Wide Margin Research Articles

Determining optimal clinical target volume margins based on microscopic extracapsular extension of metastatic nodes in patients with non-small-cell lung cancer after chemotherapy or chemotherapy combined with immunotherapy

BackgroundNo standard has been established for the clinical target volume (CTV) margins of lymph nodes (LNs) in patients with non-small-cell lung cancer (NSCLC) receiving chemotherapy or chemotherapy combined with immunotherapy followed by radiotherapy. This study aimed to discuss the CTV range of NSCLC after chemotherapy or chemotherapy combined with immunotherapy by observing the microscopic extent of tumor spread beyond the LN capsule.MethodsWe retrospectively analyzed the data of 240 patients with stage II and III NSCLC who underwent surgery without neoadjuvant therapy, with neoadjuvant chemotherapy (NAC), or with NAC combined with immunotherapy (NACI). We measured the maximal distance of extracapsular extension (ECE) using a digital microscope, analyzed the correlation between clinicopathological features and ECE distance, and determined the CTV margins of metastatic LN under different treatment methods.ResultsThe ECE distance differed significantly among the three groups (p < 0.001). We determined appropriate margin widths based on a 5% error risk as 3.00, 2.30, and 1.40 mm for direct surgery, NAC, and NACI, respectively. Multivariate analysis revealed that the ECE of metastatic LN correlated with the treatment methods and LN size.ConclusionThe existing CTV delineation standards may increase the radiation toxicity of patients. We believe that different CTV margins should be used for LN in patients with NSCLC receiving different treatments. To ensure 95% coverage of ECE, the gross tumor volume of untreated, chemotherapy-treated, and chemotherapy combined with immunotherapy-treated patients should be expanded by 3.00, 2.30, and 1.40 mm, respectively, to obtain the CTV.

Significance of anatomical resection and wide surgical margin for HCC patients with MVI undergoing laparoscopic hepatectomy: A multicenter study

ObjectiveTo investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR). MethodsA retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR). ResultsIn the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %. ConclusionsAnatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.

Cost-effectiveness analysis of Tumor Treating Fields treatment in Chinese patients with metastatic non-small cell lung cancer.

The LUNAR trial demonstrated the significant efficacy and safety of Tumor Treating Fields (TTFields) plus standard-of-care (SOC) [immune checkpoint inhibitor (ICI) and docetaxel (DTX)] for patients with previously treated metastatic non-small cell lung cancer (mNSCLC). However, it remains uncertain as to whether the high costs are justified by the corresponding survival benefits. Here, the cost-effectiveness of using TTFields plus SOC for treating mNSCLC was evaluated from the perspective of the Chinese healthcare system. A Markov model with a 15-year time horizon was established and used to comparedeveloped to enable the simulation of treatment-associated costs and patient outcomes when comparing TTFields plus SOC to SOC alone. Primary outcomes for these analyses included total costs, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER) values. The impact of paramere uncertainty on model outcomes was evaluated through sensitivity analyses. Additional subgroup and scenario analyses were also performed to extend these results. While TTFields plus SOC exhibited a $74,688 increase in total costs relative to SOC ($96,092 vs. $21,404), it was associated with 0.38 additional QALYs (1.08 vs. 0.82 QALYs) for an ICER of $284,490/QALY. This value exceeded the $35,983/QALY willingness-to-pay (WTP) threshold selected for these analyses by a wide margin. Relative to ICI and DTX treatment, the incremental costs of TTFields plus ICI and TTFields plus DTX were $78,115 and $71,307, respectively, with corresponding gains of 0.42 and 0.13 QALYs, yielding ICERs of $187,434/QALY, and $546,386/QALY. The parameter that most strongly impacted the results of these analyses was the cost of TTFields. The results indicated that given current treatment costs, TTFields plus SOC was insufficiently cost-effective in treating patients with mNSCLC in China, although TTFields plus ICI yields substantial health benefits.

Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.

A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions. This case highlights the rare potential of a previously benign BPOP to undergo malignant transformation after recurrence. A wide margin resection may be considered primarily when surgery is indicated to prevent recurrence and its potential sequelae. [Orthopedics. 202x;4x(x):xx-xx.].

Image-Guided Breast Conserving Surgery

Background: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p&lt;0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p&lt;0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p&lt;0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach.

Radiation-Induced Breast Angiosarcoma-A Single-Institution Experience.

Introduction: Radiation-induced breast angiosarcoma (RIBAS) is a rare adverse event associated with postoperative breast irradiation. The data from the literature indicate that RIBAS occurs in less than 0.3% of patients treated with adjuvant radiotherapy for breast cancer. Given the rarity, diverse clinical presentation, poor prognosis, and lack of consensus on the management, this study aimed to present experiences of our specialized cancer center with RIBAS, in terms of the incidence, presentation, management, and outcomes. Methods: We reviewed the medical records of 10,834 breast cancer patients treated at the Institute for Oncology and Radiology of Serbia between January 2013 and June 2024 to detect patients that had breast-conserving surgery, followed by postoperative irradiation, and developed angiosarcoma in the irradiated area at least 3 years after radiotherapy, without distant metastases. The incidence, latency period, management, and treatment outcomes were analyzed. Results: A total of nine female patients with RIBAS were identified and included in this study. The median age at RIBAS diagnosis was 64 years (range: 36-68), with a median latency of 64 months (95% CI > 57) from irradiation to diagnosis. The mean tumor size was 55 mm (SD 32.78). Patients were followed for a median of 30 months (range: 7-40) after initial RIBAS surgery. Local recurrence occurred in seven patients (77.8%), with five undergoing re-do surgery with curative intent. Three patients developed distant metastases during follow-up. The median overall survival (OS) was 31 months (95% CI > 30), with a 3-year survival rate of 15.2% (95% CI 2.5-91.6%). The median local recurrence-free interval was 10 months (95% CI > 3). Median OS after RIBAS local recurrence and after breast cancer treatment was 17 months (95% CI > 15) and 108 months (95% CI > 88), respectively. Conclusions: RIBAS is a rare but increasingly prevalent adverse event associated with BC irradiation, marked by an aggressive disease course and high relapse rates. Awareness, prompt diagnosis, and a radical surgical approach with wide clear margins are critical for improving patients' outcomes.

Can transcutaneous bilirubinometry safely be used to monitor rebound hyperbilirubinaemia after phototherapy in neonates ≥35 weeks’ gestation? A prospective, comparative study

IntroductionThere is insufficient evidence to determine if non-invasive transcutaneous bilirubin (TcB) measurement can replace serum bilirubin (SBR) in assessing rebound hyperbilirubinaemia after phototherapy.ObjectiveTo investigate if TcB can safely guide management...

Dedifferentiated liposarcoma of the extremities: a Korean multi-center study of 107 cases

BackgroundDedifferentiated liposarcoma of the extremities (DDL-E) is rare in comparison to that of the retroperitoneum. Its clinical features and surgical principle for resection margins at the dedifferentiated and the well-differentiated components are yet to be elucidated.MethodsThis retrospective multi-center study examined patients diagnosed with DDL-E from August 2004 to May 2023 at 5 sarcoma centers. Clinical features, oncologic outcomes, and prognostic factors were analyzed.ResultsA total of 107 patients were reviewed. The 5-year local recurrence free survival (LRFS), metastasis-free survival (MFS) and disease specific survival (DSS) were 84.7%, 78.6%, and 87.8%, respectively. Other primary malignancies and extrapulmonary metastasis were observed in 27 and 4 patients, respectively. The independent risk factor for local recurrence was R1/2 margin at the dedifferentiated component of the tumor. Metastasis was associated with tumor size in univariate analysis. The independent risk factor for DSS was tumor grade. Previous unplanned excision, de novo presentation, tumor depth, absence of the well-differentiated component, infiltrative border, R1/2 margin at the well-differentiated component were not associated with oncologic outcomes.ConclusionsThis is the largest study examining DDL-E to-date. Localized DDL-E has low potential for metastasis and carries an excellent prognosis. Other primary malignancy and extrapulmonary metastasis are more frequent in DDL-E, thus close monitoring of other sites during follow-up is recommended. While wide resection margin is the standard surgical approach for DDL-E, further investigation into moderated wide resection margin at the well-differentiated component is warranted.

Indocyanine green fluorescence identification of the intersegmental plane by the target segmental vein-first single-blocking during thoracoscopic segmentectomy

BackgroundInnovative attempt to explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane by the target segmental veins preferential ligation during thoracoscopic segmentectomy.MethodsA retrospective analysis was conducted on clinical data of 32 consecutive patients who underwent thoracoscopic segmentectomy with intersegmental plane identification using both ICGF and inflation-deflation method after target segmental veins prioritized blocking at Nanjing Chest Hospital from December 2022 to June 2023. Preoperative three-dimensional reconstruction was used to identify the target segment and the anatomical structure of the arteries, veins, and bronchi. After ligating the target segmental veins during surgery, the first intersegmental plane was immediately identified and marked with an electrocoagulation device using an inflation-deflation method. Subsequently, the second intersegmental plane was determined using the ICGF method. Finally, the consistency of the two intersegmental planes was evaluated.ResultsAll the 32 patients successfully completed thoracoscopic segmentectomy without ICG-related complications and perioperative death. The average operation time was (98.59 ± 20.72) min, the average intraoperative blood loss was (45.31 ± 35.65) ml, and the average postoperative chest tube removal time was (3.5 ± 1.16) days. The average postoperative hospital stay was (4.66 ± 1.29) days, and the average tumor margin width was (26.96 ± 5.86) mm. The intersegmental plane determined by ICGF method was basically consistent with inflation-deflation method in all patients.ConclusionThe ICGF can safely and accurately identify the intersegmental plane by target segmental veins preferential ligation during thoracoscopic segmentectomy, which is a beneficial exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.

A Nomogram Using Imaging Features to Predict Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ.

To develop a nomogram that integrates clinical-pathologic and imaging variables to predict ipsilateral breast tumor recurrence (IBTR) in women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS). This retrospective study included consecutive women with DCIS who underwent BCS at two hospitals. Patients who underwent BCS between 2003 and 2016 in one hospital and between 2005 and 2013 in another were classified into development and validation cohorts, respectively. Twelve clinical-pathologic variables (age, family history, initial presentation, nuclear grade, necrosis, margin width, number of excisions, DCIS size, estrogen receptor, progesterone receptor, radiation therapy, and endocrine therapy) and six mammography and ultrasound variables (breast density, detection modality, mammography and ultrasound patterns, morphology and distribution of calcifications) were analyzed. A nomogram for predicting 10-year IBTR probabilities was constructed using the variables associated with IBTR identified from the Cox proportional hazard regression analysis in the development cohort. The performance of the developed nomogram was evaluated in the external validation cohort using a calibration plot and 10-year area under the receiver operating characteristic curve (AUROC) and compared with the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram. The development cohort included 702 women (median age [interquartile range], 50 [44-56] years), of whom 30 (4%) women experienced IBTR. The validation cohort included 182 women (48 [43-54] years), 18 (10%) of whom developed IBTR. A nomogram was constructed using three clinical-pathologic variables (age, margin, and use of adjuvant radiation therapy) and two mammographic variables (breast density and calcification morphology). The nomogram was appropriately calibrated and demonstrated a comparable 10-year AUROC to the MSKCC nomogram (0.73 vs. 0.66, P = 0.534) in the validation cohort. Our nomogram provided individualized risk estimates for women with DCIS treated with BCS, demonstrating a discriminative ability comparable to that of the MSKCC nomogram.

Evaluation of Marginal Adaptation of SDR Plus, Fiber-Reinforced and Nanofilled Composites in Endodontically Treated Teeth: A Scanning Electron Microscopic Study.

Endodontically treated teeth (ETT) undergo structural changes, including a reduction in water content and loss of dentin elasticity, which can compromise their mechanical properties. One critical factor influencing the long-term prognosis of a restored ETT is the marginal adaptation of the restorative material. The present study compared the marginal adaptability of Smart Dentin Replacement (SDR) Plus, fiber-reinforced, and nanofilled composites in ETT using scanning electron microscopy (SEM). Cavities were made in 30 recently extracted maxillary premolars distributed into three experimental groups depending on the restorative material used: group 1 as SDR Plus (Dentsply Sirona, Charlotte, North Carolina, USA), group 2 as fiber-reinforced composite (EverX, GC Corp., Tokyo, Japan), and supra nanofilled composite (Estelite Sigma Quick, Tokuyama Dental Corp., Tokyo, Japan). Standardized access openings were performed, and endodontic treatment was completed in all teeth. Specific composite restoration techniques were applied according to the manufacturer's instructions. After thermocycling for 30 days, the restored teeth were sectioned and viewed using SEM (Labindia Instruments Pvt. Ltd., Maharashtra, India) to measure the width of the marginal gap. The data were analyzed using statistical software. The mean marginal gap width varied significantly among the groups. Group 1 had a lower mean marginal gap of 2.99 μm, group 2 exhibited the highest mean marginal gap of 10.24 μm, and group 3 had a mean marginal gap of 5.51 μm. Overall, group 2 consistently showed significantly larger marginal gaps than the other groups. Within the limitations of this study, SDR Plus demonstrated better marginal adaptation than fiber-reinforced and supra-nanofilled resins in the coronal restoration of ETT. Fiber-reinforced composites demonstrated the maximum marginal gap, followed by nanofilled composites. Thus, SDR Plus may be recommended as a suitable restorative material to enhance the longevity and success of endodontic treatments.

Postoperative surgical margin results of the phyllodes tumors from a tertiary hospital.

Phyllodes tumors in the breast are exceptionally uncommon fibroepithelial tumors. In the literature, they are typically categorized as benign phyllodes tumor, borderline phyllodes tumor, and malignant phyllodes tumor. This study aims to assess and present the clinical and surgical outcomes of patients diagnosed with phyllodes tumor. The outcomes of patients aged 18 years and above diagnosed with phyllodes tumor between 2006 and 2023 were retrospectively reviewed. Patients were grouped as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared by clinical and surgical results. Of all 57 patients with phyllodes tumor, 64.9% (n=37) were benign phyllodes tumor and 35.1% (n=20) were borderline/malignant phyllodes tumor [22.8% (n=13) borderline phyllodes tumor and 12.3% (n=7) malignant phyllodes tumor]. When the patients were divided into two groups as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared, our cumulative (total) recurrence rate was 14.0%, with final surgical margin width between groups [(0<final surgical margin<2 mm vs final surgical margin≥2 mm) (p=0.154)] and recurrence [(8.1% benign phyllodes tumor vs 25.0% borderline/malignant phyllodes tumor) (p=0.080)]; there was no significant difference between our rates. Phyllodes tumors of the breast can be followed up with a narrow negative surgical margin (0 mm<final surgical margin<2 mm). However, after the initial surgery, re-excision is recommended for positive margins, while a wider surgical margin (≥10 mm) is not necessary for excision.

A Foundation Language-Image Model of the Retina (FLAIR): encoding expert knowledge in text supervision

Foundation vision-language models are currently transforming computer vision, and are on the rise in medical imaging fueled by their very promising generalization capabilities. However, the initial attempts to transfer this new paradigm to medical imaging have shown less impressive performances than those observed in other domains, due to the significant domain shift and the complex, expert domain knowledge inherent to medical-imaging tasks. Motivated by the need for domain-expert foundation models, we present FLAIR, a pre-trained vision-language model for universal retinal fundus image understanding. To this end, we compiled 38 open-access, mostly categorical fundus imaging datasets from various sources, with up to 101 different target conditions and 288,307 images. We integrate the expert’s domain knowledge in the form of descriptive textual prompts, during both pre-training and zero-shot inference, enhancing the less-informative categorical supervision of the data. Such a textual expert’s knowledge, which we compiled from the relevant clinical literature and community standards, describes the fine-grained features of the pathologies as well as the hierarchies and dependencies between them. We report comprehensive evaluations, which illustrate the benefit of integrating expert knowledge and the strong generalization capabilities of FLAIR under difficult scenarios with domain shifts or unseen categories. When adapted with a lightweight linear probe, FLAIR outperforms fully-trained, dataset-focused models, more so in the few-shot regimes. Interestingly, FLAIR outperforms by a wide margin larger-scale generalist image-language models and retina domain-specific self-supervised networks, which emphasizes the potential of embedding experts’ domain knowledge and the limitations of generalist models in medical imaging. The pre-trained model is available at: https://github.com/jusiro/FLAIR.

Toxicity Potential of Nutraceuticals.

During the past few decades and especially during and after the COVID-19 pandemic, the use of nutraceuticals has become increasingly popular in both humans and animals due to their easy access, cost-effectiveness, and tolerability with a wide margin of safety. While some nutraceuticals are safe, others have an inherent toxic potential. For a large number of nutraceuticals, no toxicity/safety data are available due to a lack of pharmacological/toxicological studies. The safety of some nutraceuticals can be compromised via contamination with toxic plants, metals, mycotoxins, pesticides, fertilizers, drugs of abuse, etc. Knowledge of pharmacokinetic/toxicokinetic studies and biomarkers of exposure, effect, and susceptibility appears to play a pivotal role in the safety and toxicity assessment of nutraceuticals. Interaction studies are essential to determine efficacy, safety, and toxicity when nutraceuticals and therapeutic drugs are used concomitantly or when polypharmacy is involved. This chapter describes various aspects of nutraceuticals, particularly their toxic potential, and the factors that influence their safety.

Exploring the Potentials of Digital Economy for Accelerated Economic Growth and Sustainable GDP in Nigeria’s Agricultural Sector

Purpose: The study investigated the potentials of the digital economy for accelerated economic growth in Nigeria. Specifically, the study was guided by the following objectives; potential of the digital economy for accelerated economic growth and sustainable GPD, constraints to attaining the utilization of the digital economy for accelerated economic growth and sustainable GDP and ways of improving the implementation of digital economy for accelerated economic growth and sustainable GDP. Theoretical Reference: Diffusion of Innovation (DOI) Theory, developed by E.M. Rogers in 1962, formed the theoretical foundation of this study. It originated to explain how, over time, an idea or product gains momentum and diffuses (or spreads) through a specific population or social system. The result of this diffusion is that people, as part of a social system, adopt a new idea, behavior, or product. Method: The descriptive survey design was adopted using 130 farmers selected through a convenience sampling approach in the four North Central States of Nasarawa, Benue, Plateau and Niger including the FCT Abuja. Data was gathered using closed-ended questionnaires and measured using modified three-point Likert Scale of Agree = 3, Uncertain = 2 and Disagree = 1. The Lawshe’s formula yielded a content validity ratio (CVR) of 0.99, which confirmed the representativeness and clarity of the questionnaire. A reliability coefficient alpha (r - coefficient) of 0.84 was reported by Cronbach Alpha to determine the internal consistency of the questionnaire. The data was collected on the spot and analyzed using frequency counts (f) and percentages (%), and presented in tables and graphs. Results/Conclusion: The findings showed that the farmers understood clearly the potential of the digital economy in creating jobs and accelerating their economic status and contributing significantly to a sustainable GDP in Nigeria if properly utilized. However, the attainment of these enormous benefits to farmers is affected by the reduction in access to the Internet, affordability and quality of service, training and government support. Digital economy could boost agricultural production with wide project margin if infrastructure for implementation are available and utilization is effective. The study recommended the provision of broadband sufficient to provide extensive access to the Internet in order to accelerate utilization and improve productivity, especially among rural dwellers. Implication: Understanding the potential offered by embracing and utilizing the digital economy, as well as the difficulties and strong tactics farmers must employ to successfully capitalize on these advances in order to boost GDP and economic growth in Nigeria's agriculture sector Originality/Value: The originality of this investigation lay in its empirical evidence regarding the potentials, challenges, and strategies for enhancing farmers' utilization to support economic growth and GDP in the agricultural sector, which helped to expand the body of literature on digital economy in the agricultural sector, particularly in Nigeria.

Reassigned surgical margins after neoadjuvant chemotherapy results in low local recurrence in dogs with mast cell tumours.

Neoadjuvant chemotherapy (NAC) is delivered before surgery to allow less extensive tumour resection, but the optimal surgical margin width after NAC is unknown. The aim of this study was to determine the impact of reassigned margins on local recurrence after NAC in dogs with mast cell tumours (MCTs). A retrospective analysis was conducted for dogs with MCTs undergoing NAC consisting of vinblastine and prednisolone, subsequent tumour resection and lymphadenectomy, and a minimum follow-up of 6 months. Surgical margins were reassigned based on the size of the MCT after NAC. Pre- and post-NAC measurements of MCTs were recorded. The margin status was assessed with a combined radial and tangential sectioning technique; pre-NAC MCT cytograde and lymph node (LN) cytological status were compared with the Kiupel grade and Weishaar stage, respectively. Twenty-two dogs were included. MCT shrinkage after NAC consistently occurred, with a median reduction rate of 40.4% (range 5%-94.5%). Margins were complete in 15 of 22 dogs, and two MCTs and three LNs appeared histologically downgraded and downstaged, respectively. Two (9.1%) MCTs recurred. The limitations of this study were the small sample size and relatively short follow-up. NAC leads to shrinkage of canine MCTs, with the resulting reassigned surgical margins being associated witha low recurrence rate.

En Bloc Total Vertebrectomy of the Thoracic and Lumbar Spine.

Background/Objectives: We evaluated the outcomes of patients undergoing en bloc total vertebrectomy at our institution within the last three decades. The aim of our study was to analyse the oncological and neurological outcomes and the changes over time. Methods: We included 22 consecutive patients treated with a total vertebrectomy at our institution between January 1990 and December 2022. The standard follow-up protocol for sarcoma patients was performed. Early complications were defined as complications within the first three months postoperatively. Local recurrence was defined as the reoccurrence of a tumour at least four months after surgery. Adequate statistical methods were applied to evaluate the survival rates and the influence of potential risk factors. A p-value of <0.05 was considered statistically significant. Results: From 1990 to 2010, five total vertebrectomies were performed each decade, whereas twelve patients underwent the procedure in the period from 2010 to 2022. The mean follow-up period was 101.25 months (±112; 2-339). The one-, five- and ten-year overall survival rates were 91% (CI = (0.79; 1.00)), 59% (CI = (0.37; 0.81)) and 51% (CI = (0.27; 0.75)), respectively. For soft tissue tumours, the average overall survival was 6.2 years, whereas, for bone sarcomas, it was 13.6 years. None of the patients with wide surgical margins developed local recurrence. Complications necessitating revision procedures occurred in 54% of all cases. Conclusions: A total vertebrectomy is a highly demanding procedure, requiring accurate patient selection, meticulous preoperative planning and a highly collaborative interdisciplinary team. Adequate surgical treatment seems to be indispensable when aiming for curative treatment. Owing to the rarity of the indications, this procedure should be restricted to large tumour centres.

Bridging Structure- and Ligand-Based Virtual Screening through Fragmented Interaction Fingerprint.

Ligand-based virtual screening (LBVS) and structure-based virtual screening (SBVS), and their combinations, are frequently conducted in modern drug discovery campaigns. As a form of combination, an amalgamation of methods from ligand- and structure-based information, termed hybrid VS approaches, has been extensively investigated such as using interaction fingerprints (IFPs) in combination with machine learning (ML) models. This approach has the potential to prioritize active compounds in terms of protein-ligand binding and ligand structural characteristics, which is assumed to be difficult using either one of the approaches. Herein, we present an IFP, named the fragmented interaction fingerprint (FIFI), for hybrid VS approaches. FIFI is constructed from the extended connectivity fingerprint atom environments of a ligand proximal to the protein residues in the binding site. Each unique ligand substructure within each amino acid residue is encoded as a bit in FIFI while retaining sequence order. From the retrospective evaluation of activity prediction using a limited number and variety of active compounds for six biological targets, FIFI consistently showed higher prediction accuracy than that using previously proposed IFPs. For the same data sets, the screening performance of LBVS, SBVS sequential VS, parallel VS, and other hybrid VS approaches was investigated. Compared to these approaches, FIFI in combination with ML showed overall stable and high prediction accuracy, except for one target: the kappa opioid receptor, where the extended connectivity fingerprint combined with ML models showed better performance than other approaches by wide margins.

NEFELI: A deep-learning detection and tracking pipeline for enhancing autonomy in advanced air mobility

Efficient detection and accurate collision estimation for non-cooperative aerial vehicles are crucial for the realization of fully autonomous aircraft and Advanced Air Mobility (AAM). This paper introduces NEFELI, a machine learning software utilizing optical sensors to detect and track non-cooperative aerial vehicles. NEFELI's detector employs an enhanced YOLOv5-large model, strengthened with a sliced inference step to enhance detection capabilities for distant, diminutive objects. Furthermore, NEFELI introduces several innovations in its tracking component. A key advancement lies in the creation and utilization of the first large-scale re-identification (Re-ID) dataset of aerial objects. This dataset is used to train the deep learning appearance (Re-ID) model of the tracking module and integrates appearance information into the detection and tracking pipeline, resulting in more robust and reliable tracking performance. Moreover, the tracking model combines the deep learning appearance model with a Kalman Filter-based motion model to address the challenge of precisely tracking distant aerial objects. Notably, an extensive comparative analysis that was conducted showed that NEFELI outperforms state-of-the-art detection and tracking models in terms of Higher Order Tracking Accuracy (HOTA) metric, ID switches, and Association Accuracy (AssA) by a wide margin. A crucial aspect of this work is NEFELI's software architecture design, which enables efficient implementation on a low SWaP (Size, Weight, and Power) edge Graphic Processing Unit (GPU). To further showcase NEFELI's generalization capabilities and edge implementation performance, real-world flight experiments with small UAVs were carried out. The experimental results demonstrate NEFELI's ability to detect and track small UAVs at distances of up to 145 m in real-time speed of 6.7 fps.

An ensemble machine learning-based approach to predict thyroid disease using hybrid feature selection

Thyroid issues are becoming more and more common, and early detection is critical for therapy that reduces mortality and complications. Because of these factors, detecting thyroid problems has become more crucial in the medical field. Estimating the course of a disease accurately and understanding how clinical features interact are critical for medical diagnosis and treatment. All of these limits are overcome in our study by using a standard machine-learning model with proper clinical feature analysis and an ensemble-learning technique. Predicting sickness progression and the interdependence of clinical features or aspects are critical in medical diagnosis and therapy. However, machine learning has enabled us to detect the risk factors for this sickness. To select the best thyroid prediction outcome, we used five machine learning models in addition to the Ensemble ML classifier (hard voting). Class balancing approaches greatly increase classification performance. It has been demonstrated that using random oversampling improves classification results dramatically. Based on the experimental data, our suggested model outperforms existing methods by a wide margin. Using the XGBoost and SelectKBest feature selection strategies, the Ensemble ML classifier achieves the best results on hard voting on RF and DT, with 100 % sensitivity and 99.71 % accuracy. When features are decreased and the issue of high-class imbalance is addressed, the ensemble ML classifier (hard voting) performs better in dealing with classification challenges.