Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life. A prospective multicentre randomised controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial)

<p>Abstract</p> <p>Background</p> <p>Breast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume of the resected breast tissue being the major determinant. There is clear evidence for the efficacy of ultrasonography in the resection of nonpalpable tumours. Surgical resection of palpable breast cancer is performed with guidance by intra-operative palpation. These palpation-guided excisions often result in an unnecessarily wide resection of adjacent healthy breast tissue, while the rate of tumour-involved resection margins is still high. It is hypothesised that the use of intra-operative ultrasonography in the excision of palpable breast cancer will improve the ability to spare healthy breast tissue while maintaining or even improving the oncological margin status. The aim of this study is to compare ultrasound-guided surgery for palpable tumours with the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumour-free margins, cosmetic outcomes and quality of life.</p> <p>Methods/design</p> <p>In this prospective multicentre randomised controlled clinical trial, 120 women who have been diagnosed with palpable early-stage (T1-2N0-1) primary invasive breast cancer and deemed suitable for breast-conserving surgery will be randomised between ultrasound-guided surgery and palpation-guided surgery. With this sample size, an expected 20% reduction of resected breast tissue and an 18% difference in tumour-free margins can be detected with a power of 80%. Secondary endpoints include cosmetic outcomes and quality of life. The rationale, study design and planned analyses are described.</p> <p>Conclusion</p> <p>The COBALT trial is a prospective, multicentre, randomised controlled study to assess the efficacy of ultrasound-guided breast-conserving surgery in patients with palpable early-stage primary invasive breast cancer in terms of the sparing of breast tissue, oncological margin status, cosmetic outcomes and quality of life.</p> <p>Trial Registration Number</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2579">NTR2579</a></p

Multi-criteria Analysis of Sustainable Aviation Fuel Technologies: Integrating Environmental, Economic, Social, and Technical Criteria along with Stakeholder Perspectives to Compare Fast Pyrolysis, Hydrothermal Liquefaction, and HEFA Pathways

The aviation sector, responsible for approximately 2% of global anthropogenic greenhouse gas emissions, is projected to grow 4-6 times by 2050, conflicting with the European Union’s Green Deal target of achieving net-zero emissions by the same year. While aircraft electrification offers a promising solution, its application is largely limited to short-haul flights due to range and weight limitations. Sustainable Aviation Fuel (SAF) emerges as a compelling alternative for long-haul operations, as it is compatible with both existing infrastructure and can be blended with fossil fuels. Currently, Hydroprocessed Esters and Fatty Acids (HEFA) is the predominant pathway for producing SAF. There remains a significant supply gap for SAF, emphasising the need to scale up production and explore alternative technologies. This thesis evaluates the potential of hydrothermal liquefaction (HTL) and fast pyrolysis (FP) to address this supply gap.The research objective is to compare HTL and FP with HEFA. A literature review identified three main knowledge gaps: (1) a lack of studies on the social impacts of HTL and FP, (2) the absence of stakeholder involvement in evaluating these technologies, and (3) the need for updated data integration to effectively compare HTL and FP with established SAF technologies like HEFA. This study addresses these gaps using a multi-criteria analysis (MCA) to provide a holistic evaluation across a multi-temporal timescale while considering diverse stakeholder perspectives.The study employed a four-phase methodology. The first phase began with the identification of stakeholders through desk research. The second phase involved establishing the criteria for the MCA via a literature review focusing on four main dimensions: environmental (Global Warming Potential and use of by-products), economic (capital expenditure, operating expenditure, and feedstock price), technical (technology readiness level and efficiency), and social (safety and social impacts related to feedstock use). The stakeholders assigned the weightings of each criterion relative to the others during structured interviews using the Best-Worst Method (BWM). In the third phase, each technology was assessed against the established criteria through detailed analysis using specific methods. Based on the findings of the analysis, SAF experts assigned performance scores to each technology per criterion. Finally, in the fourth phase, the criteria and their weightings, along with the performance scores, were integrated to calculate a final weighted MCA score for each technology. This resulted in a final ranking of the technologies based on their overall MCA scores for each stakeholder.HTL and FP are potential alternatives to the HEFA pathway to produce SAF, each with different advantages and disadvantages. Technically and economically, HEFA currently outperforms due to its maturity and lower costs. At the same time, HTL and FP offer potential environmental and social benefits, particularly in terms of the kind of feedstocks used and the possibilities of by-product valorisation. The preference for each technology varies between stakeholders, indicating the need for a balanced approach that integrates multiple perspectives in SAF implementation decision-making. This research provides actionable insights for advancing SAF technologies and supports the broader goal of achieving sustainable aviation.Complex Systems Engineering and Management (CoSEM

Dissertatio juridica inauguralis De civili, inprimis privata, personarum conditione, sive statu, ex codice legum civilium ...

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Ultrasound guided lumpectomy is superior to wire guided resection of nonpalpable breast cancer: a prospective randomised trial.

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