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Simple Summary: Currently, it is unclear which kind of axillary staging surgery breast cancer patients with lymph node metastasis should receive after neoadjuvant chemotherapy. For decades, these patients have been treated with a full axillary lymph node dissection, even if they converted to clinical node negativity. However, the removal of a large number of lymph nodes during the procedure can increase arm morbidity and impact quality of life. Therefore, several studies investigated less radical surgical strategies in this setting, such as sentinel lymph node biopsy or targeted axillary dissection, i.e., removal of a previously marked node combined with sentinel node removal. In this review, we summarize current evidence on the different surgical techniques and compare national and international recommendations. We show that many questions regarding oncological safety of different surgery types and the optimal marking technique remain unanswered and present the multinational prospective cohort study AXSANA that will address these open issues.
Abstract: In the last two decades, surgical methods for axillary staging in breast cancer patients have become less extensive, and full axillary lymph node dissection (ALND) is confined to selected patients. In initially node-positive patients undergoing neoadjuvant chemotherapy, however, the optimal management remains unclear. Current guidelines vary widely, endorsing different strategies. We performed a literature review on axillary staging strategies and their place in international recommendations. This overview defines knowledge gaps associated with specific procedures, summarizes currently ongoing clinical trials that address these unsolved issues, and provides the rationale for further research. While some guidelines have already implemented surgical de-escalation, replacing ALND with, e.g., sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) in cN+ patients converting to clinical node negativity, others recommend ALND. Numerous techniques are in use for tagging lymph node metastasis, but many questions regarding the marking technique, i.e., the optimal time for marker placement and the number of marked nodes, remain unanswered. The optimal number of SLNs to be excised also remains a matter of debate. Data on oncological safety and quality of life following different staging procedures are lacking. These results provide the rationale for the multinational prospective cohort study AXSANA initiated by EUBREAST, which started enrollment in June 2020 and aims at recruiting 3000 patients in 20 countries (NCT04373655; Funded by AGO-B, Claudia von Schilling Foundation for Breast Cancer Research, AWOgyn, EndoMag, Mammotome, and MeritMedical).
Geometrical frustration among interacting spins combined with strong quantum fluctuations destabilize long-range magnetic order in favor of more exotic states such as spin liquids. By following this guiding principle, a number of spin liquid candidate systems were identified in quasi-two-dimensional (quasi-2D) systems. For 3D, however, the situation is less favorable as quantum fluctuations are reduced and competing states become more relevant. Here we report a comprehensive study of thermodynamic, magnetic and dielectric properties on single crystalline and pressed-powder samples of PbCuTe2O6, a candidate material for a 3D frustrated quantum spin liquid featuring a hyperkagome lattice. Whereas the low-temperature properties of the powder samples are consistent with the recently proposed quantum spin liquid state, an even more exotic behavior is revealed for the single crystals. These crystals show ferroelectric order at TFE ≈ 1 K, accompanied by strong lattice distortions, and a modified magnetic response—still consistent with a quantum spin liquid—but with clear indications for quantum critical behavior.
Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.
This paper reports on Monte Carlo simulation results for future measurements of the moduli of time-like proton electromagnetic form factors, |GE | and |GM|, using the ¯pp → μ+μ− reaction at PANDA (FAIR). The electromagnetic form factors are fundamental quantities parameterizing the electric and magnetic structure of hadrons. This work estimates the statistical and total accuracy with which the form factors can be measured at PANDA, using an analysis of simulated data within the PandaRoot software framework. The most crucial background channel is ¯pp → π+π−,due to the very similar behavior of muons and pions in the detector. The suppression factors are evaluated for this and all other relevant background channels at different values of antiproton beam momentum. The signal/background separation is based on a multivariate analysis, using the Boosted Decision Trees method. An expected background subtraction is included in this study, based on realistic angular distribuations of the background contribution. Systematic uncertainties are considered and the relative total uncertainties of the form factor measurements are presented.
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) can present with different histopathological growth patterns. The impact of these histopathological growth patterns on relapse characteristics is unknown. We therefore analyzed paired biopsies obtained at initial diagnosis and relapse from 33 NLPHL patients who had received first‐line treatment within German Hodgkin Study Group (GHSG) trial protocols, and from a second cohort of 41 relapsed NLPHL patients who had been treated outside GHSG studies. Among the 33 GHSG patients, 21 patients presented with a typical growth pattern at initial diagnosis, whereas 12 patients had a variant histology. The histopathological growth patterns at initial diagnosis and at relapse were consistent in 67% of cases. A variant histology at initial diagnosis was associated with a shorter median time to lymphoma recurrence (2.8 vs 5.2 years; P = .0219). A similar tendency towards a shorter median time to lymphoma recurrence was observed for patients presenting with a variant histology at relapse, irrespective of the growth pattern at initial diagnosis. Results obtained from the 41 NLPHL patients who had been treated outside GHSG studies were comparable (median time to lymphoma recurrence for variant histology vs typical growth pattern at initial diagnosis: 1.5 vs 7.0 years). In conclusion, the histopathological growth pattern remains consistent at relapse in the majority of NLPHL cases, and has major impact on the time of relapse.
The mass spectrum and the ion molecule reactions of phosphirane and of mixtures of phosphirane with NH3 , NH2D, NHD2 and ND3 have been studied by ion cyclotron resonance spectrometry. Almost all important product ions are formed by PH-group transfer reactions, where ethene is generated as the neutral particle. Only two of the more abundant ions, the protonated molecule, H2P(CH2)2+ and the ion m/e=63, P2H+, are formed via other reaction pathways. Secondary, tertiary and quarternary product ions with the general formula R(PH)n+ (R: phosphirane fragment, n-1, 2, 3) have been detected.
The molecular ion is proved to have a cyclic structure. Two possible structures of the product ions with two and three phosphorus atoms are discussed: a structure with an open phosphorus chain, leaving the phosphirane ring intact and a ring extended structure, produced by a ring extension reaction of the PH-group.
Several rate constants of the ion molecule reactions of the phosphirane molecular ion are given.
The ion-molecule reactions of thiothionylfluoride have been studied by ion cyclotron resonance spectrometry. The major secondary ions are S2F3+ , S3F+ , and S3F2+. In a consecutive reaction of S3F2+ the tertiary ion S4F2+ is formed. The rate constant of the IMR with the greatest yield S2F2+ + SSF2 → S3F2+ + SF was estimated to k = 2 · 10-9 cm 3 molecule -1 sec -1 . The results were compared with the mass spectrum of thiothionylfluoride. They permit conclusions on chemical reactions of lower sulphurfluorides.
Die FOURIER-Nullkomponente der Bindungsmatrix Gij G(0) in 1 Beziehung (5.16) wurde durch Summation spezieller Diagramme in der sogen. „Kettenapproximation“ und der „Wassermelonenapproximation“ näherungsweise berechnet. Auf der Basis von (5.16) in 1 wurde in der Kettenapproximation und der Wassermelonenapproximation die magnetische Suszeptibilität und die Magnetisierung des dreidimensionalen ISING-Modells bestimmt. In der Kettenapproximation wurden ferner die freie Energie, die innere Energie und die Atomwärme des dreidimensionalen ISING-Ferromagneten sowie die Druck-Dichte-Isothermen des dreidimensionalen Gittergases ausgerechnet.
Die „Selbstenergien“ Gn in 1 wurden durch näherungsweise Auswertung einer größeren Klasse von Selbstenergiediagrammen approximativ berechnet. Das Gleichungssystem (3.3) in 1 für die renormierten Semiinvarianten wurde umgeformt und durch zusätzliche Näherungsannahmen vereinfacht. Durch Näherungsansätze für die Semiinvarianten M2, M3,... konnten einfache Gleichungen für die Magnetisierung M1 hergeleitet werden. Diese Gleichungen wurden numerisch gelöst. Auf der Grundlage der Beziehungen (3.5) und (4.8) in 1 wurden ferner die innere Energie, die freie Energie und die Atomwärme des zweidimensionalen Ising-Ferromagneten sowie die Druck-Dichte-Isothermen des zweidimensionalen Gittergases numerisch ausgerechnet.