Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations

4U 1626-67 as seen by Suzaku before and after the 2008 torque reversal

Aims. The accretion-powered pulsar 4U 1626-67 experienced a new torque reversal at the beginning of 2008, after about 18 years of steadily spinning down. The main goal of the present work is to study this recent torque reversal that occurred in 2008 February. Methods. We present a spectral analysis of this source using two pointed observations performed by Suzaku in 2006 March and in 2010 September. Results. We confirm with Suzaku the presence of a strong emission-line complex centered on 1 keV, with the strongest line being the hydrogen-like Ne Ly-alpha at 1.025(3) keV. We were able to resolve this complex with up to seven emission lines. A dramatic increase of the intensity of the Ne Ly-alpha line after the 2008 torque reversal occurred, with the equivalent width of this line reaching almost the same value measured by ASCA in 1993. We also report on the detection of a cyclotron line feature centered at ~37 keV. In spite of the fact that an increase of the X-ray luminosity (0.5-100 keV) of a factor of ~2.8 occurred between these two observations, no significant change in the energy of the cyclotron line feature was observed. However, the intensity of the ~1 keV line complex increased by an overall factor of ~8. Conclusions. Our results favor a scenario in which the neutron star in 4U 1626-67 accretes material from a geometrically thin disk during both the spin-up and spin-down phases.Comment: 7 pages, 5 figures and 2 tables. Accepted in A&

Pelvic floor disorders in gynecological malignancies. An overlooked problem?

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors

COMMENTS ABOUT HIGGS FIELDS, NONCOMMUTATIVE GEOMETRY AND THE STANDARD MODEL

We make a short review of the formalism that describes Higgs and Yang Mills fields as two particular cases of an appropriate generalization of the notion of connection. We also comment about the several variants of this formalism, their interest, the relations with noncommutative geometry, the existence (or lack of existence) of phenomenological predictions, the relation with Lie super-algebras etc.Comment: pp 20, LaTeX file, no figures, also available via anonymous ftp at ftp://cpt.univ-mrs.fr/ or via gopher gopher://cpt.univ-mrs.fr

Using Synchronic and Diachronic Relations for Summarizing Multiple Documents Describing Evolving Events

In this paper we present a fresh look at the problem of summarizing evolving events from multiple sources. After a discussion concerning the nature of evolving events we introduce a distinction between linearly and non-linearly evolving events. We present then a general methodology for the automatic creation of summaries from evolving events. At its heart lie the notions of Synchronic and Diachronic cross-document Relations (SDRs), whose aim is the identification of similarities and differences between sources, from a synchronical and diachronical perspective. SDRs do not connect documents or textual elements found therein, but structures one might call messages. Applying this methodology will yield a set of messages and relations, SDRs, connecting them, that is a graph which we call grid. We will show how such a grid can be considered as the starting point of a Natural Language Generation System. The methodology is evaluated in two case-studies, one for linearly evolving events (descriptions of football matches) and another one for non-linearly evolving events (terrorist incidents involving hostages). In both cases we evaluate the results produced by our computational systems.Comment: 45 pages, 6 figures. To appear in the Journal of Intelligent Information System

Spinning-Up: The Case of the Symbiotic X-Ray Binary 3A 1954+319

We present a timing and spectral analysis of the variable X-ray source 3A 1954+319, Our analysis is mainly based on an outburst serendipitously observed during INTEGRAL Key Program observations of the Cygnus region in 2008 fall and on the Swift/BAT longterm light curve, Previous observations, though sparse, have identified the source to be one of only nine known symbiotic X-ray binaries, i.e., systems composed of an accreting neutron star orbiting in a highly inhomogeneous medium around an M-giant companion. The spectrum of 3A 1954+319 above 20 keY can be best described by a broken power law model. The extremely long pulse period of approx.5.3 hours is clearly visible in the INTEGRAL/ISGRI light curve and confirmed through an epoch folding period search. Furthermore, the light curve allows us to determine a very strong spin up of -2x10(exp 4)h/h during the outburst. This spin up is confirmed by the pulse period evolution calculated from Swift/BAT data. The Swift/BAT data also show a long spin-down trend prior to the 2008 outburst. which is confirmed in archival INTEGRAL/ISGRI data. We discuss possible accretion models and geometries allowing for the transfer of such large amounts of angular momentum and investigate the harder spectrum of this outburst compared to previously published results

Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations

Sofosbuvir add-on to ribavirin for chronic hepatitis E in a cirrhotic liver transplant recipient: a case report.

Chronic hepatitis E represents an emerging challenge in organ transplantation, as there are currently no established treatment options for patients who fail to clear hepatitis E virus (HEV) following reduction of immunosuppressive therapy and/or treatment with ribavirin. Sofosbuvir has shown antiviral activity against HEV in vitro but clinical utility in vivo is unknown. We describe a 57-year-old liver transplant recipient with decompensated graft cirrhosis due to chronic hepatitis E. Reduction of immunosuppressive treatment as well ribavirin alone for 4 months did not result in viral clearance. Add-on of sofosbuvir for 6 months was associated with HEV RNA becoming undetectable in plasma. However, sustained viral clearance could not be achieved. Sofosbuvir may have some antiviral activity against HEV when added to ribavirin. However, this did not suffice to yield sustained viral clearance. Our well-characterized observation emphasizes the need for new treatment options to cure chronic hepatitis E in the setting of organ transplantation

Cyclotron resonant scattering feature simulations. I. Thermally averaged cyclotron scattering cross sections, mean free photon-path tables, and electron momentum sampling

Electron cyclotron resonant scattering features (CRSFs) are observed as absorption-like lines in the spectra of X-ray pulsars. A significant fraction of the computing time for Monte Carlo simulations of these quantum mechanical features is spent on the calculation of the mean free path for each individual photon before scattering, since it involves a complex numerical integration over the scattering cross section and the (thermal) velocity distribution of the scattering electrons. We aim to numerically calculate interpolation tables which can be used in CRSF simulations to sample the mean free path of the scattering photon and the momentum of the scattering electron. The tables also contain all the information required for sampling the scattering electron's final spin. The tables were calculated using an adaptive Simpson integration scheme. The energy and angle grids were refined until a prescribed accuracy is reached. The tables are used by our simulation code to produce artificial CRSF spectra. The electron momenta sampled during these simulations were analyzed and justified using theoretically determined boundaries. We present a complete set of tables suited for mean free path calculations of Monte Carlo simulations of the cyclotron scattering process for conditions expected in typical X-ray pulsar accretion columns (0.01<B/B_{crit}<=0.12, where B_{crit}=4.413x10^{13} G and 3keV<=kT<15keV). The sampling of the tables is chosen such that the results have an estimated relative error of at most 1/15 for all points in the grid. The tables are available online at http://www.sternwarte.uni-erlangen.de/research/cyclo.Comment: A&A, in pres