Vaginal Recurrence More than 17 Years after Hysterectomy and Adjuvant Treatment for Uterine Carcinoma with Successful Salvage Brachytherapy: A Case Report

Purpose: Although the majority of recurrences occur within the first 3 years of hysterectomy for endometrioid carcinoma, we report herein a successful salvage vaginal brachytherapy in a patient with endometrioid uterine carcinoma which recurred more than 17 years after initial treatment. Materials and Methods: A 61-year-old female was diagnosed with endometrioid adenocarcinoma of the uterus and treated with TAH-BSO, followed by adjuvant external beam radiation therapy (EBRT) to the whole pelvis. After remaining free of any recurrent or metastatic disease for more than 17 years, she was diagnosed with isolated vaginal cuff recurrence and successfully treated with a salvage high-dose-rate intracavitary vaginal brachytherapy. Results: The patient remained disease free until her death from unrelated causes 7 years later. Conclusion: To the best of our knowledge, this case represents the longest time to recurrence of endometrial cancer in someone who had been treated with TAH-BSO and adjuvant pelvic EBRT. This case highlights that even with adjuvant therapy, late recurrences may occur, and successful salvage brachytherapy is very effective

Sinkholes in hypogene versus epigene karst systems, illustrated with the hypogene gypsum karst of the Sant Miquel de Campmajor Valley, NE Spain

The Garrotxa-Banyoles artesian aquifer system in NE Spain includes zones with epigene and hypogene evaporite karst and sinkhole development. The sinkhole fields related to hypogene evaporite dissolution are associated with the discharge zones of the aquifer, where groundwater from a confined limestone rises traversing an overlying gypsum formation capped by thick marls. This work analyses the sinkhole field developed in the Sant Miquel de Campmajor Valley (SMCV), a discharge area of the aquifer, where a cartographic inventory including 94 sinkholes has been produced. Sinkholes in this hypogene gypsum karst are mainly large caprock-collapse sinkholes rooted in deep-seated cavities generated by interstratal hypogene karstification, as corroborated by an electrical resistivity imaging (ERI) survey. They show a non-clustered distribution within the sinkhole field and the variations in size and density across the area are mainly controlled by the thickness of the marl caprock. The magnitude and frequency relationships of the sinkholes can be modelled with a high goodness of fit with a log-normal function, like in other regions of the world. However, in this deep-seated hypogene system the depressions show much larger dimensions. Potential differences between the sinkholes developed in hypogene and epigene karst environments are discussed, including their distribution with respect to the groundwater flow system, their spatial patterns and dimensions

Investigating the enigma of an irregular groundwater age pattern in a confined, presumed “fossil” complex aquifer through mixing cell flow modeling

Significant fluctuations in the groundwater (GW) age along the eastern flow path of the Nubian Sandstone Aquifer's (NSA), as derived from Krypton-81 groundwater dating, have suggested that this aquifer, located in Israel's Negev Desert and previously presumed to be a fossil, is not entirely isolated but mixes with younger and even recent water. The intermittent rejuvenation and drastic increases in the GW age across short distances most likely imply hydraulic connectivity with the surrounding aquifers, which contribute both younger and more ancient water to the NSA. The current study aims at modeling the GW flow system to locate and quantify its water sources despite the aquifer's hydrogeological complexity and the scarcity of hydrological data. We implemented the Mixing Cell Modeling (MCM) approach, understanding that the alternating rejuvenations and increases in the GW age downstream of the NSA's eastern flow trajectory reflect the mixing of the NSA's groundwater with young and old GW bodies, respectively. Thus, prompted by the 81Kr water age distribution, yet independent of the Kr radioisotope data, a multi-tracer mixing cell flow model was adopted based on a set of balance equations of water, dissolved minerals, and stable environmental isotopes. The findings indicate that (1) there is a small, yet substantial, intrusion of old brackish GW from a deep-seated, highly pressurized aquifer into the NSA in the northeastern Negev; (2) the rejuvenation of GW in the NSA is due to significant mixing with water from nearby overlying carbonate and chert aquifers, and (3) the NSA is substantially replenished through the Nubian Sandstone (NS) outcrops along the Negev Desert anticlines. Most GW intrusions into the NSA occur near the intersections of the eastern flow path with some of the Negev's major faults and synclines, such as the Paran and Ramon Fault zones and the Zin Syncline. In light of the relatively young GW age at the end of the NSA's western flow path in the northern Negev, and based on the similarities in the hydrogeological structures in the Negev and northern Sinai Deserts, we propose that similar mixing processes with GW from the overlying carbonate aquifers and direct GW recharge through the NS outcrops also occur in the northern Sinai Peninsula. The approach presented in this study might apply to examining recharge processes and hydraulic connectivity in other aquifers that were formerly classified as “fossil,” such as the immense NSA found in the Arabian (Jordan & Saudi Arabia) and the Western (Egypt) Deserts

Vegetation history and climatic fluctuations on a transect along the Dead Sea west shore and impact on past societies over the last 3500 years.

This study represents the vegetation history of the last 3500 years and conducts an analysis of the climatic fluctuations on a 75 km long transect on the western Dead Sea shore. Palynological and sedimentological data are available from six cores near Mount Sedom, Ein Boqueq, and Ein Gedi and from outcrops near Ze'elim and Ein Feshkha. The comparison of the pollen data with the lake levels shows synchronous trends. During the Middle Bronze Age, Iron Age and Hellenistic to Byzantine Period the high lake level of the Dead Sea signals an increase in precipitation. Contemporaneously, values of cultivated plants indicate an increase in agriculture. Lake level is low during the Late Bronze Age, within the Iron Age and at the end of the Byzantine period, indicating dry periods when all pds show a decrease of cultivated plants. Forest regeneration led by drought-resistant pines is observed in all pollen diagrams (pds) following the agricultural decline in the Byzantine period and, in the pds near Ein Boqeq, Ze'elim and Ein Feshkha, during the late Iron Age. The modern vegetation gradient is reflected in the palaeo-records: a stronger expansion of Mediterranean vegetation and cultivated plants in the northern sites is recognisable

Pathologic response rates after neoadjuvant therapy for sarcoma: A single institution study

(1) Background: Pathologic necrosis of soft tissue sarcomas (STS) has been used to determine treatment response, but its relationship to neoadjuvant treatments remains indeterminate. In this retrospective, single institution study, we hypothesized that neoadjuvant chemoradiation (NA-CRT) yields higher rates of pathologic complete response (pCR) than neoadjuvant radiation (NA-XRT) or chemotherapy (NA-CT) alone. (2) Methods: Patients with extremity STS between 2011–2020 who received neoadjuvant treatment were included. pCR was defined as percent necrosis of the surgical specimen greater than or equal to 90%. (3) Results: 79 patients were analyzed. 51.9% of the population were male with a mean age of 58.4 years. 49.4% identified as Non-Hispanic White. Twenty-six (32.9%) patients achieved pCR while 53 (67.1%) did not. NA-CT (OR 15.82, 95% CI = 2.58–96.9, p = 0.003 in univariate (UVA) and OR 24.7, 95% CI = 2.88–211.2, p = 0.003 in multivariate (MVA), respectively) and NA-XRT (OR 5.73, 95% CI = 1.51–21.8, p = 0.010 in UVA and OR 7.95, 95% CI = 1.87–33.7, p = 0.005 in MVA, respectively) was significantly associated with non-pCR when compared to NA-CRT. The analysis also demonstrated that grade 3 tumors, when using grade 2 as reference, also had significantly higher odds of achieving pCR (OR 0.23, 95% CI = 0.06–0.80, p = 0.022 in UVA and OR 0.16, 95% CI = 0.04–0.70, p = 0.015 in MVA, respectively). (4) Conclusion: NA-CRT yields superior pCR compared to other neoadjuvant regimens. This extends to higher grade tumors

Hydrogeochemical characterization of an evaporite karst area affected by sinkholes (Ebro Valley, NE Spain)

The main processes controlling the hydrochemistry of an alluvium-covered evaporite karst area with high sinkhole risk (Ebro Valley, NE Spain) are examined by means of multivariate analyses (Principal Component Analysis and Hierarchical Cluster Analysis), ion correlations and geochemical speciation-solubility calculations. The hydrogeochemistry of the studied system seems to be governed by the interaction between the groundwater from the salt-bearing evaporitic karst aquifer and from the overlying Ebro River alluvial aquifer. The observed hydrochemical features in the alluvial-karst aquifer system are mainly determined by the relative contribution of gypsum/anhydrite and halite dissolution, showing a wide spectrum from relatively fresh recharge waters (mainly irrigation waters) to highly evolved groundwater from the evaporitic aquifer. The variability of these contributions is especially evident at sinkhole ponds which, in some cases, seem to be associated with discharge areas of the karst aquifer in the valley bottom alluvium. Calculated saturation indexes suggest that, in contrast to gypsum, the amounts of halite in the sampled portions of evaporitic aquifer are not large enough to attain equilibrium, which is consistent with the predominance of gypsum/anhydrite reported for these materials. Furthermore, the observed Na:Cl and Ca:SO4 correlations and stoichiometries suggest that other possible processes, such as glauberite dissolution or Na/Ca-exchange, generally play a minor role (compared to halite and gypsum dissolution) in this system. Another important process in the system is the dissolution of carbonate minerals (dolomite and, possibly, calcite) fostered by the input of CO2(g), which is probably produced by pedogenic processes. Dolomite dissolution seems to be particularly relevant in the evaporitic materials probably due to dedolomitisation triggered by gypsum/anhydrite dissolution

MRI T2 mapping assessment of T2 relaxation time in desmoid tumors as a quantitative imaging biomarker of tumor response: preliminary results

ObjectivesBecause size-based imaging criteria poorly capture biologic response in desmoid-type fibromatosis (DF), changes in MRI T2 signal intensity are frequently used as a response surrogate, but remain qualitative. We hypothesized that absolute quantification of DF T2 relaxation time derived from parametric T2 maps would be a feasible and effective imaging biomarker of disease activity.MethodsThis IRB-approved retrospective study included 11 patients with DF, managed by observation or systemic therapy, assessed by 3T MRI. Tumor maximum diameter, volume, and T2-weighted signal intensity were derived from manual tumor segmentations. Tumor:muscle T2 signal ratios were recorded. Two readers measured tumor T2 relaxation times using a commercial T2 scanning sequence, manual ROI delineation and commercial calculation software enabling estimation of reader reliability. Objective response rates based on RECIST1.1 and best responses were compared between size-based and signal-based parameters.ResultsMedian patient age was 52.6 years; 8 subjects were female (73%). Nine patients with longitudinal assessments were followed for an average of 314 days. Median baseline tumor diameter was 7.2 cm (range 4.4 - 18.2 cm). Median baseline T2 was 65.1 ms (range 40.4 - 94.8 ms, n=11); median at last follow-up was 44.3 ms (-32% from baseline; range 29.3 - 94.7 ms, n=9). T2 relaxation times correlated with tumor:muscle T2 signal ratios, Spearman p=0.78 (p<0.001). T2 mapping showed high inter-reader reliability, ICC=0.84. The best response as a percentage change in T2 values was statistically significant (mean -17.9%, p=0.05, paired t-test) while change in diameter was not (mean -8.9%, p=0.12).ConclusionsAnalysis of T2 relaxation time maps of DF may offer a feasible quantitative biomarker for assessing the extent of response to treatment. This approach may have high inter-reader reliability

Еволюція рослинного світу в природному і культигенному середовищі

У ході засідань Міжнародної наукової конференції “Еволюція рослинного світу в природному і культигенному середовищі”, присвяченої 200-річчю від Дня народження Чарльза Дарвіна, обговорено актуальні питання еволюційної теорії, ботаніки, фізіології рослин, інтродукції, генетики й селекції, екології, збереження і примноження глобального та локального біорізноманіття, лісових культур і фітомеліорації та інших біологічних наук.В ходе заседаний Международной научной конференции “Эволюция растительного мира в естественной и культигенной среде”, посвященной 200-летию со дня рождения Чарльза Дарвина, обсуждены актуальные вопросы эволюционной теории, ботаники, физиологии растений, интродукции, генетики и селекции, экологии, сохранения и приумножения глобального и локального биоразнообразия, лесных культур и фитомелиорации и других биологических наук.During meetings of the International scientific conference “Evolution of the natural and cultivated plants” to devoted a 200-year from the day of birth of Charles Darwin topical problems of the evolutional theory are discussed, including botany, physiology of plants, introduction of plants, genetics and breeding of plants, ecology, preventing the loss of global and loca biodiversity, arboriculture, forest-growing and other biological sciences