressors evolving in the Arctic.
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