To investigate the value of conventional MRI and diffusion-weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer.
102 patients with cervical ...cancer who underwent MRI and DWI scan were included. 137 lymph nodes were analyzed, including 44 metastatic lymph nodes (MLNs) and 93 non-metastatic lymph nodes (non-MLNs). The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short-axis diameter (D
), long-axis diameter (D
), ratio of short-to-long-axis diameter (D
), fatty hilum, asymmetry, ADC
, ADC
and ADC
. The Mann-Whitney U-test, independent sample t-test and Chi-square test were employed to compare the differences of all criteria between MLNs and non-MLNs. Logistic regression and decision tree were used to develop the combined diagnostic model. ROC analyses were used to evaluate the diagnostic performance.
The D
and D
of MLNs were significantly higher than those of non-MLNs (
< 0.05), the ADC
, ADC
and ADC
of MLNs were significantly lower than those of non-MLNs (
< 0.05). Presence of fatty hilum and asymmetric lymph nodes between MLNs and non-MLNs were significantly different (
＜0.05). Combined measurement of ADC
, D
and D
had the highest AUC 0.937 with 90.9% sensitivity and 87.1% specificity. The accuracy of decision tree was 88.3%.
MRI with DWI had potential in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. The combined evaluation of D
, D
and ADC
of lymph nodes and decision tree of the combined measure showed better diagnostic performances than sole criteria.
The short-axis diameter, ratio of short-to-long-axis diameter and ADC
of lymph nodes have moderate value in the diagnosis of the metastases of the normal-sized lymph nodes for the patient with cervical cancer as the sole indices. The combined evaluation of D
, D
and ADC
is much more valuable in the detection of metastatic lymph nodes.
The optimal timing of radiotherapy after radical prostatectomy for prostate cancer is uncertain. We aimed to compare the efficacy and safety of adjuvant radiotherapy versus an observation policy with ...salvage radiotherapy for prostate-specific antigen (PSA) biochemical progression.
We did a randomised controlled trial enrolling patients with at least one risk factor (pathological T-stage 3 or 4, Gleason score of 7–10, positive margins, or preoperative PSA ≥10 ng/mL) for biochemical progression after radical prostatectomy (RADICALS-RT). The study took place in trial-accredited centres in Canada, Denmark, Ireland, and the UK. Patients were randomly assigned in a 1:1 ratio to adjuvant radiotherapy or an observation policy with salvage radiotherapy for PSA biochemical progression (PSA ≥0·1 ng/mL or three consecutive rises). Masking was not deemed feasible. Stratification factors were Gleason score, margin status, planned radiotherapy schedule (52·5 Gy in 20 fractions or 66 Gy in 33 fractions), and centre. The primary outcome measure was freedom from distant metastases, designed with 80% power to detect an improvement from 90% with salvage radiotherapy (control) to 95% at 10 years with adjuvant radiotherapy. We report on biochemical progression-free survival, freedom from non-protocol hormone therapy, safety, and patient-reported outcomes. Standard survival analysis methods were used. A hazard ratio (HR) of less than 1 favoured adjuvant radiotherapy. This study is registered with ClinicalTrials.gov, NCT00541047.
Between Nov 22, 2007, and Dec 30, 2016, 1396 patients were randomly assigned, 699 (50%) to salvage radiotherapy and 697 (50%) to adjuvant radiotherapy. Allocated groups were balanced with a median age of 65 years (IQR 60–68). Median follow-up was 4·9 years (IQR 3·0–6·1). 649 (93%) of 697 participants in the adjuvant radiotherapy group reported radiotherapy within 6 months; 228 (33%) of 699 in the salvage radiotherapy group reported radiotherapy within 8 years after randomisation. With 169 events, 5-year biochemical progression-free survival was 85% for those in the adjuvant radiotherapy group and 88% for those in the salvage radiotherapy group (HR 1·10, 95% CI 0·81–1·49; p=0·56). Freedom from non-protocol hormone therapy at 5 years was 93% for those in the adjuvant radiotherapy group versus 92% for those in the salvage radiotherapy group (HR 0·88, 95% CI 0·58–1·33; p=0·53). Self-reported urinary incontinence was worse at 1 year for those in the adjuvant radiotherapy group (mean score 4·8 vs 4·0; p=0·0023). Grade 3–4 urethral stricture within 2 years was reported in 6% of individuals in the adjuvant radiotherapy group versus 4% in the salvage radiotherapy group (p=0·020).
These initial results do not support routine administration of adjuvant radiotherapy after radical prostatectomy. Adjuvant radiotherapy increases the risk of urinary morbidity. An observation policy with salvage radiotherapy for PSA biochemical progression should be the current standard after radical prostatectomy.
Cancer Research UK, MRC Clinical Trials Unit, and Canadian Cancer Society.
Birds can use different types of gaits to move on the ground: they either walk, hop, or run. Although velocity can easily explain a preference for running, it remains unclear what drives a bird ...species to favor hopping over walking. As many hopping birds are relatively small and arboreal, we wanted to test the link between size, arboreality, and hopping ability. First, we carried out ancestral character state reconstructions of size range, hopping ability, and habitat traits on over 1000 species of birds. We found that both hopping ability and arboreality were derived and significantly correlated traits in avian evolution. Second, we tested the influence of hopping ability on the morphology of the lower appendicular skeleton by quantifying the shape differences of the pelvis and the three long bones of the hind limbs in 47 avian species with different habitats and gait preferences. We used geometric morphometrics on 3D landmarks, digitized on micro–computed tomography (micro-CT) and surface scans of the pelvis, femur, tibiotarsus, and tarsometatarsus. Locomotion habits significantly influence the conformation of the pelvis, especially at the origin of hip and knee muscle extensors. Interestingly, habitat, more than locomotion habits, significantly changed tarsometatarsus conformation. The morphology of the distal part of the tarsometatarsus constrains digit orientation, which leads to a greater ability to perch, an advantageous trait in arboreality. The results of this work suggest an arboreal origin of hopping and illuminate the evolution of avian terrestrial locomotion.
Robotic gait training may improve overground ambulation for individuals with poor control over pelvic motion. However, there is a need for an overground gait training robotic device that allows full ...control of pelvic movement and synchronizes applied forces to the user's gait. This work evaluates an overground robotic gait trainer that applies synchronized forces on the user's pelvis, the mobile Tethered Pelvic Assist Device. To illustrate one possible control scheme, we apply assistive frontal plane pelvic moments synchronized with the user's continuous gait in real-time. Ten healthy adults walked with the robotic device, with and without frontal plane moments. The frontal plane moments corresponded to 10% of the user's body weight with a moment arm of half their pelvic width. The frontal plane moments significantly increased the range of frontal plane pelvic angles from 2.6° to 9.9° and the sagittal and transverse planes from 4.6° to 10.1° and 3.0° to 8.3°, respectively. The frontal plane moments also significantly increased the activation of the left gluteus medius muscle, which assists in regulating pelvic obliquity. The right gluteus medius muscle activation did not significantly differ when frontal plane moments were applied. This work highlights the ability of the mobile Tethered Pelvic Assist Device to apply a continuous pelvic moment that is synchronized with the user's gait cycle. This capability could change how overground robotic gait training strategies are designed and applied. The potential for gait training interventions that target gait deficits or muscle weakness can now be explored with the mobile Tethered Pelvic Assist Device.
Abstract Injuries due to backward fall apart from sideways fall are a major health problem, particularly among the aged populations. The objectives of this study was to evaluate the responses to ...changing body configurations (angle between the trunk and impacting floor as 0°, 15°, 45° and 80°) during backward fall, based on a previously developed CT-scan-derived 3D non-linear and non-homogeneous finite element (FE) model of pelvis–femur–soft tissue complex with simplified biomechanical representation of the whole body. Under constant impact energy, these FE models evaluated the pelvic injury situations on the basis of peak impact force (7.64–16.74 kN) and peak principal compressive strain (more than 1.5%), consistent with the clinically observed injuries (sacral insufficiency, coccydynia). Also the change in location of peak strain and increase in peak impact force for changing configurations from 0° to 80° indicated the effect of whole body inertia during backward fall. It was also concluded that the inclusion of sacro-iliac and acetabular cartilages in the above FE models will further reduce above findings marginally (9.2% for 15° fall). These quantifications would also be helpful for a better design and development of safety structures such as safety floor for the nursing home or home for the aged persons.
A case report of pelvic lipomatosis Jorge Ernesto González-García; Yudis Acea-Paredes; Dianelys Molina-Macias
Revista electrónica "Dr. Zoilo E. Marinello Vidaurreta",
01/2022
Journal Article
Recenzirano
Odprti dostop
Pelvic lipomatosis is a rare condition defined as a non-malignant excessive growth of normal fat in the pelvis. Its first symptoms are usually atypical and some patients are not diagnosed until ...severe upper tract obstruction or even kidney failure occurs. We present the case of a 48-year-old female patient with a history of obesity, who presents complaining of an increase in volume in the lower abdominal region, as well as of some urinary incontinence. On physical examination a non-painful and somewhat mobile tumor mass in the hypogastrium of about 10 cm in diameter was palpated. Investigations, electrocardiogram and simple chest x-ray are performed. A computerized axial tomography of the hypogastrium shows a hypodense image, of fat density that displaces intestinal loops towards the periphery and the bladder and uterus downwards. An exploratory laparotomy is performed and a large, fatty-looking tumor mass is observed, occupying the entire hypogastrium, adhering to the serosa of the urinary bladder. Excision is performed, sending the specimen for histological study. It is concluded as a lipoma. The patient progresses favorably and is discharged the day after the operation without complications.
Episiotomy during vaginal delivery was first recommended as a way to protect the pelvic floor from lacerations and protect the fetal head from trauma. It was rapidly adopted as a standard practice ...and has been widely used since then. However, over the last several decades, there has been a growing body of evidence that episiotomy does not provide these purported benefits and may contribute to more severe perineal lacerations and future pelvic floor dysfunction. In this review, we examine the evidence that led to changing episiotomy practices and the debate that has surrounded episiotomy. By doing so, we can not only evaluate this specific obstetric procedure, but also gain insights into the challenge of changing medical practice as new data emerge. Thus this study focuses on improving the student nurses competency in Episiotomy care. A total of 60 nursing students belonging to 3rd year GNM and 4th year B.Sc. were selected by purposive sampling for this study.
We report on a 31-year-old male patient with non-invasive papillary urothelial carcinoma, low grade of the renal pelvis disguised as xanthogranulomatous pyelonephritis. The only symptom of the ...patient was lower back pain. The initial renal-enhanced computed tomography, magnetic resonance imaging and contrast-enhanced ultrasonography showed that the right kidney had a benign lesion and this inflammatory lesion might be xanthogranulomatous pyelonephritis. A percutaneous renal biopsy was performed and histopathologic examination revealed a xanthogranulomatous pyelonephritis. Initially, we diagnosed it as xanthogranulomatous pyelonephritis and treated it with antibiotics. One and a half years later, the patient suffered from back pain again. The lesion increased significantly and a right renal pelvic lesion with retroperitoneal lymphadenopathy was considered a malignant lesion on computed tomography scan. Therefore, radical resection of right renal pelvis carcinoma was performed under retroperitoneal laparoscopy. Intraoperative frozen section was reported as right renal urothelial carcinoma with no metastasis in renal hilar lymph node. Postoperative histopathologic examination revealed non-invasive papillary urothelial carcinoma, low grade of renal pelvis.
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