text:
City Targets Two Troubled East Side Properties
by Mark Reagan
Google screenshot
The City of San Antonio ordered the Handy Stop on the 600 block of North New Braunfels Avenue shut down.
The City of San Antonio this week took legal action to shut down two properties on the near East Side that authorities say are hot spots for drug use.
News broke Friday that the Handy Stop, at 627 N. New Braunfels, will be forced to close its doors in October, the San Antonio Express-News reports. The City has also filed a lawsuit seeking the closure of a private residence on the 900 block of East Crockett for one year. Police say reason behind both legal actions include crack cocaine and rampant crime.
Handy Stop agreed to shut down after a San Antonio Police Department Dangerous Assessment Response Team, or DART, investigated the property after receiving 600 calls for police service over the past few years because of shootings, knife attacks, prostitution, aggravated assaults and drug use, according to a Nuisance Abatement Compliance Agreement first obtained by the Rivard Report.
After the City gave the Handy Stop a long list of violations it needed to remedy, including patching up bullet holes in the building, the business owners agreed to close up shop, according to E-N.
As for the property on the 900 block of East Crockett, staff with Councilman Alan Warrick's office (both locations are in his district) say it's a well-known crack house that police have been called to more than 200 times in the past three years. "Defendant has continually and knowingly maintained a place to which persons habitually go for the purposes of possession, manufacture, use and/or delivery of controlled substances," the lawsuit states. "Over the course of three years, there have been 215 calls for police service regarding the criminal activity at the single-family residential property."
Warrick said on Friday afternoon that the latest action against the Handy Stop and the private residence on East Crockett are part of a concerted effort to crack down on landlords and business owners who he says have negatively impacted progress made in the Dignowity Hill neighborhood. He said 15 properties in total have been targeted by DART teams since the beginning of the year.
"You see, the issue we have had is all the development is closer to Downtown and not on the New Braunfels corridor," Warrick said. "There's kind of a stark difference in the atmosphere."
Near the city's center, places like Dignowity Meats and Alamo Brewery have taken hold. There's been an increase in higher end apartment complexes that have cropped up. Developers are restoring vacant historic homes and selling them for hundreds of thousands of dollars. But just up the street on New Braunfels, there are hundreds of police calls for service, various shootings, some fatal, and constant crime," Warrick said.
As the district continues to try and balance development with gentrification in Dignowity Hill, Warrick said the effort to target nuisance businesses will continue on New Braunfels, pushing farther east. "Economic development is a deterrent to crime and violence, but crime and violence are a deterrent to economic development," Warrick said.
Warrick hopes new established businesses, like say a Valero, will move into places like the Handy Stop. He believes that shutting down properties where crime is a common occurrence will make companies reconsider opening up business on New Braunfels, bringing jobs for residents. "We don't want to kick [long-time residents] out," he said. "We want to give them a way to stay as the real value and intrinsic value of the neighborhood increases."


text:
Feature Know Your Military
Guide to U.S. Military Bands and Music
You have accessed part of a historical collection on defense.gov. Some of the information contained within may be outdated and links may not function. Please contact the DOD Webmaster with any questions.
Whether you like jazz music, a marching band or orchestra music, the U.S. military has you covered. Each branch of the military boasts a diverse offering of musical talent that serves for ceremonial purposes but also for entertainment and outreach. Check out these bands to stay in tune with military music.
Air Force Bands
Performing worldwide, Air Force musicians honor, inspire and connect with more than six million listeners at live and televised events each year.
Army Bands
Army Japan Band
Soldiers from the U.S. Army Japan Band perform at Mahoroba Hall, Miyagi Prefecture, Japan, Sept. 9, 2018. The USARJ band was on tour and plays a variety of bebop, jazz and big band classics during events. Navy Photo by Petty Officer 2nd Class Andrew P. Holmes
Photo By: Mass Communication Specialist 2nd Class Andrew P. Holmes
VIRIN: 180908-N-ZH960-2058B
Army bands play a variety of music styles to inspire soldiers, foster the support of citizens and promote national interests at home and abroad.
Marine Band
Founded by Congress in 1798, the Marine Band is America's oldest continuously active professional musical organization. Today, "The President's Own" is celebrated for its role at the White House and its dynamic public performances, which total more than 500 annually.
Navy Band
Singing Sailor
Navy Seaman Crissy Villalva sings during a free concert in Times Square as part of Fleet Week New York in New York City, May 26, 2017. Villalva is a musician assigned to the Navy Band Northeast's Rhode Island Sound. Navy photo by Petty Officer 2nd Class Charles Oki
Photo By: Petty Officer 2nd Class Charles Oki
VIRIN: 170526-N-SF508-024A
The United States Navy Band is the premier musical organization of the Navy. Comprised of six primary performing groups as well as a host of smaller ensembles, "The World's Finest" is capable of playing any style of music in any setting.
Coast Guard Band
The Coast Guard Band performs during its 12-day national tour, Greenwood, Del., June 7, 2018. The 55-member band is touring the Coast Guard Mid-Atlantic region May 30 to June 10, 2018, to promote the work of the men and women in the Coast Guard and serve as a bridge between the service and the American people. Coast Guard photo by Petty Officer 2nd Class Lisa Ferdinando
Photo By: Petty Officer 2nd Class Lisa Ferdinando
VIRIN: 180607-G-BN624-060
The United States Coast Guard Band is the premier band representing the Coast Guard and the Department of Homeland Security. The 55-member ensemble has performed at some of the most prestigious venues in the nation including the John F. Kennedy Center for the Performing Arts, Lincoln Center and Carnegie Hall.
military bands Know Your Military Entertainment

redpajama_set_name: RedPajamaCommonCrawl


text:
#include "src/trace_processor/importers/proto/heap_profile_tracker.h"

#include "perfetto/base/logging.h"
#include "src/trace_processor/importers/common/process_tracker.h"
#include "src/trace_processor/types/trace_processor_context.h"

#include "protos/perfetto/trace/profiling/profile_common.pbzero.h"
#include "protos/perfetto/trace/profiling/profile_packet.pbzero.h"

namespace perfetto {
namespace trace_processor {

HeapProfileTracker::HeapProfileTracker(TraceProcessorContext* context)
    : context_(context),
      empty_(context_->storage->InternString({"", 0})),
      art_heap_(context_->storage->InternString("com.android.art")) {}

HeapProfileTracker::~HeapProfileTracker() = default;

void HeapProfileTracker::SetProfilePacketIndex(uint32_t seq_id,
                                               uint64_t index) {
  SequenceState& sequence_state = sequence_state_[seq_id];
  bool dropped_packet = false;
  // heapprofd starts counting at index = 0.
  if (!sequence_state.prev_index && index != 0) {
    dropped_packet = true;
  }

  if (sequence_state.prev_index && *sequence_state.prev_index + 1 != index) {
    dropped_packet = true;
  }

  if (dropped_packet) {
    if (sequence_state.prev_index) {
      PERFETTO_ELOG("Missing packets between %" PRIu64 " and %" PRIu64,
                    *sequence_state.prev_index, index);
    } else {
      PERFETTO_ELOG("Invalid first packet index %" PRIu64 " (!= 0)", index);
    }

    context_->storage->IncrementStats(stats::heapprofd_missing_packet);
  }
  sequence_state.prev_index = index;
}

void HeapProfileTracker::AddAllocation(
    uint32_t seq_id,
    SequenceStackProfileTracker* sequence_stack_profile_tracker,
    const SourceAllocation& alloc,
    const SequenceStackProfileTracker::InternLookup* intern_lookup) {
  SequenceState& sequence_state = sequence_state_[seq_id];

  auto opt_callstack_id = sequence_stack_profile_tracker->FindOrInsertCallstack(
      alloc.callstack_id, intern_lookup);
  if (!opt_callstack_id)
    return;

  CallsiteId callstack_id = *opt_callstack_id;

  UniquePid upid = context_->process_tracker->GetOrCreateProcess(
      static_cast<uint32_t>(alloc.pid));

  tables::HeapProfileAllocationTable::Row alloc_row{
      alloc.timestamp,
      upid,
      alloc.heap_name,
      callstack_id,
      static_cast<int64_t>(alloc.alloc_count),
      static_cast<int64_t>(alloc.self_allocated)};

  tables::HeapProfileAllocationTable::Row free_row{
      alloc.timestamp,
      upid,
      alloc.heap_name,
      callstack_id,
      -static_cast<int64_t>(alloc.free_count),
      -static_cast<int64_t>(alloc.self_freed)};

  auto prev_alloc_it = sequence_state.prev_alloc.find({upid, callstack_id});
  if (prev_alloc_it == sequence_state.prev_alloc.end()) {
    std::tie(prev_alloc_it, std::ignore) = sequence_state.prev_alloc.emplace(
        std::make_pair(upid, callstack_id),
        tables::HeapProfileAllocationTable::Row{});
  }

  tables::HeapProfileAllocationTable::Row& prev_alloc = prev_alloc_it->second;

  auto prev_free_it = sequence_state.prev_free.find({upid, callstack_id});
  if (prev_free_it == sequence_state.prev_free.end()) {
    std::tie(prev_free_it, std::ignore) = sequence_state.prev_free.emplace(
        std::make_pair(upid, callstack_id),
        tables::HeapProfileAllocationTable::Row{});
  }

  tables::HeapProfileAllocationTable::Row& prev_free = prev_free_it->second;

  std::set<CallsiteId>& callstacks_for_source_callstack_id =
      sequence_state.seen_callstacks[SourceAllocationIndex{
          upid, alloc.callstack_id, alloc.heap_name}];
  bool new_callstack;
  std::tie(std::ignore, new_callstack) =
      callstacks_for_source_callstack_id.emplace(callstack_id);

  if (new_callstack) {
    sequence_state.alloc_correction[alloc.callstack_id] = prev_alloc;
    sequence_state.free_correction[alloc.callstack_id] = prev_free;
  }

  auto alloc_correction_it =
      sequence_state.alloc_correction.find(alloc.callstack_id);
  if (alloc_correction_it != sequence_state.alloc_correction.end()) {
    const auto& alloc_correction = alloc_correction_it->second;
    alloc_row.count += alloc_correction.count;
    alloc_row.size += alloc_correction.size;
  }

  auto free_correction_it =
      sequence_state.free_correction.find(alloc.callstack_id);
  if (free_correction_it != sequence_state.free_correction.end()) {
    const auto& free_correction = free_correction_it->second;
    free_row.count += free_correction.count;
    free_row.size += free_correction.size;
  }

  tables::HeapProfileAllocationTable::Row alloc_delta = alloc_row;
  tables::HeapProfileAllocationTable::Row free_delta = free_row;

  alloc_delta.count -= prev_alloc.count;
  alloc_delta.size -= prev_alloc.size;

  free_delta.count -= prev_free.count;
  free_delta.size -= prev_free.size;

  if (alloc_delta.count < 0 || alloc_delta.size < 0 || free_delta.count > 0 ||
      free_delta.size > 0) {
    PERFETTO_DLOG("Non-monotonous allocation.");
    context_->storage->IncrementIndexedStats(stats::heapprofd_malformed_packet,
                                             static_cast<int>(upid));
    return;
  }

  // Dump at max profiles do not have .count set.
  if (alloc_delta.count || alloc_delta.size) {
    context_->storage->mutable_heap_profile_allocation_table()->Insert(
        alloc_delta);
  }

  // ART only reports allocations, and not frees. This throws off our logic
  // that assumes that if a new object was allocated with the same address,
  // the old one has to have been freed in the meantime.
  // See HeapTracker::RecordMalloc in bookkeeping.cc.
  if (alloc.heap_name != art_heap_ && (free_delta.count || free_delta.size)) {
    context_->storage->mutable_heap_profile_allocation_table()->Insert(
        free_delta);
  }

  prev_alloc = alloc_row;
  prev_free = free_row;
}

void HeapProfileTracker::StoreAllocation(uint32_t seq_id,
                                         SourceAllocation alloc) {
  SequenceState& sequence_state = sequence_state_[seq_id];
  sequence_state.pending_allocs.emplace_back(std::move(alloc));
}

void HeapProfileTracker::CommitAllocations(
    uint32_t seq_id,
    SequenceStackProfileTracker* sequence_stack_profile_tracker,
    const SequenceStackProfileTracker::InternLookup* intern_lookup) {
  SequenceState& sequence_state = sequence_state_[seq_id];
  for (const auto& p : sequence_state.pending_allocs)
    AddAllocation(seq_id, sequence_stack_profile_tracker, p, intern_lookup);
  sequence_state.pending_allocs.clear();
}

void HeapProfileTracker::FinalizeProfile(
    uint32_t seq_id,
    SequenceStackProfileTracker* sequence_stack_profile_tracker,
    const SequenceStackProfileTracker::InternLookup* intern_lookup) {
  CommitAllocations(seq_id, sequence_stack_profile_tracker, intern_lookup);
  sequence_stack_profile_tracker->ClearIndices();
}

void HeapProfileTracker::NotifyEndOfFile() {
  for (const auto& key_and_sequence_state : sequence_state_) {
    const SequenceState& sequence_state = key_and_sequence_state.second;
    if (!sequence_state.pending_allocs.empty()) {
      context_->storage->IncrementStats(stats::heapprofd_non_finalized_profile);
    }
  }
}

}  // namespace trace_processor
}  // namespace perfetto

redpajama_set_name: RedPajamaGithub


text:
Hogan v. Swayze
Ravarino v. Price
Price v. Lloyd, 31 Utah 86, 86 P. 767.Hargreaves v. Burton, 59 Utah 575, 206 P. 262; Hogan v. Swayze, 65 Utah…
MILLER v. HANCOCK ET AL
3. FRAUDS, STATUTE OF. Several writings may be construed together as containing all the terms of a contract,…
Full title:HOGAN v. SWAYZE et al
Court:Supreme Court of Utah
Date published: May 12, 1925
237 P. 1097 (Utah 1925)
237 P. 1097
Supreme Court of Utah
Decided May 12, 1925. Rehearing Denied June 5, 1925.
1. EVIDENCE — PAROL EVIDENCE RULE APPLIES TO PRIOR OR CONTEMPORANEOUS ORAL AGREEMENTS AND NOT THOSE SUBSEQUENT TO WRITTEN CONTRACT. Parol evidence rule, that prior or contemporaneous oral agreements are merged in written contract, and are not admissible in evidence to vary it, is not applicable to oral agreements subsequently made. 2. SPECIFIC PERFORMANCE — EVIDENCE HELD TO SHOW MAKING OF ORAL AGREEMENT SUBSEQUENT TO WRITTEN CONTRACT OF SALE OF LAND. In an action for specific performance to compel conveyance to plaintiff of east one-half of land rather than an undivided one-half as tenant in common, evidence held to sustain a finding that parol agreement to convey east one-half of land in question was made subsequent to written contract of sale. 3. VENDOR AND PURCHASER — IMPROVEMENTS HELD TO CONSTITUTE CONSIDERATION FOR PAROL AGREEMENT SUBSEQUENT TO WRITTEN CONTRACT FOR SALE OF LAND. Parol agreement, made subsequent to written contract for sale of land, held sufficiently supported by consideration, where improvements made by vendee at vendor's assent and promise to convey, such improvements enhancing value of adjacent property. 4. SPECIFIC PERFORMANCE — EVIDENCE HELD TO SUSTAIN FINDING THAT VENDEE MADE IMPROVEMENTS IN RELIANCE ON PAROL AGREEMENT. In action for specific performance of parol agreement to convey specific one-half of land rather than undivided one-half under written contract, finding that vendee made improvements in reliance on parol agreement held supported by preponderance of evidence. 5. SPECIFIC PERFORMANCE — FACTS HELD TO SHOW RELATIONSHIP OF VENDOR AND VENDEE RATHER THAN TENANTS IN COMMON. In an action for specific performance of parol agreement to convey specific one-half of land rather than undivided one-half under written agreement, facts held to show relationship of vendor and vendee rather than tenants in common; oral agreement being clearly modification of written agreement, and mere fact that vendor paid one-half of taxes and vendee one-half was insignificant. 6. FRAUDS, STATUTE OF — POSSESSION AND IMPROVEMENT OF PART OF LAND UNDER PAROL AGREEMENT HELD PART PERFORMANCE AS TO ALL LAND COVERED BY SUCH AGREEMENT. A parol agreement to convey the east one-half of certain land, made subsequent to written agreement to convey undivided one-half was taken out of Comp. Laws 1917, §§ 5811, 5813, where land was definitely described, vendee paid purchase price, entered upon east one-half of land in reliance on parol agreement, with vendor's consent and knowledge, actually occupied a substantial portion thereof, and made substantial improvements thereon; part performance as to portion of such half of land being part performance as to entire one-half. 7. SPECIFIC PERFORMANCE — SPECIFIC PERFORMANCE OF ORAL CONTRACT TO CONVEY GRANTED WHERE PARTLY PERFORMED. Where vendee, under parol contract to convey east one-half of land, made pursuant to written contract to convey undivided one-half, paid purchase price, entered upon and took possession of part of such half in reliance on parol agreement, and made substantial permanent improvements thereon he was entitled to specific performance of written contract as modified by parol agreement compelling conveyance of entire one-half of land in question. 8. SPECIFIC PERFORMANCE — SPECIFIC PERFORMANCE DECREED IN FAVOR OF DONEE TAKING POSSESSION AND IMPROVINO LAND IN RELIANCE ON PAROL GIFT. Specific performance will be decreed even in favor of donee of parol gift of land, where gift is followed by possession and substantial improvements in reliance thereon.
Distinguishing Moon v. Bollwinkel, 47 Utah, 389, 154 P. 939; Adams v. Manning, 46 Utah, 82, 148 P. 465.
Price v. Lloyd, 31 Utah, 86, 86 P. 767, L.R.A. (N.S.) 870; Hargreaves v. Burton, 59 Utah, 575, 206 P. 262, 33 A.L.R. 1481.
See Headnote 1. 22 C.J. pp. 1102, 1274.
Headnote 2. 36 Cyc. p. 784 (Anno.).
Headnote 3. 39 Cyc. p. 1352.
Headnote 6. 27 C.J. p. 349, 36 Cyc. p. 657.
Headnote 7. 36 Cyc. p. 657.
Appeal from District Court, First District, Box Elder County; M.H. Harris, Judge.
Action by Edward Hogan against D.N. Swayze and others. From a judgment for plaintiff, defendants appeal.
Evans Sullivan, of Salt Lake City, for appellants.
D.H. Thomas, of Salt Lake City, for respondent.
THURMAN, J.
This is an action to enforce the specific performance of a contract for the sale of land in Box Elder county, Utah. At the time of the execution of the contract, viz. on August 12, 1913, title to the land was in the Central Pacific Railroad Company, and one W.E. Whittaker had a contract with said company for the purchase of the land, which contract, together with a warranty deed from said company to Whittaker was deposited in escrow with Walker Bros. Bankers of Salt Lake City. While said escrow was pending Whittaker and his wife offered to sell their equity in said land to the defendant D.N. Swayze and one W.E. Farrier for the sum of $4,800, which price was to be reduced to $3,700 if paid on or before August 13, 1913. In order to obtain the money to avail themselves of the discount, Swayze and Farrier entered into negotiations with the plaintiff, which ripened into a contract by which plaintiff agreed to purchase a one-half interest in the land for the sum of $4,800, $3,700 of which was to pay Whittaker, the remainder to Swayze and Farrier. Swayze and Farrier were to pay the railroad company the remainder of the purchase price under its contract with Whittaker, as the same became due, and when title was secured from said company were to execute a deed to plaintiff for a one-half interest in the land. The land consists of a square section, and is described as section 31, township 13 north, range 12 west, Salt Lake meridian.
Farrier died before the commencement of this action, and is represented here by the defendant Swayze as administrator of Farrier's estate. Farrier's widow and daughter are also made defendants.
The contract between Swayze and Farrier of the first part and plaintiff of the second part, which is the subject of controversy here, was executed August 12, 1913. The contract was in writing, signed by the parties, and purports to convey an undivided one-half of said section. It is alleged by plaintiff, in his complaint, that the contract was afterwards modified by mutual agreement between himself and Swayze and Farrier, to the effect that plaintiff was to have the east half of the section and Swayze and Farrier the west half. The defendant's deny the alleged subsequent agreement. They afterwards procured title from the railroad company, and refused to convey to plaintiff the east half of the land, but offered and are still willing to deed to him an undivided one-half of the section. Defendants stand upon the written contract which reads as follows:
"Witness: That Walker Bros. Bankers, of Salt Lake City, Utah, now hold an agreement contract, and deed, covering the transfer of Sec. 31, Tp. 13 N.R. 12 W., executed by W.E. Whittaker and Emily Whittaker, his wife, to D.N. Swayze and W.E. Farrier; there being due W.E. Whittaker, his heirs and assigns certain sums of money under the afore-mentioned agreement. And since W.E. Whittaker and Emily Whittaker, his wife, have, under supplementary agreement dated July 3, 1913, agreed to discount all sums of money, together with their interest mentioned and contained under the original or first agreement, upon the payment to their credit at Walker Bros.' Bank, Salt Lake City, Utah, the sum of thirty-seven hundred dollars ($3,700.00) on or before August 12, 1913. Now comes Edward Hogan of Park Valley Precinct, Box Elder county, Utah, to D.N. Swayze and W.F. Farrier, and agrees to purchase an undivided one-half interest in the above-mentioned section, viz. Sec. 31, Tp. 13 N.R. 12 W., for the sum of forty-eight hundred dollars ($4,800.00), and further agrees to furnish and does hereby furnish the sum of thirty-seven hundred dollars ($3,700.00) to be paid W.E. Whittaker and Emily Whittaker, his wife, for their right, title and interest as contained in original and supplementary agreement now in favor of D.N. Swayze and W.F. Farrier, and receipt of the balance of the purchase price for the undivided one-half interest, amounting to eleven hundred dollars ($1,100.00) is hereby acknowledged by D.N. Swayze and W.F. Farrier. The balance of indebtedness holden against Sec. 31, Tp. 13 N., R. 12 W., shall be paid by D.N. Swayze, and W.F. Farrier. However, in the event that Edward Hogan, as owner of an undivided one-half interest of the above-mentioned section, should elect to pay the Central Pacific contract off and acquire the discounts in connection therewith, he is hereby privileged to do so, and D.N. Swayze and W.F. Farrier hereby agree to execute a mortgage unto the said Edward Hogan for the sum paid the said Central Pacific Company, plus the discounts obtained by the said Edward Hogan. In the event that D.N. Swayze and W.F. Farrier should decide to transfer their right and interest to any one other than Edward Hogan, it is hereby agreed and understood that the section will automatically be divided by the transfer of interest from an east and west standpoint, and the east one-half will be considered as belonging unto Edward Hogan and the west one-half to the party or parties whom D.N. Swayze and W.F. Farrier may sell their interests unto."
The written contract is not in dispute. It was executed at Walker Bros.' Bank, Salt Lake City, at which time plaintiff paid the money, as stated in the contract.
The principal questions before the trial court were: (1) Was there a subsequent oral agreement to convey to plaintiff the east half of the land? (2) If there was such an agreement, was the conduct of the parties such as to avoid the statute of frauds relating to the sale of real estate? The trial court found the issues in favor of the plaintiff, and entered judgment accordingly. Defendants appeal.
Appellants' assignment of errors presents numerous questions for our determination. It suits our convenience to first dispose of the principal questions above referred to.
The first question is, Was there a subsequent oral agreement that plaintiff should have the east half of the land? Plaintiff, testifying in his own behalf, in substance, said that after they had executed the written contract and came out of the bank onto the sidewalk they talked about what was to be done on the place and the money to be expended on improvements; that he stated to Swayze and Farrier that he had not seen anything in the contract giving him the east half; that Farrier said, "Oh, we settled that yesterday; you go on and do this improvement and when this contract is paid out to the railroad company we will deed you the east half;" that Swayze also said, "Yes, we settled that yesterday, and you go ahead and do what you can on the land up there." Plaintiff also testified that Swayze said they would deed him the east half when the land was paid for; that both Swayze and Farrier stated they had settled that question before. Plaintiff further testified, in substance, that he had subsequent conversations with both Swayze and Farrier separately, and it was understood he was to have the east half of the land.
Harold Latter, son-in-law and witness for plaintiff, testified that he was present at Walker Bros.' Bank when the contract was executed. He said they were all talking about the place up there, and plaintiff said to Swayze and Farrier that he did not see anything in the contract about his having the east half; that plaintiff said, "I thought we agreed that I was to have the east half and you was going to have that put in there;" that Farrier said, "Why I thought we settled that question last night, Mr. Hogan, and just as soon as we get this contract paid off to the railroad company, and we get the deed, it is understood that you are to get a deed for the east half," and Swayze said, "Yes; that's right." Witness also testified that plaintiff said something about how soon he could get possession, and Farrier said that Mr. Whittaker had agreed to give possession at once; that plaintiff said he was going to do some plowing.
John Hogan, son of plaintiff, testified to helping his father raise a crop on the east half of the land, and also assisted in building and repairing fences, etc.; that while working up there he planted about an acre of potatoes over on the west half of the land; that this was in 1914; that he had some talk with Swayze about the ownership of the west half; that Swayze and Farrier were having a lawsuit with some parties over a spring that arose on the west half; that witness walked over with Swayze to look at the spring; that Swayze saw the potatoes and wanted to know what we had planted there; that witness informed him they had planted potatoes, and that Swayze said as long as he was furnishing the ground he ought to have some of the potatoes; that Swayze said he and Farrier owned the west half.
Whittaker, who formerly owned an equity in the land, sworn as a witness for plaintiff, referring to the section of land in question, testified that on one occasion, while conveying Swayze and Farrier to Rosetti to look at some land they had there, they told witness they were moving a man on the east half of the section; that they had sold Mr. Hogan the east half. The witness stated that Swayze had told him at different times that he had sold the east half to Mr. Hogan. Witness thought the conversation was in the spring of 1914. On cross-examination, witness said he asked Swayze why they did not divide the section east and west instead of north and south; that Swayze said he had sold the east half.
The foregoing is substantially all the evidence on behalf of plaintiff in support of the alleged oral agreement, except the fact that he immediately entered upon the east half of the section and commenced to cultivate and improve the same. This will be considered later on.
Defendant Swayze, testifying for the defendants denied that any agreement was entered into by which plaintiff was to have the east half of the land, and denied having made any statement to anybody to that effect.
As corroborative of Swayze's testimony defendants rely on numerous circumstances, prominent among which it is mentioned that the alleged oral agreement was made almost contemporaneously with the written agreement, and, being entirely inconsistent with it, is therefore improbable; that the taxes were assessed on the entire section as a unit, Swayze and Farrier paying one-half thereof and plaintiff the remainder; also the fact that the written contract provided for a sale of the whole section as a unit, and division of the proceeds on a basis of one-half to plaintiff and remainder to Swayze and Farrier; and, finally, that there was not sufficient evidence of part performance to take the case out of the statute of frauds.
In order to keep the evidence relating to the oral agreement separate from other matters material to the issues involved in this appeal, we have thus far avoided reference to evidence bearing upon the question of part performance of the contract.
The uncontradicted evidence shows that very soon after the contract between the parties was entered into plaintiff entered upon the east half of the land with his son, equipped with farming implements, and commenced to plow and cultivate the land. There was a three-room log house, a barn, blacksmith shop, and some fence around the place all of which were out of repair. The house had a dirt roof; the inside walls were bare. Plaintiff put a new roof on the house, and "chinked" it up with lime and sand, and got it in shape to live in. He also put a new roof on the blacksmith shop and on the barn and sheds for his horses and cows, so as to take care of them through the winter. There were 10 or 12 acres of the land which had been cultivated before. Plaintiff plowed the land, bought seed, and planted rye. This was in the fall of 1913. He lived there that winter. As soon as snow was off the next spring they went to work to clear off more land, broke down sage brush, raked it up, pulled up tree stumps, and burned the brush. They cleared 14 3/4 acres, and hired a man to plow the land, planted it in barley, and harvested the crop. While the hired man was doing this work, plaintiff and his son were cleaning up some other small patches of ground in order to "straighten it up." They cleared about 2 acres and put it in grain. They cleared and plowed around the barn and hay, as a protection against fire. That fall plaintiff put two other men on the place. The next year they plowed and cropped the land. During 1914 plaintiff and his hired man moved and straightened up some fences so as to inclose the land he had cleared and intended to crop. All of the fence was on the east half of the section. The amount of land inclosed was 40 or 45 acres. That was all of the fencing done, except for some corrals. It was a barbed wire fence with cedar posts, most all new. Plaintiff thought the fence cost over $200. The cost of clearing and plowing the land was $14 an acre. About 3 more acres were cleared and broken up by the two men he employed. They were there also in 1916 and 1917, raised crops, and kept up the place. In all about 35 acres were cultivated. Plaintiff testified that he had paid out all of $1,000, exclusive of the price of machinery and other personal property, and that, if he figured in wages for himself and son, it would be more than $1,000. Plaintiff said the improvements were made in reliance upon the promise of Swayze and Farrier that when they got their deed they would deed to him the east half of the section.
The foregoing statement of the evidence contains substantially all that was offered by the parties litigant in support of the issues tried by the court below.
It was strenuously contended by appellants at the trial that the oral agreement was inadmissible as being an attempt to alter the terms of a written agreement by parol evidence. Objection was made to its admissibility on that ground. The court overruled the objection, and appellants assign the ruling as error.
It is true that the alleged oral agreement was, in point of time, closely connected with the execution of the written contract. It was, nevertheless, subsequent thereto, for, if made at all, as far as appears from the evidence admitted, it was made after the written contract was completely executed by signing the same and payment of the stipulated price. In Elliott on Contracts, vol. 2 § 1640, it is said:
"If the parol contract was, in fact, made subsequent to the written contract, and evidence thereof is otherwise unobjectionable, it makes no difference how short the interval may have been."
This proposition ought not to be seriously questioned. It may be said in passing, however that the rule that parol evidence is inadmissible to vary the terms of a plain, unambiguous instrument, in writing, is elementary in this and every 1 other jurisidiction of the country. Consequently it is not necessary to cite the authorities relied on by appellants. Such authorities apply only to prior or contemporaneous agreements, and not to agreements subsequently made. Prior or contemporaneous agreements are held to be merged in the written contract, and therefore not admissible in evidence.
As to whether or not there was a subsequent parol agreement to convey to plaintiff the east half of the land, as contended by plaintiff, we are constrained to hold, as did the trial court, that the evidence clearly preponderates in favor of the plaintiff. It would serve no beneficial purpose to 2 review the evidence. We have set it out, in substance, and, in our opinion, the trial court was justified in the conclusion reached.
Appellants also assign as error the admission of the parol agreement in evidence, upon the ground that it violates Comp. Laws Utah 1917, §§ 5811 and 5813, commonly referred to as the statute of frauds.
Whether the acts and conduct of the plaintiff in the instant case amounted to a part performance of the contract, as required by law in cases of this kind, is the most important question to be determined.
Appellants insist there is no evidence to show a part performance of the contract. It is not strenuously contended that the improvements made by plaintiff upon the land were not permanent, or that they were not of sufficient value to satisfy the law, but it is contended that what was done upon the land was as a tenant in common, with the consent and acquiescence of all the parties to the written contract; that the taxes were paid by all the parties upon the entire section as a unit; that everything done by the plaintiff on the land was consistent with a tenancy in common; and that plaintiff did not discharge the burden of proof resting upon him by merely showing that he entered into physical possession of a partciular portion of the land. Furthermore, appellants make the points that plaintiff had the written contract recorded after the alleged oral agreement, that there was no consideration for it, and that the improvements must have been made in reliance upon its fulfillment.
The last three points will be first considered. The recording of the contract by plaintiff after the oral agreement has no probative effect against plaintiff's contention. The oral agreement purports to be nothing more than a modification of one feature of the written contract. Both the written agreement and the oral agreement are necessary to constitute the contract upon which plaintiff founded his right of action. The oral agreement does not even describe the land which is the subject of the action. In 2 Elliott on Contracts, § 1640, the author says:
"A new and distinct agreement, based on a new consideration, may usually be shown by parol evidence, either as a substitute for the old agreement, or in addition to it; and it is a general rule that an executory bilateral written contract, nor under seal, may, before breach thereof, be waived or annulled, modified or varied, by a new valid parol contract, even though it is to be taken in connection with the written agreement and proved partly by the writing, and partly by the new parol terms, provided the statute of frauds does not require it to be entirely in writing."
As to the consideration for the oral agreement, the writer is of opinion it is sustainable on more grounds than one. In the first place, at the time the oral agreement was made, it appears the plaintiff desired to make some improvements on the land, that he called attention to the fact that the written contract said nothing about his having the east half, and that Swayze and Farrier told him, in effect, to go on and do the work, and when they received title from the railroad company 3, 4 they would deed him the east half, in the second place, it must be conceded that any permanent improvements, such as buildings, fences, clearings, and cultivation, made upon any one portion of a tract of wild land, will enhance, to some extent, the value of adjacent land. We are of opinion there was ample consideration for the oral agreement. As to the last of the three points above mentioned, plaintiff expressly testified he made the improvements upon reliance that the agreement would be fulfilled. The trial court specifically found that plaintiff made the improvements upon such reliance, and we are of opinion the finding is sustained by a preponderance of the evidence.
We readily concede that, where a tenant in common enters upon a tract of land owned by himself and his cotenants, and cultivates the same and makes improvements thereon, there is a presumption that such acts are for the benefit of all the tenants in common, and his actual occupation and improvement of a part of the land in such case afford no presumption of his exclusive ownership of the portion so occupied and improved. But under the facts of this case the relationship of the parties appears to have been that of vendors and vendee rather than that of tenants in common. The oral agreement of the parties was clearly a modification of the written agreement, to the effect that plaintiff became the purchaser of the east half of the land.
The fact that the annual taxes were paid, one-half by defendants and the other half by plaintiff, is of but little significance. The contract with the railroad 5 company was in the name of the defendants, and no doubt the taxes were assessed against them until the title was perfected. In view of all the circumstances of the case, the part played by plaintiff in furnishing the money to take up the Whittaker option, together with the profits made by defendants in the deal it is not at all significant that the taxes were apportioned in the manner stated until the contract should finally ripen into a complete title.
But defendants contend there was not a part performance of the contract, because plaintiff did not enter into physical possession of all the east half of the section.
It certainly cannot be seriously contended that plaintiff was required either to fence all the land or cultivate every foot of it, for that would be to apply the rule of pedis possessio, which can have no just application in a case of this kind. It is impracticable, if not impossible, for a person claiming to own one or more parcels of land of any considerable area to improve and cultivate it all at once, or even enter into actual possession and occupancy thereof. This proposition is 6 recognized by many authorities, and has been applied in numerous actions for specific performance in which the statute of frauds was relied on as a defense. The rule has even been maintained in cases where several parcels of land are included in the contract. The possession of one parcel carries with it possession of all.
In Bartz, v. Paff et al., 95 Wis. 95, 69 N.W. 297, 37 L.R.A. 848, the second headnote states the rule:
"Where several parcels of land are included in one parol contract of sale, part payment of the purchase money and a delivery of possession of one of those parcels, is sufficient to enable the purchaser to enforce specific performance of the contract as to all the parcels."
Tillis et al. v. Folmar, 145 Ala. 176, 39 So. 913, 8 Ann. Cas. 78, 117 Am. St. Rep. 31, is also in point. The note at the close of the case is especially enlightening. It reads in part, as follows:
"The holding in the reported case is in accord with the general rule that when a purchaser has entered into possession of one of several distinct parcels of real estate, all of which have been purchased under an entire parol contract and for a sum in gross, there is such a part performance of the contract of sale as to require its enforcement in equity notwithstanding the statute of frauds. Bigelow v. Armes, 108 U.S. 10, 1 U.S. Sup. Ct. Rep. 83; Metropolitan Lumber Co. v. Lake Superior Ship Canal, Etc., Co., 101 Mich. 577, 60 N.W. 278; Hitchins v. Pettingill, 58 N.H. 386; Smith v. Underdunck, 1 Sandf. Ch. (N.Y.) 579. See, also, Bartz v. Paff, 95 Wis. 95, 69 N.W. 297. In Jones v. Pease, 21 Wis. 652, the court said: `It is however contended by the appellant that the contract is not taken out of the statute unless possession is delivered to the purchaser under the contract of all the real estate. It appears to us that this position is untenable. As we said before, the contract must as a whole be enforced, or entirely rescinded; and we see less difficulty in fully carrying into effect the agreement of the parties, than in undoing what they have done. And we do not think, when a party agrees by parol to convey different parcels of land, that possession of each parcel under the contract is necessary to take it out of the statute. If it is, then possession may be given of the most valuable portion of the lands, and the purchase money all be paid, and yet the purchaser be turned out of possession of the very lands he has taken possession of under the contract, by an action of ejectment, and compelled to pay for their use and occupation, and be left to an action at law to recover the purchase money paid.' Where the purchaser divides the land into parcels and sells one parcel to a third party, the possession thereof by such third party, it seems, inures to the benefit of the purchaser and becomes part performance of the entire contract. Blalock v. Waggoner, 82 Ga. 122, 8 S.E. 48."
If such is the rule in the cases referred to, when several parcels of land are covered by a parol contract, for a much stronger reason it ought to be the rule where only one parcel of land is in controversy, as in the instant case. The land is definitely described in the contract; there is no uncertainty as to that. The plaintiff, as hereinbefore found, entered upon the land claimed by him in pursuance of and in reliance upon the contract, and actually occupied a substantial portion thereof, and made permanent and valuable improvements thereon. These facts clearly distinguish this case from the cases of Adams v. Manning, 46 Utah, 82, 148 P. 465, and Moon v. Bollwinkel, 47 Utah, 389, 154 P. 939, cited and relied on by appellants. A casual reading of the cases, without further comment, will clearly show the distinction.
The written contract, as modified by the oral agreement is definite, certain, and specific in all its terms. It constitutes a valid contract for the purchase of the east half of the land in question. Plaintiff paid the full purchase price, and with the knowledge and consent of the vendors entered into possession and made valuable improvements thereon. It nowhere appears in the evidence that the land had any rental value, or that plaintiff derived any benefit therefrom.
The only question remaining to be determined is one of law. Under the facts and circumstances above set forth, is plaintiff, in equity, entitled to a decree enforcing 7 a specific performance of the contract? The following general statement of the doctrine is found in Pomeroy on Contracts (2d. Ed.) § 126:
"The making of valuable permanent improvements on the land by a vendee or lessee, in pursuance of the agreement, and with the knowledge of the other party, is always considered to be the strongest and most unequivocal act of part performance by which a verbal contract to sell and convey, or to lease, is taken out of the statute. It is very plain that such proceedings satisfy the equitable principle upon which the doctrine of part performance rests, much more completely than a mere possession does. If the purchaser has simply taken possession, it might seem possible for him to be restored to his former situation; but, when he has made outlays for valuable and permanent improvements, and thus changed the character of the property, it would be in the highest degree unjust for the owner, who has permitted these expenditures and alterations to be made in reliance upon the agreement, to interpose the statute and prevent the completion of his contract, and at the same time retain and enjoy all the benefit of the additional value imparted to his land. For these reasons, the courts have never hesitated to assert and enforce the rule as above stated."
In 36 Cyc. at page 656, the author states the rule as follows:
"Possession taken in pursuance of the contract and payment of the purchase price in full or in part, followed by valuable improvements, together constitute a part performance which is recognized as sufficient whenever the doctrine is not wholly rejected."
Even in the case of a parol gift of land, followed by possession and valuable permanent improvements by the donee, in reliance upon the gift, specific performance will be enforced. 25 R.C.L. p. 279; 36 Cyc. 681; Pomeroy on Contracts, supra, § 130.
The rule above stated prevails in nearly every jurisdiction of the country. The exceptions, as stated by Cyc, supra, in the note at page 658, are Massachusetts, 8 Pennsylvania, and probably Virginia. See, also, Price v. Lloyd, 31 Utah, 86, 86 P. 767, L.R.A. (N.S.) 870, Hargreaves v. Burton, 59 Utah, 575, 206 P. 262, 33 A.L.R. 1481, and exhaustive notes commencing on page 1489.
While in each of the Utah cases specfic performance was denied, yet the law as to what constitutes part performance is clearly stated. The note to A.L.R. supra, is exhaustive, and appears to cover the whole field of the law applicable to the instant case.
Under all of the authorities above cited, which also reflect the great and overwhelming weight of authority, both in this country and in England, in this class of cases, the plaintiff herein is clearly entitled to the relief prayed for in his complaint.
The judgment of the trial court is therefore affirmed, at appellants' costs.
GIDEON, C.J., and FRICK, CHERRY, and STRAUP, JJ., concur.


text:
Local tumor control of thoracoabdominal wall seeding tumor from hepatocellular carcinoma with ultrasound-guided interventional treatment: A summarized study
Chao An, Xin Li, Ping Liang, Jie Yu, Zhigang Cheng, Zhiyu Han, Mengjuan Mu
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
Date of Web Publication 1-Apr-2019
Dr. Jie Yu
Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853
Dr. Ping Liang
DOI: 10.4103/jcrt.JCRT_784_18
> Abstract
Objective: The aim of the study is to evaluate the effectiveness of ultrasound (US)-guided interventional treatments in local tumor control (LTC) for thoracoabdominal wall seeding tumor (TAWST) from hepatocellular carcinoma (HCC), and explore the survival outcomes of the patients underwent surgical resection (SR) and microwave ablation (MWA) for intrahepatic tumor.
Materials and Methods: A total of 40 patients with 47 TAWST from HCC were recruited from April 2007 to May 2018. LTC was evaluated by contrast-enchanced image. Long-time survival outcomes were compared. Overall survival (OS), disease-free survival (DFS), and local seeding progress-free survival (LSPFS) were analyzed.
Results: One-year LTC rate was 65.2% in all patients; 72%, 0%, 50%, and 0% in the patients who underwent MWA, high-intensity focused US, iodine-125 (125I) brachytherapy and MWA combined with 125I brachytherapy, respectively. The 3-year OS, DFS rates and LSPFS rates were 51.8% and 28.6%, 12.0% and 23.8%, and 10.0% and 10.0% after MWA and SR, respectively. Univariate analysis results showed that age (P = 0.049), Karnofsky performance scale (KPS) (P = 0.002), and chemoradiation (P = 0.032); and multivariate analysis results showed that age (P = 0.045) and KPS (P = 0.010) might be predictors for LCT. While univariate analysis results showed that KPS (P = 0.032), intrahepatic tumor size (P = 0.006), chemoradiation (P = 0.003), preoperative alpha-fetoprotein level (P = 0.007), metastasis (P = 0.049), and albumin-bilirubin grade (P = 0.002), and multivariate analysis results showed that comorbidities (P = 0.004), KPS (P = 0.007), and metastasis (P = 0.009) might be predictors for OS. The pain degree of patients was improved obviously after treatments.
Conclusions: US-guided interventional treatments were an effective option in LTC for TAWST from HCC, and MWA could achieve comparable long-time survival outcomes with SR for HCC patients with TAWST.
Keywords: Hepatocellular carcinoma, high-intensity focused ultrasound, iodine-125 brachytherapy, microwave ablation, thoracoabdominal wall seeding tumor
An C, Li X, Liang P, Yu J, Cheng Z, Han Z, Mu M. Local tumor control of thoracoabdominal wall seeding tumor from hepatocellular carcinoma with ultrasound-guided interventional treatment: A summarized study. J Can Res Ther 2019;15:404-14
An C, Li X, Liang P, Yu J, Cheng Z, Han Z, Mu M. Local tumor control of thoracoabdominal wall seeding tumor from hepatocellular carcinoma with ultrasound-guided interventional treatment: A summarized study. J Can Res Ther [serial online] 2019 [cited 2019 Jul 19];15:404-14. Available from: http://www.cancerjournal.net/text.asp?2019/15/2/404/255106
> Introduction
Hepatocellular carcinoma (HCC) is one of the most common malignancies with increasing incidence in China, which is closely related with viral hepatitis B and C infection.[1],[2],[3] Thoracoabdominal wall seeding tumor (TAWST) from HCC is considered to represent highly advanced disease stage, resulting from poorly controlled intrahepatic tumor, which occasionally emerges after the percutaneous procedures or surgery.[4],[5],[6],[7] Currently, most studies report that the main treatment for seeding is surgical resection (SR); however, some patients have advanced tumor stage that is inoperable or requires surgical reconstruction because of its large size and invaded muscle of seeding lesion.[8],[9] By contrast, ultrasound (US)-guided interventional treatments appear as therapeutic alternatives for TAWST with the advantages of being minimally invasive, less expensive, and enabling a shorter hospital stay.[10],[11]
Limited reports have provided some evidence for the efficacy of surgery or interventional treatment for TAWST from HCC. Takemura et al.[12] reported that SR of the thoracoabdominal wall in HCC metastasis could provide acceptable long-term survival as long as the intrahepatic lesions are controlled. The cumulative 1-, 3-, and 5-year overall survival (OS) rates were 71%, 44%, and 39%, respectively, with a median survival time of 34.5 months. Previously, the results of SR and microwave ablation (MWA) for TAWST were compared in a retrospective study by our group,[13] and the cumulative 1-, 3-, and 5-year OS rates were 82.6%, 73.5%, and 63% in the MWA group, and 72.2%, 56.1%, and 48.8% in SR group, respectively. However, this study was mainly focused on survival outcomes for patients; local tumor control (LTC) and the improvement to the physical status of the patients were not studied.
Recently, US-guided MWA, radiofrequency ablation, iodine-125 (125I) seed implantation, and high-intensity focused US (HIFU) in the treatment of TAWST had been reported to hold therapeutic effectiveness against solid malignancies.[14],[15],[16],[17] Thermal ablation has shown promise with respect to LTC and its minimally invasive advantages, but care must be taken to avoid burning adjacent tissue and skin. 125I seed implantation is a form of radiotherapy for unresectable tumor in trouble position. LTC was demonstrated to be improved with fewer complications using the modality that continuously delivers low doses of X-rays inside the tumor. Finally, HIFU can yield thermal coagulation necrosis of a target lesion without surgical exposure or insertion of applicators. Effective LTC was obtained though HIFU energy delivered from a US transducer. However, there is a paucity of data on the effectiveness of locally directed treatment of TAWST.
The purpose of this study was to evaluate the effectiveness of US-guided interventional treatment of LTC for TAWST from HCC. In addition, a retrospective study was performed to explore the long-time survival outcomes of HCC patients with TAWST who underwent initial SR and MWA for intrahepatic tumors.
> Materials and Methods
Patients and primary tumors
This study is a retrospective analysis, approved by our Institutional Review Board. Each patient obtained informed consent for treatment procedures. The medical records of all HCC patients with thoracoabdominal wall seeding between April 2007 and May 2018 were reviewed. The eligibility criteria are selected as follows: (1) the entire TAWST could be showed clearly but US, (2) maximum diameter of TAWST ≤5 cm and the number <3, (3) Child-Pugh class A or B, (4) absence of hydrothorax or ascites, and (5) patients refused to receive surgery. The exclusion criteria are as follows: (1) severe cardiopulmonary disease, (2) severe coagulation abnormalities (prothrombin time >25 s, prothrombin activity >40%, and platelet count >40 cells × 109/L), and (3) serious infection. All selected patients accept US-guided interventional treatment due to tumor stage which made them inoperable or had comorbidities, advanced age, or refused to undergo SR. All thoracoabdominal wall nodules were seeding metastasis.
During the study period, 3718 patients with 4424 HCCs who underwent various treatments, including SR, MWA, and so on in our hospital. Among them, 40 patients with 47 lesions (mean age: 56.4 years ± 9.9; range, 30–73 years) met the inclusion criteria and were included in our study. In addition, each patient received a Karnofsky performance scale (KPS) score to show his physical condition before the treatment.[18] In all, ten patients with ten intrahepatic primary tumors accept SR, and 30 patients with 36 intrahepatic primary tumors accept US-guided MWA. The diagnosis of HCC was confirmed by pathologic findings in all patients from the SR group. For the MWA group, the diagnosis of HCC was based on pathologic findings of needle biopsy samples before ablation.
The following demographic and clinicopathologic parameters was obtained from each patient [Table 1]: Age, gender, comorbidities, etiology, and cirrhosis; Child-Pugh grade, maximum diameter of the intrahepatic lesion, number of intrahepatic lesions, pathologic differentiation, and seeding characteristics; chemoradiation, metastasis, local tumor progression (LTP), and procedure session; and laboratory findings including alanine aminotransferase, aspartate aminotransferase, serum total bilirubin, serum albumin, and alpha-fetoprotein (AFP). The occur date and site of TAWST, and date and status on the last follow-up were collected. We also recorded the reasons for death.
Table 1: Baseline characteristics hepatocellular carcinoma patients with thoracoabdominal wall seeding tumor
Characteristics of seeding on the thoracoabdominal wall
About 47 TAWST were found after the treatment for intrahepatic primary tumors, and the median time was 29.1 months (range, 0.9–143.9 months). In all, 24 seeding lesions located on the abdominal wall and 23 on the thoracic wall; 45 seeding lesions appeared on the right side and two on the subxiphoid. The median maximum diameter of seeding lesion was 2.3 (0.8–5) cm. Thirty-five patients had single tumor, and five patients had multiple tumors. Nine patients with seeding lesions were found within 1 year, and the 31 patients were found ≥1 year. All seeding lesions were treated by US-guided interventional treatment as follows: 34 patients accepted MWA, six patients accepted 125I seed implantation, three patients accepted MWA combined with 125I brachytherapy, and four patients accepted HIFU. In the 47 seeding lesions, 40 underwent one session and seven by two sessions. Ten (25%) patients accept chemotherapy or radiation after seeding was eradicated.
Ultrasound-guided microwave ablation procedure
A KY2000 MW ablation system (Kangyou Medical Instruments, Nanjing, China) consisting of two independent MW generators, two flexible coaxial cables and two water-pumping machines, which could drive two 15-G cooled-shaft antennae simultaneously was used. Before treatment, all patients were scanned using contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) and US, and an appropriate puncture route was chosen by US. After local anesthesia with 1% lidocaine, US-guided biopsy was performed in 2–3 separate punctures using an automatic biopsy gun with an 18-G cutting needle. Subsequently, the antenna was inserted percutaneously into the tumor and placed at designated sites under US guidance. One antenna was inserted into the center of tumors <1.7 cm, and multiple antennae were inserted into tumors 1.7 cm or larger. Two antennae were used simultaneously during MW ablation to achieve a larger ablation zone. A power output of 50W for 10 min was routinely used during MWA. After all the punctures, intravenous anesthesia with a combination of propofol (Diprivan; Zeneca Pharmaceuticals, Wilmington, Del) and ketamine (Shuanghe Pharmaceuticals, Beijing, China) was administered through the peripheral vein. If the heat-generated hyperechoic water vapor did not completely encompass the entire tumor, prolonged microwave emission was applied until the desired temperature was reached. When the tumor was located not ≥5 mm from the skin surface or adjacent to bowel, gallbladder or other important tissues, the hydrodissection was executed [Figure 1]. In addition, microwave needle tract need to be ablated during the needle withdrawal. For tumors with subcutaneous invasion, an ice bag was placed on the skin to avoid scalding during MWA.
Figure 1: Treatment process of ultrasound-guided microwave ablation for seeding on the right thoracic wall combined with hydrodissection was showed. A hyperenhancement nodule of 3.1 cm × 2.7 cm × 2.3 cm was found on the right thoracic wall in the arterial phase contrast-enhanced ultrasound (a). Artificial pleural effusion was injected between tumor and skin, between tumor and thoracic wall (b and c). One antenna was inserted into the lesion and heat-generated hyperechoic water covered the tumor (d). Completed ablation zone was displayed in contrast-enhanced ultrasound (e)
Ultrasound-guided iodine-125 seed implantation procedure
All patients were scanned using contrast-enhanced CT or MRI before US-guided 125I seed implantation. A series of imaging data related with seeding before interventional treatment were converted to Digital Imaging and Communications in Medicine format and then imported into three-dimensional (3D) visualization treatment platform (made in Hokai company, Zhuhai, China). The system assisted the radiologist in 3D reconstruction of the seeding lesion, surrounding tissues, and vessels; calculation of the required number of 125I seeds; and planning of the needle insertion path [Figure 2]. 125I radioactive seed (29.6 MBq, 0.8 mCi) (Beijing Atom and High Technique Industries Inc., Beijing, China) has a half-life of 59.4 days with a low energy level of 27.4 KeV and the seed distance of 1 cm. Patient's position was dependent on the location of the tumors. Electrocardiography monitoring was used when necessary during the procedure. Conventional gray scale US or contrast-enhanced US (CEUS) was used to find a safe puncture path, and guide the procedure. An 18-G needle was placed into the tumor lesions, and the radioactive seeds were implanted using a Mick applicator and spaced at intervals of 1.0 cm using the same needle. After the seed implantation, the needle was withdrawn, and then the puncture point was sterilized with alcohol. The presence of abnormal effusion or hematoma around the treated lesion was checked with US.
Figure 2: Preoperative treatment planning for seeding on the abdominal wall used by the three-dimensional visualized seed planning and navigation system were showed
Ultrasound-guided microwave ablation combined with iodine-125 seed implantation procedure
According to preoperative planning based on size, shape, and location of seeding lesion in 3D visualization treatment platform, the protocols of MWA combined with 125I seed implantation were used. US-guided MWA for seeding lesion was applied, and postoperative evaluation was used by CEUS. The residual seeding lesion was treated by 125I seed implantation, which was arranged in a few days.
High-intensity focused ultrasound procedure
A HIFU system (model JC; Chongqing Haifu Technology, Chongqing, China) was used to treat the seeding lesions using real-time US guidance. The focused US energy is produced from a 20-cm diameter therapeutic transducer with a focal length of 120 mm operating at a frequency of 0.9 MHz. The focal region is 6.8 mm along the beam axis and 1.2 mm in the transverse direction. In the center of the HIFU transducer, a 5–8 MHz linear array diagnostic US probe is mounted coaxially as the imaging unit of the system to provide real-time imaging for targeting. The integrated transducer is immersed in a water reservoir filled with degassed water maintained at a temperature of 12°C–15°C. During treatment, the HIFU beam was directed upward toward the seeding lesion.
Imaging assessment of local tumor control
All postprocedure imaging to assessment of local seeding lesion control was retrospectively reviewed by two interventional radiologists who had 10 years of imaging diagnosis experience. LTP was defined based on imaging findings of irregular nodular, scattered, or eccentric pattern of peripheral enhancement around the local treatment zone on first posttreatment imaging within 60 days was considered residual seeding lesion (6.4%, 3/47). Any follow-up imaging of ≥60 days after local treatment was assessed for tumor progression. Enhanced US, CT, MRI, and PET/CT imaging was available for 53.2% (25/47), 23.4% (11/47), 63.8% (30/47), and 21.3% (10/47) of seeding lesions, respectively. If tumor progression and/or residual tumor were seen on initial follow-up imaging, duration of LTC was considered to be 0 days. If the patient died or was otherwise lost to follow-up, the duration of LTC was based on their last set of imaging showing no residual or recurrent disease.
Postprocedural observation and follow-up
Follow-up imaging was performed at 1, 3, 6, 9, and 12 months after interventional treatment for the 1st year and every 6 months thereafter. Thereafter, the follow-up visit covered several evaluations, including routine physical examination and laboratory tests such as total bilirubin, serum albumin, and tumor marker levels, and parameter related to liver function. Technique effectiveness was defined as the absence of contrast-enhancement on imaging in any area of the mass after 1 month. All these patients accepted preoperative and postoperative review by enhanced MRI and US shows in. Intervals for CT/MRI were shortened when levels of tumor marker were increased after the treatment. If no viable lesion was detected on CT/MRI (with enhancement in the arterial phase), the intrahepatic lesions were regarded as well controlled. If viable lesions were decreased or unchanged in size and number, the disease was considered as stable, whereas the presence of new lesions or an increase of at least 20% in the sum of the diameters of remnant intrahepatic viable lesions indicated a poor control. Complications were defined in line with the HCC ablation reporting standards.[19] Follow-up was closed until the last visit or on the time of death and seeding lesions progression.
Assessment of pain palliation
Pain scores were obtained for 57.4% (27/47) of treated seeding lesion before and 4 weeks after the procedure and were compared using the Mann–Whitney U-test. MWA was used for 66.7% (18/27) of lesions, 22.2% (6/27) were treated with 125I brachytherapy, and HIFU was used for 3.7% (1/27). Patients treated for pain palliation had a pain score of based on the Numerical Rating Scale (NRS; 10 points pain score with ten representing maximal pain) before treatment.[20] Successful pain palliation was defined as a decrease in NRS by ≥2. Pain increase was defined as any increase in NRS pain score after the treatment.
Data between the MWA and SR groups were compared with the Student's t-test. Continuous variables were analyzed by the Wilcoxon signed-rank test, and categorical variables were analyzed using either the Pearson's Chi-square test or the Fisher's exact test. OS, disease-free survival (DFS), and local seeding progress-free survival (LSPFS) were assessed by the Kaplan–Meier method with log-rank test. A Cox proportional hazards model was used to identify the significant effects of multiple factors on survival and local progress rate. Statistical analyses were performed using SPSS 19.0 (SPSS, Chicago, IL, USA). For all tests, P < 0.05 was considered to be statistically significant.
> Results
Local control of thoracoabdominal wall seeding tumor from hepatocellular carcinoma
Thirty-five TAWST were lost to follow-up at various time points. Local seeding lesions control results are summarized in [Table 2]. Over local control rates were 89.4%, 74.5%, 70%, 65.2%, 42.1%, and 33.3% in 3, 6, 9, 12 months, 2 and 3 years, respectively. The 3, 6, 9, 12 months, 2 and 3 years of LTC rates in TAWST from HCC were 91.2%, 79.4%, 68.7%, 60%, 22,6%, and 33.3% for MWA; 100%, 100%, 100%, 50%, 0%, and 0% for 125I brachytherapy; 50%, 50%, 25%, 25%, 0%, and 0% for HIFU; 100%, 80%, 80%, 70%, 33.3%, and 25% for local interventional treatment combined with chemoradiation, respectively.
Table 2: Cumulative local tumor control rates for thoracoabdominal wall seeding tumor from hepatocellular carcinoma patients after ultrasound-guided interventional treatments
Long-time outcomes of hepatocellular carcinoma patients with thoracoabdominal wall seeding tumor
The median follow-up period was 72.6 months (range, 14.5–172.5 months). The 1-, 3-, and 5-year cumulative OS rates were 100%, 83.1%, and 42.4%. The 1-, 3-, and 5-year cumulative DFS rates were 75%, 30%, and 10%. The 1-, 2-, and 3-year cumulative LSPFS rates were 65.0%, 45.0%, and 16.7%. The median follow-up period was 75.4 months (range, 16.5–172.5 months) in the MWA group, and 66.2 months (range, 14.5–143.5 months) in the SR group. Mortality rate was 26.7% (eight of 30 patients) in the MWA group, four patients (40%; four of 10 patients) died in the SR group, and the cause of death in both was HCC local or systemic progression. On the basis of follow-up imaging, 100% technique effectiveness was achieved in both groups (MWA: 30 of 30 treatments; SR: 10 of 10 treatments). The 1-, 2-, and 3-year cumulative LSPFS rates in the MWA group and SR group were 62.9%, 44.9%, and 12.0% and 71.4%, 47.6%, and 23.8%, respectively [Figure 3]a, showing no significant statistical difference (P = 0.732). The 1-, 3-, and 5-year cumulative OS rates in the MWA group and SR group were 100%, 82.9%, and 51.8% and 100%, 83.3%, and 28.6%, respectively. [Figure 3]b, showing no significant statistical difference (P = 0.879). The 1-, 3-, and 5-year cumulative DFS rates in the MWA group and SR group were 80%, 40%, and 10% and 70%, 10%, and 10%, respectively. [Figure 3]c, showing no significant statistical difference (P = 0.482).
Figure 3: The 1-, 2-, and 3-year cumulative local seeding progress-free survival rates in the microwave ablation group and surgical resection group were 62.9%, 44.9%, and 12.0% and 71.4%, 47.6%, and 23.8%, respectively (a). The 1-, 3-, and 5-year cumulative overall survival rates in the microwave ablation group and surgical resection group were 100%, 82.9%, and 51.8% and 100%, 83.3%, and 28.6%, respectively (b). The 1-, 3-, and 5-year cumulative disease-free survival rates in the microwave ablation group and surgical resection group were 80%, 40%, and 10% and 70%, 10%, and 10%, respectively (c)
Univariate and multivariate analysis multivariate analysis for local tumor control and overall survival in thoracoabdominal wall seeding tumor from hepatocellular carcinoma patients after ultrasound-guided interventional treatments
The univariate analysis [Table 3] showed statistically significant differences between groups in terms of local seeding progress rates, depending on the age (χ2 = 3.795; P = 0.049), KPS (χ2 = 9.511; P = 0.002), and chemoradiation (χ2 = 4.625 P = 0.032). The multivariate analysis [Table 3] showed that the factors that significantly affected the local seeding progress rate were age (P = 0.045) and KPS (P = 0.010). The univariate analysis [Table 4] showed statistically significant differences between groups in terms of OS rates, depending on the intrahepatic tumor size (P = 0.006), preoperative AFP level (P = 0.007), metastasis (P = 0.049), chemoradiation (P = 0.003), and albumin-bilirubin grade (P = 0.002). The multivariate analysis showed that the factors that significantly affected the survival rate were comorbidities (P = 0.004), KPS (P = 0.007), and metastasis (P = 0.009), [Table 4].
Table 3: Univariate and multivariate analysis of variables for local tumor control in thoracoabdominal wall seeding tumor from hepatocellular carcinoma patients after ultrasound-guided interventional treatments
Table 4: Univariate and multivariate analysis of variables for overall survival in thoracoabdominal wall seeding tumor from hepatocellular carcinoma patients after ultrasound-guided interventional treatments
Pain palliation
Median pain scores decreased from 6 (interquartile range: 5.0–9.0) to 3 (interquartile range: 1.0–4.0), 1 month after US-guided interventional treatment (P < 0.001). Remaining pain palliation results are summarized in [Table 5]. Moreover, one patient increased pain after therapy. A 65-year-old male with diabetes and the lesion measured 32.8 cm3 (MTD: 5.0 cm) and was treated with MWA with pre- and post-ablation pain scores of 4 and 7.
Table 5: The changes of pain degree in thoracoabdominal wall seeding tumor from hepatocellular carcinoma patients after ultrasound-guided interventional treatments
No mortality was directly related to any of treatment procedures. Two major complications (5%; two of 40 patients) occurred after US-guided interventional treatment with 50 sessions. These adverse events were abdominal wall edema which occurred in one patient and persistent pain in another patient who had diabetes.
Seeding lesions in thoracoabdominal wall are primarily induced by implanted tumor cells, which originate during the passageway of a needle or incision after the treatment.[21],[22],[23] The incidence of such a phenomenon, although very low, has a relatively high-reoccurrence rate. SR was the first choice for treatment of seeding on the chest or abdominal wall, although it carries a risk of hemorrhage and possible postoperative incisional hernia, and patients usually require further reconstruction, such as abdominoplasty.[24] In contrast, US-guided interventional treatment has minimally invasive characteristics, which is a better choice to treat our patients who had poor physical condition and immunologic status.[25]
According to seeding lesion size and location, three types of antennae, including 0.5, 0.7, and 1.1 cm of tips, were used in this study. Previous research reported that an antenna tip of 0.7 cm and 0.5 cm can ablate a diameter of 2.4–2.6 cm and 2.2–2.4 cm, respectively, in ex vivo porcine livers with an output power of 60 W and a setting time of 10 min.[26] Therefore, the ablation zone is relatively small, and hydro-dissection was used on our patients by injecting 0.9% saline between tumor and subcutaneous tissue which avoids burning the skin in the superficial tumor during the procedure.[27],[28] In addition, 125I seed implantation has emerged as another percutaneous treatment modality and has achieved good therapeutic effects for inoperable malignancies.[29],[30] In this study, we used 3D visualized seed planning, developed in our laboratory, to assist the operators in performing the 125I seed implantation procedure for the seeding lesion, and improve the efficiency and accuracy of implantation. For tumors with irregular shape or special position, we used this protocol that MWA for eradicate most proportion of seeding lesion and the remnant part implant 125I seed. Compared to the above-mentioned types of treatments, HIFU ablation is an extracorporeal treatment, which may become an attractive option for the treatment of seeding.
US-guided interventional treatment is a safe, effective therapy for achieving local control and pain palliation during seeding of the thoracoabdominal wall. Aggressive local treatment with the intent of achieving seeding lesion control has been performed for varying indications depending on the clinical circumstances. In this study, the 1-year overall local control rate for seeding that underwent interventional treatment was 65.2%. Among these minimally invasive treatments, MWA had the highest 1-year local control rate and there was no significant statistical difference between different interventional treatments in the follow-up period. Age and KPS had a significant impact on local seeding progression. These two factors can explain tumor recurrence associated with poor physical condition. Moreover, 60% (15/25) of lesions treated with MWA resulted in pain palliation at 1 month and local control at 3 months, suggestive of a correlation between these two goals of therapy.
In this study, ten patients with HC underwent SR and 30 patients underwent MWA. Seeding was found on the thoracoabdominal wall after 29.1 months and all patients accepted US-guided interventional treatment. Compared with SR, MWA had comparable long-term survival outcomes as patients with HCC seeding. The present study analyzed the prognostic factors associated with the survival of HCC patients with seeding. It is worthy of note that the time of seeding occurrence after initial treatment had no significant impact on both OS and DFS, suggesting that HCC implantation time had no associations with the patient survival. Fewer comorbidities, high KPS and metastasis were identified as factors predictive of prolonged OS. Metastasis was considered to represent less invasive biologic behavior of the tumor, and therefore correlated with improved survival.[31] Comorbidities and KPS indicate that immune surveillance and defense of patients enabled the immune system to eliminate the residual and migrating tumor cells. Ten patients accepted chemoradiation treatments including four with SR and six with MWA. Univariate analysis found that chemoradiation could prolong a patient survival which is a similar outcome as previously reported.[32]
There were two complications and not excluding skip burn. Given that we used 3D visualized seed planning and hydrodissection, the occurrence rate of skip burn should be reduced significantly and requires a larger sample size for further study. An important limitation of this study was its retrospective design with a relatively small patient series. A limited sample sizes may have reduced the statistical power of the comparative analysis so that some associations were not detected. Furthermore, the success of MWA was assessed by radiographic findings versus pathologic margin-free status. Therefore, despite intermediate follow-up being reported, it might take longer for radiographic techniques to detect MWA failures. Finally, besides HCC patients with seeding who underwent MWA, data on other treatment modalities were few.
> Conclusions
In summary, US-guided interventional treatments represent an effective option for the LTC from HCC. Finally, MWA had comparable long-term survival outcomes as SR for HCC patients with TAWST.
This work was supported by the National Key R&D Program of China (No. 2017YFC0112000), three grants 81430039, 81627803, and 81801723 from the National Scientific Foundation Committee of China; 2017FC-CXYY-3005 from the Clinical Research Support Foundation of the Chinese, PLA General Hospital.
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An C
Li X
Liang P
Yu J
Cheng Z
Han Z
Mu M
high-intensity focused ultrasound
iodine-125 brachytherapy
microwave ablation
thoracoabdominal wall seeding tumor
>Abstract
>Introduction
>Materials and Me...
>Results
>Discussion
>Conclusions
>References
>Article Figures
>Article Tables
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