#lnds 3.0

[lost-oasis]

I don't have any expectations that could be considered special... but when the candle goes out, close your eyes. Then I'll tell you what rests in my heart."

- Sylus

[lost-oasis]

Okay - I fucking did it, woo. I'm not gonna be awake for the livestream, so RIP. I'll watch the playback when I get to work though because fuck corporate prison realm.

Heyyy! I made a simple bingo design with canva for the update!!! Feel free to fill it out with things you want/wish are added/predictions!!!

[semipreciousgemstonejade]

Cosmic Encounter

Version 3.0

Anniversary Celebration

Tagline: Together at the Pinnacle of Our Love.

We're all about to lose our minds! I am so excited!

Are we getting some answers to some questions?

Xavier's collar...

Zayne's curse...

Rafayel's oath...

Sylus' eye...

Love and Deepspace Version 3.0 Cosmic Encounter will be released on Dec. 31.

💫Ver. 3.0 Special Program Pt. 1 [Love Upon You] is around the corner!

At 19:30 (UTC+8) on Dec 27, 2024, please focus on the Love and Deepspace Official YouTube Channel!

Anniversary Celebration Details, Awaiting Hunter's Discovery.

[d3vonss]

sooo, misty invasion pt. 2 huh—

I need to be put down 😁

[lisharchivez]

One Year Ago[Event]❄️ Touring in Love event Chat with Zayne: all possible outcomes

❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️

Requirements

No affinity reward.

since it has [Event] tag this is definitely related to the ongoing new event Touring in Love

But you don't have to enter the event or finsih any prolohue for this as You will get notification of this chat when you enter the game after 3.0 update Given that no other chat was clogging up in the way. (or else after finishing the clogged chats it might take a moment to appear)

❄️

❄️He starts the Chat

And you have a set of options

❄️

❄️Outcomes

happy snowman sticker used : "analyzing"

❄️❄️

❄️Next options

❄️❄️

❄️Outcomes

❄️❄️❄️

❄️Next options

❄️❄️❄️

❄️Outcomes

*Chat Ends*

Please like & re-blog, Help me reach more Lads players who might want to know these

Curious about other posts and chats outcomes from zayne ,sylus and others ? Checks more in my pinned.

Like & follow for more.

The end ;)

❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️❄️

[hes-sunshine-im-midnight-rain]

[feywrlds]

the scream I let out, wat hing the 3.0 lnds live stream? WHAT'S THATTTT

[ann-beth]

Other moments i hope I get some lore info on in LnDS 3.0 pt 3

Prologue to Tomorrow|| Chansia Journey/Thorns under the Moon vs Prestara University/Outcast's Voyage subchapters. A link, maybe?

[ladymisteria]

I posted 2.543 times in 2021

641 posts created (25%)

1902 posts reblogged (75%)

For every post I created, I reblogged 3.0 posts.

I added 3.087 tags in 2021

#the phantom of the opera - 522 posts

#legacies - 503 posts

#quotes - 346 posts

#erik x christine - 331 posts

#azzurri - 328 posts

#hope mikaelson - 291 posts

#shadow and bone - 280 posts

#tribute - 187 posts

#erik - 173 posts

#darklina - 126 posts

Longest Tag: 61 characters

#i mean... i do want to kill someone when this happen to me...

My Top Posts in 2021

#5

My Favourite OTP Daily Video.

PotO/LND- "Everything" (Erik ♥ Christine)- Phantom of the Opera

19 notes • Posted 2021-01-19 12:38:25 GMT

#4

My Favourite OTP Daily Video.

On My Own [Phantom of the Opera]

20 notes • Posted 2021-02-06 16:28:41 GMT

#3

A Kiss For Any Of Your OTPs

Eleven/River (Doctor Who).

Aragorn/Arwen (Lord of The Rings).

See the full post

41 notes • Posted 2021-07-31 00:49:11 GMT

#2

Christine, when Erik wounds Raoul in the cemetery:

Christine when Raoul, only seconds later, tries to kill Erik:

96 notes • Posted 2021-07-22 11:27:47 GMT

#1

Every time I see this:

compared with this:

See the full post

136 notes • Posted 2021-09-22 00:31:20 GMT

Get your Tumblr 2021 Year in Review →

[ourhaileydavies]

Pediatric Versus Adult Papillary Thyroid Carcinoma: Different Diseases Requiring Different Surgical Approaches-Juniper publishers

Introduction

Differentiated thyroid carcinoma is rare in young age and represents 0.5% to 3.0% of childhood carcinomas: the incidence increases with age, and peak incidence is observed between 15 and 19 years of age [1]. Even at large referral centers, only few pediatric thyroid cancers are treated every year; it may take ≥30 years for a major center to collect a series of 100 children and adolescents with thyroid cancer [2]. Papillary thyroid cancer (PTC), the most common type of differentiated thyroid cancer, spreads predominantly via the lymphatics to the local draining lymph nodes: cervical lymph node involvement in 60% to 80% of cases and lung metastases at diagnosis in 20% of cases [3]. Since pediatric thyroid cancer is such a rare disease, treatment recommendations have been based on expert opinion and retrospective data collected from different practices over decades [4-6]. Given the paucity of evidence-based pediatric data, guidelines for adult thyroid cancer occasionally have been generalized to children, treating them “just like little adults.” Such extrapolations may not be warranted, in particular when it comes to postoperative morbidity after thyroidectomy [7].

Traditionally, in most institutions, the therapy for pediatric and adolescence PTC has been the same as for adults, aimed to the eradication of all clinical and subclinical neoplastic foci both at thyroid and lymph-node level. The reasons for such an approach were  

To have a better progression-free survival and overall survival,   

To detect subclinical metastases by radioactive iodine (RAI) scintigraphic scan and treat them by RAI ablation,   

To make the value of serum thyroglobulin level a very sensitive marker of post-treatment relapse, and   

To avoid possible dedifferentiation of occult neoplastic microfoci over time [8]. PTC in children and adolescents is treated in similar fashion as that in adults, primarily because of rarity of disease in pediatric population and lack of availability of pediatric PTC treatment guidelines [9].

As well as in adults, the treatment of PTC is based on the combination of three therapeutic modalities: surgery, hormone replacement with levothyroxine, and radioiodine treatment. Surgery ranges from lobectomy to total thyroidectomy accompanied by different cervical lymphadenectomies. Latest guidelines recommend total thyroidectomy, mainly for tumors larger than 1 cm associated with cervical dissection of central or lateral compartment block if lymph node metastases are seen in preoperative imaging or during the surgery [10,11]. The main surgical complications include persist enthypo parathyroidism and laryngeal nerve damage that may cause a wide spectrum of clinical consequences: from hoarseness to total vocal cord paralysis, with need for definitive tracheotomy [12]. Thus, most societies recommend radioiodine ablation in the vast majority of patients under 45 years old but none of them make specific recommendations for children and adolescents [10,13].

In contrast to adults, pediatric PTC has some distinctive differences such as   

Larger primary tumor at the time of diagnosis,   

High prevalence of neck lymph nodes and distant metastases (DM) at the time of diagnosis,  

The high risk of recurrences [13], and   

Multifocality [14,15]. Nevertheless, advanced pediatric cancers are more likely to respond to therapy and have a better prognosis compared to their adult counterparts [16].

The unusual association between the aggressive presentation of pediatric PTC and its favorable prognosis is behind the controversy regarding its most appropriate initial management, particularly when it comes to choose between total thyroidectomy and thyroid lobectomy. Despite its seemingly aggressive biologic behavior, pediatric PTC is considered a favorable prognosis cancer.

An important difference between thyroid carcinoma in pediatric and adult age is related to the high prevalence of expression of sodium-iodide transporter (NIS) in metastatic focus found in children [17]. In the absence of stimulation of thyroid-stimulating hormone (TSH), the expression of NIS is undetectable in 65% of papillary tumors in patients under 20 years of age [18]. In contrast, the expression of NIS is absent or negligible in 90% of differentiated carcinomas in adults [19]. The greater expression of NIS in the pediatric population results in greater responsiveness to radioiodine treatment and better prognosis. In young patients, the recurrence risk increases in patients that do not express the protein NIS when compared to those that express it. Thus, the degree of NIS expression correlates with radioiodine avidity by metastases and lower clinical recurrence rates [20]. The management of patients with PTC consisted basically of primary surgery followed by evaluation for RAI treatment. Criteria for RAI ablation in patients with PTC was tumor size >1cm, lymph node metastasis (LNM), presence of extra thyroid extension, macroscopic postoperative residual disease in the neck, and/or DM [21,22].

Another important difference between PTC in pediatric and adult age was represented by a very high sensitivity shown by pediatric PTC to hormonal manipulation consisting of L-thyroxine administration at TSH-suppressive doses that can inhibit normal and neoplastic proliferation, thus preventing cancer progression and relapse. These findings, together with the significant morbidity of radical surgery and RAI therapy, led to the proposal by several groups for a conservative approach for pediatric PTC, not aimed at the eradication of all clinical and subclinical neoplastic foci by surgery plus RAI therapy, but rather the removal of only the grossly detectable disease, followed by TSH-suppressive hormone therapy to control subclinical disease, and reserving more aggressive approaches to selected cases. All these results highlight the extremely high sensitivity to hormonal manipulation that can control subclinical disease and prevent the occurrence of clinical relapse. This sensitivity to hormonal manipulation seems to represent an important biological difference with respect to adult PTC.

All these observations are in keeping with the proposal made by Cady et al. [23] on clinical grounds and supported by genetic findings that thyroid carcinomas in children and adults are different diseases and not merely different stages in a single disease, with specific prognosis and therapy needs [23,24]. Thus, the category of microcarcinoma (including tumors with less than 1cm), commonly used in adults, should be avoided in children, since a 1cm tumor constitutes a very important finding in this age group. Regarding the molecular biology of these tumors, apparently RET-PTC rearrangements occur in childhood more frequently than in adults, especially in the radiation-related tumors [25].

The prognosis remains excellent with a low rate of mortality even in advanced stages [26], but local recurrence is more frequent than in adults, leading to reoperation [27]. Predictive factors of recurrence remain incompletely known, although some factors have been suggested from retrospective studies [15,28,29]. They include young age (<16 years), lymph node involvement or DM at diagnosis, and histopathologic characteristics (mainly the diffuse sclerosing papillary variant, which is frequent in children) [30]. Among them, nodal status is considered one of the most statistically significant predictors for an adverse prognosis in young patients [31-33].

The American Thyroid Association (ATA) guidelines for pediatric PTC doesn’t recommend prophylactic lymph node dissection (LND) in children clinically negative for LNM due to the higher rates of complications as recurrent laryngeal nerve injury and hypocalcemia, which ranges from 1-4% even in experienced hands [34-38]. Moreover for ATA, in patients with pre-operative evidence of central and/or lateral neck metastasis, a therapeutic LND should be performed. For this kind of patients, LND is associated with a decreased risk of persistent/ recurrent locoregional disease as well as the potential to increase the efficacy of RAI ablation for distant metastases [39,40]. According with ATA, Borson-Chazot et al. [41] suggest a lymph node dissection with the addition of RAI ablation, in presence of palpable cervical lymph nodes at diagnosis because it is associated with more invasive forms of malignancy and is a predictive factor of recurrence.

Tumors with diffuse sclerosing variant are more common in younger patients between 15 and 30 years of age according to Koo et al. [30]. In their study pediatric patients with diffuse sclerosing variant had a higher incidence of bilateral thyroid involvement, extrathyroidal extension, lymph node involvement and recurrence. Also for Lloyd et al. [42], the diffuse sclerosing variant tumors are characterized by diffuse involvement of the thyroid (both lobes are typically involved), lymph node and lung metastasis, but the tumors do not usually lead to the demise of the patient.

Recently, indications for an optimal surgical management have been proposed [15,43]: patients with tumor smaller than 2cm, limited to one lobe, no lymph node involvement and absence of distant metastasis can be treated with conservative surgery. In absence of these parameters, radical surgery should be performed.

[lost-oasis]

look, i've been locked in, but when i say i'm so fucking locked in. i mean it from the depths of my aching soul.

chivalry will never die when sylus is your lover.

[cancersfakianakis1]

Outcome After Sentinel Lymph Node Dissection in Vulvar Cancer: A Subgroup Analysis of the AGO-CaRE-1 Study

Abstract

Purpose

Analyzing the large patient cohort of the multicenter AGO-CaRE-1 study, we compared isolated sentinel lymph node dissection (SLND) with radical lymph node dissection (LND) of the groin in relation to recurrence rates and survival.

Methods

The AGO-CaRE-1 study retrospectively collected data on treatment patterns and follow-up of vulvar cancer patients [International Federation of Gynecology and Obstetrics (FIGO) stage ≥1B] treated at 29 gynecologic cancer centers between 1998 and 2008. This subgroup analysis evaluated the influence of SLND alone on progression-free survival (PFS) and overall survival (OS).

Results

In 487 (63.1%) of 772 included patients with tumors smaller than 4 cm, an LND was performed and no metastatic lymph nodes were detected (LN0). Another 69/772 (8.9%) women underwent SLND alone, showing a negative SLN (SLN0). Tumors in the LN0 group were larger and showed a deeper invasion (LN0 vs. SLN0 tumor diameter: 20.0 vs. 13.0 mm, p < 0.001; depth of invasion: 4.0 vs. 3.0 mm, p = 0.002). After a median follow-up of 33 months (0–156), no significant differences in relation to isolated groin recurrence rates (SLN0 3.0% vs. LN0 3.4%, p = 0.845) were detected. Similarly, univariate 3-year PFS analysis showed no significant differences between both groups (SLN0 82.7% vs. LN0 77.6%, p = 0.230). A multivariate Cox regression analysis, including tumor diameter, depth of invasion, age, grading, and lymphovascular space invasion was performed: PFS [hazard ratio (HR) 0.970, 95% confidence interval (CI) 0.517–1.821] and OS (HR 0.695, 95% CI 0.261–1.849) did not differ significantly between both cohorts.

Conclusion

This subgroup analysis of the large AGO-CaRE-1 study showed similar results for groin LND and SLND alone with regard to recurrence rates and survival in node-negative patients with tumors <4 cm.

http://ift.tt/2oDEvpk

[lost-oasis]

i have loved you in every lifetime.

[lost-oasis]

ma, i love him. THANK YOU FOR COMING HOME EARLY??? 😭😭

find my spazzing headassery and delulu aaaa self down below alksdjfkls but no you really don't have to okay bye omfg

HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HUSBAND HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME HE'S HOME

SCREAMING INTO THE ABYSS

gonna be delulu on main real quick and believe that he saw rafayel and was like "FUCK NO" and hauled his ass into the same pull. yep, that's exactly how it went alsdkfjasldjfdklasfklasjdfjsdk

SLADGHAKLSDHGKLASDHGKLSHDKLGAHSDLKGASDHGASDGHLSDGHS I'M CRYING SOBBING FROWING UP LOOK AT HIMMMMMMM i need him so bad alskdfj thank you UNIVERSE FOR THIS DELICIOUS MEAL

PLEASEPLEASLEKHDLGHDSLG I CAN'T OML I HATE THAT I'M WORKIGN RIGHT NOW BC I JUST WANNA REPLAY THIS CARD OVER AND OVER AGAIN, i'm scared for the story though like alsdkjfskldlf what will it entaiL alskdghklsadghksldg screams it's fine, everything fine 🫠🫠🫠🫠

the way i just wanna [redacted] and give him the best [redacted] and push him on the bed and [redacted] until the sunset, into the next day, and more after- i mean what who said that JFC ALSKDJFSDLFJS

[lost-oasis]

SHUT UP, SHUT UP. HE NUZZLE. IDC. my gods these poses are everything. as if i needed more reasons to live in glint photobooth

[lost-oasis]

DON'T FORGET TO CLAIM!! 🖤