1,721,010 research outputs found
ASO Author Reflections: Conization Before Radical Hysterectomy Improves Disease-Free Survival in Early Stage Cervical Cancer
No full textPast
A well-known randomized study demonstrated that minimally invasive radical hysterectomy was associated with poorer disease-free and overall survival in patients with early stage cervical cancer, when compared with an open approach.1 Despite not yet understanding the technical reasons for this result, different options have been proposed to explain the difference in oncological outcomes. One of these is potential peritoneal ‘contamination’ at time of colpotomy: this possibility is intuitively more likely in cases of bulky tumors.2,3 In this context, conization before radical hysterectomy may reduce the risk of peritoneal exposure to cancer tissue, maintaining the oncological safety of the surgical procedure.
Very few studies have investigated the impact of conization in cervical cancer survival, demonstrating an association between conization and reduced risk of recurrence.3
Present
In this multicenter, retrospective, observational cohort study, we analyzed the survival outcomes of a population of FIGO 2009 stage IB1 cervical cancer, by comparing the group that underwent conization with the group that did not undergo conization before radical hysterectomy. Three hundred and thirty-two patients (166, 50% in each group) were included after balance with a propensity match analysis. On the conization specimens, 14.4% and 85.6% of patients had negative and positive surgical margins, respectively. However, 41.6% of conization patients did not have residual tumor on the hysterectomy specimen, therefore significantly reducing the risk of peritoneal tumor ‘contamination’.
Patients undergoing conization before radical hysterectomy were less likely to receive adjuvant treatment (p < 0.001) and had a better 5-year disease-free survival than patients who did not receive conization (89.8% vs. 80.0%, respectively; p = 0.010). No difference in 5-year overall survival (97.1% vs. 91.4%, respectively; p = 0.114) and in recurrence pattern (p = 0.115) was reported between the two groups. Conization before radical hysterectomy and tumor diameter ≤ 20 mm were independently associated with reduced risk of recurrence.
Future
More and more evidence supports the role of protecting maneuvers performed at the time of radical hysterectomy to avoid peritoneal exposure to tumor cells. Amongst these, the avoidance of using a uterine manipulator, the closure of the vaginal cuff and, now, pre-operative conization, can be listed as actions aimed at reducing or eliminating the risk of peritoneal tumor contamination during minimally invasive surgery.4 Nevertheless, at the moment, most international guidelines and societies’ statements are cautious regarding the use of minimally invasive radical hysterectomy, particularly for tumors > 20 mm, unless within the setting of clinical trials. Prospective randomized trials are ongoing to further confirm or deny the detrimental effect of a minimally invasive approach to radical hysterectomy.5 Importantly, these trials promote or aim to assess the use of protective maneuvers to avoid peritoneal tumor exposure at the time of colpotomy, and conization could be proposed as one of these. Nevertheless, a randomized trial to specifically compare the survival of patients undergoing or not undergoing pre-operative conization, may be necessary in the future to better define and personalize the correct management of early stage cervical cancer.
References
1.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379(20):1895–904.
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2.
Pedone Anchora L, Bizzarri N, Kucukmetin A, et al. Investigating the possible impact of peritoneal tumor exposure amongst women with early stage cervical cancer treated with minimally invasive approach. Eur J Surg Oncol. 2020;7983(20):30829–5. https://doi.org/10.1016/j.ejso.2020.09.038.
3.
Casarin J, Buda A, Bogani G, et al. Predictors of recurrence following laparoscopic radical hysterectomy for early-stage cervical cancer: a multi-institutional study. Gynecol Oncol. 2020;159(1):164–70.
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4.
Bizzarri N, Pedone Anchora L, Kucukmetin A, et al. Protective role of conization before radical hysterectomy in early-stage cervical cancer: a propensity-score matching study. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-09695-4.
5.
Basaran D, Leitao MM Jr. The landmark series: minimally invasive surgery for cervical cancer. Ann SurgOncol. 2021;28(1):204–11
A novel MAC scheduler to minimize the energy consumption in a Wireless Sensor Network
Full text linkThe rising success of the Internet of Things has led the Wireless Sensor Networks to play an important role in many fields, ranging from military to civilian applications. However, since sensor nodes are battery powered, communication protocols and applications for these networks must be carefully designed in order to limit the power consumption. In this work, a new MAC protocol able to significantly reduce the power consumption and compatible with the IEEE 802.15.4 standard, is designed and validated. The defined protocol is based on an efficient setting of the node's duty cycle as a function of the transmission times of the neighbor nodes. In a duty cycle period, each node wakes up once to transmit and N times to receive, where N is the number of neighbors, while it remains in sleep mode for the rest of the time. The defined protocol has been validated through both an analytical and a simulative approach. By using the first approach, the proposed solution is compared with another energy-efficient protocol, namely AS-MAC; then, the differences between the simulated scenario and the analytical one are analyzed. By using the second approach (through Omnet++ simulator), we carried out a performance comparison between our protocol and the current MAC protocol compliant with the ZigBee standard. All the results have shown the effectiveness of the proposed solution, which has proved to be flexible and efficient, since it is able to provide high energy savings at different date rate, without a negative impact on the packets delivery
Cytoreductive surgery plus platinum-based hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer: A promising integrated approach to improve locoregional control
No full textAn adaptive FEC scheme to reduce bursty losses in a 802.11 network
No full textOne of the challenges that video transmission over wireless networks (such as IEEE 802.11) must face is the packet loss that can heavily decrease the received video quality. What makes the challenge more difficult is the bursty nature of wireless losses. Many video decoders can mask the effects of small amounts of random packet loss, however, most are unable to successfully hide the effects of burst losses (periods with high loss data rate). Forward error correction (FEC) is a technique extensively adopted to increase error resilience. In unicast transmission, the FEC redundancy is usually added adaptively on the basis of a loss pattern feedback. In many cases the loss pattern is represented through a very simple statistics: the average packer error rate (PER). This paper proposes a technique to adaptively introduce FEC redundancy that exploits a feedback scheme based on a 4-state Markov model to describe the loss pattern. The model allows us to obtain a description of the loss pattern in terms of burst and gap length and density. The feedback is based on the RTCP extended Report - IP Video Metrics Report Blocks that includes statistics on error patterns, such as the average PER, burst length and density. Our simulation results show that the proposed method smoothes out the burst losses and outperforms solutions based on the average PER. © 2006 IEEE
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Risk factors of the antenatal depression in a sample of Italian pregnant women: A preliminary study
Full text linkBackground: Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.
Methods: The sample was composed by Italian pregnant women (N=247, mean age of 33.77, SD=4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.
Results: Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.
Conclusions: Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period
Fertility-sparing surgery in ovarian cancer extended beyond the ovaries: A case report and review of the literature
No full textBackground: Much attention has been recently focused on the role of fertility-sparing surgery in patients with ovarian cancer. However, few data are currently available on the feasibility of conservative approaches in women with disease extending beyond the ovaries. Aim: This review article aims at summarizing the oncologic and obstetric outcome of patients with stage II-III ovarian cancer treated with fertility-sparing surgery. We also describe a successful conservative management of a stage IIC endometrioid ovarian carcinoma. Methods: A literature search through Medline was carried out to locate published articles using the following keywords for selection: 'Fertility-sparing surgery and ovarian cancer'. From every single case series, we retrieved data on patients with stage II-III disease submitted to conservative surgery. Results: We identified 21 patients with stage II-III disease receiving fertility-sparing surgery. Recurrent disease was observed in 9 women (42.8%), and 5 (23.8%) of them died of disease. In contrast, a successful obstetric outcome has been reported in 3 cases (14.2%). Conclusions: Radical surgical staging remains the standard of care for all women with stage II-III disease. A fertility-sparing approach may be considered only in the presence of a favorable histology and a very strong fertility desire. Copyright © 2013 S. Karger AG, Basel
A performance evaluation tool for spectrum sharing in multi-operator LTE networks
No full textRecent advances in wireless networking introduce the concept of resource sharing as one promising way to enhance the performance of radio communications. As the wireless spectrum is a scarce resource, and its usage is often found to be inefficient, it may be meaningful to design solutions where multiple operators join their efforts, so that wireless access of their terminals takes place on shared, rather than proprietary to a single operator, frequency bands. In spite of the conceptual simplicity of this idea, the resulting mathematical analysis may be very complex, since it involves analytical representation of multiple wireless channels. Simulation studies may be extremely useful to obtain a correct performance characterization of wireless networks with shared resources. In this spirit, the present paper introduces and evaluates an original extension of the well known ns-3 network simulator, which focuses on multiple operators of the most up-to-date cellular scenarios, i.e., the Long Term Evolution of UMTS employing OFDMA multiplexing. Spectrum sharing is represented through a proper software architecture, where several sharing policies can be framed. A detailed simulation campaign is run to assess the computational performance of the proposed architecture, and to show its effectiveness in analyzing realistic scenarios. © 2012 Elsevier B.V. All rights reserved
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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