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Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery
- C. Herbert, V. Moiseenko, M. McKenzie, G. Redekop, F. Hsu, E. Gete, B. Gill, R. Lee, K. Luchka, A. Lee, C. Haw, B. Toyota, M. Martin
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 38 / Issue 6 / November 2011
- Published online by Cambridge University Press:
- 02 December 2014, pp. 845-850
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- Article
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Objective:
To investigate predictive factors of complete obliteration following treatment with linac-based stereotactic radiosurgery for intracerebral arteriovenous malformations.
Methods:Archived plans for 48 patients treated at the British Columbia Cancer Agency and who underwent post-treatment digital subtraction angiography to assess obliteration were studied. Actuarial estimates of obliteration were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of obliteration. Log-rank test was used to search for parameters associated with obliteration.
Results:Complete nidus obliteration was achieved in 38/48 patients (79.2%). Actuarial rate of obliteration was 75.9% at 4 years (95% confidence interval 63.1%-88.6%). On univariate analysis, prescribed dose to the margin (p=0.002) and dose to isocentre (p=0.022) showed statistical significance. No parameters were significant in a multivariate model. According to the log-rank test, prescribed dose to the margin of >20 Gy (p=0.004) and dose to the isocentre of >25 Gy (p=0.004) were associated with obliteration.
Conclusion:Reported series in the literature suggest a number of different factors are predictive of complete obliteration of arteriovenous malformations following radiosurgery. However, differing definitions of volume and complete obliteration makes direct comparison between series difficult. This study demonstrates that complete obliteration of the nidus following linear accelerator-based stereotactic radiosurgery for arteriovenous malformations appears to be most closely related to the prescribed marginal dose. In particular, a marginal dose of >20Gy is strongly associated with obtaining complete obliteration of the nidus.
On-farm evaluation of methods to assess welfare of gestating sows
- S. Conte, R. Bergeron, J. Grégoire, M. Gète, S. D’Allaire, M.-C. Meunier-Salaün, N. Devillers
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The objectives were to evaluate quantitative animal-based measures of sow welfare (lameness, oral stereotypies and reactivity to humans) under commercial farm conditions, and to estimate the influence of housing, sow parity and stage of gestation on the outcome of these measures. Across 10 farms, 311 sows were used. Farms differed in terms of housing design (pen v. stall), space allowance, floor type in stalls (partially v. fully slatted), and feeding system in pens (floor v. trough). Lameness was assessed in terms of gait score, walking speed, stride length, stepping behaviour, response to a stand-up test and latency to lie down after feeding. The presence of oral stereotypies and saliva foam were recorded. Reactivity to humans was assessed by approach (attempt to touch the sow between the ears) and handling tests (exit of the stall for stall-housed sows, or isolation of the animal for pen-housed sows). Only stride length and walking speed were associated with lameness in stall-housed sows (P<0.05 and P<0.01). In stalls, the probability that a sow was lame when it presented a short stride length (<83 cm) or a low speed (<1 m/s) was high (69% and 72%, respectively), suggesting that these variables were good indicators of lameness, but were not sufficient to detect every lame sow in a herd (sensitivity of 0.39 and 0.71, respectively). The stage of gestation and parity also influenced measures of stride length and walking speed (P<0.05). Saliva foam around the mouth was associated with the presence of sham chewing and fixture biting (P<0.05). The probability that a sow presents sham chewing behaviour when saliva foam around her mouth was observed was moderate (63%) but was not sufficient to detect all sows with stereotypies (41%). A high discrimination index was obtained for behavioural measures (aggressions, escapes) and vocalisations during the approach test (stalls: 78.0 and 64.0; pens: 71.9 and 75.0, respectively), the number of interventions needed to make the sow exit the stall during the handling test for stall-housed sows (74.9), and attempts to escape during the handling test for pen-housed sows (96.9). These results suggest that these measures have a good power to discriminate between sows with low and high reactivity to humans. Finally, the outcome of several measures of lameness, stereotypies and reactivity to humans were influenced by the housing characteristics, sow parity and stage of gestation. Therefore, these factors should be considered to avoid misinterpretations of these measures in terms of welfare.