New Zealand patients have a higher melanoma burden in sentinel nodes and completion lymphadenectomy than patients in MSLT-II.

New Zealand has the highest rate of melanoma-related mortality in the world. Access to immunotherapy and radiology is limited and surgical treatment of regional disease remains important. A recent pilot study of a single health district observed a higher nodal melanoma burden than was reported in the second Multicentre Selective Lymphadenectomy Trial (MSLT-II). In this study, a series of regional censuses were undertaken covering the 10 years immediately prior to the publication of MSLT-II. The study population was seven District Health Boards covering 62.2% of the population of New Zealand across a 10-year period preceding MSLT-II. The primary outcomes measured were the size of sentinel lymph node metastases and non-sentinel node (NSN) positivity on completion lymph node dissection (CLND) for patients with a positive sentinel lymph node biopsy (SLNB). In the 2323 SLNB identified, the mean sentinel lymph node metastatic deposit size was larger compared to MSLT-II (2.55 vs. 1.07/1.11 mm). A greater proportion of New Zealand patients (44.2%) had metastatic deposits larger than 1 mm compared to MSLT-II (33.2/34.5%) and the rate of non-sentinel node involvement on CLND was also higher (22.2% vs. 11.5%). These findings indicate that New Zealand is a high-risk population for nodal melanoma metastases. Due to these differences, the conclusions of MSLT-II may not be able to be applied to melanoma patients in the 7 regions studied in New Zealand.

The detuning effect of crystal monochromator in self-seeding and oscillator free electron laser.

Self-amplified spontaneous emission (SASE) free electron laser (FEL) is capable of generating ultra-short, high power and high brightness X-ray pulses, but its temporal coherence is poor. Self-seeding scheme is an approach to improve the temporal coherence by employing a crystal monochromator. The crystal detuning effect is the phenomenon that the Bragg angle deviates from the middle of the reflection domain due to the refraction effect, and can affect the seed power of hard X-ray self-seeding (HXRSS) FEL. In this paper, we introduce a novel idea to maximize the seed power by tuning the incident angle off the Bragg condition where the Bragg photon energy is corresponding to the central photon energy of the input X-ray pulse. We present the numerical analysis of the detuning effect in different reflecting atomic planes and different asymmetry angles of diamond crystal. Moreover, we analyze how the detuning affects the seed efficiency of HXRSS FEL, and discuss the application to X-ray FEL oscillator (XFELO). We find when the detuning is much smaller than the bandwidth of input X-ray pulse, we can neglect the detuning effect. However, if the detuning is much larger than or comparable with the bandwidth of input X-ray pulse, the detuning effect can not be ignored. This work can give a guidance to HXRSS FEL and XFELO commissioning for high efficiency FEL output.