A Prospective Analysis on Functional Outcomes Following Extended Latissimus Dorsi Flap Breast Reconstruction.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesTo prospectively assess the functional effect of using the extended latissimus dorsi flap in immediate breast reconstructions.A total of 15 consecutive patients undergoing breast reconstruction with extended latissimus dorsi flap participated. Shoulder range of motion, muscle strength, lateral flexion of the torso, and position of scapula were measured pre-operatively and 1, 6, and 12 months post-operatively, in addition to donor-site post-operative complications.At 12 months post-operatively, patients had achieved full range of shoulder movement, when compared to pre-operative values. Lateral flexion of the torso was, however, significantly reduced bilaterally at 1 and 6 months post-operatively (p = 0.001, p = 0.01) and to the not operated side at 12 months (p = 0.01). Muscle strength in flexion-extension-internal rotation was significantly (p = 0.01) reduced on the operated side 12 months post-operatively. All but one patient had numbness around the donor-site scar 12 months post-operatively, 33% had slight adhesions but all were pain free.Although invariably, patients having extended latissimus dorsi flap may expect to achieve full range of shoulder movement, they should be informed of possible functional consequences and the time and effort it takes to recover. Further research is needed to investigate the potential long-term functional implications that extended latissimus dorsi flap may have as a result of changes in the lateral flexion of the torso and scapula position

Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II

PURPOSE: The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN). METHODS: GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter < 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS: From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases > 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (≤ 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL. CONCLUSION: Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL

Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: Study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II)

Background: A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R0 resection rate in LRRC. Methods: Thismulticentre, international, open-label, phase III, parallel-arms study will enrol 364 patients with resectable LRRC after previous partial or total mesorectal resection without synchronous distant metastases or recent chemo- and/or radiotherapy treatment. Patients will be randomized to receive either induction chemotherapy (three 3-week cycles of CAPOX (capecitabine, oxaliplatin), four 2- week cycles of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) or FOLFORI (5-fluorouracil, leucovorin, irinotecan)) followed by neoadjuvant chemoradiotherapy and surgery (experimental arm) or neoadjuvant chemoradiotherapy and surgery alone (control arm). Tumours will be restaged usingMRI and, in the experimental arm, a further cycle of CAPOX or two cycles of FOLFOX/FOLFIRI will be administered before chemoradiotherapy in case of stable or responsive disease. The radiotherapy dose will be 25 × 2.0 Gy or 28 × 1.8Gy in radiotherapy-naive patients, and 15 × 2.0Gy in previously irradiated patients. The concomitant chemotherapy agent will be capecitabine administered twice daily at a dose of 825mg/m2 on radiotherapy days. The primary endpoint of the study is the R0 resection rate. Secondary endpoints are long-termoncological outcomes, radiological and pathological response, toxicity, postoperative complications, costs, and quality of life. Discussion: This trial protocol describes the PelvEx II study. PelvEx II, designed as a multicentre, open-label, phase III, parallel-arms study, is the first randomized study to compare induction chemotherapy followed by neoadjuvant chemo(re)irradiation and surgery with neoadjuvant chemo(re)irradiation and surgery alone in patients with locally recurrent rectal cancer, with the aim of improving the number of R0 resections

Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II)

Background A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R0 resection rate in LRRC. Methods This multicentre, international, open-label, phase III, parallel-arms study will enrol 364 patients with resectable LRRC after previous partial or total mesorectal resection without synchronous distant metastases or recent chemo- and/or radiotherapy treatment. Patients will be randomized to receive either induction chemotherapy (three 3-week cycles of CAPOX (capecitabine, oxaliplatin), four 2-week cycles of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) or FOLFORI (5-fluorouracil, leucovorin, irinotecan)) followed by neoadjuvant chemoradiotherapy and surgery (experimental arm) or neoadjuvant chemoradiotherapy and surgery alone (control arm). Tumours will be restaged using MRI and, in the experimental arm, a further cycle of CAPOX or two cycles of FOLFOX/FOLFIRI will be administered before chemoradiotherapy in case of stable or responsive disease. The radiotherapy dose will be 25 × 2.0 Gy or 28 × 1.8 Gy in radiotherapy-naive patients, and 15 × 2.0 Gy in previously irradiated patients. The concomitant chemotherapy agent will be capecitabine administered twice daily at a dose of 825 mg/m2 on radiotherapy days. The primary endpoint of the study is the R0 resection rate. Secondary endpoints are long-term oncological outcomes, radiological and pathological response, toxicity, postoperative complications, costs, and quality of life. Discussion This trial protocol describes the PelvEx II study. PelvEx II, designed as a multicentre, open-label, phase III, parallel-arms study, is the first randomized study to compare induction chemotherapy followed by neoadjuvant chemo(re)irradiation and surgery with neoadjuvant chemo(re)irradiation and surgery alone in patients with locally recurrent rectal cancer, with the aim of improving the number of R0 resections

The Relationship Between Satisfaction With Life, ADHD Symptoms, and Associated Problems Among University Students

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: To ascertain whether ADHD symptoms, and associated problems, are negatively related to subjective well-being. METHOD: The Satisfaction With Life Scale (SWLS) was completed by 369 university students, along with the Reasoning & Rehabilitation (R&R) ADHD Training Evaluation (RATE), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Scale for current ADHD symptoms, and the Depression Anxiety Stress Scales (DASS). RESULTS: The SWLS was negatively correlated with all the other measures, and the strongest correlations were with the Total RATE score. A multiple regression analysis showed that the variables in the study accounted for 22% and 25% of the variance of the SWLS among males and females, respectively. Among males poor social functioning was the best predictor of dissatisfaction with life, whereas among females it was poor emotional control. CONCLUSION: Both ADHD symptoms and associated problems are significantly related to poorer satisfaction with life

Agrupamentos de fitólitos ao longo de um gradiente de antiga perturbação humana na Amazônia Ocidental

The ecological status of prehistoric Amazonian forests remains widely debated. The concept of ancient Amazonia as a pristine wilderness is largely discredited, but the alternative hypothesis of extensive anthropogenic landscapes remains untested in many regions. We assessed the degree of ancient human impacts across western Amazonia based on archeological and paleoecological data using methodologies that would allow inter-regional comparisons. We also aimed to establish baselines for estimating the legacies of ancient disturbances on modern vegetation. We analyzed charcoal and phytolith assemblages from soil samples from an archeological site, sites in close proximity to archeological sites, sites from riverine and interfluvial forests, and a biological research station believed to contain some of the least disturbed forests within Amazonia. We then quantitatively compared phytolith assemblages within and between the surveyed regions. Palm enrichment was evident at the archeological site, and the biological station survey contained little to no evidence of ancient human activity. The other sites exhibited a gradient of ancient disturbance across the landscape. The phytolith assemblages showed statistically significant between-region variations that indicated our metrics were sufficiently sensitive to detecting ancient disturbance. Our data highlight the spatial heterogeneity of ancient human disturbances in Amazonian forests. The quantification of these disturbances provides empirical data and a more concrete link between the composition of the modern forest and ancient disturbance regimes. Accounting for ancient disturbances will allow a deeper understanding of the landscape heterogeneity observed in the modern forests.O status ecológico das florestas amazônicas pré-históricas continua sendo debatido; o conceito da Amazônia antiga como uma selva virgem está amplamente desacreditado, embora a hipótese alternativa de amplas paisagens antropogênicas não tenha sido testada em muitas regiões. Avaliamos o grau de impactos humanos antigos em toda a Amazônia Ocidental com base em dados arqueológicos e paleontológicos utilizando metodologias que permitem comparações inter-regionais. Também temos como objetivo estabelecer linhas de base para estimar os legados de distúrbios antigos sobre a vegetação moderna. Analisamos agrupamentos de carvão e fitólitos de amostras de solo de um sítio arqueológico, locais nas proximidades de sítios arqueológicos, locais de ribeirinhos e florestas interfluviais, e uma estação de pesquisa biológica onde se acredita está o local com algumas das florestas menos perturbadas na Amazônia. Então comparamos quantitativamente agrupamentos de fitólitos dentro e entre as regiões pesquisadas. Os agrupamentos de fitólitos mostraram significativas variações estatísticas entre regiões, demonstrando que nossas métricas eram suficientemente sensíveis para detectar perturbações antigas. Os dados coletados destacam a heterogeneidade espacial de perturbações humanas antigas em florestas amazônicas. A quantificação desses distúrbios fornece dados empíricos e uma ligação mais concreta entre a composição da floresta moderna e regimes de perturbação antigos e a contabilização de distúrbios antigos permitirá uma compreensão mais profunda da heterogeneidade da paisagem observada nas florestas modernas

Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node : Results of GROINSS-V II

PURPOSE The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN). METHODS GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter &amp;lt; 4 cm) without signs of lymph node involvement at imaging, who had primary surgical treatment (local excision with SN biopsy). Where the SN was involved (metastasis of any size), inguinofemoral radiotherapy was given (50 Gy). The primary end point was isolated groin recurrence rate at 24 months. Stopping rules were defined for the occurrence of groin recurrences. RESULTS From December 2005 until October 2016, 1,535 eligible patients were registered. The SN showed metastasis in 322 (21.0%) patients. In June 2010, with 91 SN-positive patients included, the stopping rule was activated because the isolated groin recurrence rate in this group went above our predefined threshold. Among 10 patients with an isolated groin recurrence, nine had SN metastases &amp;gt; 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (&amp;gt; 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (&amp;lt;= 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL. CONCLUSION Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL.Funding Agencies|Dutch Cancer Society (KWF Kankerbestrijding)KWF Kankerbestrijding; NRG Oncology</p