Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty

Breast Care ◽  
2021 ◽  
pp. 1-15
Author(s):  
Guldeniz Karadeniz Cakmak

<b><i>Background:</i></b> Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. <b><i>Summary:</i></b> The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. <b><i>Key messages:</i></b> The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient’s satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.

2021 ◽  
Vol 14 (5) ◽  
pp. 785-798
Author(s):  
Daokun Hu ◽  
Zhiwen Chen ◽  
Jianbing Wu ◽  
Jianhua Sun ◽  
Hao Chen

Persistent memory (PM) is increasingly being leveraged to build hash-based indexing structures featuring cheap persistence, high performance, and instant recovery, especially with the recent release of Intel Optane DC Persistent Memory Modules. However, most of them are evaluated on DRAM-based emulators with unreal assumptions, or focus on the evaluation of specific metrics with important properties sidestepped. Thus, it is essential to understand how well the proposed hash indexes perform on real PM and how they differentiate from each other if a wider range of performance metrics are considered. To this end, this paper provides a comprehensive evaluation of persistent hash tables. In particular, we focus on the evaluation of six state-of-the-art hash tables including Level hashing, CCEH, Dash, PCLHT, Clevel, and SOFT, with real PM hardware. Our evaluation was conducted using a unified benchmarking framework and representative workloads. Besides characterizing common performance properties, we also explore how hardware configurations (such as PM bandwidth, CPU instructions, and NUMA) affect the performance of PM-based hash tables. With our in-depth analysis, we identify design trade-offs and good paradigms in prior arts, and suggest desirable optimizations and directions for the future development of PM-based hash tables.


2020 ◽  
Vol 6 ◽  
Author(s):  
Jinwoo Kim

Operation-level vision-based monitoring and documentation has drawn significant attention from construction practitioners and researchers. To automate the operation-level monitoring of construction and built environments, there have been much effort to develop computer vision technologies. Despite their encouraging findings, it remains a major challenge to exploit technologies in real construction projects, implying that there are knowledge gaps in practice and theory. To fill such knowledge gaps, this study thoroughly reviews 119 papers on operation-level vision-based construction monitoring, published in mainstream construction informatics journals. Existing research papers can be categorized into three sequential technologies: (1) camera placement for operation-level construction monitoring, (2) single-camera-based construction monitoring and documentation, and (3) multi-camera-based onsite information integration and construction monitoring. For each technology, state-of-the-art algorithms, open challenges, and future directions are discussed.


2020 ◽  
Vol 14 (4) ◽  
pp. 653-667
Author(s):  
Laxman Dhulipala ◽  
Changwan Hong ◽  
Julian Shun

Connected components is a fundamental kernel in graph applications. The fastest existing multicore algorithms for solving graph connectivity are based on some form of edge sampling and/or linking and compressing trees. However, many combinations of these design choices have been left unexplored. In this paper, we design the ConnectIt framework, which provides different sampling strategies as well as various tree linking and compression schemes. ConnectIt enables us to obtain several hundred new variants of connectivity algorithms, most of which extend to computing spanning forest. In addition to static graphs, we also extend ConnectIt to support mixes of insertions and connectivity queries in the concurrent setting. We present an experimental evaluation of ConnectIt on a 72-core machine, which we believe is the most comprehensive evaluation of parallel connectivity algorithms to date. Compared to a collection of state-of-the-art static multicore algorithms, we obtain an average speedup of 12.4x (2.36x average speedup over the fastest existing implementation for each graph). Using ConnectIt, we are able to compute connectivity on the largest publicly-available graph (with over 3.5 billion vertices and 128 billion edges) in under 10 seconds using a 72-core machine, providing a 3.1x speedup over the fastest existing connectivity result for this graph, in any computational setting. For our incremental algorithms, we show that our algorithms can ingest graph updates at up to several billion edges per second. To guide the user in selecting the best variants in ConnectIt for different situations, we provide a detailed analysis of the different strategies. Finally, we show how the techniques in ConnectIt can be used to speed up two important graph applications: approximate minimum spanning forest and SCAN clustering.


Mastology ◽  
2021 ◽  
Vol 31 ◽  
Author(s):  
Idam de Oliveira-Junior ◽  
Raphael Luiz Haikel ◽  
René Aloísio da Costa Vieira

Breast-conserving treatment was established as an oncologically safe procedure for breast cancer. However, the cosmetic outcomes of breast-conserving treatments are often unsatisfactory. In this scenario, oncoplastic breast-conserving surgery incorporated plastic surgery concepts and techniques into the oncological treatment in order to ensure better cosmesis, thus increasing the indications for breast-conserving treatment. At the same time, oncoplastic breast-conserving surgery is usually presented as a generic term, which should be evaluated taking many aspects into account: indication, patient selection, the surgery itself, cosmetic quality, and quality of life — data that are still scarce in the literature.


2017 ◽  
Author(s):  
Anne Kuritzky ◽  
Laila Khazai ◽  
Roberto Diaz ◽  
Christine Laronga

The identification of an axillary metastasis in the absence of a primary breast cancer can pose a diagnostic and therapeutic dilemma. The clinician should first use more sensitive imaging modalities, such as breast magnetic resonance imaging, to attempt to find the primary index lesion. If the primary cancer remains occult and the molecular markers are consistent with a breast origin, then the recommended treatment includes multimodality therapy including surgery, chemotherapy/endocrine treatment, and radiation. Historically, the modified radical mastectomy was the standard of practice. Recently, in the era of improved adjuvant therapies, breast-conserving surgery with irradiation is also being considered. Multiple retrospective reviews have shown no difference in survival or recurrence with these two surgical pathways. However, due to the rare nature of this clinical presentation, no multiinstitutional or prospective clinical trial data are available.  Key words: axillary lymph node dissection, axillary metastasis, breast cancer, breast conservation, local recurrence, occult primary tumor, radiotherapy 


Author(s):  
Yi Song ◽  
Xuesong Lu ◽  
Sadegh Nobari ◽  
Stéphane Bressan ◽  
Panagiotis Karras

One is either on Facebook or not. Of course, this assessment is controversial and its rationale arguable. It is nevertheless not far, for many, from the reason behind joining social media and publishing and sharing details of their professional and private lives. Not only the personal details that may be revealed, but also the structure of the networks are sources of invaluable information for any organization wanting to understand and learn about social groups, their dynamics and members. These organizations may or may not be benevolent. It is important to devise, design and evaluate solutions that guarantee some privacy. One approach that reconciles the different stakeholders’ requirement is the publication of a modified graph. The perturbation is hoped to be sufficient to protect members’ privacy while it maintains sufficient utility for analysts wanting to study the social media as a whole. In this paper, the authors try to empirically quantify the inevitable trade-off between utility and privacy. They do so for two state-of-the-art graph anonymization algorithms that protect against most structural attacks, the k-automorphism algorithm and the k-degree anonymity algorithm. The authors measure several metrics for a series of real graphs from various social media before and after their anonymization under various settings.


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