Purpose
The postpartum abdomen presents significant challenges to the surgeon. It is anatomically complex, with often substantial symptomatic divarication of the rectus abdominis, affecting all ...anterior abdominal wall layers. This may lead to profound functional sequelae, and often, of more importance to patients, a significant physical deformity. The complex interplay of functional/physical symptoms can result in reduced quality of life (QoL) as well as negative body image/self-esteem. Postpartum women may seek abdominoplasty to address the whole scope of these concerns. Whilst techniques have evolved achieving such goals operatively, the impact of such surgery on QoL/mental health has yet to be established.
Methods
We perform a comprehensive review of potential options of validated patient-reported outcome measures (PROMs) for consideration of use in postpartum women seeking abdominoplasty; in addition to discussing current driving factors for seeking surgery and associated ethics.
Results
Pressure on postpartum women to return their abdominal wall contour to a pre-pregnant state is high. This poses important ethical considerations for surgeons. There are several well-established/validated PROMs used in body contouring in massive weight loss/bariatric population groups, including Body-Q and Body-QoL scales, but none yet specific to postpartum women.
Conclusion
PROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients’ mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial.
We report a study of ν(μ) charged-current quasielastic events in the segmented scintillator inner tracker of the MINERvA experiment running in the NuMI neutrino beam at Fermilab. The events were ...selected by requiring a μ- and low calorimetric recoil energy separated from the interaction vertex. We measure the flux-averaged differential cross section, dσ/dQ², and study the low energy particle content of the final state. Deviations are found between the measured dσ/dQ² and the expectations of a model of independent nucleons in a relativistic Fermi gas. We also observe an excess of energy near the vertex consistent with multiple protons in the final state.
We have isolated ν(μ) charged-current quasielastic (QE) interactions occurring in the segmented scintillator tracking region of the MINERvA detector running in the NuMI neutrino beam at Fermilab. We ...measure the flux-averaged differential cross section, dσ/dQ², and compare to several theoretical models of QE scattering. Good agreement is obtained with a model where the nucleon axial mass, M(A), is set to 0.99 GeV/c² but the nucleon vector form factors are modified to account for the observed enhancement, relative to the free nucleon case, of the cross section for the exchange of transversely polarized photons in electron-nucleus scattering. Our data at higher Q² favor this interpretation over an alternative in which the axial mass is increased.
Please cite this paper as: Cross P, Naik R, Patel A, Nayar A, Hemming J, Williamson S, Henry J, Edmondson R, Godfrey K, Galaal K, Kucukmetin A, Lopes A. Intra‐operative frozen section analysis for ...suspected early‐stage ovarian cancer: 11 years of Gateshead Cancer Centre experience. BJOG 2012;119:194–201.
Objective In centres in which intra‐operative frozen section (FS) analysis is not performed, ‘apparent’ early‐stage ovarian cancer diagnosed after surgery on paraffin section may require further restaging laparotomy or adjuvant chemotherapy. Previous studies on FS analysis have reported high sensitivity, specificity and overall accuracy. The objective of this article is to present the largest published dataset on the accuracy of FS analysis over an 11‐year period from a single institution.
Design Diagnostic test accuracy.
Setting Northern Gynaecological Oncology Centre and Department of Cellular Pathology, Gateshead, UK.
Population 1439 intra‐operative FS analyses performed between January 2000 and December 2010 for suspected ovarian cancer.
Methods Prospectively collected data on FS analysis were compared with gold standard paraffin section.
Main outcome measures Sensitivity, specificity, likelihood ratios and post‐test probability.
Results The overall sensitivity and specificity of FS analysis were 91.2% and 98.6%, respectively. Positive and negative likelihood ratios were 64.7% and 0.09%, respectively. The pre‐test probability of an ovarian tumour being borderline or malignant was 45.8%. When FS analysis was reported to be positive, the post‐test probability increased to 98% (confidence interval, 97–99%). Conversely, when FS analysis was reported to be negative, the post‐test probability decreased to 7% (confidence interval, 6–9%). The majority of false test results were either borderline tumours or of mucinous differentiation.
Conclusions Intra‐operative FS analysis has excellent diagnostic test accuracy and assists gynaecological oncologists to perform the appropriate surgery in 95% of cases, thereby preventing the morbidity of surgical staging in benign cases and the morbidity of restaging procedures or chemotherapy in early‐stage malignant tumours.
Purpose
In HER2-positive breast cancer (HER2+ BC), neoadjuvant chemotherapy (NACT) with dual HER2-targeted therapy achieves high pathologic complete response (pCR) rates. Anthracycline-free NACT ...regimens avoid toxicities associated with anthracyclines, but every 3-week TCHP also has substantial side effects. We hypothesized that a weekly regimen might have equivalent efficacy with less toxicity; we also investigated whether poorly responding patients would benefit from switching to AC.
Methods
Patients with clinical stage II–III HER2+ BC received weekly paclitaxel 80 mg/m
2
and carboplatin AUC2 with every 3-week trastuzumab and pertuzumab (wPCbTP), with the option of splitting the pertuzumab loading dose. After 12 weeks, responding patients continued wPCbTP for another 6 weeks, while non-responders switched to AC. Dose modifications and post-op therapy were at investigator discretion.
Results
In 30 evaluable patients, the pCR rate was 77% (95% CI 58–90%); 12/14 (86%) in ER-negative and 11/16 (69%) in ER-positive. Only two patients transitioned to AC for non-response, of which one achieved pCR. There were no episodes of febrile neutropenia or grade ≥ 3 peripheral neuropathy, though several patients who continued wPCbTP stopped before week 18. Split-dose pertuzumab was associated with less grade ≥ 2 diarrhea (40%) than the standard loading dose (60%).
Conclusion
pCR rates with our regimen were as high as reported with TCHP with fewer grade ≥ 3 toxicities, though diarrhea remains a concern. Too few patients had a suboptimal response to adequately test switching to AC. The wPCbTP regimen should be considered an alternative to TCHP as neoadjuvant therapy for HER2+ BC.
Trail Registration
ClinicalTrials.gov identifier: NCT02789657.
Cancer risk from galactic cosmic radiation exposure is considered a potential "showstopper" for a manned mission to Mars. Calculating the actual risks confronted by spaceflight crews is complicated ...by our limited understanding of the carcinogenic effects of high-charge, high-energy (HZE) ions, a radiation type for which no human exposure data exist. Using a mouse model of genetic diversity, we find that the histotype spectrum of HZE ion-induced tumors is similar to the spectra of spontaneous and γ-ray-induced tumors and that the genomic loci controlling susceptibilities overlap between groups for some tumor types. Where it occurs, this overlap indicates shared tumorigenesis mechanisms regardless of the type of radiation exposure and supports the use of human epidemiological data from γ-ray exposures to predict cancer risks from galactic cosmic rays.
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► A novel fluorinated polycarbonate with a high Tg has been synthesized. ► The activation volume for the γ relaxation is extremely large. ► An Arrhenius plot of the isochronal and ...isothermal γ relaxation data is anomalous. ► The variations of the γ peak height with pressure and temperature are anomalous.
The relative permittivity, loss and dielectric strength have been measured for a polycarbonate-based material, tetraaryl bisphenol A polycarbonate, that has been fluorine substituted (DiF p-TABPA-PC). The new material has a glass transition temperature, Tg=489K, that is higher than that for either conventional bisphenol A polycarbonate (BPA-PC) for which Tg=421K or for a copolymer of tetraaryl bisphenol A (TABPA) and bisphenol A (BPA) (TABPA-BPA-PC) for which Tg=464K. In addition, the dielectric strength of DiF p-TABPA-PC is almost identical to that for purified BPA-PC and slightly larger than the value for TABPA-BPA-PC. The relative permittivity and loss measurements were carried out from 10 to 105Hz over a wide temperature range and at pressures up to 0.25GPa. Variable temperature results for the α relaxation and both temperature and pressure results for the γ relaxation regions are reported. The α relaxation exhibits standard behavior. The γ relaxation exhibits unusual characteristics such as a strong increase in peak height as temperature increases and a strong decrease in peak height with increasing pressure. The data for the γ relaxation have been analyzed using several formulations. Expressions for the peak height and peak position based on a two state (inequivalent well) model and the resulting parameters are discussed in terms of the insight they provide into the molecular mechanisms responsible for the sub-Tg relaxation. Ab initio SCF results for a related model compound are presented. Finally, the real part of the relative permittivity for the new polymer is about 10% higher than for BPA-PC.
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