Search

This paper presents a numerical and analytical study on single-storey cross-laminated timber (CLT) shear-walls with openings subjected to lateral loads. The main objective was to investigate the location and distribution of maximum values of axial and shear forces in relevant wall sections. The influence of parameters such as wall geometry (different sizes of wall openings, door openings, lintel/parapet lengths and heights, wall thickness) and different stiffness levels of mechanical anchors for CLT wall connection with floor/foundation were studied. Finite element (FE) parametric analyses were performed on a set of single-storey CLT shear-walls with door and window openings and were compared with analytical models for determination of internal forces. The importance of wall connections’ flexibility was identified, as the distribution of internal forces in walls with rigid and flexible anchors were considerably different. The obtained outcomes of this study provide a solid base for the next step, an experimental investigation of in-plane internal force distribution in CLT walls with openings, which will serve for further development of numerical, analytical and design approaches.

Megaprojects require substantial R&D activities involving many different organisations. Megaprojects are therefore an ideal setting for Open Innovation (OI), which favours risk-sharing, enables trustful collaboration, and facilitates the development of breakthrough innovations. OI has been widely studied at the organisational level, however far less attention has been paid at the individual level, including the motivations, costs and benefits perceived by the people involved in the innovation process. This paper aims to address this gap by studying the micro-foundations of OI in megaprojects and focusing on the experiences of people involved in university-industry co-supervised Ph.D. projects. The paper provides two original contributions. Firstly, it contributes to the micro-foundations literature, by analysing the experience of university and industrial supervisors and Ph.D. students involved in megaprojects. Secondly, it expands the OI literature by describing how the interpersonal interactions and the intentional knowledge spillovers promote innovation outside the original boundaries of the Ph.D. project.

Adequate management of intellectual property (IP) is critical to sustaining competitive advantage and managing outbound open innovation (OI), which describes the inside-out flows of knowledge and technology. This article presents an IP strategic framework comprising the following strategies: a ‘defensive’ strategy, aimed at avoiding knowledge spillovers and building barriers to competition; a ‘collaborative’ strategy, aimed at collaborating with other organizations and entering new markets; and an ‘impromptu’ strategy, which describes firms protecting their IP without a clear purpose. We investigate the relationships of such IP strategies with outbound OI and innovation performance in 158 Italian firms. Most of them declared an impromptu IP strategy. We found that not having any IP protection strategy can be a barrier to outbound OI and that firms with a defensive IP strategy embraced outbound OI more than those declaring a collaborative IP strategy. Finally, firms with collaborative IP strategies outperformed those with defensive strategies.

Background It is controversial whether sentinel node biopsy (SNB) is adequate in breast cancer patients who become cN0 after primary chemotherapy. To address this we retrospectively compared outcomes in T2 cases given primary chemotherapy, comparing those given axillary dissection (AD) with those given SNB but no AD if sentinel nodes were clinically negative post-chemotherapy. Methods We examined overall survival (OS), disease-free survival (DFS), and axillary failure in 317 consecutive cT2 cN0/1 patients given primary chemotherapy followed by quadrantectomy/mastectomy, between January 2002 and December 2007. The approach to the axilla changed over time allowing division into three groups: 101 (31.9%) given upfront AD; 139 (43.8%) given SNB + AD; and 77 (24.3%) given SNB only because the SNs were negative. Results After median follow-ups of 92 (AD), 99 (SNB + AD) and 72 months (SNB-only), OS (p = 0.131) and DFS (p = 0.087) did not differ between the 3 groups, or between SNB-only and the ypN1 and ypN0 subgroups of SNB + AD, or between the cN0 and cN1 subgroups (before chemotherapy) of the SNB-only group. No SNB-only patient had axillary failure. OS (p = 0.004) and DFS (p = 0.002) were better in patients with complete response than those with partial response or stable/progressive disease. Conclusions SNB is adequate in T2 patients who are cN0 after primary chemotherapy, irrespective of axillary status before. Better outcomes after complete pathological remission confirm the prognostic importance of response to primary chemotherapy, and suggest that all T2 patients should receive primary chemotherapy.

Background Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information. Patients and methods A total of 145 cT1N0 BC patients, aged 24–70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy. Results FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected ( p = 0.009) in FDG-PET false-negative (FDG-PET−) patients. Kaplan–Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients ( p = 0.035) as compared to N+/FDG-PET− patients, which overlapped with survival curves of N− and FDG-PET+ or − patients. Conclusions Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N− BC patients could reduce the surgical and adjuvant therapeutic intervention.

We approached the issue of surgical margins in the conservative treatment of breast cancer by examining the literature germane to four precise questions: At what distance from the macroscopic margin of the tumour should the resection margin be? To what extent do histologically clear resection margins indicate complete local control of the disease? To what extent do histologically involved margins indicate persistence of disease? and Does the local recurrence rate correlate with the status of the resection margin? We propose categorizing margin involvement into five groups (absent, focal, minimal, moderate and extensive involvement) according to strict histological criteria, and assigning increasingly aggressive subsequent treatments according to the extent of any margin involvement.

The hormonal milieu at time of tumor surgery seems to have a significant impact on survival in premenopausal breast cancer patients. Indeed, surgery performed during the follicular phase of the menstrual cycle was suggested to correlate with a poor prognosis. To investigate the relationship between prognosis and menstrual cycle at time of surgery, we analyzed the expression of some markers associated with tumor aggressiveness, such as the hormone receptors, HER2, p53, Bcl2, and cathepsin D in breast carcinomas obtained from 198 premenopausal women who underwent surgery during different phases of the menstrual cycle. HER2 overexpression was found to fluctuate in hormone receptor-positive tumors. In actual fact, 20% of the tumors removed during the follicular phase scored HER2-positive, versus 8% of those removed during the luteal phase. Similarly, a number of hormone receptor-positive tumor specimens, obtained from the same patients during follicular and luteal phases, were scored HER2-positive when the sample was removed during the follicular phase and HER2-negative when removed in the luteal phase. Southern blot analysis of the HER2 gene indicated that, in hormone receptor-positive cases, the overexpression of HER2 is often not associated with gene amplification. The finding that overexpression of the HER2 gene, associated with tumor aggressiveness, can fluctuate according to the hormonal milieu may explain the increased survival of patients operated during the luteal phase. It is also relevant to the selection and treatment of patients most likely to benefit from anti-HER2 antibody therapy.

Resumen Se entiende por cancer de mama asociado al embarazo aquella neoplasia maligna de la mama que se diagnostica durante el periodo de gestacion o durante el ano siguiente al parto. Su incidencia es de aproximadamente 1/3.000 embarazos. La mayoria de las ocasiones se diagnostica en estadios avanzados debido a las dificultades de exploracion, por lo que el pronostico es, en general, muy malo. Las opciones de tratamiento del cancer estan condicionadas por los posibles danos que se pueda ocasionar al feto, asi como por la edad gestacional. Presentamos el caso de una mujer de 34 anos embarazada de 28 semanas a la que se le diagnostico un cancer de mama y fue tratada con mastectomia. Esta asociacion es poco frecuente pero no excepcional, por lo que su conocimiento es necesario para permitir un diagnostico temprano y una mejoria del pronostico.

Purpose : The influence of radiotherapy in the cosmetic outcome after conservative surgery for breast cancer was evaluated using an objective method of calculating the asymmetry between the two breasts. Methods and Materials : One hundred and one patients treated with the same conservative surgery were evaluated for cosmetic outcome. Sixty-one of them received external radiotherapy (50 + 10 Gy) to the residual breast ; the remaining 40 underwent surgery only. The aspect of the patients' breasts was objectively assessed for symmetry by means of a computerized technique. A subjective assessment of the cosmetic outcome was performed both by physician and patient. These objective and subjective assessments were compared in the two groups treated with or without radiotherapy. Results : The results obtained did not show significant differences in terms of cosmetic outcome in the two groups. Skin telangectasia was noted in two radiotherapy patients, while hypertrophic breast scars were only noted in six nonirradiated patients. Conclusions : We found that standard radiotherapy does not seem to influence the symmetry and the cosmetic results in breast conservative treatment when compared to a similar group of patients with the same quadrantectomy procedure and no radiotherapy.

An objective evaluation of the cosmetic outcome after conservative treatment for breast cancer was applied on 136 patients treated with quadrantectomy, axillary dissection and radiotherapy. Differences in the symmetry between the operated and non-operated breasts were calculated and expressed by an ‘asymmetry index’. This value represented a parameter of the asymmetry between the two breasts. The ‘asymmetry index’ reflected the qualitative judgment expressed by the observer and the patient's self-assessment. These combined systems of evaluation proved quadrantectomy to have satisfactory cosmetic results despite the large amount of tissue removed by this procedure.

We followed 777 consecutive patients with breast carcinoma and positive axillary nodes for a mean of 60 months to evaluate the prognostic weight of both the total number of involved nodes and their distribution by level. Quadrantectomy was performed in 223 cases and mastectomy in 552. Complete axillary dissection was performed in all cases with identification and removal of the three levels of lymph nodes. Metastases at level I were identified in 420 patients (54%), at levels I and II 175 patients (22.5%), and at all 3 levels in 173 (22.3%). In 9 patients (1.2%) there was involvement of level II nodes in the absence of level I involvement (skip metastases). In 18 other patients (2.3%) axillary involvement was discontinuous in that the first and third levels were involved while the second level was free. Overall survival for patients with 1–3, 4–10 and >10 metastatic nodes was 80%, 62% and 35% respectively; and when level I only, levels I and II, and all 3 levels were involved, overall survival was 82%, 52% and 38% respectively. Both the total number of involved axillary nodes and the extent of axillary invasion by level had strong prognostic significance. Multivariate analysis showed that the prognostic power of levels of nodal involvement, measured as hazard ratios, is superior to that of the number of involved nodes. It is therefore recommended that surgeons and pathologists record this important information whenever axillary dissection is performed.

In the diagnosis of breast disease, mammography in radiologically dense breasts in frequently of little value and where a suspicious lump is palpated, ultrasound may resolve the diagnosis. 140 patients with palpable breast masses, in whom the mammograms were intensely radiopaque, were examined using breast ultrasound. 42 were considered benign and checked at 4 monthly intervals. The accuracy of ultrasound in the remaining 98 patients with intensely radiopaque breasts was evaluated by comparison with cyto/histological findings. The 90 benign lesions found were correctly diagnosed by ultrasound in 69 instances (76.6%). It is concluded that in the presence of a palpable mass, ultrasound is a useful adjunct to mammography in the differential diagnosis of benign non-inflammatory breast pathology. However, mammography remains the first line diagnostic tool.

From June to December 1990, 110 consecutive patients with breast cancer underwent a modified radical mastectomy (n=33) or quadrantectomy (n=77) combined with a complete axillary dissection and removal or interpectoral lymphatic tissue. The average number of lymph nodes removed from the axilla and interpectoral region was 22: 12.5 at Level I, 6.4 at Level II, 3.7 at Level III and 1.5 from the interpectoral tissue. In 59 110 patients fatty tissue only was found in the interpectoral region and in the remaining 51 patients, interpectoral lymph nodes were identified and these were involved in 22 patients (37.3% of total group). In 3 patients these were the only nodes involved. During axillary dissection the interpectoral space should be explored and palpable interpectoral nodes removed and submitted for histology.

Octreotide is a somatostatin analogue that, chelated with diethylenetriamine-pentacetic acid (DTPA) and labelled with indium-1 11 (In-l 1 l), is used for the in vivo localization of somatostatin receptors type 2 and 5,’ that have been demonstrated on several neoplasms, including breast turnours.* We present two cases of breast carcinoma correctly identified as being bifocal by somatostatin receptor scintigraphy (SRS) with In-l 1 1-pentetreotide.

Until now axillary, dissection has been considered an integral part of breast cancer treatment and is routinely carried out even after the introduction of breast conserving surgery into clinical practice. However we believe that axillary surgery can be avoided in selected breast cancer patients. In this perspective we have analyzed 401 breast cancer patients who underwent breast surgery without axillary dissection from January 1986 to June 1994. In these patients axillary dissection was spared in consideration of some reasons, principally age, small breast cancer and previous contralateral tumor. 323 (81%) patients were in post-menopausal whereas 78 (19%) in pre-menopausal status and the mean age was 62.9 years (range 30–83). No patients had clinically involved nodes in homolateral axilla, and 312 patients (78%) had no palpable node. 216 out of 401 patients (53.6%) had a pathological tumor diameter ≤1 cm, 133 (33.6%) were between 1 and 2 cm, whereas 38 (9.5%) had a tumor size > 2 cm. The remaining 4 patients had no evaluable diameter due to previous incisional biopsy. The histological diagnosis was ductal infiltrating carcinoma in 188 cases (46.9%), associated to DCIS in 73 cases (18.2%) or to lobular infiltrating carcinoma (LIC) in 17 cases (4.2%). LIC was present only as histotype in 59 cases (14.7%). Breast conservative surgery was performed in 383 patients (95.6%) and only 18 patients (4.4%) underwent total mastectomy in consideration of the presence of extensive intraductal component. 257 patients (64.1%) received radiotherapy to the operated breast. In elderly patients an adjuvant hormonotherapy was preferred considering the hormonal receptorial status. An accurate follow-up > 24 months was obtained in 209 patients (mean 46.5 months, range 24–93); 25 patients died, 12 for uncorrelated or unknown causes. 20 patients had distant metastases only and 2 patients had axillary and distant metastases syncronally. 27 patients had clinically axillary metastases as only and first site of metastatic disease: 21 patients underwent full axillary dissection showing pathological metastases in 17 cases. The mean number of metastatic nodes was 6 (1–32) and the mean diameter of the primary tumour in these metastatic cases was 16.8 mm. Only one case had a tumour diameter

Primary or Neo-Adjuvant chemotherapy is to be understood as antineoplastic pharmacological treatment carried out prior to loco-regional treatment in an attempt to [1] render the tumor amenable to radical surgical control when it is locally advanced; [2] bring a systemic therapy into play, at an early stage, against micrometastatic disease; [3] permit conservative surgery where the initial dimensions of the tumor would normally required a demolitive or mutilatory intervention.

The European Society of Mastology was conceived on lines which differ from the traditional concept of scientific societies. Consisting of 10 study groups, each of which deals with different aspects and problems involved in breast cancer, the Society aims to discuss controversial topics across the board, thereby involving all those throughout Europe interested in contributing to the debate. After having established a preliminary structure of groups each with its own Chairman, Core Group and prospective members, the Society planned its First International Conference on the 12th and 13th of March, 1991. Over 700 participants attended the two-day meeting and joined in intense discussion and activities of a variety of topics. within Study Group meetings, and general sessions. The aims of the Conference were to cover the principle themes relative to Breast Cancer and prepare guidelines and more up-to-date diagnostic and therapeutic protocols for distribution, so that they may be used throughout Europe. The Conference also provided an educational update with presentations by invited speakers and some Chairman of the Study Groups. In the Plenary Session, Dr. Peter Boyle, Director of the Division of Epidemiology and Biostatistics of the European Institute of Oncology, and Chairman of the Epidemiology & Prevention Group. reviewed Epidemiology and Risk Factors. Dr. Peter Maguire, Chairman of the Rehabilitation & Counselling Group covered the need for improving psychological care. New advances in the molecular Biology of Breast Cancer were presented by Dr. William Gullick. Chairman of the Biology & Immunology Group. The Role of the Pathologist in the Definition of New Prognostic Factors was discussed by Professor Franc0 Rilke from the National Cancer Institute of Milan. The programme also included a workshop on Early Detection, coordinated by Dr. Stefano Ciatto from the Oncological Prevention Centre in Florence, who is Chairman of the Detection & Diagnosis Group. The Conference was brought to a close by Professor Michael Baum from the Royal Marsden Hospital in London, and Vice-President of the Society, who entertained the participants and speakers alike, with a witty and fascinating lecture on Breast Cancer in the Year 2000. In summing up, Professor Umberto Veronesi, Director of the National Cancer Institute in Milan, and President of EUSOMA, outlined the prospects for European cancer patients under the heading of Future Developments. The most stimulating part of the Conference from the point of view of the aims of the Society was. however, the time dedicated to the Study Groups, who were meeting for the first time. On both days, sufficient time was allocated to each group, and reports were drawn up by the Chairmen. Subsequently, these reports have been collected and published in the form of a booklet which has been sent to all members of the society. A second major step was the adoption by the Society of a new Journal entitled The Breast. launched in the Spring of 1992. It was deemed appropriate that a Society dealing with an organ specific disease should have an organ specific Journal. It is clear that each Group within the Society will not be able to have a specitic meeting on a regular basis, and it was felt that communication with these members through the journal was a good way of reminding members of their association with the Society. The editor of the journal, Mr. Michael Dixon, is seeking good quality papers for publication. From March 1992 each paying member of EUSOMA will receive The Breast, the price of the subscription is included in the 60 ECU annual membership fee of the Society. The study groups have been active since the first EUSOMA conference, Dr. Gullick held a most interesting meeting of the Biology & Immunology Core Group, in London at the end of 199 1, a report of which was published in the June issue of The Bt-ectst. During the same month. Dr. Peter Maguire also held a meeting of the Rehabilitation & Counselling Core Group. During 1992, Dr Peter Boyle will be holding a meeting of the Epidemiology & Prevention Core Group in Milan and Dr. Petit is organising a meeting of the Reconstructive

Antiendomysial antibodies (EMA) are today considered the most sensitive and specific serological marker of celiac disease (CD). The aim of the present study was to assess the occurrence of EMA of IgG isotype in EMA IgA negative children with clinical suspicion of malabsorption and their relationship with CD. Serum EMA IgG1 determination was performed on 30 EMA IgA negative children with clinical suspicion of CD. Total serum IgA levels were further investigated. Sixty children with gastroenterological diseases other than CD were used as control disease patients and 63 healthy children were evaluated as the control group. Eighteen out of 30 children in the study showed EMA IgG1 positivity in sera and a villous height/crypt depth ratio

Out of 753 patients with breast cancer treated with radical mastectomy from 1968 to 1970 at the National Cancer Institute of Milan, Italy, 308 had histologically proven positive nodes. The number of positive nodes was not dependent on the location of the primary tumour, its diameter and the patient's age. Extracapsular invasion was related to the number of positive nodes at a statistically significant level: P value 2 × 10 −9 . Survival was influenced by the number of positive nodes and extension of metastases beyond their capsule and age. Each of these criteria had an independent impact on survival. Three subgroups with different prognosis were identified in patients older than 40 : (a) with a single involved node and 69.9% 10 year survival rate, (b) patients with two or more nodes with matastatic deposit still confined within node capsule and 47.4% 10 year survival rate, (c) patients with two or more involved nodes and extracapsular invasion and 25.3% 10 year survival rate. In patients younger than 40 no subgroup was identified: this group had an intermediate 10 year survival rate ( 50.9% ). The authors conclude that there is a need (a) of re-consideration of the prognosis of patients with positive nodes and (b) to agree on the definition of “high-risk patients”.