Intraoperative assessment of resection margins by Raman spectroscopy to guide oral cancer surgery.

Patients with oral cavity cancer are almost always treated with surgery. The goal is to remove the tumor with a margin of more than 5 mm of surrounding healthy tissue. Unfortunately, this is only achieved in about 15% to 26% of cases. Intraoperative assessment of tumor resection margins (IOARM) can dramatically improve surgical results. However, current methods are laborious, subjective, and logistically demanding. This hinders broad adoption of IOARM, to the detriment of patients. Here we present the development and validation of a high-wavenumber Raman spectroscopic technology, for quick and objective intraoperative measurement of resection margins on fresh specimens. It employs a thin fiber-optic needle probe, which is inserted into the tissue, to measure the distance between a resection surface and the tumor. A tissue classification model was developed to discriminate oral cavity squamous cell carcinoma (OCSCC) from healthy oral tissue, with a sensitivity of 0.85 and a specificity of 0.92. The tissue classification model was then used to develop a margin length prediction model, showing a mean difference between margin length predicted by Raman spectroscopy and histopathology of -0.17 mm.

Mortars for Conservation of Late 19th and Early 20th Century Buildings-Combination of Natural Cements with Air Lime.

With the availability of commercial Natural cements (NC) for the conservation purposes raises a fundamental question about the compatibility between historic and repair mortars. The properties of Natural cements are dependent on the geological location of the raw material extraction and also on the production parameters, both having an impact on the final properties of the mortars produced from each distinct. Therefore, the significance of preservation of 19th and 20th century heritage and selection of the proper binder compatible with the original materials necessitate the study of existing NCs, that nowadays are produced by several manufacturers. This work provides a complex study of the mortars prepared from three NCs available in the market: Groupe Prompt Vicat, France (NCPV); Cemento Collet Marfil (NCM) and Cemento Natural Tigre (NCT), both from Spain. Various mortar sets based on individual NC containing different binder/aggregate ratios and air lime additions were analyzed after 28, 60, and 90 days of curing with the focus on their mineralogical composition (XRD), morphology (SEM), mechanical (flexural and compressive strength), and physical properties such as water absorption by capillarity, water vapor permeability, and water vapor diffusion resistance. Mortars prepared from NCPV, NCM, and NCT show distinct physical-mechanical properties with varying binder/aggregate ratio and air lime addition. This study shows that the NC variability should be taken into consideration when selecting materials for the conservation and rehabilitation of historic renders and plasters. Based on the comparison with original NC mortars, several NC mortars developed in this study show adequate properties for conservation of the buildings from late 19th and early 20th century in terms of compressive strength (>12 MPa), water absorption by capillarity (<20 kg·m−2·h−0.5), water vapor permeability (<4 × 10−10 kg·s−1·m−1·Pa−1), and water vapor diffusion resistance (<28) values.

Computational dose evaluation on children exposed to natural radioactivity from granitic rocks used as architectural materials.

Considering the higher radiosensitivity of children in comparison to adults, studies related to children's exposure to ionising radiation have been long considered of relevance. For this study, the MCNPX2.7.0 Monte Carlo code and four paediatric voxel computational anthropomorphic phantoms, of both genders and aged 5 and 10 years, were used to simulate scenarios, where children are exposed to natural radiation emitted by sources in the ground by radionuclides of40K and of232Th and238U radioactive series. These elements are part of the composition of ten different types of ornamental rocks obtained from three regions of Brazil, and used as architectural material for flooring of houses. The virtual paediatric anthropomorphic phantoms were positioned in a room with dimensions of (4.0 × 5.0 × 2.8) m3filled with atmospheric air and a 3 cm thick granitic floor acting as a uniformly distributed planar gamma radiation source. The walls of the room were composed of 20 cm thick concrete. Gonads, bone marrow, bladder, colon, and skin were found to be the organs which receive the highest doses. The mean values of effective dose per air kerma at 1 m above the ground summed for all three radionuclides, were 0.96 and 0.68 Sv Gy-1for the 5 and 10 year old phantoms, respectively. The obtained results showed that the granitic rocks considered implicate annual effective doses which are 69%-78% lower than the annual limits, recommended by ICRP Publication 103.

Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way.

The goal of head and neck oncological surgery is complete tumor resection with adequate resection margins while preserving acceptable function and appearance. For oral cavity squamous cell carcinoma (OCSCC), different studies showed that only 15%-26% of all resections are adequate. A major reason for the low number of adequate resections is the lack of information during surgery; the margin status is only available after the final histopathologic assessment, days after surgery. The surgeons and pathologists at the Erasmus MC University Medical Center in Rotterdam started the implementation of specimen-driven intraoperative assessment of resection margins (IOARM) in 2013, which became the standard of care in 2015. This method enables the surgeon to turn an inadequate resection into an adequate resection by performing an additional resection during the initial surgery. Intraoperative assessment is supported by a relocation method procedure that allows accurate identification of inadequate margins (found on the specimen) in the wound bed. The implementation of this protocol resulted in an improvement of adequate resections from 15%-40%. However, the specimen-driven IOARM is not widely adopted because grossing fresh tissue is counter-intuitive for pathologists. The fear exists that grossing fresh tissue will deteriorate the anatomical orientation, shape, and size of the specimen and therefore will affect the final histopathologic assessment. These possible negative effects are countered by the described protocol. Here, the protocol for specimen-driven IOARM is presented in detail, as performed at the institute.

Performance of Intraoperative Assessment of Resection Margins in Oral Cancer Surgery: A Review of Literature.

INTRODUCTION: Achieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance. METHODS: A literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available. RESULTS: Eighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome. CONCLUSION: IOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.

Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

OBJECTIVE: The depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC. METHODS: A retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8th edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files. RESULTS: A total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1-1.5, p = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined). CONCLUSION: The DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.

Squawks in interstitial lung disease prevalence and causes in a cohort of one thousand patients.

Squawks are lung adventitious sounds with a mix of both musical and nonmusical components heard during the inspiratory phase. Small series have described squawks in interstitial lung diseases. Hypersensitivity pneumonitis and other diseases involving small airways can result in squawks, but new interstitial lung diseases (ILDs) involving peripheral airways are being described. A retrospective analysis was performed on 1000 consecutive patients from a database of ILD of a tertiary referral center. Squawks were recorded in 49 cases (4.9%), hypersensitivity pneumonitis (23 cases), connective tissue disease (7), microaspiration (4), pleuroparenchymal fibroelastosis (4), fibrosing cryptogenic organizing pneumonia (, 3), familial ILD (2), sarcoidosis (2), idiopathic pulmonary fibrosis (IPF; 1), bronchiolitis (2), and nonspecific interstitial pneumonia (1). One patient had a final diagnosis of IPF. There was a significant association between mosaic pattern and squawks: 20 cases with squawks (40.8%) had mosaic pattern compared with 140 (14.7%) cases without squawks (x = 23.6, P < .001).Findings indicative of fibrosis were described on high-resolution chest tomography (HRCT) in 715 cases (71.5%). Squawks were more common in patients with findings indicative of fibrosis on HRCT: 45 of 715 (6.3%) compared with 4 of 285 (1.4%) of those without findings indicative of fibrosis (x = 10.46, P = .001).In conclusion, squawks are an uncommon finding on physical examination in patients with ILD, but when present suggest fibrosing ILD associated with bronchiolar involvement. However, squawks are rare in IPF.

Substrate and Mg doping effects in GaAs nanowires.

Mg doping of GaAs nanowires has been established as a viable alternative to Be doping in order to achieve p-type electrical conductivity. Although reports on the optical properties are available, few reports exist about the physical properties of intermediate-to-high Mg doping in GaAs nanowires grown by molecular beam epitaxy (MBE) on GaAs(111)B and Si(111) substrates. In this work, we address this topic and present further understanding on the fundamental aspects. As the Mg doping was increased, structural and optical investigations revealed: i) a lower influence of the polytypic nature of the GaAs nanowires on their electronic structure; ii) a considerable reduction of the density of vertical nanowires, which is almost null for growth on Si(111); iii) the occurrence of a higher WZ phase fraction, in particular for growth on Si(111); iv) an increase of the activation energy to release the less bound carrier in the radiative state from nanowires grown on GaAs(111)B; and v) a higher influence of defects on the activation of nonradiative de-excitation channels in the case of nanowires only grown on Si(111). Back-gate field effect transistors were fabricated with individual nanowires and the p-type electrical conductivity was measured with free hole concentration ranging from 2.7 × 1016 cm-3 to 1.4 × 1017 cm-3. The estimated electrical mobility was in the range ≈0.3-39 cm2/Vs and the dominant scattering mechanism is ascribed to the WZ/ZB interfaces. Electrical and optical measurements showed a lower influence of the polytypic structure of the nanowires on their electronic structure. The involvement of Mg in one of the radiative transitions observed for growth on the Si(111) substrate is suggested.