Adjuvant radiotherapy treatment for soft tissue sarcoma of extremities and trunk. A retrospective mono-institutional analysis

Soft tissue sarcomas (STS) are uncommon, heterogeneous malignant tumors of mesodermal origin. Other than conservative surgery (CS), neoadjuvant or adjuvant radiotherapy (RT) is recommended when the risk of local recurrence is high. The aim of this study is to present our Institutional experience in adjuvant RT for treatment of STS of extremities and trunk (with either brachytherapy (BRT), external beam RT (EBRT), or both) and to provide an insight of toxicity and oncological outcomes for each RT modality. According to the RT treatment approach, patients were divided into three categories: 1) BRT alone; 2) EBRT alone; 3) combined BRT+EBRT. Differences among the three groups were assessed by the Chi-squared test. Patients' follow-up was performed every 6 months for the first two years after the end of RT and then once a year. Data from 90 patients were analyzed. The overall 3-year distant relapse-free survival (DRFS), progression-free survival (PFS), and overall survival (OS) were 84%, 80%, and 97%, respectively. Acute erythema was the most frequent side effect, although severe grade 3 toxicity was present in 5 patients. Chronic toxicity of any grade was reported in 14 patients. The incidence of chronic toxicity did not show any association with treatment modality. Multivariate analysis suggested a significant correlation between acute toxicity and tumor size, RT modality, and RT dose. In conclusion, good local control and toxicity profile were observed, despite negative patients' selection at baseline. Further investigation on wider series is warranted in order to define the optimal combination with systemic therapy.

Diet selenium improves the antioxidant defense system of juveniles Nile tilapia ( Oreochromis niloticus L.)

Abstract From the advancement of tilapia production in recent years, diets are sought that allow the maximum growth, improving health and fish quality. In this study growth, biochemical, hematological and oxidative parameters were evaluated of tilapia fed with increasing selenium levels: 0.53, 0.86, 1.04 and 1.22 mg kg-1. It was used 400 juveniles (initial weight = 36.51 ± 10.88 g), fed for six weeks. There was no effect of selenium on fish growth, biochemical and hematological parameters. In the oxidative parameters, there was an increase in non-protein thiols and a decrease in malondialdehyde levels, evidencing antioxidant effects of selenium. The diet selenium levels above 0.86 mg kg-1 improved the antioxidant system and does not affect to biochemical, hematological and growth parameters of tilapia juveniles.

Growth and digestive enzymes of silver catfish fed diets containing fruit residue

ABSTRACT In fish farming, the use of alternative ingredients has been studied, so that alternative sources can be used to minimize feed costs. This study evaluated the incorporation of grape, orange, guava, and fig residues in diets for silver catfish and its effects on growth, digestive enzymes and body composition. A total of 180 fish (initial mean weight = 22.93±0.75 g) were reared in a recirculation aquaculture system. There was no difference (P>0.05) in the parameters of growth, dry matter, mineral matter, plasma protein, cholesterol, triglycerides, lipase, and trypsin of fish. Glucose levels were higher in fish fed diets containing fig, orange, and grape residue (P<0.05). Lipase activity was higher in fish fed orange residue, compared to guava (P<0.05). Diets containing guava and fig provided more body protein in silver catfish. The fish fed with diet containing orange residue had a higher content of body lipids. It can be concluded that the tested fruit residues can be used in silver catfish feeding.

Radical hysterectomy after chemoradiation in FIGO stage III cervical cancer patients versus chemoradiation and brachytherapy: Complications and 3-years survival

BACKGROUND

To compare patterns and rates of early and late complications, and survival outcome in FIGO stage III cervical cancer patients underwent to radical hysterectomy after chemo-radiation (CT-RT) vs. chemo-radiation alone.

METHODS

Between May 1996 and April 2013 150 FIGO stage III cervical cancer patients were treated. We divide patients according to type of treatment: 77 were submitted to standard treatment (Group A), and 73 to completion hysterectomy after chemo-radiation (Group B).

RESULTS

The baseline characteristics of the 2 groups were superimposable. We observed lower intra-operative and treatment-related early urinary and gastro-intestinal complications in Group B with respect to Group A (p < 0.001). Vascular complications were registered only in Group B (p < 0.001). We found a significantly higher rate of local recurrences in the Group A than in the Group B (p < 0.002). We registered 29 deaths in the Group A and 22 in the Group B (p = 0.021). The 3-years disease-free survival rate in the Group A and in the Group B was 62.9% and 68.3%, respectively (p = 0.686), and the 3-years overall survival rate in the Group A and in the Group B was 63.2% and 67.7%, respectively (p = 0.675).

CONCLUSIONS

This study confirms that radical hysterectomy after CT-RT is an effective therapeutic approach for advanced cervical cancer. Further prospective and randomized studies should be performed in order to solve the question about the standard approach, and how the different pattern of complication could impact on the quality of life.

A surveillance system of Invasive Pneumococcal Disease in North-Eastern Italy

BACKGROUND

From 2007, in the Veneto Region (Italy), a surveillance system for invasive pneumococcal diseases (IPD) was implemented to estimate the regional epidemiology of IPD and to evaluate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) vaccination.

METHODS

Data were collected from 2007 to 2014 and the total, annual and age-specific IPD notification rates were calculated. A Poisson regression model was used to identify the possible risk factors for developing IPD.

RESULTS

A total of 713 IPD cases were notified and the overall IPD notification rate was equal to 2.0 cases per 100,000 population (95% CI: 1.7-2.1), with an increasing trend between 2007 and 2014. The pneumococcal serotypes were identified in 608 (85.3%) isolates from biological specimens, and the most distributed serotypes were those contained in PCV13. Children <5 year-old and the adults over 65 year-old showed the highest PCV13 vaccine-type IPD notification rate, equal to 2.7/100,000 and 2.8/100,000, respectively. The risk to develop IPD was greater in children aged <5 years (RR = 8.9, 95% CI: 5.1-15.9; p<0.0001) and in adults aged >65 years (RR = 4.3, 95% CI: 2.7-6.9; p<0.0001), especially in males > 65 years of age (RR = 1.7, 95% CI: 1.0-2.8; p = 0.042). The invasive pneumococcal disease was mainly caused by the PCV13 serotypes (RR = 2.9, 95%CI: 2.3-3.9; p<0.0001), principally after the PCV13 introduction (RR = 2.3, 95% CI: 1.4-3.8; p<0.001). In spite of that, a significant reduction of the overall IPD incidence is evident in the period following the PCV13 vaccine introduction (RR = 0.4, 95% CI: 0.3-0.5; p<0.0001), particularly in children aged <5 years (RR = 0.3, 95% CI: 0.2-0.7; p = 0.002), demonstrating the real efficacy of PCV13 immunization for children.

CONCLUSIONS

In the Veneto Region, the surveillance system has allowed to describe the detailed epidemiological profile of invasive pneumococcal disease, pointing out that the most circulating pneumococcal serotypes were those contained in the PCV13 vaccine.

Utilização de embalagens Tetra Pak® como isolante térmico no revestimento de escamoteadores para leitões

RESUMOForam conduzidos dois experimentos em laboratório e em condições de campo para avaliação da eficiência térmica da embalagem Tetra Pak(r)como isolante térmico em escamoteadores aquecidos. No experimento em laboratório, foi utilizado o delineamento inteiramente ao acaso, adotando-se dois tratamentos (com e sem revestimento de embalagens Tetra Pak(r)) com 15 repetições (dias). O experimento em condições de campo foi conduzido na sala de maternidade de suínos. O delineamento foi inteiramente ao acaso, adotando-se dois tratamentos com 12 repetições. Os tratamentos foram: escamoteadores aquecidos com e sem revestimento interno com embalagem Tetra Pak(r). Foram medidos os dados de temperatura ambiente, umidade relativa do ar, temperatura superficial do piso, temperatura superficial da pele, comportamento e ganho de peso dos leitões lactentes. O uso da embalagem Tetra Pak(r)como isolante térmico no revestimento de escamoteadores manteve a temperatura ambiente confortável (32°C), proporcionando conforto térmico aos leitões lactentes.

Adaptive Mathematical Model of Tumor Response to Radiotherapy Based on CBCT Data

Mathematical modeling of tumor response to radiotherapy has the potential of enhancing the quality of the treatment plan, which can be even tailored on an individual basis. Lack of extensive in vivo validation has prevented, however, reliable clinical translation of modeling outcomes. Image-guided radiotherapy is a consolidated treatment modality based on computed tomographic (CT) imaging for tumor delineation and volumetric cone beam CT data for periodic checks during treatment. In this study, a macroscopic model of tumor growth and radiation response is proposed, being able to adapt along the treatment course as volumetric tumor data become available. Model parameter learning was based on cone beam CT images in 13 uterine cervical cancer patients, subdivided into three groups (G1, G2, G3) according to tumor type and treatment. Three group-specific parameter sets (PS1, PS2, and PS3) on one general parameter set (PSa) were applied. The corresponding average model fitting errors were 14%, 18%, 13%, and 21%, respectively. The model adaptation testing was performed using volume data of three patients, other than the ones involved in the parameter learning. The extrapolation performance of the general model was improved, while comparable prediction errors were found for the group-specific approach. This suggests that an online parameter tuning can overcome the limitations of a suboptimal patient stratification, which appeared otherwise a critical issue.

Diferentes níveis de incorporação de farinha de resíduos de jundiás (Rhamdiaquelen) cultivados na dieta

O estudo foi desenvolvido no Laboratório de Piscicultura do Departamento de Zootecnia da Universidade Federal de Santa Maria, com duração de oito semanas, de abril a junho de 2011. O objetivo foi definir o melhor nível de incorporação do resíduo de peixes na alimentação de juvenis de jundiá, em sistema de recirculação d'água, utilizando-se 450 alevinos de jundiás, com peso médio inicial de 7,2±0,27g. Foram testadas cinco diferentes dietas, em três repetições, com níveis diferentes (0; 3,75; 7,5; 15; e 30%) de incorporação de farinha de carcaça de jundiás com vísceras (FCJCV). As dietas continham, aproximadamente, 37% de PB e 3200kcal de EM/kg de dieta. Foram coletados dados de ganho em peso diário, sobrevivência, fator de condição, taxa de crescimento específico, conversão alimentar aparente, rendimento de carcaça, taxa de eficiência proteica e deposição de proteína e lipídio corporal. O maior ganho de peso foi para o nível 30% de inclusão de FCJCV, com peso final de 45,47g e ganho em peso diário de 0,68g/dia. A dieta com nível de 30% de inclusão de FCJCV apresentou melhores valores para taxa de crescimento específico (3,34%/dia), conversão alimentar aparente (1,05: 1), biomassa final 1.105,45g, deposição proteica corporal (64,9mg/dia), taxa de eficiência proteica (1,9) e coeficiente de retenção proteica (1,96%). Concluiu-se que a utilização de farinha de resíduos de processamento de jundiá no nível de 30% de inclusão na dieta foi a que apresentou maior eficiência no desenvolvimento de juvenis de jundiá.

Ractopamina na dieta da carpa húngara (Cyprnus carpio) criada em tanques-rede

Avaliou-se a utilização da ractopamina como promotor de crescimento para carpa húngara em experimento com 56 dias de duração, realizado em 12 tanques-rede de pequeno volume, utilizando-se 360 peixes com peso inicial de 18,64±1,25g. Foram testadas três quantidades de ractopamina, 7, 14 e 21ppm/kg, mais a dieta controle. Avaliaram-se o peso médio, o comprimento total, a altura, a taxa de crescimento específico e o fator de condição. Foram também analisadas a composição corporal, a deposição tecidual e a glicose plasmática dos peixes. Não foi observado efeito significativo da adição de ractopamina sobre as características de desempenho. Observou-se maior concentração de glicose, 61,67mg/dL, nos peixes alimentados sem a adição de ractopamina na dieta. A adição de ractopamina na dieta proporcionou maior quantidade de gordura corporal nos peixes e não afetou a quantidade de proteína. Conclui-se que a adição de ractopamina na dieta não é eficiente para juvenis de carpa húngara.

Experience of vaccination against invasive bacterial diseases in Veneto region (north east Italy)

The goal of this study was to describe and comment the experience of the Veneto Region in the bacterial invasive disease. Vaccination coverage was 93% against pneumococcus and 95% against haemophilus influenzae type B. Regard to meningococcus C the coverage rate was 90.1% In children, 81% at 6 years of age and 78.2% at 15 years. The preliminary data of an active surveillance of invasive bacterial diseases show that the Streptoccoccus pneumoniae was the main agent involved and that its consequences were particularly serious in elderly subjects. With regard to Neisseria meningitidis, we observed a substantial reduction in the number of cases due to serogroup C and a concomitant rise in the percentage of cases due to serogroup B. The suspension of mandatory vaccination should be maintained, the monitoring of vaccination coverage and the active surveillance proved to be a very good assessment tools.

Fontes energéticas vegetais para juvenis de jundiá e carpa

Para avaliar o desempenho, o metabolismo e a composição corporal de juvenis de jundiá (Rhamdia quelen) e de carpa húngara (Cyprinus carpio) alimentados com fontes energéticas vegetais, foi conduzido experimento de 60 dias. Três dietas compostas por aveia descascada, farelo de arroz desengordurado estabilizado (FADE) ou por farelo de trigo e milho (dieta-controle) foram ofertadas três vezes ao dia a 360 juvenis de jundiá (5,59±0,06g) ou de carpa húngara (5,82±0,14g) distribuídos em 18 tanques (280L), totalizando nove tanques por espécie. Não foram observadas diferenças significativas no desempenho das espécies estudadas. Em relação aos parâmetros metabólicos, as menores concentrações séricas de colesterol total no jundiá foram verificadas nas dietas com aveia (214,49mg/dL) e FADE (216,3mg/dL), enquanto para a carpa húngara as menores concentrações observadas foram nos peixes alimentados com FADE (222,54mg/dL). Quanto à composição centesimal, os valores de gordura no filé foram menores nos jundiás dos tratamentos controle (3,76%) e aveia (3,95%). A inclusão de aveia proporcionou menor deposição de gordura corporal em ambas as espécies. Conclui-se que 20% de aveia descascada ou de farelo de arroz desengordurado podem ser incluídos na dieta de juvenis de jundiá e de carpa húngara sem prejuízos para o crescimento.

[Robotic rectal resection in rectal cancer: short term results in a monocentric prospective study]

AIM

The aim of this study was to evaluate technical feasibility, oncological safety and short-term clinical results of robotic rectal resection for cancer.

METHODS

From January 2008 to July 2010, 46 patients (27 males and 19 females, median age 69 years, median BMI 24.6 kg/m2) with histologically-proven adenocarcinoma of medium and distal rectum were enrolled in a prospective database. Preoperative assessment was performed with colonoscopy with biopsies, thoraco-abdominal CT scan, pelvic MRI and endorectal-ultrasound (ERUS). In the case of locally advanced non metastatic disease (T3/4 or N1/2), patients received preoperative radiotherapy (45 Grays in 5 weeks) and chemotherapy (oral Capecitabine). The robotic system was a four-arms Da Vinci® (Intuitive Surgical, Sunnyvale, CA, USA); arms position is not modified during the entire surgical procedure.

RESULTS

Twenty-five patients received a preoperative radio-chemotherapy. Surgical procedure was an abdomino-perineal amputation in nine patients and an anterior resection in the remaining 37, with temporary ileostomy in 16 cases and a laparoscopic mobilization of splenic flexure in 25. Median operative time was 251 minutes, median time of first bowel movements 1.7 days and median hospital stay 6.7 days. Major complications requiring reoperation verified in 2 patients, while overall complication rate is 15.2%. Median number of harvested lymph nodes per patient was 18; median distance of the tumour from distal resection margin was 2 cm; distance of the tumour from circumferential margin was superior to 1 mm in all of the patients. At a median follow up of 11 months, all patients are alive and disease-free.

CONCLUSION

Robotic rectal resection is a feasible technique which can provide good oncological and short-term clinical results.

Inflammatory cells, cytokines and matrix metalloproteinases in amicrobial pustulosis of the folds and other neutrophilic dermatoses

Amicrobial pustulosis of the folds (APF) is a rare cutaneous disease characterized by relapsing sterile pustules frequently associated with autoimmune disorders. Although APF pathophysiology is still undefined, scattered reports suggest involvement of neutrophils. The aim of the present study is to evaluate the role of the skin inflammatory infiltrate, selected multifunctional cytokines and effectors of tissue damage in APF and other neutrophilic dermatoses. We studied, by immunohistochemical methods, inflammatory cell markers (CD3, CD163, myeloperoxidase), cytokines (TNF-alpha, IL-8, IL-17), metalloproteinases (MMP-2, MMP-9) and vascular-endothelial-growth-factor (VEGF) in lesional skin from six patients with APF, 11 with pyoderma gangrenosum (PG), 7 with Sweet's syndrome, and in 20 normal skin samples. Immunoreactivities of CD3, CD163, myeloperoxidase, TNF-alpha, IL-8, IL-17, MMP-2, MMP-9 and VEGF were significantly higher in APF, PG and Sweet's syndrome than in controls (p=0.0001). IL-8 was more expressed in PG than in APF (P=0.002) and Sweet's syndrome (p=0.001). In APF, MMP-9 reactivity was higher than in Sweet's syndrome (p=0.035), but less intense than in PG (p=0.020). Our study supports the role of proinflammatory cytokines/chemokines and MMPs as important effectors for the tissue damage in APF similarly to classic neutrophilic dermatoses.

Drug-induced subacute cutaneous lupus erythematosus: evidence for differences from its idiopathic counterpart

BACKGROUND

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is a lupus variant with predominant skin involvement temporally related to drug exposure and resolving after drug discontinuation. It usually presents with annular polycyclic or papulosquamous eruptions on sun-exposed skin and shows serum anti-Ro/SSA antibodies.

OBJECTIVES

To address the question whether DI-SCLE differs significantly from idiopathic SCLE by virtue of clinical features.

METHODS

Ninety patients with SCLE seen in our departments from 2001 to 2010 were reviewed. Eleven of them diagnosed as having DI-SCLE were evaluated for type of skin lesions, systemic involvement, clinical course, and histopathological, direct immunofluorescence and laboratory findings. The cutaneous features were compared with those of the 79 patients with idiopathic SCLE.

RESULTS

The cutaneous picture was widespread in 82% of patients with DI-SCLE and in 6% of those with idiopathic SCLE [odds ratio (OR) 66·6, 95% confidence interval (CI) 11·2-394·9; P = 0·0001]. Bullous and erythema multiforme (EM)-like lesions were present in 45% of patients with DI-SCLE and in 1% of those with idiopathic SCLE (OR 65·0, 95% CI 6·5-649·6; P = 0·0001). Vasculitic lesions were observed in 45% of patients with DI-SCLE and in 3% of those with idiopathic SCLE (OR 32·1, 95% CI 5·1-201·7; P = 0·0001). Malar rash occurred in 45% of patients with DI-SCLE and in 6% of those with idiopathic SCLE (OR 12·3, 95% CI 2·8-54·9; P = 0·001). Visceral manifestations were excluded in all patients with DI-SCLE. Anti-Ro/SSA antibodies were found in all but one patient with DI-SCLE and disappeared after resolution in 73% of cases.

CONCLUSIONS

DI-SCLE differs from idiopathic SCLE by virtue of distinctive cutaneous features, particularly the widespread presentation and the frequent occurrence of malar rash and bullous, EM-like and vasculitic manifestations.

Acute radiation dermatitis in breast cancer: topical therapy with vitamin E acetate in lipophilic gel base

BACKGROUND

Radiotherapy can cause adverse skin reactions over the course of their treatment. Currently, management is based on several tropical products although there is no gold-standard approach to prevention and management of radiation toxicity.

METHOD

We report our experience of vitamin E acetate in the treatment of radiation dermatitis in breast cancer patients who experienced grade 4 side effects (according to Radiation Therapy Oncology Group criteria).

RESULTS

Clinical management consisted of oral antibiotics and local application of vitamin E acetate and local escarectomy. All of the patients achieved complete re-epithelialization within 40 days.

CONCLUSION

Skin ulceration and necrosis post-radiation may interrupt oncological treatment in breast cancer patients. In acute radiodermatitis with skin necrosis, we propose the use of oral antibiotics together with escarectomy and the application of vitamin E acetate to facilitate the healing process in order to minimize the interruption to the oncological treatment.

Desempenho e composição dos filés de jundiás (Rhamdia quelen) submetidos a diferentes dietas na fase de recria

Avaliaram-se o crescimento e a composição dos filés de juvenis de jundiá após 90 dias de alimentação com dietas contendo diferentes fontes protéicas. Foram utilizados 540 peixes, peso inicial=15,0±0,62g; comprimento inicial=11,98±0,35cm, distribuídos ao acaso em 18 tanques (30 peixes/tanque) com sistema de recirculação de água. Foram testadas seis dietas: 1 - farinha de carne e ossos + levedura (CL), 2 - farelo de soja + levedura (SL), 3 - farelo de soja (S), 4 - farinha de carne e ossos + farelo de soja (CS), 5 - farinha de peixe + levedura (PL) e 6 - farinha de peixe + farelo de soja (PS). Avaliaram-se: peso, comprimento total, taxa de crescimento específico, fator de condição, sobrevivência, conversão alimentar aparente, taxa de eficiência protéica e consumo diário. Também foram analisadas as composições do filé - umidade, proteína, lipídios, cinzas -, as taxas de deposição de proteína e gordura, além dos rendimentos de filé e carcaça. Maiores pesos, 111,5 e 108,6g, comprimento total, 22,6 e 21,6cm, e taxa de crescimento específico, 2,1 e 2,2%/dia, foram observados nos peixes alimentados com as dietas CS e PS. Os peixes alimentados com CS e PS também apresentaram maior deposição de proteína, 69,8 e 71,5mg/dia, e lipídios, 77,2 e 78,3mg/dia. A sobrevivência foi menor na dieta PS, 92,9%. Os maiores rendimentos de carcaça foram observados nos peixes alimentados com PS e PL, 82,9 e 82,7%, e o menor rendimento de filé ocorreu na dieta CL, 34,1%.

Desempenho reprodutivo de fêmeas de jundiá alimentadas com diferentes fontes protéicas

Dois experimentos foram conduzidos para avaliar o desempenho reprodutivo de fêmeas de jundiá alimentadas durante 71 dias com diferentes fontes protéicas. No experimento 1, foi avaliado o farelo de soja associado à farinha de carne e ossos (CS), levedura (LS) ou farinha de peixe (PS). No segundo experimento avaliaram-se os níveis de 0, 35 e 70% de substituição da farinha de carne e ossos da dieta CS do experimento 1 por farelo de soja (CS0, CS35 e CS70, respectivamente). As fêmeas foram induzidas à desova utilizando-se extrato hipofisário de carpa. No experimento 1, o diâmetro do saco vitelino foi maior nos ovos das matrizes alimentadas com as dietas CS e PS. No experimento 2, o desenvolvimento embrionário, vitelínico e larval foi superior no tratamento CS0. Conclui-se que a utilização de farinha de carne e ossos e farelo de soja como fontes protéicas apresentam-se como boa opção na alimentação de fêmeas reprodutoras de jundiá.

Full-dose intra-operative radiotherapy with electrons (ELIOT) during breast-conserving surgery: experience with 1246 cases

Background:

Previous studies showed that after breast-conserving surgery for breast cancer, radiotherapy may be applied to the portion of the breast where the primary tumour was removed (partial breast irradiation (PBI), avoiding the irradiation of the whole breast. We developed a procedure of PBI consisting of a single high dose of radiotherapy of 21 Gy with electrons equivalent to 58–60 Gy in fractionated doses, delivered during the surgical session by a mobile linear accelerator, positioned close to the operating table.

Patients and methods:

From July 1999 to December 2006, 1246 patients with primary carcinoma of less than 2.5-cm maximum diameter, mostly over 48 years, were treated with electron intra-operative radiotherapy (ELIOT) at a single dose of 21 Gy.

Results:

After a follow-up from 0.3 to 94.7 months (median 26), 24 (1.9%) patients showed a local recurrence and 22 developed distant metastases. Sixteen patients died, seven from breast carcinoma and nine from others causes. The five-year crude survival was 96.5%. Six (0.5%) developed severe breast fibrosis, which resolved in 2–3 years. An additional 40 patients suffered for mild fibrosis. Cosmetic results were good.

Conclusions:

Electron intra-operative radiotherapy is a safe method for treating conservatively operated breasts and avoids the long period of post-operative radiotherapy, greatly improving the quality of life and reduces the cost of radiotherapy. ELIOT markedly reduces the radiation to normal surrounding tissues and deep organs. Results on short- and medium-term toxicity are good. Data on local control are encouraging.

When mastectomy becomes inevitable: The nipple-sparing approach

The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.

Self-organized growth of nanoparticles on a surface patterned by a buried dislocation network

The self-organized growth of Co nanoparticles is achieved at room temperature on an inhomogenously strained Ag(001) surface arising from an underlying square misfit dislocation network of 10 nm periodicity buried at the interface between a 5 nm-thick Ag film and a MgO(001) substrate. This is revealed by in situ grazing-incidence small-angle x-ray scattering. Simulations of the data performed in the distorted wave Born approximation framework demonstrate that the Co clusters grow above the dislocation crossing lines. This is confirmed by molecular dynamic simulations indicating preferential Co adsorption on tensile sites.