Multimodality Treatment for Locally Advanced and Recurrent Rectal Cancer

Colorectal cancer is a major problem in the western world and has a rising incidence.1,2 Approximately one third of these tumours originate in the rectum. Although colon and rectal cancer share similar features there is a distinct difference in clinical behaviour and therapeutical approach.3 The treatment of primary rectal cancer has evolved into a multidisciplinary treatment with standardized surgical, pathological and radiotherapeutical procedures.2,4-6 The introduction of preoperative short-term radiotherapy (5*5Gy) in combination with total mesorectal excision (TME) has lead to a signifi cant decreased local recurrence rate.7 Based on these benefi cial results the treatment protocol in the region of the Comprehensive Cancer Centre Rotterdam of patients with a tumour in the lower two-third of the rectum was changed.2 In chapter 2 we report the results of a registration study in the region of the Comprehensive Cancer Centre Rotterdam. The aim of this study was to identify the compliance to a new standardized treatment protocol i.e. the introduction of preoperative radiotherapy. Furthermore, the results of rectal cancer treatment in the Rotterdam region were analyzed and compared with reference values based on selected patients from randomised trials in the recent literature

User-centered shape grammars for housing transformations: towards post-handover grammars

This paper presents a post-handover shape grammar for introducing inhabitants wishes in the transformation of individual houses of the Malagueira housing complex by Álvaro Siza Vieira in Évora, Portugal. The presented research includes a case study developed in the context of the workshop Gramática da Forma em estudos de habitação - análise, geração e customização at the Universidade Federal do Rio de Janeiro, Brazil. In this paper we present the first developments of the Malagueira transformation grammar, including corpus of analysis, shape rules, and derivations, and we discuss the opportunities that shape grammar brings to user-centered design.info:eu-repo/semantics/publishedVersio

The quality of designs by shape grammar systems and architects: a comparative test on refurbishing Lisbon’s Rabo-de-Bacalhau apartments

This paper compares the quality of designs generated by shape grammar systems with designs created by professional architects. It describes an experiment in which evaluators ranked the quality of preliminary designs for refurbishing Lisbon's rabo-de-bacalhau apartments. The result showed that the design quality of the grammar solutions for the task was similar to that of the designs by professional architects. Thus, this paper argues that shape grammars can be used as stand-alone design systems in architecture. The practical value is that shape grammar systems become alternative means of taking up design challenges that currently require too much effort by architects to be economically feasible, such as refurbishing all of Lisbon's rabo-de-bacalhau apartments.info:eu-repo/semantics/acceptedVersio

Biogeomorphology in the field: bedforms and species, a mystic relationship

Fine-scale seabed mapping (Owenia fusiformis, and the razor clam Ensis directus) occur near bedload convergence zones resulting from a mutually evasive flood- and ebb-dominant channel system. Such zones are at the end of the channels, hence also fine grained sediments, food and larvae are trapped. The combination of the coarser-grained bedload with thedeposition of fines is indeed the optimum for a lot of suspension and detritus feeders. Still, highest abundances occur at the fringes of such a system where stress levels are intermediate. Hypotheses were successfully tested along the Dutch coastal zone. Those insights are important to assess changes in seafloor integrity and hydrographic conditions

On relativistic elements of reality

Several arguments have been proposed some years ago, attempting to prove the impossibility of defining Lorentz-invariant elements of reality. I find that a sufficient condition for the existence of elements of reality, introduced in these proofs, seems to be used also as a necessary condition. I argue that Lorentz-invariant elements of reality can be defined but, as Vaidman pointed out, they won't satisfy the so-called product rule. In so doing I obtain algebraic constraints on elements of reality associated with a maximal set of commuting Hermitian operators.Comment: Clarifications, reference added; published versio

Total Pelvic Exenteration for Primary and Recurrent Malignancies

Contains fulltext : 81087.pdf (publisher's version ) (Open Access)INTRODUCTION: Complete resection is the most important prognostic factor in surgery for pelvic tumors. In locally advanced and recurrent pelvic malignancies, radical margins are sometimes difficult to obtain because of close relation to or growth in adjacent organs/structures. Total pelvic exenteration (TPE) is an exenterative operation for these advanced tumors and involves en bloc resection of the rectum, bladder, and internal genital organs (prostate/seminal vesicles or uterus, ovaries and/or vagina). METHODS: Between 1994 and 2008, a TPE was performed in 69 patients with pelvic cancer; 48 with rectal cancer (32 primary and 16 recurrent), 14 with cervical cancer (1 primary and 13 recurrent), 5 with sarcoma (3 primary and 2 recurrent), 1 with primary vaginal, and 1 with recurrent endometrial carcinoma. Ten patients were treated with neoadjuvant chemotherapy and 66 patients with preoperative radiotherapy to induce down-staging. Eighteen patients received IORT because of an incomplete or marginal complete resection. RESULTS: The median follow-up was 43 (range, 1-196) months. Median duration of surgery was 448 (range, 300-670) minutes, median blood loss was 6,300 (range, 750-21,000) ml, and hospitalization was 17 (range, 4-65) days. Overall major and minor complication rates were 34% and 57%, respectively. The in-hospital mortality rate was 1%. A complete resection was possible in 75% of all patients, a microscopically incomplete resection (R1) in 16%, and a macroscopically incomplete resection (R2) in 9%. Five-year local control for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 89%, 38%, and 64%, respectively. Overall survival after 5 years for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 66%, 8%, and 45%. CONCLUSIONS: Total pelvic exenteration is accompanied with considerable morbidity, but good local control and acceptable overall survival justifies the use of this extensive surgical technique in most patients, especially patients with primary locally advanced rectal cancer and recurrent cervical cancer

A Study of the Type II-P Supernova 2003gd in M74

We present photometric and spectroscopic data of the type II-P supernova 2003gd, which was discovered in M74 close to the end of its plateau phase. SN 2003gd is the first type II supernova to have a directly confirmed red supergiant progenitor. We compare SN 2003gd with SN 1999em, a similar type II-P supernova, and estimate an explosion date of 18th March 2003. We determine a reddening towards the supernova of E(B-V) = 0.14+/-0.06, using three different methods. We also calculate three new distances to M74 of 9.6+/-2.8 Mpc, 7.7+/-1.7 Mpc and 9.6+/-2.2 Mpc. The former was estimated using the Standardised Candle Method (SCM), for type II supernovae, and the latter two using the Brightest Supergiants Method (BSM). When combined with existing kinematic and BSM distance estimates, we derive a mean value of 9.3+/-1.8 Mpc. SN 2003gd was found to have a lower tail luminosity compared to other ``normal'' type II-P SNe bringing into question the nature of this supernova. We present a discussion concluding that this is a ``normal'' type II-P supernova which is consistent with the observed progenitor mass of 8(+4/-2) Mo.Comment: 23 pages, 24 figures to appear in MNRA

A fresh look at the evolution and diversification of photochemical reaction centers

In this review, I reexamine the origin and diversification of photochemical reaction centers based on the known phylogenetic relations of the core subunits, and with the aid of sequence and structural alignments. I show, for example, that the protein folds at the C-terminus of the D1 and D2 subunits of Photosystem II, which are essential for the coordination of the water-oxidizing complex, were already in place in the most ancestral Type II reaction center subunit. I then evaluate the evolution of reaction centers in the context of the rise and expansion of the different groups of bacteria based on recent large-scale phylogenetic analyses. I find that the Heliobacteriaceae family of Firmicutes appears to be the earliest branching of the known groups of phototrophic bacteria; however, the origin of photochemical reaction centers and chlorophyll synthesis cannot be placed in this group. Moreover, it becomes evident that the Acidobacteria and the Proteobacteria shared a more recent common phototrophic ancestor, and this is also likely for the Chloroflexi and the Cyanobacteria. Finally, I argue that the discrepancies among the phylogenies of the reaction center proteins, chlorophyll synthesis enzymes, and the species tree of bacteria are best explained if both types of photochemical reaction centers evolved before the diversification of the known phyla of phototrophic bacteria. The primordial phototrophic ancestor must have had both Type I and Type II reaction centers