Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation

PurposeTo present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes.Materials and methodsEighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits.ResultsThirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group.ConclusionIORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation.

PURPOSE: To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. MATERIALS AND METHODS: Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. RESULTS: Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. CONCLUSION: IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Influence of workload and weather conditions on rolling behaviour of horses and mules.

We evaluated the influences of workload intensity, bath handling and environmental conditions in the rolling behaviour of horses and mules. For this purpose, animals were observed after being exposed to different levels of workload and the rolling behaviour was recorded and described. During all testing procedures, the weather condition (temperature and humidity) was registered by a Black globe and Wet Bulb apparatus. Horses frequently rolled after intense exercise and after bath handling, independently of the weather condition. Mules frequently rolled after control (no exercise) and intense exercise in warmer and wetter days and after bath handlings in colder and drier days. Rolling behaviour characteristics were slightly different between species. While mules exhibited more frequently the behaviours of rest, self-care, yawn, tail swishing, complete spins, snort vocalization and use of the same spot to roll, horses exhibited more frequently the behaviours of paw, sniff, head and neck rubbing movements and incomplete spins to the right and left. This findings evidence that rolling is an important and frequently exhibited behaviour by domestic horses and mules, but animals may express it differently and may have their own motivations. In this sense, we believe that domestic equines, mainly those raised in more intensive livestock, should have the opportunities to freely express the rolling, as a way to improve their welfare conditions and with agreement with a more rational handling practice.

Dominance and Leadership in the Equine Social Structure: A Preliminary Study About Mules and Sex Influence.

Little is known about the dominance and leadership behaviors in the social structure of mules (Equus caballus × Equus asinus). Based on the frequency of threat and aggressive behaviors, we compared the social structure, dominance, and leadership of independent groups of mules and horses (n = 11 per group), and filmed the frequency of these behaviors over a period of four days. In both groups, aggressions were uncommon and, when based on threats, the social structure was linear and consistent with males ranking higher in dominance. When compared to horses, mules exhibited some agonistic social interactions without a recognized submissive individual and displayed more specific aggressive behaviors, whereas horses presented more specific threat behaviors. Comparing between groups, mares exhibited more leader behaviors than female mules, in contrast to male horses which showed fewer leader behaviors than male mules. Regarding behaviors within the mule group, males showed more leader and threat behaviors than females, while females showed more frequent aggression. While in horses, the females showed more leader behaviors than male horses and, although there were differences in specific agonistic behaviors, both sexes presented more often threat behaviors. In this preliminary study, we conclude that the social structure of mules, although similar to those of horses, showed to be less stable, since it involves more aggression and agonistic social interactions without a submissive. Moreover, although mules did not present a sex influence on leadership as horses did, they presented it on aggression: females showed more aggression than males.

Comparison of right and left common carotid arteries of horses and mules by two-dimensional ultrasound and Doppler flow / Comparação das artérias carótidas comuns direita e esquerda dos gêneros de equinos e muares por ultrassonografia bidimensional e Dopplerfluxométrico

In ultrasonography, the bi-dimensional mode (B-mode) allows the morphological and morphometric evaluation of several types of organs and tissues, while the Doppler mode allows the hemodynamic evaluation. In humans, the Doppler evaluation is routinely used in the assessment of important arteries and veins, such as the carotid arteries and jugular veins, with significant differences between genres and sides. However, in veterinary medicine, this diagnostic method is not yet well established in the evaluation of the carotid arteries, with only few reports in domestic horses. This study aims to compare the right and left common carotid arteries of domestic horses and mules using bi-dimensional and Doppler ultrasound evaluation. The common carotid arteries from 10 domestic horses (five males and five females) and 10 mules (five males and five females) were evaluated. The following variables were measured at three different portions (cranial, middle and caudal): diameter, intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI), peak of systolic velocity (pSV) and final diastolic velocity (fDV). No significant differences were observed in the bi-dimensional variables (diameter and IMT) between the common carotid arteries of horses and mules, regardless of gender (p>0.05). In Doppler mode, there were no significant differences between carotid values in male and female horses (p> 0.05). In the mules, it was only possible to observe differences between the RI and PI values (p<0.05), being higher on the left side (0.81 and 2.04 respectively), and the fDV (p<0.05) higher, on the right side (14.35) in males. As for females, there was only in fDV (p<0.05), with the upper right side (23.16). Diameters and IMT do not differ between sides in horses and mules in B-mode ultrasound. Spectral Doppler in horses does not differ between sides, regardless of gender. As for mules, males differ in RI, PI and fDV between sides, while females differ only in fDV.(AU)

Na ultrassonografia, o modo bidimensional (modo B) permite a avaliação morfológica e morfométrica de vários tipos de órgãos e tecidos, enquanto o modo Doppler permite a avaliação hemodinâmica. Em humanos, a avaliação com Doppler é usada rotineiramente na avaliação de artérias e veias importantes, como as artérias carótidas e veias jugulares, com diferenças significativas entre gêneros e lados. No entanto, em medicina veterinária, este método diagnóstico ainda não está bem estabelecido na avaliação das artérias carótidas, com apenas poucos relatos em equinos domésticos. Este estudo tem como objetivo comparar as artérias carótidas comuns direita e esquerda de equinos e mulas domésticos, utilizando a avaliação bidimensional (modo B) e por ultrassonografia Doppler espectral. Avaliaram-se as artérias carótidas comuns de 10 equinos domésticos (cinco machos e cinco fêmeas) e 10 mulas (cinco machos e cinco fêmeas). As seguintes variáveis foram medidas em três porções diferentes (cranial, médio e caudal): diâmetro, espessura íntima-média (IMT), índice de resistividade (RI), índice de pulsatilidade (PI), pico de velocidade sistólica (pSV) e velocidade diastólica final (fDV). Não foram observadas diferenças significativas nas variáveis bidimensionais (diâmetro e IMT) entre as artérias carótidas comuns de cavalos e muares, independentemente do gênero (p>0,05). No modo Doppler, não houve diferenças significativas entre os valores para carótidas em equinos machos e fêmeas (p>0,05). Nos muares, só foi possível observar diferenças entre os valores de RI e PI (p<0,05), sendo maiores no lado esquerdo (0,81 e 2,04 respectivamente), e o fDV (p<0,05) superior no lado direito (14,35) nos machos. Quanto as fêmeas, houve apenas no fDV (p<0,05), sendo o lado direito superior (23,16). Os diâmetros e IMT não diferem entre os lados em equinos e muares na ultrassonografia modo B. Já o Doppler espectral nos equinos não difere entre os lados, independentemente do gênero. Quanto aos muares, os machos diferenciam no IR, IP e fDV entre os lados, enquanto as fêmeas apenas para fDV.(AU)

Efficacy and safety assessment of different dosage of benznidazol for the treatment of Chagas disease in chronic phase in adults (MULTIBENZ study): study protocol for a multicenter randomized Phase II non-inferiority clinical trial.

BACKGROUND: Chagas disease (CD) continues to be a neglected infectious disease with one of the largest burdens globally. Despite the modest cure rates in adult chronic patients and its safety profile, benznidazole (BNZ) is still the drug of choice. Its current recommended dose is based on nonrandomized studies, and efficacy and safety of the optimal dose of BNZ have been scarcely analyzed in clinical trials. METHODS/DESIGN: MULTIBENZ is a phase II, randomized, noninferiority, double-blind, multicenter international clinical trial. A total of 240 patients with Trypanosoma CD in the chronic phase will be recruited in four different countries (Argentina, Brazil, Colombia, and Spain). Patients will be randomized to receive BNZ 150 mg/day for 60 days, 400 mg/day for 15 days, or 300 mg/day for 60 days (comparator arm). The primary outcome is the efficacy of three different BNZ therapeutic schemes in terms of dose and duration. Efficacy will be assessed according to the proportion of patients with sustained parasitic load suppression in peripheral blood measured by polymerase chain reaction. The secondary outcomes are related to pharmacokinetics and drug tolerability. The follow-up will be 12 months from randomization to end of study participation. Recruitment was started in April 2018. CONCLUSION: This is a clinical trial conducted for the assessment of different dose schemes of BNZ compared with the standard treatment regimen for the treatment of CD in the chronic phase. MULTIBENZ may help to clarify which is the most adequate BNZ regimen in terms of efficacy and safety, predicated on sustained parasitic load suppression in peripheral blood. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03191162. Registered on 19 June 2017.

Grayscale histogram analysis to study the echogenicity and echotexture of the walls of the common carotid arteries of horses and mules / Análise por histograma em escala de cinza para estudo da ecogenicidade e ecotextura das paredes das artérias carótidas comuns de equinos e muares

Visual inspection of ultrasound examination for assessment of echogenicity and echotexture of blood vessel tissues is a technique routinely used in medical practice in humans. However, simple visual inspection can lead to poor quality diagnoses and errors. The use of grayscale histogram (GSH) analysis has proved to be an efficient technique to quantify the region of interest, allowing minimization of image interpretation errors. This study aimed to evaluate and compare the echogenicity and echotexture of the walls of the common carotid arteries of healthy female horses and mules using the GSH technique and correlate them with age, body mass, and vessel diameters. B-mode ultrasound examinations were performed in the left and right common carotid arteries in three regions (cranial, middle, and caudal) in 11 horses and 11 healthy mules. The GSH of the animals showed heterogeneous walls, but did not differentiate statistically between female horses and mules. The Mean variable of the middle right, middle left and caudal right sides showed differences, more significant in the mules. On the middle right side, the Min variable was different, higher in the mules. On the middle and caudal left side, the variables Max and Mode showed higher values in the mules. For the mules, the age factor presented negative correlation with the Mean, Mode,, Mode(Count), and Mode(Count)/Count(%) variables, and the body mass factor presented negative correlation with the Mode, Mean and Max variables. For the female horses, the body mass factor showed positive correlation with the Mean and Mode variables. Echogenicity of the carotid artery walls differed between female horses and mules, whereas echotexture was heterogeneous and statistically similar among the animals. The age and body mass factors inversely influenced the echogenicity of the mules, but were not significant in the female horses, in which only the body mass factor positively influenced echogenicity.(AU)

A técnica de avaliação da ecogenicidade e ecotextura dos tecidos dos vasos sanguíneos por inspeção visual do exame de ultrassonografia, já é uma prática da rotina médica em humanos. No entanto, a simples visualização manual pode induzir à erros e diagnósticos de pouca qualidade. O uso de análise por histograma em escala de cinza (HEC) tem se demostrado uma eficiente técnica para quantificar a região avaliada, permitindo minimizar erros de interpretação. O objetivo deste trabalho foi avaliar e comparar a ecogenicidade e ecotextura das paredes das artérias carótidas comuns das fêmeas equina e muares hígidos usando a técnica de HEC, e correlacioná-las com a idade, massa corpórea e diâmetros dos vasos. Exames de ultrassonografia modo-B foram realizados nas artérias carótidas comuns esquerda e direita em três regiões (cranial, médio e caudal) em 11 fêmeas equina e 11 muares hígidos. O HEC dos animais apresentou paredes heterogêneas, mas não diferenciaram estatisticamente entre fêmeas equinas e muares. A variável Mean do lado direito médio, esquerdo médio e caudal apresentou diferenças, sendo maiores nos muares. No lado direito médio, o Min foi diferente, sendo superior nos muares. Já para o lado esquerdo médio e caudal, as variáveis Max e Mode apresentaram valores maiores nos muares. Para os muares, o fator idade apresentou correlação negativa com Mean, Mode, Mode (Count) e Mode(Count)/Count (%) e o fator massa corpórea apresentou correlação negativa com Mode, Mean e Max. Para as fêmeas equinas o fator massa corpórea apresentou correlação positiva com Mean e Mode. A ecogenicidade das paredes das artérias carótidas diferiram entre fêmeas equina e muares, já a ecotextura foi heterogênea e semelhante estatisticamente entre os animais. A idade e a massa corpórea influenciaram inversamente na ecogenicidade dos muares, enquanto que nas fêmeas equina a idade não foi significativa, apenas a massa corpórea influenciou positivamente com a ecogenicidade.(AU)

Urine human papillomavirus prevalence in women with high-grade cervical lesions.

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) in urine samples from women with high-grade cervical lesions. Secondary objectives are to identify the influence of socio-demographic factors and the different genotypes with urinary HPV positivity. STUDY DESIGN: 75 women with a positive biopsy for CIN2+ were included in the study from October 2010 to July 2011. A sample of urine was collected immediately before conization at the outpatient clinic. We analyzed the presence of HPV using a PCR technique. RESULTS: The mean age of the patients was 34.8 years (range 24 to 61). All patients had histological CIN2+, of whom 54.67% had CIN3. The prevalence of HPV in urine test was 58.82% in CIN2 population versus 78.05% in CIN3 patients (p 0.072). 31 different genotypes were found. The most frequent HPV genotype was 16-HPV, which was identified in 58% of women with positive HPV-DNA in urine samples. No demographic characteristics were significantly associated to urinary HPV prevalence. CONCLUSION: Most of the patients with CIN2+ showed positive results for urine HPV test. The prevalence of positive urinary HPV test was higher for patients with CIN3. HPV urine detection could be considered as an acceptable option for high-risk population who skip regular screening programs.

Replacing egg yolk with soybean lecithin in the cryopreservation of stallion semen.

The objective of this study was to determine whether replacing the egg yolk with soybean lecithin in the Botu-Crio® cryodiluent would maintain the fertility of cryopreserved stallion sperm. Two experiments were performed to evaluate cell freezability. In experiment 1, sperm from 15 stallions were frozen in Botu-Crio® (BC) or Botu-Crio® which contained 45g/L soybean lecithin (BCLS45) in place of the egg yolk. In experiment 2, we compared different concentrations of soybean lecithin: 0, 10.0, 12.5, 15.0, 17.5 and 20.0g/L (BC, BCLS10, BCLS12.5, BCLS17.5 and BCLS20, respectively). In experiment 1, sperm frozen in BC and BCLS45 exhibited similar (P>0.05) percentages of total motile sperm (61% and 61%, respectively); progressively motile sperm (27% and 27%, respectively) and sperm with intact plasma membranes (IMP; 53% and 57%, respectively). Similarly, sperm frozen in BC or BC containing any concentration of soybean lecithin maintained similar (P>0.05) percentages of total motile sperm (61-68%) and progressively motile sperm (27-31%). In the first fertility trial, we used cryopreserved semen from a single stallion was inseminated into mares. The semen from the sperm that were frozen in BC diluent resulted in a higher fertility rate (66%, 16/24) compared to the sperm that were frozen in BCLS45 diluent (17%, 5/29; P<0.01). Similarly, in a second fertility trial, the mares that were inseminated with the sperm that were frozen in BC diluent exhibited a higher fertility rate (66%, 16/24) compared to the mares that were inseminated with the sperm that were frozen in BCLS20 (40%, 10/25; P<0.05). Finally, in a third trial, the sperm that were frozen in BC resulted in a higher fertility rate in mares (75%, 18/24) compared to the sperm that were frozen in BCLS10 (41%, 10/24; P<0.05). Although replacing the egg yolk in the BC cryodiluent with soybean lecithin provided similar laboratory results for stallion sperm, after cryopreservation, the sperm that was frozen with soybean lecithin in the diluent correlated with lower fertility rates. Based on these results, we concluded that the use of BCLS can be used as an alternative diluent for cryopreserving stallion sperm. However, the resulting reduced fertility rate is a matter of concern. Further studies are necessary to clarify the reasons for this decrease in fertility and to determine the optimal lecithin concentration for diluents to freeze stallion sperm.

[Slowly absorbable and non absorbable injectable products]. / Les produits injectables lentement et non résorbables.

Products which are non absorbable or slowly absorbable make the correction of facial wasting of any origin possible. These highly efficient products are unfortunately sometimes responsible for complications or even undesirable after effects. In order to avoid this the following are necessary: clinical and histological analysis of facias granulomas, a proposal for guidelines for their use which would predict in situ tolerance.

[Skin, wrinkles and botulinum toxin]. / Peau, rides et toxine botulique.

OBJECTIVE: To present an up-to-date analysis about the use of botulinum toxin for treating facial lines and wrinkles.Method. - A systematic search of the literature was conducted to select the most recent or relevant publications on this topic, through Medline. RESULTS: Out of the 583 articles retrieved, 90 were finally selected for the study. DISCUSSION: Validity of using botulinum toxin for cosmetic use is demonstrated, together with contra-indications and different methods to objectivate the results. The different available types of toxin are presented and compared. Modalities of preparation, conservation, and waste disposal are detailed. Anatomical bases of muscular facial balance are reviewed, with techniques of injection presented for each site, and also with adjunctive procedures. Complications and side effects are described and analysed. Most complications can be prevented through: perfect knowledge of local anatomy;use of small volumes;orientation of the needle bevel towards the muscle body, injection within the muscle body if thick, more superficial if thin;application of ice on the skin pre- and post-injecting. Adding epinephrin or diluting with xylocaïne and epinephrin is not commonly used. CONCLUSION: Botulinum toxin has found its way as a major component of the therapeutic armamentarium. Its efficacy for facial rejuvenation has made it extremely popular, but its use does follow strict rules, and should be restricted to soundly trained practitioners.

Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results.

A retrospective study was done on a population of 258 women who had undergone surgery for abdominal dermolipectomy between January of 1991 and May of 1996. The postoperative complications and flaws seen at long-term follow-up are discussed. The surgical techniques used, with or without lipoaspiration, were the infraumbilical plasty and full plasties with horizontal or inverted T scars. Six types of postoperative complications were noted: hemorrhage in 1.2 percent, lymphorrhea in 10.9 percent, infection in 7 percent, skin necrosis in 6.6 percent, secondary dehiscence of the scar in 2.3 percent, and thromboembolic accidents in 1.2 percent. No significant difference was found in the rate of necrosis development between patients who did and did not undergo lipoaspiration. However, a statistically significant difference was seen in the rate of skin necrosis between the T-type plasty (35.5 percent) and the other two procedures (1.43 percent for infraumbilical plasties and 4.60 percent for full plasties with horizontal scar). With regard to the flaws found at long-term follow-up, the rate of above-scar fat folds and/or dog-ears was 27.9 percent, and the rate of defective scars was 26 percent. No significant difference was found with regard to the rate of flaws. The rate of all secondary surgical procedures was 29.1 percent, but performance of secondary procedures depended on the willingness of the patient and on the surgeon's judgment. Abdominoplasty procedures involve a high risk of early complications. The rate of skin necrosis is clearly augmented in cases of T-type plasty. The need for secondary surgical correction is frequent, and the patient should be reminded of this possibility during preoperative consultation.

Leaching of pyrite by acidophilic heterotrophic iron-oxidizing bacteria in pure and mixed cultures.

Seven strains of heterotrophic iron-oxidizing acidophilic bacteria were examined to determine their abilities to promote oxidative dissolution of pyrite (FeS2) when they were grown in pure cultures and in mixed cultures with sulfur-oxidizing Thiobacillus spp. Only one of the isolates (strain T-24) oxidized pyrite when it was grown in pyrite-basal salts medium. However, when pyrite-containing cultures were supplemented with 0.02% (wt/vol) yeast extract, most of the isolates oxidized pyrite, and one (strain T-24) promoted rates of mineral dissolution similar to the rates observed with the iron-oxidizing autotroph Thiobacillus ferrooxidans. Pyrite oxidation by another isolate (strain T-21) occurred in cultures containing between 0.005 and 0.05% (wt/vol) yeast extract but was completely inhibited in cultures containing 0.5% yeast extract. Ferrous iron was also needed for mineral dissolution by the iron-oxidizing heterotrophs, indicating that these organisms oxidize pyrite via the "indirect" mechanism. Mixed cultures of three isolates (strains T-21, T-23, and T-24) and the sulfur-oxidizing autotroph Thiobacillus thiooxidans promoted pyrite dissolution; since neither strains T-21 and T-23 nor T. thiooxidans could oxidize this mineral in yeast extract-free media, this was a novel example of bacterial synergism. Mixed cultures of strains T-21 and T-23 and the sulfur-oxidizing mixotroph Thiobacillus acidophilus also oxidized pyrite but to a lesser extent than did mixed cultures containing T. thiooxidans. Pyrite leaching by strain T-23 grown in an organic compound-rich medium and incubated either shaken or unshaken was also assessed. The potential environmental significance of iron-oxidizing heterotrophs in accelerating pyrite oxidation is discussed.

The orbicularis oris muscle: a functional approach to its repair in the cleft lip.

Using electrical stimulation the different muscular components of the orbicularis oris muscle are defined at the time of operation for repair of the cleft. By wide dissection and differential re-arrangement, these muscular components can then be brought into their normal position. Not only is a better cosmetic and functional result achieved immediately but it is suggested that some common growth deformities will be avoided.

[Facial wounds. Statistical and aetiological study of 1488 cases (author's transl)]. / Les plaies de la face. Etude statistique et étiologie de 1,488 observations.

Study of 1,488 cases of facial injuries treated in the Department of Maxillofacial surgery of the Montpellier Teaching Hospital Centre, led the authors to draw certain conclusions with regard to causes one the one hand and secondly the individuals involved. Road accidents were by far the largest cause, accounting for 70.2% of facial wounds. Domestic accidents took second place at 13%, followed by brawls and attacks as well as work accidents (each approximately 5%).