Impact of positive surgical margins and their locations after radical prostatectomy: comparison of biochemical recurrence according to risk stratification and surgical modality

Purpose

We investigated the influence of positive surgical margins (PSMs) and their locations on biochemical recurrence (BCR) according to risk stratification and surgical modality.

Methods

A total of 1,874 post-radical-prostatectomy (RP) patients of pT2–T3a between 2000 and 2010 at three tertiary centers, and who did not receive neoadjuvant/adjuvant therapy, were included in this study. Patients were stratified according to BCR risk: low risk (PSA <10, pT2a-b, and pGS ≤6), intermediate risk (PSA 10–20 and/or pT2c and/or pGS 7), and high risk (PSA >20 or pT3a or pGS 8–10). The median follow-up was 43 months.

Results

PSMs were a significant predictor of BCR in both the intermediate- and high-risk-disease groups (P = .001, HR 2.1, 95 % CI 1.3–3.4; P < .001, HR 2.8, 95 % CI 2.0–4.1). Positive apical margin was a significant risk factor for BCR in high-risk disease (P = .003, HR 2.0, 95 % CI 1.2–3.3), but not in intermediate-risk disease (P = .06, HR 1.7, 95 % CI 0.9–3.1). Positive bladder neck margin was a significant risk factor for BCR in both intermediate- and high-risk disease (P < .001, HR 5.4, 95 % CI 2.1–13.8; P = .001, HR 4.5, 95 % CI 1.8–11.4). In subgroup analyses, robotic RP provided comparable BCR-free survival regardless of risk stratification. Patients with PSMs showed similar BCR-free survival between open and robotic RP (log-rank, P = .897).

Conclusions

Post-RP PSMs were a significantly independent predictor of disease progression in high-risk disease as well as intermediate-risk disease. Both positive apical and bladder neck margins are also significant risk factors of BCR in high-risk disease. Patients with PSMs showed similar BCR-free survival between open and robotic surgery.     

Surgical delivery of drug releasing poly(lactic-co-glycolic acid)/poly(ethylene glycol) paste with in vivo effects against glioblastoma

Introduction

The median survival of patients with glioblastoma multiforme (astrocytoma grade 4) remains less than 18 months despite radical surgery, radiotherapy and systemic chemotherapy. Surgical implantation of chemotherapy eluting wafers into the resection cavity has been shown to improve length of survival but the current licensed therapy has several drawbacks. This paper investigates in vivo efficacy of a novel drug eluting paste in glioblastoma.

Methods

Poly(lactic-co-glycolic acid)/poly(ethylene glycol) (PLGA/PEG) self-sintering paste was loaded with the chemotherapeutic agent etoposide and delivered surgically into partially resected tumours in a flank murine glioblastoma xenograft model.

Results

Surgical delivery of the paste was successful and practical, with no toxicity or surgical morbidity to the animals. The paste was retained in the tumour cavity, and preliminary results suggest a useful antitumour and antiangiogenic effect, particularly at higher doses. Bioluminescent imaging was not affected significantly by the presence of the paste in the tumour.

Conclusions

Chemotherapy loaded PLGA/PEG paste seems to be a promising technology capable of delivering active drugs into partially resected tumours. The preliminary results of this study suggest efficacy with no toxicity and will lead to larger scale efficacy studies in orthotopic glioblastoma models.     

The effect of electron density in furan pendant group on thermal-reversible Diels–Alder reaction based self-healing properties of polymethacrylate derivatives

Herein, we discuss the effect of electron density in a furan pendant group on the thermally reversible Diels–Alder (DA) reaction based self-healing efficiency in polymethacrylate derivatives. First, the furan-functionalized polymethacrylates (rPFMA and dPFMA) having different electron density in the furan pendant groups were prepared through free-radical polymerization. The healing efficiency of rPFMA, which was expected to have high healing efficiency due to the high reactivity of DA reaction originating from the electron density in the furan moiety, was shown to be 95.89% in the first and 69.86% in the second healing process, respectively, where it is higher than that of dPFMA having relatively low electron density in the furan moiety. To illustrate these results, kinetic tests of the DA reaction for rPFMA64 and dPFMA64 were performed, where the reactivity of the DA reaction for rPFMA64 was much higher than that for dPFMA64. This could be explained by the electron density in the furan pendant groups which controls the reactivity of DA reaction having a major effect on the efficiency of self-healing performance in furan-functionalized polymethacrylates.

Herein, we discuss the effect of electron density in a furan pendant group on the thermally reversible Diels–Alder (DA) reaction based self-healing efficiency in polymethacrylate derivatives.     

Clinical features and treatment outcomes of limited-stage mantle cell lymphoma: Consortium for Improving Survival of Lymphoma report

Annals of Hematology - Limited-stage (Ann Arbor stage I or II) mantle cell lymphoma (MCL) is an extremely rare disease. Thus, there is little data on the clinical features and treatment outcomes of...     

Primary migration of a mini-implant under a functional orthodontic loading

Objectives

The objective of this study was to examine whether cortical bone thickness and bone mineral density (BMD) can explain the primary migration of a mini-implant under a functional orthodontic tangential loading at the early stage following implantation.

Materials and methods

Mini-implants were installed in human mandibular sections. A constant tangential load (2 N) was applied to the mini-implant under hydration. Creep, which is a time-dependent viscoelastic displacement in the bone surrounding the mini-implant, was assessed as the change in displacement during 2 h of loading. The total migration was measured as a maximum displacement that combined an initial elastic displacement and creep. After removal of the mini-implant, all specimens were scanned together by cone beam computed tomography. Cortical bone thickness and BMD were measured for the bone voxels surrounding the implant site.

Results

BMD had significant correlations with the displacement parameters (p?<?0.019), but the cortical bone thickness did not (p?>?0.272). Permanent bone deformation adjacent to the implant was observed to be resulting from substantial creep development under the orthodontic functional loading level.

Conclusions

BMD controls the primary migration of the mini-implant system in mandibular bone. Viscoelastic creep can develop at a small constant functional loading level, leading to migration of the mini-implant.

Clinical relevance

The current results indicated that mini-implant migration can develop under the small level of functional orthodontic load used in clinic. If the active bone remodeling around the mini-implant accelerates the migration, the risk of causing damage in vital organs next to the mini-implant increases.     

Effect of surface properties of TiO2 on the performance of Pt/TiO2 catalysts for furfural hydrogenation

Hydrogenation of biomass-derived furfural is an important process in biofuel production. Herein, different Pt-supported TiO₂ morphologies: nanorod (NR), nanoparticle (NP), and hollow microsphere (HMS) were prepared by the impregnation–chemical reduction method. The furfural conversion increased with an increase of Pt dispersion. However, cyclopentanone selectivity was affected by TiO₂ properties, the strong metal–support interaction (SMSI) effect, and the reaction conditions. The Pt/TiO₂ NR catalyst exhibited the highest cyclopentanone selectivity of 50.4%. Based on the H₂-temperature programmed desorption (H₂-TPD) and X-ray photoelectron spectroscopy (XPS) results, the Pt/TiO₂ NR catalyst showed a SMSI effect, which was introduced by the chemical reduction method. We suggest that electron charge transfer from Ti species to Pt in the Pt/TiO₂ NR catalyst affects the cyclopentanone selectivity by controlling the adsorption strength between the reactant and the Pt surface, thus retarding the formation of byproducts.

Hydrogenation of biomass-derived furfural is an important process in biofuel production.