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This paper presents a new innovative approach for designing and manufacturing a fixture for locating and clamping porous blocks of biocompatible material, which is required for their machining on CNC machines. Manufacturing porous blocks for their application in medical and/or dental fields is gaining traction. However, limited solutions are available today. In order to address this issue, a new design has been proposed for locating and clamping porous blocks. Finite element analysis was used as a verification tool for the designed fixture with the workpiece, which showed a low concentration of stresses. After the manufacturing, dimensional verification in the form of CAD analysis showed small deviations on the manufactured object with deviations peaking around +0.015 mm, thus validating the adequate locating and clamping of the workpiece.

Introduction. Controversies on clitoral anatomy and its role in female sexual function still make clitoral reconstructive surgery very challenging. We evaluated the role of clitoral anatomic features in female to male sex reassignment surgery. Material and Methods. The study included 97 female transsexuals, aged from 18 to 41 years, who underwent single stage metoidioplasty between March 2008 and January 2013. The operative technique involved vaginectomy, the release of clitoral ligaments and urethral plate, urethroplasty by combining buccal mucosa graft and genital flaps, and scrotoplasty with insertion of testicle prostheses. Postoperative questionnaire was used to evaluate aesthetic, functional, and sexual outcome. Results. The mean followup was 30 months. The mean length of the neophallus was 7 cm, compared to mean preoperative length of the hypertrophied clitoris of 3.3 cm. Complications occurred in 27.84% of all patients, related mostly to urethroplasty. Voiding while standing was achieved in all cases. None of the patients had problems in sexual arousal, masturbation, or orgasms. Conclusion. Accurate knowledge of the clitoral anatomy, physiology, and neurovascular supply is crucial for a successful outcome of female to male sex reassignment surgery. Our approach appears to ensure overall satisfaction and high quality of sexual life.

In this work, the dry turning of Inconel 601 alloy in a dry environment with PVD-coated cutting inserts was studied. Turning was performed at various cutting speeds, feeds, insert shapes, corner radii, rake angles, and approach angles. After machining, arithmetic mean surface roughness (Ra) and flank wear (VB) were measured, and the material removal rate was also calculated (MRR). An analysis of variance (ANOVA) was performed to determine the effects of the turning input parameters. For the measured values, the turning process was modeled using an artificial neural network (ANN). Based on the obtained model, the process parameters were optimized using a genetic algorithm (GA). The objective function was to simultaneously minimize Ra and VB and maximize MRR. The accuracy of the model and the optimal values were further validated by confirmation experiments. The maximum percentage errors, which are less than 2%, indicate the possibility of practical implementation of the hybrid approach for modeling and optimization of dry turning of Inconel 601 alloy.

In uveal melanoma patients, short-term evaluation of treatment response to hepatic artery infusion chemotherapy (HAIC) using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria is challenging due to the diffuse metastatic spread. As liver enlargement can frequently be observed, this study aims to compare RECIST 1.1 and liver volumetry (LV) for the evaluation of HAIC treatment response. Treatment response was evaluated in 143 patients (mean age 65.1 ± 10.9 years, 54% female) treated by HAIC by RECIST 1.1 and LV on CT imaging performed before and after HAIC. In LV, different increases in liver volume were evaluated to set an effective threshold to distinguish between stable disease (SD) and progressive disease (PD). Overall survival (OS) was calculated as the time from first HAIC to patient death using Kaplan-Meier test and multivariate analysis was performed for RECIST 1.1 and LV. In the overall population, median OS (mOS) was 13.5 months (95% CI 11.2-15.8 months). In LV, a threshold of 10% increase in liver volume was suited to identify patients with significantly reduced OS (SD: 103/143 patients, mOS 15.9 months; PD: 40/143 patients, 6.6 months; p < 0.001). Compared to RECIST 1.1, LV was the only significant prognostic factor that was able to identify a decreased OS. In uveal melanoma patients with liver metastases, LV with a threshold for liver volume increase of 10% was suitable to evaluate treatment response and would be able to be used as a valuable add-on or even alternative to RECIST 1.1.

ABSTRACT Background To analyze the association of pathologic‐complete‐response (PCR) and survival after neoadjuvant concurrent chemo‐radiotherapy, we evaluated a large cohort of patients with potentially resectable stage IIIA–IIIC non‐small cell lung cancer (NSCLC) treated with a trimodality approach. Methods Consecutive patients underwent neoadjuvant induction chemotherapy, followed by concurrent chemo‐radiotherapy and surgery. Patients received established imaging, and diagnostics. Leave‐one‐out cross‐validation was employed to identify the most effective prognostic classifier. Results Altogether, 403 patients treated between 06/2000 and 01/2020 were included. Median follow‐up was 111 months (IQR: 71–127 months). PCR was achieved in 34% (137 patients) after neoadjuvant therapy and major‐pathologic response without PCR in 30% (MPR> 0%–≤ 10% defined as viable cells in > 0% and ≤ 10% of the sample). PCR was significantly dependent on histology (p = 0.0005) and radiotherapy fractionation schedule (p = 0.027). PCR rates were higher for squamous than for non‐squamous carcinoma with 46.2% (95% CI: 37.8%–54.7%) versus 27.3% (95% CI: 22.0%–33.2%). PCR was the most significant prognostic factor for long‐term survival with an associated hazard ratio of 0.272 (0.192–0.386), while MPR was associated with a hazard ratio of 0.671 (0.498–0.905) in comparison to lesser response. Overall survival at 5/10 years with PCR was 72.9% (95% CI: 64.4%–79.6%)/ 62.8% (53.0%–71.1%)/ event‐free survival at 5 years 69.5% (60.9%–76.7%). Identified through cross‐validation, key prognostic features included PCR, MPR, and treatment period following 18F‐FDG‐PET/CT‐guided staging. Conclusions Induction chemotherapy followed by chemo‐radiotherapy results in high PCR rates. In this investigation, PCR is followed by high event‐free and overall survival rates. These data warrant further investigation of chemo‐radiotherapy as a significant component of neoadjuvant treatment regimens in trials combined with immunotherapy. This strategy may increase the PCR rates, particularly for patients with more advanced, potentially resectable stage III NSCLC. Pathologic complete response predicts long‐term survival following neoadjuvant induction chemotherapy and chemo‐radiation in stage‐III Non‐small cell lung cancer. Through Induction‐chemotherapy and Chemoradiation to Surgery and Beyond: Pathologic Complete Response and Overall Survival in stage III NSCLC—A Long‐term observational study.

Transsexualism is a complex condition in which the person experiences the inconsistency between the desired gender and their biological gender. Absence of the vagina is devastating in male to female transsexuals. Creation of the neovagina is the main surgical problem in these patients. Historically, beginnings of the neovaginal creation have their roots in the treatment of Mayer-Rokitansky syndrome and conditions such as cloacal anomalies, certain intersex disorders, vaginal malignancies, or severe vaginal trauma, but have more recently found great purpose in male to female sex reassignment surgery. Many operative procedures have been described but none is ideal. Therefore, the search for new, improved solutions continues. In neovaginoplasty reconstruction of the vulvovaginal complex is performed in its entity. The gold standard in neovaginal reconstruction in male to female sex reassignment surgery is penile skin inversion technique with or without scrotal flaps, which enables adequate sensation of the neovagina, good neovaginal depth, good erotic sensitivity of the neclitoris, and esthetically acceptable labia minora and maiora.

This study compares the diagnostic potential of conventional staging (computed tomography (CT), axillary sonography and bone scintigraphy), whole-body magnetic resonance imaging (MRI) and whole-body F-fluorodeoxyglucose positron emission tomography ( F-FDG PET/)MRI for N and M staging in newly diagnosed breast cancer. A total of 208 patients with newly diagnosed breast cancer were prospectively included in this study and underwent contrast-enhanced thoracoabdominal CT, bone scintigraphy and axillary sonography as well as contrast-enhanced whole-body F-FDG PET/MRI. The datasets were analyzed with respect to lesion localization and characterization. Histopathology and follow-up imaging served as the reference standard. A McNemar test was used to compare the diagnostic performance of conventional staging, MRI and F-FDG PET/MRI and a Wilcoxon test was used to compare differences in true positive findings for nodal staging. Conventional staging determined the N stage with a sensitivity of 80.9%, a specificity of 99.2%, a PPV (positive predictive value) of 98.6% and a NPV (negative predictive value) of 87.4%. The corresponding results for MRI were 79.6%, 100%, 100% and 87.0%, and were 86.5%, 94.1%, 91.7% and 90.3% for F-FDG PET/MRI. F-FDG PET/MRI was significantly more sensitive in determining malignant lymph nodes than conventional imaging and MRI ( < 0.0001 and = 0.0005). Furthermore, F-FDG PET/MRI accurately estimated the clinical lymph node stage in significantly more cases than conventional imaging and MRI (each < 0.05). Sensitivity, specificity, PPV and NPV for the M stage in conventional staging were 83.3%, 98.5%, 76.9% and 98.9%, respectively. The corresponding results for both MRI and F-FDG PET/MRI were 100.0%, 98.5%, 80.0% and 100.0%. No significant differences between the imaging modalities were seen for the staging of distant metastases. F-FDG PET/MRI detects lymph node metastases in significantly more patients and estimates clinical lymph node stage more accurately than conventional imaging and MRI. No significant differences were found between imaging modalities with respect to the detection of distant metastases.

[sup.18]F-FDG PET/MRI is superior in nodal staging in patients with newly diagnosed breast cancer compared to conventional imaging by sonography, CT and bone scintigraphy and compared to MRI alone. [sup.18]F-FDG PET/MRI correctly detects not only nodal positive status in significantly more patients, but also classifies this positive nodal status into the correct clinical lymph node stage more often than conventional imaging and than MRI alone. [sup.18]F-FDG PET/MRI may be a future tool as a potential alternative to invasive staging procedures for assessing the N stage. In terms of the detection of distant metastases, there is a trend towards a higher sensitivity of MRI and [sup.18]F-FDG PET/MRI, which, however, did not show significant differences compared with conventional staging by CT and bone scintigraphy. This demonstrates that the imaging currently recommended by multiple guidelines seems to be sufficient for the staging of distant metastases. Background: This study compares the diagnostic potential of conventional staging (computed tomography (CT), axillary sonography and bone scintigraphy), whole-body magnetic resonance imaging (MRI) and whole-body [sup.18]F-fluorodeoxyglucose positron emission tomography ([sup.18]F-FDG PET/)MRI for N and M staging in newly diagnosed breast cancer. Methods: A total of 208 patients with newly diagnosed breast cancer were prospectively included in this study and underwent contrast-enhanced thoracoabdominal CT, bone scintigraphy and axillary sonography as well as contrast-enhanced whole-body [sup.18]F-FDG PET/MRI. The datasets were analyzed with respect to lesion localization and characterization. Histopathology and follow-up imaging served as the reference standard. A McNemar test was used to compare the diagnostic performance of conventional staging, MRI and [sup.18]F-FDG PET/MRI and a Wilcoxon test was used to compare differences in true positive findings for nodal staging. Results: Conventional staging determined the N stage with a sensitivity of 80.9%, a specificity of 99.2%, a PPV (positive predictive value) of 98.6% and a NPV (negative predictive value) of 87.4%. The corresponding results for MRI were 79.6%, 100%, 100% and 87.0%, and were 86.5%, 94.1%, 91.7% and 90.3% for [sup.18]F-FDG PET/MRI. [sup.18]F-FDG PET/MRI was significantly more sensitive in determining malignant lymph nodes than conventional imaging and MRI (p < 0.0001 and p = 0.0005). Furthermore, [sup.18]F-FDG PET/MRI accurately estimated the clinical lymph node stage in significantly more cases than conventional imaging and MRI (each p < 0.05). Sensitivity, specificity, PPV and NPV for the M stage in conventional staging were 83.3%, 98.5%, 76.9% and 98.9%, respectively. The corresponding results for both MRI and [sup.18]F-FDG PET/MRI were 100.0%, 98.5%, 80.0% and 100.0%. No significant differences between the imaging modalities were seen for the staging of distant metastases. Conclusions:[sup.18]F-FDG PET/MRI detects lymph node metastases in significantly more patients and estimates clinical lymph node stage more accurately than conventional imaging and MRI. No significant differences were found between imaging modalities with respect to the detection of distant metastases.

Background: This study compares the diagnostic potential of conventional staging (computed tomography (CT), axillary sonography and bone scintigraphy), whole-body magnetic resonance imaging (MRI) and whole-body 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/)MRI for N and M staging in newly diagnosed breast cancer. Methods: A total of 208 patients with newly diagnosed breast cancer were prospectively included in this study and underwent contrast-enhanced thoracoabdominal CT, bone scintigraphy and axillary sonography as well as contrast-enhanced whole-body 18F-FDG PET/MRI. The datasets were analyzed with respect to lesion localization and characterization. Histopathology and follow-up imaging served as the reference standard. A McNemar test was used to compare the diagnostic performance of conventional staging, MRI and 18F-FDG PET/MRI and a Wilcoxon test was used to compare differences in true positive findings for nodal staging. Results: Conventional staging determined the N stage with a sensitivity of 80.9%, a specificity of 99.2%, a PPV (positive predictive value) of 98.6% and a NPV (negative predictive value) of 87.4%. The corresponding results for MRI were 79.6%, 100%, 100% and 87.0%, and were 86.5%, 94.1%, 91.7% and 90.3% for 18F-FDG PET/MRI. 18F-FDG PET/MRI was significantly more sensitive in determining malignant lymph nodes than conventional imaging and MRI (p < 0.0001 and p = 0.0005). Furthermore, 18F-FDG PET/MRI accurately estimated the clinical lymph node stage in significantly more cases than conventional imaging and MRI (each p < 0.05). Sensitivity, specificity, PPV and NPV for the M stage in conventional staging were 83.3%, 98.5%, 76.9% and 98.9%, respectively. The corresponding results for both MRI and 18F-FDG PET/MRI were 100.0%, 98.5%, 80.0% and 100.0%. No significant differences between the imaging modalities were seen for the staging of distant metastases. Conclusions:18F-FDG PET/MRI detects lymph node metastases in significantly more patients and estimates clinical lymph node stage more accurately than conventional imaging and MRI. No significant differences were found between imaging modalities with respect to the detection of distant metastases.

The paper analyzes the global rise in with-in countries inequality, with special emphasis on the sharp increase in inequality beginning in the 1980s, as a re- sult of the neoliberal policy reforms that were designed to prevent economic stagnation and decline by reiterating the importance of financial deregulation and trade liberalisation. Following this worldwide trend, the paper employs different theoretical frameworks in order to explain how a further increase in income inequality could lead to the formation of violent conflict. By using frustration, identity and opportunity factors, the authors attempt to illustrate how the \"search for more\" is transformed into violence, followed by mate- rial and human casualties. Finally, the paper analyzes different instruments and policies that could reduce inequality, e.g. tax and transfer systems (the impact on income distribution), labour market policies (the trade-off between high minimal wage and employment reduction) and institutions and education policies (through strengthening public education, in particular). An adequate policy response to rising inequality, according to the authors, should include all of these complementary measures. [PUBLICATION ABSTRACT]