The standard treatment for gestational choriocarcinoma is chemotherapy.
To describe the risk of recurrence with expectant management of gestational choriocarcinoma that has reached a normal human ...chorionic gonadotropin level after tumor removal without adjuvant chemotherapy.
A retrospective multicenter international cohort study was conducted from 1981 to 2017 involving 11 gestational trophoblastic disease reference centers with patient's follow-up extended until 2023. Clinical and biological data of included patients were extracted from each center's database. The inclusion criteria were i) histological diagnosis of gestational choriocarcinoma in any kind of placental tissue retrieved, ii) spontaneous normalization of human chorionic gonadotropin level following choriocarcinoma retrieval, iii) patient did not receive any oncological treatment for the choriocarcinoma, iv) and at least 6 months of follow-up after the first human chorionic gonadotropin level normalization.
Among 80 patients with retrieved gestational choriocarcinoma and whose human chorionic gonadotropin level normalized without any other oncological therapy, none had a recurrence of choriocarcinoma after a median follow-up of 50 months. The median interval between choriocarcinoma excision and human chorionic gonadotropin level normalization was 48 days. The International Federation of Gynecology and Obstetrics/World Health Organization risk score was ≤6 in 93.7% of the cases.
This multicenter international study reports that selected patients with gestational choriocarcinoma managed in gestational trophoblastic disease reference centers did not experience any relapse when the initial tumor evacuation is followed by human chorionic gonadotropin level normalization without any additional treatment. Expectant management may be a safe approach for highly selected patients.
•Gestational choriocarcinoma may be diagnosed after complete tumor excision while human chorionic gonadotropin level has already normalized.•This international study including 80 patients with normalized human chorionic gonadotropin after complete choriocarcinoma surgical evacuation supports that surveillance without chemotherapy is safe in the context of a highly selected patient population.•No recurrences were observed during the median follow-up of 4 years.
To overcome the intrinsic brittleness of tungsten (W), a tungsten fiber-reinforced tungsten-composite material (Wf/W) is under development. The composite addresses the brittleness of W by extrinsic ...toughening through the introduction of energy dissipation mechanisms. These mechanisms allow the reduction of stress peaks and thus improve the materials resistance against crack growth. They do not rely on the intrinsinc material properties such as ductility. By utilizing powder metallurgy (PM) one could benefit from available industrialized approaches for composite production and alloying routes. In this contribution the PM method of hot isostatic pressing (HIP) is used to produce Wf/W samples containing W fibers coated with an Er2O3 interface. Analysis of the matrix material demonstrates a dense tungsten bulk, a deformed fiber and a deformed, but still intact interface layer. Metallographic analysis reveals indentations of powder particles in the interface, forming a complex 3D structure. Special emphasis is placed on push-out tests of single fiber HIP samples, where a load is applied via a small indenter on the fiber, to test the debonding and frictional properties of the Er2O3 interface region enabling the energy dissipation mechanisms. Together with the obtained experimental results, an axisymmetric finite element model is discussed and compared to existing work. In the HIP Wf/W composites the matrix adhesion is rather large and can dominate the push-out behavior. This is in contrast to the previously tested CVD produced samples.
Velamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical orifice. In case of ...spontaneous rupture of the membranes, there is a major risk of fetal haemorrhage, which is often lethal for the unborn baby. The challenge of care is based on the prenatal diagnosis during the 2nd trimester ultrasound. In case a vasa praevia is confirmed during the 3rd trimester, elective caesarean section should be carried out prior to the onset of labour, between 34 and 36 weeks of pregnancy. Corticosteroid treatment for fetal lung maturation is recommended at 32 weeks of gestation because of the increased risk of preterm delivery. Velamentous cord insertion may be associated with other adverse pregnancy outcomes such as intrauterine growth restriction, death in utero, placental abnormalities.
Regardless of the technique used, extraction of the uterus is a crucial step in hysterectomy. There is currently no scoring system to predict its feasibility.
Our main objective was to determine a ...predictive score of uterine extraction feasibility to optimise surgical planning of total hysterectomy. As secondary objectives, we examined the correlation between uterine volume predicted by preoperative ultrasound and the final weight of the surgical specimen and analysed the impact of the uterine extraction modality on operative and hospitalisation times.
We defined a Uterine Extraction Score (UES) based on the ratio between uterine sizes and vaginal access. This score was retrospectively applied to a cohort of 178 patients who were hysterectomised for benign conditions between January 2019 and December 2022.
The UES allows identification of three groups of decreasing feasibility of vaginal extraction, symbolised by traffic light colours: green - vaginal extraction without morcellation, orange -vaginal extraction with morcellation, red - abdominal morcellation by mini-laparotomy or primary laparotomy.
The results show that the UES--predicted, and the observed routes of extraction concord in 92% of cases. There is a strong correlation between estimated volume and final uterine weight. Uterine morcellation lengthens the operative time and the hospital stay.
The UES seems to be a reliable tool to predict the route of uterine extraction in total hysterectomy.
The development of a new scoring system empowers surgeons with decisive information to enhance perioperative outcomes.
Tungsten features a unique combination of properties which makes it a candidate for the use as a plasma-facing material in fusion reactors. The main drawbacks of tungsten are its brittleness at ...moderate temperature and the susceptibility to embrittlement during operation. To overcome this limitations tungsten fibre-reinforced tungsten composites (Wf/W) have been developed. The interlayer between the tungsten fibre and tungsten matrix enables the activation of extrinsic mechanisms to improve the toughness similar to ceramic fibre-reinforced ceramics. In addition, the evaluation of the interlayer parameter is a necessary for the efforts to model the composite behaviour. Therefore, single fibre model systems with Er2O3 and Y2O3 as interlayer were evaluated by push-out and pull-out tests. The results were used to determine the interfacial shear strength (τdeb), the interfacial frictional shear stress (τfr) and the fracture energy of the interlayer (Γi). In addition, tensile tests on the composite material were performed to evaluate the interfacial frictional shear stress. The evaluation methods were critically discussed as the results show that the influence of the evaluation method is larger than the actual tested interlayer material.
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•Evaluation of the interlayer properties of W f/W with three different methods.•The interlayer testing method has a larger influence on the evaluated values than the actual tested interlayer material.•For the further material screening pull-out test is preferred over push-out test for W f/W.
Louboutin and Christian Louboutin
IIC - International Review of Intellectual Property and Competition Law,
9/2018, Letnik:
49, Številka:
7
Journal Article
Recenzirano
Article 3(1)(e)(iii) of Directive 2008/95/EC of the European Parliament and of the Council of 22 October 2008 to approximate the laws of the Member States relating to trade marks must be interpreted ...as meaning that a sign consisting of a colour applied to the sole of a high-heeled shoe, such as that at issue in the main proceedings, does not consist exclusively of a ‘shape’, within the meaning of that provision.
Lorentz symmetry is a fundamental space-time symmetry underlying the Standard Model of particle physics and gravity. However, unified theories, such as string theory, allow for violation of this ...symmetry. Thus, the discovery of Lorentz symmetry violation could be the first hint of these theories. Here, we use high-energy atmospheric neutrinos observed at the IceCube Neutrino Observatory to search for anomalous neutrino oscillations as signals of Lorentz violation. The large range of neutrino energies and propagation baselines, together with high statistics, let us perform the most precise test of space-time symmetry in the neutrino sector to date. We find no evidence for Lorentz violation. This allows us to constrain the size of the dimension-four operator in the Standard-Model Extension for Lorentz violation to the \(10^{-28}\) level and to set limits on higher dimensional operators of that theory. These are among the most stringent limits on Lorentz violation across all fields of physics.
We present a measurement of the atmospheric neutrino oscillation parameters using three years of data from the IceCube Neutrino Observatory. The DeepCore infill array in the center of IceCube enables ...detection and reconstruction of neutrinos produced by the interaction of cosmic rays in the Earth's atmosphere at energies as low as \(\sim5\) GeV. That energy threshold permits measurements of muon neutrino disappearance, over a range of baselines up to the diameter of the Earth, probing the same range of \(L/E_\nu\) as long-baseline experiments but with substantially higher energy neutrinos. This analysis uses neutrinos from the full sky with reconstructed energies from \(5.6\) - \(56\) GeV. We measure \(\Delta m^2_{32}=2.31^{+0.11}_{-0.13} \times 10^{-3}\) eV\(^2\) and \(\sin^2 \theta_{23}=0.51^{+0.07}_{-0.09}\), assuming normal neutrino mass ordering. These results are consistent with, and of similar precision to, those from accelerator and reactor-based experiments.
We present a search for coincidence between IceCube TeV neutrinos and fast radio bursts (FRBs). During the search period from 2010 May 31 to 2016 May 12, a total of 29 FRBs with 13 unique locations ...have been detected in the whole sky. An unbinned maximum likelihood method was used to search for spatial and temporal coincidence between neutrinos and FRBs in expanding time windows, in both the northern and southern hemispheres. No significant correlation was found in six years of IceCube data. Therefore, we set upper limits on neutrino fluence emitted by FRBs as a function of time window duration. We set the most stringent limit obtained to date on neutrino fluence from FRBs with an \(E^{-2}\) energy spectrum assumed, which is 0.0021 GeV cm\(^{-2}\) per burst for emission timescales up to \textasciitilde10\(^2\) seconds from the northern hemisphere stacking search.
Neutrinos interact only very weakly, so they are extremely penetrating. However, the theoretical neutrino-nucleon interaction cross section rises with energy such that, at energies above 40 TeV, ...neutrinos are expected to be absorbed as they pass through the Earth. Experimentally, the cross section has been measured only at the relatively low energies (below 400 GeV) available at neutrino beams from accelerators \cite{Agashe:2014kda, Formaggio:2013kya}. Here we report the first measurement of neutrino absorption in the Earth, using a sample of 10,784 energetic upward-going neutrino-induced muons observed with the IceCube Neutrino Observatory. The flux of high-energy neutrinos transiting long paths through the Earth is attenuated compared to a reference sample that follows shorter trajectories through the Earth. Using a fit to the two-dimensional distribution of muon energy and zenith angle, we determine the cross section for neutrino energies between 6.3 TeV and 980 TeV, more than an order of magnitude higher in energy than previous measurements. The measured cross section is \(1.30^{+0.21}_{-0.19}\) (stat.) \(^{+0.39}_{-0.43}\) (syst.) times the prediction of the Standard Model \cite{CooperSarkar:2011pa}, consistent with the expectation for charged and neutral current interactions. We do not observe a dramatic increase in the cross section, expected in some speculative models, including those invoking new compact dimensions \cite{AlvarezMuniz:2002ga} or the production of leptoquarks \cite{Romero:2009vu}.
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