Quality Of Margins Research Articles

High cover of hedgerows in the landscape supports multiple ecosystem services in Mediterranean cereal fields

Summary Field‐margin diversification through conservation and restoration of hedgerows is becoming a prominent intervention for promoting biodiversity and associated ecosystem services in intensive agricultural landscapes. However, how increasing cover of hedgerows in the landscape can affect ecosystem services has rarely been considered. Here, we assessed the effect of increased field‐margin complexity at the local scale and increasing cover of hedgerows in the landscape on the provision of pest control, weed control and potential pollination. Locally, three types of field margin were compared as follows: (i) standard grass margin, (ii) simple hedgerow and (iii) complex hedgerow, along two independent gradients of hedgerow cover and arable land cover in the landscape. We performed an exclusion experiment to measure biological control of cereal aphids and assessed natural enemy and pest abundance in the field. We sampled plant weed communities and performed a phytometer experiment to test the effects of pollinators on plant reproductive success. At the local scale, planting a new hedgerow or improving its structural complexity and vegetation diversity did not enhance the delivery of ecosystem services in the neighbouring field. However, high cover of hedgerows in the landscape enhanced aphid parasitism (from 12 to 18%) and potential pollination (visitation rate and seed set increased up to 70%) irrespective of local margin quality. The cover of arable land in the landscape reduced the abundance of plant‐dwelling predators and weed diversity, but did not affect the delivery of the investigated ecosystem services. Synthesis and applications. Our results highlight the key importance of the surrounding landscape context, rather than local factors, to the delivery of ecosystem services. This suggests a need for new policies that pay particular attention to the conservation of hedgerows at large scales for promoting multiple ecosystem services in agroecosystems. Specifically, hedgerows can serve to develop a network of ecological corridors that can facilitate the movement of beneficial organisms, such as pollinators and natural enemies in the agricultural matrix. Such interventions may be a ‘low cost–high benefit solution’, since farmers can create or conserve high‐quality habitats taking little or no land from crop production and without the need to change their crop management.

Sacral Chordoma: Long-term Outcome of a Large Series of Patients Surgically Treated at Two Reference Centers.

Retrospective case series. To report on the natural history and long-term outcome of a large series of consecutive primary sacral chordoma patients surgically treated at two reference centers. Sacral chordomas are rare tumors with poor long-term prognosis mainly caused by local failure. Till date, a few large series with long follow up are available in literature. All consecutive patients affected by primary localized sacral chordoma operated on at two Italian reference centers between 1981 and 2012 were included. Overall survival (OS), disease free survival (DFS), crude cumulative incidence (CCI) of local recurrence (LR), and distant metastases (DM) were calculated. Multivariable analyses for OS, DFS, LR, and DM were performed. A total of 99 patients were identified: 65 males and 34 females. Median age was 59 years (range 22-77 yrs), median tumor size was 9 cm (range 4-22). Nineteen patients received pre- or postoperative radiotherapy (RT). Wide (R0) surgical margins were achieved in 46 patients, marginal (R1) margins in 43 patients and intralesional (R2) margins in 10 patients. At a median follow up of 8.7 years (range 1-23.8 yrs) 30 patients died of disease, 31 patients developed local relapse, 16 patients developed distant metastasis, whereas 51 patients are alive without disease. OS and DFS at 5, 10, and 15 year were 92% and 63%, 45% and 62%, 36% and 21%, respectively, without any evidence of a plateau in the curves.CCI of LR and DM were 30% and 9% at 5 years, 46% and 18% at 10 years, 56% and 23% at 15 years. Size of the tumor and quality of surgical margins were the only significant predictors of long-term outcome. DFS for 15 years was, in fact, 49% for R0 and 7% for R1, respectively. In this series, long-term outcome of resected sacral chordoma was poor, with less than 25% patients were disease-free at 15 years. Interestingly, only half of the patients treated with R0 resection had no evidence of recurrence at 15 years. When surgical margins are expected to be positive other treatment modalities should be considered, especially when expected sequelae are substantial as in the case of more cephalad levels of resection. 3.

Evaluation of the In Vitro Effects of Cervical Marginal Relocation Using Composite Resins on the Marginal Quality of CAD/CAM Crowns.

To evaluate the effect of cervical margin relocation (CMR) for crowns designed using CAD/CAM technology, and made of pre-cured resin or lithium disilicate, before and after thermomechanical loading. The test hypothesis was that the marginal quality of the crowns would not be influenced by the CMR with composite resins before or after thermomechanical loading. Standard crown preparations were created in 40 human molars. The margins were located in enamel, except for the mesial proximal box, where the cervical margin was 2.0 mm below the cementoenamel junction, with 4.0 mm in the buccolingual and 2.0 mm in the mesiodistal dimension. For the CMR technique, a 2-mm layer of conventional or flowable composite resin was applied to the mesial box. Using the Cerec CAD/CAM system, 40 standard crowns were prepared, and restorations were luted using a dual-curing adhesive cement. SEM analysis was performed using epoxy resin replicas before and after loading to assess the marginal quality of interfaces of the mesial proximal box with CMR/crown and the distal face of the tooth without CMR. Statistical differences between groups were analyzed using the Kruskal-Wallis test and Bonferroni's post-hoc test. The null hypothesis was accepted, since no statistically significant differences were found in marginal quality before and after thermomechanical cycling (p > 0.05). The implementation of CMR before and after thermomechanical cycling had no effect on the quality of cervical margins. To establish whether CMR is a suitable procedure for the adhesive luting of composite resin crowns in deep proximal boxes, additional studies are required.

Are self-adhesive resin cements suitable as core build-up materials? Analyses of maximum load capability, margin integrity, and physical properties.

The aim of the present study was to test a self-adhesive resin cement used as core build-up material in comparison to two commercially available core build-up materials. Forty human anterior teeth were endodontically treated and fiber post insertion (RelyX Fiber posts) and core build-ups were performed using two core build-up materials applied with an etch-and-rinse adhesive approach (Luxacore Dual-LC and Clearfil Core-CC) and an experimental self-adhesive resin cement (SAR) in two application modes (SAR Handmix and SAR Automix). Samples were subjected to thermo-mechanical loading. Margin integrity was determined using scanning electron microscopy (SEM), and maximum load capability (Fmax) was evaluated. Physical properties of the tested materials were also examined. Fmax was significantly affected by the core build-up material (p < 0.0005; one-way ANOVA). CC [481 (158) N] revealed significantly higher Fmax compared to LC [226 (80) N], SAR Hand [205 (115), and SAR Automix [197 (134) N] (p < 0.05; Tukey-B). The percentage of margin quality "continuous margin" in enamel after thermo-mechanical loading (TML) differed significantly among groups (p < 0.0005; Kruskal-Wallis); CC demonstrated a significantly higher percentage of margin quality "continuous margin" compared to the other groups. Physical properties were significantly affected by the different core materials (p < 0.0005; ANOVA); CC and LC demonstrated significantly higher flexural strength compared to both SAR groups as well as significantly higher water sorption of both SAR groups compared to CC and LC. Within the limitations of the present in vitro study, we conclude that the investigated experimental self-adhesive resin cement is not suitable as a core build-up material due to the lower maximum load capability, low margin quality, and the data of the mechanical properties. The investigated experimental self-adhesive resin cement cannot be recommended as a core build-up material.

Evaluation of a novel repetitive gas-enhanced permeation test for restoration leakage determination after thermo-mechanical loading

Objectives: To assess leakage of class-I restorations using a gas-enhanced permeation test (GEPT) as compared with conventional SEM or dye analysis.Materials and methods: Pressure differences over time and penetrating water volumes were measured simultaneously in a two-chamber system (GEPT) before and after class I cavity preparation in 30 molars. Ten teeth were restored with a composite restoration without bonding (A1), a composite restoration with bonding (A2) or a ceramic indirect restoration (B). Five intact teeth served as controls (C). Another GEPT measurement was performed and impressions were taken. Teeth were subjected to thermodynamic loading (1 200 000 cycles) and final GEPT measurements and impressions were made. SEM evaluation of the marginal continuity was performed and teeth were subjected to a Fuchsin dye penetration test. Spearman’s rank test was used to compare results from different tests.Results: The GEPT and SEM values did not correlate before loading (0.359, p = 0.051), but significantly correlated afterwards (0.662, p < 0.0001). The correlations between the Fuchsin dye penetration test and GEPT and SEM surface marginal analysis were significant (0.777 and 0.534, p-values < 0.0001 and 0.002, respectively).Conclusions: SEM marginal analysis was mainly limited in reflecting the surface restoration integrity. GEPT evaluation may, therefore, serve as a tool to non-destructively assess restoration sub-surface integrity over time.Clinical relevance: The current study provided proof that restoration margin quality does not necessarily reflect its leakage behaviour.

Adjuvant chemotherapy for soft tissue sarcoma.

Adjuvant chemotherapy is not standard treatment in soft tissue sarcoma (STS). However, when the risk of relapse is high, it is an option for shared decision making with the patient in conditions of uncertainty. This is because available evidence is conflicting, even if several randomized clinical trials have been performed for 4 decades and also have been pooled into meta-analyses. Indeed, available meta-analyses point to a benefit in the 5% to 10% range in terms of survival and distant relapse rate. Some local benefit also was suggested by some trials. Placing chemotherapy in the preoperative setting may help gain a local advantage in terms of the quality of surgical margins or decreased sequelae. This may be done within a personalized approach according to the clinical presentation. Attempts to personalize treatment on the basis of the variegated pathology and molecular biology of STS subgroups are ongoing as well, according to what is done in the medical treatment of advanced STS. Thus, decision making for adjuvant and neoadjuvant indications deserves personalization in clinical research and in clinical practice, taking profit from all multidisciplinary clinical skills available at a sarcoma reference center, though with a degree of subjectivity because of the limitations of available evidence.

The trophic and metabolic pathways of foraminifera in the Arabian Sea: evidence from cellular stable isotopes

Abstract. The Arabian Sea is a region of elevated productivity with the highest globally recorded fluxes of particulate organic matter (POM) to the deep ocean, providing an abundant food source for fauna at the seafloor. However, benthic communities are also strongly influenced by an intense oxygen minimum zone (OMZ), which impinges on the continental slope from 100 to 1000 m water depth. We compared the trophic ecology of foraminifera on the Oman and Pakistan margins of the Arabian Sea (140–3185 m water depth). These two margins are contrasting both in terms of the abundance of sedimentary organic matter and the intensity of the OMZ. Organic carbon concentrations of surficial sediments were higher on the Oman margin (3.32 ± 1.4%) compared to the Pakistan margin (2.45 ± 1.1%) and sedimentary organic matter (SOM) quality estimated from the Hydrogen Index was also higher on the Oman margin (300–400 mg HC mg TOC−1) compared to the Pakistan margin (&lt; 250 mg HC mg TOC−1). The δ13C and δ15N values of sediments were similar on both margins (−20 and 8‰, respectively). Stable isotope analysis (SIA) showed that foraminiferal cells had a wide range of δ13C values (−25.5 to −11.5‰), implying that they utilise multiple food sources; indeed δ13C values varied between depths, foraminiferal types and between the two margins. Foraminifera had broad ranges in δ15N values (−7.8 to 27.3‰). The enriched values suggest that some species may store nitrate to utilise in respiration; this was most notable on the Pakistan margin. Depleted foraminiferal δ15N values, particularly at the Oman margin, may reflect feeding on chemosynthetic bacteria. We suggest that differences in productivity regimes may be responsible for the differences observed in foraminiferal isotopic composition. In addition, at the time of sampling, whole jellyfish carcasses (Crambionella orsini) and a carpet of jelly detritus were observed across the Oman margin transect. Associated chemosynthetic bacteria may have provided an organic-rich food source for foraminifera at these sites. Our data suggest that foraminifera in OMZ settings can utilise a variety of food sources and metabolic pathways to meet their energetic demands.

Postoperative recurrence of desmoid tumors: clinical and pathological perspectives.

BackgroundThe clinical features and the pathological changes of desmoid tumors were studied to point out the key factors affecting the recurrence.MethodsThe clinical data and specimens of 56 patients who underwent desmoid tumor resection from 2003 to 2008 were reviewed. Possible clinical factors related to the postoperative recurrence were analyzed statistically. The specimens round the lesions were studied histopathologically.ResultsThe overall recurrence rate was 39.3%. The postoperative recurrence rate of the patients with negative surgical margins and no tumor invasion of the major vessels and nerves was low (P < 0.05). However, the desmoid tumors could destroy the cortical bone and invade the medullary cavity.ConclusionsDesmoid tumors were pathologically benign, which could extensively invade tissues around the lesions. The invasion of major vessels and nerves and quality of surgical margins are the key factors for the high postoperative recurrence rate.

Comparison of Micro-Leakage from Resin-Modified Glass Ionomer Restorations in Cavities Prepared by Er:YAG (Erbium-Doped Yttrium Aluminum Garnet) Laser and Conventional Method in Primary Teeth.

In recent years, significant developments have been taking place in caries removal and cavity preparation using laser in dentistry. As laser use is considered for cavity preparation, it is necessary to determine the quality of restoration margins. Glass ionomer cements have great applications for conservative restoration in the pediatric field. The purpose of this in vitro study was to compare resin-modified glass ionomer restorations micro-leakage in cavities prepared by Er:YAG (Erbium-Doped Yttrium Aluminum Garnet) laser irradiation and conventional method in primary teeth. This was an in vitro experimental study. Forty primary canine teeth were divided into 2 groups: group 1 represented cavities prepared by the no. 008 diamond bur, group 2 represented cavities prepared by Er:YAG laser. After cavity preparation, samples were restored by resin-modified glass ionomer. The teeth were thermocycled for 700 cycles, placed in 2% methylene blue for 24h and sectioned in the buccolingual direction. The degree of dye penetration was scored by 3 examiners. Data was analyzed using Mann-Whitney Test. There was no statistical difference in micro-leakage between the two modes of cavity preparation (P=0.862) CONCLUSION: Since preparing conservative cavities is very important in pediatric dentistry, it is possible to use Er:YAG laser because of its novel and portable technology. However, further investigations of other restorative materials and other laser powers are required.

Resin composites: Modulus of elasticity and marginal quality

ObjectiveTo investigate how the modulus of elasticity of resin composites influences marginal quality in restorations submitted to thermocyclic and mechanical loading. MethodsCharisma, Filtek Supreme XTE and Grandio were selected as they were found to possess different moduli of elasticity but quite similar polymerization contraction. MOD cavities (n=30) were prepared in extracted premolars, restored and then subjected to thermocyclic and mechanical loading. Marginal quality of the restorations before and after loading was analyzed on epoxy replicas under a scanning electron microscope. The percentage of gap-free margins and occurrence of paramarginal fractures were registered. Modulus of elasticity and polymerization contraction were analyzed with parametric and margins with nonparametric ANOVA and post hoc Tukey HSD or Wilcoxon rank-sum tests, respectively. The number of paramarginal fractures was analyzed with exact Fisher tests (α=0.05). ResultsGrandio demonstrated significantly more gap-free enamel margins than Charisma and Filtek Supreme XTE, before and after loading (p<0.01), whereas there was no difference between Charisma and Filtek Supreme XTE (p>0.05). No significant effect of resin composite (p=0.81) on the quality of dentine margins was observed, before or after loading. Deterioration of all margins was evident after loading (p<0.0001). More paramarginal enamel fractures were observed after loading in teeth restored with Grandio when compared to Charisma (p=0.008). ConclusionsThe resin composite with the highest modulus of elasticity resulted in the highest number of gap-free enamel margins but with an increased incidence of paramarginal enamel fractures. Clinical significanceThe results from this study suggest that the marginal quality of restorations can be improved by the selection of a resin composite with modulus of elasticity close to that of dentine, although an increase in paramarginal enamel fractures can result as a consequence.

Resection margins in bone tumors: what is adequate?

In multimodal therapy concepts for bone sarcomas, tumor resection is a deciding factor. Modern imaging techniques have made preoperative resection planning much easier and precisely allow tumor boundaries to be defined. There is recent data clearly showing that compartmental resections have no significant advantages compared to wide resections in terms of local recurrence or overall survival. But it remains unclear, how "wide" a "wide resection" should be done. A literature review of the last 15 years, discussion of review articles and multidisciplinary expert opinions as published in major multinational studies. Intralesional resection (R1) is feasible in highly differentiated (G1) chondrosarcoma (atypical cartilaginous tumor) of the extremity. In both osteosarcoma and Ewing's sarcoma, R0 resection is mandatory. If these fails, there is evidence that in selected cases of osteosarcoma, adjuvant radiotherapy is justified if a second resection is not possible. Expecting contaminated (R1) margins in patients with Ewing's sarcoma (e.g., in critical locations such as the pelvis), radiotherapy only is better than hoping for the "cure" of insufficient resections margins with a combination of both methods. With regard to the necessary safety distances for a R0 resection, recommendations from the literature are heterogeneous. In addition to the distance measurement, the quality of the anatomic resection margins (e.g., fascia) is of great importance. A distinct recommendation of at least x millimeters or centimeters cannot be given based on the currently available data. The aim of the resection of a bone sarcoma should be a wide margin with the exception of chondrosarcoma (G1). Ultraradical resections which sacrifice vital structures in order to extend an already wide (R0) resection margin showed no significant benefits. In patients with osteosarcoma, adjuvant radiotherapy should be considered if resection or re-resection is not in sound tissue (R1). Patients with Ewing's sarcoma should not undergo resection if a contaminated margin is expected. In patients with chondrosarcoma, the available data as for example from pelvic tumors are contradictory and do not allow a clear recommendation.

Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is challenging but rewarding.

Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms. Using data from a large spine tumor center, we answered the following questions: (1) Does multilevel total en bloc spondylectomy result in acceptable function, survival rates, and local control in spinal neoplasms? (2) Is reconstruction after this procedure feasible? (3) What complications are associated with this procedure? (4) is it possible to achieve adequate surgical margins with this procedure? We retrospectively investigated 38 patients undergoing multilevel total en bloc spondylectomy by a single surgeon (AL) from 1994 to 2011. Indications for this procedure were primary spinal sarcomas, solitary metastases, and aggressive primary benign tumors involving multiple segments of the thoracic or lumbar spine. Patients had to be medically fit and have no visceral metastases. Analysis was by chart and radiographic review. Margin quality was classified into intralesional, marginal, and wide. Radiographs, MR images, and CT scans were studied for local recurrence. Graft healing and instrumentation failures at subsequent followup were assessed. Complications were divided into major or minor and further classified as intraoperative and early and late postoperative. We evaluated the oncologic status using cumulative disease-specific and metastases-free survival analysis. Minimum followup was 24 months (mean, 39 months; range, 24-124 months). Of the 38 patients, 34 (89%) were alive and walking without support at final followup. Thirty-one (81%) had no evidence of disease. Two patients died postoperatively and another two died of systemic disease (without local recurrence). Only three patients (8%) had a local recurrence. There were 14 major complications and 22 minor complications in 25 patients (65%). Only one patient required revision of implants secondary to mechanical failure. Two cases of cage subsidence were noted but had no clinical significance. Wide margins were achieved in nine patients (23%), marginal in 25 (66%), and intralesional in four (11%). In patients with multisegmental spinal tumors, oncologic resections were achieved by multilevel en bloc spondylectomy and led to an acceptable survival rate with reasonable local control. Multilevel en bloc surgery was associated with a high complication rate; however, most patients recovered from their complications. Although the surgical procedure is challenging, our encouraging mid-term results clearly favor and validate this technique. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Prognostic factors and outcome of spermatic cord sarcoma.

To evaluate management and outcome in a large series of patients with spermatic cord sarcomas (SCS), a rare malignancy. Eighty-two patients with localized SCS treated at two dedicated sarcoma units between 1992 and 2013 were included. Disease-specific survival (DSS) and crude cumulative incidence of local recurrence and distant metastases (DM) were estimated by Kaplan-Meier plots and log rank tests. Median follow-up was 33months (interquartile range 13-72months). Sixty-one patients presented with primary disease. Liposarcoma was the most common histotype, but surprisingly, 37% of tumors were of high grade. Seventeen patients (21%) received radiotherapy and 12 patients (15%) chemotherapy. Five-year DSS for the whole series was 92% [95% confidence interval (CI) 83-97]. Five-year rates of local recurrence and DM were 26% (95% CI 15-42) and 24% (95% CI 15-38), respectively. Tumor grade was found to be a significant predictor of both DSS and DM (both p<0.001). Quality of surgical margins was proved to affect the local outcome (p=0.025), while the rates of distant metastases were found to differ significantly by histology (p=0.010). Exclusively in the liposarcoma subgroup, quality of surgical margins was also directly associated with DSS (p=0.043). Wide excision of the tumor is critical for cure, especially in the liposarcoma subgroup. The role of radiotherapy and chemotherapy is not established.

“En bloc” resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases

"En bloc" resection of sacral chordomas (SC) with wide margins is statistically linked with a decrease of local recurrence (LR). Nevertheless, surgery potentially leads to complications and neurological deficits. The effectiveness of radiotherapy (RT) and chemotherapy (CT) remains controversial. The aim of the study was to evaluate the margins of tumor resection, the morbidity of "En bloc" resection of SC by combined anterior and posterior surgical approach and to look for predictive factors on survival and LR. We performed sacrococcygectomy by surgical combined approach in 29 SC between 1985 and 2012. We analyzed overall survival and survival to LR with survival analysis using Kaplan-Meier method. Complications and morbidity were reported. The mean follow-up was of 77.9 months (0-241 months). We found 18 (62.1%) postoperative infections and 7 (24.1%) wound dehiscences. Eighteen patients had tumor wide margins (62.1%), 6 marginal (20.7%) and 4 intralesional (13.8%). Seven patients had a LR (24.1%). OS rate was 84.4% at 5 and 10 years, survival rate with LR was 64 and 56%, respectively, after 5 and 10 years. Quality of margins (p = 0.106), tumor volume (p = 0.103), postoperative RT (p = 0.245) and postoperative local infection (p = 0.754) did not have effect on LR. "En bloc" resection by combined surgical approach seems to be a relevant alternative especially for SC invading the high sacrum above S3. Nevertheless, it yet remains the problem of postoperative infection. Systematic Adjuvant RT might allow better control on LR in association with surgery.

Short‐ and long‐term impact of body mass index on laparoscopic rectal cancer surgery

Obesity is associated with increased technical difficulty in laparoscopic surgery. However, its impact has been measured mainly for colectomy but not specifically for rectal excision. The aim of the study was to assess the impact of body mass index (BMI) on technical feasibility and oncological outcome of laparoscopic rectal excision for cancer. A total of 490 patients treated by laparoscopic rectal excision for rectal cancer from January 1999 to June 2010 were included. Seventy per cent had had preoperative radiochemotherapy. Patients were separated into four groups according to BMI (kg/m(2) ): < 20, 20-25, 25-30 and ≥ 30. The impact of BMI on conversion, surgical morbidity, quality of excision (Quirke mesorectal grade and circumferential resection margin) and long-term oncological outcome was determined. Among the 490 patients BMI was < 20 in 43, 20-25 in 223, 25-30 in 177 and ≥ 30 in 47. Mortality (overall 1%) and morbidity (overall 19%) were similar between the groups. Conversion in the four groups was 5%, 14%, 23% and 32% (P = 0.001). The quality of mesorectal excision and circumferential margins did not differ between the groups. The 5-year local recurrence rates (0%, 4.6%, 5.3% and 5.9% respectively; P = 0.823) and the overall and disease-free survival were not significantly influenced by BMI. In laparoscopic surgery for rectal cancer, BMI influenced the risk of conversion but not surgical morbidity, quality of surgery and survival. This suggests that all patients, including obese patients, are suitable for laparoscopic surgery.

Local control and sequelae in localised Ewing tumours of the spine: A French retrospective study

ObjectivesTo evaluate both local outcome and sequelae of non-metastatic spinal Ewing tumours (EWT). Patients and methodsA French cohort of patients ⩽50years with localised spinal EWT treated between 1988 and 2009, was analysed in regard to tumour characteristics (e.g. volume, vertebral compartment, spinal cord compression, paraspinal soft tissue invasion), local treatment modalities (surgery (S) and margin quality, radiotherapy (RT) dose), response to treatment (e.g. histological response to neoadjuvant chemotherapy (CT)), tumour local control (LC) and sequelae. ResultsSeventy-five patients treated in successive trials were evaluated for LC: SFOP-EW88 (n=14), SFOP-EW93 (n=17) and EuroEwing99 (n=44). Fifty-seven patients (79%) presented initial neurological compression and 69% had inaugural decompressive S. Local treatment modality was S+RT (n=50), RT alone (n=19) and S alone (n=6). Surgery was mainly intralesional (66%). Local recurrences had occurred in 19patients (14 local, 5 loco-regional) with a median interval of 25months (1–50). After a 7year median follow-up (1–22years), the 5-year LC, relapse-free survival (RFS) and overall survival (OS) reached 78.0% (95%CI: 62.6–84.6), 57.0% (95%CI: 45.2–68.9) and 70.0% (95%CI: 59.1–81.0), respectively. Vertebral compartment involved was the only prognostic factor (5-year LC rate 100% versus 71% for favourable and unfavourable compartment, p<0.03). Among 41 five-year survivors, we observed spinal curvature deformation (35%), growth retardation (28%), spinal reduction mobility (40%), spinal pain (25%) and neurological sequelae (32%) without any significant association with a particular local procedure. ConclusionRT is the backbone of a successful local treatment of spinal EWT. The place of S remains a pending question. Its actual benefit will likely evolve with new available RT techniques.

Impact of Complete Bladder Neck Preservation on Urinary Continence, Quality of Life and Surgical Margins After Radical Prostatectomy: A Randomized, Controlled, Single Blind Trial

Impact of Complete Bladder Neck Preservation on Urinary Continence, Quality of Life and Surgical Margins After Radical Prostatectomy: A Randomized, Controlled, Single Blind Trial

Impact of Complete Bladder Neck Preservation on Urinary Continence, Quality of Life and Surgical Margins After Radical Prostatectomy: A Randomized, Controlled, Single Blind Trial

We investigated the influence of bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy. A total of 208 men who presented for radical prostatectomy were randomized to complete bladder neck preservation with subsequent urethro-urethral anastomosis or to no preservation as controls. Patients with failed bladder neck preservation were not included in study. We documented objective continence by the 24-hour pad test, social continence by the number of pads per day and quality of life outcomes by the validated Incontinence Quality of Life questionnaire in a single blind setting. Cancer resection was assessed by surgical margin status. At 0, 3, 6 and 12 months mean urine loss in the control vs the bladder neck preservation group was 713.3 vs 237.0, 49.6 vs 15.6, 44.4 vs 5.5 and 25.4 vs 3.1 gm, respectively (each p <0.001). At 3, 6 and 12 months in the control vs the preservation group the social continence rate was 55.3% vs 84.2% (p <0.001), 74.8% vs 89.5% (p = 0.05) and 81.4% vs 94.7% (p = 0.027), and the quality of life score was 80.4 vs 90.3 (p <0.001), 85.4 vs 91.7 (p = 0.016) and 86.0 vs 93.8 (p = 0.001), respectively. We noted significantly less urine loss, higher objective and social continence rates, and higher quality of life scores after complete bladder neck preservation at all followup points. On multiple logistic regression analysis complete bladder neck preservation was an independent positive predictor of continence. No significant difference was found in surgical margin status between the control and bladder neck preservation groups (12.5% vs 14.7%, p = 0.65). In what is to our knowledge the first prospective, randomized, controlled, single blind trial complete bladder neck preservation during radical prostatectomy was associated with a significantly higher urinary continence rate and increased patient satisfaction without compromising resection margins.

Intérêt de la réalisation de recoupes systématiques dans la chirurgie conservatrice du cancer du sein

The quality of surgical margins in lumpectomy are strong criteria to define risk of locoregional recurrence when conservative treatment is undertaken. Intraoperatively, the limits of adequate resection are sometimes difficult to define. This is why some teams propose the realization of systematic cavity margins during the excision of lumpectomy during the same operation. We expose the potential benefits of this type of practice using data from the literature.

Assessing the groundwater quality by applying fuzzy logic in GIS environment– A case study in Southwest Iran

Water quality is a key environmental issue concerning the agricultural sector. Here, the application of fuzzy set theory for decision-making in the assessment of groundwater quality for agricultural purposes is being discussed. The experiments conducted in this study area located, Shahrekord plain that, lies in the Chaharmahal and Bakhtiari province, in the southwest Iran. Four groundwater parameters (EC, Mg, Na and Ca) are selected for water quality analysis and thematic maps are drawn for each of the parameters with the Kriging model. Different Fuzzy membership functions obtained from the related literature were employed and the weights for each parameter were calculated according to Analytic Hierarchy Process (AHP) that relies on pair wise comparisons. The Fuzzy theory showed 14.22% of the study area as having high groundwater quality, 19.86% as having moderate quality, 48.90% as having margin quality and 16.99% as having poor quality. In order to evaluate the accuracy of this method, eight different points were randomly selected. It is concluded that the Fuzzy method allows for obtaining results that correspond to the current conditions in the study area.