Sentinel node surgery9/25/2023 13Īdditional trials of SLNB followed by lymphadenectomy as the reference standard are needed to inform practice in EC. Of published studies that have evaluated SLNB predominantly in this patient population, most were retrospective and performed at a single center, 10 - 12 did not perform PALND, 10 - 12 or used technetium Tc 99m or blue dye rather than more contemporary tracers. Only 13% of patients in the Sentinel Node and Endometrial Cancer (SENTI-ENDO) trial, 7 28% in the Determining the Sensitivity of Sentinel Lymph Nodes Identified With Robotic Fluorescence Imaging (FIRES) trial, 8 and 49% in the Pelvic Sentinel Lymph Node Detection in High-Risk Endometrial Cancer (SHREC) trial 9 had high-grade histologic subtypes. 4 - 6Īlthough SLNB has gained acceptance in the context of low-grade EC, its role in high-grade EC remains unclear. 4, 5 Theoretically, SLNB should reflect the status of the entire nodal basin and provide the pathologic information required to guide decisions on adjuvant therapy while avoiding the heightened risks of intraoperative injury, chronic lymphedema, and other complications associated with complete lymphadenectomy. Sentinel lymph node biopsy (SLNB), or resection of only the first nodes receiving lymphatic drainage from the tumor site, has therefore been proposed as a less invasive strategy for nodal assessment. 1 Nodal metastases are traditionally identified on pelvic lymphadenectomy (PLND) and para-aortic lymphadenectomy (PALND), but 2 randomized clinical trials 2, 3 have suggested that lymph node resection independent of the effect of adjuvant therapy does not improve survival in patients with EC. The findings suggest that SLNB is a viable option for the surgical staging of EC.Įndometrial cancer (EC) that has metastasized to surrounding lymph nodes is associated with a poor prognosis and requires administration of adjuvant therapy. Seven of 27 patients with node-positive cancer (26%) were identified outside traditional PLND boundaries or required immunohistochemistry for diagnosis.Ĭonclusions and Relevance In this prospective cohort study, SLNB had acceptable diagnostic accuracy for patients with high-grade EC at increased risk of nodal metastases and improved the detection of node-positive cases compared with lymphadenectomy. Only 1 patient (0.6%) was misclassified by the SLNB algorithm. Of 27 patients (17%) with nodal metastases, 26 patients were correctly identified by the SLNB algorithm, yielding a sensitivity of 96% (95% CI, 81%-100%), a false-negative rate of 4% (95% CI, 0%-19%), and a negative predictive value of 99% (95% CI, 96%-100%). All patients underwent SLNB and PLND, and 101 patients (80%) with high-grade EC also underwent PALND. Results The study enrolled 156 patients (median age, 65.5 years range, 40-86 years median body mass index, 27.5 range, 17.6-49.3), including 126 with high-grade EC. Secondary outcomes were additional measures of diagnostic accuracy, sentinel lymph node detection rates, and adverse events. Main Outcomes and Measures The primary outcome was sensitivity of the SLNB algorithm. Patients with grade 2 endometrioid EC underwent pelvic lymphadenectomy (PLND) alone, and patients with high-grade EC underwent PLND and para-aortic lymphadenectomy (PALND). The study included patients with clinical stage I grade 2 endometrioid or high-grade EC scheduled to undergo laparoscopic or robotic hysterectomy with an intent to complete staging at 3 designated cancer centers in Toronto, Ontario, Canada.Įxposures All patients underwent SLNB followed by lymphadenectomy as the reference standard. Objective To examine the diagnostic accuracy of, performance characteristics of, and morbidity associated with SLNB using indocyanine green in patients with intermediate- and high-grade EC.ĭesign, Setting, and Participants In this prospective, multicenter cohort study (Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging study), accrual occurred from July 1, 2015, to June 30, 2019, with early stoppage because of prespecified accuracy criteria. Importance Whether sentinel lymph node biopsy (SLNB) can replace lymphadenectomy for surgical staging in patients with high-grade endometrial cancer (EC) is unclear. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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Pillars of eternity portraits download9/25/2023 ~/Library/Application Support/Steam/steamapps/common/Pillars of Eternity/PillarsOfEternity.app/Contents/Data/art/gui/portraits/player/male/ ~/Library/Application Support/Steam/steamapps/common/Pillars of Eternity/PillarsOfEternity.app/Contents/Data/art/gui/portraits/player/female/ ~/.steam/steam/SteamApps/common/Pillars of Eternity/PillarsOfEternity_Data/data/art/gui/portraits/player/male/ ~/.steam/steam/SteamApps/common/Pillars of Eternity/PillarsOfEternity_Data/data/art/gui/portraits/player/female/ PillarsOfEternity_Data/data/art/gui/portraits/player/male/ PillarsOfEternity_Data/data/art/gui/portraits/player/female/ \Steam\SteamApps\common\Pillars of Eternity\PillarsOfEternity_Data\data\art\gui\portraits\player\female\ \Steam\SteamApps\common\Pillars of Eternity\PillarsOfEternity_Data\data\art\gui\portraits\player\male\ \Pillars of Eternity\PillarsOfEternity_Data\data\art\gui\portraits\player Once you have your portrait files (created or downloaded), you'll want to copy them into the following directories: Place in, instructions copied from official wiki: Preview image - Very compressed preview for fast load. YMMV of course, and naturally it's mainly humans because those are the most common art portraits found online, but there are quite a few elves and others too. The portraits are picked from the internets and slightly edited to be quite similar in style so it doesn't jank you out of the Pillars of Eternity feeling. I made this mainly for myself but I'm guessing a lot of people want more portraits to choose from for their heroes. Instead, after submission, click the button under your post to assign the appropriate link flair, which will produce the same spoiler tags. You cannot use the above spoiler formatting to mask submission titles. Note: Spoiler tags only apply to text in the body of posts or comments, and not to titles themselves. To mark a spoiler as relevant to a specific part or subject of Pillars of Eternity, use the alternate formatting: (#s "Stuff happens") Spoiler tags can be used by typing followed immediately by (#s "xxxxxx"), with the content of your spoiler inside the quotation marks. Note that spoiler tags will not work when browsing on a mobile app, or when viewing a post from the front page of reddit, as /r/projecteternity's CSS will not apply there. r/projecteternity supports spoiler tags, which can be used to hide spoilers from other users until they mouse over the text, revealing it. Reported posts get looked at by the moderators faster.Īll content posted should be related to Pillars of Eternity and/or its sequels/expansions. Use the "Report" button to report any non-marked spoilers or other rule violations. For story spoilers in other threads, use Spoiler Tags as described in the section below. No story spoilers in titles! Mark threads or links that contain spoilers with a tag in the title. Pillars of Eternity aims to recapture the magic, imagination, depth, and nostalgia of classic RPGs. Paying homage to the great Infinity Engine games of years past: Baldur’s Gate, Icewind Dale, and Planescape: Torment. Pillars of Eternity and Pillars of Eternity II: Deadfire are isometric, party-based RPGs set in a new fantasy world developed by Obsidian Entertainment. Update 4, : Corrections in some male small portraits and additional portraits (new total 67 female & 32 male = 99).Welcome to the Pillars of Eternity Subreddit! Update 3, : Additional godlike aspect portraits (new total, 88 portraits) and small existing picture adjustments. Additional corrections in picture positioning using Photoshop to add textures to the top of some pictures lacking space (examples: bgii_aerie_sm.png, se_legend_sm.png). Including plenty of Baldur's Gate characters (tribute to one of the best games of all time) and Shadow Era heroes and companions. Update 2, : Increased the total number of portraits from 39 to 77. Update 1, : Smaller pictures positioning corrected. (I did not create the original images)Īll you need to do is copy them in this folders:Ĭ:\Program Files (x86)\Steam\steamapps\common\Pillars of Eternity\PillarsOfEternity_Data\data\art\gui\portraits\player\maleĬ:\Program Files (x86)\Steam\steamapps\common\Pillars of Eternity\PillarsOfEternity_Data\data\art\gui\portraits\player\female Some of them are taken from artwork designed for other famous videogames or directly from artwork created by artists like Luis Royo. I just wanted to share a set of character portraits I made for myself. 12 oz red bull caffeine content9/25/2023 Red Bull’s success can largely be attributed to its unique marketing strategy, which focuses on sponsoring extreme sports events, athletes, and teams and organizing its own branded events. 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Six months earlier and had a 4-year-old son. Relationship with him because he had just ended an eight-year marriage "Older women who are single and independent, with a sense ofįreedom, are attractive to younger men, especially if their children areĬummings' mother introduced her to her future husband, GeraldĬummings, who was 36 when she was 39. Younger women," says Cummings, who lives in Decatur, Ga. "Older womenįind it difficult to find older men because older men are looking for That the trend of older women marrying younger men developed partlyīecause so many older men are pursuing younger women. Miriam Cummings, who is three years older than her husband, says So what if his spirit is locked in the body of a younger But there are considerations, she says, stressing that ifĪ woman is considering dating a younger man, she should make sure he hasĬornish, who is 40 and married to the 32-year-old Livingstone (aĬhemistry professor), says: "Go for it if you're looking for Stereotypes to prevent them from being with the person they'reĪttracted to. Like other experts, Cornish encourages women not to allow Hamilton, a Sacramento psychologist, says an active sex life is aĬonsideration for many older women who "may be looking for someone Younger woman might not know." On the other hand, Dr. Man might choose a 40-woman because he thinks she has some tricks that a It's more likely to be the other way around. Greer, a clinical psychologist in Columbus, Ohio, says Also many people think older women are seeking sex, butĭr. Usually associated with older woman/younger man relationships: He'sĪfter her money she wants to mold him he's looking for a To have to deal with the longstanding, preconceived notions that are However, if women decide to "go for it," they are likely Hurting anybody, nor hurting yourself, go for it!" She writes: "Sis, wherever you find happiness, if you're not In her book, You Deserve Healthy Love, Sis! To settle down, and then I started dating him." They dated for sixĬornish advises other women not to just swim in the shallow end She says, when she learned that 29-year-old Richard Livingstone was Cornish was 37 and happily celibate for three years, New York-based psychologist and author Grace Cornish is part of On the subject) that 48 percent of women who married for the first timeīetween 19 were the same age or older than their husbands. Census Bureau reported in 1996 (the most recent statistics McMillan, 50, whose husband Jonathan Plummer is 27.īut it's not only famous women who are finding love in younger Williams, 39, whose husband Rick Fox is 33 and Terry Some other famous women who have connected with a man with fewerīirthdays include Whitney Houston, 39, whose husband Bobby Brown is 33 Many people already have stopped looking at age. One day the world will stop looking at age." So what's her adviceįor other women? "Don't see with your eyes, but with your Now feels that she has found her soul mate. Intimacy alone, so they waited until their wedding day on April 12,Ģ001, she says, to share their first kiss.ĭating a man 13 years younger was new for Knight, but she says she Two wanted a Christ-centered marriage that was not based on physical Heart that he would be interested in me," says Knight, now 58. He initiated a long-distanceĬourtship-mostly by phone-for about six months. You can have any young girl you want."īut 43-year-old McDowell, now co-owner of a real estate company, "Youĭidn't ask me," said Knight, who at the time was 56 andĪssumed McDowell was in his mid 30s. Told her that she should have married him in the first place. When Knight divorced for the third time, McDowell, who was alsoĭivorced, said he felt badly that her marriage didn't work out, but Herself as old-fashioned and non-aggressive. Myself to be more than a good friend," says Knight, who describes Went to La Costa Resort and Spa in Carlsbad, Calif., she enjoyed talking William McDowell, for 14 years before they started dating. Is Grammy Award-winning singer Gladys Knight, who knew her husband, One woman who says she found the love of her life in a younger man Generation gap, but an increasing number of Black women and men are Right arrives late and shows up several years younger.ĭating and marriage are tough enough without the extra burden of a Retrieved from įALLING in love doesn't always happen the way women expect.
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