Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo) radiotherapy: An international multi-centre comparative study

Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (≥5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND- (p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent significant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution

\pi^0 \pi^0 Production in Proton-Proton Collisions at Tp=1.4 GeV

The reaction pp->pppi0pi0 has been investigated at a beam energy of 1.4 GeV using the WASA-at-COSY facility. The total cross section is found to be (324 +- 21_systematic +- 58_normalization) mub. In order to to study the production mechanism, differential kinematical distributions have been evaluated. The differential distributions indicate that both initial state protons are excited into intermediate Delta(1232) resonances, each decaying into a proton and a single pion, thereby producing the pion pair in the final state. No significant contribution of the Roper resonance N*(1440) via its decay into a proton and two pions is foundComment: Submitted to PL

Beating the empty pelvis syndrome: the PelvEx Collaborative core outcome set study protocol

Introduction: the empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. ‘PelvEx—Beating the empty pelvis syndrome’ aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.Methods and analysis: a modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.Ethics and dissemination: the University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.Trial registration number: NCT05683795.</p

Acciones de la SUDECO en el desarrollo del Centro-Oeste en el estado de Goiás

v. 31,n. 2, p.179-191, jul./dez. 2011.Submitted by Marlene Santos ([email protected]) on 2013-08-06T21:28:25Z No. of bitstreams: 1 16852-69171-2-PB.pdf: 463297 bytes, checksum: 22ea3851dec90bd0207855cd674ef2cf (MD5)Approved for entry into archive by Claudia Moura ([email protected]) on 2013-08-09T19:19:50Z (GMT) No. of bitstreams: 1 16852-69171-2-PB.pdf: 463297 bytes, checksum: 22ea3851dec90bd0207855cd674ef2cf (MD5)Approved for entry into archive by Claudia Moura ([email protected]) on 2013-08-09T19:20:26Z (GMT) No. of bitstreams: 1 16852-69171-2-PB.pdf: 463297 bytes, checksum: 22ea3851dec90bd0207855cd674ef2cf (MD5)Made available in DSpace on 2013-08-09T19:20:42Z (GMT). No. of bitstreams: 1 16852-69171-2-PB.pdf: 463297 bytes, checksum: 22ea3851dec90bd0207855cd674ef2cf (MD5) Previous issue date: 2011-12CAPES/CNPq; Programa de Apoio às Publicações Periódicas Científicas (PROAPUPEC) da UFGA Superintendência de Desenvolvimento do Centro-Oeste (SUDECO) desempenhou um papel importante na produção do território goiano. Aproximadamente por uma década 1975/1985 Goiás foi palco de dois grandes programas implementados por este órgão: o Programa de Desenvolvimento das Áreas de Cerrado (POLOCENTRO), criado com o objetivo de ocupar as zonas com cobertura vegetal predominante de Cerrado, incorporando estas terras à fronteira agrícola, a partir do emprego de modernas técnicas de produção; e o Programa da Região Geoeconômica de Brasília (PERGEB), que norteou ações no sentido de desenvolver as áreas limítrofes ao Distrito Federal, formando uma “zona tampão” que preservasse o caráter político, administrativo e cultural arquitetado para a capital da República. _______________________________________________________________________________________________________________________ ABSTRACT _______________________________________________________________________________________________________________________ The Superintendência de Desenvolvimento do Centro-Oeste – SUDECO – played an important role in the production in the state of Goiás. For nearly a decade, during the 1975/1985 period, Goiás took the center stage in two big programs implemented by this body: the Program for Development of Areas of Cerrado - POLOCENTRO – established with the objective of occupying areas with predominantly cerrado vegetation cover, incorporating these lands into the agricultural frontier, owing to the use of modern techniques of production; and the Program for the Geographical and Economical Region of Brasilia – PERGEB – who directed actions to develop the areas bordering the Federal District, forming a “buffer zone” in order to preserve the political, administrative and cultural characters, originally conceived for the federal capital. _______________________________________________________________________________________________________________________ ABSTRACT _______________________________________________________________________________________________________________________ La Superintendência de Desenvolvimento do Centro-Oeste – SUDECO – tuvo un papel importante en el segmento productivo en el territorio goiano. Aproximadamente por una década 1975/1985 Goiás fue el escenario de dos de los grandes programas implementados por esta entidad: El Programa de Desarrollo de las Areas del Cerrado (Ecoregion de la sabana Brasilera) – POLOCENTRO –, creado con el objetivo de ocupar las zonas con cobertura vegetal predominante de la vegetación de cerrado, incorporando estas tierras a la frontera agrícola, a partir del uso de técnicas modernas de producción; y el Programa da Região Geoeconômica de Brasília – PERGEB –, que direccionó acciones en el sentido de desarrollar áreas limítrofes al Distrito Federal, formando una “zona amortecedora” preservando el caráter político, administrativo y cultural arquitectado para la capital de la república

Palliative pelvic exenteration: A systematic review of patient-centered outcomes

Objective: Palliative pelvic exenteration (PPE) is a technically complex operation with high morbidity and mortality rates, considered in patients with limited life expectancy. There is little evidence to guide practice. We performed a systematic review to evaluate the impact of PPE on symptom relief and quality of life (QoL). Methods: A systematic review was conducted according to the PRISMA guidelines using Ovid MEDLINE, EMBASe, and PubMed databases for studies reporting on outcomes of PPE for symptom relief or QoL. Descriptive statistics were used on pooled patient cohorts. Results: Twenty-three historical cohorts and case series were included, comprising 509 patients. No comparative studies were found. Most malignancies were of colorectal, gynaecological and urological origin. Common indications for PPE were pain, symptomatic fistula, bleeding, malodour, obstruction and pelvic sepsis. The pooled median postoperative morbidity rate was 53.6% (13\u2013100%), the median in-hospital mortality was 6.3% (0\u201366.7%), and median OS was 14 months (4\u201340 months). Some symptom relief was reported in a median of 79% (50\u2013100%) of the patients, although the magnitude of effect was poorly measured. Data for QoL measures were inconclusive. Five studies discouraged performing PPE in any patient, while 18 studies concluded that the procedure can be considered in highly selected patients. Conclusion: Available evidence on PPE is of low-quality. Morbidity and mortality rates are high with a short median OS interval. While some symptom relief may be afforded by this procedure, evidence for improvement in QoL is limited. A highly selective individualised approach is required to optimise the risk:benefit equation

Predicting outcomes of pelvic exenteration using machine learning

Aim: We aim to compare machine learning with neural network performance in predicting R0 resection (R0), length of stay &gt;&nbsp;14&nbsp;days (LOS), major complication rates at 30&nbsp;days postoperatively (COMP) and survival greater than 1 year (SURV) for patients having pelvic exenteration for locally advanced and recurrent rectal cancer. Method: A deep learning computer was built and the programming environment was established. The PelvEx Collaborative database was used which contains anonymized data on patients who underwent pelvic exenteration for locally advanced or locally recurrent colorectal cancer between 2004 and 2014. Logistic regression, a support vector machine and an artificial neural network (ANN) were trained. Twenty per cent of the data were used as a test set for calculating prediction accuracy for R0, LOS, COMP and SURV. Model performance was measured by plotting receiver operating characteristic (ROC) curves and calculating the area under the ROC curve (AUROC). Results: Machine learning models and ANNs were trained on 1147 cases. The AUROC for all outcome predictions ranged from 0.608 to 0.793 indicating modest to moderate predictive ability. The models performed best at predicting LOS &gt;&nbsp;14&nbsp;days with an AUROC of 0.793 using preoperative and operative data. Visualized logistic regression model weights indicate a varying impact of variables on the outcome in question. Conclusion: This paper highlights the potential for predictive modelling of large international databases. Current data allow moderate predictive ability of both complex ANNs and more classic methods