European Society of Surgical Oncology's strategy for clinical research: Paving the way for a culture of research in cancer surgery.

As part of its mission to promote the best surgical care for cancer patients, the European Society of Surgical Oncology (ESSO) has been developing multiple programmes for clinical research along with its educational portfolio. This position paper describes the different research activities of the Society over the past decade and an action plan for the upcoming five years to lead innovative and high quality surgical oncology research. ESSO proposes to consider pragmatic research methodologies as a complement to randomised clinical trials (RCT), advocates for increased funding and operational support in conducting research and aims to enable young surgeons to be active in research and establish partnerships for translational research activities.

Higher ER load is not associated with better outcome in stage 1-3 breast cancer: a descriptive overview of quantitative HR analysis in operable breast cancer.

PURPOSE: In breast cancer, hormone receptor (HR) status is generally a qualitative measure; positive or negative. Quantitatively measured oestrogen and progesterone receptors (ER and PR) are frequently proposed prognostic and predictive markers, some guidelines even provide different treatment options for patients with strong versus weak expression. AIM: To evaluate quantitative HR load assessed by immunohistochemistry as a prognostic and predictive measure in stage 1-3 breast cancer. METHODS: We reviewed all the available literature on quantitatively measured HRs using immunohistochemistry. RESULTS: All included studies (n = 19) comprised a cohort of 30,754 patients. Only 2 out of 17 studies found a clear correlation between higher quantitative ER and better disease outcome. Only one trial examined quantitative ER both as prognostic and predictive marker and found no association between ER% and survival. Ten studies examined quantitative PR load, only two of those found a significant correlation between higher PR load and better disease outcome. Two trials examined quantitative PR both as prognostic and predictive marker, neither found any association between PR% and disease outcome. CONCLUSIONS: There is no clear evidence for using quantitatively assessed ER and PR as prognostic nor predictive marker in patients with stage 1-3 breast cancer. We recommend only using a qualitative HR status in future guidelines and treatment considerations.

Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review.

PURPOSE: Anterior cervical discectomy and fusion (ACDF) has proven effective in treating radicular arm pain. Post-operatively, cervical spine stability is temporarily challenged, but data on bony fusion and speed of fusion are ambiguous; optimum evaluation method and criteria are debated. AIM: To study bony fusion accomplishment and to obtain an overview of methods to evaluate fusion. METHODS: A literature search was performed in PubMed and Embase. Included studies had to report original data concerning 1- or 2-level ACDF with intervertebral device or bone graft, where bony fusion was assessed using CT scans or X-rays. RESULTS: A total of 146 articles comprising 10,208 patients were included. Bony fusion was generally defined as "the presence of trabecular bridging" and/or "the absence of motion". Fusion was accomplished in 90.1% of patients at the final follow-up. No gold standard for assessment could be derived from the results. Addition of plates and/or cages with screws resulted in slightly higher accomplishment of fusion, but differences were not clinically relevant. Eighteen studies correlated clinical outcome with bony fusion, and 3 found a significant correlation between accomplishment and better clinical outcome. CONCLUSIONS: In approximately 90% of patients, bony fusion is accomplished one year after ACDF. As there is no generally accepted definition of bony fusion, different measuring techniques cannot be compared to a gold standard and it is impossible to determine the most accurate method. Variations in study design hamper conclusions on optimising the rate of bony fusion by choice of material and/or additives. Insufficient attention is paid to correlation between bony fusion and clinical outcome. These slides can be retrieved from electronic supplementary material.

Relations between intelligibility of narrow-band speech and auditory functions, both in the 1-kHz frequency region.

Relations between perception of suprathreshold speech and auditory functions were examined in 24 hearing-impaired listeners and 12 normal-hearing listeners. The speech intelligibility index (SII) was used to account for audibility. The auditory functions included detection efficiency, temporal and spectral resolution, temporal and spectral integration, and discrimination of intensity, frequency, rhythm, and spectro-temporal shape. All auditory functions were measured at 1 kHz. Speech intelligibility was assessed with the speech-reception threshold (SRT) in quiet and in noise, and with the speech-reception bandwidth threshold (SRBT), previously developed for investigating speech perception in a limited frequency region around 1 kHz. The results showed that the elevated SRT in quiet could be explained on the basis of audibility. Audibility could only partly account for the elevated SRT values in noise and the deviant SRBT values, suggesting that suprathreshold deficits affected intelligibility in these conditions. SII predictions for the SRBT improved significantly by including the individually measured upward spread of masking in the SII model. Reduced spectral resolution, reduced temporal resolution, and reduced frequency discrimination appeared to be related to speech perception deficits. Loss of peripheral compression appeared to have the smallest effect on the intelligibility of suprathreshold speech.

Measuring the threshold for speech reception by adaptive variation of the signal bandwidth. II. Hearing-impaired listeners.

In a previous study [Noordhoek et al., J. Acoust. Soc. Am. 105, 2895-2902 (1999)], an adaptive test was developed to determine the speech-reception bandwidth threshold (SRBT), i.e., the width of a speech band around 1 kHz required for a 50% intelligibility score. In this test, the band-filtered speech is presented in complementary bandstop-filtered noise. In the present study, the performance of 34 hearing-impaired listeners was measured on this SRBT test and on more common SRT (speech-reception threshold) tests, namely the SRT in quiet, the standard SRT in noise (standard speech spectrum), and the spectrally adapted SRT in noise (fitted to the individual's dynamic range). The aim was to investigate to what extent the performance on these tests could be explained simply from audibility, as estimated with the SII (speech intelligibility index) model, or require the assumption of suprathreshold deficits. For most listeners, an elevated SRT in quiet or an elevated standard SRT in noise could be explained on the basis of audibility. For the spectrally adapted SRT in noise, and especially for the SRBT, the data of most listeners could not be explained from audibility, suggesting that the effects of suprathreshold deficits may be present. Possibly, such a deficit is an increased downward spread of masking.

Measuring the threshold for speech reception by adaptive variation of the signal bandwidth. I. Normal-hearing listeners.

An adaptive test has been developed to determine the minimum bandwidth of speech that a listener needs to reach 50% intelligibility. Measuring this speech-reception bandwidth threshold (SRBT), in addition to the more common speech-reception threshold (SRT) in noise, may be useful in investigating the factors underlying impaired suprathreshold speech perception. Speech was bandpass filtered (center frequency: 1 kHz) and complementary bandstop filtered noise was added. To obtain reference values, the SRBT was measured in 12 normal-hearing listeners at four sound-pressure levels, in combination with three overall spectral tilts. Plotting SRBT as a function of sound-pressure level resulted in U-shaped curves. The most narrow SRBT (1.4 octave) was obtained at an A-weighted sound-pressure level of 55 dB. The required bandwidth increases with increasing level, probably due to upward spread of masking. At a lower level (40 dBA) listeners also need a broader band, because parts of the speech signal will be below threshold. The SII (Speech Intelligibility Index) model reasonably predicts the data, although it seems to underestimate upward spread of masking.

Effect of reducing temporal intensity modulations on sentence intelligibility.

Modulations in the temporal intensity envelope of 24 1/4-octave bands were reduced by proportionally raising the troughs and lowering the peaks relative to the mean intensity in each band. The effect on intelligibility of various degrees of modulation reduction was investigated by measuring the speech-reception threshold (SRT) in noise. For conditions of severe modulation reduction, the number of correctly received sentences in quiet was scored. The effect of this deterministic modulation reduction was compared to the effect of stochastic modulation reduction obtained with addition of noise. Results for 12 normal-hearing subjects show that in the case of deterministic modulation reduction, intelligibility is reduced to 50% when the modulation-transfer factor equals 0.10, whereas in the case of modulation reduction by addition of noise, this intelligibility is reached already at a modulation-transfer factor of 0.27. This confirms that the effect of additive noise on intelligibility cannot be understood completely as a result of only modulation reduction. As suggested by Drullman [J. Acoust. Soc. Am. 97, 585-592 (1995)] two other factors associated with the addition of noise have to be taken into account: (1) the introduction of nonrelevant modulations, and (2) the corruption of the fine structure.