Abstract
Inadequate surgical margins occur frequently in oral squamous cell carcinoma surgery. Fluorescence molecular imaging (FMI) has been explored for intraoperative margin assessment, but data ...are limited to phase-I studies. In this single-arm phase-II study (NCT03134846), our primary endpoints were to determine the sensitivity, specificity and positive predictive value of cetuximab-800CW for tumor-positive margins detection. Secondary endpoints were safety, close margin detection rate and intrinsic cetuximab-800CW fluorescence. In 65 patients with 66 tumors, cetuximab-800CW was well-tolerated. Fluorescent spots identified in the surgical margin with signal-to-background ratios (SBR) of ≥2 identify tumor-positive margins with 100% sensitivity, 85.9% specificity, 58.3% positive predictive value, and 100% negative predictive value. An SBR of ≥1.5 identifies close margins with 70.3% sensitivity, 76.1% specificity, 60.5% positive predictive value, and 83.1% negative predictive value. Performing frozen section analysis aimed at the fluorescent spots with an SBR of ≥1.5 enables safe, intraoperative adjustment of surgical margins.
Objectives
We assessed the radiation dosages (Dmean) on implant regions to identify the threshold for implant loss in patients with an intraoral malignancy treated with dental implants to support a ...mandibular denture during ablative surgery before volumetric‐modulated arc therapy (VMAT).
Materials and Methods
Data was collected prospectively from 28 patients treated surgically for an intraoral malignancy, followed by postoperative radiotherapy (VMAT) and analyzed retrospectively. Patients received 2 implants in the native mandible during ablative surgery. Implant‐specific Dmean values were retrieved from the patients' files. Radiographic bone loss was measured 1 year after implant placement and during the last follow‐up appointment. Implant survival was analyzed with the Kaplan–Meier method. Univariate logistic regression and Cox‐regression analyses were performed to investigate the effect of increasing implant‐specific radiation dosages on implant loss.
Results
Five out of 56 placed implants were lost during follow‐up (median 36.0 months, IQR 39.0). Radiographically, peri‐implant bone loss occurred in implants with a Dmean > 40 Gy. Implant loss occurred only in implants with a Dmean > 50 Gy.
Conclusion
An implant‐specific Dmean higher than 50 Gy is related to more peri‐implant bone loss and, eventually, implant loss.
Cribriform adenocarcinoma of salivary gland (CASG) is a rare, salivary gland tumor. In this report, we describe a case of CASG harboring a novel PPP2R2A::PRKD1 fusion. A 58‐year‐old female presented ...with an intraoral mass adjacent to the lower left third molar region. Morphological features at histological examination, immunohistochemical staining (p63+, p40−), and tumor location were indicative of CASG. However, due to the potential focal presence of a biphasic component within the tumor, RNA sequencing was performed to confirm the diagnosis. The subsequently found novel PPP2R2A::PRKD1 fusion adds to the rapidly evolving molecular landscape of salivary gland tumors. Additionally, we report that CASG may show some entrapment of pre‐existent salivary gland ducts, which may be misinterpreted as tumor cells with myoepithelial differentiation.
In Europe, the Energy Performance of Buildings Directive (EPBD) provides for compulsory energy performance certification (labelling) for all existing dwellings. In the Netherlands, a labelling scheme ...was introduced in 2008. Certificates contain the energy label of the dwelling and corresponding theoretical gas and electricity consumption, calculated based on the dwellings physical characteristics, its heating, ventilation and cooling systems and standard use characteristics. This paper reports on a large-scale study of around 200,000 dwellings comparing labels and theoretical energy use with data on actual energy use. The study shows that dwellings with a low energy label actually consume much less energy than predicted by the label, but on the other hand, energy-efficient dwellings consume more than predicted. In practice, policy targets are set according to the theoretical rather than the actual consumptions of the building stock. In line with identified discrepancies, the study shows that whereas most energy reduction targets can be met according to the theoretical energy consumption of the dwelling stock, the future actual energy reduction potential is much lower and fails to meet most of the current energy reduction targets.
► Actual gas consumption in Dutch dwellings is lower than the theoretical. ► In the dwellings with label A–B, theoretical gas consumption is lower than actual gas consumption. ► In less efficient dwellings, theoretical gas consumption is much higher than the actual. ► Most current energy reduction targets are unachievable if modelled with actual instead of theoretical energy consumption.
Introduction
When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of ...such reconstructions is mostly caused by plate fracture and screw pull‐out. This study aims to develop a reliable, mechanically superior, yet slender patient‐specific reconstruction plate that reduces failure due to these causes.
Patients and Methods
Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D‐VSP) with a novel patient‐specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy.
Results
All PS plates were placed accurately according to the 3D‐VSP. Mean 3D screw entry point deviation was 1.54 mm (SD: 0.85, R: 0.10–3.19), and mean screw angular deviation was 5.76° (SD: 3.27, R: 1.26–16.62). FEA indicated decreased stress and screw pull‐out inducing forces. No mechanical failures appeared (mean follow‐up: 16 months, R: 7–29).
Conclusion
Reconstructing mandibular continuity defects with bookshelf‐reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull‐out and plate fractures.
► Study of German and Austrian post-occupancy evaluation research on passive houses. ► Survey of end-user experiences in Dutch nearly zero-energy houses. ► Study relates comfort, control and ...information parameters to end-user appraisal. ► Satisfaction depends highly on summer comfort, heating and ventilation systems. ► Focus should be on quality assurance and information.
High end-user satisfaction levels are key for the acceptance of nearly zero-energy housing. Post-occupancy evaluation research on highly energy-efficient dwellings can lead to recommendations which will influence their performance in the expected future large volume market of such houses. This study analysed mainly German, Austrian and Swiss post-occupancy evaluation research results on nearly zero-energy dwellings and undertook a survey of occupants of nearly zero-energy houses in the Netherlands. The study determined how various comfort parameters (such as winter thermal comfort, summer thermal comfort, indoor air quality and acoustics), information provision and control parameters are related to positive or negative end-user appraisal, finding that summer comfort design and the quality of – and information about – heating and ventilation systems are critical factors which must be addressed to improve user satisfaction in nearly zero-energy dwellings.
•Modelling energy savings of renovations in the Dutch non-profit housing stock.•Assessment of 1.6 million dwellings, 21 building features and 3 empirical models.•Empirical models outperform the ...theoretical building energy model.•Shortcomings exist when predicting effects of specific energy-saving interventions.
In Europe, the energy performance of dwellings is measured using theoretical building energy models based on the Energy Performance of Buildings Directive (EPBD), which estimates the energy consumption of dwellings. However, literature shows large performance gaps between the theoretically predicted energy consumption and the actual energy consumption of dwellings. The goal of this paper is to investigate the extent to which empirical models provide more accurate estimations of actual energy consumption when compared to a theoretical building energy model, in order to estimate average actual energy savings of renovations. We used the Dutch non-profit housing stock to demonstrate the results. We examined three empirical models to predict the actual energy consumption of dwellings: a linear regression model, a non-linear regression model, and a machine learning model (GBM). This paper shows that these three models alleviate the performance gap by giving a good prediction of actual energy consumption on sectoral cross-sections. However, these models still have shortcomings when predicting the effects of specific renovation interventions, for example newly introduced heat pumps. The non-linear and machine learning model (GBM) outperform the theoretical model in terms of estimating energy savings through renovation interventions.
Achieving energy efficiency in the built environment requires extensive efforts in the renovation and adaptation of housing stock. A promising design solution is the heat pump. While gas boiler ...systems are commonly used in Dutch non-profit housing stock, the share of dwellings with a heat pump grew from 1.6% in 2017 to 3.2% in 2021. However, building characteristics and the energy consumption of dwellings with a heat pump are unclear. Therefore, a dataset of 69,422 dwellings with different types of heat pumps has been examined and compared to dwellings with a traditional HR107 condensing gas boiler. This research reports average characteristics and the average actual energy consumption of dwellings with all-electric, hybrid and gas absorption heat pump systems. Dwellings with a heat pump system are on average of higher building quality, their gas consumption is lower and their electricity consumption is higher than dwellings with an HR107 condensing gas boiler. Detailed insight is provided for dwellings with different heat pump systems and for dwellings with different building characteristics. Further research to determine the energy performance of dwellings with specific heat pump configurations is recommended in light of the energy transition in the built environment.
Abstract
In the Netherlands, district heating with a lower temperature supply (<70°C) will play a crucial part in accomplishing the energy transition goals of delivering natural gas-free sustainable ...heating to dwellings. The existing dwellings often require energy renovations to make them suitable for lower temperature heating. However, choosing renovation strategies that promote the transition to lower temperature district heating while improving energy efficiency and thermal comfort is challenging. This study aims to identify minimum renovation requirements for comfortably heating homes using lower temperature heat from district heating. Identifying minimum renovation strategies to prepare existing dwellings for lower temperature district heating would be vital in addressing the European Renovation Wave’s target of improving worst-performing buildings. For the same, the study uses a typical intermediate terraced house built before 1945 as a case study to investigate renovation strategies based on four levels of renovation intervention (no renovation, basic, moderate and deep). The impact of renovations on space heating demand and thermal comfort was tested with medium (70/50°C) and low supply (55/35°C) temperatures against key performance indicators (KPIs) using dynamic simulation. The study found that for the case study dwelling, moderate renovation strategy of upgrading the building envelope insulation by 0.40 W/m
2
K for opaque parts and 1.5 W/m
2
K for glazing, improving the airtightness by 0.3h
-1
and replacing existing radiators with LT radiators can be considered as a no-regret solution for comfortably heating homes with both medium and lower temperature supply from district heating.
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