Radiotherapy for Soft Tissue Sarcomas after Isolated Limb Perfusion and Surgical Resection: Essential for Local Control in All Patients?

Background: Standard treatment for localized soft tissue sarcoma (STS) is resection plus adjuvant radiotherapy (RTx). In approximately 10% of cases, resection would cause severe loss of function or even require amputation because of the extent of disease. Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-α) and melphalan can achieve regression of the tumor, facilitating limb-saving resection. RTx improves local control but may lead to increased morbidity. Methods: In our database of over 500 ILPs, 122 patients with unifocal STS were treated by ILP followed by limb-sparing surgery. All included patients were candidates for amputation. Results: Surgery resulted in 69 R0 resections (57%), and in 53 specimens (43%) resection margins contained microscopic evidence of tumor (R1). Histopathological examination revealed >50% ILP-induced tumor necrosis in 59 cases (48%). RTx was administered in 73 patients (60%). Local recurrence rate was 21% after median follow-up of 31 months (2-182 months). Recurrence was significantly less in patients with >50% ILP-induced necrosis versus ≤50% necrosis (7% vs. 33%, P = 0.001). A similar significant correlation was observed for R0 versus R1 resections (15% vs. 28%, P = 0.04). In 36 patients with R0 resection and >50% necrosis, of whom 21 were spared RTx, no recurrences were observed during follow-up. Conclusions: In patients with locally advanced primary STS, treated with ILP followed by R0 resection, and with >50% ILP-induced necrosis in the resected specimen, RTx is of no further benefit

Robotics and automation in the city: a research agenda

Globally cities are becoming experimental sites for new forms of robotic and automation technologies applied across a wide variety of sectors in multiple areas of economic and social life. As these innovations leave the laboratory and factory, this paper analyses how robotics and automation systems are being layered upon existing urban digital networks, extending the capabilities and capacities of human agency and infrastructure networks, and reshaping the city and citizen’s everyday experiences. To date, most work in this field has been speculative and isolated in nature. We set out a research agenda that goes beyond analysis of discrete applications and effects, to investigate how robotics and automation connect across urban domains and the implications for: differential urban geographies, the selective enhancement of individuals and collective management of infrastructures, the socio-spatial sorting of cities and the potential for responsible urban innovation

Radioembolization of liver tumors

Radioembolization is a therapy during which radioactive microspheres are administered through a microcatheter placed in the hepatic arterial vasculature in order to irradiate liver tumors from within. In the past decennium, this treatment has evolved as a safe and effective treatment option for patients with chemorefractory liver metastases and locally advanced primary liver tumors. Yet, there are still aspects that require improvement before this treatment can live up to its true potential. Various studies with the aim to optimize treatment workup to evaluation, performed at the Department of Radiology and Nuclear Medicine of the University Medical Center Utrecht between 2012 and 2015, are presented in this dissertation. Part I gives a comprehensive overview of hepatic radioembolization. Part II describes anatomical considerations and imaging strategies that are important during the workup of radioembolization candidates. Part III describes different aspects of the treatment itself, including the use of a single-session treatment approach, a novel anti-reflux catheter and holmium-166 microspheres. Part IV is concerned with the evaluation of treatment toxicity and efficacy. Thus, we have tried to provide more insight into the many challenges that arise in clinical practice, and provide much-needed scientific evidence for decision-making. Large randomized controlled trials are currently comparing the treatment efficacy of radioembolization to standard-of-care therapies on a group level. Yet, further research is still required to optimize treatment planning, strategy and evaluation in the individual patient

Radioembolization of liver tumors

Radioembolization is a therapy during which radioactive microspheres are administered through a microcatheter placed in the hepatic arterial vasculature in order to irradiate liver tumors from within. In the past decennium, this treatment has evolved as a safe and effective treatment option for patients with chemorefractory liver metastases and locally advanced primary liver tumors. Yet, there are still aspects that require improvement before this treatment can live up to its true potential. Various studies with the aim to optimize treatment workup to evaluation, performed at the Department of Radiology and Nuclear Medicine of the University Medical Center Utrecht between 2012 and 2015, are presented in this dissertation. Part I gives a comprehensive overview of hepatic radioembolization. Part II describes anatomical considerations and imaging strategies that are important during the workup of radioembolization candidates. Part III describes different aspects of the treatment itself, including the use of a single-session treatment approach, a novel anti-reflux catheter and holmium-166 microspheres. Part IV is concerned with the evaluation of treatment toxicity and efficacy. Thus, we have tried to provide more insight into the many challenges that arise in clinical practice, and provide much-needed scientific evidence for decision-making. Large randomized controlled trials are currently comparing the treatment efficacy of radioembolization to standard-of-care therapies on a group level. Yet, further research is still required to optimize treatment planning, strategy and evaluation in the individual patient

Preserving objects, preserving memories: repair professionals and object owners on the relation between memories and traces on personal possessions

Traces of ageing and use on the material of products, and memories associated with products, have been found to contribute to product attachment and can stimulate product longevity. We present findings of a qualitative study that focused on the relation between traces of ageing and use on personal possessions and memories and the effects of repair on objects. With this research, we intended to increase our understanding of the role of traces on personal possessions and memories. We interviewed five professionals at their workplace who worked as a restorer or did repairs of personal possessions, and five owners of a repaired or restored possession. The motivations for bringing an object for repair were not only related to the deteriorating condition of the object but were also triggered by situational events or circumstances, such as passing on ownership or knowing someone who could repair the object. We found five different categories of traces among the possessions of the interviewed object owners: Traces of use, traces of ageing, traces of repair, traces of accidents and alterations. We found that objects gained meaning after the repair. When object owners or repair professionals decided not to repair traces, it was often for aesthetical and reminding reasons, but also because it may be how the owner remembered the object. Traces can cue associations to their use in the past, and also to the (imagined) history of the objects. These findings indicate that repair can enhance the cueing of memories and that preservation of meaningful traces may contribute to attachment

A qualitative exploration of memory cuing by personal items in the home

\u3cp\u3eWe are surrounded by personal items that can trigger memories, such as photos, souvenirs and heirlooms. Also during holidays, we collect items to remind us of the events, but not all bring back memories to the same extent. Therefore, we explored peoples’ responses to personal items related to a holiday, using the home tour interviewing method. In total, 63 accounts of cuing responses from nine home tours were analysed using thematic analysis. This resulted in four types of cuing responses: (a) ‘no-memory’ responses, (b) ‘know’ responses, (c) ‘memory evoked think or feel’ responses and (d) ‘remember’ responses. For each of these cuing response categories, we looked into the types of items and their characteristics. Furthermore, we found that some items can evoke multiple memories. The majority of the memories’ content refers to events close to the moment of acquiring the item.\u3c/p\u3

Core Values and Value Conflicts in Cybersecurity: Beyond Privacy Versus Security

This chapter analyses some of the main values, and values conflicts, in relation to cybersecurity by distinguishing four important value clusters that should be considered when deciding on cybersecurity measures. These clusters are security, privacy, fairness and accountability. Each cluster consists of a range of further values, which can be viewed as articulating specific moral reasons relevant when devising cybersecurity measures. In addition to the four value clusters, domain-specific values that are served by computer systems, such as health, are important. Following a detailed discussion of the four relevant value clusters, potential value conflicts and value tensions are considered. The relationships of five pairs of values (privacy-security, privacy-fairness, privacy-accountability, security-accountability and security-fairness) are analysed in terms of whether they are largely supportive or conflicting. In addition, possible methods for addressing these potential value conflicts are discussed. It is concluded that values, and value conflicts, in cybersecurity should be considered in context, also taking into account the specific computer systems at play, to enable the use of nuanced and fine-grained methods for addressing the relevant value conflicts.Values Technology and Innovatio