Final Specimen Research Articles

MP15-20 NEO-ADJUVANT 177Lu-PSMA-I&T RADIONUCLIDE IN HIGH-RISK PROSTATE CANCER BEFORE RADICAL PROSTATECTOMY: A FEASIBILITY TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-20 NEO-ADJUVANT 177Lu-PSMA-I&T RADIONUCLIDE IN HIGH-RISK PROSTATE CANCER BEFORE RADICAL PROSTATECTOMY: A FEASIBILITY TRIAL Michael Frumer, Eli Rosenbaum, Daniel Kedar, Yarden Zohar, Jack Baniel, Adam Steinmetz, Hanna Bernstine, David Groshar, and Shay Golan Michael FrumerMichael Frumer More articles by this author , Eli RosenbaumEli Rosenbaum More articles by this author , Daniel KedarDaniel Kedar More articles by this author , Yarden ZoharYarden Zohar More articles by this author , Jack BanielJack Baniel More articles by this author , Adam SteinmetzAdam Steinmetz More articles by this author , Hanna BernstineHanna Bernstine More articles by this author , David GrosharDavid Groshar More articles by this author , and Shay GolanShay Golan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We report preliminary results of an open-label, single-arm clinical trial evaluating the safety and immediate oncological outcomes of 177Lu-PSMA-I&T (LuPSMA), followed by radical prostatectomy (RP) with pelvic lymph node dissection (PLND) in patients with high-risk prostate cancer (HRPCa). METHODS: Consecutive HRPCa patients with high PSMA avidity on 68Ga- PSMA PET/CT received two 7.4 GBq LuPSMA treatments 6 and 8 weeks before RP with PLND. LuPSMA side effects and surgical parameters were documented. Final surgical pathology and postoperative biochemical response were recorded. All patients completed validated health-related quality of life questionnaires at baseline and during postoperative follow-up. RESULTS: Seven patients with HRPCa were treated with two LuPSMA treatments, and as of this writing, six of them were operated on. The median age was 66 years (IQR 60, 68) and the median baseline PSA was 11.4 ng/dL (IQR 7.6, 27). Four patients were Gleason grade group 4 and three were Gleason grade group 5. The only reported adverse event during LuPSMA treatment was fatigue in 1 patient (14%). In 2 out of 6 operated patients, periprostatic adhesions were encountered during surgery without any intraoperative complications. The median surgical length and median estimated blood loss was 240 minutes (IQR 200, 260) and 250 ml (IQR 200, 350), respectively. The only postoperative event was fever in 1 patient (14%). The median hospital stay was 3 days (IQR 2, 4). Treatment-related histological changes were noted in 4 of 6 final surgical specimens. Positive surgical margins were identified in 2 patients. Biochemical response was observed in all patients, with a median postoperative PSA of 0.01 ng/dL (IQR 0.01, 0.07). All 6 patients required ≤1 pad at 3 months after surgery. CONCLUSIONS: Preliminary data suggest that two LuPSMA treatments followed by RP can be safely applied to patients with locally advanced HRPCa. While longer oncological outcomes are pending, continence recovery seems to be unaffected by LuPSMA treatment. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e271-e271 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Frumer More articles by this author Eli Rosenbaum More articles by this author Daniel Kedar More articles by this author Yarden Zohar More articles by this author Jack Baniel More articles by this author Adam Steinmetz More articles by this author Hanna Bernstine More articles by this author David Groshar More articles by this author Shay Golan More articles by this author Expand All Advertisement Loading ...

A texture study of nanostructured Al–Cu multi-layered composite manufactured via the accumulative roll bonding (ARB)

In this study, texture development during the accumulative roll bonding (ARB) of Al–Cu multilayered composite was investigated using X-ray diffraction. Microstructural investigations were also conducted using optical and transmission electron microscopy. The results of textural investigation of the rolled specimens indicated that a strong β-fiber was developed and dominated mainly by the Brass and Copper components in both the Al and Cu layers during the early stages of the ARB process. Moreover, the intensity of the most textural components in both of the metallic layers decreased in the last two ARB cycles. No component other than a weak Rotated Cube was found in the Al layer after the last ARB cycle. In the Cu layer, on the other hand, a Cube component, known as the "recrystallization texture ", was developed which was accompanied by a "rolling texture" represented by the β fiber. Furthermore, the increased misorientation between the grains at high ARB cycles confirmed the formation of high angle grain boundaries in both of the metallic layers. Microstructural investigations showed that the average grain size of the final specimens (after 7 ARB cycles) was less than 500 nm in both Al and Cu layers.

Radiomics of MRI for the Prediction of the Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: A Single Referral Centre Analysis.

Simple SummaryNowadays, the only widely recognized method for evaluating the efficacy of neoadjuvant chemotherapy is the assessment of the pathological response through surgery. However, delivering chemotherapy to not-responders could expose them to unnecessary drug toxicity with delayed access to other potentially effective therapies. Radiomics could be useful in the early detection of resistance to chemotherapy, which is crucial for switching treatment strategy. We determined whether tumor radiomic features extracted from a highly homogeneous database of breast MRI can improve the prediction of response to chemotherapy in patients with breast cancer, in addiction to biological characteristics, potentially avoiding unnecessary treatment.Objectives: We aimed to determine whether radiomic features extracted from a highly homogeneous database of breast MRI could non-invasively predict pathological complete responses (pCR) to neoadjuvant chemotherapy (NACT) in patients with breast cancer. Methods: One hundred patients with breast cancer receiving NACT in a single center (01/2017–06/2019) and undergoing breast MRI were retrospectively evaluated. For each patient, radiomic features were extracted within the biopsy-proven tumor on T1-weighted (T1-w) contrast-enhanced MRI performed before NACT. The pCR to NACT was determined based on the final surgical specimen. The association of clinical/biological and radiomic features with response to NACT was evaluated by univariate and multivariable analysis by using random forest and logistic regression. The performances of all models were assessed using the areas under the receiver operating characteristic curves (AUC) with 95% confidence intervals (CI). Results: Eighty-three patients (mean (SD) age, 47.26 (8.6) years) were included. Patients with HER2+, basal-like molecular subtypes and Ki67 ≥ 20% presented a pCR to NACT more frequently; the clinical/biological model’s AUC (95% CI) was 0.81 (0.71–0.90). Using 136 representative radiomics features selected through cluster analysis from the 1037 extracted features, a radiomic score was calculated to predict the response to NACT, with AUC (95% CI): 0.64 (0.51–0.75). After combining the clinical/biological and radiomics models, the AUC (95% CI) was 0.83 (0.73–0.92). Conclusions: MRI-based radiomic features slightly improved the pre-treatment prediction of pCR to NACT, in addiction to biological characteristics. If confirmed on larger cohorts, it could be helpful to identify such patients, to avoid unnecessary treatment.

Unplanned excision of soft tissue sarcoma: does it impact the accuracy of intra-operative pathologic assessment at time of re-excision?

An "unplanned excision" refers to soft tissue sarcomas excised without planning imaging studies and a diagnostic biopsy, resulting in the presence of residual disease and usually necessitating a re-excision procedure.We aimed to assess the impact of previous unplanned excisions on the intra-operative pathologic assessment at the time of re-excision, in terms of need to perform repeat assessments and the accuracy to predict margin status of the final pathologic specimen. Data was collected for all patients with extremity soft tissue sarcoma who had undergone wide local excision limb salvage surgery or amputation between 2012 and 2017. Intra-operative pathologic assessment with frozen sections was performed in all cases and was classified as negative, negative but close (< 1mm), and positive. A total of 173 patients with extremity soft tissue sarcoma were included, 54 in the unplanned excision group and 119 in the planned excision group. The accuracy of intra-operative pathologic assessment to predict the margin status on final pathology was similar between groups (87% unplanned vs. 90.7% planned excisions). However, the need for repeat intra-operative pathologic assessment and subsequent resection due to microscopically positive margins was found to be higher within the unplanned excision group ((p = 0.04), OR = 3.2 (95% CI: 1.1-9.1, p = 0.048)). Intra-operative pathologic assessment of resection margins had a similar accuracy in planned and unplanned excisions; however, unplanned excisions showed a higher risk of re-resection during the same surgical setting.

Leiomyosarcoma in pregnancy: Incidental finding during routine caesarean section

Uterine leiomyosarcoma (LMS) is uncommon tumour arising from the female reproductive tract. Incidence of LMS in pregnancy is extremely rare, with only 10 cases reported thus far in medical literature. We present a case of myomectomy performed during elective caesarean section for breech presentation, due to its easy accessibility and well contracted uterus. Subsequent histology revealed LMS on final specimen. Patient subsequently underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. No chemotherapy was given as she opted for close clinical- radiological monitoring instead. This case report highlights the importance of discussion with patients regarding the risk of occult malignancy in a fibroid uterus. Appropriate management of uterine leiomyosarcoma in pregnancy remains unclear. Consideration of removing an enlarging leiomyoma during caesarean section might be ideal in view of its malignant potential, just like in this case; however, location of the tumour and risk of bleeding needs to be weighed. Ultimately, management of such cases needs proper discussion between obstetrician and the patient.

Rice bran-based bioplastics: Effects of the mixing temperature on starch plastification and final properties

The agro-food industry produces huge amounts of wastes and by-products with high levels of carbohydrates and proteins, basic food groups that, properly treated, can be employed for the development of bioplastics. These high added-value products represent an alternative to traditional polymers. In this research work, rice bran was mixed with glycerol and water obtaining homogeneous blends which then are processed into bioplastics via injection moulding. The mixing temperature aids starch plastification and thus, affects the properties of the final specimens. In this way, the mechanical characterization revealed improvements for the highest temperature (110 °C) used which, at the same time, exhibited poor physical integrity during water immersion. Although the mechanical properties of the dried system obtained at 80 °C are slightly inferior to those obtained for the non-dried 110 °C system, these specimens are considered more adequate since they exhibited higher physical integrity and, consequently, better operating conditions.

The Association Between Clearance of Human Papillomavirus After Conization for Cervical Cancer and Absence of Cancer.

We assessed the relation between clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) and absence of residual disease, in women diagnosed with cervical cancer (CC) and adenocarcinoma in situ (AIS). Data were collected from 92 women diagnosed with CC and AIS who were positive to HR-HPV and had a repeat cervical HPV test 3-12 weeks after LLETZ (in which CC/AIS were diagnosed) and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV after LLETZ. The HR-HPV results after the LLETZ operation were negative in 40 women and positive in 52 women. The HR-HPV-negative group included a significantly higher incidence of AIS: 14 (35%) vs 5 (9.6%, p < .006).In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among 34 women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p < .0005). The positive predictive value for absence of residual cancer, with clearance of HR-HPV after LLETZ, was 95%. Clearance of HR-HPV from the cervix a short time after LLETZ has a high association with the absence of residual cancer in the final outcome, either in the pathology or the follow-up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

Clinical and pathological factors affecting the accuracy of estimating myometrial invasion on magnetic resonance imaging in early-stage endometrial cancer

<h3>Objectives:</h3> To determine the accuracy of MRI at estimating myometrial invasion (MI) and the clinical and pathological factors that may affect this accuracy in patients with early stage endometrial cancer undergoing hysterectomy. <h3>Methods:</h3> This IRB approved, retrospective study included all patients who had an MRI within 90 days preceding hysterectomy for endometrial cancer from January 2013 through December 2019 across 3 Mount Sinai-affiliated hospitals. Charts were reviewed for clinical characteristics including BMI, menopausal status, abnormal uterine bleeding, and prior pelvic surgery. MRIs were re-reviewed by 3 radiologists blinded to original interpretations. The radiologists recorded degree of myometrial invasion (MI; <50%, or ≥50%) and presence of benign pathology findings such as fibroids, endometriosis and adenomyosis. The degree of MI from MRI was collapsed to one value representing a combination of the 3 radiologist readers. This reading was compared to the degree of MI from the final pathology specimen to calculate accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI evaluation. The association between patient characteristics and MRI accuracy was assessed by using the Chi-square or Fisher's exact test for categorical characteristics and the Mann-Whitney test for continuous characteristics. <h3>Results:</h3> A total of 53 patients were included; charts and MRIs were reviewed. Median patient age was 61 (range 29-86); median BMI, 29.9 (range 17.6-65.1) kg/m². On final pathology specimen, 29 patients had FIGO stage 1A (53.7%) and 10 patients with FIGO stage 1B (18.5%). The median depth of MI on pathology was 0.5cm (range 0-10cm). Degree of MI was dichotomized into ≥50% vs <50% with MI on final pathology as the gold standard. The accuracy of MRI in evaluating MI across the 3 radiologists ranged from 70-80%; sensitivity of 65-80%; specificity of 65-82%; PPV 57-70%; and NPV of 79-87%. Twenty-nine patients on final pathology were classified as stage 1A and 10 patients were classified as stage 1B. For stage 1A on final pathology, MI was accurately estimated on MRI for 23/28 (82.1%) and overestimated for 5/28 (17.9%). For stage 1B on final pathology, MI was accurately estimated on MRI for 7/10 patients (70.0%) and underestimated for 3/10 (30.0%). Patient characteristics such as BMI, prior pelvic surgery, menopausal status, and presence of abnormal bleeding did not have a statistically significant effect on the accuracy or MI estimation on MRI (p≥0.13). Benign MRI findings including fibroids, adenomyosis, and endometriosis were not found to affect accuracy of MI invasion. <h3>Conclusions:</h3> Pelvic MRI is the best radiologic modality available that is currently utilized in assessment of the depth of myometrial invasion in patients with endometrial cancer. Accurate prediction of presence or absence of invasion has significant implication on clinical management particularly in patients with early stage endometrial cancer desiring fertility preservation. In our study, presence of myometrial invasion was underestimated in 30% of patients. Patients have to be appropriately counseled with regards to MRI accuracy in predicting invasion. Neither patients' clinical characteristics nor presence of other pathological findings on MRI were found to impact the accuracy of MRI estimation of MI.

Predictive model for systemic recurrence following cisplatin-based neoadjuvant chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma

IntroductionNeoadjuvant chemotherapy (NAC) is increasingly used prior to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Systemic recurrence (SR) carries a dismal prognosis. We sought to determine risk factors associated with SR in this setting. MethodsWe evaluated a multi-center database of patients with UTUC who received cisplatin-based NAC before RNU. Final pathology at RNU was dichotomized into ypT<2 vs ypT≥2. Univariable and multivariable analyses were performed to identify risk factors associated with SR. Three groups were defined based on the number of significant risk factors (groups 1, 2, 3 for 0-1, 2, 3 risk factors, respectively) and evaluated for recurrence-free survival (RFS) using the Kaplan-Meier method. Results106 patients were identified between 2004 and 2018. Median age was 67.0 years [IQR = 61-73.3]; 57 (54%) and 49 (46 %) patients received MVAC and GC, respectively. Final pathological stage was ypT<2 in 57 (54%); 23% (24/106) had SR. On univariable analysis, pathological variables on final specimen including ypT≥2, lymphovascular invasion (ypLVI), and nodal involvement were associated with SR. On multivariable analysis, ypLVI OR = 4.1 (95% CI 1.2-13.6; P = 0.024) and pathological nodal involvement OR = 4.5 (95% CI 1.3-15.7; P = 0.017) were predictive of recurrence. Stratifying by the number of risk factors, the 2-year RFS was 95%, 55%, and 18% for groups 1, 2, and 3 respectively (log-rank <0.001). ConclusionThis model evaluates the risk of SR following NAC and RNU to guide counseling and decision-making after surgery. Adverse pathological variable including ypLVI and nodal involvement, in combination with ypT-stage, are strongly associated with SR.

Manufacturing PLA/PCL Blends by Ultrasonic Molding Technology.

Ultrasonic molding (USM) is a good candidate for studying the plasticization of polymer mixtures or other composite materials due to either the little amount of material needed for processing, low waste or the needed low pressure and residence time of the mold. Thus, the novelty of this research is the capability of USM technology to process PLA/PCL blends and their corresponding neat materials, encompassing all the production stages, from raw material to the final specimen. The major findings of the work revealed that the thermal properties of the blends were not affected by the USM process, although the crystallinity degree experienced variations, decreasing for PLA and increasing for PCL, which was attributed to the crystallization rate of each polymer, the high process speed, the short cooling time and the small particle size. The employed ultrasonic energy increased the molecular weight with low variations through the specimen. However, the degradation results aligned with the expected trend of these material blends. Moreover, this study also showed the effect pellet shape and dimensions have over the process parameters, as well as the effect of the blend composition. It can be concluded that USM is a technology suitable to successfully process PLA/PCL blends with the correct determination of process parameter windows.

An effective stress constitutive framework for the prediction of desiccation crack in lime-treated soil: Experimental characterization and constitutive prediction

The present work investigates the desiccation effects on a lime-treated silty clay. Original experimental techniques have been developed to control suction conditions (with osmotic technique), to track volume variations and cracks occurrence upon drying. Free and constrained desiccations are performed to evaluate the shrinkage potential (for free drying) and the conditions of desiccation crack triggering (upon constrained drying). Also, indirect tensile tests and uniaxial compression tests are carried out to evaluate the strength and stiffness at various suctions. Those investigations have been performed on natural and lime-treated compacted silty clay in order to emphasize the benefits of the lime treatment in the triggering and/or mitigation of the cracking process. To simulate the field conditions of compaction and obtain specimens having geomechanical properties as close as possible of the real material on site, the particular kneading compaction process in a CBR mould was used, and the final specimens were cut at required sizes with a milling machine numerically controlled by computer (CNC). At the end, generalized effective stress framework with an effective stress parameter χ calibrated according to a power law is used to provide a constitutive interpretation of the occurrence of desiccation cracks in relation with the water retention properties, the soil stiffness, the tensile strength and the geometrical constraints of the soil specimens. It is observed that the cracks initiate under positive (compressive) effective stress. For the used compacted materials, it is demonstrated that the lime treatment postpones the occurrence of desiccation cracks, that are triggered at higher suctions. So, lime treatment plays a favourable role in the reduction of shrinkage and crack occurrence of soft soils subject to drying.

Effect of CNT content on microstructure and hardness of AlSi/MWCNT nano composite

The utilization of aluminum alloy grows rapidly in automobile and aerospace industries due to its low weight to high strength. Going a step further, with the process of reinforcing MWCNT (multi walled carbon nanotubes) gives better properties with an observable decrease in its overall weight. In the present investigation, increasing of CNT wt% with ball milling time on hardness and micro structure of metal matrix composite is studied. Multi wall carbon nanotubes are mixed uniformly with Aluminum silicon alloy powder in the weight percentage of 0, 0.25, 0.50 & 0.75 using high energy ball milling process. Followed by compaction to prepare a specimen size of 20 mm diameter and 20 mm length. Sintering and extrusion process combined to utilize the heat of sintering and thus gives the final specimen with size of 8 mm diameter and 60 mm length. Finally, the Micro structural analysis (XRD, SEM WITH EDAX and OM) are performed for each composition which was followed by Vickers hardness test.

The effect of cyclic twist angle on mechanical properties for AISI 1038 medium carbon steel

A group of 11 specimens AISI 1038 Medium carbon steel alloy fabricated according to ASTM standard D790-02 torsion test were twisted cyclically one in positive another to negative angle in range of angles (0o-50o), step 5 degrees for each specimen. The data from torsion test device help to get actual torques and shear stresses, later the specimens tested the tensile test to figure out the effects of cyclic angle of twist on mechanical properties for AISI 1038 Medium carbon steel. The results showed a good agreement between the theoretical and actual data (torque, shear stress) for specimens with positive angle of twist by the percentage: 98%, 91%, 96%, 93%, 91%, 89%, 88%, 85%, 82%, 81%, 80%. In other side the results for experimental tests showed a dangerous decrements in mechanical properties for cyclic or negative twist angles, the yield stress for reference specimen without twist angle is 490 Mpa, yield stress increased for angels (5o,10o,15o) by 1%, 3%, 6%, then decreased for angels (20o,25o,30o,35o,40o,45o) by 3%, 5%, 13%, 18%, 24% and 35% Respectively and the final specimen with 50o angle of twist had been broken torsional before tensile test as a result specimens groups consequent of the extrusion – intrusion defects concomitant from twisting load.

Surface Micromorphology and Structure of Stainless and Maraging Steel Obtained via Selective Laser Melting: A Mössbauer Spectroscopy Study

Selective laser melting (SLM) as an additive manufacturing method makes it possible to quickly produce complexly shaped three-dimensional (3D) metal specimens from a powder. This work describes how SLM affects the surface phase composition of a 3D printed specimen, as analyzed with conversion electron Mössbauer spectroscopy (CEMS), conversion X-ray Mössbauer spectroscopy (CXMS) and X-ray diffraction (XRD). Both stainless 1.4404 (CL20ES) steel and maraging 1.2709 (CL50WS) steel have been investigated. A transformation of the phase composition from the ferritic phase into an austenitic one was proven by comparing the initial CL50WS powder and the final specimen using CXMS. This transformation takes place during the SLM process. No transformation was identified in stainless steel. The differences identified via CEMS between the surface phase composition of the final non-annealed specimens and the surface of the final annealed specimens demonstrated the oxidation of the surface layer. The oxidation occurs during the annealing of the sample in surface layers less than 1 μm thick. The quality of the surface was examined using scanning electron microscopy (SEM), which presented imperfections on the face of the final specimen. Granules of the initial powder bonded to the surface of the specimen and both irregular and spherical pores were observed.

Effects of shade and thickness on the translucency parameter of anatomic-contour zirconia, transmitted light intensity, and degree of conversion of the resin cement

Statement of problemAnatomic-contour zirconia prostheses are usually cemented with resin cement. However, information regarding the effects of the zirconia shade and thicknesses on the translucency of the prosthesis, the intensity of the transmitted light beneath the prosthesis, and the subsequent degree of conversion in the resin cement is sparse. PurposeThe purpose of this in vitro study was to investigate the translucency parameter in 3 anatomic-contour zirconia specimens of 2 shades at 5 different thicknesses and to investigate the transmitted light intensity and degree of conversion of the resin cement beneath the ceramic specimens by using a traditional zirconia and a lithium disilicate glass-ceramic as controls. Material and methodsCeramic specimens from 1 anatomic-contour zirconia in a generic shade (CAP FZ) and 2 anatomic-contour zirconias in A2 shade (Zirlux and Luxisse) were used. Lithium disilicate in HT A2 shade (IPS e.max CAD) and traditional zirconia in a generic shade (CAP QZ) were used as controls. A total of 125 ceramic specimens (n=25) were fabricated to a final specimen dimension of 12×12 mm and in thicknesses of 1.0, 1.25, 1.5, 1.75, and 2.0 mm according to the manufacturers’ recommendations. The CIELab color space for all specimens placed against a white and black background was measured with a spectrophotometer (CM-2600D), and the translucency parameters were calculated for the materials at various thicknesses. A light-polymerizing unit (DEMI LED) was used to polymerize the resin cement (Variolink II) placed beneath the ceramic specimens. Transmitted light intensity from the polymerization unit beneath the ceramic specimens was measured by using a spectrophotometer (MARC Resin Calibrator), and the transmittance of each specimen was calculated. The coefficient of absorption of each material was calculated from the regression analysis between the natural log of transmittance and specimen thickness. The degree of conversion of resin cement was measured by using a Fourier transformation infrared (FTIR) spectrophotometer. The results were analyzed by using 2-way ANOVA (α=.05). The relationship between the transmittance and the translucency parameter was evaluated by plotting the transmittance against the translucency parameter value of each specimen. ResultsThe translucency parameter decreased with increasing thickness in all 5 material groups. All anatomic-contour zirconia had lower translucency parameters than e.max CAD (P<.001). The same results were found for the intensity of the transmitted light (P<.001). Both A2 shade anatomic-contour zirconia (Zirlux and Luxisse) showed significantly lower light transmittance than a generic shade anatomic-contour zirconia (CAP FZ) (P<.001). The coefficients of absorption were found to range from 0.63 to 1.72 mm-1, and reflectance from 0.10 to 0.25. The results from the degree of conversion of resin cement after polymerization through 1 to 2 mm of specimens showed a significantly higher degree of conversion in the e.max group than in all other groups (P<.001). The correlation between translucency parameter and the intensity of the transmitted light suggested that the relationship was shade dependent. ConclusionsThe translucency parameter and the transmitted light intensity of ceramic material were influenced by the type of ceramic and the shade and thickness of the ceramic. The combined effects of layer thickness and the intensity of the transmitted light in the A2 shade anatomic-contour zirconia (Zirlux and Luxisse) resulted in a lower degree of conversion in resin cement than in a generic shade anatomic-contour zirconia (CAP FZ) at layer thicknesses of 1.75 and 2 mm.

CIN2 in childbearing-age women: may colposcopy help choosing the proper management?

CIN2 is considered a biologically equivocal lesion falling between low- and high-grade cervical dysplasia, but it is often managed with cervical conization as a high-grade lesion. However, since cervical conization can lead to an increased risk of adverse obstetric events, it might be interesting to identify, by colposcopy, a subgroup of women with a low risk of "occult" CIN3 who could be managed with a "wait and see" approach. All the women with CIN2 cervical biopsy from 1999 to 2019 were retrospectively identified. Their colposcopic patterns at the time of biopsy and the histopathological findings on the final cone specimen were compared. Among the 354 women with CIN2 biopsy included, the overall CIN3+ lesion rate on final cone specimen was 21.4%. The rate of CIN3 on final specimen was higher in women with G2 colposcopy compared to G1 (27.2% vs. 15.9%, P=0.01). Among women with G1 colposcopy, the rate of CIN3+ lesions was significantly higher in women with fine punctation (P=0.02) while no differences in women with thin acetowhite epithelium or fine mosaic emerged. In women with CIN2 biopsy, when a G2 pattern or G1 with fine punctation on colposcopy is detected, there is an increased risk of CIN3+ on final histology, therefore an excisional treatment should be preferred. Otherwise, in women with CIN2 biopsy and other G1 patterns on colposcopy, a "wait-and-see" approach could be considered.

Obesity, an independent predictor of pre and postoperative tumor grading disagreement in endometrial cancer

IntroductionObesity is a known independent risk factor for endometrial cancer (EC), and obese patients have a 4.7-fold increased risk compared to the general population to develop the neoplasm. To date, a general pre and postoperative tumor grading agreement from 53 % to 82 % is reported for endometrial analysis, and a consensus on which factors might influence the tumor grading discordance is still absent.Furthermore, although obesity alters the endometrial microenvironment, no studies investigated the role of obesity in the grading agreement of EC patients. This study aims to analyze the role of obesity in the pre and postoperative tumor grading agreement. Materials and methodsA retrospective analysis was conducted on EC cancer women subjected to surgical treatment. Upgrading discordance was defined as higher tumor grading on final pathological analysis compared to tumor grading on the preoperative examination. Downgrading discordance was defined as a lower tumor grading at the postoperative surgical specimen analysis compared to the preoperative biopsy. ResultsOf the 293 selected patients, 245 were included in the analysis. One hundred and forty nine (60.8 %) patients were tumor grade G1, 52 (21.2 %) G2, and 44 (18.0 %) G3. Grading agreement was 83.9 % for G1 patients, 51.9 % for G2 patients, and 83.3 % for G3 patients. The multivariate analysis showed obesity (BMI > 30 kg/m2) as significant factor influencing pre and postoperative grading agreement (p = 0.014, Odds Ratio 2.036, 95 % Confidence Interval 1.141–3.635). ConclusionsOur study for the first time showed obesity as the only factor in the multivariate analysis lowering the pre and postoperative tumor grading concordance. Grade 2 tumor was the factor that most frequently disagreed with the final surgical specimen analysis both in the general and in obese patients.

Can 68Ga-PSMA-11 PET/CT predict pathological upgrading of prostate cancer from MRI-targeted biopsy to radical prostatectomy?

Prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET) is an ideal tool for staging and restaging of prostate cancer (PCa). This study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting pathological upgrading from multiparametric magnetic resonance imaging-targeted biopsy (mpMRI-TB) to final radical prostatectomy (RP) specimens in patients with localized PCa. A total of 67 biopsy-confirmed localized PCa patients with mpMRI and 68Ga-PSMA-11 PET/CT prior to RP were included. Clinical and imaging characteristics derived from mpMRI and PET/CT were compared in patients with or without pathological upgrading. Predictors for pathological upgrading were evaluated by using univariate and multivariable analyses. A prediction model was developed based on the identified parameters and validated using internal validation. Pathological upgrading from mpMRI-TB to final RP specimens occurred in 38.8% (26/67) of the patients. Multivariable logistic regression analysis showed SUVmax (OR: 1.223, 95% CI 1.068-1.399, p= 0.003); highest tumor grade at mpMRI-TB, ISUP grade group (ISUP GG) 1 vs. 4 (OR: 0.11, 95% CI 0.000-0.452, p= 0.018) and ISUP GG 2 vs. 4 (OR: 0.16, 95% CI 0.001-0.252, p= 0.003); and multifocality on PET/CT (OR: 9.821, 95% CI 1.438-67.085, p= 0.02) were independent risk factors for pathological upgrading. Our developed prediction model based on the identified parameter showed good calibration at internal validation (mean absolute error = 0.033). 68Ga-PSMA-11 PET/CT was found to be an ideal biomarker for the prediction of pathological upgrading from mpMRI-TB to RP, especially for patients with lower tumor grade at mpMRI-TB.

Correlations of morphological features and surgical management with clinical outcome in a multicentre study of 241 phyllodes tumours of the breast.

Phyllodes tumours (PTs) represent an unusual but complex group of breast lesions with a tendency to recur locally and, less commonly, metastasise. On core biopsies, their appearances can be difficult to discriminate from those of other fibroepithelial lesions, which may compromise their surgical management. The aims of this study were to assess the preoperative diagnosis of PTs and to evaluate the impacts of surgical management and morphological features on their behaviour. We combined datasets from three centres over two decades, including core biopsies, excision specimens, and follow-up. Core biopsy results were compared with final excision specimens. The relationships of surgical procedure and morphological features with local recurrence (LR) and metastasis were assessed. Two hundred and forty-one PTs were studied. Core biopsy resulted in a diagnosis of possible or definite PT in 76% of cases. Malignant tumours were more likely to be larger, occurred at an older age, and were surgically more challenging, with difficulties being encountered in achieving negative margins. There were 12 cases (5%) that showed LR alone, and another six cases (2.5%) that had distant metastases. Morphological features associated with adverse outcome were grade of PT, increased mitotic counts, necrosis, infiltrative margins, stromal atypia, and heterologous components. Both LR and metastatic behaviour correlated with larger size and distance to margins. Our results suggest that excision margins have a significant impact on LR of PT, whereas metastatic behaviour is influenced by tumour biology. We add to the evidence base on histological features of tumours that contribute to long-term outcomes of PT patients.

Investigation of Conventional vs Nonoriginal CAD/CAM Bars with Production Stage Differences: An In Vitro Precision Study Using a Novel Technique.

The aim of this study was to evaluate the precision of fit of bar frameworks fabricated using three different production processes and the effect of changes in the CAD/CAM process steps on the precision of the resulting bar frameworks. Four implants were applied to a mandibular phantom model, and three different production techniques were used to fabricate 30 bar frameworks. In the first group, the bar frameworks were fabricated with the conventional production process (the lost-wax technique; n = 10). In the second group, a CAD/CAM production process was used with digital data collected individually from the master model for the production of each of the final bar specimens (n = 10). In the third group, a CAD/CAM production process was used with the master model being scanned once, and the single resulting data value was used for the production of all final bar specimens (n = 10). The marginal gap between bar frameworks and implants was digitally calculated (ATOS So High-End 3D Digitizer for Small Objects, GOM Inspect). Newman-Keuls multiple comparison tests, a Tukey multiple comparison test, and Pearson correlation tests were applied to the data with a level of significance of P < .05. The mean marginal gap value of group 1 was 95.25 ± 76.15 μm, which was statistically significantly lower than the other groups (P = .0001). For group 2, the mean marginal gap value was 152.00 ± 97.19 μm, whereas for group 3, the mean marginal gap value was 156.7 ± 78.70 μm. Among group 2 and group 3, no statistically significant difference was observed at the mean marginal gap value. The marginal gap values in the CAD/CAM bar framework groups were significantly higher than the conventional bar framework group. Among the CAD/CAM groups, the mean marginal gap values were not statistically significant.