Effectiveness of Conventional Periodontal Treatment With Tetracycline Fiber Versus Minocycline Gel Application Subgingivally in Periodontitis Patients.

BACKGROUND: Locally delivered antibiotics are adjunctive therapies for the selective removal or inhibition of pathogenic microbes in combination with scaling and root planing (SRP) for the management of periodontitis. OBJECTIVE: The primary objective of this study was to evaluate the effectiveness of tetracycline fibers against minocycline gel when used as local drug delivery in conjunction with SRP for treating periodontitis. METHODS AND MATERIALS: This is a pilot randomized open single, blinded trial study comparing three treatment modalities: SRP with topical tetracycline fibers (SRP+T), SRP with topical minocycline HCL 2% gel (SRP+M), and SRP only as a control group. Probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) percentages were recorded at baseline, one month, and at the end of three months. The data were subjected to analysis using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Repeated measures ANOVA was used to compare the clinical outcomes between the three treatment groups, accounting for the repeated measurements at baseline, one month, and three months. A p-value less than 0.05 at a 95% confidence interval was deemed statistically significant. RESULTS: There were statistically significant changes within the groups in all the clinical parameters, including pocket depth, clinical attachment loss, and bleeding on probing score, at different time intervals, with the greatest mean pocket depth changes seen in the tetracycline group after one month (mean changes = 1.4 mm, P < 0.001) and over three months (mean changes = 1.79 mm, p < 0.001). For clinical attachment loss, after one month, the highest improvement in clinical level was seen in the minocycline group (mean changes = 0.7mm, p < 0.05), and the overall improvement was seen in the control group (mean changes = 1.1mm, p < 0.05). The minocycline group showed greater mean changes in bleeding on probing percentage, with the greatest changes after one month (mean changes = 19.34%, p < 0.001) and over three months (mean changes = 26.42%, p <0.001). However, there was no significant difference between the groups. CONCLUSION: Locally delivered tetracycline and minocycline gel are effective as adjuncts to SRP and may improve the healing outcome in the management of periodontitis.

Spatiotemporal drivers of urban water pollution: Assessment of 102 cities across the Yangtze River Basin.

Effective management of large basins necessitates pinpointing the spatial and temporal drivers of primary index exceedances and urban risk factors, offering crucial insights for basin administrators. Yet, comprehensive examinations of multiple pollutants within the Yangtze River Basin remain scarce. Here we introduce a pollution inventory for urban clusters surrounding the Yangtze River Basin, analyzing water quality data from 102 cities during 2018-2019. We assessed the exceedance rates for six pivotal indicators: dissolved oxygen (DO), ammonia nitrogen (NH3-N), chemical oxygen demand (COD), biochemical oxygen demand (BOD), total phosphorus (TP), and the permanganate index (CODMn) for each city. Employing random forest regression and SHapley Additive exPlanations (SHAP) analyses, we identified the spatiotemporal factors influencing these key indicators. Our results highlight agricultural activities as the primary contributors to the exceedance of all six indicators, thus pinpointing them as the leading pollution source in the basin. Additionally, forest coverage, livestock farming, chemical and pharmaceutical sectors, along with meteorological elements like precipitation and temperature, significantly impacted various indicators' exceedances. Furthermore, we delineate five core urban risk components through principal component analysis, which are (1) anthropogenic and industrial activities, (2) agricultural practices and forest extent, (3) climatic variables, (4) livestock rearing, and (5) principal polluting sectors. The cities were subsequently evaluated and categorized based on these risk components, incorporating policy interventions and administrative performance within each region. The comprehensive analysis advocates for a customized strategy in addressing the discerned risk factors, especially for cities presenting elevated risk levels.

Alpha anteriorization and theta posteriorization during deep sleep.

Brain states (wake, sleep, general anesthesia, etc.) are profoundly associated with the spatiotemporal dynamics of brain oscillations. Previous studies showed that the EEG alpha power shifted from the occipital cortex to the frontal cortex (alpha anteriorization) after being induced into a state of general anesthesia via propofol. The sleep research literature suggests that slow waves and sleep spindles are generated locally and propagated gradually to different brain regions. Since sleep and general anesthesia are conceptualized under the same framework of consciousness, the present study examines whether alpha anteriorization similarly occurs during sleep and how the EEG power in other frequency bands changes during different sleep stages. The results from the analysis of three polysomnography datasets of 234 participants show consistent alpha anteriorization during the sleep stages N2 and N3, beta anteriorization during stage REM, and theta posteriorization during stages N2 and N3. Although it is known that the neural circuits responsible for sleep are not exactly the same for general anesthesia, the findings of alpha anteriorization in this study suggest that, at macro level, the circuits for alpha oscillations are organized in the similar cortical areas. The spatial shifts of EEG power in different frequency bands during sleep may offer meaningful neurophysiological markers for the level of consciousness.

Infrared Thermographic Imaging as a Tool to Assess Inflammatory and Ischemic Response With Rubber Ring Tail Docking in Suffolk and Hampshire Lambs (Ovis Aries).

Tail docking in lambs is associated with an acute inflammatory and ischemic response correlated to pain. The present study sought to quantify these responses by utilizing infrared thermographic imaging (IRT) after tail docking lambs. Images were taken for each lamb before tail docking (T0), within a minute after the band was placed (T1), at 5 minutes (T5), and 15 minutes (T15) respectively and analyzed for pixel intensity in areas on the lamb's rump, tail base, and two locations below the docking band. The pixel intensity at 2 cm below the docking band did significantly decrease (p < 0.05) over the course of the study at 15 minutes, indicating the presence of ischemia, and a significant decrease in the pixel intensity of the rump and tail base was observed. The closest location to the rubber ring showed the presence of inflammation as an indirect indicator of acute pain . IRT is a valuable tool in the detection of inflammation and ischemic areas and has the potential to be used to quantify and measure the experience of inflammation and pain after tail docking.

Finite element validation dataset of additively manufactured equal angle section stub columns.

This article provides experimental and numerical data pertaining to the compressive testing and model calibration for a novel design of 316 L stainless steel equal angle sections (EAS) produced through additive manufacturing, wherein each leg of the EAS is replaced by a wavy surface resembling high order buckling modes of the flat plate. The experimental data were acquired from testing 9 unique stub column sections, in all combinations of 3 different thicknesses and 2 wave magnitudes, with a control section provided for each thickness. The provided numerical data was produced to calibrate a finite element model of the tested sections by varying imperfection magnitudes, and selected values fit strongly to the physical tests. Both physical and numerical tests data herein are given in two parts each, one summary spreadsheet describing section geometry and peak load, and one more detailed spreadsheet providing load-displacement history for all physical sections and selected finite element sections. This data provides insight into finite element analysis of additively manufactured stainless steel sections, making it valuable for the validation of numerical models and stainless steel material behaviour.

Strategies of plants to overcome abiotic and biotic stresses.

In their environment, plants are exposed to a multitude of abiotic and biotic stresses that differ in intensity, duration and severity. As sessile organisms, they cannot escape these stresses, but instead have developed strategies to overcome them or to compensate for the consequences of stress exposure. Defence can take place at different levels and the mechanisms involved are thought to differ in efficiency across these levels. To minimise metabolic constraints and to reduce the costs of stress defence, plants prioritise first-line defence strategies in the apoplastic space, involving ascorbate, defensins and small peptides, as well as secondary metabolites, before cellular processes are affected. In addition, a large number of different symplastic mechanisms also provide efficient stress defence, including chemical antioxidants, antioxidative enzymes, secondary metabolites, defensins and other peptides as well as proteins. At both the symplastic and the apoplastic level of stress defence and compensation, a number of specialised transporters are thought to be involved in exchange across membranes that still have not been identified, and information on the regeneration of different defence compounds remains ambiguous. In addition, strategies to overcome and compensate for stress exposure operate not only at the cellular, but also at the organ and whole-plant levels, including stomatal regulation, and hypersensitive and systemic responses to prevent or reduce the spread of stress impacts within the plant. Defence can also take place at the ecosystem level by root exudation of signalling molecules and the emission of volatile organic compounds, either directly or indirectly into the rhizosphere and/or the aboveground atmosphere. The mechanisms by which plants control the production of these compounds and that mediate perception of stressful conditions are still not fully understood. Here we summarise plant defence strategies from the cellular to ecosystem level, discuss their advantages and disadvantages for plant growth and development, elucidate the current state of research on the transport and regeneration capacity of defence metabolites, and outline insufficiently explored questions for further investigation.

Long-term outcomes of 1-2 cm rectal neuroendocrine tumors after local excision or radical resection: A population-based multicenter study.

Objectives: Studies on rectal neuroendocrine tumors (R-NETs) that are 1-2 cm in size are limited, and the optimal treatment for these tumors is not well established. Methods: Data from patients with primary localized R-NETs 1-2 cm in size were retrospectively collected from 17 large-scale referral medical centers in China. Long-term prognosis, quality of life (QOL), and fecal incontinence were evaluated, and the effects of local excision (LE) or radical resection (RR) were elucidated using propensity score matching (PSM). Results: A total of 272 patients were included in this study; 233 underwent LE, and the remaining 39 underwent RR. Patients in the LE group showed lower tumor location, fewer postoperative Clavien-Dindo III-V complications, more G1 tumors, and lower tumor stage. There were no significant differences in the relapse-free survival or overall survival (OS) between the LE and RR groups after PSM. Patients in the LE group reported superior physical, role, emotional, social, and cognitive functions, global QOL, and Wexner fecal incontinence scores compared with those in the RR group (all P < 0.050). Eighteen (6.6%) patients had lymph node metastases. Multivariable analysis revealed that tumor location (odds ratio [OR] = 3.19, 95% confidence interval [CI] 1.04-10.07, P = 0.010), neutrophil-to-lymphocyte ratio (NLR) > 1.80 (OR = 4.50, 1.46-15.89, P = 0.012), and T3-T4 (OR = 36.31, 95% CI 7.85-208.62, P < 0.001) were independent risk factor for lymph node metastasis. Conclusions: R-NETs measuring 1-2 cm generally have a favorable prognosis, and there is no difference in postoperative survival between LE and RR. For patients without lymph node metastasis, LE should be the preferred choice; however, for patients with a higher tumor location, preoperative NLR >1.8 or T3/T4 tumors, RR should be considered.

Pyogenic Granuloma in a One-Year-Old Child: A Rare Entity.

Pyogenic granuloma (PG) is a benign vascular neoplasm seen in the first and second decades of life, and it has a female predilection. It presents as a small reddish exophytic lesion, gingiva being the most common site. This article describes an unusual presentation of PG in a one-year-old female child and highlights the importance of its early diagnosis and management to avoid discomfort and distress in these patients. The diagnosis was verified by histological examination, which revealed significant markers such as endothelial growth, vascular abundance, and chronic inflammatory cell infiltration. The chosen treatment protocol was surgical excision, which led to a successful outcome with no symptoms of recurrence, as confirmed by thorough follow-up examinations.

Coupling of Electric and Flow Fields to Enhance Ion Transport for Energy-Efficient Electrochemical Tap-Water Softening.

Electrochemical-induced precipitation is a sustainable approach for tap-water softening, but the hardness removal performance and energy efficiency are vastly limited by the ultraslow ion transport and the superlow local HCO3-/Ca2+ ratio compared to the industrial scenarios. To tackle the challenges, we herein report an energy-efficient electrochemical tap-water softening strategy by utilizing an integrated cathode-anode-cathode (CAC) reactor in which the direction of the electric field is reversed to that of the flow field in the upstream cell, while the same in the downstream cell. As a result, the transport of ions, especially HCO3-, is significantly accelerated in the downstream cell under a flow field. The local HCO3-/Ca2+ ratio is increased by 1.5 times, as revealed by the finite element numerical simulation and in situ imaging. In addition, a continuous flow electrochemical system with an integrated CAC reactor is operated for 240 h to soften tap water. Experiments show that a much lower cell voltage (9.24 V decreased) and energy consumption (28% decreased) are obtained. The proposed ion-transport enhancement strategy by coupled electric and flow fields provides a new perspective on developing electrochemical technologies to meet the flexible and economic demand for tap-water softening.

Association of anesthetic modality and other variables on 1-year functional patency of cephalic-based arteriovenous fistulae.

OBJECTIVES: Some studies suggest that regional (RA) provides better patency for arteriovenous fistula (AVF) for hemodialysis (HD) access as compared to Local (LA) and General Anesthesia (GA). This study evaluates the impact of anesthetic modality on long term fistula function at 12 months. METHODS: A retrospective review of patients undergoing cephalic vein-based HD access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic based lower forearm and wrist versus upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months. RESULTS: There were 818 cephalic based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (p=0.009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (p=0.343). Multivariate regression analysis identified that history of AVF/AVG (OR 0.24, p=0.007), receiving intraoperative systemic anticoagulation (OR 2.49, p<0.001), and vein diameter (OR 1.85, p=0.039) as independently associated with AVF functional patency at 12 months. CONCLUSION: There was no association between anesthetic modality and functional patency of cephalic based-AVF at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia.

Endoscopic Posterior Cervical Foraminotomy under Lateral Decubitus Position with Local Anesthesia.

Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. This study describes a technique utilizing lateral decubitus position for an endoscopic posterior cervical foraminotomy under Monitored Anesthesia Care (MAC) and local anesthesia only. 10 patients with contraindications to general anesthesia underwent the procedure, resulting in an improvement in cervical radicular pain with no perioperative complications. The findings suggest that this approach is a viable alternative for high-risk patients for general anesthesia care, expanding the surgical options for the treatment of radiculopathy.

A Systematic Review and Meta-analysis of the Impact of Local Therapies on Local Event Suppression in Metastatic Hormone-sensitive Prostate Cancer.

CONTEXT: It remains unclear to what extent the therapy of the primary local tumor, such as radical prostatectomy (RP) and radiation therapy (RT), improves overall survival in patients with low-volume metastatic hormone-sensitive prostate cancer (mHSPC). However, data suggest a benefit of these therapies in preventing local events secondary to local tumor progression. OBJECTIVE: To evaluate the efficacy of adding local therapy (RP or RT) to systemic therapies, including androgen deprivation therapy, docetaxel, and/or androgen receptor axis-targeted agents, in preventing local events in mHSPC patients compared with systemic therapy alone (ie, without RT of the prostate or RP). EVIDENCE ACQUISITION: Three databases and meeting abstracts were queried in November 2023 for studies analyzing mHSPC patients treated with local therapy. The primary outcome of interest was the prevention of overall local events (urinary tract infection, urinary tract obstruction, and gross hematuria) due to local disease progression. Subgroup analyses were conducted to assess the differential outcomes according to the type of local therapy (RP or RT). EVIDENCE SYNTHESIS: Overall, six studies, comprising two randomized controlled trials, were included for a systematic review and meta-analysis. The overall incidence of local events was significantly lower in the local treatment plus systemic therapy group than in the systemic therapy only groups (relative risk [RR]: 0.50, 95% confidence interval [CI]: 0.28-0.88, p = 0.016). RP significantly reduced the incidence of overall local events (RR: 0.24, 95% CI: 0.11-0.52) and that of local events requiring surgical intervention (RR: 0.08, 95% CI: 0.03-0.25). Although there was no statistically significant difference between the RT plus systemic therapy and systemic therapy only groups in terms of overall local events, the incidence of local events requiring surgical intervention was significantly lower in the RT plus systemic therapy group (RR: 0.70, 95% CI: 0.49-0.99); local events requiring surgical intervention of the upper urinary tract was significantly lower in local treatment groups (RR: 0.60, 95% CI: 0.37-0.98, p = 0.04). However, a subgroup analysis revealed that neither RP nor RT significantly impacted the prevention of local events requiring surgical intervention of the upper urinary tract. CONCLUSIONS: In some patients with mHSPC, RP or RT of primary tumor seems to reduce the incidence of local progression and events requiring surgical intervention. Identifying which patients are most likely to benefit from local therapy, and at what time point (eg, after response of metastases), will be necessary to set up a study assessing the risk, benefits, and alternatives to therapy of the primary tumor in the mHSPC setting. PATIENT SUMMARY: Our study suggests that local therapy of the prostate, such as radical prostatectomy or radiotherapy, in patients with metastatic hormone-sensitive prostate cancer can prevent local events, such as urinary obstruction and gross hematuria.

Population genomics highlights structural variations in local adaptation to saline coastal environments in woolly grape.

Structural variations (SVs) are a feature of plant genomes that has been largely unexplored despite their significant impact on plant phenotypic traits and local adaptation to abiotic and biotic stress. In this study, we employed woolly grape (Vitis retordii), a species native to the tropical and subtropical regions of East Asia with both coastal and inland habitats, as a valuable model for examining the impact of SVs on local adaptation. We assembled a haplotype-resolved chromosomal reference genome for woolly grape, and conducted population genetic analyses based on whole-genome sequencing (WGS) data from coastal and inland populations. The demographic analyses revealed recent bottlenecks in all populations and asymmetric gene flow from the inland to the coastal population. In total, 1,035 genes associated with plant adaptive regulation for salt stress, radiation, and environmental adaptation were detected underlying local selection by SVs and SNPs in the coastal population, of which 37.29% and 65.26% were detected by SVs and SNPs, respectively. Candidate genes such as FSD2, RGA1, and AAP8 associated with salt tolerance were found to be highly differentiated and selected during the process of local adaptation to coastal habitats in SV regions. Our study highlights the importance of SVs in local adaptation; candidate genes related to salt stress and climatic adaptation to tropical and subtropical environments are important genomic resources for future breeding programs of grapevine and its rootstocks.

Comparative Evaluation of Effect of TENS on Controlling Pain Associated with Orthodontic Separator Placement-A Clinical Study.

Aim: To assess and contrast the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and topical anesthetic gel in reducing the level of pain associated with the placement of orthodontic separators. Materials and Methods: A cohort of 40 individuals, aged between 16 and 20 years, who were in need of fixed orthodontic treatment, was chosen for the study. Elastomeric separators were positioned bilaterally adjacent to the first molars in all participants, who were subsequently separated into two distinct cohorts. Those in group I received topical anesthetic gel, while those in group II underwent TENS therapy. After the placement of separators, the assessment of pain was conducted using the Visual Analog Scale (VAS) at specific intervals: Immediately after placement, 6, 12, 24, and 48 hours. Result: TENS group showed a significantly lower VAS score compared to the local anesthetic gel group at immediate, 6 hours, and 12 hours. Conclusion: Following the placement of elastomeric separators, it was found that TENS was more successful at reducing pain.

Comparative Analysis of Local Anesthetic Techniques for Pain Management in Pediatric Dental Procedures: A Randomized Clinical Trial.

Objective: The present study aims to conduct a comparative analysis of different local anesthetic techniques for pain management in pediatric dental procedures. Goal is to evaluate and compare the efficacy and safety of various local anesthetic methods to identify the most effective approach in reducing pain and discomfort during dental treatments in children. Methods: A prospective, randomized clinical trial was conducted with 60 pediatric patients (aged 3 to 10 years) undergoing dental procedures in a single dental clinic. The participants were randomly assigned into three groups: Group A received conventional infiltration anesthesia (lidocaine 2% with epinephrine 1:100,000), Group B received topical anesthesia followed by the same infiltration anesthesia, and Group C received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The patients' demographic data, treatment details, and pre-procedure anxiety levels were recorded. Results: The study demonstrated that all three local anesthetic techniques effectively managed pain during pediatric dental procedures. However, Group C, which received intraosseous anesthesia, showed significantly lower pain scores (mean ± standard deviation) compared to Group A and Group B: 1.5 ± 0.6, 2.3 ± 0.8, and 2.1 ± 0.7, respectively (P < 0.05). Additionally, Group C exhibited a shorter onset of anesthesia compared to Group A and Group B, with mean onset times of 1.8 ± 0.4, 3.2 ± 0.6, and 2.9 ± 0.5 minutes, respectively (P < 0.001). No significant differences in adverse events or post-procedure complications among the groups. Conclusion: Intraosseous anesthesia (articaine 4% with epinephrine 1:100,000) was found most effective local anesthetic technique for pain management during pediatric dental procedures.

Comparative Evaluation of Two Different Topical Anesthetic Agents against Pain Associated with Intraoral Injections in Pediatric Dental Patients.

Aim: This study aimed to examine the effectiveness of two topical anesthetics in minimizing the discomfort related to intraoral injections. Material and Method: For the study, 40 healthy kids between the ages of 6 and 10 were chosen. To the injection site, two topical anesthetic products were applied: lignocaine hydrochloride gel and benzocaine 20% gel. The effectiveness of the topical agents was evaluated using a four-point scale, which was previously used by Topçuoglu and colleagues to evaluate pain. Result: A significant difference between the lignocaine group (2.1 ± 0.5) and the benzocaine group (1.2 ± 0.6) was found on a four-point scale (P < 0.05). Conclusion: Benzocaine demonstrates a higher degree of efficacy in comparison with lignocaine. However, additional research is necessary to ascertain the result of this study.

Growth and Fruit morphometric characteristics of local avocado germplasm (Persea americana Mill.) grown in northern Tanzania.

Tanzania has a diverse agroecological area suitable for growing tropical fruits, including avocados. In Northern Tanzania, avocados have been growing under variable soil and altitudinal characteristics for over 100 years, allowing the naturalisation of this crop in this region. However, the region's avocado germplasm is uncharacterised, thus impeding the selection of elite genotypes for increased value and breeding programmes. This study examined the growth and fruit morphometric characteristics of avocado populations grown under variable soil pH and altitude in six districts in the Tanga, Kilimanjaro and Arusha regions. Variations in growth and fruit morphometric characteristics were compared using a one-way analysis of variance (ANOVA). Pearson product-moment correlations (r) were used to evaluate the relationship between studied growth and fruit morphometric traits. A linear mixed-effects model (LMM) was used to assess the influence of the soil pH, altitude, tree height, canopy diameter, and trunk diameter on fruit length, fruit diameter, pulp thickness, and seed diameter. Principal Component Analysis (PCA) was used to depict the extent of the racial admixtures in the avocado germplasm in the Northern regions of Tanzania. The results revealed a significant variation in growth and fruit morphometric characteristics (p < 0.05). The Korogwe population had the highest tree height, while the Karatu had the lowest. Tree height was positively correlated with the trunk diameter (r = 0.63, p < 0.001. There was a positive correlation between fruit length and pulp thickness (r = 0.51, p < 0.001), fruit diameter and pulp thickness (r = 0.47, p < 0.001), and fruit length and fruit diameter (r = 0.36, p < 0.001). The fruit diameter was positively correlated with the seed diameter (r = 0.61, p < 0.001). There was a significant but weak association between fruit length and trunk diameter (-0.01), fruit length and canopy diameter (0.15), and between seed diameter and tree height (2.95e-2). These findings highlight the influence of individual tree genetic makeup on the variation in growth and fruit morphometric characteristics. The morphometric trait correlations may prove valuable in field measurements, especially when resources are limited. The study further indicates the presence of all avocado races within the local germplasm, highlighting its high diversity. Remarkably, the observed admixture of variant races implies gene flow among studied avocado populations, possibly facilitated by sharing seedlings among farmers or seed disposal through avocado fruit trading. Further study is needed, particularly in quantifying the above-ground biomass of local avocados in northern Tanzania, potentially contributing to carbon credit initiatives for fruit crops..

Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques.

INTRODUCTION: Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. METHODS: Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as "in field," "marginal" or "out of field." Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. RESULTS: Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both "in field" and "out of field." No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. CONCLUSIONS: The onset of local-regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed.