Our objective was to assess the global cost of the sentinel lymph node detection axillary sentinel lymph node detection (ASLND) compared with standard axillary lymphadenectomy axillary lymph node ...dissection (ALND) for early breast cancer patients.
We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.
Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy €2947 (σ = 580) versus €3331 (σ = 902); P = 0.0001.
ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
Many mistletoe species produce 'bird'-pollinated flowers; however, the reproductive biology of the majority of these species has not been studied. Psittacanthus auriculatus is a Mexican endemic ...mistletoe, most common in open, dry mesquite grassland. Knowledge of the reproductive biology of P. auriculatus is essential for understanding species formation and diversification of Psittacanthus mistletoes, but it is currently poorly understood. Thus, we studied floral biology and phenology, nectar production and breeding system and pollination of this species. The hermaphroditic red-pink flowers open from the middle to the tip and petals are curly, but remain partially fused forming a floral tube of ca. 20-mm long. Flowers are partially protandrous, produce large amounts of nectar, last 2 days, and stigma receptivity is highest during the second day. We recorded hummingbirds (Cynanthus latirostris, Hylocharis leucotis, Amazilia beryllina, A. violiceps, Calothorax lucifer, Archilochus colubris) and less commonly butterflies (Agraulis vanillae, Anteos clorinde, Papilio multicaudatus, Phocides urania, Phoebis sennae) as floral visitors. P. auriculatus flowers are self-compatible. However, this mistletoe is an obligate animal-pollinated species, as the sensitive stigma avoids self-pollination. Under natural conditions, reproductive success was higher than in manually selfed or cross-pollinated flowers, likely due to the traplining foraging behaviour of hummingbirds. We suggest that the apparent efficient foraging behaviour of hummingbirds maintains gene flow among P. auriculatus, promoting outcrossing.
The meta‐terphenyl diphosphine, m‐P2, 1, was utilized to support Ni centers in the oxidation states 0, I, and II. A series of complexes bearing different substituents or ligands at Ni was prepared to ...investigate the dependence of metal–arene interactions on oxidation state and substitution at the metal center. Complex (m‐P2)Ni (2) shows strong Ni0–arene interactions involving the central arene ring of the terphenyl ligand both in solution and the solid state. These interactions are significantly less pronounced in Ni0 complexes bearing L‐type ligands (2‐L: L=CH3CN, CO, Ph2CN2), NiIX complexes (3‐X: X=Cl, BF4, N3, N3B(C6F5)3), and (m‐P2)NiIICl2 (4). Complex 2 reacts with substrates, such as diphenyldiazoalkane, sulfur ylides (Ph2SCH2), organoazides (RN3: R=para‐C6H4OMe, para‐C6H4CF3, 1‐adamantyl), and N2O with the locus of observed reactivity dependent on the nature of the substrate. These reactions led to isolation of an η1‐diphenyldiazoalkane adduct (2‐Ph2CN2), methylidene insertion into a NiP bond followed by rearrangement of a nickel‐bound phosphorus ylide (5) to a benzylphosphine (6), Staudinger oxidation of the phosphine arms, and metal‐mediated nitrene insertion into an arene CH bond of 1, all derived from the same compound (2). Hydrogen‐atom ion from a NiI–amide (9) and the resulting nitrene transfer supports the viability of Ni–imide intermediates in the reaction of 1 with 1‐azido‐arenes.
Put a ring on it: The utilization of a meta‐terphenyl diphosphine ligand leads to labile metal‐arene interactions in Ni complexes in various oxidation states and coordination environments. When these complexes are treated with group‐transfer reagents, such as diazoalkanes, sulfur ylides, or azides, various types of ligand‐centered reactivity were observed, including methylidene insertion into a PC bond and amination of an arene CH bond (see scheme; Ad=adamantyl).
The electrical behaviour of glass-ceramics in the system, RO-BaO-SiO2 (R=Mg, Zn), was characterised in the range from 500 to 850 deg C by electrochemical impedance spectroscopy (EIS) simulating the ...start-up thermal treatment programme of an SOFC. The thermal treatment covers the sintering and crystallisation temperature range of the glass-ceramics. Over the whole temperature range, samples presented an electrical resistance much higher than 104Omegacm, thus behaving like insulators. Impedance spectra were expressed as Bode plots showing the impedance as a function of frequency and phase angle. Electrical properties corresponding to the bulk specimen were obtained by employing an equivalent circuit to simulate the impedance spectra. The influence of crystallisation on electrical properties has been followed by EIS showing the capability of this method as a thermal analysis technique. The specific conductivities were illustrated by Arrhenius plots and its derivative (-dlogsigma/d(1/T)). Glass transition and crystallisation processes strongly affect the derivative, whose shape can provide information about both processes. Hot-stage microscopy (HSM) and differential thermal analysis (DTA) were carried out under the same thermal conditions. The results obtained by the different techniques were analysed in detail resulting in good agreement.
The knee meniscus is a crucial component of the knee that functions to stabilize the joint, distribute load, and maintain congruency. Meniscus tears and degeneration are common, and natural healing ...is limited. Notably, few children present with meniscus injuries and other related fibrocartilaginous tissues heal regeneratively in immature animals and in the fetus. In this work, we evaluated fetal, juvenile, and adult bovine meniscus properties and repair capacity in vitro. Although no changes in cell behavior (migration and proliferation) were noted with age, drastic alterations in the density and distribution of the major components of meniscus tissue (proteoglycan, collagen, and DNA) occurred with development. Coincident with these marked tissue changes, the in vitro healing capacity of the tissue decreased with age. Fetal and juvenile meniscus formed a robust repair over 8 weeks on both a histological and mechanical basis, despite a lack of vascular supply. In contrast, adult meniscus did not integrate over this period. However, integration was improved significantly with the addition of the growth factor transforming growth factor-beta 3. Finally, to evaluate engineered scaffold integration in the context of aging, we monitored cellular infiltration from native tissue into engineered nanofibrous constructs. Our findings suggest that maturation processes that enable load bearing in the adult limit endogenous healing potential and identify new metrics for the development of tissue-engineered meniscus implants.
Magnetic resonance imaging (MRI)-based texture analysis has been shown to be effective in classifying multiple sclerosis lesions. Regarding the clinical use of texture analysis in multiple sclerosis, ...our intention was to show which parts of the analysis are sensitive to slight changes in textural data acquisition and which steps tolerate interference.
The MRI datasets of 38 multiple sclerosis patients were used in this study. Three imaging sequences were compared in quantitative analyses, including a comparison of anatomical levels of interest, variance between sequential slices and two methods of region of interest drawing. We focused on the classification of white matter and multiple sclerosis lesions in determining the discriminatory power of textural parameters. Analyses were run with MaZda software for texture analysis, and statistical tests were performed for raw parameters.
MRI texture analysis based on statistical, autoregressive-model and wavelet-derived texture parameters provided an excellent distinction between the image regions corresponding to multiple sclerosis plaques and white matter or normal-appearing white matter with high accuracy (nonlinear discriminant analysis 96%-100%). There were no significant differences in the classification results between imaging sequences or between anatomical levels. Standardized regions of interest were tolerant of changes within an anatomical level when intra-tissue variance was tested.
The MRI texture analysis protocol with fixed imaging sequence and anatomical levels of interest shows promise as a robust quantitative clinical means for evaluating multiple sclerosis lesions.
Cervical cancer is treated mainly by surgery and radiotherapy. Toxicity due to radiation is a limiting factor for treatment success. Determination of lymphocyte radiosensitivity by radio-induced ...apoptosis arises as a possible method for predictive test development. The aim of this study was to analyze radio-induced apoptosis of peripheral blood lymphocytes.
Ninety four consecutive patients suffering from cervical carcinoma, diagnosed and treated in our institution, and four healthy controls were included in the study. Toxicity was evaluated using the Lent-Soma scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24, 48 and 72 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide to determine early and late apoptosis. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody.
Radiation-induced apoptosis (RIA) increased with radiation dose and time of incubation. Data strongly fitted to a semi logarithmic model as follows: RIA = betaln(Gy) + alpha. This mathematical model was defined by two constants: alpha, is the origin of the curve in the Y axis and determines the percentage of spontaneous cell death and beta, is the slope of the curve and determines the percentage of cell death induced at a determined radiation dose (beta = DeltaRIA/Deltaln(Gy)). Higher beta values (increased rate of RIA at given radiation doses) were observed in patients with low sexual toxicity (Exp(B) = 0.83, C.I. 95% (0.73-0.95), p = 0.007; Exp(B) = 0.88, C.I. 95% (0.82-0.94), p = 0.001; Exp(B) = 0.93, C.I. 95% (0.88-0.99), p = 0.026 for 24, 48 and 72 hours respectively). This relation was also found with rectal (Exp(B) = 0.89, C.I. 95% (0.81-0.98), p = 0.026; Exp(B) = 0.95, C.I. 95% (0.91-0.98), p = 0.013 for 48 and 72 hours respectively) and urinary (Exp(B) = 0.83, C.I. 95% (0.71-0.97), p = 0.021 for 24 hours) toxicity.
Radiation induced apoptosis at different time points and radiation doses fitted to a semi logarithmic model defined by a mathematical equation that gives an individual value of radiosensitivity and could predict late toxicity due to radiotherapy. Other prospective studies with higher number of patients are needed to validate these results.
We examine the factors controlling accuracy and precision of monazite microprobe ages, using a JEOL 733 Superprobe equipped with 4 PET crystals, and both 1-atm gas flow Ar X-ray detectors and sealed ...Xe X-ray detectors. Multiple PET crystals allow for simultaneous determination of Pb concentration on up to 3 detectors, and the effects of different detector gases on spectral form can be addressed. Numerous factors in the X-ray production, detection, and counting sequence affect spectral form, including: choice of accelerating voltage, changes in d-spacing of the diffraction crystal, use of X-ray collimation slits, and type of detector gas. The energy difference between ArKα X-rays and XeLα X-rays results in, for 1-atm Ar detectors, escape peaks of second-order LREE L line X-rays that cannot be filtered using differential mode PHA. The second-order LREE energies are passed to the counter and produce, for a 140 mm Rowland circle, several problematic interferences in the Pb region of a monazite wavelength-dispersive (WD) spectrum. WD monazite spectra produced with Xe detectors are free from second-order LREE interferences in the Pb region; escape peaks of the second-order LREE are filterable with differential mode PHA if Xe detectors are employed. Silicon, Ca, Y, Ce, P, Th, U, and Pb (2 spectrometers) are measured as part of the monazite microprobe dating protocol; ±2σ variations in elements fixed for ZAF corrections do not affect the age outside of analytical uncertainty. ThMα, UMβ, and PbMα are the analyzed lines of the age components. Corrections for interference of ThMζ1,2 and YLγ2,3 on PbMα are significant, but can be done precisely, and reduce the precision of the Mα analysis by a trivially small amount. ThMγ, M3-N4, and M5-P3 interferences on UMβ can be corrected, as well, but ThM5 and M4 absorption edges in high-Th samples make estimation of UMβ background problematic. Background fits for UMβ peaks show that linear vs. exponential fits for UMβ do not, in general, produce statistically significant differences in microprobe ages. However, linear vs. exponential background fits for PbMα peaks do produce significantly different ages, most likely because of (1) low Pb concentrations relative to U; (2) ThMζ1 interference on backgrounds between ThMζ1 and PbMβ; and (3) SKα and Kβ interference in S-bearing monazite. For 6-min analyses (3 min peak, 3 min background) at 25 keV and 200 nA, 1σ Pb precisions are approximately 3-4% at 1700 ppm and 9.5% at 750 ppm; at 15 keV, precision decreases by roughly 25% of the 25 keV value. These precisions are constant for fixed current, analysis time, and concentration, but the statistical precision of distinct populations of monazite grains (domains) is a function of the total number of analyses within the domain. Instrumental errors (current measurement, dead time, pulse shift, d-spacing change) add 1-10% to random errors, but errors caused by pulse shift and d-spacing changes can be accounted for and corrected. Decreasing accelerating voltage from 25 to 15 keV decreases ZAF correction factors by as much as 50% relative, but replicate age analyses of Trebilcock monazite at 15 and 25 keV are statistically indistinguishable. Grain orientation, miscalculated background intensity, uncorrected interferences, and surface effects also introduce systematic errors. Accurate background interpolation and interference correction reduces systematic error to approximately 5-20% in addition to random (counting) error. Microprobe ages (approximately 420 Ma) and 208Pb/232Th SIMS ages (approximately 430 Ma) of monazite from Vermont are in agreement to within approximately 10 m.y. The discrepancy between U-Th-total Pb microprobe ages and 208Pb/232Th ages is removed when the high background measurement for PbMα is shifted to the short-wavelength side of PbMβ, removing a possible ThMζ1 interference.
In recent years, increasing automotive safety and energy efficiency has become a major concern in the automotive industry. Advanced high-strength steel (AHSS) was chosen for its weight reduction and ...high mechanical strength for the body in white (BIW). Specifically, it has been used in 22MnB5 steel press hardening type steel (PHS) with patchweld technology, which enables the production of reinforced and structural parts in a single stroke during the hot forming process. This study aimed to evaluate the resistance spot welding parameters for patchweld before hot stamping, considering the minimum and maximum residual stress, while ensuring a welding nugget diameter within the approved range. Microhardness and X-ray diffraction were used to analyze the welding zones for phase identification and residual stress measurements. After five weeks of elapsed time, the spot weld showed cracks that were not seen immediately after welding and were probably due to a high residual stress state.
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