Margin Size Research Articles

Volume staging for arteriovenous malformation SRS treatment using VMAT.

Volume staging involves dividing the target volume into smaller parts and treating each part separately. In this study, the feasibility of volume-staged stereotactic radiosurgery (VS-SRS) on a linear accelerator using volumetric modulated arc therapy (VMAT) and a frameless patient positioning system is investigated. Ten patients, previously treated with hypofractionated stereotactic radiotherapy with arteriovenous malformation (AVM) sized from 1.6 to 4.0cm in diameter, were selected. VS-SRS plans were created with the VMAT technique on the Varian Eclipse treatment planning system (TPS) using the TrueBeam STx linear accelerator. For each patient, an AVM-VMAT set was planned with the AVM as the target and a PTV-VMAT set using the (PTV=AVM+1mm) as the target. All targets were divided into two sub-volumes. The TPS data from the AVM-VMAT plans was compared to Gamma Knife (GK) VS-SRS plan data available in the literature. The AVM-VMAT and PTV-VMAT plans were compared to investigate the effect of a 1mm PTV margin on normal brain (NB) dose. End-to-end testing was performed using a GaFchromic EBT3 film and point-dose measurements. Dosimetric effects of multiple setups were investigated through film-to-film comparisons. Median target dose coverage, NB V12Gy , and conformity index for the AVM-VMAT plans were 97.5%, 17cm3 , and 0.8, respectively. PTV-VMAT plans attained comparable target dose coverage, but the average NB V12Gy increased by 48.9% when compared to the AVM-VMAT plans. Agreement of point-dose measurements with TPS calculations was -0.6% when averaged over all patients. Gamma analysis passing rates were above 90% for all film-to-film comparisons (2%/1mm criteria), and for the film to TPS comparison (5%/1mm). This work suggests that VMAT is capable of producing VS-SRS plans with similar dose falloff characteristics as GK plans. NB dose depends on PTV margin size, and two-stage treatment setups do not appear to contribute additional uncertainty to treatment delivery.

Improved biological dosimetric margin model for different PTV margins with stereotactic body radiation therapy in homogeneous and nonhomogeneous tumor regions.

The purpose of this study was to improve the biological dosimetric margin (BDM) corresponding to different planning target volume (PTV) margins in homogeneous and nonhomogeneous tumor regions using an improved biological conversion factor (BCF) model for stereotactic body radiation therapy (SBRT). The PTV margin was 5-20 mm from the clinical target volume. The biologically equivalent dose (BED) was calculated using the linear-quadratic model. The biological parameters were α/β = 10 Gy, and the dose per fraction (DPF) was d = 3-20 Gy/fr. The isocenter was offset at intervals of 1 mm; 95% of the clinical target volume covered more than 90% of the prescribed physical dose, and BED was defined as biological and physical DMs. The BCF formula was defined as a function of the DPF. The difference in the BCF caused by the DPF was within 0.05 for the homogeneous and nonhomogeneous phantoms. In the virtual nonhomogeneous phantom, the data with a PTV margin of 10-20 mm were not significantly different; thus, these were combined to fit the BCF. In the virtual homogeneous phantom, the BCF was fitted to each PTV margin. The current study improved a scheme to estimate the BDM considering the size of the PTV margin and homogeneous and nonhomogeneous regions. This technique is expected to enable BED-based treatment planning using treatment systems based on physical doses for SBRT.

Multivariate evaluation of prognostic markers in synovial sarcoma

AimsSynovial sarcoma (SS) is an aggressive neoplasm but with varied clinical outcomes despite standard treatment protocols. Several clinicopathological features and immunohistochemical stains have been proposed as prognostic markers in SS....

Surgical Resection for Pediatric Synovial Sarcoma: What Margin Is Adequate?

INTRODUCTION: Synovial sarcoma is the most common nonrhabdomyosarcoma soft tissue sarcoma in children. Guidelines concerning the size of resection margins are lacking. We sought to evaluate if negative microscopic resection margins predicted overall survival. METHODS: A retrospective chart review showed 22 patients with synovial sarcoma from September 2011 to November 2019 at Texas Children’s Hospital. Pearson’s chi-square test and multivariate regression analyses were used. RESULTS: Relapsed free survival was 59% and overall survival was 72% with a median follow-up of 3 years (with interquartile range [IQR] 1.6 to 4.9 years) from initial resection (Figure). The patients with negative margins had a median resection margin of 1.5 mm (IQR 1 to 27mm). Positive microscopic margins were noted in 71% (5/7) of the patients who died compared with 12% (2/16) of patients who survived (p = 0.01). Survival in patients with surgical margins of <5 mm was 100% (7/7) compared with the 28% (2/7) of patients with positive surgical margins (p = 0.02). Positive microscopic margin was an independent risk factor for death (odds ratio 40, 95% CI 1.98 to 807; p = 0.02) when adjusting for adjuvant chemotherapy and radiation.FigureCONCLUSION: This study revealed that a negative microscopic surgical margin in pediatric synovial sarcoma is an independent prognostic predictor of overall survival.

Persistent lymph nodes after curative chemoradiotherapy for head and neck cancer: imaging predictors of response for decision-making.

To identify response predictors in patients with head and neck squamous cell carcinoma (N + HNSCC) and persistent lymph nodes after curative chemoradiotherapy treatment (CCRT). Consecutive patients with N + HNSCC treated with CCRT and persistent lymph nodes at first follow-up between 2015 and 2021 were identified and analyzed. Complete response was defined as the absence of lymph node metastatic involvement in patients with salvage lymphadenectomy or the absence of progression after 1 year of successive follow-ups. Tumour type and location, staging, and human papillomavirus (HPV) status were considered for analysis. The number and size of lymph nodes, type, shape, enhancement and margins on diagnostic and follow-up CT were also analyzed. The cohort included 46 patients with 134 pathological lymph nodes. Logistic regression models showed the following variables to be significant: performance of salvage lymphadenectomy (OR 0.094, [CI 95% 0.004-0.61], p = 0.037); the type of lymphadenopathy on diagnostic CE-CT (solid vs. cystic) (N1: OR = 4.11, [CI 95% 1.11-17.93], p = 0.042 and N3: OR 6.42, [CI 95% 1.2-42.56], p = 0.036); the change of shape (round to oval) on the follow-up CE-CT (OR 9.76, [CI 95% 1.79-8.57], p = 0.016) and the time in days between CCRT and the first follow-up CE-CT (OR 1.06, [CI 95% 1.004-1.13], p = 0.048). In our experience, the presence of solid lymph nodes on pre-treatment CT and the change in shape from round to oval on post-treatment CT are predictors of response to treatment in patients with N + HNSCC persistent lymph nodes after CCRT. Increasing the temporal interval between treatment and follow-up CT should be considered to avoid unnecessary nodal dissections.

Expansion of Field Margin Size Mitigate the Hazard of Rotary Tillage to Earthworm in Rice-Rape Rotation System

Field margin (FM) provides refuges for earthworm survival in rape-rice system after flooding, while the effects of FM with different size on earthworm in arable field (AF) is unclear. In this study, we investigated the effects of different FM sizes, a conventional size (FM I) and three expanding sizes (FM II, FM III, FM IV), on earthworm population characteristics in FM and AF. The results showed that the mean abundance of earthworm under the expanding sizes at 1 day and 60 day of flooding after rape harvest was 16.5 and 20.2 times higher than that of FM I, respectively. After stopping flooding, juveniles first migrated from FM to AF, whereas more than half of them were killed by subsequent rotary tillage, and the mortality decreased with expanding FM size. Subsequently, expanding FM sizes promoted earthworm to distribute evenly through the AF at faster speeds. At rape maturity, the mean abundance and total biomass of earthworm of AF under expanding FM sizes were significantly greater than that of FM I, and this positive effect increased with expanding FM size. The results indicated that expanding FM size can mitigate the hazard of rotary tillage to earthworm and promote rapid recovery of earthworm population in AF.

A concept for anisotropic PTV margins including rotational setup uncertainties and its impact on the tumor control probability in canine brain tumors

Objective. In this modelling study, we pursued two main goals. The first was to establish a new CTV-to-PTV expansion which considers the closest and most critical organ at risk (OAR). The second goal was to investigate the impact of the planning target volume (PTV) margin size on the tumor control probability (TCP) and its dependence on the geometrical setup uncertainties. The aim was to achieve a smaller margin expansion close to the OAR while allowing a moderately larger expansion in less critical areas further away from the OAR and whilst maintaining the TCP. Approach. Imaging data of radiation therapy plans from pet dogs which had undergone radiation therapy for brain tumor were used to estimate the clinic specific rotational setup uncertainties. A Monte-Carlo methodology using a voxel-based TCP model was used to quantify the implications of rotational setup uncertainties on the TCP. A combination of algorithms was utilized to establish a computational CTV-to-PTV expansion method based on probability density. This was achieved by choosing a center of rotation close to an OAR. All required software modules were developed and integrated into a software package that directly interacts with the Varian Eclipse treatment planning system. Main results. Several uniform and non-isotropic PTVs were created. To ensure comparability and consistency, standardized RT plans with equal optimization constraints were defined, automatically applied and calculated on these targets. The resulting TCPs were then computed, evaluated and compared. Significance. The non-isotropic margins were found to result in larger TCPs with smaller margin excess volume. Further, we presented an additional application of the newly established CTV-to-PTV expansion method for radiation therapy of the spinal axis of human patients.

Margin Size for Unique Skin Tumors Treated With Mohs Micrographic Surgery: A Survey of Practice Patterns.

Mohs micrographic surgery (MMS) has shown lower recurrence rates for unique skin tumors compared with wide local excision, but there is a lack of standardization on margin size. We aimed to assess MMS practice patterns of margin sizes for unique skin tumors. A survey was distributed to members of the American College of Mohs Surgery (ACMS). Demographic information on participants was collected in addition to initial/subsequent MMS margin size for unique skin tumors, including dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), melanoma, sebaceous carcinoma, microcystic adnexal carcinoma (MAC), poorly differentiated squamous cell carcinoma (SCC), and Merkel cell carcinoma. Eighty-seven respondents completed the survey (response rate <10%). Given that no guidelines exist on MMS margins for less commonly treated skin tumors, this study helps give Mohs surgeons perspective on current practice patterns for margin sizes. Mohs surgeons are more likely to take larger initial margins for these common skin tumors compared with BCCs or SCCs.

Patient-specific hydrogel phantoms for the preoperative simulation of nephron-sparing surgery in Wilms’ tumor patients: A feasibility study

Nephron-sparing surgery (NSS) for Wilms Tumor patients has a positive surgical margin rate of 15.7–36.4%. Innovative approaches may reduce the occurrence of positive surgical margins in NSS and prevent these children from having additional radiotherapy and chemotherapy. The feasibility of performing mock surgery on patient-specific hydrogel phantoms of the kidney, tumor, and arterial vasculature for preoperative simulation of NSS was assessed in two patients. The development of patient-specific phantoms allowed the surgeon to practice surgery. Moreover, phantom specimens were assessed using MRI to understand the location and size of the smallest surgical margin. Surgeons reported that simulation surgery helped perform NSS safely and improved intraoperative tumor localization and resection planning. The technique is considered feasible and useful when preparing for NSS. In the future, this technique may further help to achieve negative surgical margins in NSS and may also allow the use of NSS in patients typically regarded as ineligible for this procedure.

Narrower clinical margin in high or very high-risk squamous cell carcinoma: a retrospective, multicenter study of 1,000 patients.

In cutaneous squamous cell carcinoma (cSCC), adherence to guideline-recommended fixed surgical margins is often difficult, and narrower margins are preferable. This study aimed to evaluate relapse and disease-specific death with narrower margins for high or very high-risk cSCC. We retrospectively investigated high or very high-risk cSCC patients who underwent tumor excision. Patients were divided into guideline-recommended standard margin group (SMG) and narrower-margin group (NMG). Co-primary outcomes were local relapse, SCC relapse, and SCC death. Cumulative incidence function (CIF) was used to describe SCC death probability and competing risk mortality. Gray's test was used to compare differences in CIF between the groups. In total, 1,000 patients with cSCC (high-risk, 570; very high-risk, 430) were included. In the high-risk cohort, there were no significant differences in incomplete excision rate (IER) between SMG and NMG (2.6% vs. 3.0%, P>0.99). However, in the very high-risk cohort, IER in SMG was significantly lower than in NMG (8.9% vs. 16.2%, P = 0.03). No significant differences were observed between SMG and NMG for local relapse (high-risk, P = 0.56; very high-risk, P = 0.70), SCC relapse (high-risk, P = 0.30; very high-risk, P = 0.47), and SCC death (high-risk, P = 0.23; very high-risk, P = 0.83). Surgical margin size has limited impact on margin control, relapse, and disease-specific death in high-risk cSCC.

ANALYSIS OF FACTORS AFFECTING AUDITOR SWITCHING IN INDONESIA

This study's goal is to ascertain the impact of The goal of this study is to identify the factors that affect auditor turnover, including auditor opinion, financial distress, client business growth, and KAP size. The LQ 45 index businesses listed on the Indonesian Stock Exchange for the years 2018 through 2021 made up the study's population. 15 businesses were chosen as a sample using the purposive sampling method. Using Software Reviews, analyze survey data using multiple linear regression analysis 9. The findings of this study indicate that auditors' ability to move firms is influenced by audit opinion and margin size. At the same time, the turnover of auditors is unaffected by client firm development and financial difficulty.

A mini-review of end-of-life management of wind turbines: Current practices and closing the circular economy gap.

Renewable energy generation and increased electrification are pivotal to reducing greenhouse gas emissions and mitigating climate change. Consequently, global deployment of wind turbines has soared, and the trend is expected to continue. Installed turbines have only recently started reaching the end of their design lives, and waste volumes are projected to escalate rapidly. Approximately 94% of a wind turbine (by mass) is recyclable, but the waste polymer composite blades are most commonly landfilled. This mini-review aims to review current end-of-life (EoL) management practices in the large-scale wind industry for countries with established EoL standards as well as those with less mature regulations. Data on current EoL management practices, initiatives and regulations in industry was sourced primarily from literature reviews and publicly available internet information. Additional insights and perspectives were gained from WindEurope's EoL Issues and Strategies 2020 seminar and through communication with select individuals from various sectors such as wind energy development and operations, government, industry associations, academia and research organizations. The results show that the decision on EoL options is dictated by the remaining useful life (RUL) of the wind turbines, prevailing policies and electricity prices. The contribution of this article is, firstly, identifying a number of key technical, economic and regulatory questions that must be asked before deciding on the most appropriate EoL option. Secondly, the article identifies factors that impede current EoL management efforts to close the circular economy gap and those that can support sustainable technology deployment. Finally, the article considers the way that countries with a young fleet of wind farms may learn from more experienced nations. There are few proven business cases, and barriers to the profitability and effectiveness of EoL strategies include uncertainty about the assets' RUL, collection logistics, the size of wind farm operation margins, low waste feedstock and limited markets for recycled products. Designing for circularity, stakeholder collaboration, circular business models and technology-specific regulations can improve EoL sustainability. The research found that wind turbine EoL management is dynamic and complex and needs to consider multiple, often conflicting factors. However, it is necessary and has immense environmental, technical and economic potential as the industry matures and business cases are proven.

Noninferiority Margin Size and Acceptance of Trial Results: Contingent Valuation Survey of Clinician Preferences for Noninferior Mortality.

ObjectivesWe used modified contingent valuation methodology to determine how noninferiority margin sizes influence clinicians’ willingness to accept clinical trial results that compare mortality in critically ill children.MethodsWe surveyed pediatric infectious diseases and critical care clinicians in Canada, Australia, and New Zealand and randomized respondents to review 1 of 9 mock abstracts describing a noninferiority trial of bacteremic critically ill children assigned to 7 or 14 d of antibiotics. Each scenario showed higher mortality in the 7-d group but met noninferiority criterion. We explored how noninferiority margins and baseline mortality rates influenced respondent acceptance of results.ResultsThere were 106 survey respondents: 65 (61%) critical care clinicians, 28 (26%) infectious diseases physicians, and 13 (12%) pharmacists. When noninferiority margins were 5% and 10%, 73% (24/33) and 79% (27/33) respondents would accept shorter treatment, compared with 44% (17/39) when the margin was 20% (P = 0.003). Logistic regression adjusted for baseline mortality showed 5% and 10% noninferiority margins were more likely to be associated with acceptance of shorter treatment compared with 20% margins (odds ratio [OR] 3.5, 95% confidence interval [CI]: 1.3–9.6, P = 0.013; OR 5.1, 95% CI: 1.8–14.6, P = 0.002). Baseline mortality was not a significant predictor of acceptance of shorter treatment.ConclusionsClinicians are more likely to accept shorter treatment when noninferiority margins are ≤10%. However, nearly half of respondents who reviewed abstracts with 20% margins were still willing to accept shorter treatment. This is a novel application of contingent valuation methodology to elicit acceptance of research results among end users of the medical literature.HighlightsClinicians are more likely to accept shorter treatment durations based on noninferior mortality results when the noninferiority margin is 5% or 10% than if the margin is 20%.However, nearly half of clinicians would still accept shorter-duration treatment as noninferior with margins of 20%.Baseline mortality does not independently predict acceptance of shorter-duration treatment.Contingent valuation is a novel approach to elicit the acceptance of research design parameters from the perspective of endusers of the medical literature.

Influence of Surface Tension on Dynamic Characteristics of Single Bubble in Free-Field Exposed to Ultrasound.

The motion of bubbles in an ultrasonic field is a fundamental physical mechanism in most applications of acoustic cavitation. In these applications, surface-active solutes, which could lower the surface tension of the liquid, are always utilized to improve efficiency by reducing the cavitation threshold. This paper examines the influence of liquids’ surface tension on single micro-bubbles motion in an ultrasonic field. A novel experimental system based on high-speed photography has been designed to investigate the temporary evolution of a single bubble in the free-field exposed to a 20.43 kHz ultrasound in liquids with different surface tensions. In addition, the R-P equations in the liquid with different surface tension are solved. It is found that the influences of the surface tension on the bubble dynamics are obvious, which reflect on the changes in the maximum size and speed of the bubble margin during bubble oscillating, as well as the weaker stability of the bubble in the liquid with low surface tension, especially for the oscillating bubble with higher speed. These effects of the surface tension on the bubble dynamics can explain the mechanism of surfactants for promoting acoustic cavitation in numerous application fields.

Taxonomic analysis of certain taxa of Epipactis in Slovenia

The predominantly allogamous Broad-leaved Helleborines (Epipactis helleborine) and the predominantly autogamous Narrow-lipped Helleborines (Epipactis leptochila) represent two taxonomically complex groups with great morphological diversity and close genetic relationships at the subspecies level. They are influenced by environment, clinal variability, hybridization between allogamous taxa, and in particularly by speciation through transitions from allogamy to autogamy. We analysed floral traits, genome size and performed molecular analyses (Internal transcribed spacer region, ITS; Amplified Fragment Length Polymorphism, AFLP) of several individuals of E. helleborine and E. leptochila aggregate from different geographical regions in Slovenia, focusing on intermediate traits of E. helleborine subsp. moratoria, E. helleborine subsp. leutei and E. leptochila subsp. neglecta. In order to successfully distinguish studied taxa, the main attention should be paid to the shape of the epichil and the ovary, as well as to the size ratio of sepals and petals. Among the microfloral characters, the shape and size of the lower margin of the stigma and staminodes are found to be supportive. E. neglecta clearly shows intermediate floral characteristics between E. leptochila and E. leutei, suggesting that the transition to autogamy evolved E. neglecta as an intermediate stage in the speciation process, coinciding with the colonisation of forest sites with lower light intensity. Analysis of genome size revealed significant differences, with E. neglecta having the greatest value. Using molecular markers, we were able to determine two main ribotype clusters within the E. helleborine group, which were also determined by AFLP analyses. E. leutei and E. neglecta formed two clearly defined subclusters within the E. leptochila lineage. The results of the presented study suggest that combining molecular markers and genome size with information on how variation in floral morphology is distributed, using multivariate analyses, is the most reliable way to gain improved insight into the relationships among the taxa analysed.

Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: A retrospective, multicenter study of 79 cases

To the Editor: Cutaneous leiomyosarcoma (cLMS) is a rare skin sarcoma reported to have a good prognosis.1Winchester D.S. Hocker T.L. Brewer J.D. et al.Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes.J Am Acad Dermatol. 2014; 71: 919-925https://doi.org/10.1016/j.jaad.2014.07.020Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar In this large, retrospective, and multicenter study of cLMS (confined to the dermis or involving the subcutis layers), conducted from January 2000 to June 2019, we aimed to better define its clinicopathologic features and prognostic factors. Statistical analyses combined the Kaplan-Meier method (to estimate overall survival and progression-free survival) and the log-rank test (to identify prognostic factors). We also performed molecular analyses using whole-genome copy number analyses as well as targeted DNA and RNA sequencing. Seventy-nine patients were included (Supplementary Table I, available via Mendeley at https://data.mendeley.com/datasets/sjk9p9rgtz/1). Most cases occurred in the lower portion of the limbs (n = 29 [36.7%]) and showed subcutis invasion (n = 35 [44.3%]) and a low histologic grade (grade I, n = 49, [62.0%]) according to the Fédération Nationale des Centres de Lutte Contre le Cancer2Coindre J.M. Trojani M. Contesso G. et al.Reproducibility of a histopathologic grading system for adult soft tissue sarcoma.Cancer. 1986; 58: 306-309https://doi.org/10.1002/1097-0142(19860715)58:2<306::aid-cncr2820580216>3.0.co;2-7Crossref PubMed Google Scholar grading system. The margin status was R0 in 59 cases (74.7%, ie, complete surgical resection, without residual tumor). Recurrence occurred in 12 patients (15.2%), whereas regional or distant metastasis occurred in 7 patients (8.9%). Eight patients died, 6 of them because of metastatic cLMS. The median overall survival and progression-free survival was 38.8 (range, 4.9-73.9) and 25.2 months (range, 2.8-66.1), respectively. The estimated 24-month overall survival and progression-free survival rates were 92% and 77%, respectively. There was no significant association between outcomes and clinical parameters (age, sex, tumor location, and tumor size). However, the margin sizes were wider in the population without relapse (n = 33, margin size = 1.80 cm) than in the population with relapse (n = 9, margins size = 1.06 cm, P = .03). Conversely, an intermediate or high Fédération Nationale des Centres de Lutte Contre le Cancer grade (II-III) was significantly associated with a higher risk of recurrence or metastasis (hazard ratio, 4.8; 95% CI, 1.6-14.6; P = .01). There was no prognostic association with other histologic factors; the hazard ratio of the recurrence/metastasis of subcutis invasion was 7.4 (95% CI, 0.9-58.2; P = .06). Subcutis invasion (n = 35) was observed in 51% of cases with grade I versus 40% of cases with grade II/III cLMS. Eleven cases were molecularly explored, showing heterogeneous profiles (Supplementary Table II, available via Mendeley at https://data.mendeley.com/datasets/8t7hcb8jw7/1): 4 cases presented with >10 segmental copy number alterations (CNAs) (case numbers, 1-4), 3 cases presented with only 1 CNA (case numbers, 5-7). The recurrent abnormalities were the deletion of the RB1 (n = 5) or TP53 gene (n = 4) and the amplification of MYOCD (n = 2). Four cases presented with no CNA (case numbers, 8-11). TP53 mutations were identified, but no fusion gene was identified. The limitation of this study is its retrospective design; nevertheless, the following data deserve to be highlighted. cLMS has a good prognosis, with the 5-year survival rate ranging from 86% (in our series) to 92% (Surveillance, Epidemiology, and End Results Database). However, recurrence/metastasis may have occured.1Winchester D.S. Hocker T.L. Brewer J.D. et al.Leiomyosarcoma of the skin: clinical, histopathologic, and prognostic factors that influence outcomes.J Am Acad Dermatol. 2014; 71: 919-925https://doi.org/10.1016/j.jaad.2014.07.020Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar,3Wong G.N. Webb A. Gyorki D. et al.Cutaneous leiomyosarcoma: dermal and subcutaneous.Australas J Dermatol. 2020; 61: 243-249https://doi.org/10.1111/ajd.13307Crossref PubMed Scopus (5) Google Scholar Few previous studies correlated prognosis with clinicohistologic parameters.3Wong G.N. Webb A. Gyorki D. et al.Cutaneous leiomyosarcoma: dermal and subcutaneous.Australas J Dermatol. 2020; 61: 243-249https://doi.org/10.1111/ajd.13307Crossref PubMed Scopus (5) Google Scholar We reported for the first time that Fédération Nationale des Centres de Lutte Contre le Cancer grading is the most important prognostic factor. Therefore, cLMS of grade II/III should be managed with wider local excision, as already suggested, and we recommend margins of 2 cm.4Kazlouskaya V. Lai Y.C. Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management.Int J Dermatol. 2020; 59: 165-172https://doi.org/10.1111/ijd.14705Crossref PubMed Scopus (9) Google Scholar Our study was the first to explore pan-genomic CNAs as well as targeted mutations and fusion genes. Patients with cLMS with a complex genomic quantitative profile (case numbers, 1-4, which showed subcutaneous extension) share some molecular features described in patients with deep soft tissue leiomyosarcoma: TP53 and RB1 alterations and MYOCD amplification.5Dry S.M. Fröhling S. Leiomyosarcoma. WHO Classification of Soft Tissue and Bone Tumours.5th ed. IARC, 2019: 195-197Google Scholar Patients with cLMS with such molecular features might have a pejorative prognosis, which should be confirmed in a larger cohort. None disclosed.

ANALYSIS OF THE FACTORS AFFECTING THE FINANCIAL PERFORMANCE OF INSURANCE COMPANIES LISTED ON THE PALESTINE STOCK EXCHANGE

The objective of this study was to investigate the factors affecting the financial performance of insurance companies in Palestine. The entire study population was targeted at 7 insurance companies listed on the Palestine Exchange for the period between 2010 and 2019. The researchers used multiple linear regression analysis to create two models that represent the financial performance; the study adopted two models for measuring financial performance, the first model measuring financial performance by return on assets, and the other measuring financial performance by return on equity. The results showed a positive and statistically significant impact on the solvency margin, the state's legal system, the size of the board of directors, and the size of the company on the return on assets. There is a negative, statistically significant impact on each of the claims loss ratios, the dependence on the four major auditing firms, and the ownership of board members on the return on assets. The reliability of reinsurance and the audit committee did not show a statistically significant effect on the return on assets. The results showed a positive, statistically significant impact of the solvency margin and company size on the return on equity. The results indicate a negative, statistically significant impact of both the claims loss ratio and the Audit Committee on the return on equity. Reinsurance dependent, dependence on the four major auditing companies, the state's legal system, the size of the board of directors, and the ownership of board members have no significant effect on the return on equity. The study recommends that insurance companies in Palestine should comply with the required margin of money, which was set by the Palestinian Capital Market Authority at 150%.

Seasonal and Longitudinal Variations in Suspended Load Connectivity Between River Channels and Their Margins

AbstractInput of organic matter into stream channels is the primary energy source for headwater ecosystems and ultimately carbon to the oceans and hence is an important component of the global carbon cycle. Here, we quantify organic‐rich fine sediment mobilization, transport, and storage in a Strahler fourth‐order stream during individual intermediate‐sized storm events. By combining measurements of fallout radionuclides (FRNs) 7Be and 210Pb and stable water isotopes with a conceptual model of suspended load trapping by channel margins, we find that the channel bed was consistently a source of suspended load to the channel margins. Relative to storage on the channel margins, suspended load export increased through the spring and summer, perhaps related to the in‐channel decomposition of organic debris as indicated by its FRN exposure age and changing bulk δ13C composition. Trapping of suspended load by riparian margins limits sediment transport distances, which, given sufficient discharge to fully suspend the load, is nearly independent of stream discharge for sub‐bankfull discharges. Limited data indicate that the fractional size of the channel margins where trapping occurs decreases with increasing watershed area. Increasing transport length and decreasing fractional margin area with increasing watershed area results in a systematic downstream decoupling of the channel from local terrestrial organic matter exchange. These findings provide a framework for understanding suspended load dynamics in formerly glaciated regions where sediment production and fluxes are generally low and thus the annual input of organic debris is a major component of suspended load budget.

Interest Rate Liberalization and Commercial Bank Performance: New Evidence From Chinese A-Share Banks

Abundant literature infers the negative incidence of financial liberalization in the banking sector. As interest rate marketization is a reality in China, we empirically investigate the determinants of commercial banks’ financial performance using 10 listed Chinese commercial banks for 1999 to 2019. Our findings suggest that net interest margin (NIM), non-performing loans (NPL), and asset size (LnAsset) are the key drivers of profitability in Chinese banks. Interestingly, for the sample of city banks observed, we find that bank performance is strongly driven by sound management of the assets and the retail interest margins. On the opposite, the joint-stock banks’ strong diversification leads to lower reliance on net interest margins. Our results also suggest that joint-stock banks’ asset size puts strong pressure on their overall performance and exert a diminishing return effect as their assets’ critical size generates proportional administrative expenses that hinder profitability.

ANALYSIS OF FACTORS AFFECTING PROFIT MANAGEMENT IN PROPERTY COMPANIES

This study aims to determine the effect of Financei Leverage, Return on Assets, Net Profit Margin, Company Size on Management in Property Companies listed on Bursa Efek Indonesia 2017-2019. The data used is sourced from annual data via the www.idx.co.id website, which has been selected based on predetermined criteria. The population used in this company is all property companies, totaling 15 companies, using a purposive sample of 45 samples. This research is expected to become a science that can help further researchers and can also help students or the general public who need information from this research. From this research, it can be seen that Finance Leverage and partially old management have no influence on Return.On in Property Companies, while Net Profit Margin and Company Size partially affect Profit Management in Property Companies