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41.
《European journal of surgical oncology》2020,46(2):277-281
ObjectivesWhat constitutes an adequate margin of resection for infiltrative subtypes of soft-tissue sarcomas remains unclear. We aimed to determine the prognostic significance of the margin in millimetres for myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS).Methods305 patients diagnosed with either a high-grade, localised MFS (n = 98) or UPS (n = 207) were included. The relationship of closest margin in millimetres to viable tumour and oncological outcomes was analysed.ResultsThe overall local recurrence (LR) rate for all patients were 12%: 19% with positive margin and 10% with negative margin (p = 0.051). The LR rate was similar in patients with negative but <10 mm margin; 13%, 6%, 15%, 17% with 0.1–0.9 mm, 1.0–1.9 mm, 2.0–4.9 mm, and 5.0–9.9 mm margin, respectively. However, the LR rate decreased to 3% if the margin was ≥10 mm. By the R- or R+1-classification, the 10-year cumulative probability of LR was 9%, 15%, 48% for R0, R1, R2 resections, respectively, which was not sensitive enough to stratify the LR risk in patients with negative margins. However, the cumulative probability of LR was significantly stratified by metric distance; the 10-year cumulative LR probability was 3%, 14%, 25% with ≥10.0 mm, 0.1–9.9 mm, and 0 mm, respectively (p = 0.026). A trend towards improved local control by adjuvant radiotherapy was seen in patients with 0–9.9 mm margin (p = 0.078).ConclusionThe resection margin, when measured as a metric distance, correlates with a reduction in LR, and appears to be more significant on local control than radiotherapy. To minimise the risk of LR, a margin distance of at least 10 mm is advocated for MFS and UPS. 相似文献
42.
Lida Mademli Adamantios Arampatzis Kiros Karamanidis 《European journal of applied physiology》2008,103(3):295-306
Many studies report that muscle strength loss may alter the human system’s capacity to generate rapid force for balance corrections
after perturbations, leading to deficient recovery behaviours. Yet little is known regarding the effect of modifications in
the neuromuscular system induced by fatigue on dynamic stability control during postural perturbations. This study investigates
the effect of muscle strength decline induced by fatiguing contractions on the dynamic stability control of young and older
adults during forward falls. Eleven young and eleven older male adults had to regain balance after sudden falls before and
after submaximal fatiguing knee extension–flexion contractions. Young subjects had a higher margin of stability than older
ones before and after the fatiguing task. This reflects their enhanced ability in using mechanisms for maintaining dynamic
stability (i.e. a greater base of support). The margin of stability, the boundary of the base of support and the position
of the extrapolated centre of mass, remained unaffected by the reduction in muscle strength induced by the fatiguing contractions,
indicating an appropriate adjustment of the motor commands to compensate the deficit in muscle strength. Both young and older
adults were able to counteract the decreased horizontal ground reaction forces after the fatiguing task by flexing their knee
to a greater extent, leading to similar decreases in the horizontal velocity of centre of mass as in the pre fatigue condition.
The results demonstrate the ability of the central nervous system to rapidly modify the execution of postural corrections
including mechanisms for maintaining dynamic stability. 相似文献
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44.
Christian Rønn Hansen Jørgen Johansen Eva Samsøe Elo Andersen Jørgen B.B. Petersen Kenneth Jensen Lisbeth J. Andersen Hella M.B. Sand Anders S. Bertelsen Cai Grau 《Radiotherapy and oncology》2018,126(1):43-47
Background and purpose
Defining margins around the Gross Tumour Volume (GTV) to create a Clinical Target Volume (CTV) for head and neck cancer radiotherapy has traditionally been based on presumed knowledge of anatomical routes of spread. However, using a concentric geometric expansion around the GTV may be more reproducible. The purpose of this study was to analyse the inter-observer consistency of geometric CTV delineation with adaptation for anatomical boundaries versus anatomically defined CTVs.Material and methods
Radiation oncologists at four Danish cancer centres delineated high, intermediate and elective dose CTVs (CTV1, CTV2 and CTV3, respectively) in a patient-case template (stage IV squamous cell carcinoma of the oropharynx), first using mainly anatomical margins (original standard) and then using concentric geometric expansion (new standard). Each centre made a dummy-run radiotherapy plan based on the delineated CTVs. The difference between the CTV contours and the radiotherapy plans was evaluated across the centres.Results
Anatomy-based contours were significantly more heterogenous and showed larger volume differences between centres than geometric margins. Dice similarity coefficient increased by 0.29 and mean surface distance decreased by 4 mm for CTV1. Use of consistent CTV volumes resulted in more consistent irradiated volumes between centres.Conclusion
Introduction of geometric margins resulted in more uniform CTV1 and CTV2 delineation. Geometric CTV expansion was easier, left less room for misinterpretation, and resulted in more uniform treatment plans with similar irradiated high and intermediate dose volumes across all centres. 相似文献45.
Purpose
There is increasing interest in personalized prediction of disease progression for soft tissue sarcoma patients. Currently, available prediction models are limited to predictions from time of surgery or diagnosis. This study updates predictions of overall survival at different times during follow-up by using the concept of dynamic prediction.Patients and methods
Information from 2232 patients with high-grade extremity soft tissue sarcoma, who underwent surgery at 14 specialized sarcoma centers, was used to develop a dynamic prediction model. The model provides updated 5-year survival probabilities from different prediction time points during follow-up. Baseline covariates as well as time-dependent covariates, such as status of local recurrence and distant metastases, were included in the model. In addition, the effect of covariates over time was investigated and modelled accordingly in the prediction model.Results
Surgical margin and tumor histology show a significant time-varying effect on overall survival. The effect of margin is strongest shortly after surgery and diminishes slightly over time. Development of local recurrence and distant metastases during follow-up have a strong effect on overall survival and updated predictions must account for their occurrence.Conclusion
The presence of time-varying effects, as well as the effect of local recurrence and distant metastases on survival, suggest the importance of updating predictions during follow-up. This newly developed dynamic prediction model which updates survival probabilities over time can be used to make better individualized treatment decisions based on a dynamic assessment of a patient's prognosis. 相似文献46.
目的:如何减少四肢创伤手术切口感染的发生率。方法:主要根据我院骨科2007—2009年度进行四肢创伤手术的200例患者进行回顾性系统分析。结果及结论:调查的患者中发生院内手术切口感染的患者有8名,占全部手术病人的4%,对其原因分析高龄,手术清创不够彻底,术前未使用有效的抗生素进行预防,有基础疾病,四肢主干血管损伤缺血严重未及时再通,手术季节和情绪与伤口感染有确切关系。 相似文献
47.
48.
《Gait & posture》2019
BackgroundCerebral palsy (CP) is associated with a high risk of falling during walking. Many gait abnormalities associated with CP likely alter foot placement and center of mass (CoM) movement in a way that affects anterior or lateral dynamic stability, in turn influencing fall risk.Research questionDo children with CP demonstrate altered anterior or lateral dynamic stability compared to typically-developing (TD) children?MethodsIn this case-control, observational study, we measured gait kinematics of two groups of children (15 CP, 11 GMFCS level I, 4 GMFCS level II; 14 TD; age 5–12) in walking conditions of a preferred speed, a fast speed, and a preferred speed while completing a cognitive task. For dominant and non-dominant limbs, the margin of stability (MoS), a spatial measure of dynamic stability, was calculated as the distance between the edge of the base of support and the CoM position after accounting for scaled velocity. Statistical comparisons of were made using mixed factorial ANOVAs. Post hoc comparisons were Sidak adjusted.ResultsThe anterior MoS before foot strike and at mid-swing differed between each condition but not between groups. Based on the minimum lateral MoS, children with CP had more stability when bearing weight on their non-dominant limb compared to TD children. These differences were not apparent when on the dominant limb.SignificanceThis high-functioning group of children with CP exhibited a more conservative lateral stability strategy during walking when bearing weight with the non-dominant limb. This strategy may be protective against lateral falls. We observed no between-group differences in anterior stability. Because CP has been previously associated with impaired anterior balance reactions, and there was no observed compensation in anterior gait stability, this lack of group differences could contribute to a higher risk of falling in that direction. 相似文献
49.
50.
目的检测直肠癌环周切缘组织内是否含有肿瘤干细胞,并观察环周切缘浸润对患者预后的影响。方法取直肠癌患者手术切除标本的环周切缘,4%甲醛固定后做成病理切片;根据环周切缘有无浸润分为环周切缘阳性组和环周切缘阴性组,2组均做免疫组织化学标记CD133肿瘤干细胞,观察CD133表达情况;随访2组患者术后1~2年复发情况。结果环周切缘阳性组免疫组织化学标记CD133+,存在CD133+肿瘤干细胞,但与环周切缘阴性组相比无统计学意义(P>0.05)。环周切缘阳性组患者1~2年复发率显著高于阴性组(P<0.05)。结论环周切缘浸润是导致直肠癌患者术后复发的重要因素,部分环周切缘浸润中存在肿瘤干细胞。 相似文献