Background
In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a ...markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.
Methods
Data were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.
Results
Fifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.
Conclusion
Breast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 (
http://www.trialregister.nl).
Not good for the large breast
Renal transplant candidates with donor‐specific alloantibody (DSA) have increased risk of antibody‐mediated allograft injury. The goal of this study was to correlate the risk of antibody‐mediated ...rejection (AMR), transplant glomerulopathy (TG) and graft survival with the baseline DSA level (prior to initiation of pretransplant conditioning). These analyses include 119 positive crossmatch (+XM) compared to 70 negative crossmatch (−XM) transplants performed between April 2000 and July 2007. Using a combination of cell‐based crossmatch tests, DSA level was stratified into very high +XM, high +XM, low +XM and −XM groups. In +XM transplants, increasing DSA level was associated with increased risk for AMR (HR = 1.76 1.51, 2.07, p = 0.0001) but not TG (p = 0.18). We found an increased risk for both early and late allograft loss associated with very high DSA (HR = 7.71 2.95, 20.1, p = 0.0001). Although lower DSA recipients commonly developed AMR and TG, allograft survival was similar to that of −XM patients (p = 0.31). We conclude that the baseline DSA level correlates with risk of early and late alloantibody‐mediated allograft injury. With current protocols, very high baseline DSA patients have high rates of AMR and poor long‐term allograft survival highlighting the need for improved therapy for these candidates.
Although the risk for acute ABMR is associated with high baseline DSA level in +XM recipients, the incidence of TG in +XM recipients is similar regardless of baseline DSA level.
Renal transplant candidates with high levels of donor‐specific anti‐HLA antibodies have low transplantation rates and high mortality rates on dialysis. Using desensitization protocols, good ...short‐term outcomes are possible in “positive crossmatch kidney transplants (+XMKTx)”, but long‐term outcome data are lacking. The aim of the current study was to determine actual 5‐year graft outcomes of +XMKTx. We compared graft survival and the functional and histologic status of 102 +XMKTx to 204 −XMKTx matched for age and sex. Actual 5‐year death‐censored graft survival was lower in the +XMKTx group (70.7% vs. 88.0%, p < 0.01) and chronic injury (glomerulopathy) was present in 54.5% of surviving grafts. Graft survival was higher in recipients with antibody against donor class I only compared with antibody against class II (either alone or in combination with class I) (85.3% vs. 62.6%, p = 0.05) and was similar to −XMKTx (85.3 vs. 88.0%, p = 0.64). Renal function and proteinuria ranged across a wide spectrum in all groups reflecting the different histological findings at 5 years. We conclude that when compared to −XMKTx, +XMKTx have inferior outcomes at 5 years, however, almost half of the surviving grafts do not have glomerulopathy and avoiding antibodies against donor class II may improve outcomes.
This study demonstrates that patients with anti‐class II donor‐specific antibodies at baseline in positive crossmatch kidney transplants have increased early transplant glomerulopathy at one year and higher rates of graft loss compared to anti‐class I antibodies alone.
To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related ...moderators of these effects.
Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics.
For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g = −0.09, 95% CI −0.16; −0.02). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances.
This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.
•The exercise interventions can reduce sleep disturbances in patients with cancer•There is no significant improvement of sleep quality after an exercise intervention.•The demographic, clinical, or intervention-related factors were not found to significantly moderate the effect of exercise on sleep.
Background
Implant‐based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct ...one‐stage IBBR with use of an acellular dermal matrix (ADM) is more cost‐effective than two‐stage (expander‐implant) breast reconstruction.
Methods
The BRIOS (Breast Reconstruction In One Stage) study was an open‐label multicentre RCT in which women scheduled for skin‐sparing mastectomy and immediate IBBR were randomized between one‐stage IBBR with ADM or two‐stage IBBR. Duration of surgery and hospital stay, and visits for the primary surgery, unplanned and cosmetic procedures were recorded. Costs were estimated at an institutional level. Health status was assessed by means of the EuroQol Five Dimensions 5L questionnaire.
Results
Fifty‐nine patients (91 breasts) underwent one‐stage IBBR with ADM and 62 patients (92 breasts) two‐stage IBBR. The mean(s.d.) duration of surgery in the one‐stage group was significantly longer than that for two‐stage IBBR for unilateral (2·52(0·55) versus 2·02(0·35) h; P < 0·001) and bilateral (4·03(1·00) versus 3·25(0·58) h; P = 0·017) reconstructions. Costs were higher for one‐stage compared with two‐stage IBBR for both unilateral (€12 448 (95 per cent c.i. 10 722 to 14 387) versus €9871 (9373 to 10 445) respectively; P = 0·025) and bilateral (€16 939 (14 887 to 19 360) versus €13 383 (12 414 to 14 669); P = 0·002) reconstructions. This was partly related to the use of relatively expensive ADM. There was no difference in postoperative health status between the groups.
Conclusion
One‐stage IBBR with ADM was associated with higher costs, but similar health status, compared with conventional two‐stage IBBR. Registration number: NTR5446 (
http://www.trialregister.nl).
In this multicentre open‐label RCT, women scheduled for skin‐sparing mastectomy and immediate implant‐based breast reconstruction (IBBR) were randomized to undergo one‐stage IBBR with acellular dermal matrix (ADM) or two‐stage IBBR. Fifty‐nine patients (91 breasts) underwent one‐stage IBBR with ADM and 62 patients (92 breasts) two‐stage IBBR. One‐stage IBBR with ADM was associated with higher costs, which was partly explained by the relatively expensive ADM, and similar health status, compared with conventional two‐stage IBBR.
One‐stage not cost‐effective
Variable x-ray and γ-ray emission is characteristic of the most extreme physical processes in the universe. We present multiwavelength observations of a unique γ-ray—selected transient detected by ...the Swift satellite, accompanied by bright emission across the electromagnetic spectrum, and whose properties are unlike any previously observed source. We pinpoint the event to the center of a small, star-forming galaxy at redshift z = 0.3534. Its high-energy emission has lasted much longer than any γ-ray burst, whereas its peak luminosity was ∼100 times higher than bright active galactic nuclei. The association of the outburst with the center of its host galaxy suggests that this phenomenon has its origin in a rare mechanism involving the massive black hole in the nucleus of that galaxy.
The Kuiper Belt is a broad, torus-shaped region in the outer Solar System beyond Neptune’s orbit. It contains primordial planetary building blocks and dwarf planets. NASA’s New Horizons spacecraft ...conducted a flyby of Pluto and its system of moons on 14 July 2015. New Horizons then continued farther into the Kuiper Belt, adjusting its trajectory to fly close to the small Kuiper Belt object (486958) 2014 MU69 (henceforth MU69; also informally known as Ultima Thule). Stellar occultation observations in 2017 showed that MU69 was ~25 to 35 km in diameter, and therefore smaller than the diameter of Pluto (2375 km) by a factor of ~100 and less massive than Pluto by a factor of ~106. MU69 is located about 1.6 billion kilometers farther from the Sun than Pluto was at the time of the New Horizons flyby. MU69’s orbit indicates that it is a “cold classical” Kuiper Belt object, thought to be the least dynamically evolved population in the Solar System. A major goal of flying past this target is to investigate accretion processes in the outer Solar System and how those processes led to the formation of the planets. Because no small Kuiper Belt object had previously been explored by spacecraft, we also sought to provide a close-up look at such a body’s geology and composition, and to search for satellites, rings, and evidence of present or past atmosphere. We report initial scientific results and interpretations from that flyby.
We report the detection of a transiting super-Earth-sized planet (
R
= 1.39 ± 0.09
R
⊕
) in a 1.4-day orbit around L 168-9 (TOI-134), a bright M1V dwarf (
V
= 11,
K
= 7.1) located at 25.15 ± 0.02 pc. ...The host star was observed in the first sector of the Transiting Exoplanet Survey Satellite (TESS) mission. For confirmation and planet mass measurement purposes, this was followed up with ground-based photometry, seeing-limited and high-resolution imaging, and precise radial velocity (PRV) observations using the HARPS and
Magellan
/PFS spectrographs. By combining the TESS data and PRV observations, we find the mass of L 168-9 b to be 4.60 ± 0.56
M
⊕
and thus the bulk density to be 1.74
−0.33
+0.44
times higher than that of the Earth. The orbital eccentricity is smaller than 0.21 (95% confidence). This planet is a level one candidate for the TESS mission’s scientific objective of measuring the masses of 50 small planets, and it is one of the most observationally accessible terrestrial planets for future atmospheric characterization.
Context. Gamma-ray bursts (GRBs) generate an afterglow emission that can be detected from radio to X-rays during days, or even weeks after the initial explosion. The peak of this emission crosses the ...millimeter and submillimeter range during the first hours to days, making their study in this range crucial for constraining the models. Observations have been limited until now due to the low sensitivity of the observatories in this range. This situation will be greatly improved with the start of scientific operations of the Atacama Large Millimeter/submillimeter Array (ALMA). Aims. In this work we do a statistical analysis of the complete sample of mm/submm observations of GRB afterglows obtained before the beginning of scientific operations at ALMA. Methods. We present observations of 11 GRB afterglows obtained from the Atacama Pathfinder Experiment (APEX) and the SubMillimeter Array (SMA), as well as the first detection of a GRB with ALMA, still in the commissioning phase, and put them into context with a catalogue of all the observations that have been published until now in the spectral range that is covered by ALMA. Results. The catalogue of mm/submm observations collected here is the largest to date and is composed of 102 GRBs, of which 88 have afterglow observations, whereas the rest are host galaxy searches. With our programmes, we contributed with data of 11 GRBs and the discovery of 2 submm counterparts. In total, the full sample, including data from the literature, has 22 afterglow detections with redshifts ranging from 0.168 to 8.2. GRBs have been detected in mm/submm wavelengths with peak luminosities spanning 2.5 orders of magnitude, the most luminous reaching 1033erg s-1Hz-1. We observe a correlation between the X-ray brightness at 0.5 days and the mm/submm peak brightness. Finally we give a rough estimate of the distribution of peak flux densities of GRB afterglows, based on the current mm/submm sample. Conclusions. Observations in the mm/submm bands have been shown to be crucial for our understanding of the physics of GRBs, but have until now been limited by the sensitivity of the observatories. With the start of the operations at ALMA, the sensitivity has improved by more than an order of magnitude, opening a new era in the study of GRB afterglows and their host galaxies. Our estimates predict that, once completed, ALMA will detect up to ~98% of the afterglows if observed during the passage of the peak synchrotron emission.
Since 2014, NASA's K2 mission has observed large portions of the ecliptic plane in search of transiting planets and has detected hundreds of planet candidates. With observations planned until at ...least early 2018, K2 will continue to identify more planet candidates. We present here 275 planet candidates observed during Campaigns 0-10 of the K2 mission that are orbiting stars brighter than 13 mag (in Kepler band) and for which we have obtained high-resolution spectra (R = 44,000). These candidates are analyzed using the vespa package in order to calculate their false-positive probabilities (FPP). We find that 149 candidates are validated with an FPP lower than 0.1%, 39 of which were previously only candidates and 56 of which were previously undetected. The processes of data reduction, candidate identification, and statistical validation are described, and the demographics of the candidates and newly validated planets are explored. We show tentative evidence of a gap in the planet radius distribution of our candidate sample. Comparing our sample to the Kepler candidate sample investigated by Fulton et al., we conclude that more planets are required to quantitatively confirm the gap with K2 candidates or validated planets. This work, in addition to increasing the population of validated K2 planets by nearly 50% and providing new targets for follow-up observations, will also serve as a framework for validating candidates from upcoming K2 campaigns and the Transiting Exoplanet Survey Satellite, expected to launch in 2018.
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