Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study

BACKGROUND: Treatment strategies for spinal metastases for myeloma range from conservative measures (radiation and chemotherapy) to invasive (surgical). Identifying better predictors of overall survival (OS) would help in surgical decision making. Analytic morphometrics has been shown to predict survival in oncologic patients, and our study evaluates whether morphometrics is predictive of survival in patients with multiple myeloma (MM) spinal metastases. METHODS: For this observational retrospective cohort study, we identified 46 patients with MM spinal metastases who had undergone stereotactic body radiation therapy. OS was the primary outcome measure. Morphometric analysis of the psoas muscle was performed using computed tomography scans of the lumbar spine. RESULTS: OS was statistically correlated with age (P = 0.025), tumor burden (P = 0.023), and number of levels radiated (P = 0.029), but not with gender. Patients in the lowest tertile of average psoas size had significantly shorter survival compared to the highest tertile, hazard ratio (HZ) 6.87 (95% CI = 1.65-28.5, P = 0.008). When calculating the psoas size to vertebral body ratio and correlating this measure to OS, the lowest tertile again had significantly shorter OS compared to the highest tertile, HZ 6.87 (95% CI = 1.57-29.89, P = 0.010); the middle tertile also showed significantly shorter OS compared to the highest tertile, HZ 5.07 (95% CI = 1.34-19.10, P = 0.016). Kaplan-Meier survival curves were used to visually illustrate the differences in survival between different tertiles (Log-rank test P = 0.006). CONCLUSIONS: Morphometric analysis successfully predicts long-term survival in patients with MM. More research is needed to validate these results and to see if these methodologies can be applied to other cancer histologies

Feasibility of inguinal hernioplasty under local anaesthesia in elderly patients.

BACKGROUND: The aim of this study is to evaluate the feasibility and the safety of hernioplasty under local anaesthesia in elderly patients with significant comorbidity. METHODS: A total of 218 patients underwent inguinal hernia repair with mesh between June 2009 and July 2012. Presence of comorbid conditions and complications were compared between patients younger and older than 70 years. RESULTS: Hernia repair in older patients were more likely associated with comorbid conditions than in their younger counterparts ( hypertension: 25% vs 8.16%; cardiovascular diseases: 50% vs 22%; benign prostatic hypertrophy 60% vs 30%). The most common postoperative complications in both groups were recurrence, wound infection, urinary retention. There was a slightly higher rate of complication in elderly group. CONCLUSIONS: Inguinal hernia repair with local anaesthesia is quite safe and results in a good success rate in elderly patients despite a higher rate of comorbidity typical of this kind of patient

A Simplified Sanitary Sewer System Generator for Exploratory Modelling at City-Scale

Future climatic, demographic, technological, urban and socio-economic challenges call for more flexible and sustainable wastewater infrastructure systems. Exploratory modelling can help to investigate the consequences of these developments on the infrastructure. In order to explore large numbers of adaptation strategies, we need to re-balance the degree of realism of sewer network and ability to reflect key performance characteristics against the model's parsimony and computational efficiency. We present a spatially explicit algorithm for creating sanitary sewer networks that realistically represent key characteristics of a real system. Basic topographic, demographic and urban characteristics are abstracted into a squared grid of ‘Blocks’ which are the foundation for the sewer network's topology delineation. We compare three different pipe dimensioning approaches and found a good balance between detail and computational efficiency. With a basic hydraulic performance assessment, we demonstrate that we attain a computationally efficient and high-fidelity wastewater sewer network with adequate hydraulic performance. A spatial resolution of 250 m Block size in combination with a sequential Pipe-by-Pipe (PBP) design algorithm provides a sound trade-off between computational time and fidelity of relevant structural and hydraulic properties for exploratory modelling. We can generate a simplified sewer network (both topology and hydraulic design) in 18 s using PBP, versus 36 min using a highly detailed model or 1 s using a highly abstract model. Moreover, this simplification can cut up to 1/10th to 1/50th the computational time for the hydraulic simulations depending on the routing method implemented. We anticipate our model to be a starting point for sophisticated exploratory modelling into possible infrastructure adaptation measures of topological and loading changes of sewer systems for long-term planning.Policy AnalysisSanitary Engineerin

Ddifferential diagnosis of vascular anomalies in lower limbs, a review

Vascular anomalies are a heterogeneous group of diseases which include vascular tumors and vascular malformations, are also divided into fast-flow and slow-flow lesions accord- ing to the ISSVA Classification. These pathologies overlaps in clinical presentation especially in lower limbs where asym- metric overgrowth and bone involvement are features in com- mon between the main of these pathologies. PubMed, Scopus and ScienceDirect databases were searched for articles using the terms: Vascular Anomalies, Vascular Tumors, Vascular Malformations and the significant full text were downloaded and analyzed. From literature review, a description of the differences in clinical features and the differential diagnosis among vascular anomalies was given. It is important to reach an early diagnosis in order to offer the best clinical manage- ment to patients and avoid economic waste. This is achievable by a correct and accurate clinical examination accompanied by a US and Doppler examination. Other investigations, in- cluding MRI that is the more effective, must be used care- fully

Reirradiation of the spine with stereotactic radiosurgery: Efficacy and toxicity

PURPOSE: To determine the potential benefits and adverse effects associated with reirradiating the spinal cord when at least 1 course of radiation therapy (RT) is stereotactic radiosurgery (SRS). METHODS AND MATERIALS: This institutional review board-approved retrospective review included 162 patients (237 reirradiated spine lesions). All patients received SRS at our institution between 2001 and 2013. Electronic medical records were reviewed for clinical exams and radiologic tests (computed tomography/magnetic resonance imaging). Primary endpoints were pain, neurological, radiographic responses, and the development of adverse effects. RESULTS: A total of 120 patients (74.1%) were deceased with a median survival of 13 months. Time between courses of RT was a median of 10.2 months. Median SRS dose was 16 Gy in 1 fraction, whereas the median conventional external beam radiation therapy (cEBRT) dose was 30 Gy in 10 fractions. The median tumor equivalent dose in 2-Gy fractions (EQD2) for SRS doses was 34.7 Gy, whereas the median tumor EQD2 for cEBRT was 32.5 Gy, providing a median total tumor EQD2 of 69.3 Gy (22-145.6 Gy). The median critical nervous tissue EQD2 for SRS and cEBRT was 56 Gy and 37.5 Gy, respectively, resulting in a median total critical nervous tissue EQD2 of 93.5 Gy. Overall pain, neurological, and radiographic response rates were 81%, 82%, and 71%, respectively. Adverse effects occurred in 11 (6.8%) patients. Seventy-seven vertebral compression fractures were observed, 22 (9.3%) of which may be attributed to RT. CONCLUSIONS: Our results demonstrate that reirradiation achieves favorable response rates with minimal toxicity if recommended dose constraints to the spinal cord with SRS are carefully observed. To the best of our knowledge, this is the largest reported single-institution experience analyzing the efficacy and toxicity of reirradiation of the spine when at least 1 course of RT is stereotactic radiosurgery