2-mm surgical margins are adequate for most basal cell carcinomas in Japanese: a retrospective multicentre study on 1000 basal cell carcinomas

BACKGROUND

Surgery is the gold standard for basal cell carcinomas (BCC). Current recommended surgical margins for BCCs are determined from studies in Caucasian populations. However, the appropriate surgical margins for BCCs in non-white races are unclear.

OBJECTIVES

To investigate the accuracy of preoperative determination of clinical tumour borders and appropriate surgical margins in Japanese patients with BCC.

METHODS

The maximum calculated differences in distance between the preoperatively determined surgical margins and the actual histologic tumour side margins were considered as 'accuracy gaps' of clinical tumour borders. Estimated side margin positivity rates (ESMPRs) with narrower (2 and 3 mm) surgical margins were calculated on the basis of the accuracy gaps.

RESULTS

Overall, 1000 surgically excised BCCs from 980 Japanese patients were included. The most frequent histologic subtype was nodular BCC (67%). The median accuracy gap was 0.3 mm [interquartile range (IQR): -0.5 to +1 mm]. The ESMPRs with 2- and 3-mm surgical margins were 3.8% and 1.4%, respectively. Only the ESMPRs between the well-defined (n = 921) and poorly defined clinical tumour border groups (n = 79) showed statistical difference [2-mm margin: 3.1% vs. 11.7%, OR: 3.89, 95% confidential interval (CI): 1.41-10.71, P <0.01; 3-mm margin: 0.97% vs. 6.3%, OR: 6.58, 95% CI: 1.67-25.99, P <0.01]. No significant differences in ESMPRs were noted in other subgroups including risk classifications.

CONCLUSIONS

The determined clinical tumour border accuracy gaps in this Japanese cohort were negligible. Dermatologic surgeons may use narrower surgical margins with acceptable margin positivity rates. The clarity of clinical tumour borders could be an appropriate guide for selection of different surgical margins in the Japanese cohort.

Directly calculating the glue component of the nucleon in lattice QCD: QCDSF–UKQCD–CSSM Collaborations

We are investigating the direct determination and non-perturbative renormalisation of gluon matrix elements. Such quantities are sensitive to ultra– violet fluctuations, and are in general statistically noisy. To obtain statistically significant results, we extend an earlier application of the Feynman–Hellmann theorem to gluonic matrix elements to calculate a renormalisation factor in the RI – MOM scheme, in the quenched case. This work demonstrates that the Feynman–Hellmann method is capable of providing a feasible option for calculating gluon quantities.

Clinical Courses Of Corneal Endothelial Dysfunction Due To Gomphocarpus physocarpus Milky Latex-Induced Injury: A Case Series

Purpose

To investigate the clinical courses of patients with corneal endothelial dysfunction due to Gomphocarpus physocarpus milky latex-induced injury.

Patients and methods

In this retrospective case series, we included consecutive patients who visited Miyata Eye Hospital or Kagoshima Miyata Eye Clinic between October 2010 and August 2017 and had corneal edema caused by G. physocarpus milky latex-induced injury. Patient information and data on central corneal thickness (CCT), corneal endothelial cell density (ECD), best-corrected visual acuity (BCVA), and treatment were retrospectively reviewed.

Results

Five eyes of four patients were included. The mean age was 79.0 ± 7.1 years. All patients complaining of symptoms visited the hospital 1 or 2 days after the injury. All patients had corneal edema; two of the five eyes showed hyperemia, whereas none showed corneal epithelial defect or blepharitis. The mean CCT was 699.8 ± 95.9 μm at the first visit and decreased to 563.2 ± 74.0 μm 1 week after the injury with treatment with topical steroids and antibiotics. The mean ECD and BCVA were 2695.8 ± 191.3 cells/mm² and 0.22 ± 0.19 at the first visit and 2826.0 ± 132.9 cells/mm² and 0.10 ± 0.09 one week after the injury, respectively.

Conclusion

G. physocarpus caused transient dysfunction of the corneal endothelium and thereby, corneal edema. Accurate diagnosis with history taking is important to ascertain the types of plants the patient has touched and to exclude other possible diagnoses.

Helicity-Changing Brillouin Light Scattering by Magnons in a Ferromagnetic Crystal

Brillouin light scattering in ferromagnetic materials usually involves one magnon and two photons and their total angular momentum is conserved. Here, we experimentally demonstrate the presence of a helicity-changing two-magnon Brillouin light scattering in a ferromagnetic crystal, which can be viewed as a four-wave mixing process involving two magnons and two photons. Moreover, we observe an unconventional helicity-changing one-magnon Brillouin light scattering, which apparently infringes the conservation law of the angular momentum. We show that the crystal angular momentum intervenes to compensate the missing angular momentum in the latter scattering process.

1407Drug effect of luseogliflozin and voglibose on heart failure with preserved ejection fraction in diabetic patients: a multicenter randomized-controlled trial

Background

Recent randomized, placebo-controlled trial in patients with type 2 diabetes demonstrated that the sodium-glucose cotransporter 2 inhibitors reduced mortality, cardiovascular events and hospitalization for heart failure. However, those trials were not specialized design to investigate the effect of sodium-glucose cotransporter 2 inhibitors in patients with heart failure, in particular with heart failure with preserved ejection fraction.

Purpose

The aim of this study was to evaluate the drug efficacy of luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, compared with voglibose, an alpha-glucosidase inhibitor, using brain natriuretic peptide (BNP) in type 2 diabetes patients with heart failure with preserved ejection fraction.

Methods

This study was a prospective, multicenter, open-label, randomized-controlled trial, comparing luseogliflozin 2.5 mg once daily or voglibose 0.2 mg three times daily in patients with type 2 diabetes suffering from heart failure with preserved ejection fraction (left ventricular ejection fraction >45% and BNP ≥35 pg/ml2) in a 1:1 randomization fashion. Randomization was undertaken using a computer-generated random sequence web response system. The primary outcome was the difference from baseline in BNP after 12 weeks of treatment between two drugs. The key secondary outcomes were the change from baseline in left ventricular ejection fraction and E/e' in echocardiographic parameters, body weight, glycohemoglobin level after 12 weeks of treatment. The safety outcomes included the incidence of major adverse cardiovascular events, hypoglycemic adverse events, and urinary tract infection.

Results

Between December 2015 and September 2018, 173 patients from 16 hospitals and clinics have been included in this study. Of those, 83 patients were assigned to receive luseogliflozin and 82 to receive voglibose. There was no significant difference in the reduction in the BNP concentration after 12 weeks from baseline between the two groups; the ratio of the average values at week 12 to the baseline value was 0.91 in the luseoglifllzin group as compared with 0.98 in the voglibose group (percent change, −9.0% vs. −1.9%, ratio of change with luseogliflozin vs. voglibose, 0.93; 95% confidence interval, 0.78 to 1.10; p=0.26). The key secondary outcomes including left ventricular ejection fraction, E/e', body weight, glycohemoglobin level and the safety outcomes did not differ significantly between the two groups.

Conclusions

In type 2 diabetes patients with heart failure with preserved ejection fraction, the administration of luseogliflozin did not lead to a significant reduction in the BNP concentration than that of voglibose. Left ventricular ejection fraction, E/e', body weight and glycohemoglobin level after 12 weeks of treatment, comparing with at baseline did not differ significantly between the two groups. (UMIN Clinical Trial Registry number, UMINehz748.005618395)

Acknowledgement/Funding

Novartis