Interobserver variations of target volume delineation in multicatheter partial breast brachytherapy after open cavity surgery

PURPOSE To investigate interobserver variations of target volume delineations in accelerated partial breast irradiation with multicatheter brachytherapy (BT) and to assess the impact of guidelines on consistency of contouring. METHODS AND MATERIALS A contouring study with two phases in interstitial accelerated partial breast irradiation after open cavity surgery was conducted by the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology Breast Cancer Working Group. Contours of cavity and planning target volume (PTV) on preimplant and postimplant CT images were delineated. In Phase 1, nine radiation oncologists defined the target volumes of 5 patients, whereas in Phase 2, four observers draw the contours of 4 patients applying guidelines. In Phase 1, experience in breast BT after open cavity surgery was assessed. The delineations were compared between Phase 1 and Phase 2, the impact of guidelines was assessed, and cavity visualization score was related to consistency of delineations. RESULTS Significant interobserver variability in delineations of lumpectomy cavity and PTV was observed among the participants. Observers with BT experience after open cavity surgery outlined the cavity and PTV more consistently (conformity indexgen: 0.52 vs. 0.48 and 0.59 vs. 0.55 for preimplant and postimplant cavities). For all volumes, the mean Vmax/Vmin was 2.2 vs. 2.8. Having used guidelines all conformity indices increased significantly. For cavity, the increase was 14% and 11%, whereas for the PTV, 28% and 17% on the preimplant and postimplant CT images, respectively. A strong correlation was found between consistency of contours and cavity visualization score. CONCLUSIONS Simple guidelines on defining the lumpectomy cavity significantly increased the consistency of contouring. Reliable consistency of target volume definition can be expected only for good cavity visibility.

Primary prevention of peri-implantitis: managing peri-implant mucositis

AIMS Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. METHODS Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. RESULTS Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. CONCLUSIONS Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.

Whole-exome sequencing reveals a C-terminal germline variant in CEBPA-associated acute myeloid leukemia: 45-year follow-up of a large family.

Familial acute myeloid leukemia is rare and linked to germline mutations in RUNX1, GATA2 or CCAAT/enhancer binding protein-α (CEBPA). We re-evaluated a large family with acute myeloid leukemia originally seen at NIH in 1969. We utilized whole-exome sequencing to study this family, and conducted in silico bioinformatics analysis, protein structural modeling and laboratory experiments to assess the impact of the identified CEBPA Q311P mutation. Unlike most previously identified germline mutations in CEBPA, which were N-terminal frameshift mutations, we identified a novel Q311P variant that was located in the C-terminal bZip domain of C/EBPα. Protein structural modeling suggested that the Q311P mutation alters the ability of the CEBPA dimer to bind DNA. Electrophoretic mobility shift assays showed that the Q311P mutant had attenuated binding to DNA, as predicted by the protein modeling. Consistent with these findings, we found that the Q311P mutation has reduced transactivation, consistent with a loss-of-function mutation. From 45 years of follow-up, we observed incomplete penetrance (46%) of CEBPA Q311P. This study of a large multi-generational pedigree reveals that a germline mutation in the C-terminal bZip domain can alter the ability of C/EBP-α to bind DNA and reduces transactivation, leading to acute myeloid leukemia.

Actions of the International Union of Soil Science towards a global agenda for the sustainable use of soils

In a multi-level stakeholder approach the international level is of primordial importance not only in terms of legal frameworks, but also in terms of scientific analysis of the needs, options and constraints, as well as related to monitoring and evaluation systems. The Working Group on 'International Actions for the Sustainable Use of Soils' (IASUS) of the International Union of Soil Science (IUSS) identified a number of issues and measures in preparation of the 17thWorld Congress of Soil Science held in Bangkok, Thailand, in August 2002, and prepared a resolution in support of a 'global agenda for the sustainable use of soils', which was adopted on 21st August 2002 on the closing day of the congress.

EACTS expert consensus statement for surgical management of pleural empyema

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.

The evidence from systematic reviews and meta-analyses published in orthodontic literature. Where do we stand?

AIM To analyse meta-analyses included in systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) focusing on orthodontic literature and to assess the quality of the existing evidence. MATERIALS AND METHODS Electronic searching was undertaken to identify SRs published in five major orthodontic journals and the CDSR between January 2000 and June 2014. Quality assessment of the overall body of evidence from meta-analyses was conducted using the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE) tool. RESULTS One hundred and fifty-seven SRs were identified; meta-analysis was present in 43 of these (27.4 per cent). The highest proportion of SRs that included a meta-analysis was found in Orthodontics and Craniofacial Research (6/13; 46.1 per cent), followed by the CDSR (12/33; 36.4 per cent) and the American Journal of Orthodontics and Dentofacial Orthopaedics (15/44; 34.1 per cent). Class II treatment was the most commonly addressed topic within SRs in orthodontics (n = 18/157; 11.5 per cent). The number of trials combined to produce a summary estimate was small for most meta-analyses with a median of 4 (range: 2-52). Only 21 per cent (n = 9) of included meta-analyses were considered to have a high/moderate quality of evidence according to GRADE, while the majority were of low or very low quality (n = 34; 79.0 per cent). CONCLUSIONS Overall, approximately one quarter of orthodontic SRs included quantitative synthesis, with a median of four trials per meta-analysis. The overall quality of evidence from the selected orthodontic SRs was predominantly low to very low indicating the relative lack of high quality of evidence from SRs to inform clinical practice guidelines.

[Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures].

Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and international publications, the dramatically changing epidemiology of pelvic ring fractures, further developments in diagnostics and the changes in operative procedures over time could be demonstrated. Last but not least the now well-established diagnostic and therapeutic algorithms for pelvic ring fractures, which could be derived from the information collated in registry studies, reflect the clinical impact of the registry.

Salivary cortisol, psychological stress and depressive symptoms among patients undergoing colon cancer screenings

As the second leading cause of cancer-related deaths in the United States, colon cancer has a high cure rate if detected early by a colonoscopy (U.S. Cancer Statistics Working Group, 2007). However, more than 41 million at-risk Americans are not properly receiving colonoscopy screenings according to the recommendations of the Center for Disease Control. This study provides insight into the physiological and psychological benefits of the colonoscopy procedure over and above cancer detection and prevention. Thirty-six patients receiving colonoscopic screening at the University of Connecticut Health Center participated in this study. A questionnaire battery that assessed perceived stress, depressive symptoms, colon cancer related worry, and social support, and optional saliva sampling was completed 2 weeks prior to and post colonoscopy. It was hypothesized that salivary cortisol concentrations, perceived stress, and self-reported depressive symptoms would show significant decreases from pre to post colonoscopy, and that these variables would all be positively correlated with one another. Results showed significant, positive correlations between depressive symptoms and both salivary cortisol (r (34)= .348, p< .05) and perceived stress (r (34)= .635, p< .01). Morning salivary cortisol levels decreased significantly from pre to post colonoscopy to levels below the population mean (t (16)=-3.711, p<. 01). No such differences were observed in either perceived stress or depressive symptoms. These results indicate that by decreasing cortisol concentrations to levels below that of the population mean, the colonoscopy provided physiological health benefits to patients beyond cancer screening. From a health psychology standpoint, this may encourage some of the 41 million Americans not receiving proper colon cancer screenings to adopt this potentially life-saving health behavior.

Incident hypertension among pre-hypertensive adolescents: Evaluation of pre-hypertension as an independent risk factor among secondary school students in the Houston area

Cardiovascular disease has been the leading cause of death in the United States for over fifty years. While multiple risk factors for cardiovascular disease have been identified, hypertension is one of the most commonly recognized and treatable. Recent studies indicate that the prevalence of hypertension among children and adolescents is between 3-5%, much higher than originally estimated and likely rising due to the epidemic of obesity in the U.S. In 2004, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents published new guidelines for the diagnosis and treatment of hypertension in this population. Included in these recommendations was the creation of a new diagnosis, pre-hypertension, aimed at identifying children at-risk for hypertension to provide early lifestyle interventions in an effort to prevent its ultimate development. In order to determine the risk associated with pre-hypertension for the development of incident HTN, a secondary analysis of a repeated cross-sectional study measuring blood pressure in Houston area adolescents from 2000 to 2007 was performed. Of 1006 students participating in the blood pressure screening on more than one occasion not diagnosed with hypertension at initial encounter, eleven were later found to have hypertension providing an overall incident rate of 0.5% per year. Incidence rates were higher among overweight adolescents–1.9% per year [IRR 8.6 (1.97, 51.63)]; students “at-risk for hypertension” (pre-hypertensive or initial blood pressure in the hypertensive range but falling on subsequent measures)–1.4% per year [IRR 4.77 (1.21, 19.78)]; and those with blood pressure ≥90th percentile on three occasions–6.6% per year [IRR 21.87 (3.40, 112.40)]. Students with pre-hypertension as currently defined by the Task Force did have an increased rate of hypertension (1.1% per year) but it did not reach statistical significance [IRR 2.44 (0.42, 10.18)]. Further research is needed to determine the morbidity and mortality associated with pre-hypertension in this age group as well as the effectiveness of various interventions for preventing the development of hypertensive disease among these at-risk individuals. ^

Problemas de Sociología del Deporte

El presente artículo es una apuesta por reconstruir, articular y problematizar los aportes y los avances de investigación en torno a los estudios sociales del deporte y el tiempo libre, puestos en discusiones en el marco de la mesa de trabajo sobre problemáticas de la sociología del deporte, llevada a cabo durante el 9no Congreso Argentino y 4to Latinoamericano de Educación Física y Ciencias. La lectura holística e integral de las diferentes producciones académicas, y los diálogos que de ellas se derivaron son puestos en cuestión y en relación a partir de la formulación de tres ejes problemáticos en torno a los cuales se estructura el presente artículo: la violencia y su relación con el fenómeno deportivo en los entramados sociales contemporáneos, las vinculaciones histórico sociales entre políticas públicas y deporte y, por último, el modo en que se articulan y en que resulta posible articular la relación entre los fenómenos deportivos y las ciencias sociales. Poner de relieve, sistematizar y problematizar los argumentos de los diferentes trabajos e investigaciones discutidos es el camino por el cual el presente artículo aspira a contribuir al estado actual de discusión sobre los estudios sociales del deporte y del tiempo libre

Problemas de Sociología del Deporte

El presente artículo es una apuesta por reconstruir, articular y problematizar los aportes y los avances de investigación en torno a los estudios sociales del deporte y el tiempo libre, puestos en discusiones en el marco de la mesa de trabajo sobre problemáticas de la sociología del deporte, llevada a cabo durante el 9no Congreso Argentino y 4to Latinoamericano de Educación Física y Ciencias. La lectura holística e integral de las diferentes producciones académicas, y los diálogos que de ellas se derivaron son puestos en cuestión y en relación a partir de la formulación de tres ejes problemáticos en torno a los cuales se estructura el presente artículo: la violencia y su relación con el fenómeno deportivo en los entramados sociales contemporáneos, las vinculaciones histórico sociales entre políticas públicas y deporte y, por último, el modo en que se articulan y en que resulta posible articular la relación entre los fenómenos deportivos y las ciencias sociales. Poner de relieve, sistematizar y problematizar los argumentos de los diferentes trabajos e investigaciones discutidos es el camino por el cual el presente artículo aspira a contribuir al estado actual de discusión sobre los estudios sociales del deporte y del tiempo libre

Problemas de Sociología del Deporte

El presente artículo es una apuesta por reconstruir, articular y problematizar los aportes y los avances de investigación en torno a los estudios sociales del deporte y el tiempo libre, puestos en discusiones en el marco de la mesa de trabajo sobre problemáticas de la sociología del deporte, llevada a cabo durante el 9no Congreso Argentino y 4to Latinoamericano de Educación Física y Ciencias. La lectura holística e integral de las diferentes producciones académicas, y los diálogos que de ellas se derivaron son puestos en cuestión y en relación a partir de la formulación de tres ejes problemáticos en torno a los cuales se estructura el presente artículo: la violencia y su relación con el fenómeno deportivo en los entramados sociales contemporáneos, las vinculaciones histórico sociales entre políticas públicas y deporte y, por último, el modo en que se articulan y en que resulta posible articular la relación entre los fenómenos deportivos y las ciencias sociales. Poner de relieve, sistematizar y problematizar los argumentos de los diferentes trabajos e investigaciones discutidos es el camino por el cual el presente artículo aspira a contribuir al estado actual de discusión sobre los estudios sociales del deporte y del tiempo libre

Abundance and biomass of the benthic infauna of the North Sea

In 1986 participants of the Benthos Ecology Working Group of ICES conducted a synoptic mapping of the infauna of the southern and central North Sea. Together with a mapping of the infauna of the northern North Sea by Eleftheriou and Basford (1989, doi:10.1017/S0025315400049158) this provides the database for the description of the benthic infauna of the whole North Sea in this paper. Division of the infauna into assemblages by TWINSPAN analysis separated northern assemblages from southern assemblages along the 70 m depth contour. Assemblages were further separated by the 30, 50 m and 100 m depth contour as well as by the sediment type. In addition to widely distributed species, cold water species do not occur further south than the northern edge of the Dogger Bank, which corresponds to the 50 m depth contour. Warm water species were not found north of the 100 m depth contour. Some species occur on all types of sediment but most are restricted to a special sediment and therefore these species are limited in their distribution. The factors structuring species distributions and assemblages seem to be temperature, the influence of different water masses, e.g. Atlantic water, the type of sediment and the food supply to the benthos.

Radiolarian stratigraphy across the Oligocene/Miocene transition in low latitudes

Recently the International Union of Geological Sciences (Commission on Stratigraphy, Working Group on the Paleogene/Neogene Boundary) proposed that the Oligocene/Miocene boundary be placed at the base of Chron C6Cn2n at 23.8 Ma on the Cande and Kent (1992) magnetic time scale, where it is approximated by planktic foraminifera at the first occurrence of Globorotulia kugleri, and by calcareous nannofossils at the last occurrence of Sphenolithus ciperoensis and the first and last occurrences of Sphenolithus delphix and S. capricornutus. Herein we show that, in terms of radiolarians, the base of Chron C6Cn2n can be correlated with the upper part of the Lychnocanoma elongata Zone between the last occurrence of Artophormis gracilis (23.94 Ma) and the first occurrence of Cyrtocapsella tetrapera (23.69 Ma). Since the proposed stratotype at Lemme-Carrosio (Italy) does not contain radiolarians at the boundary, we re-examined 13 DSDP sites and established the stratigraphic sequence of 29 first and last radiolarian occurrences and one evolutionary transition across the boundary. Nine of these sites contain both calcareous and siliceous microfossils and thus allow for an integrated biostratigraphy. Paleomagnetic stratigraphy is not available for any of the DSDP cores examined. However, use of Hodell and Woodruff's (1994) strontium isotope curve from DSDP Site 289 has permitted calibration of several low latitude microfossil datum levels against the geomagnetic polarity scale. Two new species, Lychnocanoma apodora and Eucyrtidium plesiodiaphanes, are described.