Oncological and surgical outcome after oncoplastic breast surgery

BACKGROUND

Oncoplastic surgery combines breast-conserving treatment and plastic surgery techniques. The aim of the study was to identify breast and tumor-related characteristics that contribute to the rate of complications and recurrence.

METHODS

This retrospective study included 72 patients with a median follow-up of 32 months. For each patient, a comprehensive set of data was collected, including epidemiology, tumor characteristics, preoperative information, detailed pathology reports, radiotherapy treatment and type of surgical technique. The rate of complications, recurrence and survival were studied.

RESULTS

Complete tumor removal was performed with clear margins in all patients but in 25 of them margins were less than 2 mm. One patient had local recurrence and another developed distant metastases. The study showed that the size of the margin was not predictive of recurrence as long as not positive; the greater the resection volume, the larger the excision margin. The resection size was the only factor influencing complications and no specific tumor-related factor significantly increased the complication rate. Surgical complications did not delay the initiation of chemotherapy and radiotherapy.

CONCLUSIONS

This is the first oncoplastic study where both tumor and breast characteristics were analyzed using the most recent criteria of the literature. Oncoplastic surgery can be considered as oncologically safe. The resection size was the sole significant risk factor for postoperative complications. Complications after oncoplastic breast surgery did not differ neoadjuvant therapy. Long-term event-free survival was excellent (96% at 7 years).

Oncological and Surgical Outcome after Oncoplastic Breast Surgery

BACKGROUND

Oncoplastic surgery combines breast-conserving treatment and plastic surgery techniques. The aim of the study was to identify breast and tumor-related characteristics that contribute to the rate of complications and recurrence.

MATERIAL & METHODS

This retrospective study included 72 patients with a median follow-up of 32 months. For each patient, a comprehensive set of data was collected, including epidemiology, tumor characteristics, preoperative information, detailed pathology reports, radiotherapy treatment and type of surgical technique. The rate of complications, recurrence and survival were studied.

RESULTS

Complete tumor removal was performed with clear margins in all patients but in 25 of them margins were less than 2 mm. One patient had local recurrence and another developed distant metastases. The study showed that the size of the margin was not predictive of recurrence as long as not positive; the greater the resection volume, the larger the excision margin. The resection size was the only factor influencing complications and no specific tumor-related factor significantly increased the complication rate. Surgical complications did not delay the initiation of chemotherapy and radiotherapy.

CONCLUSION

This is the first oncoplastic study where both tumor and breast characteristics were analyzed using the most recent criteria of the literature. Oncoplastic surgery can be considered as oncologically safe. The resection size was the sole significant risk factor for postoperative complications. Complications after oncoplastic breast surgery did not differ neoadjuvant therapy. Long-term event-free survival was excellent (96% at 7 years).

Depth of remission in Crohn's disease patients seen in a referral centre : associated factors and impact on disease outcome

INTRODUCTION

Our goals were to assess the prevalence of biological and tissue remission in routine practice in Crohn's disease, and to evaluate the correlation between biological or tissue remission and clinical or demographic characteristics as well as their impact on disease outcome.

METHODS

We performed a retrospective monocenter study. Biological remission was defined by a CRP < 5 mg/I. Tissue remission was defined by the absence of ulcer at endoscopy and/or absence of signs of acute inflammation at MRI. Association with demographic, clinical and laboratory markers was studied by logistic regression models and rates of relapses, hospitalizations and surgeries were compared using the logrank test.

RESULTS

Among the 263 patients included, 147 were in clinical remission; 102/147 (69%) were in biological remission. Fifty-six patients also had morphological evaluation: 37 (66%) were in tissue remission. Biological remission was associated with older age, higher hemoglobin and lower BMI. Tissue remission was associated with older age, lower platelets count, absence of previous surgery, and the use of immunosuppressant. Time-to-relapse was significantly longer in patients with biological remission and in patients with tissue remission as compared to patients without biological or tissue remission.

CONCLUSIONS

Among the patients in clinical remission seen as outpatients, two thirds were either in biological and/or tissue remission. Biological and/or tissue remission was associated with a better outcome than clinical remission alone.

Serum calprotectin as a biomarker for Crohn's disease

BACKGROUND AND AIMS

In Crohn's disease, correlation between clinical assessment and disease activity at tissue level is weak. Our aim was to evaluate the value of serum calprotectin as a biomarker for Crohn's disease.

METHODS

The STORI trial patients (n=115) were studied at baseline, in clinical remission before infliximab withdrawal, or at the time of relapse after infliximab withdrawal. Forty healthy controls were also studied. Serum calprotectin level was measured by ELISA. Data were analyzed through correlation analyses, Kaplan Meier curves and Cox model, using available Crohn's Disease Activity Index (CDAI), Crohn's Disease Endoscopic Index of Severity (CDEIS), fecal calprotectin and C-reactive protein levels (hsCRP).

RESULTS

Median serum calprotectin was 8892 ng/mL (range: 410-125,000 ng/mL) in Crohn disease patients as compared with 1318 ng/mL (range: 215.8-3770 ng/mL) in controls (P<0.0001). Serum calprotectin was significantly higher for active disease (median=19,584 ng/mL) than for inactive disease (median=8353 ng/mL) (P<0.0001). Serum calprotectin correlated with hsCRP (r=0.4092, P<0.0001) and CDAI (r=0.4442, P<0.0001), but not with CDEIS, on the contrary to fecal calprotectin (r=0.6458, 0.5515, 0.2577 with P<0.0001, P<0.0001, P=0.019 respectively). In multivariate analysis, serum calprotectin used as a discrete variable (threshold: 5675 ng/ml), appeared complementary to hsCRP (>5 mg/l) and fecal calprotectin (>250 μg/g) to predict relapse after infliximab withdrawal (P=0.0173, 0.0024 and 0.0002; HR: 3.191, 3.561 and 4.120).

CONCLUSIONS

As a CD biomarker, serum calprotectin has a similar profile as hsCRP. It is also complementary to fecal calprotectin and hsCRP for prediction of relapse after infliximab withdrawal.

Pressure dependent product formation in the photochemically initiated allyl + allyl reaction

Photochemically driven reactions involving unsaturated radicals produce a thick global layer of organic haze on Titan, Saturn's largest moon. The allyl radical self-reaction is an example for this type of chemistry and was examined at room temperature from an experimental and kinetic modelling perspective. The experiments were performed in a static reactor with a volume of 5 L under wall free conditions. The allyl radicals were produced from laser flash photolysis of three different precursors allyl bromide (C3H5Br), allyl chloride (C3H5Cl), and 1,5-hexadiene (CH2CH(CH2)2CHCH2) at 193 nm. Stable products were identified by their characteristic vibrational modes and quantified using FTIR spectroscopy. In addition to the (re-) combination pathway C3H5+C3H5 → C6H10 we found at low pressures around 1 mbar the highest final product yields for allene and propene for the precursor C3H5Br. A kinetic analysis indicates that the end product formation is influenced by specific reaction kinetics of photochemically activated allyl radicals. Above 10 mbar the (re-) combination pathway becomes dominant. These findings exemplify the specificities of reaction kinetics involving chemically activated species, which for certain conditions cannot be simply deduced from combustion kinetics or atmospheric chemistry on Earth.

Onset of quantum chaos in molecular systems and the zeros of the Husimi function

The distribution of zeros of the Husimi function has proven a useful tool in the characterization of regular and chaotic quantum states of dynamical systems. In a previous paper [Phys. Rev. E 82, 026201 (2010)], we showed how the quantum transition from order to chaos in three different molecular systems (LiCN, HCN, and HO(2)) can be understood by means of the correlation diagram of eigenenergies versus the Planck's constant. An order-chaos frontier of scars (eigenstates localized over unstable and stable complementary, in the sense of the Poincaré-Birkhoff theorem, periodic orbits) was observed. In this paper, we show how the distribution of zeros of the Husimi function can be related to the onset of chaos in these molecular systems, showing a very interesting feature at the frontier of scars; namely, some zeros of the Husimi function localize over the stable and unstable fixed points corresponding to the two complementary periodic orbits, this representing the quantum equivalent to the Poincaré-Birkhoff theorem.

Diffuse large B-cell lymphoma of Waldeyer's ring has distinct clinicopathologic features: a GELA study

BACKGROUND

Diffuse large B-cell lymphomas (DLBCLs) arising in specific extranodal sites have peculiar clinicopathologic features.

PATIENTS AND METHODS

We analyzed a cohort of 187 primary Waldeyer's ring (WR) DLBCLs retrieved from GELA protocols using anthracyclin-based polychemotherapy.

RESULTS

Most patients (92%) had stage I-II disease. A germinal center B-cell-like (GCB) immunophenotype was observed in 61%, and BCL2 expression in 55%, of WR DLBCLs. BCL2, BCL6, IRF4 and MYC breakpoints were observed in, respectively, 3 of 42 (7%), 9 of 36 (25%), 2 of 26 (8%) and 4 of 40 (10%) contributive cases. A variable follicular pattern was evidenced in 30 of 68 (44%) large biopsy specimens. The 5-year progression-free survival (PFS) and the overall survival (OS) of 153 WR DLBCL patients with survival information were 69.5% and 77.8%, respectively. The GCB immunophenotype correlated with a better OS (P = 0.0015), while BCL2 expression predicted a worse OS (P = 0.037), an effect overcome by the GCB/non-GCB classification. Compared with matched nodal DLBCLs, WR DLBCLs with no age-adjusted international prognostic index factor disclosed a better 5-year PFS rate (77.5% versus 70.7%; P = 0.03).

CONCLUSIONS

WR DLBCLs display distinct clinicopathologic features compared with conventional DLBCLs, with usual localized-stage disease, common follicular features and a high frequency of GCB immunophenotype contrasting with a low rate of BCL2 rearrangements. In addition, they seem to be associated with a better outcome than their nodal counterpart.

Does co-treatment with immunosuppressors improve outcome in patients with Crohn's disease treated with adalimumab?

BACKGROUND

There is clear benefit from combination therapy with infliximab and immunosuppressive drugs (IS), but few data are available for adalimumab (ADA).

AIM

To assess the efficacy of ADA monotherapy and ADA+IS for induction and maintenance therapy in Crohn's disease.

METHODS

Retrospective study of patients with Crohn's disease treated with ADA in Oxford, UK or Liège, Belgium. Treatment periods were divided into 6-month semesters. A combination therapy semester was defined as ADA+IS for at least 3 months; successful induction meant clinical response; a semester with flare as ADA dose escalation, starting steroids, perianal complication, or surgery; and ADA failure as ADA withdrawal for secondary loss of response or intolerance. Semesters with and without flares were compared through univariate and multivariate analysis.

RESULTS

Successful induction was achieved in 171/207 (83%) patients, with no significant difference between ADA+IS and ADA monotherapy (85% vs. 82%, P = 0.50). Five hundred and sixty-two semesters in 181 patients were included for maintenance analysis. ADA+IS was not associated with fewer semesters with flare (34% vs. 35%, P = 0.96), or with ADA failure (6% vs. 8%, P = 0.43). Nevertheless, combination therapy in the first semester was associated with a lower risk of ADA failure (5% vs. 10%, P = 0.04, OR = 0.48) and combination therapy beyond 6 months was associated with fewer semesters with flares (14% vs. 36%, P = 0.02, OR = 0.31).

CONCLUSIONS

There may be a benefit from adalimumab+immunosuppressive drugs combination therapy during the first semester of initiating adalimumab, with a slight decrease in adalimumab failure and lower need for adalimumab dosage escalation.

Is FENO50 useful diagnostic tool in suspected asthma?

BACKGROUND

Asthma diagnosis is based on the presence of symptoms and the demonstration of airflow variability. Airway inflammation measured by fractional exhaled nitric oxide, measured at a flow rate of 50 ml/s (FE(NO50)) remains a controversial diagnostic tool.

AIM

To assess the ability of FE(NO50) to identify bronchial hyperresponsiveness (BHR) to methacholine (provocative concentration of methacholine causing a 20% fall in FEV(1); PC20M ≤ 16 mg/ml) and to establish whether or not symptoms relate to FE(NO50) and PC20M in patients with no demonstrated reversibility to β(2) -agonist.

METHODS

We conducted a prospective study on 174 steroid naive patients with respiratory symptoms, forced expiratory volume in 1 s (FEV(1) ) ≥ 70% predicted and no demonstrated reversibility to β(2) -agonist. Patients answered to a standardised symptom questionnaire and underwent FE(NO50) and methacholine challenge. Receiver-operating characteristic (ROC) curve and logistic regression analysis assessed the relationship between PC20M and FE(NO50) , taking into account covariates (smoking, atopy, age, gender and FEV(1)).

RESULTS

A total of 82 patients had a PC20M ≤ 16 mg/ml and had significantly higher FE(NO50) (19 ppb vs. 15 ppb; p < 0.05). By constructing ROC curve, we found that FE(NO50) cut-off value of 34 ppb was able to identify not only BHR with high specificity (95%) and positive predictive value (88%) but low sensitivity (35%) and negative predictive value (62%). When combining all variables into the logistic model, FE(NO50) (p = 0.0011) and FEV(1) (p < 0.0001) were independent predictors of BHR whereas age, gender, smoking and atopy had no influence. The presence of diurnal and nocturnal wheezing was associated with raised FE(NO50) (p < 0.001 and p < 0.05, respectively).

CONCLUSION

The value of FE(NO50) > 34 ppb has high predictive value of PC20M < 16 in patients with suspected asthma in whom bronchodilating test failed to demonstrate reversibility or was not indicated. However, FE(NO50) ≤ 34 ppb does not rule out BHR and should prompt the clinician to ask for a methacholine challenge.

Combustion Chemistry of the Butane Isomers in Premixed Low-Pressure Flames

The combustion chemistry of the two butane isomers represents a subset in a comprehensive description of C1–C4 hydrocarbon and oxygenated fuels. A critical examination of combustion models and their capability to predict emissions from this class of fuels must rely on high-quality experimental data that address the respective chemical decomposition and oxidation pathways, including quantitative intermediate species mole fractions. Premixed flat low-pressure (40 mbar) flames of the two butane isomers were thus studied under identical, fuel-rich (φ=1.71) conditions. Two independent molecular-beam mass spectrometer (MBMS) set-ups were used to provide quantitative species profiles. Both data sets, one from electron ionization (EI)-MBMS with high mass resolution and one from photoionization (PI)-MBMS with high energy resolution, are in overall good agreement. Simulations with a flame model were used to analyze the respective reaction pathways, and differences in the combustion behavior of the two isomers are discussed.

Scars at the edge of the transition from order to chaos in the isomerizing molecular systems LiNC-LiCN and HCN-HNC, and HO2

Correlation diagrams of energy levels using ℏ as the varying parameter have proven very useful in the characterization of quantum vibrational dynamics of small polyatomic molecules, specially in relation to the transition from order to chaos. In this paper, we present calculations of such correlation diagrams for three molecular systems with very different characteristics, which can be traced down to the topology of their potential energy surfaces. By studying the broad avoided crossings existing in the diagrams, we show that the transition from regular to irregular states always corresponds to a frontier formed by scarred states.

[Comparative study of five techniques of preparation of platelet-rich plasma]

AIM OF THE STUDY

Injections of platelet-rich plasma (PRP) constitute a new therapeutic for treating chronic tendinopathies. The injection being carried out in the tendon, the volume of PRP should thus be minimal (to decrease the intratendinous pressure and to minimize pain). This PRP should also have a raised platelet count. The quantity of released growth factors could be related to the system of preparation employed. We thus carried out a comparative study of five techniques of preparation of PRP described in the literature.

MATERIALS AND METHODS

Samples of venous blood were taken among five patients in order to compare five techniques of preparation of PRP: University Hospital of Liège technique, Curasan(®) PRP Kit, Plateltex(®), GPS(®)II and RegenLab(®).

RESULTS

The various techniques make it possible to obtain more important platelet concentration than in blood, with variable volumes (0,3 to 6ml). The number of platelets per microlitre appears higher with Plateltex(®) and obtains smallest volume of PRP. The other techniques also give small volumes except for the GPS(®)II. The number of collected platelets with this technique appears thus higher. The best collect efficiency is obtained with RegenLab(®).

CONCLUSION

The technique Plateltex(®) makes it possible to collect the highest concentration of platelets in the smallest volume available.

[Predictive index for preeclampsia before conception and primary prevention]

OBJECTIVE

To derive a prediction index based on the most salient history, laboratory and clinical parameters for identifying women at high risk of developing preeclampsia (PE) and to suggest a primary prevention.

MATERIAL AND METHOD

Non-pregnant women with a history of PE (n=101) were compared to non-pregnant parous women with a history of one or more successful normotensive pregnancies (n=50) but with comparable age, gestation and parity profiles. The parameters included history and clinical examination; laboratory studies (hemostasis, coagulation, vitamins); and morphological and functional tests (cardiovascular and renal functions). Stepwise logistic regression analysis was applied to develop a three step PE prediction index based on the most discriminant parameters. Strategies to prevent PE in the high-risk group are described.

RESULTS

Identification of women at high risk of PE can be done efficiently (88% sensitivity and specificity) using a predictive index based on a simple history, laboratory, clinical and functional information. Strategies to prevent PE in our high-risk group have given encouraging results during next pregnancy.

CONCLUSION

Our study gives a predictive index of PE outside of pregnancy and possibilities to do a primary prevention.