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- Bielack, Stefan S, et al.
(författare)
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Methotrexate, Doxorubicin, and Cisplatin (MAP) Plus Maintenance Pegylated Interferon Alfa-2b Versus MAP Alone in Patients With Resectable High-Grade Osteosarcoma and Good Histologic Response to Preoperative MAP: First Results of the EURAMOS-1 Good Response Randomized Controlled Trial
- 2015
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Ingår i: Journal of Clinical Oncology. - 1527-7755. ; 33:20, s. 2279-2287
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Tidskriftsartikel (refereegranskat)abstract
- Purpose EURAMOS-1, an international randomized controlled trial, investigated maintenance therapy with pegylated interferon alfa-2b (IFN-α-2b) in patients whose osteosarcoma showed good histologic response (good response) to induction chemotherapy. Patients and Methods At diagnosis, patients age ≤ 40 years with resectable high-grade osteosarcoma were registered. Eligibility after surgery for good response random assignment included ≥ two cycles of preoperative MAP (methotrexate, doxorubicin, and cisplatin), macroscopically complete surgery of primary tumor, < 10% viable tumor, and no disease progression. These patients were randomly assigned to four additional cycles MAP with or without IFN-α-2b (0.5 to 1.0 μg/kg per week subcutaneously, after chemotherapy until 2 years postregistration). Outcome measures were event-free survival (EFS; primary) and overall survival and toxicity (secondary). Results Good response was reported in 1,041 of 2,260 registered patients; 716 consented to random assignment (MAP, n = 359; MAP plus IFN-α-2b, n = 357), with baseline characteristics balanced by arm. A total of 271 of 357 started IFN-α-2b; 105 stopped early, and 38 continued to receive treatment at data freeze. Refusal and toxicity were the main reasons for never starting IFN-α-2b and for stopping prematurely, respectively. Median IFN-α-2b duration, if started, was 67 weeks. A total of 133 of 268 patients who started IFN-α-2b and provided toxicity information reported grade ≥ 3 toxicity during IFN-α-2b treatment. With median follow-up of 44 months, 3-year EFS for all 716 randomly assigned patients was 76% (95% CI, 72% to 79%); 174 EFS events were reported (MAP, n = 93; MAP plus IFN-α-2b, n = 81). Hazard ratio was 0.83 (95% CI, 0.61 to 1.12; P = .214) from an adjusted Cox model. Conclusion At the preplanned analysis time, MAP plus IFN-α-2b was not statistically different from MAP alone. A considerable proportion of patients never started IFN-α-2b or stopped prematurely. Long-term follow-up for events and survival continues.
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- Benca, E., et al.
(författare)
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Patient-Specific Guides for Accurate and Precise Positioning of Osseointegrated Implants in Transfemoral Amputations: A Proof-of-Concept In Vitro Study
- 2023
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Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 59:3
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: The treatment of transfemoral amputees using osseointegrated implants for prosthetic anchorage requires accurate implant positioning when using threaded bone-anchoring implants due to the curvature of the femur and the risk of cortical penetration in misaligned implants. This study investigated the accuracy and precision in implant positioning using additively manufactured case-specific positioning guides. Materials and Methods: The geometry and density distribution of twenty anatomic specimens of human femora were assessed in quantitative computed tomography (QCT) scanning. The imaging series were used to create digital 3D specimen models, preoperatively plan the optimal implant position and manufacture specimen-specific positioning guides. Following the surgical bone preparation and insertion of the fixture (threaded bone-anchoring element) (OPRA; Integrum AB, Molndal, Sweden), a second QCT imaging series and 3D model design were conducted to assess the operatively achieved implant position. The 3D models were registered and the deviations of the intraoperatively achieved implant position from the preoperatively planned implant position were analyzed as follows. The achieved, compared to the planned implant position, was presented as resulting mean hip abduction or adduction (A/A) and extension or flexion (E/F) and mean implant axis offset in medial or lateral (M/L) and anterior or posterior (A/P) direction measured at the most distal implant axis point. Results: The achieved implant position deviated from the preoperative plan by 0.33 +/- 0.33 degrees (A/A) and 0.68 +/- 0.66 degrees (E/F) and 0.62 +/- 0.55 mm (M/L) and 0.68 +/- 0.56 mm (A/P), respectively. Conclusions: Using case-specific guides, it was feasible to achieve not only accurate but also precise positioning of the implants compared to the preoperative plan. Thus, their design and application in the clinical routine should be considered, especially in absence of viable alternatives.
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- Benca, E., et al.
(författare)
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Thermal Effects during Bone Preparation and Insertion of Osseointegrated Transfemoral Implants
- 2021
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Ingår i: Sensors. - : MDPI AG. - 1424-8220. ; 21:18
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Tidskriftsartikel (refereegranskat)abstract
- Background: The preparation of bone for the insertion of an osseointegrated transfemoral implant and the insertion process are performed at very low speeds in order to avoid thermal damages to bone tissue which may potentially jeopardize implant stability. The aim of this study was to quantify the temperature increase in the femur at different sites and insertion depths, relative to the final implant position during the stepwise implantation procedure. Methods: The procedure for installation of the osseointegrated implant was performed on 24 femoral specimens. In one specimen of each pair, the surgery was performed at the clinically practiced speed, while the speed was doubled in the contralateral specimen. Six 0.075 mm K fine gauge thermocouples (RS Components, Sorby, UK) were inserted into the specimen at a distance of 0.5 mm from the final implant surface, and six were inserted at a distance of 1.0 mm. Results: Drilling caused a temperature increase of <2.5 degrees C and was not statistically significantly different for most drill sizes (0.002 < p < 0.845). The mean increase in temperature during thread tapping and implant insertion was <5.0 degrees C, whereas the speed had an effect on the temperature increase during thread tapping. Conclusions: Drilling is the most time-consuming part of the surgery. Doubling the clinically practiced speed did not generate more heat during this step, suggesting the speed and thus the time- and cost-effectiveness of the procedure could be increased. The frequent withdrawal of the instruments and removal of the bone chips is beneficial to prevent temperature peaks, especially during thread tapping.
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- Conroy, Melanie, et al.
(författare)
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Uncertainty in humanities network visualization
- 2024
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Ingår i: Frontiers in Communication. - : Frontiers Media S.A.. - 2297-900X. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Network visualization is one of the most widely used tools in digital humanities research. The idea of uncertain or “fuzzy” data is also a core notion in digital humanities research. Yet network visualizations in digital humanities do not always prominently represent uncertainty. In this article, we present a mathematical and logical model of uncertainty as a range of values which can be used in network visualizations. We review some of the principles for visualizing uncertainty of different kinds, visual variables that can be used for representing uncertainty, and how these variables have been used to represent different data types in visualizations drawn from a range of non-humanities fields like climate science and bioinformatics. We then provide examples of two diagrams: one in which the variables displaying degrees of uncertainty are integrated into the graph and one in which glyphs are added to represent data certainty and uncertainty. Finally, we discuss how probabilistic data and what-if scenarios could be used to expand the representation of uncertainty in humanities network visualizations.
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- Grimer, RJ, et al.
(författare)
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Osteosarcoma over the age of forty
- 2003
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Ingår i: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 0959-8049. ; 39:2, s. 157-163
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Hobusch, G. M., et al.
(författare)
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Advanced techniques in amputation surgery and prosthetic technology in the lower extremity
- 2020
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Ingår i: EFORT Open Reviews. - : Bioscientifica. - 2396-7544 .- 2058-5241. ; 5:10, s. 724-741
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Tidskriftsartikel (refereegranskat)abstract
- Bone-anchored implants give patients with unmanage-able stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates. Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons. Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines. Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints. As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price. Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ ankles (A-MPK/As) might succeed in uneven ground walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way. Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor controlled prosthetic components.
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