Efficiency of Staging Work-Ups in the Evaluation of Carcinoma of the Uterine Cervix

International Nuclear Information System (INIS)

Kim, Jae Sung; Ha, Sung Whan

1991-01-01

A series of 510 patients with carcinoma of the uterine cervix given the curative radiation therapy from March 1979 through December 1986 was evaluated to determine the value of intravenous pyelography(IVP), cystoscopy, sigmoidoscopy, and abdomino-pelvic CT as staging work-up prior to treatment. On IVP and cystoscopy, 10.7%(49/456) and 5/3%(24/452) showed abnormality, respectively, but only 0.7% (3/413) did on signoidoscopy. As a result of these work-ups prerequisite to FIGO staging, twenty six (5.1%) out of 510 patients were upstaged from the stage determined by the findings of physical examination alone. The proportions of upstaging in each stage were as follows none in stage IB(35), IIA (89) and IIIA(8), 7.9%(20/252) in stage IIB(14 patients to FIGO Stage IIIB, 6 patients to FIGO stage IVA), and 4.8% (6/126) in stage IIIB (all to FIGO stage IVA). Positive findings of staging work-ups were found only in patients with advanced stages of stage IIB or over determined by physical examination alone but not in those with earlier stages. CT was performed in 337 patients. CT detected pelvic lymph node (LN) enlargement in 25.2% (85/337) and paraaortic LN enlargement in 7.4% (25/337). Pelvic LN positivity was well correlated with increasing stage but paraaortic LN positivity was not. In the evaluation of parametrial involvement, CT findings were in accordance with those of physical examination only in 65.6%(442/674). When compared with endoscopic studies, CT had much lower positive predictive value than negative predictive value in the evaluation of adjacent organ invasion. The staging work-ups should be individualized by the disease extent of each patient, and then the efficiency of work-ups may be increased without compromising the appropriate FIGO staging and treatment

Radical surgery for early stage cervical cancer

NARCIS (Netherlands)

Derks, M.

2017-01-01

Cervical cancer is one of the most common malignancies in women worldwide. Due to an effective screening programme, in the Netherlands cervical cancer is often detected in early stages of disease. For early stage (International Federation of Gynaecology and Obstetrics (FIGO) stage IB/IIA) cervical

Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT in patients with advanced ovarian cancer stage FIGO III - The OVAR-IMRT-02 Study

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Eichbaum Michael H

2011-01-01

Full Text Available Abstract Background The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. Methods/design The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border, heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Discussion Intensity-modulated WAR provides

Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT) in patients with advanced ovarian cancer stage FIGO III - The OVAR-IMRT-02 Study

International Nuclear Information System (INIS)

Rochet, Nathalie; Debus, Juergen; Kieser, Meinhard; Sterzing, Florian; Krause, Sonja; Lindel, Katja; Harms, Wolfgang; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof

2011-01-01

The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border), heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Intensity-modulated WAR provides a new promising option in the consolidation treatment of

Mapping the extent of disease by multislice computed tomography, magnetic resonance imaging and sentinel node evaluation in stage I and II cervical carcinoma

Directory of Open Access Journals (Sweden)

Rajaram S

2010-01-01

Full Text Available Aims: (1 To map the extent of disease in women with stage I and II carcinoma cervix by multislice spiral computed tomography (CT, magnetic resonance imaging (MRI and sentinel nodes. (2 To assess accuracy of each modality individually and in conjunction with FIGO clinical staging. Design and Setting: Prospective, single-blind study. Departments of Obstetrics and Gynaecology, Radiodiagnosis, and Pathology, UCMS and GTBH and Division of Radiological Imaging and Bioinformatics, INMAS, Delhi. Material and Method: The study was conducted on 25 women with cervical cancer FIGO stage I and II. Each woman underwent clinical staging, multislice spiral CT and MRI which was compared to the gold-standard histopathology/cytology. The overall accuracy of each modality and improvement of clinical staging by CT/MRI were noted. Sentinel nodes were evaluated by intracervical Patent Blue V dye injection. Statistical Analysis: Sensitivity, specificity, positive and negative predictive values were calculated by 2Χ2 contingency tables. Results: The accuracy of staging by FIGO, CT and MRI was 68%, 52% and 80%, respectively. MRI and CT improved the overall accuracy of FIGO staging to 96% and 80%, respectively. Sentinel nodes were identified in 89% of patients with 91% accuracy. Conclusion: MRI emerges as the most valuable stand-alone modality improving accuracy of FIGO staging to 96%. Sentinel lymph-node evaluation appears promising in evaluating spread beyond cervix.

Distribution of causes of abnormal uterine bleeding using the new FIGO classification system

International Nuclear Information System (INIS)

Qureshi, F.U.; Yusuf, A.W.

2013-01-01

Objective: To categorise all women with Abnormal Uterine Bleeding attending a tertiary care centre according to new classification system by the International Federation of Gynaecology and Obstetrics (FIGO). Methods: The descriptive cross-sectional study comprised all non-gravid women of reproductive age with unpredictable, excessive duration, abnormal volume, and/or abnormal frequency of menses for at least 3 months coming to the outpatient department of Lady Willingdon Hospital, Lahore, from August 2010 to July 2011. The subjects underwent structured history, physical examination and pelvic ultrasonography. Endometrium and hysterectomy specimen were obtained for histopathology where applicable. Possible underlying causes were categorised according to the new classification system. Results: A total of 2109 women comprised 19.6% of total of the 10712 woman who visited the gynecological outpatients clinic, 2109(19.6%) had abnormal uterine bleeding. PALM-COEIN categorization done in 991(47%) cases that showed 30(3%) polyp, 15(15%) adenomyosis, 250(25%) leiomyoma, 66(6.6%) malignancy and hyperplasia, 3(0.3%) coagulopathy, 236(24%) ovulatory dysfunction, 48(5%) endometritis, and 53(6%) iatrogenic. The remaining 155(15%) cases were uncategorised. Conclusion: The classification should facilitate multi-institutional investigation into the epidemiology, etiology and treatment of women with Abnormal Uterine Bleeding. (author)

PREFERÊNCIA SENSORIAL DE COMPOTA E DOCE DE FRUTA EM CALDA ELABORADOS COM FIGO EM FUNÇÃO DO MODO DE PREPARO

OpenAIRE

Caetano, Priscilla Kárim; FCA/UNESP; Mendonça, Veridiana Zoocoler de; FCA/UNESP; Daiuto, Érica Regina; Faculdade de Ciências Agronômicas (FCA/UNESP-Botucatu); Vieites, Rogério Lopes; FCA/UNESP

2015-01-01

Objetivou-se nesta pesquisa verificar a preferência sensorial entre compota e doce em calda de figo calda em função do modo de preparo. Foram realizados três tratamentos: compota de figo - tratamento térmico por 20 minutos, sem cozimento do fruto na calda (T1), doce de figo em calda - tratamento térmico dos frutos por 10 minutos e cozimento dos frutos na calda por 10 minutos (T2) e doce de figo em calda - sem tratamento térmico e cozimento do fruto na calda por 20 minutos (T3).  A calda utili...

Produtividade e qualidade de figos Roxo de Valinhos submetidos à fertirrigação e ao armazenamento refrigerado

Directory of Open Access Journals (Sweden)

Diniz Fronza

2010-08-01

Full Text Available A baixa produtividade de figos no Brasil geralmente está relacionada com as deficiências hídrica e nutricional. Este trabalho teve como objetivo avaliar o efeito da fertirrigação com doses de nitrogênio e potássio sobre a produtividade e qualidade dos figos do cultivar Roxo de Valinhos durante o armazenamento refrigerado. O experimento de campo foi realizado durante dois anos, e que no último ano os frutos foram armazenados na temperatura de 0,5 °C por 15 dias. Os tratamentos consistiram da combinação das doses de 150, 250, 350 e 450 kg ha-1 de nitrogênio (N e 150, 250 e 350 kg ha¹ de potássio (K fornecidas via fertirrigação. Segundo os resultados, doses de até 250 kg ha-1 de N e K na fertirrigação elevam a produtividade de figos Roxo de Valinhos, e estas doses conduzem a maior produtividade entre os tratamentos avaliados. A fertirrigação aumentou em 96,7% a produtividade de figos verdes e 49% a de figos maduros em comparação ao tratamento padrão. Os níveis de N, K e a forma de aplicação não influenciam a qualidade dos frutos durante o armazenamento refrigerado.

Crescimento, produção e qualidade de frutos da bananeira 'Figo cinza', em Botucatu-SP Growth, yield and quality of 'Figo cinza' banana fruits in Botucatu-SP

Directory of Open Access Journals (Sweden)

Dayana Portes Ramos

2009-09-01

Full Text Available A bananeira Figo Cinza é uma cultivar do grupo ABB, subgrupo Figo, que apresenta tolerância ao mal-do-panamá e às sigatokas amarela e negra, demonstrando ser uma cultivar interessante para programas de melhoramento genético. Devido a isso, o presente trabalho teve como objetivo avaliar características do 1º ciclo da planta, como o crescimento, produção e atributos físico-químicos dos frutos dessa cultivar, no município de Botucatu-SP. Foram avaliadas as seguintes características de crescimento: altura de plantas, circunferência do pseudocaule e número de folhas, medidas na época de emissão da inflorescência; número de dias entre o plantio e o florescimento, número de dias entre o florescimento e a colheita, e número de dias do plantio à colheita. Também foram mensuradas as seguintes características de produção: peso do cacho, número de frutos, peso médio dos frutos, número de pencas e produtividade; na 2ª penca foram avaliados peso, número, comprimento e diâmetro dos frutos. Os atributos fisico-químicos analisados foram: textura, pH, acidez titulável, sólidos solúveis, açúcares totais, amido e teor de potássio. Foi utilizado o método das estatísticas descritivas para a caracterização da cultivar, através dos cálculos das médias. Os resultados mostraram que 'Figo Cinza' apresentou porte médio (2,9 m, ciclo de 420 dias, produtividade média de 12,74 t ha -1 e frutos com baixa acidez (0,06%.'Figo Cinza' is a cultivar of the genomic group ABB, Figo subgroup, which provides tolerance to Panama and Sigatoka diseases that may be useful in genetic breeding programs. Then, this work aimed to evaluate the plants growth, production and also the physical and chemical characteristics of the fruits from this cultivar in Botucatu city, São Paulo state, Brazil. Some growth characteristics were evaluated such as: plant height, the pseudostem circumference, number of leaves, number of days between planting and

Diagnostic imaging in the staging of gynecologic cancers

International Nuclear Information System (INIS)

Forstner, R.; Graf, A.

1999-01-01

The prognosis in patients with gynecologic cancers depends not only on the stage but also on a wide spectrum of other findings. Cross-sectional imaging modalities, including sonography, CT and MRI, have increasingly been used for optimal treatment planning in gynecologic cancers. Their staging criteria are based on the well-established FIGO staging system. CT and MRI compete with sonography, which plays a pivotal role in the valuation of the female pelvis. This paper reviews the role of sonography, CT and MRI in the staging of gynecologic malignancies. It puts the emphasis on MRI, which has been established as imaging modality of choice in the preoperative evaluation of cervical and endometrial cancer, and which seems slightly superior to CT in the staging of ovarian cancer. (orig.) [de

Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

Science.gov (United States)

Slinger, Gillian; Trautvetter, Lilli; Browning, Andrew; Rane, Ajay

2018-06-01

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. © 2018 International Federation of Gynecology and Obstetrics.

Adjuvant whole abdominal intensity modulated radiotherapy (IMRT) for high risk stage FIGO III patients with ovarian cancer (OVAR-IMRT-01) – Pilot trial of a phase I/II study: study protocol

International Nuclear Information System (INIS)

Rochet, Nathalie; Jensen, Alexandra D; Sterzing, Florian; Munter, Marc W; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

2007-01-01

The prognosis for patients with advanced epithelial ovarian cancer remains poor despite aggressive surgical resection and platinum-based chemotherapy. More than 60% of patients will develop recurrent disease, principally intraperitoneal, and die within 5 years. The use of whole abdominal irradiation (WAI) as consolidation therapy would appear to be a logical strategy given its ability to sterilize small tumour volumes. Despite the clinically proven efficacy of whole abdominal irradiation, the use of radiotherapy in ovarian cancer has profoundly decreased mainly due to high treatment-related toxicity. Modern intensity-modulated radiation therapy (IMRT) could allow to spare kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. The OVAR-IMRT-01 study is a single center pilot trial of a phase I/II study. Patients with advanced ovarian cancer stage FIGO III (R1 or R2< 1 cm) after surgical resection and platinum-based chemotherapy will be treated with whole abdomen irradiation as consolidation therapy using intensity modulated radiation therapy (IMRT) to a total dose of 30 Gy in 1.5 Gy fractions. A total of 8 patients will be included in this trial. For treatment planning bone marrow, kidneys, liver, spinal cord, vertebral bodies and pelvic bones are defined as organs at risk. The planning target volume includes the entire peritoneal cavity plus pelvic and para-aortic node regions. The primary endpoint of the study is the evaluation of the feasibility of intensity-modulated WAI and the evaluation of the study protocol. Secondary endpoint is evaluation of the toxicity of intensity modulated WAI before continuing with the phase I/II study. The aim is to explore the potential of IMRT as a new method for WAI to decrease the dose to kidneys, liver, bone marrow while covering the peritoneal cavity with a homogenous dose, and to implement whole abdominal intensity-modulated radiotherapy into the adjuvant multimodal

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer.

Science.gov (United States)

Frielink, Lindy M J; Pijlman, Brenda M; Ezendam, Nicole P M; Pijnenborg, Johanna M A

2016-01-01

Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome. © 2016 S. Karger AG, Basel.

FIGO IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy

International Nuclear Information System (INIS)

Logsdon, Mark D.; Eifel, Patricia J.

1999-01-01

Purpose: To define patient, tumor, and treatment factors that influence the outcome of patients with FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix. Methods and Materials: The records of 1,096 patients treated with radiation therapy between 1960 and 1993 for FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix were reviewed retrospectively. Of these, 983 (90%) were treated with curative intent and 113 were treated only to achieve palliation of symptoms. Of 907 patients who completed the intended curative treatment, 641 (71%) were treated with a combination of external beam irradiation (EBRT) and intracavitary irradiation (ICRT) and 266 (29%) were treated with EBRT only. The median duration of treatment for these 907 patients was 51 days. Between 1966 and 1980, only 52% of patients who completed treatment with curative intent received ICRT, compared with 92% of patients treated during 1981-1993, an increase that reflects an evolution in the philosophy of treatment for advanced tumors. In general, the intensity of ICRT correlated inversely with the dose of EBRT to the central pelvis. Median follow-up of surviving patients was 134 months. Results: For 983 patients treated with initial curative intent, disease-specific survival (DSS) was significantly worse for those who were 52 Gy of EBRT to the central pelvis had DSS rates of 27-34%, compared with 53% for patients treated with lower doses of EBRT to the central pelvis and more intensive ICRT (p 52 Gy of EBRT to the central pelvis (57-68%), compared with those who had 48-52 Gy (28%) and those who had ≤ 47 Gy of EBRT to the central pelvis (15%) (p < 0.0001). Outcome was also compared for four time periods during which different treatment policies were in place for patients with Stage IIIB disease. The highest DSS (51%) and lowest actuarial complication rate (17%) were achieved during the most recent period (1981-1993) when modest doses of EBRT were combined with relatively

Abridged republication of FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum.

Science.gov (United States)

Prat, Jaime

2015-10-01

Ovarian, fallopian tube, and peritoneal cancers have a similar clinical presentation and are treated similarly, and current evidence supports staging all 3 cancers in a single system. The primary site (i.e. ovary, fallopian tube, or peritoneum) should be designated where possible. The histologic type should be recorded. Intraoperative rupture ("surgical spill") is IC1; capsule ruptured before surgery or tumor on ovarian or fallopian tube surface is IC2; and positive peritoneal cytology with or without rupture is IC3. The new staging includes a revision of stage III patients; assignment to stage IIIA1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination. Extension of tumor from omentum to spleen or liver (stage IIIC) should be differentiated from isolated parenchymal metastases (stage IVB). © 2015 American Cancer Society.

Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years.

Science.gov (United States)

Munro, Malcolm G

2017-04-01

The FIGO systems defining the nomenclature and symptoms of abnormal uterine bleeding (AUB) in the reproductive years (System 1) and the PALM-COEIN classification of causes of AUB (System 2) are designed to facilitate research, education, and the provision of optimum clinical care for affected women. Development of these systems has been the result of a collaborative effort of experts in bench and translational and clinical research from six continents aided by a spectrum of representatives from relevant medical societies, journals, and regulatory bodies. Integral to this development has been a decision to cease the use of poorly defined and inconsistently used terms such as menorrhagia, metrorrhagia, and dysfunctional uterine bleeding, to name a few, and replace them with a set of terms and definitions that are relatively easily understood and translated into the spectrum of languages used by medical providers and patients globally. The utilization of these systems requires a disciplined approach to obtaining a menstrual history, relatively simple laboratory investigations, and the appropriate use of imaging techniques accessible to most clinicians worldwide. This section describes the two systems, their crucial role in guiding investigation, and an approach to implementation, all designed to facilitate the creation of a menu of therapeutic options, considering the identified factors contributing to the problem of nongestational AUB. Copyright © 2016. Published by Elsevier Ltd.

MR staging of endometrial carcinoma

International Nuclear Information System (INIS)

Innocenti, P.; Agostini, S.; Erroi, C.; Ambrogetti, D.; Cellerini, A.; Nori, J.

1991-01-01

Biopsy is the technique of choice for the definitive diagnosis of endometrial carcinoma. Since lymphatic tumor spread has been demonstrated to depend on the degree of myometrial involvement, the definition of the latter with imaging techniques may significantly affect both pfognosis and therapy. We investigated, by means of MR imaging at 0.5 T, 14 patients with endometrial carcinoma, to assess both tumor stage and myometrial involvement. FIGO staging system was employed, and M parameter evaluated (M0= no myometrial involvement; M1involvement confined to the inner third; M2= Involvement confined to the middle third; M3= involvement of the whole myometrium). Another parameter was the characteristic high signal of the tumor on PD and T2W images. The patients were then operated and MR information was correlated with surgical findings. Overall diagnostic accuracy of MR imaging was 85.7% in tumor staging, and 92.2% in defining M parameter. Tumor spread into adnexa and into cervical canal was poorly demonstrated by MR imaging

Revised FIGO staging system for cancer of the ovary, fallopian tube, and peritoneum: important implications for radiologists.

Science.gov (United States)

Saida, Tsukasa; Tanaka, Yumiko Oishi; Matsumoto, Koji; Satoh, Toyomi; Yoshikawa, Hiroyuki; Minami, Manabu

2016-02-01

Ovarian cancer is the seventh most common cancer diagnosis among women worldwide. The International Federation of Gynecology and Obstetrics recently significantly revised staging criteria for cancer of the ovary. The latest revision was based on the concept that high-grade serous tubal intraepithelial carcinoma (STIC) may be the origin of some high-grade serous carcinomas of the ovary and peritoneum. Therefore, staging criteria for the ovary, fallopian tube, and peritoneum have been unified. Understanding this background and other important revised points are essential for radiologists concerned with imaging diagnosis in gynecologic oncology. Through this review, we introduce the STIC theory and show examples of diseases in accordance with the new staging criteria based on magnetic resonance imaging (MRI) and computed tomography (CT) results.

Phase II study of a trimodal preoperative treatment followed by radical surgery or radiotherapy in non-resectable cervical cancer ≥ Figo IIB

International Nuclear Information System (INIS)

Cho, C.; Gellermann, J.; Jungnickel, K.; Kuemmel, S.; Hildebrandt, B.; Wust, P

2005-01-01

Full text: Regional hyperthermia is combined with radiochemotherapy to achieve resectability in non-resectable cervical carcinoma. In a phase II study at the Charite Medical School approved by the institutionals ethical committee non-resectable cervical carcinoma of at least FIGO IIB were treated with radiochemotherapy combined with regional hyperthermia. The treatment concept comprises cisplatinum therapy of 40 mg/sqm body surface once weekly during regional hyperthermia supplementing radiation therapy of 5 x 1.8 Gy to a total dose of 45 - 50.4 Gy. A gynecological status and imaging is performed for evaluation of resectability of the tumor. If a tumor resection was not feasable radiation was completed to 59.4 - 63 Gy supplemented by 4 - 5 afterloading sessions. Regional hyperthermia was conducted with SIGMA 60 or SIGMA Eye applicator of the system BSD-2000, on average steady state temperatures between 40-41 o C were achieved over the therapeutic time. From 2000 to 2003 we recruited 30 patients. Acute toxicity was in the usual range (10-15 % grade ≥ 3). Two thirds were FIGO stage III/IV with tumor diameters > 6 cm. After treatment 20/30 (67 %) of the former inoperable cases were evaluated as resectable, 3 of these patients refused surgery. Of the remaining 17 cases 14 patients were R0-resected, 2 patients were R1-resected, and 1 patient had a positive paraaortal lymphnode. In 13/30 patients nonsurgical treatment was continued. Response was achieved in 23/30 patients (77 %), i.e. 14 resectable cases with downstaging and 9 partial remissions (PR) after hyperthermic radiochemotherapy with 45 - 50.4 Gy. Response correlated well with thermal parameters, in particular the mean temperature in the vaginal reference point. For the whole group a three year overall survival of 60 % was achieved together with a moderate late toxicity ≥ 3 in 4/30 patients (13 %). R0-resected patients have an excellent prognosis with a 3-year survival of 95 % and a late toxicity ≥ 3 below

Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT)

DEFF Research Database (Denmark)

Schou Karlsen, Nikoline Marie; Karlsen, Mona Aarenstrup; Høgdall, Estrid

2016-01-01

.1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour...... presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. CONCLUSIONS...

Effective treatment of Stage I uterine papillary serous carcinoma with high dose-rate vaginal apex radiation (192Ir) and chemotherapy

International Nuclear Information System (INIS)

Turner, Bruce C.; Knisely, Jonathan P. S.; Kacinski, Barry M.; Haffty, Bruce G.; Gumbs, Andrew A.; Roberts, Kenneth B.; Frank, Alex H.; Peschel, Richard E.; Rutherford, Thomas J.; Edraki, Babak; Kohorn, Ernest I.; Chambers, Setsuko K.; Schwartz, Peter E.; Wilson, Lynn D.

1998-01-01

Purpose: Uterine papillary serous carcinoma (UPSC) is a morphologically distinct variant of endometrial carcinoma that is associated with a poor prognosis, high recurrence rate, frequent clinical understaging, and poor response to salvage treatment. We retrospectively analyzed local control, actuarial overall survival (OS), actuarial disease-free survival (DFS), salvage rate, and complications for patients with Federation International of Gynecology and Obstetrics (FIGO) (1988) Stage I UPSC. Methods and Materials: This retrospective analysis describes 38 patients with FIGO Stage I UPSC who were treated with the combinations of radiation therapy, chemotherapy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy (TAH/BSO), with or without a surgical staging procedure. Twenty of 38 patients were treated with a combination of low dose-rate (LDR) uterine/vaginal brachytherapy using 226 Ra or 137 Cs and conventional whole-abdomen radiation therapy (WART) or whole-pelvic radiation therapy (WPRT). Of 20 patients (10%) in this treatment group, 2 received cisplatin chemotherapy. Eighteen patients were treated with high dose-rate (HDR) vaginal apex brachytherapy using 192 Ir with an afterloading device and cisplatin, doxorubicin, and cyclophosphamide (CAP) chemotherapy (5 of 18 patients). Only 6 of 20 UPSC patients treated with combination LDR uterine/vaginal brachytherapy and conventional external beam radiotherapy underwent complete surgical staging, consisting of TAH/BSO, pelvic/para-aortic lymph node sampling, omentectomy, and peritoneal fluid analysis, compared to 15 of 18 patients treated with HDR vaginal apex brachytherapy. Results: The 5-year actuarial OS for patients with complete surgical staging and adjuvant radiation/chemotherapy treatment was 100% vs. 61% for patients without complete staging (p = 0.002). The 5-year actuarial OS for all Stage I UPSC patients treated with postoperative HDR vaginal apex brachytherapy and systemic chemotherapy was 94

Uterus and vagina. TNM classification of malignant tumours

International Nuclear Information System (INIS)

Harmer, M.H.

1984-01-01

Cervix uteri and Corpus uteri were amongst the first sites to be classified by the TNM system. The ''League of Nations'' Stages for carcinoma of the cervix have been used with minor modifications for nearly fifty years and because these are accepted by the Federation Internationale de Gynecologie et d'Obstetrique (FIGO), the TNM categories have been defined to correspond to the FIGO stages. Some amendments have been made in collaboration with FIGO and the classifications now published will remain unchanged until at least 1986

Ovary and abdomen. TNM classification of malignant tumours

International Nuclear Information System (INIS)

Harmer, M.H.

1984-01-01

Cervix uteri and Corpus uteri were amongst the first sites to be classified by the TNM system. The ''League of Nations'' Stages for carcinoma of the cervix have been used with minor modifications for nearly fifty years and because these are accepted by the Federation Internationale de Gynecologie et d'Obstetrique (FIGO), the TNM categories have been defined to correspond to the FIGO stages. Some amendments have been made in collaboration with FIGO and the classifications now published will remain unchanged until at least 1986

Clinical practice of adjuvant chemotherapy in patients with early-stage epithelial ovarian cancer

NARCIS (Netherlands)

Frielink, Lindy M J; Pijlman, Brenda M; Ezendam, N.P.M.; Pijnenborg, Johanna M A

2016-01-01

BACKGROUND: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

NARCIS (Netherlands)

Frielink, L.M.; Pijlman, B.M.; Ezendam, N.P.; Pijnenborg, J.M.A.

2016-01-01

BACKGROUND: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The

The Role of Vaginal Brachytherapy in the Treatment of Surgical Stage I Papillary Serous or Clear Cell Endometrial Cancer

International Nuclear Information System (INIS)

Barney, Brandon M.; Petersen, Ivy A.; Mariani, Andrea; Dowdy, Sean C.; Bakkum-Gamez, Jamie N.; Haddock, Michael G.

2013-01-01

Objectives: The optimal adjuvant therapy for International Federation of Gynecology and Obstetrics (FIGO) stage I papillary serous (UPSC) or clear cell (CC) endometrial cancer is unknown. We report on the largest single-institution experience using adjuvant high-dose-rate vaginal brachytherapy (VBT) for surgically staged women with FIGO stage I UPSC or CC endometrial cancer. Methods and Materials: From 1998-2011, 103 women with FIGO 2009 stage I UPSC (n=74), CC (n=21), or mixed UPSC/CC (n=8) endometrial cancer underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant high-dose-rate VBT. Nearly all patients (n=98, 95%) also underwent extended lymph node dissection of pelvic and paraortic lymph nodes. All VBT was performed with a vaginal cylinder, treating to a dose of 2100 cGy in 3 fractions. Thirty-five patients (34%) also received adjuvant chemotherapy. Results: At a median follow-up time of 36 months (range, 1-146 months), 2 patients had experienced vaginal recurrence, and the 5-year Kaplan Meier estimate of vaginal recurrence was 3%. The rates of isolated pelvic recurrence, locoregional recurrence (vaginal + pelvic), and extrapelvic recurrence (including intraabdominal) were similarly low, with 5-year Kaplan-Meier estimates of 4%, 7%, and 10%, respectively. The estimated 5-year overall survival was 84%. On univariate analysis, delivery of chemotherapy did not affect recurrence or survival. Conclusions: VBT is effective at preventing vaginal relapse in women with surgical stage I UPSC or CC endometrial cancer. In this cohort of patients who underwent comprehensive surgical staging, the risk of isolated pelvic or extrapelvic relapse was low, implying that more extensive adjuvant radiation therapy is likely unnecessary.

Processamento e qualidade de compotas de figo diet e convencional

Directory of Open Access Journals (Sweden)

Priscilla Kárim Caetano

2017-03-01

Full Text Available Resumo O objetivo desta pesquisa foi avaliar as características físico-químicas de qualidade de compotas de figo diet e convencional. A variedade utilizada neste experimento foi Figos cv. roxo, sendo avaliadas diferentes formulações com edulcorantes. Os testes foram realizados com nove tratamentos e três repetições, totalizando 27 amostras. As formulações da calda foram: calda de açúcar (TA; Sorbitol (TS; Eritritol (TE; Sorbitol e Erititol (TSE; Steviosídeo (TST; Ciclamato de Sódio, Sucralose e Sacarina Sódica (TCSuSa; Ciclamato sódico e Sacarina sódica (TSC; Acessulfame-K e Sucralose (TAcSu; Steviosídeo, Sacarina Sódica e Ciclamato de Sódio (TSSC. Os atributos físico-químicos avaliados, de acordo com a literatura e a legislação para este tipo de produto, foram pH, sólidos solúveis, acidez titulável, açúcar redutor, açúcar redutor total, proteína, lipídeo, cinzas e umidade. Observe-se que os resultados obtidos também estão de acordo com a literatura e a legislação para este tipo de produto. Em relação aos parâmetros de qualidade, todos os tratamentos apresentaram resultados satisfatórios, com valores de pH que variaram de 3,98 a 4,47, presença de vácuo de 11 a 13 pol Hg–1 e teores de sólidos solúveis que variaram de 9,43 a 3,90, para os tratamentos com edulcorantes. O produto desenvolvido, por suas características, se enquadra na categoria de produtos diet.

Effect of hydronephrosis on survival in advanced stage cervical cancer.

Science.gov (United States)

Goklu, Mehmet Rıfat; Seckin, Kerem Doga; Togrul, Cihan; Goklu, Yasemin; Tahaoglu, Ali Emre; Oz, Murat; Ertas, Ibrahim Egemen

2015-01-01

Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (phydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (pHydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.

L1CAM in Early-Stage Type I Endometrial Cancer: Results of a Large Multicenter Evaluation

NARCIS (Netherlands)

Zeimet, A.G.; Reimer, D.; Huszar, M.; Winterhoff, B.; Puistola, U.; Azim, S.A.; Muller-Holzner, E.; Ben-Arie, A.; Kempen, L.C.L.T. van; Petru, E.; Jahn, S.; Geels, Y.P.; Massuger, L.F.A.G.; Amant, F.; Polterauer, S.; Lappi-Blanco, E.; Bulten, J.; Meuter, A.; Tanouye, S.; Oppelt, P.; Stroh-Weigert, M.; Reinthaller, A.; Mariani, A.; Hackl, W.; Netzer, M.; Schirmer, U.; Vergote, I.; Altevogt, P.; Marth, C.; Fogel, M.

2013-01-01

BACKGROUND: Despite the excellent prognosis of Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stage I, type I endometrial cancers, a substantial number of patients experience recurrence and die from this disease. We analyzed the value of immunohistochemical L1CAM determination to

Individualized Prediction of Overall Survival After Postoperative Radiation Therapy in Patients With Early-Stage Cervical Cancer: A Korean Radiation Oncology Group Study (KROG 13-03)

International Nuclear Information System (INIS)

Lee, Hyun Jin; Han, Seungbong; Kim, Young Seok; Nam, Joo-Hyun; Kim, Hak Jae; Kim, Jae Weon; Park, Won; Kim, Byoung-Gie; Kim, Jin Hee; Cha, Soon Do; Kim, Juree; Lee, Ki-Heon; Yoon, Mee Sun

2013-01-01

Purpose: A nomogram is a predictive statistical model that generates the continuous probability of a clinical event such as death or recurrence. The aim of the study was to construct a nomogram to predict 5-year overall survival after postoperative radiation therapy for stage IB to IIA cervical cancer. Methods and Materials: The clinical data from 1702 patients with early-stage cervical cancer, treated at 10 participating hospitals from 1990 to 2011, were reviewed to develop a prediction nomogram based on the Cox proportional hazards model. Demographic, clinical, and pathologic variables were included and analyzed to formulate the nomogram. The discrimination and calibration power of the model was measured using a concordance index (c-index) and calibration curve. Results: The median follow-up period for surviving patients was 75.6 months, and the 5-year overall survival probability was 87.1%. The final model was constructed using the following variables: age, number of positive pelvic lymph nodes, parametrial invasion, lymphovascular invasion, and the use of concurrent chemotherapy. The nomogram predicted the 5-year overall survival with a c-index of 0.69, which was superior to the predictive power of the International Federation of Gynecology and Obstetrics (FIGO) staging system (c-index of 0.54). Conclusions: A survival-predicting nomogram that offers an accurate level of prediction and discrimination was developed based on a large multi-center study. The model may be more useful than the FIGO staging system for counseling individual patients regarding prognosis

Individualized Prediction of Overall Survival After Postoperative Radiation Therapy in Patients With Early-Stage Cervical Cancer: A Korean Radiation Oncology Group Study (KROG 13-03)

Energy Technology Data Exchange (ETDEWEB)

Lee, Hyun Jin [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Han, Seungbong [Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Kim, Young Seok, E-mail: ysk@amc.seoul.kr [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Nam, Joo-Hyun [Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Kim, Hak Jae [Department of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Jae Weon [Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul (Korea, Republic of); Park, Won [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Byoung-Gie [Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Cha, Soon Do [Department of Obstetrics and Gynecology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Kim, Juree [Department of Radiation Oncology, Cheil General Hospital and Women' s Healthcare Center, Kwandong University, College of Medicine, Seoul (Korea, Republic of); Lee, Ki-Heon [Department of Obstetrics and Gynecology, Cheil General Hospital and Women' s Healthcare Center, Kwandong University, College of Medicine, Seoul (Korea, Republic of); Yoon, Mee Sun [Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do (Korea, Republic of); and others

2013-11-15

Purpose: A nomogram is a predictive statistical model that generates the continuous probability of a clinical event such as death or recurrence. The aim of the study was to construct a nomogram to predict 5-year overall survival after postoperative radiation therapy for stage IB to IIA cervical cancer. Methods and Materials: The clinical data from 1702 patients with early-stage cervical cancer, treated at 10 participating hospitals from 1990 to 2011, were reviewed to develop a prediction nomogram based on the Cox proportional hazards model. Demographic, clinical, and pathologic variables were included and analyzed to formulate the nomogram. The discrimination and calibration power of the model was measured using a concordance index (c-index) and calibration curve. Results: The median follow-up period for surviving patients was 75.6 months, and the 5-year overall survival probability was 87.1%. The final model was constructed using the following variables: age, number of positive pelvic lymph nodes, parametrial invasion, lymphovascular invasion, and the use of concurrent chemotherapy. The nomogram predicted the 5-year overall survival with a c-index of 0.69, which was superior to the predictive power of the International Federation of Gynecology and Obstetrics (FIGO) staging system (c-index of 0.54). Conclusions: A survival-predicting nomogram that offers an accurate level of prediction and discrimination was developed based on a large multi-center study. The model may be more useful than the FIGO staging system for counseling individual patients regarding prognosis.

Invasive cervical carcinoma (stage IB-IIB): assessment with MR imaging

International Nuclear Information System (INIS)

Sironi, S.; Del Maschio, A.; Belloni, C.; Taccagni, L.

1990-01-01

In patients with cervical carcinoma the selection of the optimal therapy depends on the precise preoperative assessment of the extent of disease. Currently, decisions regarding the management of these patients are made on the basis of clinical (FIGO) staging that has 50% mean error rate. To investigate the value of MR imaging in staging patients with invasive cervical cancer, we performed 25 MR examinations on 23 patients with histologic diagnosis of cervical cancer. All patients were clinically considered as having stage IB or IIB disease and underwent radical hysterectomy, providing specimens for pathologic correlation. The overall accuracy of MR imaging in staging cervical carcinoma (stage IB-IIB) was 78.1%. MR imaging seems to be the most reliable preoperative modality for staging invasive cervical cancer

Stage I carcinoma of the endometrium: Some prognostic factors

International Nuclear Information System (INIS)

Perry, H.; Lefkofsky, M.M.; Chang, H.S.; Mantel, J.

1987-01-01

A total of 446 patients with FIGO stage I adenocarcinoma of the endometrium were treated from 1953 to 1980. The overall actuarial survival was 80.77% at 5 years and 72.16% at 10 years. The 5- and 10-year actuarial survivals for various stages are as follows: stage IA: 82.33% and 73.12%; stage IB: 79.80% and 71.55% (P = .4045); stage IB, grade I: 87l.34% and 79.29%; grade II, 83.11% and 75.52%; grade III, 53.62% and 48.53% (P = .0000); stage IC: for patients receiving preoperative radiation therapy with residual carcinoma in the operative specimen, 86.26% and 79.76%; for specimens containing residual tumor, 76.41% and 68.31% (P = .0802). Patient selection appeared to influence survival

Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT).

Science.gov (United States)

Karlsen, Nikoline Marie Schou; Karlsen, Mona Aarenstrup; Høgdall, Estrid; Nedergaard, Lotte; Christensen, Ib Jarle; Høgdall, Claus

2016-07-01

The aim of the study was to evaluate the rate of relapse as well as disease-free, overall, and disease-specific survival in women with borderline ovarian tumour (BOT). Furthermore, the study aims to identify the clinical parameters correlated to relapse. National clinical data of women diagnosed with BOT from January 2005 to January 2013 constituted the basis for our study population. The prognostic influence of clinical variables was evaluated using univariate and multivariate analyses. A total of 1143 women were eligible for analysis, with 87.9% in FIGO stage I and 12.1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. A general favourable prognosis in women with BOT was confirmed in our study. Our findings indicate that systematic, long-term follow-up does not seem necessary in women treated for FIGO stage IA BOT with no residual disease or microinvasion. Copyright © 2016 Elsevier Inc. All rights reserved.

Long-term Outcome after Radiotherapy for FIGO Stage IIIB and IVA Carcinoma of the Cervix

International Nuclear Information System (INIS)

Yeung, Anamaria R.; Amdur, Robert J.; Morris, Christopher G.; Morgan, Linda S.; Mendenhall, William M.

2007-01-01

Purpose: To report the long-term outcome after radiotherapy with curative intent for Stage IIIB and IVA carcinoma of the cervix. Methods and Materials: We retrospectively reviewed 91 patients treated with radiotherapy with curative intent at University of Florida between January 1980 and December 2003 for Stage IIIB (84 patients) or IVA (7 patients) carcinoma of the cervix. Results: The median follow-up of the surviving patients was 8.8 years. The 5- and 10-year estimates of local control, regional control, locoregional control, relapse-free survival, and overall survival were 53% and 53%, 55% and 47%, 34% and 29%, 30% and 26%, and 29% and 21%, respectively. Ninety percent of the recurrences occurred within 2 years of treatment. Of these, 60% of all failures were local, 29% were regional, and 11% were distant failures alone. Also, 17% of the failures were in the paraaortic nodes with no evidence of failure in the pelvis. Univariate and multivariate analyses were conducted with the endpoint of relapse-free or overall survival. No factor was statistically significant. Complications from therapy were scored using the Radiation Therapy Oncology Group grading system; the overall severe late complication rate was 13% (Grade 3-5). Conclusion: This series is one of the most mature of published reports. With long-term follow-up, approximately one-third of patients with Stage IIIB or IVA carcinoma of the cervix were cured, with a 13% complication rate

Produção de sorvetes e iogurtes a partir dos frutos figo da índia e mandacaru

Directory of Open Access Journals (Sweden)

V. R. L. Fidelis

2015-10-01

Full Text Available O figo da índia é a fruta que juntamente com o mandacaru fazem parte das espécies nativas da caatinga. Objetivou-se neste trabalho elaborar e caracterizar sorvetes e iogurte a partir do figo da índia e da polpa e casa do fruto do mandacaru. Foi obtido o sorvete de creme e iogurte natural para base e acrescido com polpa e casca para as formulações. Para a caracterização foram realizadas as análises físico-químicas de pH, vitamina C, sólidos solúveis (SS e a acidez titulável (AT. O sorvete e o iogurte apresentaram comportamento ácido. O figo da índia e o fruto do mandacaru mostraram-se com grande potencial para o desenvolvimento de subprodutos com o sorvete e iogurte. Os valores de AT do iogurte (ᴓ 0,62 estão dentro dos padrões pré-estabelecidos.Production of ice cream and yoghurt from the cactus pearfruit and mandacaruAbstract: The Opuntia is a fruit, which together with the Cereus jamacaru are native species of the savanna. The objective of this study was to prepare and characterize ice cream and yogurt from the Opuntia and pulp and peel of Cereus jamacaru fruit. The ice cream and natural yoghurt for base and increased with pulp and peel were obtained for the formulations. For the characterization were performed physicochemical analysis of pH, vitamin C, soluble solids (SS and titratable acidity (TA. The ice cream and yogurt showed acidic behavior. The Opuntia and the fruit of Cereus jamacaru have come out with great potential for the development of by-products with the ice cream and yogurt. AT values of yogurt (ᴓ 0.62 are within the pre-established by the standards.

Prognostic factors for patients with early-stage uterine serous carcinoma without adjuvant therapy.

Science.gov (United States)

Tate, Keisei; Yoshida, Hiroshi; Ishikawa, Mitsuya; Uehara, Takashi; Ikeda, Shun Ichi; Hiraoka, Nobuyoshi; Kato, Tomoyasu

2018-05-01

Uterine serous carcinoma (USC) is an aggressive type 2 endometrial cancer. Data on prognostic factors for patients with early-stage USC without adjuvant therapy are limited. This study aims to assess the baseline recurrence risk of early-stage USC patients without adjuvant treatment and to identify prognostic factors and patients who need adjuvant therapy. Sixty-eight patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-II USC between 1997 and 2016 were included. All the cases did not undergo adjuvant treatment as institutional practice. Clinicopathological features, recurrence patterns, and survival outcomes were analyzed to determine prognostic factors. FIGO stages IA, IB, and II were observed in 42, 7, and 19 cases, respectively. Median follow-up time was 60 months. Five-year disease-free survival (DFS) and overall survival (OS) rates for all cases were 73.9% and 78.0%, respectively. On multivariate analysis, cervical stromal involvement and positive pelvic cytology were significant predictors of DFS and OS, and ≥1/2 myometrial invasion was also a significant predictor of OS. Of 68 patients, 38 patients had no cervical stromal invasion or positive pelvic cytology and showed 88.8% 5-year DFS and 93.6% 5-year OS. Cervical stromal invasion and positive pelvic cytology are prognostic factors for stage I-II USC. Patients with stage IA or IB USC showing negative pelvic cytology may have an extremely favorable prognosis and need not receive any adjuvant therapies. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures

Energy Technology Data Exchange (ETDEWEB)

Hansen, Henrik Villibald [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Section for Radiotherapy, Rigshospitalet, Department of Oncology, Copenhagen (Denmark); Loft, Annika [University of Copenhagen, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Berthelsen, Anne Kiil [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); University of Copenhagen, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [University of Copenhagen, The Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); University of Copenhagen, Biotech Research and Innovation Centre (BRIC), Copenhagen (Denmark); Hoegdall, Claus [University of Copenhagen, Department of Gynecology, Rigshospitalet, Copenhagen (Denmark); Engelholm, Svend Aage [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark)

2015-11-15

In cancer of the uterine cervix, lymph node metastases are associated with a poor prognosis. Even so, the International Federation of Gynecology and Obstetrics (FIGO) does not take into account diagnostic results of methods such as PET/CT, since these are not readily available everywhere. As undetected lymph node metastases can lead to undertreatment, any difference in the underlying prevalence of false-negative scans between CT and PET/CT may be reflected in treatment outcomes. This study investigated survival outcomes in node-negative patients before and after the introduction of PET/CT. This was a single-institution retrospective analysis of 301 patients with a histopathological diagnosis of cervical cancer. The patients were receiving chemoradiotherapy with curative intent according to the standard protocol of the department for patients without lymph node metastases as assessed by pretreatment CT or PET/CT. Patients were stratified into two groups: PET/CT and non-PET/CT. Patient characteristics and treatment outcomes were acquired from the treatment database. Significant differences of 23 % (95 % CI 17 - 29 %), 19 % (95 % CI 13 - 25 %) and 12 % (95 % CI 6 - 18 %) in 5-year overall, disease-free and disease-specific survival, respectively, were observed between the two patient groups. The difference remained significant in univariate and multivariate analyses of overall survival (hazard ratio 0.61, 95 % CI 0.42 - 0.89; p = 0.010), including age, FIGO stage, performance status, BMI, and histopathology. Inclusion of PET/CT in the preradiotherapy diagnostic protocol may lead to nodal stage migration not reflected in the FIGO stage. It was found to be a significant covariate, and could lead to selection bias that needs to be taken into account when designing and reporting on clinical trials. (orig.)

Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures

International Nuclear Information System (INIS)

Hansen, Henrik Villibald; Loft, Annika; Berthelsen, Anne Kiil; Christensen, Ib Jarle; Hoegdall, Claus; Engelholm, Svend Aage

2015-01-01

In cancer of the uterine cervix, lymph node metastases are associated with a poor prognosis. Even so, the International Federation of Gynecology and Obstetrics (FIGO) does not take into account diagnostic results of methods such as PET/CT, since these are not readily available everywhere. As undetected lymph node metastases can lead to undertreatment, any difference in the underlying prevalence of false-negative scans between CT and PET/CT may be reflected in treatment outcomes. This study investigated survival outcomes in node-negative patients before and after the introduction of PET/CT. This was a single-institution retrospective analysis of 301 patients with a histopathological diagnosis of cervical cancer. The patients were receiving chemoradiotherapy with curative intent according to the standard protocol of the department for patients without lymph node metastases as assessed by pretreatment CT or PET/CT. Patients were stratified into two groups: PET/CT and non-PET/CT. Patient characteristics and treatment outcomes were acquired from the treatment database. Significant differences of 23 % (95 % CI 17 - 29 %), 19 % (95 % CI 13 - 25 %) and 12 % (95 % CI 6 - 18 %) in 5-year overall, disease-free and disease-specific survival, respectively, were observed between the two patient groups. The difference remained significant in univariate and multivariate analyses of overall survival (hazard ratio 0.61, 95 % CI 0.42 - 0.89; p = 0.010), including age, FIGO stage, performance status, BMI, and histopathology. Inclusion of PET/CT in the preradiotherapy diagnostic protocol may lead to nodal stage migration not reflected in the FIGO stage. It was found to be a significant covariate, and could lead to selection bias that needs to be taken into account when designing and reporting on clinical trials. (orig.)

The diagnostic value of PET/CT scanning in patients with cervical cancer

DEFF Research Database (Denmark)

Loft, Annika; Berthelsen, Anne Kiil; Roed, Henrik

2007-01-01

OBJECTIVE: To investigate the clinical value of PET/CT as a supplement to FIGO staging in patients with cervical cancer stage >or=1B. METHODS: This prospective study included 120 consecutive patients. After staging, a whole-body PET/CT scan was performed and these examinations were divided into two....../CT scanning for newly diagnosed cervical cancer FIGO stage >or=1B has a high sensitivity and specificity, and can be a valuable supplement to the FIGO staging procedure....

The Role & Action of Prohibition, an Antiproliferative Gene, in Ovarian Cancer

National Research Council Canada - National Science Library

Thompson, Winston E

2007-01-01

... expression pattern of prohibitin in normal ovary, ovarian tumors of patients with early (FIGO stage 1) and advanced (FIGO stage II-IV) stages of ovarian cancer, using immunohistochemistry, in situ hybridization, Western and Northern blot analyses...

Formas de preparo de figo-da-índia minimamente processado¹

Directory of Open Access Journals (Sweden)

Kelly Magalhães Marques

2011-10-01

Full Text Available O trabalho teve como objetivo avaliar a influência da forma de preparo na conservação pós-colheita de figos-da-índia minimamente processados. Foram utilizados figos-da-índia maduros de polpa alaranjada, provenientes de pomar comercial da região de Valinhos-SP. Após a seleção, os frutos foram lavados e higienizados em solução com Sumaveg® a 200 mg 100g-1 de cloro livre, por 5 minutos. Em seguida, os frutos foram levados à câmara fria, a 12±2°C, onde permaneceram por 12 horas prévias ao processamento. O processamento constituiu na retirada da casca e das extremidades para a obtenção dos frutos inteiros. Para a obtenção das metades, foi realizado um corte no sentido longitudinal da fruta descascada e, para obtenção das rodelas, foram realizados cortes, a cada 2 cm, transversais à altura do fruto descascado. Os tratamentos assim obtidos foram acondicionados em contentores de tereftalato de polietileno transparente e com tampa, com capacidade de 1.000 mL (marca Neoform® N-94. As embalagens foram armazenadas em expositores refrigerados a 3°C, por um período de 16 dias, sendo as análises realizadas a cada 4 dias. O delineamento adotado foi o inteiramente casualizado, num esquema fatorial 3x5: três processamentos e cinco datas de amostragem (0;4;8;12 e 16 dias, com três repetições por tratamento. Avaliaram-se a perda de massa fresca, os teores de sólidos solúveis (SS, acidez titulável (AT, a relação (SS/AT, ácido ascórbico, além da análise sensorial dos produtos. Os frutos inteiros foram os preferidos quanto à intenção de compra e apresentaram melhores resultados quanto ao teor de sólidos solúveis, de acidez titulável, relação sólidos solúveis/acidez titulável e teor de ácido ascórbico. A maior perda de massa fresca foi verificada no processamento em rodelas.

Relationships of nuclear, architectural and International Federation of Gynecology and Obstetrics grading systems in endometrial cancer.

Science.gov (United States)

Toptaş, Tayfun; Peştereli, Elif; Bozkurt, Selen; Erdoğan, Gülgün; Şimşek, Tayup

2018-03-01

To examine correlations among nuclear, architectural, and International Federation of Gynecology and Obstetrics (FIGO) grading systems, and their relationships with lymph node (LN) involvement in endometrioid endometrial cancer. Histopathology slides of 135 consecutive patients were reviewed with respect to tumor grade and LN metastasis. Notable nuclear atypia was defined as grade 3 nuclei. FIGO grade was established by raising the architectural grade (AG) by one grade when the tumor was composed of cells with nuclear grade (NG) 3. Correlations between the grading systems were analyzed using Spearman's rank correlation coefficients, and relationships of grading systems with LN involvement were assessed using logistic regression analysis. Correlation analysis revealed a significant and strongly positive relationship between FIGO and architectural grading systems (r=0.885, p=0.001); however, correlations of nuclear grading with the architectural (r=0.535, p=0.165) and FIGO grading systems (r=0.589, p=0.082) were moderate and statistically non-significant. Twenty-five (18.5%) patients had LN metastasis. LN involvement rates differed significantly between tumors with AG 1 and those with AG 2, and tumors with FIGO grade 1 and those with FIGO grade 2. In contrast, although the difference in LN involvement rates failed to reach statistical significance between tumors with NG 1 and those with NG 2, it was significant between NG 2 and NG 3 (p=0.042). Although all three grading systems were associated with LN involvement in univariate analyses, an independent relationship could not be established after adjustment for other confounders in multivariate analysis. Nuclear grading is significantly correlated with neither architectural nor FIGO grading systems. The differences in LN involvement rates in the nuclear grading system reach significance only in the setting of tumor cells with NG 3; however, none of the grading systems was an independent predictor of LN involvement.

Carcinoma of the uterine cervix stage IB and early stage II. Prognostic value of the histological tumor regression after initial brachytherapy

International Nuclear Information System (INIS)

Calais, G.; Le Floch, O.; Chauvet, B.; Reynaud-Bougnoux, A.; Bougnoux, P.

1989-01-01

In our center limited centro pelvic invasive carcinomas of the uterine cervix (less than 4 cm) are treated with brachytherapy and surgery. With these therapeutic modalities no residual carcinoma was observed for 80% of the patients. The purpose of this study was to evaluate our results with this treatment, and to evaluate the prognostic value of the pathological status of the cervix. From 1976 to 1987 we have treated 115 patients with these modalities. Staging system used was the FIGO classification modified for Stage II (divided in early Stage II and late Stage II). Patients were Stage IB (70 cases) and early Stage II (45 cases); 60 Gy were delivered with utero vaginal brachytherapy before any treatment. Six weeks later a radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-one patients with positive nodes received a pelvic radiotherapy (45 to 55 Gy). Local control rate was 97% (100% for Stage IB and 93% for early Stage II). Uncorrected 10-year actuarial survival rate was 96% for Stage IB and 80% for early Stage II patients. No treatment failure was observed for Stage IB patients. Ninety-two patients (80%) had no residual carcinoma in the cervix (group 1) and 23 patients (20%) had a residual tumor (group 2). The sterilization rate of the cervix was 87% for Stage IB tumors versus 69% for early Stage II, and was 82% for N- patients versus 68% for N+ patients. Ten year actuarial survival rate was 92% for group 1 and 78% for group 2 (p = 0, 1). Grade 3 complications rate was 6%. We conclude that brachytherapy + surgery is a safe treatment for limited centro pelvic carcinomas of the uterine cervix (especially Stage IB) and that pathological status of the cervix after brachytherapy is not a prognostic factor

Primary invasive squamous carcinoma of the vagina

International Nuclear Information System (INIS)

Pride, G.L.; Schultz, A.E.; Chuprevich, T.W.; Buchler, D.A.

1979-01-01

Forty-three cases of primary vaginal squamous cell cancer were treated at the University of Wisconsin Hospital between 1956 and 1971. These cases comprised of 1.2% of patients admitted to the University Hospital with female genital tract cancer. Evidence is presented to support a modification of the currently accepted FIGO staging system for vaginal carcinoma (Stage II disease). Radiation therapy using both external beam and brachyradium equivalents or interstitial implantation of suitable isotopes was an effective method for the treatment of patients having early and locally advanced invasive vaginal cancer. The 5-year absolute survival rate for the entire series was 37.2%. Absolute survival rate by modified FIGO clinical staging was 66% for Stages I and IIA, 31% for Stage IIB, 25% for Stage III, and 0% for Stage IV

Optimization of the extent of surgical treatment in patients with stage I in cervical cancer

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Chernyshova, A. L.; Lyapunov, A. Yu., E-mail: Lyapunov1720.90@mail.ru [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Kolomiets, L. A. [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Siberian State Medical University, Moskovsky Trakt 2, Tomsk, 634050 (Russian Federation); Sinilkin, I. G.; Chernov, V. I. [Tomsk Cancer Research Institute, Kooperativny Street 5, Tomsk, 634050 (Russian Federation); Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050 (Russian Federation)

2016-08-02

The study included 26 patients with FIGO stage Ia1–Ib1 cervical cancer who underwent fertility-sparing surgery (transabdominaltrachelectomy). To visualize sentinel lymph nodes, lymphoscintigraphy with injection of 99mTc-labelled nanocolloid was performed the day before surgery. Intraoperative identification of sentinel lymph nodes using hand-held gamma probe was carried out to determine the radioactive counts over the draining lymph node basin. The sentinel lymph node detection in cervical cancer patients contributes to the accurate clinical assessment of the pelvic lymph node status, precise staging of the disease and tailoring of surgical treatment to individual patient.

Condutividade e difusividade térmica do figo (Ficus carica L. "Roxo de Valinhos" Conductivity and thermal diffusivity of fig fruit (Ficus carica L. "Roxo de Valinhos"

Directory of Open Access Journals (Sweden)

Saul D. Sarria

2004-04-01

Full Text Available O resfriamento e/ou congelamento de produtos hortícolas, depois da colheita, é realizado com o objetivo de retirar o calor desses produtos, permitindo-lhes, em função disso, um tempo maior de conservação. Portanto, o conhecimento das propriedades físicas que envolvem transferência de calor do figo "Roxo de Valinhos" é útil para o cálculo de projetos e a análise de sistemas de engenharia de alimentos em geral, assim como para o emprego em equações de modelos matemáticos termodinâmicos. Neste trabalho, foram determinadas, experimentalmente, a condutividade e a difusividade térmica do figo inteiro no estádio rami e, a partir desses valores, foi determinado o calor específico. Foi utilizado o método transiente da Fonte Linear de Calor. Foi introduzida nas frutas uma sonda que contém resistência elétrica e termopares. Para manter constante a temperatura da fruta, montou-se um sistema de resfriamento a água. Encontrou-se que o figo rami apresentou um valor de condutividade térmica de 0,52 W m-1 °C, difusividade térmica de 1,56 x 10-7 m² s-1, massa específica do figo de 815,6 kg m-3 e calor específico de 4,07 kJ kg-1 °C.The post harvest cooling and/or freezing processes for horticultural products have been carried out with the objective of removing the heat from these products, allowing them a bigger period of conservation. Therefore, the knowledge of the physical properties that involve heat transference in the fig fruit "Roxo de Valinhos" is useful for calculating projects and systems of food engineering in general, as well as, for using in equations of thermodynamic mathematical models. The values of conductivity and thermal diffusivity of the whole fig fruit-rami index were determined, and from these values it was determined the value of the specific heat. For these determination it was used the transient method of the Line Heat Source. The results shown that the fig fruit has a thermal conductivity of 0.52 W m-1�

[Carcinoma of the uterine cervical canal. Staging and biometric assessment with magnetic resonance].

Science.gov (United States)

Fischetti, S G; Politi, G; Lomeo, E; Garozzo, G; Di Leo, S; Nuciforo, G

1994-10-01

In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.

Sequential versus "sandwich" sequencing of adjuvant chemoradiation for the treatment of stage III uterine endometrioid adenocarcinoma.

Science.gov (United States)

Lu, Sharon M; Chang-Halpenny, Christine; Hwang-Graziano, Julie

2015-04-01

To compare the efficacy and tolerance of adjuvant chemotherapy and radiotherapy delivered in sequential (chemotherapy followed by radiation) versus "sandwich" fashion (chemotherapy, interval radiation, and remaining chemotherapy) after surgery in patients with FIGO stage III uterine endometrioid adenocarcinoma. From 2004 to 2011, we identified 51 patients treated at our institution fitting the above criteria. All patients received surgical staging followed by adjuvant chemoradiation (external-beam radiation therapy (EBRT) with or without high-dose rate (HDR) vaginal brachytherapy (VB)). Of these, 73% and 27% of patients received their adjuvant therapy in sequential and sandwich fashion, respectively. There were no significant differences in clinical or pathologic factors between patients treated with either regimen. Thirty-nine (76%) patients had stage IIIC disease. The majority of patients received 6 cycles of paclitaxel with carboplatin or cisplatin. Median EBRT dose was 45 Gy and 54% of patients received HDR VB boost (median dose 21 Gy). There were no significant differences in the estimated 5-year overall survival, local progression-free survival, and distant metastasis-free survival between the sequential and sandwich groups: 87% vs. 77% (p=0.37), 89% vs. 100% (p=0.21), and 78% vs. 85% (p=0.79), respectively. No grade 3-4 genitourinary or gastrointestinal toxicities were reported in either group. There was a trend towards higher incidence of grade 3-4 hematologic toxicity in the sandwich group. Adjuvant chemoradiation for FIGO stage III endometrioid uterine cancer given in either sequential or sandwich fashion appears to offer equally excellent early clinical outcomes and acceptably low toxicity. Copyright © 2015 Elsevier Inc. All rights reserved.

Survival after Stage IA Endometrial Cancer; Can follow-up be altered?

DEFF Research Database (Denmark)

Lajer, Henrik; Elnegaard, Sandra; Christensen, René D

2012-01-01

IA (1988 classification) endometrial cancer patients prospectively included between 1986 and 1999. All patients had total abdominal hysterectomy and bilateral salpingo-oophorectomy without adjuvant therapy. Methods. The patient and the disease characteristics were drawn from the DEMCA database....... Of these recurrences, 15 of 23 (65%) were vaginal. Death from recurrence was observed in nine of 23 (39%) patients, and five of these nine had vaginal recurrences. Conclusions. Women with FIGO stage IA endometrial cancer have a very high disease-specific five year survival. Survival was related to histopathology...

Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial.

Science.gov (United States)

Tax, Casper; Abbink, Karin; Rovers, Maroeska M; Bekkers, Ruud L M; Zusterzeel, Petra L M

2018-01-01

Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in

Long-term results and prognostic factors in patients with stage III-IVA squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy from a single institution study

International Nuclear Information System (INIS)

Kudaka, Wataru; Nagai, Yutaka; Toita, Takafumi

2013-01-01

We evaluated the longer-term efficacy and safety of concurrent chemoradiotherapy (CCRT) incorporating high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a lower cumulative radiotherapy (RT) protocol and analyzed prognostic risk factors for survival among patients with International Federation of Gynecology and Obstetrics (FIGO) stage III-IVA squamous cell carcinoma (SCC) of the cervix. Ninety-nine patients with FIGO stage III-IVA SCC of the cervix between 1997 and 2008 were treated with CCRT using cisplatin 20 mg/m 2 for 5 days every 3 weeks or 40 mg/m 2 weekly. Acute and late toxicities were evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. Median age was 53.5 years. Median follow-up period was 58 months (range 6-170 months). Pathologically complete response was achieved in 93 patients (96.9%). The 5-year OS and DFS were 72.0 and 69.3%, respectively. The 5-year local and distant DFS were 83.0 and 75.1%, respectively. Thirty-one patients (31.3%) experienced recurrence. Multivariate analysis showed that tumor size and pretreatment hemoglobin level remained an independent risk factor for OS and DFS. Acute toxicity was moderate. In terms of late adverse effects, 2 patients (2.0%) suffered from grade 4 late intestinal toxicity because of radiation enterocolitis, with both requiring intestinal surgery. Our study demonstrates that the CCRT schedule in patients with FIGO stage III-IVA SCC is efficacious and safe. In addition, the assessment of tumor size and pretreatment anemia can provide valuable prognostic information. (author)

Gene expression profiles as prognostic markers in women with ovarian cancer

DEFF Research Database (Denmark)

Jochumsen, Kirsten M; Tan, Qihua; Høgdall, Estrid V

2009-01-01

toward investigations for more individualized therapies and the use of gene expression profiles in the clinical practice. RNA from tumor tissue from 43 Danish patients with serous epithelial ovarian carcinoma (11 International Federation of Gynecology and Obstetrics [FIGO] stage I/II, 32 FIGO stage III...

Primary invasive carcinoma of the vagina after Le Fort partial colpocleisis for stage IV pelvic organ prolapse: a case report.

Science.gov (United States)

Cho, Moon Kyoung; Kim, Chul Hong; Kim, Yoon Ha

2011-11-01

We present here the case report of a postmenopausal woman who complained of recurrent pus-like vaginal discharge and perianal pain 1 year after Le Fort colpocleisis, which was subsequently identified as a primary invasive carcinoma of the vagina. Biopsy confirmed a squamous cell carcinoma in the vagina, and the disease was classified as stage III according to FIGO staging. The patient received pelvic radiotherapy. This case emphasizes that differential diagnosis of recurrent vaginal discharge that presents remote from obliterative procedure for pelvic organ prolapse should consider not only pyometra, but also other causes.

TRAILs towards improved cervical cancer treatment

NARCIS (Netherlands)

Maduro, John

2009-01-01

Cervical cancer is a life threatening disease occurring world-wide, but affecting especially women in developing countries. Standard treatment for cevical cancer varies per FIGO stage and patient related factors. In general patients with non bulky (<4 cm) FIGO stage IB and IIA are treated with a

Monitoring of chemotherapy successfulness of Platina/Taxol chemotherapy protocol by using determination of serum urokinase plasminogen activator (uPA and soluble urokinase plasminogen activator receptor (suPAR in patients with ovarian carcinoma FIGO II

Directory of Open Access Journals (Sweden)

Dženita Ljuca

2007-05-01

Full Text Available In about 70% of cases, ovarian carcinoma has been diagnosed at an advanced stage. Invasion and metastasis of solid tumors request protease activity resulting in basal membrane destruction and surrounding matrix. In that process, urokinase plasminogen activator (uPA and its receptor, urokinase plasminogen activator receptor (suPAR play a key role, that via plasmin activation lead to basal membrane and matrix degradation in surrounding of the tumor, enable to its invasion and metastasis. Determination of serum concentration of those tumor markers can be useful in preoperative as well as in postoperative period. Their serum concentrations in ovarian cancer patients may help in good monitoring of remission or progression during chemotherapy treatment. In late 1950s and eariy 1960s, when it was found out that malignant ovarian tumors were chemosensitive, their chemotherapy treatment has begun. In the beginning it was used only mono-therapy, and by discovering new cytostatics it was replaced by poly-chemotherapy. Now days, in the therapy of advanced stages of ovarian carcinoma combination of cisplatine or carboplatine with paclitaxel is considering as standard treatment. Aim of this study was to determine serum uPA, suPAR and CEA in FIGO II and III patients with different histo-logical type (serous, mucinous, clear cell tumor before and after PT chemotherapy protocol during following three cycles. In this prospective study we have analyzed 17 patients with ovarian carcinoma, those have been after surgery treated by chemotherapy. Serum levels of uPA and suPAR have been determined by ELISA-test (Imubind uPA, Imubind uPAR, American Diagnostica, and CEA by OPUS Imunoassay method. Results of this study have shown that uPA, suPAR and CEA met criteria for prognostic markers for monitoring of successful-ness of platina/taxol chemotherapy protocol for serous, mucinous and clear cell tumor FIGO II and III stage of ovarian carcinoma. In case of PT chemotherapy

Post-operative high dose rate vaginal apex brachytherapy in stage I endometrial adenocarcinoma

International Nuclear Information System (INIS)

Gumbs, A.A.; Turner, B.C.; Knisely, J.P.S.; Kacinski, B.M.; Roberts, K.B.; Peschel, R.E.; Haffty, B.G.; Rutherford, T.J.; Edraki, B.; Schwartz, P.E.; Wilson, L.D.

1996-01-01

Purpose/Objective: Patients with Stage I endometrial adenocarcinoma have traditionally been treated with total abdominal hysterectomy/bilateral salpingo-oophorectomy and radiation. The reported incidence of local recurrence in surgically treated patients with FIGO Stage IA or IB endometrial adenocarcinoma is 4-10% at 2 years. Combined surgery and radiation has resulted in a reduction of recurrence to 2-6%. We report the presentation, actuarial survival, actuarial rate of local failure, salvage rate, and complications for patients undergoing high dose rate (HDR) vaginal apex brachytherapy following surgery. Materials and Methods: Between 1985 and 1994 a total of 286 patients with FIGO Stage I endometrioid uterine adenocarcinoma were treated with HDR Ir-192 vaginal apex brachytherapy alone to a total dose of 21 Gy in 3 fractions at 0.5 cm from the vaginal mucosa. The pathologic stage by treatment group was IA: 31%, IB: 68%, and IC: 1%. The histologic grade of the patient's tumors was grade 1: 69%, 2: 29%, and 3: 2% of patients. The median time from surgery to radiation was 34 days (range 14-66 days). The median follow-up for 286 patients with Stage IA (92 patients), IB (190 patients), and IC (4 patients) was respectively, 37, 35 and 40 months (2 patients lost to follow-up prior to 6 months). Results: Patients presented with vaginal bleeding (94%) or abnormal pap smear (6%) at a median age for Stage IA and IB, of 54 and 63 years, respectively (range 32-88). The 5-year overall actuarial survival rate was 94.5%. The 5-year actuarial survival rate by histologic grade was 97.5% and 91.5% for FIGO grade 1 and 2, respectively (p=.011). The 5-year actuarial survival rate by depth of myometrial invasion was 99.0% and 92.5% for Stage IA and IB, respectively (p=.029). Median overall time to failure is 19.5 months (range 10-36 months). The 5-year actuarial rate of local failure was 4.5%. The overall failure rate in our study group was 2.8% (8 patients), local failure only 1

A stage is a stage is a stage: a direct comparison of two scoring systems.

Science.gov (United States)

Dawson, Theo L

2003-09-01

L. Kohlberg (1969) argued that his moral stages captured a developmental sequence specific to the moral domain. To explore that contention, the author compared stage assignments obtained with the Standard Issue Scoring System (A. Colby & L. Kohlberg, 1987a, 1987b) and those obtained with a generalized content-independent stage-scoring system called the Hierarchical Complexity Scoring System (T. L. Dawson, 2002a), on 637 moral judgment interviews (participants' ages ranged from 5 to 86 years). The correlation between stage scores produced with the 2 systems was .88. Although standard issue scoring and hierarchical complexity scoring often awarded different scores up to Kohlberg's Moral Stage 2/3, from his Moral Stage 3 onward, scores awarded with the two systems predominantly agreed. The author explores the implications for developmental research.

FDG uptake heterogeneity in FIGO IIb cervical carcinoma does not predict pelvic lymph node involvement.

Science.gov (United States)

Brooks, Frank J; Grigsby, Perry W

2013-12-23

Many types of cancer are located and assessed via positron emission tomography (PET) using the 18F-fluorodeoxyglucose (FDG) radiotracer of glucose uptake. There is rapidly increasing interest in exploiting the intra-tumor heterogeneity observed in these FDG-PET images as an indicator of disease outcome. If this image heterogeneity is of genuine prognostic value, then it either correlates to known prognostic factors, such as tumor stage, or it indicates some as yet unknown tumor quality. Therefore, the first step in demonstrating the clinical usefulness of image heterogeneity is to explore the dependence of image heterogeneity metrics upon established prognostic indicators and other clinically interesting factors. If it is shown that image heterogeneity is merely a surrogate for other important tumor properties or variations in patient populations, then the theoretical value of quantified biological heterogeneity may not yet translate into the clinic given current imaging technology. We explore the relation between pelvic lymph node status at diagnosis and the visually evident uptake heterogeneity often observed in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) images of cervical carcinomas. We retrospectively studied the FDG-PET images of 47 node negative and 38 node positive patients, each having FIGO stage IIb tumors with squamous cell histology. Imaged tumors were segmented using 40% of the maximum tumor uptake as the tumor-defining threshold and then converted into sets of three-dimensional coordinates. We employed the sphericity, extent, Shannon entropy (S) and the accrued deviation from smoothest gradients (ζ) as image heterogeneity metrics. We analyze these metrics within tumor volume strata via: the Kolmogorov-Smirnov test, principal component analysis and contingency tables. We found no statistically significant difference between the positive and negative lymph node groups for any one metric or plausible combinations thereof. Additionally

FDG uptake heterogeneity in FIGO IIb cervical carcinoma does not predict pelvic lymph node involvement

International Nuclear Information System (INIS)

Brooks, Frank J; Grigsby, Perry W

2013-01-01

Many types of cancer are located and assessed via positron emission tomography (PET) using the 18F-fluorodeoxyglucose (FDG) radiotracer of glucose uptake. There is rapidly increasing interest in exploiting the intra-tumor heterogeneity observed in these FDG-PET images as an indicator of disease outcome. If this image heterogeneity is of genuine prognostic value, then it either correlates to known prognostic factors, such as tumor stage, or it indicates some as yet unknown tumor quality. Therefore, the first step in demonstrating the clinical usefulness of image heterogeneity is to explore the dependence of image heterogeneity metrics upon established prognostic indicators and other clinically interesting factors. If it is shown that image heterogeneity is merely a surrogate for other important tumor properties or variations in patient populations, then the theoretical value of quantified biological heterogeneity may not yet translate into the clinic given current imaging technology. We explore the relation between pelvic lymph node status at diagnosis and the visually evident uptake heterogeneity often observed in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) images of cervical carcinomas. We retrospectively studied the FDG-PET images of 47 node negative and 38 node positive patients, each having FIGO stage IIb tumors with squamous cell histology. Imaged tumors were segmented using 40% of the maximum tumor uptake as the tumor-defining threshold and then converted into sets of three-dimensional coordinates. We employed the sphericity, extent, Shannon entropy (S) and the accrued deviation from smoothest gradients (ζ) as image heterogeneity metrics. We analyze these metrics within tumor volume strata via: the Kolmogorov-Smirnov test, principal component analysis and contingency tables. We found no statistically significant difference between the positive and negative lymph node groups for any one metric or plausible combinations thereof. Additionally

Magnetic resonance imaging of cervical carcinoma using an endorectal surface coil

International Nuclear Information System (INIS)

Brocker, Kerstin A.; Alt, Céline D.; Gebauer, Gerhard; Sohn, Christof; Hallscheidt, Peter

2014-01-01

Introduction: The objective of this trial is to investigate the diagnostic value of magnetic resonance imaging (MRI) with an endorectal surface coil for precise local staging of patients with histologically proven cervical cancer by comparing the radiological, clinical, and histological results. Materials and methods: Women with cervical cancer were recruited for this trial between February 2007, and September 2010. All the patients were clinically staged according to the FIGO classification and underwent radiological staging by MRI that employed an endorectal surface coil. The staging results after surgery were compared to histopathology in all the operable patients. Results: A total of 74 consecutive patients were included in the trial. Forty-four (59.5%) patients underwent primary surgery, whereas 30 (40.5%) patients were inoperable according to FIGO and underwent primary radiochemotherapy. The mean age of the patients was 50.6 years. In 11 out of the 44 patients concordant staging results were obtained by all three staging modalities. Thirty-two of the 44 patients were concordantly staged by FIGO and histopathological examination, while only 16 were concordantly staged by eMRI and histopathological examination. eMRI overstaged tumors in 14 cases and understaged them in 7 cases. Conclusions: eMRI is applicable in patients with cervical cancer, yet of no benefit than staging with FIGO or standard pelvic MRI. The most precise preoperative staging procedure still appears to be the clinical examination

Prognosis of patients with stage IIIb-IVa squamous cell carcinoma of the cervix following intra-arterial neoadjuvant chemotherapy

International Nuclear Information System (INIS)

Fujiwaki, R.; Maede, Y.; Ohnishi, Y.; Watanabe, Y.; Hata, K.; Miyazaki, K.

1999-01-01

The aim was to determine the long-term prognosis in patients with stage IIIb-IVa squamous cell carcinoma of the cervix who were treated with intra-arterial neoadjuvant chemotherapy (NAC), and to analyze factors related to prognostic value. The authors assessed the disease-free survival of 21 patients with FIGO stage IIIb-IVa squamous cell carcinoma of the cervix treated with intra-arterial NAC followed by irradiation therapy. Before chemotherapy, five factors (age, clinical stage, histologic type, parametrial involvement and serum level of SCC) were evaluated for their correlation with disease-free survival. Univariate Cox's proportional hazard model also demonstrated that age was a significant prognostic factor as a continuous variable. Intra-arterial NAC thus appeared to be effective in treating older patients with stage IIIb-IVa squamous cell carcinoma of the cervix

Neutrophils as a prognostic factor in the systemic treatment of Ovarian Cancer

DEFF Research Database (Denmark)

Henriksen, Jon Røikjær; Dahl Steffensen, Karina

Background and Aims: The role of the immune system regarding development and treatment of cancer has a very high interest in modern cancer research. Research in ovarian cancer immunology is sparse compared to other tumour types. Neutrophils have been shown to possess both tumor promoting and tumor...... prognostic marker in multivariate analysis comparing low vs high baseline neutrophils (HR: 1.97) ( 95% CI: 1.18-3.30)(P=0.009). Other independent prognostic markers were FIGO stage, residual tumour and performance status. Conclusions: Baseline neutrophil blood count was found to be an independent prognostic...

Diffusion-weighted MRI of epithelial ovarian cancers: Correlation of apparent diffusion coefficient values with histologic grade and surgical stage

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Oh, Ji-Won, E-mail: fromentin@naver.com [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of); Rha, Sung Eun, E-mail: serha@catholic.ac.kr [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of); Oh, Soon Nam, E-mail: hiohsn@catholic.ac.kr [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of); Park, Michael Yong, E-mail: digirave@kmle.com [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of); Byun, Jae Young, E-mail: jybyun@catholic.ac.kr [Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of); Lee, Ahwon, E-mail: klee@catholic.ac.kr [Department of Hospital Pathology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701 (Korea, Republic of)

2015-04-15

Highlights: •The solid component of all invasive epithelial cancers showed high b{sub 1000} signal intensity. •ADCs can predict the histologic grade of epithelial ovarian cancer. •ADCs correlate negatively to the surgical stage of epithelial ovarian cancer. •ADCs may be useful imaging biomarkers to assess epithelial ovarian cancer. -- Abstract: Objective: The purpose of this article is to correlate the apparent diffusion coefficient (ADC) values of epithelial ovarian cancers with histologic grade and surgical stage. Materials and methods: We enrolled 43 patients with pathologically proven epithelial ovarian cancers for this retrospective study. All patients underwent preoperative pelvic magnetic resonance imaging (MRI) including diffusion-weighted images with b value of 0 and 1000 s/mm{sup 2} at 3.0-T unit. The mean ADC values of the solid portion of the tumor were measured and compared among different histologic grades and surgical stages. Results: The mean ADC values of epithelial ovarian cancers differed significantly between grade 1 (well-differentiated) and grade 2 (moderately-differentiated) (P = 0.013) as well as between grade 1 and grade 3 (poorly-differentiated) (P = 0.01); however, no statistically significant difference existed between grade 2 and grade 3 (P = 0.737). The receiver-operating characteristic analysis indicated that a cutoff ADC value of less than or equal to 1.09 × 10{sup −3} mm{sup 2}/s was associated with 94.4% sensitivity and 85.7% specificity in distinguishing grade 1 and grade 2/3 cancer. The difference in mean ADC values was statistically significant for early stage (FIGO stage I) and advanced stage (FIGO stage II-IV) cancer (P = 0.011). The interobserver agreement for the mean ADC values of epithelial ovarian cancers was excellent. Conclusion: The mean ADC values of the solid portion of epithelial ovarian cancers negatively correlated to histologic grade and surgical stage. The mean ADC values may be useful imaging

Composição de bagas de 'Niágara Rosada' e 'Folha-de-Figo' relacionadas ao sistema de condução

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Renata Vieira da Mota

2010-12-01

Full Text Available RESUMO Este trabalho teve como objetivo avaliar a influência do sistema de condução na qualidade de bagas de uvas 'Niágara Rosada' e 'Folha-de-Figo' cultivadas em Caldas-MG. Foram avaliados a produção por planta, o diâmetro, a massa, o teor de potássio e a temperatura das bagas, pH, teor de sólidos solúveis, açúcares redutores, acidez total e ácidos orgânicos do mosto, compostos fenólicos nas cascas e sementes, e antocianinas. As plantas foram conduzidas em espaldeira, lira, latada ou cordão simples, e os frutos, avaliados nas safras de 2006 e 2007. As videiras de 'Niágara Rosada' cultivadas em latada e 'Folha-de-Figo' em lira apresentaram produção significativamente superior aos demais sistemas de condução. Em todos os casos, as bagas apresentaram temperatura inferior à ambiente, indicando sombreamento completo ou parcial dos cachos. No sistema latada, houve menor acúmulo de sólidos solúveis e açúcares redutores nas duas cultivares. Estes resultados preliminares indicam que a composição das bagas foi pouco influenciada pelo sistema de condução.

Risk of recurrence, prognosis, and follow-up for Danish women with cervical cancer in 2005-2013

DEFF Research Database (Denmark)

Taarnhøj, Gry Assam; Christensen, Ib Jarle; Lajer, Henrik

2018-01-01

BACKGROUND: In developed countries, women attend follow-up after treatment for cervical cancer to detect recurrence. The aim of this study was to describe the Danish population of women with early-stage cervical cancer at risk for recurrence and death due to recurrence. METHODS: Data were extracted...... from 3 nationwide databases to find women diagnosed with stage 1A1 to 1B1 cervical cancer in 2005-2013. Recurrences were determined from data on oncological or surgical treatment more than 3 months after the initial diagnosis and were cross-checked with patient journals. RESULTS: In all, 1523 patients...... were diagnosed with stage 1A1 to 1B1 cervical cancer. Eighty women experienced recurrences: 8 at International Federation of Gynecology and Obstetrics (FIGO) stage 1A1, 0 at FIGO stage 1A2, and 72 at FIGO stage 1B1. The 5-year recurrence rate was 6.4%; 67.5% of the women had symptomatic recurrences...

Curative high dose rate vaginal apex brachytherapy in stage I papillary serous carcinoma of the endometrium

International Nuclear Information System (INIS)

Turner, B.C.; Kacinski, B.M.; Gumbs, A.; Peschel, R.E.; Haffty, B.G.; Wilson, L.D.

1996-01-01

Introduction: Uterine papillary serous carcinoma (UPSC) is a morphologically distinct variant of endometrial carcinoma that is associated with a poor prognosis, high recurrence rate, clinical understaging, and poor response to salvage treatment. We describe the presentation, local and distant control, survival, salvage rate, and complications for patients undergoing whole abdominal radiation therapy (WART), low dose rate (LDR) intracavitary brachytherapy, or high dose rate (HDR) vaginal brachytherapy in patients with stage I UPSC. Methods: Between 1976 and 1994 more than 1700 patients with endometrial carcinoma were treated with radiation therapy, 30 patients with stage I UPSC (1.8%) were treated with radiation before or following TAH/BSO. All patients underwent either preoperative Simon's packing or tandem and plaque which delivered 30-40 Gy to the serosa, WART, or HDR Ir-192 vaginal apex brachytherapy to a total dose of 21 Gy in 3 fractions at 0.5 cm from the vaginal mucosa. A total of 14 patients received HDR vaginal brachytherapy and (5(14)) patients received systemic chemotherapy. All patients presented with vaginal bleeding at a median age of 67 years (range 34-88). The group of 30 patients underwent TAH/BSO, 17 patients were completely staged pathologically (pelvic and para-aortic lymph nodes, omentectomy, and pelvic washings), and 2 patients underwent omental biopsy and pelvic washings only. All specimens revealed UPSC, nuclear grade 3, and lymphovascular invasion (23%). The pathologic stage was IA: 23% (7), IB: 67% (20), and IC: 10% (3). The median follow-up for all patients was 49 months (range 13-187 months). For the patients receiving postoperative HDR vaginal brachytherapy the median time from surgery to radiation was 42 days (range 29-91). Results: The 5-year actuarial disease free survival for Figo stage I UPSC patients treated with postoperative HDR vaginal brachytherapy and systemic chemotherapy was 100% compared to 74% for stage I UPSC patient

Invasive cervical carcinoma (Stages IB-IIB)

International Nuclear Information System (INIS)

Sironi, S.; Zanello, A.; Rodighiero, M.G.; Vanzulli, A.; Del Maschio, A.; Taccagni, G.L.; Belloni, C.

1991-01-01

In the patients with invasive cervical carcinoma, the accurate assessment of parametrial invasion greatly affects the therapeutic choice between surgery and radiation therapy. As a matter of fact, surgery is usually performed only in the patients with carcinoma confined to the cervix, whereas those with parametrial involvement, or more advanced stages, are treated with radiation therapy. This prospective study was aimed at investigating the comparative adequecy of CT and MR imaging in assessing parametrial status in the patients with invasive cervical cancer. Twenty-one consecutive patients, with histologic diagnosis of cervical carcinoma, were investigated. All of them were clinically considered as having invasive cervical cancer (FIGO stage IB-IIB) and subsequently underwent surgery. In all cases, detailed histology of the parametrium was obtained. Pathological data were compared with CT and MR findings in all cases. As for assessing parametrial involvement by cancer, CT had 62% accuracy, 63% sensitivity, and 60% specificity, versus MR imaging 81% accuracy, 69% sensitivity, and 80% specificify. Therefore, MR imaging appears to be superior to CT in assessing the parametrial status of patients with invasive cervical carcinoma; the method yields valuable information for treatment planning

Operation of staged membrane oxidation reactor systems

Science.gov (United States)

Repasky, John Michael

2012-10-16

A method of operating a multi-stage ion transport membrane oxidation system. The method comprises providing a multi-stage ion transport membrane oxidation system with at least a first membrane oxidation stage and a second membrane oxidation stage, operating the ion transport membrane oxidation system at operating conditions including a characteristic temperature of the first membrane oxidation stage and a characteristic temperature of the second membrane oxidation stage; and controlling the production capacity and/or the product quality by changing the characteristic temperature of the first membrane oxidation stage and/or changing the characteristic temperature of the second membrane oxidation stage.

Pelvic control following external beam radiation for surgical Stage I endometrial adenocarcinoma

International Nuclear Information System (INIS)

Rush, Stephen; Gal, David; Potters, Louis; Bosworth, Jay; Lovecchio, John

1995-01-01

Purpose: To determine if postoperative external pelvic radiation (EBRT), without vaginal brachytherapy, is sufficient to prevent vaginal cuff and pelvic recurrences in patients with surgical Stage I endometrial adenocarcinoma (ACA). Methods and Materials: The records of 122 patients with surgical Stage I endometrial cancer were reviewed. There were 87 patients with ACA who received EBRT alone and are the subject of this study. Their radiation records were reviewed. All patients underwent exploration, total abdominal hysterectomy, and bilateral salpingo-oophorectomy (TAH BSO), and pelvic and paraaortic lymph node sampling. They were staged according to the FIGO 1988 surgical staging system recommendations. Postoperatively, pelvic EBRT was administered by megavoltage equipment using four fields, to a total dose of 45 to 50.4 Gy. Actuarial survival and disease free survival were calculated according to Kaplan-Meier Method. Results: Twenty-seven patients with Stage IA Grade 1 or 2 ACA with less than one-third myometrial invasion, who did not receive EBRT, and eight patients with histology other than adenocarcinoma (i.e., serous papillary, mucinous, etc.) were not included in the study. For the remaining 87 patients who are in the study group, the median follow-up was 52 months (range: 12-82 months). The 5-year overall survival for these 87 patients was 92%, with a disease-free survival of 83%. There were no tumor recurrences in the upper vagina or in the pelvis. Two patients developed small bowel obstruction (no surgery required), and one patient developed chronic enteritis. Conclusion: Adjuvant external pelvic radiation, without vaginal brachytherapy, prevents pelvic and vaginal cuff recurrences in surgical Stage I endometrial ACA

COOLING STAGES OF CRYOGENIC SYSTEMS

OpenAIRE

Троценко, А. В.

2011-01-01

The formalized definition for cooling stage of low temperature system is done. Based on existing information about the known cryogenic unit cycles the possible types of cooling stages are single out. From analyses of these stages their classification by various characteristics is suggested. The results of thermodynamic optimization of final throttle stage of cooling, which are used as working fluids helium, hydrogen and nitrogen, are shown.

FIGO IVB (Para-aortic lymph adenopathy) squamous cell carcinoma of uterine cervix associated with a left pelvic kidney: a therapeutic challenge

International Nuclear Information System (INIS)

Ali, N.; Karsan, F.; Abbasi, A.N.; Khan, Z.R.

2012-01-01

The standard of care for locally advanced carcinoma of uterine cervix is concurrent chemoradiation therapy followed by intracavitary brachytherapy, when there is para-aortic lymphadenopathy, radiation field needs to be extended to para-aortic region. In the latter case dose limiting organs are spinal cord, kidneys and small intestine. We present a challenging case of FIGO IVB squamous cell carcinoma of cervix and a pelvic kidney. This patient received chemoradiation to pelvis and para-aortic field, brachytherapy was not performed as patient already had undergone attempted hysterectomy. Treatment, outcome and challenges encountered in this case are presented and literature is reviewed. (author)

Assessment of Parametrial Response by Growth Pattern in Patients With International Federation of Gynecology and Obstetrics Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective, Multicenter Trial (EMBRACE)

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Yoshida, Kenji [Medical University of Vienna, Comprehensive Cancer Center, Vienna (Austria); Kobe University Graduate School of Medicine, Kobe (Japan); Jastaniyah, Noha [Medical University of Vienna, Comprehensive Cancer Center, Vienna (Austria); King Faisal Specialist Hospital and Research Center, Riyadh (Saudi Arabia); Sturdza, Alina, E-mail: alina.sturdza@akhwien.at [Medical University of Vienna, Comprehensive Cancer Center, Vienna (Austria); Lindegaard, Jacob [Aarhus University Hospital, Aarhus (Denmark); Segedin, Barbara [Institute of Oncology Ljubljana, Ljubljana (Slovenia); Mahantshetty, Umesh [Tata Memorial Hospital, Mumbai (India); Rai, Bhavana [Post Graduate Institute of Medical Education and Research, Chandigarh (India); Jürgenliemk-Schulz, Ina [University Medical Center, Utrecht (Netherlands); Haie-Meder, Christine [Institut Gustave Roussy, Paris (France); Sasaki, Ryohei [Kobe University Graduate School of Medicine, Kobe (Japan); Pötter, Richard [Medical University of Vienna, Comprehensive Cancer Center, Vienna (Austria)

2015-11-15

Purpose: To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy. Methods and Materials: Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters. Results: A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm{sup 3}). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm{sup 3} vs 33.3 cm{sup 3}, P=.005). The mean high-risk clinical target volume D{sub 90} was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P<.001). Conclusion: Infiltrative tumors are more advanced at presentation and respond less favorably to chemo-radiotherapy when compared with expansive tumors that are more or less equivalent in size. The use of image

Postoperative high dose rate vaginal apex brachytherapy in stage I endometrial adenocarcinoma

International Nuclear Information System (INIS)

Turner, B.; Knisely, J.; Kacinski, B.; Roberts, K.; Peschel, R.; Gumbs, A.; Rutherford, T.; Edraki, B.; Schwartz, P.; Chambers, J.; Kohorn, E.; Wilson, L.

1996-01-01

Introduction: Patients with stage I endometrial adenocarcinoma have traditionally been treated with TAH/BSO and radiation. The reported incidence of local recurrence in surgically treated patients with Figo stage IA or IB endometrial adenocarcinoma is 4-10% at 2 years. Combined surgery and radiation has resulted in a reduction of recurrence to 2-6%. We report the presentation, local and distant control, salvage rate, survival and complications for patients undergoing high dose rate (HDR) vaginal apex brachytherapy following surgery. Methods: Between 1985 and 1994 a total of 302 patients with Figo stage I endometrial carcinoma were treated with HDR Ir-192 vaginal apex brachytherapy to a total dose of 21 Gy in 3 fractions at 0.5 cm from the vaginal mucosa. The pathologic stage by treatment group was IA: 31%, IB: 68%, and IC: 1%. The histologic grade of the patient's tumors was grade 1: 69%, 2: 27%, and 3: 4%. The median time from surgery to radiation was 33 days (range 14-66 days). The median follow-up for 300 patients with stage IA (91 patients), IB (205 patients), and IC (4 patients) was respectively 36, 34 and 40 months (2 patients lost to follow-up prior to 6 months). Results: Patients presented with vaginal bleeding (94%) or abnormal pap smear (6%) at a median age for stage IA and IB, of 55 and 64 years, respectively. The crude overall survival of the patient population at 2 years is 95%. Median overall time to failure is 19.5 months (range 10-36 months). The overall failure rate was 2.7% (8 patients), local failure only 1.0% (38% of failed group), distant failure only 0.3% (12% of failed group) and combined local/distant failure 1.3% (50% of failed group). The local failure rate for pathologic stage IA patients was 1.0% and no distant disease was observed. The local failure rate for pathologic stage IB patients was 3.4% 7/205 and distant failure was 2.4% 5/205. The majority of patients with recurrence had grade 2 histologic changes 5/8. The overall salvage rate

The Improved Dual-view Field Goniometer System FIGOS

Directory of Open Access Journals (Sweden)

Klaus I. Itten

2008-08-01

Full Text Available In spectrodirectional Remote Sensing (RS the Earth’s surface reflectance characteristics are studied by means of their angular dimensions. Almost all natural surfaces exhibit an individual anisotropic reflectance behaviour due to the contrast between the optical properties of surface elements and background and the geometric surface properties of the observed scene. The underlying concept, which describes the reflectance characteristic of a specific surface area, is called the bidirectional reflectance distribution function (BRDF. BRDF knowledge is essential for both correction of directional effects in RS data and quantitative retrieval of surface parameters. Ground-based spectrodirectional measurements are usually performed with goniometer systems. An accurate retrieval of the bidirectional reflectance factors (BRF from field goniometer measurements requires hyperspectral knowledge of the angular distribution of the reflected and the incident radiation. However, prior to the study at hand, no operational goniometer system was able to fulfill this requirement. This study presents the first dual-view field goniometer system, which is able to simultaneously collect both the reflected and the incident radiation at high angular and spectral resolution and, thus, providing the necessary spectrodirectional datasets to accurately retrieve the surface specific BRF. Furthermore, the angular distribution of the incoming diffuse radiation is characterized for various atmospheric conditions and the BRF retrieval is performed for an artificial target and compared to laboratory spectrodirectional measurement results obtained with the same goniometer system. Suggestions for further improving goniometer systems are given and the need for intercalibration of various goniometers as well as for standardizing spectrodirectional measurements is expressed.

SUVmax of 18FDG PET/CT as a predictor of high-risk endometrial cancer patients

DEFF Research Database (Denmark)

Antonsen, Sofie Leisby; Loft, Annika; Fisker, Rune Vincents

2013-01-01

OBJECTIVE: To evaluate SUVmax in the assessment of endometrial cancer preoperatively with particular focus on myometrial invasion (MI), cervical invasion (CI), FIGO stage, risk-stratification and lymph node metastases (LNM). METHODS: A total of 268 women with endometrial cancer or atypical...... endometrial hyperplasia underwent FDG PET/CT imaging before surgical treatment. SUVmax of the primary tumour was compared with histological prognostic factors. RESULTS: SUVmax was significantly higher in patients with high FIGO stages (p...

Strong Prognostic Value of Tumor-infiltrating Neutrophils and Lymphocytes Assessed by Automated Digital Image Analysis in Early Stage Cervical Cancer

DEFF Research Database (Denmark)

Carus, Andreas; Donskov, Frede; Switten Nielsen, Patricia

2014-01-01

INTRODUCTION Manual observer-assisted stereological (OAS) assessments of tumor-infiltrating neutrophils and lymphocytes are prognostic, accurate, but cumbersome. We assessed the applicability of automated digital image analysis (DIA). METHODS Visiomorph software was used to obtain DIA densities...... with the prognostically strongest manual OAS assessments in the peritumoral compartment. In multivariate analysis, CD66b and CD8 densities, assessed by DIA, and regional lymph node metastases were independent predictors of RFS, while CD163 density and FIGO stage were not. The CD66b/CD8 tumorassociated neutrophil...

Absolute depth of myometrial invasion in endometrial cancer is superior to the currently used cut-off value of 50%

NARCIS (Netherlands)

Geels, Y.P.; Pijnenborg, J.M.A.; Berg-van Erp, S.H. van den; Snijders, M.P.; Bulten, J.; Massuger, L.F.A.G.

2013-01-01

OBJECTIVE: In endometrial carcinoma, myometrial invasion is a well known predictor of recurrence, and important in the decision making for adjuvant treatment. According to the FIGO staging system, myometrial invasion is expressed as invasion of <50%> of the myometrium (50%MI). It has been suggested

Definitive radiotherapy for primary vaginal cancer. Correlation between treatment patterns and recurrence rate

International Nuclear Information System (INIS)

Kanayama, Naoyuki; Isohashi, Fumiaki; Yoshioka, Yasuo

2015-01-01

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1–169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III–IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge. (author)

Comparative study of LDR (Manchester system) and HDR image-guided conformal brachytherapy of cervical cancer: patterns of failure, late complications, and survival.

Science.gov (United States)

Narayan, Kailash; van Dyk, Sylvia; Bernshaw, David; Rajasooriyar, Chrishanthi; Kondalsamy-Chennakesavan, Srinivas

2009-08-01

To compare patterns of failure, late toxicities, and survival in locally advanced cervical cancer patients treated by either low-dose-rate (LDR) or conformal high-dose-rate (HDRc) brachytherapy as a part of curative radiotherapy. A retrospective comparative study of 217 advanced cervix cancer patients was conducted; 90 of these patients received LDR and 127 received HDRc brachytherapy. All patients were staged using International Federation of Gynecology and Obstetrics (FIGO) rules, had pretreatment magnetic resonance imaging (MRI), and were treated with concurrent cisplatin chemoradiotherapy. Both groups matched for FIGO stage, MRI tumor volume, and uterine invasion status. Local and pelvic failures were similar 12-13% and 14% both in both groups. Abdominal and systemic failures in LDR group were 21% and 24%, whereas corresponding failures in HDRc group were 20% and 24%. Sixty-eight percent (87/127) of patients treated by HDRc remained asymptomatic, whereas 42% (38/90) of patients were asymptomatic from the bowel and bladder symptoms after treatment with LDR. The 5-year OS rate was 60% (SE = 4%). The 5-year failure-free survival rate was 55% (SE = 3%). There was no significant difference between the groups. Image-guided HDRc planning led to a large decrease in late radiation effects in patients treated by HDRc. Patterns of failure and survival were similar in patients treated either by LDR or HDRc.

Comparative Study of LDR (Manchester System) and HDR Image-guided Conformal Brachytherapy of Cervical Cancer: Patterns of Failure, Late Complications, and Survival

International Nuclear Information System (INIS)

Narayan, Kailash; Dyk, Sylvia van; Bernshaw, David; Rajasooriyar, Chrishanthi; Kondalsamy-Chennakesavan, Srinivas

2009-01-01

Purpose: To compare patterns of failure, late toxicities, and survival in locally advanced cervical cancer patients treated by either low-dose-rate (LDR) or conformal high-dose-rate (HDRc) brachytherapy as a part of curative radiotherapy. Materials and Methods: A retrospective comparative study of 217 advanced cervix cancer patients was conducted; 90 of these patients received LDR and 127 received HDRc brachytherapy. All patients were staged using International Federation of Gynecology and Obstetrics (FIGO) rules, had pretreatment magnetic resonance imaging (MRI), and were treated with concurrent cisplatin chemoradiotherapy. Both groups matched for FIGO stage, MRI tumor volume, and uterine invasion status. Results: Local and pelvic failures were similar 12-13% and 14% both in both groups. Abdominal and systemic failures in LDR group were 21% and 24%, whereas corresponding failures in HDRc group were 20% and 24%. Sixty-eight percent (87/127) of patients treated by HDRc remained asymptomatic, whereas 42% (38/90) of patients were asymptomatic from the bowel and bladder symptoms after treatment with LDR. The 5-year OS rate was 60% (SE = 4%). The 5-year failure-free survival rate was 55% (SE = 3%). There was no significant difference between the groups. Conclusions: Image-guided HDRc planning led to a large decrease in late radiation effects in patients treated by HDRc. Patterns of failure and survival were similar in patients treated either by LDR or HDRc.

Radiotherapy for carcinoma of the vagina. Immunocytochemical and cytofluorometric analysis of prognostic factors

Energy Technology Data Exchange (ETDEWEB)

Blecharz, P. [Maria Sklodowska-Curie Memorial Institute, Krakow (Poland). Dept. of Gynecological Oncology; Reinfuss, M.; Jakubowicz, J. [Maria Sklodowska-Curie Memorial Institute, Krakow (Poland). Dept. of Radiation Oncology; Rys, J. [Maria Sklodowska-Curie Memorial Institute, Krakow (Poland). Dept. of Tumor Pathology Oncology; Skotnicki, P.; Wysocki, W. [Maria Sklodowska-Curie Memorial Institute, Krakow (Poland). Dept. of Oncological Surgery

2013-05-15

Background and purpose: The aim of this study was to assess the potential prognostic factors in patients with primary invasive vaginal carcinoma (PIVC) treated with radical irradiation. Patients and methods: The analysis was performed on 77 patients with PIVC treated between 1985 and 2005 in the Maria Sklodowska-Curie Memorial Institute of Oncology, Cancer Center in Krakow. A total of 36 patients (46.8 %) survived 5 years with no evidence of disease (NED). The following groups of factors were assessed for potential prognostic value: population-based (age), clinical (Karnofsky Performance Score [KPS], hemoglobin level, primary location of the vaginal lesion, macroscopic type, length of the involved vaginal wall, FIGO stage), microscopic (microscopic type, grade, mitotic index, presence of atypical mitoses, lymphatic vessels invasion, lymphocytes/plasmocytes infiltration, focal necrosis, VAIN-3), immunohistochemical (protein p53 expression, MIB-1 index), cytofluorometric (ploidity, index DI, S-phase fraction, proliferation index SG2M) factors. Results: Significantly better 5-year NED was observed in patients: < 60 years, KPS {<=} 80, FIGO stage I and II, grade G1-2, MIB-1 index < 70, S-phase fraction < 10, and proliferation index < 25. Independent factors for better prognosis in the multivariate Cox analysis were age < 60 years, FIGO stage I or II, and MIB-1 index < 70. Conclusion: Independent prognostic factors in the radically irradiated PIVC patients were as follows: age, FIGO stage, MIB-1 index. (orig.)

Influence of a live tularemia vaccine on certain indices of immune and nonspecific antitumor resistance in endometrial carcinoma patients during combined treatment and later

International Nuclear Information System (INIS)

Movsesyan, M.A.; Adamyan, R.T.

1998-01-01

The levels of T-system lymphocytes, macrophageal transformation of mononuclear and phagocytic activity of blood neutrophils were assayed in 194 patients with endometrial tumors, stage 1-4, (FIGO, 1988), 10-15 days after surgery, a subsequent course of telegammatherapy and 2-3 years after treatment. Pre-operative LTV immunization showed an immunoprotective effect at all stages of combined treatment (surgery + telegammatherapy) given for endometrial carcinoma [ru

Staged membrane oxidation reactor system

Science.gov (United States)

Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

2012-09-11

Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

Two-stage implant systems.

Science.gov (United States)

Fritz, M E

1999-06-01

Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are peri-implantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of

Early stage cervical cancer of the uterine

International Nuclear Information System (INIS)

Kaneyasu, Yuuko; Fujiwara, Hisaya

2011-01-01

This paper describes the present state of radiotherapy (RT) of early stage cervical cancer involving the history, outcomes of clinical trials, procedure for each stage, irradiation methods, concurrent chemo-RT (CCRT), late adverse events, and QOL after RT. It has a history of >100 years from the brachytherapy with radium, but is not yet completely established even now. There are many RT trials hitherto. Retrospectively, no significant difference is seen in outcomes of radical RT and surgery: 80-90% efficacy for stage I and 60-80% for II in the former, respectively, and 80-96% and 65-80%, in the latter. Between RT and surgery, there is a report of randomized comparative study in Italy. In Japan, reported are comparative outcomes based on patients' choice for therapy, retrospective studies including authors' one, prospective multi-institutional cooperative trials by Japanese Radiation Oncology Study Group, and Treatment Guidelines for Cervical Cancer (2007). RT procedure depends on the stage defined by FIGO (International Federation of Gynecology and Obstetrics) and at stages I-II, intracavitary RT is major with optimal dose 29 Gy/5 fractions for I, and 23/4 Gy with external total pelvic radiation 50 Gy for II. In external radiation, the planning target volume includes the whole pelvic field with 1.8-2 Gy/5 weeks and optionally, the extended field when metastasis suspicious. Intracavitary RT with application device in the uterine is of significance for the cancer as 50% complete cure even in stage III is reported. CCRT brings about good prognosis, which is shown in a Japanese trial to compare postoperative RT alone and CCRT with CDDP and 5-FU. The late adverse events are seen mainly in the large bowel and studies of QOL, an important factor for choice of treatment, are now in progress. (T.T.)

Adenocarcinoma of the endometrium treated with combined irradiation and surgery: Study of 437 patients

International Nuclear Information System (INIS)

Touboul, Emmanuel; Belkacemi, Yazid; Buffat, Laurent; Deniaud-Alexandre, Elisabeth; Lefranc, Jean-Pierre; Lhuillier, Pierre; Uzan, Serge; Jannet, Denis; Uzan, Michele; Antoine, Martine; Huart, Judith; Ganansia, Valerie; Milliez, Jacques; Blondon, Jean; Housset, Martin; Schlienger, Michel

2001-01-01

Purpose: To identify prognostic factors and treatment toxicity in a series of operable endometrial adenocarcinomas. Methods and Materials: Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO staging system (225 Stage IB, 107 Stage IC, 4 Stage IIA, 35 Stage IIB, 30 Stage IIIA, 6 Stage IIIB, and 30 Stage IIIC), underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without (n=140) or with (n=297) pelvic lymph node dissection. The chronology of adjuvant RT was not randomized and depended on the usual practices of the surgical teams. Seventy-nine pts (Group I) received preoperative low-dose-rate uterovaginal brachytherapy (mean dose [MD]: 57 Gy). Three hundred fifty-eight pts (Group II) received postoperative RT. One hundred ninety-six pts received low-dose-rate vaginal brachytherapy alone (MD: 50 Gy). One hundred fifty-eight pts had external beam pelvic RT (MD: 46 Gy) followed by low-dose-rate vaginal brachytherapy (MD: 17 Gy). Four pts had external beam pelvic RT alone (MD: 47 Gy). The mean follow-up from the beginning of treatment was 128 months. Results: The 10-year disease-free survival rate was 86%. From 57 recurrences, only 12 were isolated locoregional recurrences. The independent factors decreasing the probability of disease-free survival were as follows: histologic type (clear-cell carcinoma, p=0.038), largest histologic tumor diameter >3 cm (p=0.015), histologic grade (p=0.008), myometrial invasion > 1/2 (p=0.005), and 1988 FIGO staging system (p=9.10 -8 ). In Group II, the addition of external beam pelvic RT did not seem to independently improve vaginal or pelvic control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were stage FIGO (p=0.02) and pelvic lymph node dissection (p=0.011). The 10-year rate for Grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 3

Adjuvant treatment and outcomes of stage III endometrial carcinoma

International Nuclear Information System (INIS)

Connell, C.; Ludbrook, J.; Davy, M.; Yeoh, E

2003-01-01

Surgery with staging using FIGO (1988) classification is accepted management for stage III endometrial carcinoma. The delivery of adjuvant therapy is controversial and tends to be individualised. Retrospective review of stage III endometrial carcinoma patients who underwent radical surgery at the Royal Adelaide and Queen Elizabeth Hospitals from 1984 to 2003 was carried out. Medical records were reviewed for details of patient characteristics, surgery, histopathology, adjuvant therapy and recurrence/survival. Sixty-six patients with a median age of 69 (37-97), had a median follow-up of 26 months (1-188 ). For all stage III patients, the actuarial 5-year disease-free and overall survivals were 50 and 43% respectively. Thirty-five patients received pelvic +/- paraaortic radiotherapy, 5 whole abdominal radiotherapy, 14 vaginal brachytherapy boost, 10 chemotherapy and 13 adjuvant hormones. Forty-six percent of patients recurred in a median time of 13 months (0-95). For these patients, the sites of first recurrence were pelvis in 27%, pelvis and abdomen in 23%, abdomen alone in 13%, distant alone in 27%, distant and abdominal in 7% and all three sites in 3%. On univariate analysis disease-free survival was impacted by; age, grade, parametrial involvement, number of extrauterine sites, lymphovascular invasion, adjuvant radiotherapy to the pelvis alone and postoperative macroscopic residual disease. Lymphovascular invasion, post-operative residual disease and adjuvant pelvic radiotherapy remained significant on multivariate analysis. These outcomes for stage III endometrial carcinoma are comparable to the current literature. Ongoing research is required to establish the most appropriate adjuvant therapy in these high risk patients

Multi-Stage System for Automatic Target Recognition

Science.gov (United States)

Chao, Tien-Hsin; Lu, Thomas T.; Ye, David; Edens, Weston; Johnson, Oliver

2010-01-01

A multi-stage automated target recognition (ATR) system has been designed to perform computer vision tasks with adequate proficiency in mimicking human vision. The system is able to detect, identify, and track targets of interest. Potential regions of interest (ROIs) are first identified by the detection stage using an Optimum Trade-off Maximum Average Correlation Height (OT-MACH) filter combined with a wavelet transform. False positives are then eliminated by the verification stage using feature extraction methods in conjunction with neural networks. Feature extraction transforms the ROIs using filtering and binning algorithms to create feature vectors. A feedforward back-propagation neural network (NN) is then trained to classify each feature vector and to remove false positives. The system parameter optimizations process has been developed to adapt to various targets and datasets. The objective was to design an efficient computer vision system that can learn to detect multiple targets in large images with unknown backgrounds. Because the target size is small relative to the image size in this problem, there are many regions of the image that could potentially contain the target. A cursory analysis of every region can be computationally efficient, but may yield too many false positives. On the other hand, a detailed analysis of every region can yield better results, but may be computationally inefficient. The multi-stage ATR system was designed to achieve an optimal balance between accuracy and computational efficiency by incorporating both models. The detection stage first identifies potential ROIs where the target may be present by performing a fast Fourier domain OT-MACH filter-based correlation. Because threshold for this stage is chosen with the goal of detecting all true positives, a number of false positives are also detected as ROIs. The verification stage then transforms the regions of interest into feature space, and eliminates false positives using an

Expression of CD44v6 and Its Association with Prognosis in Epithelial Ovarian Carcinomas

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Dang-xia Zhou

2012-01-01

Full Text Available The aim of this study was to evaluate CD44v6 protein expression and its prognostic value of CD44v6 in ovarian carcinoma. The expression of CD44v6 was analyzed in 62 patients with ovarian carcinoma by immunohistochemical method. The data obtained were analyzed by univariate and multivariate analyses. The present study clearly demonstrates that tumor tissues from 41 (66.1% patients showed positive expression with CD44v6. The expression of CD44v6 was significantly correlated with histological type, FIGO stage and histological grade of ovarian carcinomas. Concerning the prognosis, the survival period of patients with CD44v6 positive was shorter than that of patients with CD44v6 negative (36.6% versus 66.7%, 5-year survival, P<0.05. Univariate analysis showed that CD44v6 expression, histological type, FIGO stage and histological grade were associated with 5-year survival, and CD44v6 expression was associated with histological type, FIGO stage and histological grade and 5-year survival. In multivariate analysis, using the COX-regression model, CD44v6 expression was important prognostic factor. In conclusion, these results suggest that CD44v6 may be related to histological type, FIGO stage and histological grade of ovarian carcinomas, and CD44v6 may be an important molecular marker for poor prognosis in ovarian carcinomas.

Primary radiotherapy of stage IIA/B-IIIB cervical carcinoma. A comparison of continuous versus sequential regimens

International Nuclear Information System (INIS)

Mayer, A.; Nemeskeri, C.; Petnehazi, C.; Varga, S.; Naszaly, A.; Borgulya, G.

2004-01-01

Background: comprehensive literature on cervical cancer demonstrates, even today, the need for optimization of the timing of external-beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) in the treatment of stage IIA/B-IIIB cervical carcinoma. Patients and methods: 210 patients with carcinoma of the cervix were treated in the Municipal Center of Oncoradiology between January 1991 and December 1996 (FIGO IIA: n = 10, FIGO IIB: n = 113, and FIGO IIIB: n = 87). Two regimens were compared: sequential radiation therapy (SRT) with 4 x 8 Gy HDR-BT to point A followed by EBRT, and continuous radiation therapy (CRT) in which 5 x 6 Gy HDR-BT to point A, one session per week, was integrated into the EBRT. A total dose of 68-70 Gy to point A and 52-54 Gy to point B was given in EBRT with SRT, five fractions per week were applied. Four fractions per week were applied in CRT, i.e., no EBRT was performed on the day of HDR-BT. Total doses to points A and B were identical in both regimens. Overall treatment time (OTT) amounted to 56 days for SRT and 35 days for CRT. Median follow-up time was 3.4 (2.5-4.2) years. Results: progression-free 5-year-survival (PFS) was 71% in the CRT and 56% in the SRT group. Nevertheless, this difference was not statistically significant (p = 1.00), and the same was found in a subgroup analysis of the different tumor stages, showing, however, an unequivocal trend. Late bladder and rectal injuries occurred in 13% and 25%, respectively. Late rectal injuries were significantly more frequent with SRT than CRT (35 patients in the SRT and 18 patients in the CRT group; p = 0.037). This was due to the higher doses per fraction of HDR-BT in the SRT group. No difference was found regarding late bladder injuries (p = 0.837). Conclusion: for the patients included in this study, no advantage has been found so far in using CRT, i.e., shortening the OTT by weekly integration of HDR-BT into EBRT. Nevertheless, an obvious trend exists. The dose of 8 Gy per

Ação de fungos entomopatogênicos em larvas e adultos da mosca do figo Zaprionus indianus (Diptera: Drosophilidae Action of entomopathogenic fungi on the larvae and adults of the fig fly Zaprionus indianus (Diptera: Drosophilidae

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Virgínia Michelle Svedese

2012-11-01

Full Text Available A mosca do figo, Zaprionus indianus, vem se disseminando no Brasil e causou nos últimos anos perdas de até 50% na produção de figos. Uma alternativa viável de controle desta mosca pode ser a utilização de fungos entomopatogênicos. Este trabalho foi conduzido em laboratório (27±1°C, UR 70±10% e fotoperíodo de 12h para avaliar a suscetibilidade dos estágios de larva e adulto de Z. indianus a cinco concentrações (10(8 a 10(4 conídios mL-1 de B. bassiana (URM2915; ESALQ447 e M. anisopliae (URM3349; URM4403. Não houve mortalidade larval e o período de pré-pupa não sofreu alteração em relação ao grupo controle, já o estágio de pupa foi aumentado em até três dias quando se utilizou B. bassiana. A emergência de adultos diminuiu em relação ao grupo controle: 10,6% quando as larvas foram tratadas com a maior concentração de B. bassiana URM2916 e 2,0% com M. anisopliae URM4403. No bioensaio com adultos, a mortalidade máxima atingiu 98,7% com B. bassiana e 100,0% com M. anisopliae. Os menores valores da CL50 foram de 1,09x10(5 conídios mL-1 para B. bassiana URM2916 e de 1,94x10(4 conídios mL-1 para M. anisopliae URM4403. O tempo letal médio (TL50 variou de 4,5 a 6,12 dias. Os resultados demonstraram que ambos os fungos são eficientes e mostram ser promissores agentes biocontroladores da mosca do figo, com destaque para M. anisopliae URM4403.The "fig fly", Zaprionus indianus, has spread by in Brazil and in recent years and has caused losses of up to 50% in the production of figs. A viable alternative to control this fly may be the use of entomopathogenic fungi such. The present study was developed in laboratory (27±1°C, RH 70±10% and 12h photoperiod, to assess the susceptibility of larval and adult stages of Z. indianus to five concentrations (10(8 to 10(4 conidia mL-1 of B. bassiana (URM2915; ESALQ447 and M. anisopliae (URM3349; URM4403. There was no larval mortality and the pre-pupal period did not change compared

Wide-bandwidth bilateral control using two-stage actuator system

International Nuclear Information System (INIS)

Kokuryu, Saori; Izutsu, Masaki; Kamamichi, Norihiro; Ishikawa, Jun

2015-01-01

This paper proposes a two-stage actuator system that consists of a coarse actuator driven by a ball screw with an AC motor (the first stage) and a fine actuator driven by a voice coil motor (the second stage). The proposed two-stage actuator system is applied to make a wide-bandwidth bilateral control system without needing expensive high-performance actuators. In the proposed system, the first stage has a wide moving range with a narrow control bandwidth, and the second stage has a narrow moving range with a wide control bandwidth. By consolidating these two inexpensive actuators with different control bandwidths in a complementary manner, a wide bandwidth bilateral control system can be constructed based on a mechanical impedance control. To show the validity of the proposed method, a prototype of the two-stage actuator system has been developed and basic performance was evaluated by experiment. The experimental results showed that a light mechanical impedance with a mass of 10 g and a damping coefficient of 2.5 N/(m/s) that is an important factor to establish good transparency in bilateral control has been successfully achieved and also showed that a better force and position responses between a master and slave is achieved by using the proposed two-stage actuator system compared with a narrow bandwidth case using a single ball screw system. (author)

Adenocarcinoma of the endometrium treated with combined irradiation and surgery: study of 437 patients; Adenocarcinome de l'endometre traite par association radiochirurgicale: a propos de 437 cas

Energy Technology Data Exchange (ETDEWEB)

Touboul, E.; Belkacemi, Y.; Deniaud-Alexandre, E.; Ganansia, V.; Schlienger, M. [Hopital Tenon, Service d' Oncologie-Radiotherapie, 75 - Paris (France); Buffat, L. [Hopital Tenon, Service de Biostatistique, Centre des Tumeurs, 75 - Paris (France); Lefranc, J.P.; Blondon, J. [Groupe Hospitalier Pitie-Salpetriere, Service de Chirurgie Gynecologique, 75 - Paris (France); Lhuillier, P. [Centre Hospitalier de Fontainebleau, Service de Gynecologie Obstetrique, 77 - Fontainebleau (France); Uzan, S. [Hopital Tenon, Service de Gynecologie Obstetrique, Centre des Tumeurs, 75 - Paris (France); Jannet, D.; Milliez, J. [Hopital Saint Antoine, Service de Gynecologie Obstetrique, 75 - Paris (France); Uzan, M. [Hopital Jean Verdier, Service de Gynecologie Obstetrique, 93 - Bondy (France); Antoine, M. [Hopital Tenon, Service d' Anatomopathologie, 75 - Paris (France); Ginesty, C. [Groupe Hospitalier Pitie-Salpetriere, Service d' Anatomopathologie, 75 - Paris (France); Jamali, M. [Hopital Saint Antoine, Service d' Anatomopathologie, 75 - Paris (France)

2001-08-01

To identify prognostic actors and treatment toxicity in a series of operable endometrial adenocarcinomas. Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO staging system, underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without (n = 140) or with (n = 297) pelvic lymph node dissection. The chronology of RT was not randomized and depended on the usual practices of the surgical teams. Group I: 79 pts received preoperative utero-vaginal brachytherapy (mean total dose [MD]: 57 Gy). Group II: 358 pts received postoperative RT (196 pts received vaginal brachytherapy alone [MD: 50 Gy], 158 pts had external beam pelvis RT [EPRT] [MD: 46 Gy over 5 weeks] followed by vaginal brachytherapy [MD: 17 Gy], and 4 pts had EPRT alone [MD: 46 Gy over 5 weeks]). The mean follow-up was 128 months. The 10-year disease-free survival rate was 86%. From 57 recurrences, 12 were isolated loco-regionally. Multivariate analysis showed that independent factors decreasing the probability of disease-free survival were: histologic type (clear cell carcinoma, p = 0.038), largest histologic tumor diameter > 3 cm (p = 0.015), histologic grade (p = 0.008), myometrial invasion > 1/2 (p 0.0055), and 1988 FIGO staging system (p= 9.10{sup -8}). In group II, the addition of EPRT did not seem to improve locoregional control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were FIGO stage (p = 0.02) and pelvic lymph node dissection (p = 0.011). The 10-year rate for grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 3.1 %. EPRT independently increased the 10-year rate for grade 3 and 4 late radiation complications (R.R.: 5.6, p = 0.0096). EPRT increases the risk of late radiation complications. After surgical and histopathologic staging with pelvic lymph node dissection, in a subgroup of intermediate risk

Adenocarcinoma of the endometrium treated with combined irradiation and surgery: study of 437 patients

International Nuclear Information System (INIS)

Touboul, E.; Belkacemi, Y.; Deniaud-Alexandre, E.; Ganansia, V.; Schlienger, M.; Buffat, L.; Lefranc, J.P.; Blondon, J.; Lhuillier, P.; Uzan, S.; Jannet, D.; Milliez, J.; Uzan, M.; Antoine, M.; Ginesty, C.; Jamali, M.

2001-01-01

To identify prognostic actors and treatment toxicity in a series of operable endometrial adenocarcinomas. Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO staging system, underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without (n = 140) or with (n = 297) pelvic lymph node dissection. The chronology of RT was not randomized and depended on the usual practices of the surgical teams. Group I: 79 pts received preoperative utero-vaginal brachytherapy (mean total dose [MD]: 57 Gy). Group II: 358 pts received postoperative RT (196 pts received vaginal brachytherapy alone [MD: 50 Gy], 158 pts had external beam pelvis RT [EPRT] [MD: 46 Gy over 5 weeks] followed by vaginal brachytherapy [MD: 17 Gy], and 4 pts had EPRT alone [MD: 46 Gy over 5 weeks]). The mean follow-up was 128 months. The 10-year disease-free survival rate was 86%. From 57 recurrences, 12 were isolated loco-regionally. Multivariate analysis showed that independent factors decreasing the probability of disease-free survival were: histologic type (clear cell carcinoma, p = 0.038), largest histologic tumor diameter > 3 cm (p = 0.015), histologic grade (p = 0.008), myometrial invasion > 1/2 (p 0.0055), and 1988 FIGO staging system (p= 9.10 -8 ). In group II, the addition of EPRT did not seem to improve locoregional control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were FIGO stage (p = 0.02) and pelvic lymph node dissection (p = 0.011). The 10-year rate for grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 3.1 %. EPRT independently increased the 10-year rate for grade 3 and 4 late radiation complications (R.R.: 5.6, p = 0.0096). EPRT increases the risk of late radiation complications. After surgical and histopathologic staging with pelvic lymph node dissection, in a subgroup of intermediate risk

Two-Stage Variable Sample-Rate Conversion System

Science.gov (United States)

Tkacenko, Andre

2009-01-01

A two-stage variable sample-rate conversion (SRC) system has been pro posed as part of a digital signal-processing system in a digital com munication radio receiver that utilizes a variety of data rates. The proposed system would be used as an interface between (1) an analog- todigital converter used in the front end of the receiver to sample an intermediatefrequency signal at a fixed input rate and (2) digita lly implemented tracking loops in subsequent stages that operate at v arious sample rates that are generally lower than the input sample r ate. This Two-Stage System would be capable of converting from an input sample rate to a desired lower output sample rate that could be var iable and not necessarily a rational fraction of the input rate.

Staged fluidized-bed combustion and filter system

International Nuclear Information System (INIS)

Mei, J.S.; Halow, J.S.

1994-01-01

A staged fluidized-bed combustion and filter system are described for substantially reducing the quantity of waste through the complete combustion into ash-type solids and gaseous products. The device has two fluidized-bed portions, the first primarily as a combustor/pyrolyzer bed, and the second as a combustor/filter bed. The two portions each have internal baffles to define stages so that material moving therein as fluidized beds travel in an extended route through those stages. Fluidization and movement is achieved by the introduction of gases into each stage through a directional nozzle. Gases produced in the combustor/pyrolyzer bed are permitted to travel into corresponding stages of the combustor/filter bed through screen filters that permit gas flow but inhibit solids flow. Any catalyst used in the combustor/filter bed is recycled. The two beds share a common wall to minimize total volume of the system. A slightly modified embodiment can be used for hot gas desulfurization and sorbent regeneration. Either side-by-side rectangular beds or concentric beds can be used. The system is particularly suited to the processing of radioactive and chemically hazardous waste. 10 figures

Staging of intestinal- and diffuse-type gastric cancers with the OLGA and OLGIM staging systems.

Science.gov (United States)

Cho, S-J; Choi, I J; Kook, M-C; Nam, B-H; Kim, C G; Lee, J Y; Ryu, K W; Kim, Y-W

2013-11-01

Operative link on gastritis assessment (OLGA) and Operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems have been proposed for gastric cancer (GC) risk estimation. To validate the OLGA and OLGIM staging systems in a region with high risk of GC. This retrospective study included 474 GC patients and age- and sex-matched health screening control persons in a cancer centre hospital. We classified gastritis patterns according to the OLGA and OLGIM systems using the histological database that a pathologist prospectively evaluated using the updated Sydney system. GC risk according to the OLGA and OLGIM stages was evaluated using logistic regression analysis. More GC patients had OLGA stages III-IV (46.2%) than controls (26.6%, P diffuse-type GCs (30.9%). OLGA stages III and IV were significantly associated with increased risk of GC [odds ratios (ORs), 2.09; P = 0.008 and 2.04; P = 0.014 respectively] in multivariate analysis. The association was more significant for intestinal-type (ORs, 4.76; P = 0.001 and 4.19; P = 0.002 respectively), but not diffuse-type GC. OLGIM stages from I to IV were significantly associated with increased risk of both intestinal-type (ORs, 3.64, 5.15, 7.89 and 13.20 respectively) and diffuse-type GC (ORs, 1.84, 2.59, 5.08 and 6.32 respectively) with a significantly increasing trend. As high OLGA and OLGIM stages are independent risk factors for gastric cancer, the staging systems may be useful for risk assessment in high-risk regions, especially for intestinal-type gastric cancer. © 2013 John Wiley & Sons Ltd.

Pretreatment prognostic Factors in Early Stage Carcinoma of the Uterine Cervix

International Nuclear Information System (INIS)

Kim, Mi Sook; Ha, Sung Whan

1992-01-01

From March 1979 through December 1986, 124 patients with early stage carcinoma of the uterine cervix received curative radiation therapy. According to FIGO classification, 35 patients were stage IB and 89 were stage IIA. In stage IB, five year locoregional control, five year disease A, five year locoregional control, five disease free survival, and five year overall survival were 78.0%, 66.8%, and 72.1%, respectively. To identify prognostic factor, pretreatment including age, ECOG performance status, number of pregnancies, history of diabetes mellitus and hypertension, histology, size and shape of primary tumor, CT findings and blood parameters were retrospectively analyzed in terms of locoregional control, disease free survival and overall survival using univariate analysis and multivariate analysis. In univariate analysis, tumor size on physical examination and rectal invasion on CT significantly affected locoregional control, disease free survival and overal survival. Parametrial involvement on CT was a significant prognostic factor on locoregional control and disease free survival. Hemoglobin level affected disease free survival and overall survival. Histology and age were significant pronostic factor on locoregional control. In multivariate analysis excluding CT finding, tumor size on physical examination was a significant factor in terms of locoregional control and overall survival. Hemoglobin level was significant in terms of disease free survival. In multivarate analysis including CT, histology was a prognostic factor on locoregional control and disease free survival. Hemoglobin level and rectal invasion on CT were significant factors on locoregional control

Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team

DEFF Research Database (Denmark)

Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik

2017-01-01

multidisciplinary team (MDT) decisions. Materials and Methods Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3...... classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA......-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV. Conclusions The COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre...

Severe radiation morbidity in carcinoma of the cervix: impact of pretherapy surgical staging and previous surgery

International Nuclear Information System (INIS)

Fine, Bruce A.; Hempling, Ronald E.; Piver, M. Steven; Baker, Trudy R.; McAuley, Michael; Driscoll, Deborah

1995-01-01

Purpose: The purpose of this study is to delineate the factors which (a) contribute to an increase in the severe, radiation induced complication rate and (b) have a significant effect on survival in patients with International Federation of Gynecologists and Obstetricians (FIGO) Stage I-IVA cervical cancer undergoing pretherapy surgical staging. Methods and Materials: From 1971-1991, 189 patients underwent pretherapy surgical staging via a retroperitoneal approach (67) or transperitoneal approach (122). Seventy-nine patients had previously experienced a laparotomy. Patients subsequently received a median of 85 Gy to point A. In patients receiving paraaortic radiation, a median of 45 Gy was administered. One hundred and thirty-two (69.8%) patients received hydroxyurea as a radiation sensitizer. Results: Pretherapy surgical evaluation revealed that 21 of 89 (23.6%) Stage II patients and 32 of 85 (37.6%) Stage III patients had paraaortic lymph node metastases. Multivariate logistic regression analysis detailed the significant factors favorably influencing the radiation-induced complication rate to be a retroperitoneal approach of pretherapy surgical staging and no previous laparotomy. Survival was significantly prolonged in patients receiving hydroxyurea, evaluated via a retroperitoneal incision, with negative paraaortic lymph nodes, and with an early stage of disease. Conclusion: A retroperitoneal approach to pretherapy surgical staging and absence of previous surgery reduced the incidence of subsequent radiation-induced complications. Despite improvements in the detection of occult disease, prolonged survival is impaired when the therapeutic measures currently available are used

Studies on evaluation of staging of cancer of the uterine cervix by means of CT

Energy Technology Data Exchange (ETDEWEB)

Kakizaki, D

1987-03-01

The present study was undertaken to evaluate the stage classification (FIGO) by using CT in 50 cases with cancer of the uterine cervix in which the final stage had been diagnosed. An accurate diagnosis was obtained in 6 of 14 Ib cases, 14 of 21 IIa cases, 5 of 6 IIb cases, 2 of 3 IIIa cases, 3 of 3 IIIb cases and 3 of 3 IVa cases, for a total of 33 of 50 (66 %). The diagnostic rate for Ib and IIa staging was 57 %, while that for IIb or more was 87 %, but the accuracy rate in IIIb and IVa was 100 %. As the equipment, a high resolutional GE 9800 CT using a special technique was employed. Employing special pretreatment for the patient, it became possible to accurately grasp the pelvic condition of the patients. CT evaluation was related to the extent of the cervical cancer and the presence of infiltration into the vaginal wall. According to a 4-stage classification of the CT image, the extent of infiltration to surrounding parametrium and the bladder was determined. As a result, the sensitivity for evaluating invasion into surrounding tissue raised 92 %, and it showed 100 % for cases with adhesion or invasion of the bladder. Therefore, CT can an extremely effective method to determine the clinical staging of cancer of the uterine cervix.

[Helicobacter pylori gastritis: assessment of OLGA and OLGIM staging systems].

Science.gov (United States)

Ben Slama, Sana; Ben Ghachem, Dorra; Dhaoui, Amen; Jomni, Mohamed Taieb; Dougui, Mohamed Hédi; Bellil, Khadija

2016-01-01

Helicobacter pylori (H pylori) gastritis presents a risk of cancer related to atrophy and intestinal metaplasia. Two recent classifications OLGA (Operative Link on Gastritis Assessment) and OLGIM (Operative Link on Gastritic Intestinal Metaplasia assessment) have been proposed to identify high-risk forms (stages III and IV). The aim of this study is to evaluate the OLGA and OLGIM staging systems in H pylori gastritis. A descriptive study of 100 cases of chronic H pylori gastritis was performed. The revaluation of Sydney System parameters of atrophy and intestinal metaplasia, of gastric antrum and corpus, allowed identifying respectively the stages of OLGA and OLGIM systems. The progressive risk of our H pylori gastritis was 6% according to OLGA staging and 7% according to OLGIM staging. Significant correlation was revealed between age and OLGA staging. High-risk gastritis according to OLGIM staging was significantly associated with moderate to severe atrophy. High-risk forms according to OLGA staging were associated in 80% of the cases to intestinal metaplasia. OLGA and OLGIM systems showed a highly significant positive correlation between them with a mismatch at 5% for H pylori gastritis. The OLGA and OLGIM staging systems in addition to Sydney System, allow selection of high risk forms of chronic gastritis requiring accurate observation.

Loss-of-heterozygosity on chromosome 19q in early-stage serous ovarian cancer is associated with recurrent disease

Directory of Open Access Journals (Sweden)

Skirnisdottir Ingiridur

2012-09-01

Full Text Available Abstract Background Ovarian cancer is a heterogeneous disease and prognosis for apparently similar cases of ovarian cancer varies. Recurrence of the disease in early stage (FIGO-stages I-II serous ovarian cancer results in survival that is comparable to those with recurrent advanced-stage disease. The aim of this study was to investigate if there are specific genomic aberrations that may explain recurrence and clinical outcome. Methods Fifty-one women with early stage serous ovarian cancer were included in the study. DNA was extracted from formalin fixed samples containing tumor cells from ovarian tumors. Tumor samples from thirty-seven patients were analysed for allele-specific copy numbers using OncoScan single nucleotide polymorphism arrays from Affymetrix and the bioinformatic tool Tumor Aberration Prediction Suite. Genomic gains, losses, and loss-of-heterozygosity that associated with recurrent disease were identified. Results The most significant differences (p  Conclusions The results of our study indicate that presence of two aberrations in TP53 on 17p and LOH on 19q in early stage serous ovarian cancer is associated with recurrent disease. Further studies related to the findings of chromosomes 17 and 19 are needed to elucidate the molecular mechanism behind the recurring genomic aberrations and the poor clinical outcome.

A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy

International Nuclear Information System (INIS)

Jebaraj, Isaac; Chacko, Binita Riya; Chiramel, George Koshy; Matthai, Thomas; Parameswaran, Apurve

2013-01-01

This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1), the stage of early discal calcification (stage 2), the stage of fibrous ankylosis (stage 3), and the stage of bony ankylosis (stage 4). To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease

A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy

Directory of Open Access Journals (Sweden)

Isaac Jebaraj

2013-01-01

Full Text Available This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1, the stage of early discal calcification (stage 2, the stage of fibrous ankylosis (stage 3, and the stage of bony ankylosis (stage 4. To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease.

THE EFFECT OF EARLY CERVICAL CANCER DIAGNOSIS

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Herman Haller

2018-02-01

Full Text Available Background: Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and Gynecology Rijeka, Croatia. Method: Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results: Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions: Conservative surgical approach – conization alone in stage IA1 of the squamous cell car- cinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned.

Uterine cervix cancer treatment at Radiumhemmet: 90 years′ experience. Time trends of age, stage, and histopathology distribution

International Nuclear Information System (INIS)

Hellman, Kristina; Hellström, Ann-Cathrin; Pettersson, B Folke

2014-01-01

Since the introduction of screening programs for cervical cancer (CC) the incidence has decreased and CC is discovered at an earlier stage. The purpose of this study was to analyze time trends in age, stage, and histopathology over a 90-year period and to our knowledge this is the largest single institutional series in the literature of invasive cervical carcinoma (CC) cases. This is a retrospective study comprising 18,472 women treated for CC from 1914 until 2004 at Radiumhemmet, Stockholm. The material is part of the international CC statistics published since 1937 in the League of Nations' Annual Reports, and since 1958 under the patronage of International Federation of Gynecology and Obstetrics (FIGO). During the 90-year study period, the annual number of cases treated increased to over 400 up until 1965, after which there was a gradual drop to less than 100 cases in 2004. A pronounced shift toward earlier stages at diagnosis was noted. The mean age at diagnosis increased in all stages, predominantly in advanced stages. A reduction in squamous cell carcinoma (SCC) cases and a sixfold increase in the proportion of adenocarcinoma (AC) cases were observed. The mean age at diagnosis for squamous and AC cases shifted after 1970, when the SCC cases ultimately became 3 years older than the AC cases in contrast to around 1950 when they were 3 years younger than the AC cases. The changes in the distribution by age, stage, and histopathology during this 90-year period are probably associated with: improved social conditions and increased access to health care, the introduction of screening programs for CC in the 1960s, and a change in the risk factors for CC (changed sexual behavior, introduction of contraceptive pills, and changed smoking habits). This is a study on changes in the distribution by age, stage, and histopathology in a large series of cervical cancer treated in Sweden during a 90-year period. It also includes an historical review about the development

Primary Carcinosarcoma of Ovary an Unusual Tumor Case Report ...

African Journals Online (AJOL)

radiotherapy and chemotherapy or chemotherapy alone.[2]. These tumors are .... stage of disease.[6]. The adverse prognostic factors as enumerated by various ... The effect of epithelial and stromal tumor components on. FIGO stages III and IV ...

Level of Concordance of Pre-, Intra-, and Postoperative Staging in Cervical Cancers (TREYA Study

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M. Toure

2017-01-01

Full Text Available Concomitant radiochemotherapy is the therapeutic standard for locally advanced (Ib2 to IVa stage FIGO cervical cancer. In the absence of a radiotherapy in many of our Sub-Saharan African countries, surgical resection is the only therapeutic method available in hopes of achieving a definite cure. However, criteria for curative surgery are not always met due to preoperative understaging of most of our patients. In addition to socioeconomic factors, the causes for understaging are numerous. These include the lack of personnel or underqualified personnel and the absence of complete workup to assess the resectability of the tumor, but above all the lack of decision-making through multidisciplinary consultation meetings. This study makes a plea in order to provide our hospitals with qualified personnel and adequate technical platform to allow efficient management of our patients with cervical cancer.

Prognostic value of pretreatment factors in patients with locally advanced carcinoma of the uterine cervix treated by radiotherapy alone

International Nuclear Information System (INIS)

Pedersen, D.; Soegaard, H.; Overgaard, J.; Bentzen, S.M.

1995-01-01

The prognostic effect of pretreatment patient- and tumor characteristics, and the influence of radiotherapy schedule on local control, distant metastases, and crude survival were analyzed in 424 consecutive patients with FIGO stage IIB (n = 137), IIIA (n = 10), IIIB (n = 211) and IVA (n = 66) cancer of the uterine cervix. All patients were given radiotherapy alone. From 1974 and through 1977, the external and intracavitary combined radiotherapy was given continuously in 4 to 6 weeks. From 1978 and through 1983, the treatment policy was changed to split-course radiotherapy by introducing planned pauses, resulting in an overall treatment time of 10 to 12 weeks. The results were estimated by univariate actuarial- and Cox multivariate regression analyses. Multivariate analysis showed that significant adverse variables for local control were large lateral tumor diameter, young age, low hemoglobin at time of admission, many prognancies, split-course strategy, and high FIGO stage. Risk of metastases increased with decreasing hemoglobin, increasing malignancy grade and split-course treatment. Poor survival probability were related to large lateral tumor diameter, high malignancy grade and FIGO stage, low hemoglobin, split-course therapy, and adeno/adenosquamous tumor type. (orig.)

Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study.

Science.gov (United States)

Trillsch, F; Mahner, S; Vettorazzi, E; Woelber, L; Reuss, A; Baumann, K; Keyver-Paik, M-D; Canzler, U; Wollschlaeger, K; Forner, D; Pfisterer, J; Schroeder, W; Muenstedt, K; Richter, B; Fotopoulou, C; Schmalfeldt, B; Burges, A; Ewald-Riegler, N; de Gregorio, N; Hilpert, F; Fehm, T; Meier, W; Hillemanns, P; Hanker, L; Hasenburg, A; Strauss, H-G; Hellriegel, M; Wimberger, P; Kommoss, S; Kommoss, F; Hauptmann, S; du Bois, A

2015-02-17

Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.

Attainability and minimum energy of multiple-stage cascade membrane Systems

KAUST Repository

Alshehri, Ali

2015-08-12

Process design and simulation of multi-stage membrane systems have been widely studied in many gas separation systems. However, general guidelines have not been developed yet for the attainability and the minimum energy consumption of a multi-stage membrane system. Such information is important for conceptual process design and thus it is the topic of this work. Using a well-mixed membrane model, it was determined that the attainability curve of multi-stage systems is defined by the pressure ratio and membrane selectivity. Using the constant recycle ratio scheme, the recycle ratio can shift the attainability behavior between single-stage and multi-stage membrane systems. When the recycle ratio is zero, all of the multi-stage membrane processes will decay to a single-stage membrane process. When the recycle ratio approaches infinity, the required selectivity and pressure ratio reach their absolute minimum values, which have a simple relationship with that of a single-stage membrane process, as follows: View the MathML sourceSn=S1, View the MathML sourceγn=γ1, where n is the number of stages. The minimum energy consumption of a multi-stage membrane process is primarily determined by the membrane selectivity and recycle ratio. A low recycle ratio can significantly reduce the required membrane selectivity without substantial energy penalty. The energy envelope curve can provide a guideline from an energy perspective to determine the minimum required membrane selectivity in membrane process designs to compete with conventional separation processes, such as distillation.

When Does Neoadjuvant Chemotherapy Really Avoid Radiotherapy? Clinical Predictors of Adjuvant Radiotherapy in Cervical Cancer.

Science.gov (United States)

Papadia, Andrea; Bellati, Filippo; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Lorusso, Domenica; Donfrancesco, Cristina; Gasparri, Maria Luisa; Raspagliesi, Francesco

2015-12-01

The aim of this study was to identify clinical variables that may predict the need for adjuvant radiotherapy after neoadjuvant chemotherapy (NACT) and radical surgery in locally advanced cervical cancer patients. A retrospective series of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IB2-IIB treated with NACT followed by radical surgery was analyzed. Clinical predictors of persistence of intermediate- and/or high-risk factors at final pathological analysis were investigated. Statistical analysis was performed using univariate and multivariate analysis and using a model based on artificial intelligence known as artificial neuronal network (ANN) analysis. Overall, 101 patients were available for the analyses. Fifty-two (51 %) patients were considered at high risk secondary to parametrial, resection margin and/or lymph node involvement. When disease was confined to the cervix, four (4 %) patients were considered at intermediate risk. At univariate analysis, FIGO grade 3, stage IIB disease at diagnosis and the presence of enlarged nodes before NACT predicted the presence of intermediate- and/or high-risk factors at final pathological analysis. At multivariate analysis, only FIGO grade 3 and tumor diameter maintained statistical significance. The specificity of ANN models in evaluating predictive variables was slightly superior to conventional multivariable models. FIGO grade, stage, tumor diameter, and histology are associated with persistence of pathological intermediate- and/or high-risk factors after NACT and radical surgery. This information is useful in counseling patients at the time of treatment planning with regard to the probability of being subjected to pelvic radiotherapy after completion of the initially planned treatment.

Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System.

Science.gov (United States)

Edsberg, Laura E; Black, Joyce M; Goldberg, Margaret; McNichol, Laurie; Moore, Lynn; Sieggreen, Mary

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the current understanding of the etiology of pressure injuries, as well as to clarify the anatomical features present or absent in each stage of injury. An NPUAP-appointed Task Force reviewed the literature and created drafts of definitions, which were then reviewed by stakeholders and the public, including clinicians, educators, and researchers around the world. Using a consensus-building methodology, these revised definitions were the focus of a multidisciplinary consensus conference held in April 2016. As a result of stakeholder and public input, along with the consensus conference, important changes were made and incorporated into the new staging definitions. The revised staging system uses the term injury instead of ulcer and denotes stages using Arabic numerals rather than Roman numerals. The revised definition of a pressure injury now describes the injuries as usually occurring over a bony prominence or under a medical or other device. The revised definition of a Stage 2 pressure injury seeks to clarify the difference between moisture-associated skin damage and injury caused by pressure and/or shear. The term suspected has been removed from the Deep Tissue Pressure Injury diagnostic label. Each definition now describes the extent of tissue loss present and the anatomical features that may or may not be present in the stage of injury. These important revisions reflect the methodical and collaborative approach used to examine the available evidence and incorporate current interdisciplinary clinical expertise into better defining the important phenomenon of pressure injury etiology and development.

Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

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Toita, Takafumi, E-mail: b983255@med.u-ryukyu.ac.jp [Department of Radiology, Graduate School of Medical Science, University of Ryukyus, Okinawa (Japan); Kato, Shingo [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Ehime (Japan); Shikama, Naoto [Department of Radiation Oncology, Saku Central Hospital, Saku (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Tokumaru, Sunao [Department of Radiology, Saga University, Saga (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tsukuba (Japan); Numasaki, Hodaka; Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Tokyo (Japan); Kagami, Yoshikazu [Radiation Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

2012-01-01

Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size <40 mm in diameter (assessed by T2-weighted magnetic resonance imaging), and no pelvic/para-aortic lymphadenopathy. The treatment protocol consisted of whole-pelvis external beam radiotherapy (EBRT) of 20 Gy/10 fractions, pelvic EBRT with midline block of 30 Gy/15 fractions, and HDR-ICBT of 24 Gy/4 fractions (at point A). The cumulative biologically effective dose (BED) was 62 Gy{sub 10} ({alpha}/{beta} = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6-39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7-72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%-100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%-98%) and 95% (95% CI, 89%-100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade {>=}1) were 18% (95% CI, 8%-28%) for large intestine/rectum, 4% (95% CI, 0%-8%) for small intestine, and 0% for bladder. No Grade {>=}3 cases were

Armazenamento de figo-da-índia em pó Storage of the prickly pear powder

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Cícera G. C. de Lisbôa

2012-02-01

Full Text Available Neste trabalho foram avaliadas a estabilidade do figo-da-índia em pó acondicionado em embalagens laminadas durante 100 dias de armazenamento, sob condições controladas de temperatura e umidade relativa e as amostras a cada 20 dias, por meio do teor de água, atividade de água, acidez total titulável, açúcares redutores e cor (luminosidade, intensidade de vermelho e de amarelo. Observou-se que as embalagens laminadas não evitaram a absorção de água, enquanto a atividade de água aumentou e os açúcares redutores diminuíram com o tempo; por outro lado, a acidez total titulável diminuiu mas apenas nos primeiros vinte dias; enfim, todas as amostras sofreram escurecimento durante o armazenamento.The stability of the prickly pear power packed in laminated roll for 100 days storage under controlled temperature and relative humidity was evaluated. The material was evaluated every 20 days, through the moisture content, water activity, total acidity, sugars and color (brightness, red and yellow colour intensity. It was found during storage of powder samples, that the laminated packaging did not prevent the water absorption, while water activity increased and reduced sugars decreased with time, the total acidity decreased in the first twenty days, keeping stable thereafter in all samples and there was a darkening of the powder samples stored at 40 ºC.

[Multiparameter magnetic resonance imaging in the diagnosis of cancer of the cervix uteri].

Science.gov (United States)

Tarachkova, E V; Strel'tsova, O N; Panov, V O; Bazaeva, I Ya; Tyurin, I E

2015-01-01

Cancer of the cervix uteri (CCU) ranks third in the incidence of malignancies in women. The choice of CCU treatment mainly depends on the extent of the tumor process, i.e., the stage of the disease. Determining the stage of CCU is based on the clinical classification of the International Federation of Gynecology and Obstetrics (FIGO) (2009) and has a number of substantial limitations in evaluating parametrial invasion, tumor spread to the pelvic wall, and involvement of regional lymph nodes and in determining the true tumor sizes. Magnetic resonance imaging (MRI) is now the method of choice in staging invasive CCU. Multiparameter MRI will be able to enhance the efficiency of diagnosing microinvasive CCU as well (FIGO 2009), to plan surgical and/or chemoradiation treatment, to evaluate its efficiency, and to diagnose locally recurrent CCU.

Nomogram for suboptimal cytoreduction at primary surgery for advanced stage ovarian cancer.

Science.gov (United States)

Gerestein, Cornelis G; Eijkemans, Marinus J; Bakker, Jeanette; Elgersma, Otto E; van der Burg, Maria E L; Kooi, Geertruida S; Burger, Curt W

2011-11-01

Maximal cytoreduction to minimal residual tumor is the most important determinant of prognosis in patients with advanced stage epithelial ovarian cancer (EOC). Preoperative prediction of suboptimal cytoreduction, defined as residual tumor >1 cm, could guide treatment decisions and improve counseling. The objective of this study was to identify predictive computed tomographic (CT) scan and clinical parameters for suboptimal cytoreduction at primary cytoreductive surgery for advanced stage EOC and to generate a nomogram with the identified parameters, which would be easy to use in daily clinical practice. Between October 2005 and December 2008, all patients with primary surgery for suspected advanced stage EOC at six participating teaching hospitals in the South Western part of the Netherlands entered the study protocol. To investigate independent predictors of suboptimal cytoreduction, a Cox proportional hazard model with backward stepwise elimination was utilized. One hundred and fifteen patients with FIGO stage III/IV EOC entered the study protocol. Optimal cytoreduction was achieved in 52 (45%) patients. A suboptimal cytoreduction was predicted by preoperative blood platelet count (p=0.1990; odds ratio (OR)=1.002), diffuse peritoneal thickening (DPT) (p=0.0074; OR=3.021), and presence of ascites on at least two thirds of CT scan slices (p=0.0385; OR=2.294) with a for-optimism corrected c-statistic of 0.67. Suboptimal cytoreduction was predicted by preoperative platelet count, DPT and presence of ascites. The generated nomogram can, after external validation, be used to estimate surgical outcome and to identify those patients, who might benefit from alternative treatment approaches.

The relationships between memory systems and sleep stages.

Science.gov (United States)

Rauchs, Géraldine; Desgranges, Béatrice; Foret, Jean; Eustache, Francis

2005-06-01

Sleep function remains elusive despite our rapidly increasing comprehension of the processes generating and maintaining the different sleep stages. Several lines of evidence support the hypothesis that sleep is involved in the off-line reprocessing of recently-acquired memories. In this review, we summarize the main results obtained in the field of sleep and memory consolidation in both animals and humans, and try to connect sleep stages with the different memory systems. To this end, we have collated data obtained using several methodological approaches, including electrophysiological recordings of neuronal ensembles, post-training modifications of sleep architecture, sleep deprivation and functional neuroimaging studies. Broadly speaking, all the various studies emphasize the fact that the four long-term memory systems (procedural memory, perceptual representation system, semantic and episodic memory, according to Tulving's SPI model; Tulving, 1995) benefit either from non-rapid eye movement (NREM) (not just SWS) or rapid eye movement (REM) sleep, or from both sleep stages. Tulving's classification of memory systems appears more pertinent than the declarative/non-declarative dichotomy when it comes to understanding the role of sleep in memory. Indeed, this model allows us to resolve several contradictions, notably the fact that episodic and semantic memory (the two memory systems encompassed in declarative memory) appear to rely on different sleep stages. Likewise, this model provides an explanation for why the acquisition of various types of skills (perceptual-motor, sensory-perceptual and cognitive skills) and priming effects, subserved by different brain structures but all designated by the generic term of implicit or non-declarative memory, may not benefit from the same sleep stages.

Stage III nasopharyngeal angiofibroma: Improving results with endoscopic-assisted midfacial degloving and modification to the Fisch staging system.

Science.gov (United States)

Shah, Saurin R; Keshri, Amit; Patadia, Simple; Sahu, Rabi Narayan; Srivastava, Arun Kumar; Behari, Sanjay

2015-10-01

To study outcomes with endoscopic-assisted midfacial degloving for Fisch stage III nasopharyngeal angiofibroma and propose a new staging system. Retrospective study of patients with Fisch stage III juvenile nasopharyngeal angiofibroma (JNA) including preoperative angiography, intraoperative blood loss and residue/recurrence following surgery. Tertiary care superspecialty referral center. Fifteen consecutive patients with Fisch stage III JNA undergoing operations over a period of 18 months. Preoperative angiography details, intraoperative blood loss, residue/recurrence, complications of surgery. Transarterial embolization with particulate agents followed by endoscopic-assisted midfacial degloving provides excellent outcomes with Fisch stage III JNAs. The modified Fisch staging system proposed would allow better preoperative evaluation and comparison of outcomes with different treatment options for stage III JNAs. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Sociodemographic factors and delay in the diagnosis of cervical ...

African Journals Online (AJOL)

Background: In Morocco, cervical cancer is the second most common cancer in women. The cases of cervical cancer are diagnosed at a late stage: 43.7% presented at stage II of diagnosis (FIGO) and 38.1% in advanced stage (stage III and IV). The main objective of this study is to investigate factors associated to late the ...

Radiotherapy in the management of cervical cancer in elderly patients

International Nuclear Information System (INIS)

Lindegaard, J.C.; Thranov, I.R.; Engelholm, S.A.

2000-01-01

One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients. (author)

Conservação pós-colheita de figos verdes (Ficus carica L. cv. roxo de Valinhos tratados com hipoclorito de sódio e armazenados sob refrigeração em atmosfera modificada passiva Post-harvest conservation of unripe figs (Ficus carica L. cv. "roxo de Valinhos" treated with sodium hypochlorite and stored under refrigeration in passive modified atmosphere

Directory of Open Access Journals (Sweden)

Luciana Costa Lima

2005-08-01

Full Text Available Os principais causadores de perdas da qualidade de figos são: colheita e embalagens inadequadas, falta de padronização do produto na classificação e péssimas condições de transporte e armazenamento. Com este trabalho objetivou-se avaliar o efeito da imersão em hipoclorito, tipo de embalagem e refrigeração na conservação pós-colheita de figos verdes, cv. Roxo de Valinhos, mediante as características físicas, físico-químicas e químicas, durante o armazenamento. Após seleção, os figos foram imersos ou não em solução de hipoclorito de sódio a 40 ppm conforme os tratamentos, secos ao ar e embalados em filme de PVC de 50 m ou sacos plásticos. Após os tratamentos, os frutos foram submetidos a armazenamento refrigerado (1ºC e 70% de UR em BOD, por um período de 35 dias, sendo avaliados a cada 7 dias. O uso da embalagem reduziu drasticamente a perda de massa dos figos. Frutos não embalados apresentaram-se mais ácidos e com menores teores de açúcares. Com o uso da embalagem, os figos podem ser comercializados até os 35 dias de armazenamento desde que armazenados a 1ºC e 70% de UR em BOD. Já os figos não embalados, estes podem ser comercializados somente até os 2 dias de armazenamento sob refrigeração.The chief causesof quality loss in figs are inadequate harvest and packaging, lack of standardization of the product in the classification and very bad transportation and storage conditions. This work aimed to evaluate the effects of soaking in hypochlorite, and the type of packaging and refrigeration on the post-harvest conservation of unripe figs cv. "Roxo de Valinhos", through physico-chemical analyses, during storage. After selection, the figs were soaked, or not, in a 40ppm sodium hypochlorite solution, air-dried and wrapped in 50µ PVC film or plastic bags. After the treatments, the fruits were submitted to refrigerated storage (1ºC and 70% of RH for a 35-day period, being evaluated every 7 days. Use of the

Comparison of five systems for staging lymph node metastasis in gastric cancer.

Science.gov (United States)

Yu, W; Choi, G S; Whang, I; Suh, I S

1997-09-01

There are several systems for staging lymph node metastasis in gastric cancer. Their relative merits are not clear. In this retrospective analysis, the nodal status was classified according to the Union Internacional Contra la Cancrum (UICC) and Japanese staging systems, the number and frequency of lymph node metastasis, and the level of involved nodes. Each staging system was scored as good (+1), fair (0) or poor (-1) with respect to prognostic value, theoretical value, convenience, reproducibility and surgical applicability. There were no differences between the five staging systems in predicting survival. The Japanese staging system was most arbitrary owing to the complexity of the system, although it had an advantage in surgical application. The same disadvantage was found in the UICC system and the level system. Determination of the number and frequency of involved nodes was convenient and reproducible, but the number of lymph nodes dissected must be considered when the number of positive nodes is used for staging. The classification of metastasis to the regional lymph nodes as N0 (no nodal metastasis), N1 (metastasis in 1-25 per cent of dissected nodes) and N2 (metastasis in more than 25 per cent of dissected nodes) would be a simple, convenient, reproducible staging system with an ability to predict surgical results.

Efeito de vespas não-polinizadoras sobre o mutualismo Ficus - vespas de figos Effect of non-pollinating fig wasps over fig-fig wasp mutualism

Directory of Open Access Journals (Sweden)

Larissa G. Elias

Full Text Available Relações ecológicas interespecíficas, que resultam em benefício para todos os organismos participantes, são conhecidas como mutualismo. No entanto, tal cooperação abre espaço para o surgimento de estratégias oportunistas (ou de trapaça, representadas por indivíduos parasitas do mutualismo, que recebem o benefício de um dos parceiros sem oferecer nada em troca. A interação figueiras - vespas - de - figo é um sistema adequado para o estudo do mutualismo e de estratégias oportunistas (parasitas de mutualismos. Representantes do gênero Ficus (Moraceae apresentam uma relação mutualística com pequenas vespas polinizadoras (Agaonidae e são explorados por outras espécies de vespas não-polinizadoras. Esse trabalho teve como objetivo avaliar o impacto das vespas não-polinizadoras sobre o mutualismo Ficus citrifolia e suas vespas polinizadoras, Pegoscapus tonduzi Grandi, 1919. Para tal, foi comparada a produção de aquênios (função feminina e de fêmeas da espécie polinizadora (função masculina entre amostras de sicônios altamente infestados e pouco infestados por vespas não-polinizadoras, coletadas nos municípios de Londrina (Paraná, Campinas e Ribeirão Preto (São Paulo, Brasil. Nossos resultados apontaram que as vespas não-polinizadoras exercem impacto negativo nos componentes feminino e masculino da planta, sendo maior no masculino. A produção de vespas polinizadoras foi cerca de sete vezes menor nos figos infestados, ao passo que a produção de aquênios foi 1,5 vez menor nesses mesmos figos. Hipóteses sobre a estabilidade do mutualismo na presença das espécies oportunistas são discutidas.Mutualism is the name given to interspecific interactions which result in benefit for all partners involved. However, such cooperation is open to opportunistic strategies: individuals that extract the benefit from the partner, but do not offer any benefit in exchange. The fig-fig wasp interaction is an appropriate case to

Stage I/II endometrial carcinomas: preoperative radiotherapy: results

International Nuclear Information System (INIS)

Maingon, P.; Belichard, C.; Horiot, J.C.; Barillot, I.; Fraisse, J.; Collin, F.

1996-01-01

The AIM of this retrospective study is to analyse the indications and the results of treatment of endometrial carcinomas by preoperative radiotherapy. MATERIAL: From 1976 to 1995, 183 patients FIGO stage I or II were treated by preoperative radiotherapy consisting in 95 cases of external radiotherapy (XRT) and brachytherapy (BT) followed by surgery (S) and, in 88 cases of BT alone before surgery, XRT was indicated in cases of grade 2 or 3 and/or cervical involvement. METHODS: XRT was delivered with a 4-fields technique to 40 Gy in 20 fractions with a medial shielding at 30 Gy. BT was done with low dose rate Cs137 and Fletcher-Suit-Delclos applicators with two intra-uterine tubes and vaginal ovoieds. Complications were scored using the French-Italian syllabus. RESULTS: Five-year actuarial survival rates per stage are: Ia=91%, Ib=83%, II=71%, and per grade: G1=80%, G2=79%, G3=90%. Failures were pelvic in 5/183 (2.7%), vaginal in 4 cases (2%) and nodal in 2 cases (1%). Twelve patients developed metastases (6.5%). Complications were analysed during the radiotherapy, after the surgery and with unlimited follow-up. After BT/S, 12 grade 1, 1 grade 2 and 1 grade 3 complications were observed. In the group of patients treated by RT/BT/S, 22 grade 1, 11 grade 2, 4 grade 3 occurred. There is no statistical correlation between complications and parameters of treatment (XRT, hwt, HWT, reference dose to the bladder and rectum, dose rate of brachytherapy). SUMMARY: Preoperative irradiation is an effective and safe treatment of high risk stage I/II endometrial carcinomas. Results seem independent of the pathology grade

The stages of the international drug control system.

Science.gov (United States)

Carstairs, Catherine

2005-01-01

This paper argues that the history of the international drug control system of the League of Nations/United Nations can be divided into three cumulative stages. The first stage, the supply stage, dates back to early part of the 20th century, and aimed to reduce the supply of drugs through careful monitoring and trade regulations. This has remained the dominant control strategy. In the middle of the century, demand control, in the form of treatment and criminalization of the individual user, began to appear. This was the least successful stage. Finally, in the 1980s, the dangers of the drug traffic assumed an important place on the international agenda and measures to reduce drug-related organized crime were enacted. To date, this has been a process of proliferation of regulatory strategies. Recently, new challenges to the international drug control system have emerged, including well-funded non-governmental organizations critical of the war on drugs, and the adoption of harm reduction measures in national policies around the world.

Intestinal diffuse large B-cell lymphoma: an evaluation of different staging systems.

Science.gov (United States)

Hwang, Hee Sang; Yoon, Dok Hyun; Suh, Cheolwon; Park, Chan-Sik; Huh, Jooryung

2014-01-01

The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.

Papillary Squamotransitional Cell Carcinoma of the Uterine Cervix: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Shomaila Aamir M. Akbar

2016-01-01

Full Text Available Introduction. Papillary squamotransitional cell carcinoma (PSTCC is an uncommon histopathological variant of squamous cell carcinoma (SCC of the uterine cervix, which occurs in postmenopausal women. Presentation of Case. Herein, we describe a case of a 63-year-old woman who presented with 4-month history of postmenopausal vaginal bleeding. Vaginal examination revealed a fragile lesion of size 1×1 cm invading left posterior vaginal fornice and parametrium. Biopsy showed the presence of papillae containing fibrovascular cores lined by multilayered atypical epithelial cells resembling squamous and transitional cell epithelium, confirming the diagnosis of PSTCC of the uterine cervix. After staging work-up she was staged according to the International Federation of Gynecology and Obstetrics (FIGO staging system 2009 as FIGO IIB, and she was started on extended field concurrent chemoradiation. Discussion. PSTCC of the uterine cervix is an extremely rare and aggressive entity. PSTCC is often characterized by the presence of papillary structures with prominent fibrovascular cores. PSTCC of the uterine cervix should be differentiated from transitional cell carcinoma, squamous papilloma, papillary adenocarcinoma, and cervical intraepithelial neoplasia with papillary features. Conclusion. PSTCC of the uterine cervix is a diagnostic challenge; further studies regarding the mechanism underlying the development of PSCC are warranted.

The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report.

Science.gov (United States)

Monclair, Tom; Brodeur, Garrett M; Ambros, Peter F; Brisse, Hervé J; Cecchetto, Giovanni; Holmes, Keith; Kaneko, Michio; London, Wendy B; Matthay, Katherine K; Nuchtern, Jed G; von Schweinitz, Dietrich; Simon, Thorsten; Cohn, Susan L; Pearson, Andrew D J

2009-01-10

The International Neuroblastoma Risk Group (INRG) classification system was developed to establish a consensus approach for pretreatment risk stratification. Because the International Neuroblastoma Staging System (INSS) is a postsurgical staging system, a new clinical staging system was required for the INRG pretreatment risk classification system. To stage patients before any treatment, the INRG Task Force, consisting of neuroblastoma experts from Australia/New Zealand, China, Europe, Japan, and North America, developed a new INRG staging system (INRGSS) based on clinical criteria and image-defined risk factors (IDRFs). To investigate the impact of IDRFs on outcome, survival analyses were performed on 661 European patients with INSS stages 1, 2, or 3 disease for whom IDRFs were known. In the INGRSS, locoregional tumors are staged L1 or L2 based on the absence or presence of one or more of 20 IDRFs, respectively. Metastatic tumors are defined as stage M, except for stage MS, in which metastases are confined to the skin, liver, and/or bone marrow in children younger than 18 months of age. Within the 661-patient cohort, IDRFs were present (ie, stage L2) in 21% of patients with stage 1, 45% of patients with stage 2, and 94% of patients with stage 3 disease. Patients with INRGSS stage L2 disease had significantly lower 5-year event-free survival than those with INRGSS stage L1 disease (78% +/- 4% v 90% +/- 3%; P = .0010). Use of the new staging (INRGSS) and risk classification (INRG) of neuroblastoma will greatly facilitate the comparison of risk-based clinical trials conducted in different regions of the world.

Epigenetic Alteration by DNA Methylation of ESR1, MYOD1 and hTERT Gene Promoters is Useful for Prediction of Response in Patients of Locally Advanced Invasive Cervical Carcinoma Treated by Chemoradiation.

Science.gov (United States)

Sood, S; Patel, F D; Ghosh, S; Arora, A; Dhaliwal, L K; Srinivasan, R

2015-12-01

Locally advanced invasive cervical cancer [International Federation of Gynecology and Obstetrics (FIGO) IIB/III] is treated by chemoradiation. The response to treatment is variable within a given FIGO stage. Therefore, the aim of the present study was to evaluate the gene promoter methylation profile and corresponding transcript expression of a panel of six genes to identify genes which could predict the response of patients treated by chemoradiation. In total, 100 patients with invasive cervical cancer in FIGO stage IIB/III who underwent chemoradiation treatment were evaluated. Ten patients developed systemic metastases during therapy and were excluded. On the basis of patient follow-up, 69 patients were chemoradiation-sensitive, whereas 21 were chemoradiation-resistant. Gene promoter methylation and gene expression was determined by TaqMan assay and quantitative real-time PCR, respectively, in tissue samples. The methylation frequency of ESR1, BRCA1, RASSF1A, MLH1, MYOD1 and hTERT genes ranged from 40 to 70%. Univariate and hierarchical cluster analysis revealed that gene promoter methylation of MYOD1, ESR1 and hTERT could predict for chemoradiation response. A pattern of unmethylated MYOD1, unmethylated ESR1 and methylated hTERT promoter as well as lower ESR1 transcript levels predicted for chemoradiation resistance. Methylation profiling of a panel of three genes that includes MYOD1, ESR1 and hTERT may be useful to predict the response of invasive cervical carcinoma patients treated with standard chemoradiation therapy. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

End-Stage Renal Disease Prospective Payment System

Data.gov (United States)

U.S. Department of Health & Human Services — This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities...

Uterine cervix cancer treatment at Radiumhemmet: 90 years′ experience. Time trends of age, stage, and histopathology distribution

Science.gov (United States)

Hellman, Kristina; Hellström, Ann-Cathrin; Pettersson, B Folke

2014-01-01

Since the introduction of screening programs for cervical cancer (CC) the incidence has decreased and CC is discovered at an earlier stage. The purpose of this study was to analyze time trends in age, stage, and histopathology over a 90-year period and to our knowledge this is the largest single institutional series in the literature of invasive cervical carcinoma (CC) cases. This is a retrospective study comprising 18,472 women treated for CC from 1914 until 2004 at Radiumhemmet, Stockholm. The material is part of the international CC statistics published since 1937 in the League of Nations' Annual Reports, and since 1958 under the patronage of International Federation of Gynecology and Obstetrics (FIGO). During the 90-year study period, the annual number of cases treated increased to over 400 up until 1965, after which there was a gradual drop to less than 100 cases in 2004. A pronounced shift toward earlier stages at diagnosis was noted. The mean age at diagnosis increased in all stages, predominantly in advanced stages. A reduction in squamous cell carcinoma (SCC) cases and a sixfold increase in the proportion of adenocarcinoma (AC) cases were observed. The mean age at diagnosis for squamous and AC cases shifted after 1970, when the SCC cases ultimately became 3 years older than the AC cases in contrast to around 1950 when they were 3 years younger than the AC cases. The changes in the distribution by age, stage, and histopathology during this 90-year period are probably associated with: improved social conditions and increased access to health care, the introduction of screening programs for CC in the 1960s, and a change in the risk factors for CC (changed sexual behavior, introduction of contraceptive pills, and changed smoking habits). This is a study on changes in the distribution by age, stage, and histopathology in a large series of cervical cancer treated in Sweden during a 90-year period. It also includes an historical review about the development of

Analysis of multi-stage open shop processing systems

NARCIS (Netherlands)

Eggermont, C.E.J.; Schrijver, A.; Woeginger, G.J.; Schwentick, T.; Dürr, C.

2011-01-01

We study algorithmic problems in multi-stage open shop processing systems that are centered around reachability and deadlock detection questions. We characterize safe and unsafe system states. We show that it is easy to recognize system states that can be reached from the initial state (where the

Impact of MRI in the management and staging of cancer of the uterine cervix

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Stenstedt, Kristina (Centre of Surgical Gastroenterology, Karolinska Univ. Hospital and Karolinska Inst., Stockholm (Sweden)); Hellstroem, Ann-Cathrin (Dept. of Gynecological Oncology, Radiumhemmet, Karolinska Univ. Hospital and Karolinska Inst., Stockholm (Sweden)); Fridsten, Susanne; Blomqvist, Lennart (Dept. of Diagnostic Radiology Karolinska Univ. Hospital and Karolinska Inst., Stockholm (Sweden))

2011-04-15

Background. Cervical carcinoma is the only gynecological tumor still being staged mainly by clinical examination and only a limited use of diagnostic radiology. Cross sectional imaging is increasingly used as an aid in the staging procedure. We wanted to assess the impact of magnetic resonance imaging (MRI) in addition to the clinical staging of patients with carcinoma of the uterine cervix. Material and methods. A retrospective single-centre analysis of 183 women referred to a tertiary referral centre for gynecological tumors (<= 65 years old) with cervical cancer diagnosed between January 1, 2003 and December 31, 2006 who have undergone an MRI investigation before start of treatment. Patient records were retrospectively reviewed and any change of the planned treatment after the MRI examination was noted. Results. In patients with cervical carcinoma FIGO stage Ia2-IIa treated surgically, the treatment plan was altered due to MRI results in 10/125 patients. In the smaller group of patients with clinically more advanced disease receiving radio-chemotherapy, the treatment plan was altered in 12/58 patients. Reasons for changing the treatment plan after MRI were findings indicating a higher (n = 8) or lower (n = 5) local tumor stage, findings of para aortic nodal disease (n = 4) or difficulty to clinically examine the patient due to obesity (n = 2). MRI was also an aid in deciding whether or not to offer fertility preserving treatment in three cases. Conclusion. The use of MRI affects treatment planning in patients with cancer of the uterine cervix. The impact is more obvious in more advanced stages of disease and in patients who are difficult to examine clinically due to, for example body constitution. The result of MRI is also an aid in deciding whether or not a fertility preserving operation is feasible

Impact of MRI in the management and staging of cancer of the uterine cervix

International Nuclear Information System (INIS)

Stenstedt, Kristina; Hellstroem, Ann-Cathrin; Fridsten, Susanne; Blomqvist, Lennart

2011-01-01

Background. Cervical carcinoma is the only gynecological tumor still being staged mainly by clinical examination and only a limited use of diagnostic radiology. Cross sectional imaging is increasingly used as an aid in the staging procedure. We wanted to assess the impact of magnetic resonance imaging (MRI) in addition to the clinical staging of patients with carcinoma of the uterine cervix. Material and methods. A retrospective single-centre analysis of 183 women referred to a tertiary referral centre for gynecological tumors (≤ 65 years old) with cervical cancer diagnosed between January 1, 2003 and December 31, 2006 who have undergone an MRI investigation before start of treatment. Patient records were retrospectively reviewed and any change of the planned treatment after the MRI examination was noted. Results. In patients with cervical carcinoma FIGO stage Ia2-IIa treated surgically, the treatment plan was altered due to MRI results in 10/125 patients. In the smaller group of patients with clinically more advanced disease receiving radio-chemotherapy, the treatment plan was altered in 12/58 patients. Reasons for changing the treatment plan after MRI were findings indicating a higher (n = 8) or lower (n = 5) local tumor stage, findings of para aortic nodal disease (n = 4) or difficulty to clinically examine the patient due to obesity (n = 2). MRI was also an aid in deciding whether or not to offer fertility preserving treatment in three cases. Conclusion. The use of MRI affects treatment planning in patients with cancer of the uterine cervix. The impact is more obvious in more advanced stages of disease and in patients who are difficult to examine clinically due to, for example body constitution. The result of MRI is also an aid in deciding whether or not a fertility preserving operation is feasible

The global stability of a delayed predator-prey system with two stage-structure

International Nuclear Information System (INIS)

Wang Fengyan; Pang Guoping

2009-01-01

Based on the classical delayed stage-structured model and Lotka-Volterra predator-prey model, we introduce and study a delayed predator-prey system, where prey and predator have two stages, an immature stage and a mature stage. The time delays are the time lengths between the immature's birth and maturity of prey and predator species. Results on global asymptotic stability of nonnegative equilibria of the delay system are given, which generalize and suggest that good continuity exists between the predator-prey system and its corresponding stage-structured system.

Improved survival of baby boomer women with early-stage uterine cancer: A Surveillance, Epidemiology and End Results (SEER) Study.

Science.gov (United States)

Elshaikh, Mohamed A; Ruterbusch, Julie; Cote, Michele L; Cattaneo, Richard; Munkarah, Adnan R

2013-11-01

To study the prognostic impact of baby boomer (BB) generation on survival end-points of patients with early-stage endometrial carcinoma (EC). Data were obtained from the SEER registry between 1988-2009. Inclusion criteria included women who underwent hysterectomy for stage I-II EC. Patients were divided into two birth cohorts: BB (women born between 1946 and 1964) and pre-boomers (PB) (born between 1926 and 1945). A total of 30,956 patients were analyzed. Considering that women in the PB group were older than those of the BB generation, the statistical analysis was limited to women 50-59 years of age at the time of diagnosis (n=11,473). Baby boomers had a significantly higher percentage of endometrioid histology (pgeneration compared to the PB generation (p=0.0003) with a trend for improved uterine cancer-specific survival (p=0.0752). On multivariate analysis, birth cohort (BB vs. PB) was not a significant predictor of survival end-points. Factors predictive of survival included: tumor grade, FIGO stage, African-American race, and increased number of dissected LN. Our study suggests that the survival of BB women between 50-60 years of age is better compared to women in the PB generation. As more BB patients are diagnosed with EC, further research is warranted.

[Comparison of differentiated thyroid carcinoma staging systems in a Spanish population].

Science.gov (United States)

Andía Melero, Víctor Manuel; Martín de Santa-Olalla Llanes, María; Sambo Salas, Marcel; Percovich Hualpa, Juan Carlos; Motilla de la Cámara, Marta; Collado Yurrita, Luis

2015-04-01

Differentiated thyroid carcinoma staging is increasingly important due to the current trends to a less intensive therapy in low-risk patients. The TNM system is most widely used, but other systems based on follow-up of several patient cohorts have been developed. When these systems have been applied to other populations, results have been discordant. Our study evaluates the suitability of several differentiated thyroid carcinoma staging systems in a Spanish population. 729 patients with differentiated thyroid carcinoma and staging data available were enrolled. Mean follow-up time was 10.8 years. The TNM, EORTC, AMES, Clinical class, MACIS, Ohio, NTCTCS, and Spanish systems were applied to all histological types. The Kaplan-Meier survival curves for each system were analyzed, and compared using the proportion of explained variation (PEV). The demographic and clinical characteristics of our population were similar to those of other Spanish and international cohorts reported. The best systems were NTCTCS, with 74.7% PEV, and TNM (68.3%), followed by the Ohio, MACIS, EORTC, and AMES systems with minimal differences between them, while the least adequate were the Spanish (55.2%) and Clinical class (47.1%) systems. The NTCTCS staging system was found to be better than TNM in our population but, because of its simplicity and greater dissemination, the TNM appears to be recommended for staging of patients with differentiated thyroid carcinoma. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Predictive value of {sup 18}F-FDG PET/CT in restaging patients affected by ovarian carcinoma: a multicentre study

Energy Technology Data Exchange (ETDEWEB)

Caobelli, Federico [Medizinische Hochschule Hannover, Klinik fuer Nuklearmedizin, Hanover (Germany); Alongi, Pierpaolo [University of Milano-Bicocca, Nuclear Medicine Unit, Milan (Italy); IRCSS San Raffaele Scientific Institute, Nuclear Medicine Department, Milan (Italy); Evangelista, Laura; Saladini, Giorgio [Veneto Institute of Oncology IOV - IRCCS, Radiotherapy and Nuclear Medicine Unit, Padua (Italy); Picchio, Maria [IRCSS San Raffaele Scientific Institute, Nuclear Medicine Department, Milan (Italy); Rensi, Marco; Geatti, Onelio [Hospital of Udine, Nuclear Medicine Department, Udine (Italy); Castello, Angelo; Laghai, Iashar [University of Florence, Nuclear Medicine Department, Florence (Italy); Popescu, Cristina E. [Niguarda Ca' Granda Hospital, Nuclear Medicine Department, Milan (Italy); Dolci, Carlotta; Crivellaro, Cinzia [University of Milan-Bicocca, Nuclear Medicine Department, San Gerardo Hospital, Tecnomed Foundation, Milan (Italy); Seghezzi, Silvia [Hospital of Treviglio, Nuclear Medicine Department, Treviglio, Bergamo (Italy); Kirienko, Margarita [University of Milano-Bicocca, Nuclear Medicine Unit, Milan (Italy); De Biasi, Vincenzo [Nuclear Medicine Department, Arcispedale Santa Maria Nuova, Reggio Emilia (Italy); Cocciolillo, Fabrizio [Catholic University of the Sacred Heart, Nuclear Medicine Department, Rome (Italy); Quartuccio, Natale [University of Messina, Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphological and Functional Images, Messina (Italy); Collaboration: Young AIMN Working Group

2016-03-15

Ovarian cancer is the eighth most common malignancy among women and has a high mortality rate. Prognostic factors able to drive an effective therapy are essential. {sup 18}F-Fluoro-2-deoxyglucose positron emission tomography/computed tomography ({sup 18}F-FDG PET/CT) has been investigated in patients with epithelial ovarian cancer and showed promise in diagnosing, staging, detecting recurrent lesions and monitoring treatment response. Conversely, its prognostic role remains unclear. We aimed at assessing the prognostic value of {sup 18}F-FDG PET/CT performed in the restaging process in a multicentre study. We evaluated 168 patients affected by ovarian carcinoma, who underwent a restaging {sup 18}F-FDG PET/CT. The presence of local recurrences, lymph node involvement and distant metastasis was recorded as well as lesion dimensions, maximum and mean standardized uptake values (SUV{sub max} and SUV{sub mean}, respectively). Progression-free survival (PFS) and overall survival (OS) at 3 and 4 years were computed by using Kaplan-Meier curves. Increased odds ratio was assessed using Cox regression analysis testing all lesion parameters measured by PET/CT. PFS was significantly longer in patients with a negative than a positive restaging PET/CT study (3- and 4-year PFS 64 and 53 % vs 23 and 12 %, respectively; p < 0.001). Similarly, a negative study was associated with a significantly higher OS rate after 4 years of follow-up (67 vs 25 % in negative and positive groups, respectively; p < 0.001). Lymph node or distant involvement were also independently associated with an increased risk of disease progression [hazard ratio (HR) 1.6 and 2.2, respectively; p = 0.003]. Moreover, PET/CT showed an incremental prognostic value compared to the International Federation of Gynecology and Obstetrics (FIGO) staging system. In the analysis of patient subsets, individuals with the same FIGO stage I-II but with negative PET had a significantly better 4-year OS than patients with low

Stadium IB - IIA cervical cancer patient’s survival rate after receiving definitive radiation and radical operation therapy followed by adjuvant radiation therapy along with analysis of factors affecting the patient’s survival rate

Science.gov (United States)

Ruslim, S. K.; Purwoto, G.; Widyahening, I. S.; Ramli, I.

2017-08-01

To evaluate the characteristics and overall survival rates of early stage cervical cancer (FIGO IB-IIA) patients who receive definitive radiation therapy and those who are prescribed adjuvant postoperative radiation and to conduct a factors analysis of the variables that affect the overall survival rates in both groups of therapy. The medical records of 85 patients with cervical cancer FIGO stages IB-IIA who were treated at the Department of Radiotherapy of Cipto Mangunkusumo Hospital were reviewed and analyzed to determine their overall survival and the factors that affected it between a definitive radiation group and an adjuvant postoperative radiation group. There were 25 patients in the definitive radiation and 60 patients in the adjuvant radiation group. The overall survival rates in the adjuvant radiation group at years one, two, and three were 96.7%, 95%, and 93.3%, respectively. Negative lymph node metastasis had an average association with overall survival (p 12 g/dl was a factor with an average association with the overall survival (p cervical cancer FIGO stage IB-IIA patients who received definitive radiation or adjuvant postoperative radiation. Negative lymph node metastasis had an effect on the overall survival rate in the adjuvant postoperative radiation group, while a preradiation Hb level >12 g/dl tended to affect the overall survival in the definitive radiation group patients.

Bladder cancer staging in CT urography: effect of stage labels on statistical modeling of a decision support system

Science.gov (United States)

Gandikota, Dhanuj; Hadjiiski, Lubomir; Cha, Kenny H.; Chan, Heang-Ping; Caoili, Elaine M.; Cohan, Richard H.; Weizer, Alon; Alva, Ajjai; Paramagul, Chintana; Wei, Jun; Zhou, Chuan

2018-02-01

In bladder cancer, stage T2 is an important threshold in the decision of administering neoadjuvant chemotherapy. Our long-term goal is to develop a quantitative computerized decision support system (CDSS-S) to aid clinicians in accurate staging. In this study, we examined the effect of stage labels of the training samples on modeling such a system. We used a data set of 84 bladder cancers imaged with CT Urography (CTU). At clinical staging prior to treatment, 43 lesions were staged as below stage T2 and 41 were stage T2 or above. After cystectomy and pathological staging that is considered the gold standard, 10 of the lesions were upstaged to stage T2 or above. After correcting the stage labels, 33 lesions were below stage T2, and 51 were stage T2 or above. For the CDSS-S, the lesions were segmented using our AI-CALS method and radiomic features were extracted. We trained a linear discriminant analysis (LDA) classifier with leave-one-case-out cross validation to distinguish between bladder lesions of stage T2 or above and those below stage T2. The CDSS-S was trained and tested with the corrected post-cystectomy labels, and as a comparison, CDSS-S was also trained with understaged pre-treatment labels and tested on lesions with corrected labels. The test AUC for the CDSS-S trained with corrected labels was 0.89 +/- 0.04. For the CDSS-S trained with understaged pre-treatment labels and tested on the lesions with corrected labels, the test AUC was 0.86 +/- 0.04. The likelihood of stage T2 or above for 9 out of the 10 understaged lesions was correctly increased for the CDSS-S trained with corrected labels. The CDSS-S is sensitive to the accuracy of stage labeling. The CDSS-S trained with correct labels shows promise in prediction of the bladder cancer stage.

Proposal for a new staging system for osteoradionecrosis of the mandible

NARCIS (Netherlands)

Karagozoglu, K.H.; Dekker, H.; Rietveld, D.H.F.; de Bree, R.; Schulten, E.A.J.M.; Kantola, S.; Forouzanfar, T.; van der Waal, I.

2014-01-01

The presented staging system seems well reproducible, facilitating the comparison of study groups dealing with the various issues of osteoradionecrosis of the mandible. It is yet to be evaluated whether the presently proposed staging system is useful for management purposes.

SLS Block 1-B and Exploration Upper Stage Navigation System Design

Science.gov (United States)

Oliver, T. Emerson; Park, Thomas B.; Smith, Austin; Anzalone, Evan; Bernard, Bill; Strickland, Dennis; Geohagan, Kevin; Green, Melissa; Leggett, Jarred

2018-01-01

The SLS Block 1B vehicle is planned to extend NASA's heavy lift capability beyond the initial SLS Block 1 vehicle. The most noticeable change for this vehicle from SLS Block 1 is the swapping of the upper stage from the Interim Cryogenic Propulsion stage (ICPS), a modified Delta IV upper stage, to the more capable Exploration Upper Stage (EUS). As the vehicle evolves to provide greater lift capability and execute more demanding missions so must the SLS Integrated Navigation System to support those missions. The SLS Block 1 vehicle carries two independent navigation systems. The responsibility of the two systems is delineated between ascent and upper stage flight. The Block 1 navigation system is responsible for the phase of flight between the launch pad and insertion into Low-Earth Orbit (LEO). The upper stage system assumes the mission from LEO to payload separation. For the Block 1B vehicle, the two functions are combined into a single system intended to navigate from ground to payload insertion. Both are responsible for self-disposal once payload delivery is achieved. The evolution of the navigation hardware and algorithms from an inertial-only navigation system for Block 1 ascent flight to a tightly coupled GPS-aided inertial navigation system for Block 1-B is described. The Block 1 GN&C system has been designed to meet a LEO insertion target with a specified accuracy. The Block 1-B vehicle navigation system is designed to support the Block 1 LEO target accuracy as well as trans-lunar or trans-planetary injection accuracy. This is measured in terms of payload impact and stage disposal requirements. Additionally, the Block 1-B vehicle is designed to support human exploration and thus is designed to minimize the probability of Loss of Crew (LOC) through high-quality inertial instruments and Fault Detection, Isolation, and Recovery (FDIR) logic. The preliminary Block 1B integrated navigation system design is presented along with the challenges associated with

A Lymph Node Staging System for Gastric Cancer: A Hybrid Type Based on Topographic and Numeric Systems.

Directory of Open Access Journals (Sweden)

Yoon Young Choi

Full Text Available Although changing a lymph node staging system from an anatomically based system to a numerically based system in gastric cancer offers better prognostic performance, several problems can arise: it does not offer information on the anatomical extent of disease and cannot represent the extent of lymph node dissection. The purpose of this study was to discover an alternative lymph node staging system for gastric cancer. Data from 6025 patients who underwent gastrectomy for primary gastric cancer between January 2000 and December 2010 were reviewed. The lymph node groups were reclassified into lesser-curvature, greater-curvature, and extra-perigastric groups. Presence of any metastatic lymph node in one group was considered positive. Lymph node groups were further stratified into four (new N0-new N3 according to the number of positive lymph node groups. Survival outcomes with this new N staging were compared with those of the current TNM system. For validation, two centers in Japan (large center, n = 3443; medium center, n = 560 were invited. Even among the same pN stages, the more advanced new N stage showed worse prognosis, indicating that the anatomical extent of metastatic lymph nodes is important. The prognostic performance of the new staging system was as good as that of the current TNM system for overall advanced gastric cancer as well as lymph node-positive gastric cancer (Harrell C-index was 0.799, 0.726, and 0.703 in current TNM and 0.799, 0.727, and 0.703 in new TNM stage. Validation sets supported these outcomes. The new N staging system demonstrated prognostic performance equal to that of the current TNM system and could thus be used as an alternative.

Self-tuning in master-slave synchronization of high-precision stage systems

NARCIS (Netherlands)

Heertjes, M.F.; Temizer, B.; Schneiders, M.G.E.

2013-01-01

For synchronization of high-precision stage systems, in particular the synchronization between a wafer and a reticle stage system of a wafer scanner, a master–slave controller design is presented. The design consists of a synchronization controller based on FIR filters and a data-driven self-tuning

Parachute systems for the atmospheric reentry of launcher upper stages

Directory of Open Access Journals (Sweden)

Bogdan DOBRESCU

2017-03-01

Full Text Available Parachute systems can be used to control the reentry trajectory of launcher upper stages, in order to lower the risks to the population or facilitate the retrieval of the stage. Several types of parachutes deployed at subsonic, supersonic and hypersonic speeds are analyzed, modeled as single and multistage systems. The performance of deceleration parachutes depends on their drag area and deployment conditions, while gliding parachutes are configured to achieve stable flight with a high glide ratio. Gliding parachutes can be autonomously guided to a low risk landing area. Sizing the canopy is shown to be an effective method to reduce parachute sensitivity to wind. The reentry trajectory of a launcher upper stage is simulated for each parachute system configuration and the results are compared to the nominal reentry case.

The NxStage System One.

Science.gov (United States)

Clark, William R; Turk, Joseph E

2004-01-01

Given the results of recent randomized controlled trials as well as staffing and budget challenges that today face many institutions across North America, a novel therapeutic approach is likely necessary to enable improvements in clinical outcomes for renal failure patients. The NxStage System One was developed to address these challenges. The system is an innovative, flexible device that delivers hemodialysis, hemofiltration, and/or ultrafiltration therapies to patients with renal failure or fluid overload. The unique characteristics of this system include a highly automated system design with a drop-in cartridge to facilitate training and simple operation; portable size and independence from dedicated infrastructure to minimize practical barriers to where therapy may be administered; use of high-quality premixed treatment fluids to enable capture of the potential clinical benefits of fluid purity without the hassles of local water treatment; and wide operating ranges to allow clinician flexibility in patient therapy prescriptions. In both the chronic and acute care environments, the System One presents clinicians with a new platform for delivering patient therapy improvements within real-world constraints.

Wind Solar Hybrid System Rectifier Stage Topology Simulation

OpenAIRE

Anup M. Gakare; Subhash Kamdi

2014-01-01

This paper presents power-control strategies of a grid-connected hybrid generation system with versatile power transfer. The hybrid system allows maximum utilization of freely available renewable sources like wind and photovoltaic energies. This paper presents a new system configuration of the multi input rectifier stage for a hybrid wind and photovoltaic energy system. This configuration allows the two sources to supply the load simultaneously depending on the availability of...

Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?

Science.gov (United States)

Abdel-Rahman, Omar

2018-02-01

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance, epidemiology and end results (SEER) database. SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan-Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and according to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox proportional hazard model. A total of 18  948 patients with pancreatic adenocarcinoma were identified in the period from 2010-2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between stage IA and stage IB (P = 0.307) and the comparison between stage IB and stage IIA (P = 0.116). Moreover, P value for stage IA vs IIA was 0.014; while pancreatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between IA and IB (P = 0.072), the comparison between stage IIA and stage IIB (P = 0.065), the comparison between stage IIA and stage III (P = 0.059) and the comparison between IIB and III (P = 0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was

A Thermoelectric Generation System and Its Power Electronics Stage

DEFF Research Database (Denmark)

Gao, Junling; Sun, Kai; Ni, Longxian

2012-01-01

stage and signal-conditioning circuits of the load, including DC–DC conversion, the maximum power point tracking (MPPT) controller, and other power management controllers. In this paper, a survey of existing power electronics designs for TEG systems is presented first. Second, a flat, wall-like TEG...... system consisting of 32 modules is experimentally optimized, and the improved power parameters are tested. Power-conditioning circuitry based on an interleaved boost DC–DC converter is then developed for the TEG system in terms of the tested power specification. The power electronics design features...... a combined control scheme with an MPPT and a constant output voltage as well as the low-voltage and high-current output characteristics of the TEG system. The experimental results of the TEG system with the power electronics stage and with purely resistive loads are compared. The comparisons verify...

Classical prognostic factors in patients with non-advanced endometrial cancer treated with postoperative radiotherapy

International Nuclear Information System (INIS)

Karolewski, K.; Kojs, Z.; Jakubowicz, J.; Urbanski, K.; Michalak, A.

2006-01-01

Aim: Analysis of classical prognostic factors in patients with non-advanced endometrial cancer treated with postoperative radiotherapy. Materials/Methods: In the years 1985 - 1999, 705 patients underwent postoperative radiotherapy due to endometrial cancer: 529 patients with FIGO stage I and 176 with FIGO stage II cancer. Mean age was 58 years. In 96% of patients endometrioid adenocarcinoma was found. In 49.9% the cancer had a high, in 27.9% a medium, and in 22.2% a low degree of differentiation. Results: 82% of patients had 5-year disease-free survival. In univariate analysis a significantly higher rate of disease-free survival was observed in: patients younger than 60, with moderately and well differentiated cancers, with stage I endometrioid adenocarcinoma with less than 50% myometrial invasion. In multivariate analysis degree of cancer differentiation was the only independent prognostic factor. Conclusions: In a group of patients with non-advanced endometrial cancer treated with postoperative radiotherapy, degree of cancer differentiation is the primary prognostic factor. (authors)

Srinagarind Hospital experience in concurrent chemoradiation for 100 patients with stage IB2 to IVA uterine cervical cancer

International Nuclear Information System (INIS)

Tangsiriwatthana, T.; Chumworathayi, B.; Yuenyao, P.; Luanratanakorn, S.; Pattamadilok, J.

2007-01-01

The aim of this study was to determine responses, acute adverse effects, and survival outcomes of women with stage IB2 to IVA treated with weekly cisplatin concurrent with pelvic irradiation at Srinagarind Hospital. The medical records of 100 women with cervical cancer stage IB2 to IVA who were treated with weekly cisplatin 40 mg/m 2 concurrent with pelvic radiotherapy at Srinagarind Hospital between January 2003 and June 2006 were reviewed and analyzed. During the study period, 100 women were eligible for analysis, with a mean age of 46 years (range 24-60 years). Distribution according to International Federation of Gynecology and Obstetrics (FIGO) staging was IB2 1.0%, IIB 47.0%, IIIB 51.0%, and IVA 1.0%, respectively. A total of 86 patients received five or more cycles of weekly cisplatin. Grade 3 and 4 hematologic toxicities were found in 6.0%. The overall response rate was 97.0%. Complete response was achieved in 86 patients (86.0%) and partial response in 11 patients (11.0%). Stable disease was found in 1 patient (1.0%) but no progressive disease was found. Progression-free survival and overall survival rate were 69.6% and 96.1%, respectively. Weekly cisplatin (40 mg/m 2 ) concurrent with pelvic irradiation for locally advanced cervical cancer was effective with acceptable toxicity in Thai women. (author)

Liver-inherent immune system: its role in blood-stage malaria.

Science.gov (United States)

Wunderlich, Frank; Al-Quraishy, Saleh; Dkhil, Mohamed A

2014-01-01

The liver is well known as that organ which is obligately required for the intrahepatocyte development of the pre-erythrocytic stages of the malaria-causative agent Plasmodium. However, largely neglected is the fact that the liver is also a central player of the host defense against the morbidity- and mortality-causing blood stages of the malaria parasites. Indeed, the liver is equipped with a unique immune system that acts locally, however, with systemic impact. Its main "antipodal" functions are to recognize and to generate effective immunoreactivity against pathogens on the one hand, and to generate tolerance to avoid immunoreactivity with "self" and harmless substances as dietary compounds on the other hand. This review provides an introductory survey of the liver-inherent immune system: its pathogen recognition receptors including Toll-like receptors (TLRs) and its major cell constituents with their different facilities to fight and eliminate pathogens. Then, evidence is presented that the liver is also an essential organ to overcome blood-stage malaria. Finally, we discuss effector responses of the liver-inherent immune system directed against blood-stage malaria: activation of TLRs, acute phase response, phagocytic activity, cytokine-mediated pro- and anti-inflammatory responses, generation of "protective" autoimmunity by extrathymic T cells and B-1 cells, and T cell-mediated repair of liver injuries mainly produced by malaria-induced overreactions of the liver-inherent immune system.

Effectiveness of interim stage filter in the exhaust system of glove boxes

International Nuclear Information System (INIS)

Patre, D.K.; Vangara, H.; Thanamani, S.; Gopalakrishnan, R.K.; Mhatre, Amol M.

2018-01-01

All operations in radiochemical laboratories are carried out in containment systems like Glove boxes and Fume hoods. For controlling air contamination two separate air cleaning systems are incorporated. Laboratory has general ventilation system and glove boxes are provided with a negative pressure system (NPS). Glove box exhaust air is passed through three stage filtration systems: in situ, interim and final before discharging to the atmosphere. In addition to the individual HEPA filters of each glove box, there is an interim HEPA filter bank introduced at the laboratory end. This was introduced to reduce a load on main exhaust filter system. Finally the exhaust air is discharged through the final stage HEPA filter located in the filter house through the Stack. The interim HEPA filter bank provides additional protection for the release of particulate activity and reduces load on the final stage filters. In the present work efforts have been put to validate the interim stage filter, which has been introduced, to limit the environmental release

Alternatives generation and analysis for phase I intermediate waste feed staging system design requirements

Energy Technology Data Exchange (ETDEWEB)

Britton, M.D.

1996-10-02

This document provides; a decision analysis summary; problem statement; constraints, requirements, and assumptions; decision criteria; intermediate waste feed staging system options and alternatives generation and screening; intermediate waste feed staging system design concepts; intermediate waste feed staging system alternative evaluation and analysis; and open issues and actions.

Cancer of the ovary, fallopian tube, and peritoneum: a population-based comparison of the prognostic factors and outcomes.

Science.gov (United States)

Rottmann, Miriam; Burges, A; Mahner, S; Anthuber, C; Beck, T; Grab, D; Schnelzer, A; Kiechle, M; Mayr, D; Pölcher, M; Schubert-Fritschle, G; Engel, J

2017-09-01

The objective was to compare the prognostic factors and outcomes among primary ovarian cancer (OC), fallopian tube cancer (FC), and peritoneal cancer (PC) patients in a population-based setting. We analysed 5399 OC, 327 FC, and 416 PC patients diagnosed between 1998 and 2014 in the catchment area of the Munich Cancer Registry (meanwhile 4.8 million inhabitants). Tumour site differences were examined by comparing prognostic factors, treatments, the time to progression, and survival. The effect of the tumour site was additionally analysed by a Cox regression model. The median age at diagnosis, histology, and FIGO stage significantly differed among the tumour sites (p < 0.001); PC patients were older, more often diagnosed with a serous subtype, and in FIGO stage III or IV. The time to progression and survival significantly differed among the tumour sites. When stratified by FIGO stage, the differences in time to progression disappeared, and the differences in survival considerably weakened. The differences in the multivariate survival analysis showed an almost identical outcome in PC patients (HR 1.07 [0.91-1.25]) and an improved survival of FC patients (HR 0.63 [0.49-0.81]) compared to that of OC patients. The comparison of OC, FC, and PC patients in this large-scale population-based study showed differences in the prognostic factors. These differences primarily account for the inferior outcome of PC patients, and for the improved survival of FC compared to OC patients.

Integrated care in ovarian cancer “IgV Ovar”: results of a German pilot for higher quality in treatment of ovarian cancer.

Science.gov (United States)

Keyver-Paik, M-D; Abramian, A; Domröse, C; Döser, A; Höller, T; Friedrich, M; Meier, W; Menn, K; Kuhn, W

2016-02-01

Late-stage ovarian cancer patient's survival depends on complete cytoreduction and chemotherapy. Complete cytoreduction is more often achieved in institutions with a case volume of >20 cases per year. The Integrated care program Ovar (IgV Ovar) was founded in 2005 and started recruiting in 2006 with 21 health insurances and six expert centers of ovarian cancer treatment as a quality initiative. Results of the pilot and outcomes of patients of three participating centers will be presented here. Data of 1038 patients with ovarian cancer were collected. Adjuvant patients (n = 505) stage FIGO IIB-IV (n = 307) were analyzed for cytoreduction and survival. FIGO IIIC patients were analyzed separately. Median follow-up was 32.7 months. Progression-free survival (PFS) was 23.1 months and overall survival (OS) was 53.6 months for stage IIB-IV. Patients with FIGO IIIC were completely cytoreduced in 48 %. PFS was 21, 29 months if completely cytoreduced. OS was 47.4, 64.9 months if completely cytoreduced.D ISCUSSION: Although the IgV Ovar Rhineland proved to have some structural problems with recruitment and prospective data collection, cytoreduction rates and outcome of patients prove treatment of patients in expert centers is superior to the national and international mean. Therefore, a new quality initiative will be started to bring more awareness to women and to their gynecologists and general practitioners of just how important a good referral strategy is.

A Gas-Spring-Loaded X-Y-Z Stage System for X-ray Microdiffraction Sample Manipulation

International Nuclear Information System (INIS)

Shu Deming; Cai Zhonghou; Lai, Barry

2007-01-01

We have designed and constructed a gas-spring-loaded x-y-z stage system for x-ray microdiffraction sample manipulation at the Advanced Photon Source XOR 2-ID-D station. The stage system includes three DC-motor-driven linear stages and a gas-spring-based heavy preloading structure, which provides antigravity forces to ensure that the stage system keeps high-positioning performance under variable goniometer orientation. Microdiffraction experiments with this new stage system showed significant sample manipulation performance improvement

A Three-Stage Optimal Approach for Power System Economic Dispatch Considering Microgrids

Directory of Open Access Journals (Sweden)

Wei-Tzer Huang

2016-11-01

Full Text Available The inclusion of microgrids (MGs in power systems, especially distribution-substation-level MGs, significantly affects power systems because of the large volumes of import and export power flows. Consequently, power dispatch has become complicated, and finding an optimal solution is difficult. In this study, a three-stage optimal power dispatch model is proposed to solve such dispatch problems. In the proposed model, the entire power system is divided into two parts, namely, the main power grid and MGs. The optimal power dispatch problem is resolved on the basis of multi-area concepts. In stage I, the main power system economic dispatch (ED problem is solved by sensitive factors. In stage II, the optimal power dispatches of the local MGs are addressed via an improved direct search method. In stage III, the incremental linear models for the entire power system can be established on the basis of the solutions of the previous two stages and can be subjected to linear programming to determine the optimal reschedules from the original dispatch solutions. The proposed method is coded using Matlab and tested by utilizing an IEEE 14-bus test system to verify its feasibility and accuracy. Results demonstrated that the proposed approach can be used for the ED of power systems with MGs as virtual power plants.

Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis.

Science.gov (United States)

McLeod, Donald S A; Jonklaas, Jacqueline; Brierley, James D; Ain, Kenneth B; Cooper, David S; Fein, Henry G; Haugen, Bryan R; Ladenson, Paul W; Magner, James; Ross, Douglas S; Skarulis, Monica C; Steward, David L; Xing, Mingzhao; Litofsky, Danielle R; Maxon, Harry R; Sherman, Steven I

2015-10-01

Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R(2)). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.

Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis

Science.gov (United States)

McLeod, Donald S.A.; Jonklaas, Jacqueline; Brierley, James D.; Ain, Kenneth B.; Cooper, David S.; Fein, Henry G.; Haugen, Bryan R.; Ladenson, Paul W.; Magner, James; Ross, Douglas S.; Skarulis, Monica C.; Steward, David L.; Xing, Mingzhao; Litofsky, Danielle R.; Maxon, Harry R.

2015-01-01

Background: Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. Objective: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. Methods: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R2). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. Results: The best five alternate papillary cancer systems had age cut-points of 45–50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50–55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003–0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). Conclusions: No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation. PMID:26203804

Comparative study of nasopharyngeal carcinoma staging system between the chinese 2008 and '92 Fuzhou

International Nuclear Information System (INIS)

Zong Jingfeng; Lin Shaojun; Zhang Yu; Chen Yunbin; Guo Qiaojuan; Pan Jianji

2010-01-01

Objective: To carry out a comparative study between the Chinese 2008 and '92 staging system of nasopharyngeal carcinoma (NPC). Methods: A total of 777 patients presented with untreated non disseminated NPC who had received MRI scan of nasopharynx and neck were studied retrospectively. The clinical materials and information of imaging were collected. All patients were restaged according to the Chinese 2008 and 92 staging system of nasopharyngeal carcinoma. Distribution of T, N stage, survival and prognostic value were compared. 513 patients of the 777 cases were treated with conventional radiotherapy, 264 cases with intensity modulated radiation therapy. Results: The 3-year follow-up rate was 97.6%. The consistency of T stages was 95.0%. T, N and clinical stage distributions in two systems were similar ( Kappa = 0.93, P = 0.000; Kappa = 0.58, P = 0.000; Kappa = 0.74, P = 0.000). Local failure-free survival and disease specific survival were also similar. There was no difference of distant metastasis between N 0 and N 1 (χ 2 = 1.94, P=0. 164), and a marginal difference between N 1 and N 2 (χ 2 =3.83, P=0.051) in the Chinese '92 staging system. However, although there was also no difference of distant metastasis-free survival between N 0 and N 1a (χ 2 =0.07, P =0.797), ) the difference of overall survival among N 1b , N 2 , and N 3 were significant (χ 2 = 4.95, P = 0.026; χ 2 = 6.74, P = 0.009) in the Chinese 2008 staging system. Conventional radiotherapy or intensity modulated radiation therapy was not a prognostic factor for survival (χ 2 = 3.60, P =0.058). It is reasonable for the Chinese 2008 staging system integrated lymph node characteristics such as laterality, level and extra nodal neoplastic spread into the N staging criteria (χ 2 = 6.59, P = 0.010; χ 2 =4.78, P=0. 029; χ 2 =9.32, P=0.002). Conclusions: For the Chinese 2008 staging system, it was reasonable to simplify the previous T stage. The N stage showed a better predictive role of distant

Prophylactic lower para-aortic irradiation using intensity-modulated radiotherapy mitigates the risk of para-aortic recurrence in locally advanced cervical cancer: A 10-year institutional experience.

Science.gov (United States)

Lee, Jie; Lin, Jhen-Bin; Chang, Chih-Long; Jan, Ya-Ting; Sun, Fang-Ju; Wu, Meng-Hao; Chen, Yu-Jen

2017-07-01

To evaluate the effects of prophylactic sub-renal vein radiotherapy (SRVRT) using intensity-modulated radiotherapy (IMRT) for cervical cancer. A total of 206 patients with FIGO stage IB2-IVA cervical cancer and negative para-aortic lymph nodes (PALNs) who underwent pelvic IMRT (PRT) or SRVRT between 2004 and 2013 at our institution were reviewed. SRVRT cranially extended the PRT field for PALNs up to the left renal vein level. The prescribed dose was consistent 50.4Gy in 28 fractions. Overall, 110 and 96 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage and positive pelvic lymph nodes (PLNs). The median follow-up time was 60months (range, 7-143). For the total study population, the 5-year PALN recurrence-free survival (PARFS) and overall survival (OS) for PRT vs. SRVRT were 87.6% vs. 97.9% (p=0.03) and 74.5% vs. 87.8% (p=0.04), respectively. In patients with FIGO III-IVA or positive PLNs, the 5-year PARFS and OS for PRT vs. SRVRT were 80.1% vs. 96.4% (p=0.02) and 58.1% vs. 83.5% (p=0.012), respectively. However, there were no significant differences in these outcomes for patients with FIGO IB-IIB and negative PLNs. In a multivariate analysis, only SRVRT was associated with better PARFS (HR, 0.21; 95% CI, 0.06-0.78; p=0.02). The SRVRT did not significantly increase severe late toxicities. Prophylactic SRVRT using IMRT reduced PALN recurrence with tolerable toxicities, supporting the application of risk-based radiation fields for cervical cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

Configuration of management accounting information system for multi-stage manufacturing

Science.gov (United States)

Mkrtychev, S. V.; Ochepovsky, A. V.; Enik, O. A.

2018-05-01

The article presents an approach to configuration of a management accounting information system (MAIS) that provides automated calculations and the registration of normative production losses in multi-stage manufacturing. The use of MAIS with the proposed configuration at the enterprises of textile and woodworking industries made it possible to increase the accuracy of calculations for normative production losses and to organize accounting thereof with the reference to individual stages of the technological process. Thus, high efficiency of multi-stage manufacturing control is achieved.

Two-stage model of development of heterogeneous uranium-lead systems in zircon

International Nuclear Information System (INIS)

Mel'nikov, N.N.; Zevchenkov, O.A.

1985-01-01

Behaviour of isotope systems of multiphase zircons at their two-stage distortion is considered. The results of calculations testify to the fact that linear correlations on the diagram with concordance can be explained including two-stage discovery of U-Pb systems of cogenetic zircons if zircon is considered physically heterogeneous and losing in its different part different ratios of accumulated radiogenic lead. ''Metamorphism ages'' obtained by these two-stage opening zircons are intermediate, and they not have geochronological significance while ''crystallization ages'' remain rather close to real ones. Two-stage opening zircons in some cases can be diagnosed by discordance of their crystal component

[Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system].

Science.gov (United States)

Peng, Cheng-hong; Zhao, Zhi-ming; Peng, Shu-you; Liu, Ying-bin; Wu, Yü-lian; Fang, He-qing; Jiang, Xian-chuan

2005-01-01

To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York. The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed. Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007). The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.

Changes of endocrine and ultrasound markers as ovarian aging in modifying the Stages of Reproductive Aging Workshop (STRAW) staging system with subclassification of mid reproductive age stage.

Science.gov (United States)

Ding, Ting; Luo, Aiyue; Jiang, Jingjing; Du, Xiaofang; Yang, Shuhong; Lai, Zhiwen; Shen, Wei; Lu, Yunping; Ma, Ding; Wang, Shixuan

2013-01-01

To demonstrate the changes of ovarian aging markers across the Stages of Reproductive Aging Workshop (STRAW) stages and modify it with subclassification of mid reproductive age stage (MR). Healthy females were classified according to the STRAW system. Serum basal FSH, LH, E2, and anti-Müllerian hormone (AMH) were detected, FSH/LH ratio calculated, and antral follicle counts (AFCs) determined in follicular phase. Progression through the whole STRAW stages under MR stage subdivided is associated with elevations in FSH, LH, FSH/LH ratio and decreases in E2, AMH and AFCs (p age in MR stage. 0.982 ng/ml AMH and 3 antral follicles (low level of MR 25-30 years) were set as cutoffs to distinguish MR stage into early mid reproductive age (EMR) and late mid reproductive age (LMR) stages. The women in EMR stage compared with LMR could retrieve more oocytes in IVF treatment (p stage, demonstrating disparate reproductive aging period with reduced ovarian reserve in young age across the STRAW stages.

Uterine cervix cancer treatment at Radiumhemmet: 90 years' experience. Time trends of age, stage, and histopathology distribution.

Science.gov (United States)

Hellman, Kristina; Hellström, Ann-Cathrin; Pettersson, B Folke

2014-04-01

Since the introduction of screening programs for cervical cancer (CC) the incidence has decreased and CC is discovered at an earlier stage. The purpose of this study was to analyze time trends in age, stage, and histopathology over a 90-year period and to our knowledge this is the largest single institutional series in the literature of invasive cervical carcinoma (CC) cases. This is a retrospective study comprising 18,472 women treated for CC from 1914 until 2004 at Radiumhemmet, Stockholm. The material is part of the international CC statistics published since 1937 in the League of Nations' Annual Reports, and since 1958 under the patronage of International Federation of Gynecology and Obstetrics (FIGO). During the 90-year study period, the annual number of cases treated increased to over 400 up until 1965, after which there was a gradual drop to less than 100 cases in 2004. A pronounced shift toward earlier stages at diagnosis was noted. The mean age at diagnosis increased in all stages, predominantly in advanced stages. A reduction in squamous cell carcinoma (SCC) cases and a sixfold increase in the proportion of adenocarcinoma (AC) cases were observed. The mean age at diagnosis for squamous and AC cases shifted after 1970, when the SCC cases ultimately became 3 years older than the AC cases in contrast to around 1950 when they were 3 years younger than the AC cases. The changes in the distribution by age, stage, and histopathology during this 90-year period are probably associated with: improved social conditions and increased access to health care, the introduction of screening programs for CC in the 1960s, and a change in the risk factors for CC (changed sexual behavior, introduction of contraceptive pills, and changed smoking habits). © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Comparison of four staging systems of lymph node metastasis in gastric cancer.

Science.gov (United States)

Zhang, Ming; Zhu, Guanyu; Ma, Yan; Xue, Yingwei

2009-11-01

The classification of lymph node metastasis in patients with gastric cancer is still controversial. Our aim was to evaluate the relative merits of four staging systems of lymph node metastasis. In our study, the nodal status was classified according to the 5th edition of the tumor node metastasis (TNM) system, the Japanese Classification of Gastric Carcinoma (JCGC), the ratio of metastatic lymph nodes, and the size of the largest metastatic lymph node. Each staging system was scored as good (+2), fair (+1), or poor (0) with respect to the theoretical value (extent of the anatomical lymphatic tumor spread), convenience (simplicity), surgical applicability (extent of lymph node dissection), and prognostic value (ability to predict survival rate). In the multivariate analysis including the four staging systems and other potential prognostic factors, stepwise Cox regression revealed that the ratio of metastatic lymph nodes was the most independent prognostic factor. The TNM, ratio, and size systems were convenient because they had no consideration for the location of the tumor and lymph node. Although the JCGC system had advantages in theoretical value and surgical application, it was most optional due to the complexity of the system. Although all different staging systems are comparable, the metastatic lymph node ratio system is convenient, reproducible, and has the highest ability to predict survival.

Stages in the energetics of baroclinic systems

Science.gov (United States)

Orlanski, Isidoro; Sheldon, John P.

1995-10-01

The results from several idealized and case studies are drawn together to form a comprehensive picture of "downstream baroclinic evolution" using local energetics. This new viewpoint offers a complementary alternative to the more conventional descriptions of cyclone development. These additional insights are made possible largely because the local energetics approach permits one to define an energy flux vector which accurately describes the direction of energy dispersion and quantifies the role of neighboring systems in local development. In this view, the development of a system's energetics is divided into three stages. In Stage 1, a pre-existing disturbance well upstream of an incipient trough loses energy via ageostrophic geopotential fluxes directed downstream through the intervening ridge, generating a new energy center there. In Stage 2, this new energy center grows vigorously, at first due to the convergence of these fluxes, and later by baroclinic conversion as well. As the center matures, it begins to export energy via geopotential fluxes to the eastern side of the trough, initiating yet another energy center. In Stage 3, this new energy center continues to grow while that on the western side of the trough decays due to a dwinding supply of energy via fluxes from the older upstream system and also as a consequence of its own export of energy downstream. As the eastern energy center matures, it exports energy further downstream, and the sequence begins anew. The USA "Blizzard of'93" is used as a new case study to test the limits to which this conceptual sequence might apply, as well as to augment the current limited set of case studies. It is shown that, despite the extraordinary magnitude of the event, the evolution of the trough associated with the Blizzard fits the conceptual picture of downstream baroclinic evolution quite well, with geopotential fluxes playing a critical rôle in three respects. First, fluxes from an old, decaying system in the

Evaluation of the response of concurrent high dose rate intracavitary brachytherapy with external beam radiotherapy in management of early stage carcinoma cervix.

Science.gov (United States)

Patidar, Arvind Kumar; Kumar, H S; Walke, Rahul V; Hirapara, Pushpendra H; Jakhar, Shankar Lal; Bardia, M R

2012-10-01

To evaluate local disease control and early complications of concomitant brachytherapy with external beam-radiotherapy in early stage carcinoma cervix. Fifty patients of early stage carcinoma cervix (FIGO-IB/IIA) were randomly divided into study group concomitant external beam irradiation (EBRT) and HDR-ICBT (intra-cavitary brachytherapy, xrt = 50 Gy/25 Fr, HDR 5.2 Gy*5 Fr) and the control group EBRT followed by HDR-ICBT (xrt = 50 Gy/25 Fr, HDR 7.5 Gy*3 Fr). Acute reactions and local disease response were compared between treatment and at 6-month follow up. Median overall treatment times were 38 and 61 days in the study and the control groups, respectively. Acute skin reactions and diarrhea were more in the study but manageable. At the completion of the study, there were 80 and 68 % complete responses, 16 and 20 % partial responses, 0 and 8 % stable diseases in the study group and the control group, respectively. Response was better in the study group but statistically insignificant. Larger number of patients and longer follow up are required to arrive at concrete conclusion.

Loss of heterozygosity and copy number alterations in flow-sorted bulky cervical cancer

NARCIS (Netherlands)

Tillaart, S.A. van den; Corver, W.E.; Neto, D. Ruano; Haar, N.T. ter; Goeman, J.J.; Trimbos, J.B.M.Z.; Fleuren, G.J.; Oosting, J.

2013-01-01

Treatment choices for cervical cancer are primarily based on clinical FIGO stage and the post-operative evaluation of prognostic parameters including tumor diameter, parametrial and lymph node involvement, vaso-invasion, infiltration depth, and histological type. The aim of this study was to

Prognostic Significance of Pre-treatment Serum C-Reactive Protein Level in Patients with Adenocarcinoma of the Uterine Cervix.

Science.gov (United States)

Bodner-Adler, Barbara; Kimberger, Oliver; Schneidinger, Cora; Kölbl, Heinz; Bodner, Klaus

2016-09-01

To evaluate pre-treatment serum C-reactive protein (CRP) level as a prognostic parameter in patients with adenocarcinoma of the uterine cervix. Pre-treatment CRP levels were analyzed to determine potential associations with clinicopathological parameters and to assess prognostic value in 46 patients with sole adenocarcinoma of the uterine cervix. The mean (±SD) pre-treatment serum CRP level was 5.82 (7.21) mg/l. Serum CRP concentration significantly correlated positively with age at diagnosis (p=0.001), lymphovascular space invasion (p=0.0026), recurrent disease (p=0.0001) and International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.0002). In multivariate Cox regression models with age, FIGO stage, histological grade and lymph node status, elevated CRP and cancer antigen 125 levels were associated with shortened survival (pcervix. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Influence of dispatching rules on average production lead time for multi-stage production systems.

Science.gov (United States)

Hübl, Alexander; Jodlbauer, Herbert; Altendorfer, Klaus

2013-08-01

In this paper the influence of different dispatching rules on the average production lead time is investigated. Two theorems based on covariance between processing time and production lead time are formulated and proved theoretically. Theorem 1 links the average production lead time to the "processing time weighted production lead time" for the multi-stage production systems analytically. The influence of different dispatching rules on average lead time, which is well known from simulation and empirical studies, can be proved theoretically in Theorem 2 for a single stage production system. A simulation study is conducted to gain more insight into the influence of dispatching rules on average production lead time in a multi-stage production system. We find that the "processing time weighted average production lead time" for a multi-stage production system is not invariant of the applied dispatching rule and can be used as a dispatching rule independent indicator for single-stage production systems.

LOX/LH2 propulsion system for launch vehicle upper stage, test results

Science.gov (United States)

Ikeda, T.; Imachi, U.; Yuzawa, Y.; Kondo, Y.; Miyoshi, K.; Higashino, K.

1984-01-01

The test results of small LOX/LH2 engines for two propulsion systems, a pump fed system and a pressure fed system are reported. The pump fed system has the advantages of higher performances and higher mass fraction. The pressure fed system has the advantages of higher reliability and relative simplicity. Adoption of these cryogenic propulsion systems for upper stage of launch vehicle increases the payload capability with low cost. The 1,000 kg thrust class engine was selected for this cryogenic stage. A thrust chamber assembly for the pressure fed propulsion system was tested. It is indicated that it has good performance to meet system requirements.

NxStage dialysis system-associated thrombocytopenia: a report of two cases.

Science.gov (United States)

Sekkarie, Mohamed; Waldron, Michelle; Reynolds, Texas

2016-01-01

Thrombocytopenia in hemodialysis patients has recently been reported to be commonly caused by electron-beam sterilization of dialysis filters. We report the occurrence of thrombocytopenia in the first two patients of a newly established home hemodialysis program. The 2 patients switched from conventional hemodialysis using polysulfone electron-beam sterilized dialyzers to a NxStage system, which uses gamma sterilized polyehersulfone dialyzers incorporated into a drop-in cartridge. The thrombocytopenia resolved after return to conventional dialysis in both patients and recurred upon rechallenge in the patient who opted to retry NxStage. This is the first report of thrombocytopenia with the NxStage system according to the authors’ knowledge. Dialysis-associated thrombocytopenia pathophysiology and clinical significance are not well understood and warrant additional investigations.

Results of Radiation Therapy in Stage III Uterine Cervical Cancer

Energy Technology Data Exchange (ETDEWEB)

Moon, Chang Woo; Shin, Byung Chul; Yum, Ha Yong; Jeung, Tae Sig; Yoo, Myung Jin [Kosin University College of Medicine, Seoul (Korea, Republic of)

1995-09-15

Purpose : The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. Materials and Methods : From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymph node metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. Results : Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (P<0.01). There were statistically no

Results of Radiation Therapy in Stage III Uterine Cervical Cancer

International Nuclear Information System (INIS)

Moon, Chang Woo; Shin, Byung Chul; Yum, Ha Yong; Jeung, Tae Sig; Yoo, Myung Jin

1995-01-01

Purpose : The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. Materials and Methods : From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymph node metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. Results : Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (P<0.01). There were statistically no

Treatment outcome after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer

Energy Technology Data Exchange (ETDEWEB)

Kim, Ji Young; Lee, Kyung Ja; Park, Kyung Ran [Dept. of Radiation Oncology, Ewha Womans University School of Medicine, Seoul (Korea, Republic of); and others

2016-12-15

The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0–50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

Vibration isolation and dual-stage actuation pointing system for space precision payloads

Science.gov (United States)

Kong, Yongfang; Huang, Hai

2018-02-01

Pointing and stability requirements for future space missions are becoming more and more stringent. This work follows the pointing control method which consists of a traditional spacecraft attitude control system and a payload active pointing loop, further proposing a vibration isolation and dual-stage actuation pointing system for space precision payloads based on a soft Stewart platform. Central to the concept is using the dual-stage actuator instead of the traditional voice coil motor single-stage actuator to improve the payload active pointing capability. Based on a specified payload, the corresponding platform was designed to be installed between the spacecraft bus and the payload. The performance of the proposed system is demonstrated by preliminary closed-loop control investigations in simulations. With the ordinary spacecraft bus, the line-of-sight pointing accuracy can be controlled to below a few milliarcseconds in tip and tilt. Meanwhile, utilizing the voice coil motor with the softening spring in parallel, which is a portion of the dual-stage actuator, the system effectively achieves low-frequency motion transmission and high-frequency vibration isolation along the other four degree-of-freedom directions.

Information and Analysis System Stages of Family Welfare in District Balong

Directory of Open Access Journals (Sweden)

Eka Arynda Ayu

2017-05-01

Full Text Available Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN is a family that formed due to legal marriage, is able to meet the needs of the spiritual and the material that is decent, devoted to God Almighty, have a relationship that is harmonious and balanced between members and between families with the community and the environment. Every year the government to collect data on the status of a prosperous family stage where the purpose of the data collection is in the framework of development and poverty alleviation programs. Data collection process in the District Balong is still done manually so that the risk of error in determining the status of a family stage could happen. Information and analysis system of status stages of family welfare is designed to make web-based officers in the input data and determine the status of a prosperous family stages based on selected indicators of the sheet R/1/KS. Sample of data from Bulukidul village and sub-district village of Balong Ngraket 2014. Results of the system in the form of data reports the results of process steps and the results can be viewed in graphical form. Comparison chart to show the status of the highest percentage of poor welfare families stages. Instead lowest percentage shows the stages of a prosperous family able or rich. 

Loss-of-heterozygosity on chromosome 19q in early-stage serous ovarian cancer is associated with recurrent disease

International Nuclear Information System (INIS)

Skirnisdottir, Ingiridur; Mayrhofer, Markus; Rydåker, Maria; Åkerud, Helena; Isaksson, Anders

2012-01-01

Ovarian cancer is a heterogeneous disease and prognosis for apparently similar cases of ovarian cancer varies. Recurrence of the disease in early stage (FIGO-stages I-II) serous ovarian cancer results in survival that is comparable to those with recurrent advanced-stage disease. The aim of this study was to investigate if there are specific genomic aberrations that may explain recurrence and clinical outcome. Fifty-one women with early stage serous ovarian cancer were included in the study. DNA was extracted from formalin fixed samples containing tumor cells from ovarian tumors. Tumor samples from thirty-seven patients were analysed for allele-specific copy numbers using OncoScan single nucleotide polymorphism arrays from Affymetrix and the bioinformatic tool Tumor Aberration Prediction Suite. Genomic gains, losses, and loss-of-heterozygosity that associated with recurrent disease were identified. The most significant differences (p < 0.01) in Loss-of-heterozygosity (LOH) were identified in two relatively small regions of chromosome 19; 8.0-8,8 Mbp (19 genes) and 51.5-53.0 Mbp (37 genes). Thus, 56 genes on chromosome 19 were potential candidate genes associated with clinical outcome. LOH at 19q (51-56 Mbp) was associated with shorter disease-free survival and was an independent prognostic factor for survival in a multivariate Cox regression analysis. In particular LOH on chromosome 19q (51-56 Mbp) was significantly (p < 0.01) associated with loss of TP53 function. The results of our study indicate that presence of two aberrations in TP53 on 17p and LOH on 19q in early stage serous ovarian cancer is associated with recurrent disease. Further studies related to the findings of chromosomes 17 and 19 are needed to elucidate the molecular mechanism behind the recurring genomic aberrations and the poor clinical outcome

Expression profiling of cervical cancers in Indian women at different stages to identify gene signatures during progression of the disease

International Nuclear Information System (INIS)

Thomas, Asha; Mahantshetty, Umesh; Kannan, Sadhana; Deodhar, Kedar; Shrivastava, Shyam K; Kumar-Sinha, Chandan; Mulherkar, Rita

2013-01-01

Cervical cancer is the second most common cancer among women worldwide, with developing countries accounting for >80% of the disease burden. Although in the West, active screening has been instrumental in reducing the incidence of cervical cancer, disease management is hampered due to lack of biomarkers for disease progression and defined therapeutic targets. Here we carried out gene expression profiling of 29 cervical cancer tissues from Indian women, spanning International Federation of Gynaecology and Obstetrics (FIGO) stages of the disease from early lesion (IA and IIA) to progressive stages (IIB and IIIA–B), and identified distinct gene expression signatures. Overall, metabolic pathways, pathways in cancer and signaling pathways were found to be significantly upregulated, while focal adhesion, cytokine–cytokine receptor interaction and WNT signaling were downregulated. Additionally, we identified candidate biomarkers of disease progression such as SPP1, proliferating cell nuclear antigen (PCNA), STK17A, and DUSP1 among others that were validated by quantitative real-time polymerase chain reaction (qRT-PCR) in the samples used for microarray studies as well in an independent set of 34 additional samples. Integrative analysis of our results with other cervical cancer profiling studies could facilitate the development of multiplex diagnostic markers of cervical cancer progression

Influence of capacity- and time-constrained intermediate storage in two-stage food production systems

DEFF Research Database (Denmark)

Akkerman, Renzo; van Donk, Dirk Pieter; Gaalman, Gerard

2007-01-01

In food processing, two-stage production systems with a batch processor in the first stage and packaging lines in the second stage are common and mostly separated by capacity- and time-constrained intermediate storage. This combination of constraints is common in practice, but the literature hardly...... of systems like this. Contrary to the common sense in operations management, the LPT rule is able to maximize the total production volume per day. Furthermore, we show that adding one tank has considerable effects. Finally, we conclude that the optimal setup frequency for batches in the first stage...... pays any attention to this. In this paper, we show how various capacity and time constraints influence the performance of a specific two-stage system. We study the effects of several basic scheduling and sequencing rules in the presence of these constraints in order to learn the characteristics...

Are Early Relapses in Advanced-Stage Ovarian Cancer Doomed to a Poor Prognosis?

Directory of Open Access Journals (Sweden)

Fabien Vidal

Full Text Available Early recurrence (ER after completion of therapeutic regimen in advanced-stage ovarian cancer is a challenging clinical situation. Patients are perceived as invariably having a poor prognosis. We investigated the possibility of defining different prognostic subgroups and the parameters implicated in prognosis of ER patients.We analyzed a multi-centric database of 527 FIGO stage IIIC and IV ovarian cancer patients. We defined patients relapsing within 12 months as ER and investigated using Cox logistic regression the prognostic factors in ER group. We subsequently divided ER patients into good and poor prognosis groups according to a lower or higher overall survival (OS at 12 months after relapse and determined parameters associated to poor prognosis.The median follow up was 49 months. One hundred and thirty eight patients recurred within 12 months. OS and Disease Free Survival (DFS were 24.6 and 8.6 months, respectively, in this group of patients. Among the ER patients, 73 had a poor prognosis with an OS after relapse below 12 months (mean OS = 5.2 months and 65 survived after one year (mean OS = 26.9 months. Residual disease (RD after debulking surgery and mucinous histological subtype negatively impacted prognosis (HR = 1.758, p = 0.017 and HR = 8.641, p = 0.001 respectively. The relative risk of death within 12 months following relapse in ER patients was 1.61 according to RD status. However, RD did not affect DFS (HR = 0.889, p = 0.5.ER in advanced-stage ovarian cancer does not inevitably portend a short-term poor prognosis. RD status after initial cytoreduction strongly modulates OS, that gives additional support to the concept of maximum surgical effort even in patients who will experience early recurrence. The heterogeneity in outcomes within the ER group suggests a role for tumor biology in addition to classical clinical parameters.

Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis

Directory of Open Access Journals (Sweden)

TIAN Yan

2015-03-01

Full Text Available ObjectiveTo evaluate the clinical value of five-stage prognostic system in predicting the short-term outcome of patients with liver cirrhosis, and to compare it with the Child-Turcotte-Pugh (CTP and Model of End-Stage Liver Disease (MELD scores. MethodsTwo hundred and one hospitalized patients with liver cirrhosis in the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University from January 2011 to January 2014 were enrolled in the study and followed up for at least six months. Patients were classified accorded to the five-stage prognostic system, and the mortality rate in each stage was measured. The receiver operating characteristic (ROC curve and the area under the ROC curve (AUC were used to assess the accuracy of the five-stage prognostic system in predicting the short-term death risk of cirrhotic patients, which was then compared with the CTP and MELD scores. Categorical data were analyzed by chi-square test. Comparison of AUC was made by normal distribution Z test. Spearman′s correlation analysis was used to investigate the correlation of the five-stage prognostic system with the CTP and MELD scores. ResultsThe study used the admission time as the starting point and the death of patients or study termination time as the endpoint. Among the 201 patients, 50 (24.9% died within six months. Based on the five-stage prognostic system, the mortality rates for stages 1 to 5 were 0(0/11, 0（0/18, 4.2%（2/48, 16.3% (7/43, and 50.6%（41/81, respectively. In patients with decompensated cirrhosis (stages 3, 4, and 5, the mortality increased with stage, and the differences in mortality between patients in stages 3 and 4, 3 and 5, and 4 and 5 were all significant (χ2=3.89, 35.33, and 13.96, respectively; P=0.049, 0.000, and 0.049, respectively. The AUC for the five-stage prognostic system, five-stage prognostic system combined with CTP and MELD score, and CTP score were 0820, 0.915, 0.888, and 0

YKL-40 tissue expression and plasma levels in patients with ovarian cancer

International Nuclear Information System (INIS)

Høgdall, Estrid VS; Christensen, Lise H; Ringsholt, Merete; Høgdall, Claus K; Christensen, Ib Jarle; Johansen, Julia S; Kjaer, Susanne K; Blaakaer, Jan; Ostenfeld-Møller, Lene; Price, Paul A

2009-01-01

YKL-40 (chitinase-3-like-1) is a member of 'mammalian chitinase-like proteins'. The protein is expressed in many types of cancer cells and the highest plasma YKL-40 levels have been found in patients with metastatic disease, short recurrence/progression-free intervals, and short overall survival. The aim of the study was to determine the expression of YKL-40 in tumor tissue and plasma in patients with borderline ovarian tumor or epithelial ovarian cancer (OC), and investigate prognostic value of this marker. YKL-40 protein expression was determined by immunohistochemistry in tissue arrays from 181 borderline tumors and 473 OC. Plasma YKL-40 was determined by ELISA in preoperative samples from 19 patients with borderline tumor and 76 OC patients. YKL-40 protein expression was found in cancer cells, tumor associated macrophages, neutrophils and mast cells. The tumor cell expression was higher in OC than in borderline tumors (p = 0.001), and associated with FIGO stage (p < 0.0001) and histological subtype (p = 0.0009). Positive YKL-40 expression (≥ 5% staining) was not associated with reduced survival. Plasma YKL-40 was also higher in patients with OC than in patients with borderline tumors (p < 0.0001), and it was positively correlated to serum CA-125 (p < 0.0001) and FIGO stage (p = 0.0001). Univariate Cox analysis of plasma YKL-40 showed association with overall survival (p < 0.0001). Multivariate Cox analysis, including plasma YKL-40, serum CA125, FIGO stage, age and radicality after primary surgery as variables, showed that elevated plasma YKL-40 was associated with a shorter survival (HR = 2.13, 95% CI: 1.40–3.25, p = 0.0004). YKL-40 in OC tissue and plasma are related to stage and histology, but only plasma YKL-40 is a prognostic biomarker in patients with OC

Computed Tomography–Planned High-Dose-Rate Brachytherapy for Treating Uterine Cervical Cancer

Energy Technology Data Exchange (ETDEWEB)

Zolciak-Siwinska, Agnieszka, E-mail: agnieszka.zolciak@wp.pl [Department of Brachytherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Gruszczynska, Ewelina; Bijok, Michal [Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Jonska-Gmyrek, Joanna [Department of Teleradiotherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Dabkowski, Mateusz [Department of Brachytherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Staniaszek, Jagna [Department of Teleradiotherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Michalski, Wojciech [Department of Clinical Trials and Biostatistics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Kowalczyk, Adam; Milanowska, Katarzyna [Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland)

2016-09-01

Purpose: To evaluate the long-term results of computed tomography (CT)–planned high-dose-rate (HDR) brachytherapy (BT) for treating cervical cancer patients. Methods and Materials: CT-planned HDR BT was performed according to the adapted Group European de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) recommendations in 216 consecutive patients with locally advanced cervical cancer, International Federation of Gynecology and Obstetrics (FIGO) stage IB to IVA, who were treated with conformal external beam radiation therapy and concomitant chemotherapy. We analyzed outcomes and late side effects evaluated according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Subjective, Objective, Management, Analysis evaluation scoring system and compared them with the results from a historical group. Results: The median age was 56 years (range, 32-83 years). The median follow-up time for living patients was 52 months (range 37-63 months). The 5-year cumulative incidence function for the local recurrence rate for patients with FIGO II and III was 5.5% and 20%, respectively (P=.001). The 5-year rates of overall survival (OS) and disease-free survival (DFS) were 66.4% and 58.5%, respectively. The relative risk of failure for OS and DFS for FIGO III in relation to FIGO II was 2.24 (P=.003) and 2.6 (P=.000) and for lymph node enlargement was 2.3 (P=.002) and 2 (P=.006), respectively. In 2 patients, rectovaginal fistula occurred, and in 1 patient, vesicovaginal fistula occurred without local progression. Comparison of late adverse effects in patients treated according to the GEC-ESTRO recommendations and in the historical group revealed a reduction in fistula formation of 59% and also a reduction in rectal grade 3 to 4 late toxicity of >59%. Conclusions: This is the largest report with mature data of CT-planned BT HDR for the treatment of cervical cancer with good local control and

Two case reports: Carcinoma of the cervix and carcinoma of the endometrium treated with radiotherapy after previous irradiation for benign uterine bleeding

Energy Technology Data Exchange (ETDEWEB)

MacLeod, C. [Royal Prince Alfred Hospital, Camperdown, NSW (Australia). Department of Radiation Oncology

1998-08-01

In the 1940s, 1950s and 1960s, low doses of radiotherapy were used to treat benign uterine bleeding. The cases of two women who received this form of therapy and later developed gynaecological malignancies and had high-dose pelvic radiotherapy are presented. A 76-year-old woman with an International Federation of Gynecology and Obstetrics (FIGO) stage-II B squamous cell carcinoma of the cervix received external beam radiotherapy and intra-uterine brachytherapy and a 77-year-old woman with a FIGO stage-I B endometrial adenocarcinoma received adjuvant postoperative pelvic radiotherapy. Both women had a significant past history of low-dose-rate intra-uterine irradiation for dysfunctional uterine bleeding. Therefore the theoretical question of carcinogenesis was raised, and also the practical questions of what dose had previously been given and what further dose could be safely given with regard to normal tissue tolerance. Copyright (1998) Blackwell Science Pty Ltd 20 refs.

Two case reports: Carcinoma of the cervix and carcinoma of the endometrium treated with radiotherapy after previous irradiation for benign uterine bleeding

International Nuclear Information System (INIS)

MacLeod, C.

1998-01-01

In the 1940s, 1950s and 1960s, low doses of radiotherapy were used to treat benign uterine bleeding. The cases of two women who received this form of therapy and later developed gynaecological malignancies and had high-dose pelvic radiotherapy are presented. A 76-year-old woman with an International Federation of Gynecology and Obstetrics (FIGO) stage-II B squamous cell carcinoma of the cervix received external beam radiotherapy and intra-uterine brachytherapy and a 77-year-old woman with a FIGO stage-I B endometrial adenocarcinoma received adjuvant postoperative pelvic radiotherapy. Both women had a significant past history of low-dose-rate intra-uterine irradiation for dysfunctional uterine bleeding. Therefore the theoretical question of carcinogenesis was raised, and also the practical questions of what dose had previously been given and what further dose could be safely given with regard to normal tissue tolerance. Copyright (1998) Blackwell Science Pty Ltd

Optimization of a Two Stage Pulse Tube Refrigerator for the Integrated Current Lead System

Science.gov (United States)

Maekawa, R.; Matsubara, Y.; Okada, A.; Takami, S.; Konno, M.; Tomioka, A.; Imayoshi, T.; Hayashi, H.; Mito, T.

2008-03-01

Implementation of a conventional current lead with a pulse tube refrigerator has been validated to be working as an Integrated Current Lead (ICL) system for the Superconducting Magnetic Energy Storage (SMES). Realization of the system is primarily accounted for the flexibility of a pulse tube refrigerator, which does not posses any mechanical piston and/or displacer. As for an ultimate version of the ICL system, a High Temperature Superconducting (HTS) lead links a superconducting coil with a conventional copper lead. To ensure the minimization of heat loads to the superconducting coil, a pulse tube refrigerator has been upgraded to have a second cooling stage. This arrangement reduces not only the heat loads to the superconducting coil but also the operating cost for a SMES system. A prototype two-stage pulse tube refrigerator, series connected arrangement, was designed and fabricated to satisfy the requirements for the ICL system. Operation of the first stage refrigerator is a four-valve mode, while the second stage utilizes a double inlet configuration to ensure its confined geometry. The paper discusses the optimization of second stage cooling to validate the conceptual design

Multi-stage fuzzy PID power system automatic generation controller in deregulated environments

International Nuclear Information System (INIS)

Shayeghi, H.; Shayanfar, H.A.; Jalili, A.

2006-01-01

In this paper, a multi-stage fuzzy proportional integral derivative (PID) type controller is proposed to solve the automatic generation control (AGC) problem in a deregulated power system that operates under deregulation based on the bilateral policy scheme. In each control area, the effects of the possible contracts are treated as a set of new input signals in a modified traditional dynamical model. The multi-stage controller uses the fuzzy switch to blend a proportional derivative (PD) fuzzy logic controller with an integral fuzzy logic input. The proposed controller operates on fuzzy values passing the consequence of a prior stage on to the next stage as fact. The salient advantage of this strategy is its high insensitivity to large load changes and disturbances in the presence of plant parameter variations and system nonlinearities. This newly developed strategy leads to a flexible controller with simple structure that is easy to implement, and therefore, it can be useful for the real world power systems. The proposed method is tested on a three area power system with different contracted scenarios under various operating conditions. The results of the proposed controller are compared with those of the classical fuzzy PID type controller and classical PID controller through some performance indices to illustrate its robust performance

Computer simulation of a staging system for a theta-pinch reactor (RTPR)

International Nuclear Information System (INIS)

Crnkovich, P.G.

1976-02-01

To reduce excessive energy requirements for the implosion heating system of a theta-pinch reactor, two staging methods, the brute force and bucking field options, were proposed. A Marshall coil and a segmented coil were also considered. Calculations involved in coding these coil designs and staging options into a PL/I subprogram are described. A marked savings in the energy required for the IH system is realized with the bucking option and others

Fill Rates of Single-Stage and Multistage Supply Systems

OpenAIRE

Matthew J. Sobel

2004-01-01

A supply system's fill rate is the fraction of demand that is met from on-hand inventory. This paper presents formulas for the fill rate of periodic review supply systems that use base-stock-level policies. The first part of the paper contains fill-rate formulas for a single-stage system and general distributions of demand. When demand is normally distributed, an exact expression uses only the standard normal distribution and density functions, and a good approximation uses only the standard ...

Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis).

Science.gov (United States)

Tekola, Fasil; Ayele, Zewdu; Mariam, Dereje Haile; Fuller, Claire; Davey, Gail

2008-10-01

To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high-podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1-week repeatability and the inter-observer agreement of the final staging system. The five-stage system is readily understood by community workers with little health training. Kappa for 1-week repeatability was 0.88 (95% CI 0.80-0.96), for agreement between health professionals was 0.71 (95% CI 0.60-0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52-0.78). This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.

Ovarian Sertoli-Leydig Cell Tumor with Elevated Inhibin B As a Cause of Secondary Amenorrhea in Adolescents with Germline DICER1 Mutation

Science.gov (United States)

2017-04-06

history was significant for a right ovarian SLCT, found at age eight years which presented with ovarian torsion. The tumor was 12 cm in size, para...was International Federation of Obstetrics and Gynecology (FIGO) stage IC due to involved peritoneal washings at the pel vie entry . The patient...patient with secondary amenorrhea involves a thorough history and physical exam to look for progression of height, weight, and Tanner staging

A two-stage stochastic programming approach for operating multi-energy systems

DEFF Research Database (Denmark)

Zeng, Qing; Fang, Jiakun; Chen, Zhe

2017-01-01

This paper provides a two-stage stochastic programming approach for joint operating multi-energy systems under uncertainty. Simulation is carried out in a test system to demonstrate the feasibility and efficiency of the proposed approach. The test energy system includes a gas subsystem with a gas...

PATIENTS WITH SQUAMOUS-CELL VERSUS ADENO(SQUAMOUS) CARCINOMA OF THE CERVIX, WHAT FACTORS DETERMINE THE PROGNOSIS

NARCIS (Netherlands)

TINGA, DJ; BOUMA, J; AALDERS, JG

1992-01-01

Patients with squamous cell carcinoma of the cervix FIGO stages IB to IV (n = 306) were compared to patients with adeno(squamous) carcinoma (n = 70). There was no difference between the mean ages of the groups. In the patients who underwent radical surgical treatment, whether or not in combination

Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation

International Nuclear Information System (INIS)

Marconi, Daniel Grossi; Fregnani, Jose Humberto Tavares Guerreiro; Rossini, Rodrigo Ribeiro; Netto, Ana Karina Borges Junqueira; Lucchesi, Fabiano Rubião; Tsunoda, Audrey Tieko; Kamrava, Mitchell

2016-01-01

Diffusion Weighted (DW) Magnetic Resonance Imaging (MRI) has been studed in several cancers including cervical cancer. This study was designed to investigate the association of DW-MRI parameters with baseline clinical features and clinical outcomes (local regional control (LRC), disease free survival (DFS) and disease specific survival (DSS)) in cervical cancer patients treated with definitive chemoradiation. This was a retrospective study approved by an institutional review board that included 66 women with cervical cancer treated with definitive chemoradiation who underwent pre-treatment MRI at our institution between 2012 and 2013. A region of interest (ROI) was manually drawn by one of three radiologists with experience in pelvic imaging on a single axial CT slice encompassing the widest diameter of the cervical tumor while excluding areas of necrosis. The following apparent diffusion coefficient (ADC) values (×10 −3 mm 2 /s) were extracted for each ROI: Minimum - ADC min , Maximum - ADC max , Mean - ADC mean , and Standard Deviation of the ADC - ADC dev . Receiver operating characteristic (ROC) curves were built to choose the most accurate cut off value for each ADC value. Correlation between imaging metrics and baseline clinical features were evaluated using the Mann Whitney test. Confirmatory multi-variate Cox modeling was used to test associations with LRC (adjusted by gross tumor volume – GTV), DFS and DSS (both adjusted by FIGO stage). Kaplan Meyer curves were built for DFS and DSS. A p-value < 0.05 was considered significant. Women median age was 52 years (range 23–90). 67 % had FIGO stage I-II disease while 33 % had FIGO stage III-IV disease. Eighty-two percent had squamous cell cancer. Eighty-eight percent received concurrent cisplatin chemotherapy with radiation. Median EQD2 of external beam and brachytherapy was 82.2 Gy (range 74–84). Women with disease staged III-IV (FIGO) had significantly higher mean ADC max values compared with those

The experimental study of a two-stage photovoltaic thermal system based on solar trough concentration

International Nuclear Information System (INIS)

Tan, Lijun; Ji, Xu; Li, Ming; Leng, Congbin; Luo, Xi; Li, Haili

2014-01-01

Highlights: • A two-stage photovoltaic thermal system based on solar trough concentration. • Maximum cell efficiency of 5.21% with the mirror opening width of 57 cm. • With single cycle, maximum temperatures rise in the heating stage is 12.06 °C. • With 30 min multiple cycles, working medium temperature 62.8 °C, increased 28.7 °C. - Abstract: A two-stage photovoltaic thermal system based on solar trough concentration is proposed, in which the metal cavity heating stage is added on the basis of the PV/T stage, and thermal energy with higher temperature is output while electric energy is output. With the 1.8 m 2 mirror PV/T system, the characteristic parameters of the space solar cell under non-concentrating solar radiation and concentrating solar radiation are respectively tested experimentally, and the solar cell output characteristics at different opening widths of concentrating mirror of the PV/T stage under condensation are also tested experimentally. When the mirror opening width was 57 cm, the solar cell efficiency reached maximum value of 5.21%. The experimental platform of the two-stage photovoltaic thermal system was established, with a 1.8 m 2 mirror PV/T stage and a 15 m 2 mirror heating stage, or a 1.8 m 2 mirror PV/T stage and a 30 m 2 mirror heating stage. The results showed that with single cycle, the long metal cavity heating stage would bring lower thermal efficiency, but temperature rise of the working medium is higher, up to 12.06 °C with only single cycle. With 30 min closed multiple cycles, the temperature of the working medium in the water tank was 62.8 °C, with an increase of 28.7 °C, and thermal energy with higher temperature could be output

Performance assessment and transient optimization of air precooling in multi-stage solid desiccant air conditioning systems

International Nuclear Information System (INIS)

Gadalla, Mohamed; Saghafifar, Mohammad

2016-01-01

Highlights: • Studying three two-stage solid desiccant cooling systems using Maisotsenko cooler. • Proposing precooling to improve two-stage desiccant systems’ COP for humid climates. • Performing transient analysis for a two-stage solid desiccant cooler in UAE. • Optimizing daily performance of a two-stage solid desiccant cooler for UAE. - Abstract: Renewable energy is one of the most promising solutions to both energy and global warming crisis. Energy consumption can be minimized considerably by utilizing solar energy in air conditioning systems operation. One of the popular solar air conditioning technologies is desiccant air conditioning. Nonetheless, conventional desiccant air conditioning systems have a relatively low coefficient of performance (COP). In consequence, two-stage desiccant air-conditioning systems are proposed to improve desiccant air conditioning systems’ COP. Moreover, a recently commercialized cooling method named Maisotsenko cooling cycle which is capable of cooling air near to its dew point temperature is considered to be integrated within the proposed multi-stage desiccant cooling systems. In this paper, three new two-stage desiccant air conditioning systems incorporating Maisotsenko cooling cycle are proposed and investigated in details for hot and humid climates such as UAE. Furthermore, air precooling is considered to improve two stage desiccant air conditioning systems’ COP. Moreover, full transient analysis and optimization are carried out in UAE within June–October. The proposed system can minimize the required solar heating during noon time as the ambient air dry bulb temperature rises. Average COP of the system during electricity load peak hours (10:00–14:00) for all five considered and combined months is 1.77. Average rate of heat input required to operate the system and average building cooling load are determined to be 100.3 kW and 46.2 kW, respectively. Therefore, system average COP is computed to be 0.46.

A two-stage stochastic programming model for the optimal design of distributed energy systems

International Nuclear Information System (INIS)

Zhou, Zhe; Zhang, Jianyun; Liu, Pei; Li, Zheng; Georgiadis, Michael C.; Pistikopoulos, Efstratios N.

2013-01-01

Highlights: ► The optimal design of distributed energy systems under uncertainty is studied. ► A stochastic model is developed using genetic algorithm and Monte Carlo method. ► The proposed system possesses inherent robustness under uncertainty. ► The inherent robustness is due to energy storage facilities and grid connection. -- Abstract: A distributed energy system is a multi-input and multi-output energy system with substantial energy, economic and environmental benefits. The optimal design of such a complex system under energy demand and supply uncertainty poses significant challenges in terms of both modelling and corresponding solution strategies. This paper proposes a two-stage stochastic programming model for the optimal design of distributed energy systems. A two-stage decomposition based solution strategy is used to solve the optimization problem with genetic algorithm performing the search on the first stage variables and a Monte Carlo method dealing with uncertainty in the second stage. The model is applied to the planning of a distributed energy system in a hotel. Detailed computational results are presented and compared with those generated by a deterministic model. The impacts of demand and supply uncertainty on the optimal design of distributed energy systems are systematically investigated using proposed modelling framework and solution approach.

Comparison of single-stage and temperature-phased two-stage anaerobic digestion of oily food waste

International Nuclear Information System (INIS)

Wu, Li-Jie; Kobayashi, Takuro; Li, Yu-You; Xu, Kai-Qin

2015-01-01

Highlights: • A single-stage and two two-stage anaerobic systems were synchronously operated. • Similar methane production 0.44 L/g VS_a_d_d_e_d from oily food waste was achieved. • The first stage of the two-stage process became inefficient due to serious pH drop. • Recycle favored the hythan production in the two-stage digestion. • The conversion of unsaturated fatty acids was enhanced by recycle introduction. - Abstract: Anaerobic digestion is an effective technology to recover energy from oily food waste. A single-stage system and temperature-phased two-stage systems with and without recycle for anaerobic digestion of oily food waste were constructed to compare the operation performances. The synchronous operation indicated the similar ability to produce methane in the three systems, with a methane yield of 0.44 L/g VS_a_d_d_e_d. The pH drop to less than 4.0 in the first stage of two-stage system without recycle resulted in poor hydrolysis, and methane or hydrogen was not produced in this stage. Alkalinity supplement from the second stage of two-stage system with recycle improved pH in the first stage to 5.4. Consequently, 35.3% of the particulate COD in the influent was reduced in the first stage of two-stage system with recycle according to a COD mass balance, and hydrogen was produced with a percentage of 31.7%, accordingly. Similar solids and organic matter were removed in the single-stage system and two-stage system without recycle. More lipid degradation and the conversion of long-chain fatty acids were achieved in the single-stage system. Recycling was proved to be effective in promoting the conversion of unsaturated long-chain fatty acids into saturated fatty acids in the two-stage system.

Detection of sentinel lymph nodes in cervical cancer. A comparison of two protocols

International Nuclear Information System (INIS)

Kraft, O.; Sevcik, L.; Klat, J.; Koliba, P.; Curik, R.; Kriozva, H.

2006-01-01

The aim of this study was lymphatic mapping to identify SLN in cervical cancer (CaCerv) with radioactive colloids, intraoperative detection with patent blue dye (PBD) and gamma probe (GP) and biopsy and comparison of two protocols. In 54 patients with CaCerv before hysterectomy and lymph nodes dissection (LND) we performed preoperative lymphoscintigraphy utilizing 99m Tc-colloid (Nanocoll, SentiScint or Nanocis), activity 40 MBq, on the operation day (30 women) or the day before operation (24 women). Gynaecologists injected 4 peritumoral injections of colloid into the cervix around the tumour. Scintigraphy followed 25-50 minutes (one-day protocol) or 12-19 hours (two-day protocol) after injection. Gynaecologists also injected 4 peritumoral injections of PBD into the cervix around the tumour. All women underwent SLN biopsy and LND (in average 35 lymph nodes were taken) and hysterectomy. SLNs (active and/or blue lymph nodes) were examined by a pathologist [histopathology and immunohistochemistry (IH) with detection of cytokeratine]. No SLN was examined without IH. The gynaecologists withdrew 123 SLNs (on average 2.27/1 patient) and in total 1898 lymph nodes (on average 35/1 patient). In 1 woman the tumour was inoperable. Two-day protocol, which involved scintigraphy, PBD and GP detected SLNs on both sides (45 SLNs) in 17 women (70.8%), SLNs on the one side (6 SLNs) in 3 patients (12.5%) and no SLNs were found in 4 women (16.7%). One-day protocol detected SLNs on both sides in 23 patients (74.1%) - 63 SLNs, in 7 women on one side (25.9%) - 9 SLNs. Metastases in SLNs (with or without metastases in other LN) were found in 21 patients (38.9%) - in 1 woman of stage FIGO IB1, in 1 woman of stage FIGO IB2, in 1 patient of stage FIGO IIIA and in all 18 patients of stage FIGO IIIB. False negative SLN detection was 0%. In SLN detection in patients with CaCerv, all 3 methods - scintigraphy, PBD and GP - should be used, and the success rate of SLN detection increases, although

Comparative Analysis between preoperative Radiotherapy and postoperative Radiotherapy in Clinical Stage I and II Endometrial Carcinoma

International Nuclear Information System (INIS)

Keum, Ki Chang; Lee, Chang Geol; Chung, Eun Ji; Lee, Sang Wook; Kim, Woo Cheol; Chang, Sei Kyung; Oh, Young Taek; Suh, Chang Ok; Kim, Gwi Eon

1995-01-01

Purpose : To obtain the optical treatment method in patients with endometrial carcinoma(clinical stage FIGO I, II) by comparative analysis between preoperative radiotherapy(pre-op R) and postoperative radiotherapy(post-op RT). Materials and Methods : A retrospective review of 62 endometrial carcinoma patients referred to the Yonsei Cancer Center for radiotherapy between 1985 and 1991 was undertaken. Of 62 patients, 19 patients(Stage I; 12 patients, Stage II; 7 patients) received pre-op RT before TAH(Total Abdominal Hysterectomy) and BSO(Bilateral Salphingoophorectomy) (Group 1) and 43 patients( Stage 1; 32 patients, Stage 2; 11 patients) received post-op RT after TAH and BSO (Group 2). Pre-op irradiation was given 4-6 weeks prior to surgery and post-op RT was administered on 4-5 weeks following surgery. All patients exept 1 patient(Group2; ICR alone) received external irradiation. Seventy percent(13/19) of pre-op RT group and 54 percent(23/42) of post-op RT group received external pelvic irradiation and intracavitary radiation therapy(ICR). External radiation dose was 39.6-55Gy(median 45Gy) in 5-6 week through opposed AP/PA fields or 4-field box technique treating daily, five days per week, 180cGy per fraction. ICR doses were prescribed to point A(20-39.6 Gy, median 39Gy) in Group 1 and 0.5cm depth from vaginal surface (18-30 Gy, median 21Gy) in Group2. Results : The overall 5 year survival rate was 95%. No survival difference between pre-op and post-op RT group.(89.3% vs 97.7%, p>0.1) There was no survival difference by stage, grade and histology between two groups. The survival rate was not affected by presence of residual tumor of surgical specimen after pre-op RT in Group 1(p>0.1), but affected by presence of lymph node metastasis in post-op RT group(p<0.5). The complication rate of pre-op RT group was higher than post-op RT.(16% vs 5%) Conclusion : Post-op radiotherapy offers the advantages of accurate surgical-pathological staging and low complication rate

A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study

DEFF Research Database (Denmark)

Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten Lindberg; Høgdall, Estrid Vilma Solyom

2016-01-01

The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood...... samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor...... removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0...

A Two-stage DC-DC Converter for the Fuel Cell-Supercapacitor Hybrid System

DEFF Research Database (Denmark)

Zhang, Zhe; Thomsen, Ole Cornelius; Andersen, Michael A. E.

2009-01-01

A wide input range multi-stage converter is proposed with the fuel cells and supercapacitors as a hybrid system. The front-end two-phase boost converter is used to optimize the output power and to reduce the current ripple of fuel cells. The supercapacitor power module is connected by push...... and designed. A 1kW prototype controlled by TMS320F2808 DSP is built in the lab. Simulation and experimental results confirm the feasibility of the proposed two stage dc-dc converter system.......-pull-forward half bridge (PPFHB) converter with coupled inductors in the second stage to handle the slow transient response of the fuel cells and realize the bidirectional power flow control. Moreover, this cascaded structure simplifies the power management. The control strategy for the whole system is analyzed...

Two-stage energy storage equalization system for lithium-ion battery pack

Science.gov (United States)

Chen, W.; Yang, Z. X.; Dong, G. Q.; Li, Y. B.; He, Q. Y.

2017-11-01

How to raise the efficiency of energy storage and maximize storage capacity is a core problem in current energy storage management. For that, two-stage energy storage equalization system which contains two-stage equalization topology and control strategy based on a symmetric multi-winding transformer and DC-DC (direct current-direct current) converter is proposed with bidirectional active equalization theory, in order to realize the objectives of consistent lithium-ion battery packs voltages and cells voltages inside packs by using a method of the Range. Modeling analysis demonstrates that the voltage dispersion of lithium-ion battery packs and cells inside packs can be kept within 2 percent during charging and discharging. Equalization time was 0.5 ms, which shortened equalization time of 33.3 percent compared with DC-DC converter. Therefore, the proposed two-stage lithium-ion battery equalization system can achieve maximum storage capacity between lithium-ion battery packs and cells inside packs, meanwhile efficiency of energy storage is significantly improved.

Target tracking system based on preliminary and precise two-stage compound cameras

Science.gov (United States)

Shen, Yiyan; Hu, Ruolan; She, Jun; Luo, Yiming; Zhou, Jie

2018-02-01

Early detection of goals and high-precision of target tracking is two important performance indicators which need to be balanced in actual target search tracking system. This paper proposed a target tracking system with preliminary and precise two - stage compound. This system using a large field of view to achieve the target search. After the target was searched and confirmed, switch into a small field of view for two field of view target tracking. In this system, an appropriate filed switching strategy is the key to achieve tracking. At the same time, two groups PID parameters are add into the system to reduce tracking error. This combination way with preliminary and precise two-stage compound can extend the scope of the target and improve the target tracking accuracy and this method has practical value.

Coupling effect and control strategies of the maglev dual-stage inertially stabilization system based on frequency-domain analysis.

Science.gov (United States)

Lin, Zhuchong; Liu, Kun; Zhang, Li; Zeng, Delin

2016-09-01

Maglev dual-stage inertially stabilization (MDIS) system is a newly proposed system which combines a conventional two-axis gimbal assembly and a 5-DOF (degree of freedom) magnetic bearing with vernier tilting capacity to perform dual-stage stabilization for the LOS of the suspended optical instrument. Compared with traditional dual-stage system, maglev dual-stage system exhibits different characteristics due to the negative position stiffness of the magnetic forces, which introduces additional coupling in the dual stage control system. In this paper, the coupling effect on the system performance is addressed based on frequency-domain analysis, including disturbance rejection, fine stage saturation and coarse stage structural resonance suppression. The difference between various control strategies is also discussed, including pile-up(PU), stabilize-follow (SF) and stabilize-compensate (SC). A number of principles for the design of a maglev dual stage system are proposed. A general process is also suggested, which leads to a cost-effective design striking a balance between high performance and complexity. At last, a simulation example is presented to illustrate the arguments in the paper. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

Production system and harvesting stage influence on nitrate content and quality of butterhead lettuce

Directory of Open Access Journals (Sweden)

Siti Fairuz Yosoff

2015-01-01

Full Text Available Leafy vegetables such as lettuce grown under different production systems may accumulate different concentrations of nitrate which may reach to the levels potentially toxic to humans. Moreover, nitrate accumulation varies in various plant parts and physiological age of the plant. Therefore, to determine the effect of production system and harvesting stage on nitrate accumulation and quality of butterhead lettuce, a study was conducted considering two lettuce production systems namely hydroponic and organic, and four different harvesting stages such as 35, 38, 41 and 44 days after transplanting (DAT. The experimental design was complete randomized design (CRD with four replications. Hydroponic and organic systems performed similar in terms of yield, quality and nitrate content of butterhead lettuce. Delaying harvesting can not only increase yield but also can minimize nitrate accumulation and health hazard risk as well. Delay in harvesting stage may result in quality deterioration of lettuce and increased production cost. Thus, a compromise is necessary to consider 41 DAT as the optimum stage to harvest butterhead lettuce with significantly higher reduction of nitrate content in both outer adult leaf blades and young leaves of hydroponic lettuce. Fresh weight, firmness and color of butterhead lettuce at this stage were still acceptable.

Seventh edition (2010) of the AJCC/UICC staging system for gastric adenocarcinoma: is there room for improvement?

Science.gov (United States)

Patel, Manali I; Rhoads, Kim F; Ma, Yifei; Ford, James M; Visser, Brendan C; Kunz, Pamela L; Fisher, George A; Chang, Daniel T; Koong, Albert; Norton, Jeffrey A; Poultsides, George A

2013-05-01

The gastric cancer AJCC/UICC staging system recently underwent significant revisions, but studies on Asian patients have reported a lack of adequate discrimination between various consecutive stages. We sought to validate the new system on a U.S. population database. California Cancer Registry data linked to the Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (esophagogastric junction and gastric cardia tumors excluded) who underwent curative-intent surgical resection in California from 2002 to 2006. AJCC/UICC stage was recalculated based on the latest seventh edition. Overall survival probabilities were calculated using the Kaplan-Meier method. Of 1905 patients analyzed, 54 % were males with a median age of 70 years. Median number of pathologically examined lymph nodes was 12 (range, 1-90); 40 % of patients received adjuvant chemotherapy, and 31 % received adjuvant radiotherapy. The seventh edition AJCC/UICC system did not distinguish outcome adequately between stages IB and IIA (P = 0.40), or IIB and IIIA (P = 0.34). By merging stage II into 1 category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system with improved discriminatory ability In this first study validating the new seventh edition AJCC/UICC staging system for gastric cancer on a U.S. population with a relatively limited number of lymph nodes examined, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC/UICC staging system that better discriminates between outcomes.

Proposal for a new staging system for osteoradionecrosis of the mandible

NARCIS (Netherlands)

Karagozoglu, K.H.; Dekker, H.A.; Rietveld, D.; de Bree, R.; Schulten, E.A.J.M.; Kantola, S.; Forouzanfar, T.; van der Waal, I.

2014-01-01

A new staging system for osteoradionecrosis of the mandible has been retrospectively applied to a group of 31 patients. In this system clinicoradiographic signs and symptoms are incorporated in a simplified manner. For imaging purposes the use of plain radiographs such as periapical films and

Embryonic staging using a 3D virtual reality system

NARCIS (Netherlands)

C.M. Verwoerd-Dikkeboom (Christine); A.H.J. Koning (Anton); P.J. van der Spek (Peter); N. Exalto (Niek); R.P.M. Steegers-Theunissen (Régine)

2008-01-01

textabstractBACKGROUND: The aim of this study was to demonstrate that Carnegie Stages could be assigned to embryos visualized with a 3D virtual reality system. METHODS: We analysed 48 3D ultrasound scans of 19 IVF/ICSI pregnancies at 7-10 weeks' gestation. These datasets were visualized as 3D

Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

Science.gov (United States)

Bril, Aleksander; Kalinina, Olga; Levina, Anastasia

2018-03-01

The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

Two-stage commercial evaluation of engineering systems production projects for high-rise buildings

Directory of Open Access Journals (Sweden)

Bril Aleksander

2018-01-01

Full Text Available The paper is devoted to the current and debatable problem of methodology of choosing the effective innovative enterprises for venture financing. A two-stage system of commercial innovation evaluation based on the UNIDO methodology is proposed. Engineering systems account for 25 to 40% of the cost of high-rise residential buildings. This proportion increases with the use of new construction technologies. Analysis of the construction market in Russia showed that the production of internal engineering systems elements based on innovative technologies has a growth trend. The production of simple elements is organized in small enterprises on the basis of new technologies. The most attractive for development is the use of venture financing of small innovative business. To improve the efficiency of these operations, the paper proposes a methodology for a two-stage evaluation of small business development projects. A two-stage system of commercial evaluation of innovative projects allows creating an information base for informed and coordinated decision-making on venture financing of enterprises that produce engineering systems elements for the construction business.

Validation of the Mayo Clinic Staging System in Determining Prognoses of Patients With Perihilar Cholangiocarcinoma

NARCIS (Netherlands)

Coelen, Robert J. S.; Gaspersz, Marcia P.; Labeur, Tim A.; van Vugt, Jeroen L. A.; van Dieren, Susan; Willemssen, François E. J. A.; Nio, Chung Y.; Ijzermans, Jan N. M.; Klümpen, Heinz-Josef; Groot Koerkamp, Bas; van Gulik, Thomas M.

2017-01-01

BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We

Development and applications of a two-dimensional tip-tilting stage system with nanoradian-level positioning resolution

Energy Technology Data Exchange (ETDEWEB)

Shu Deming, E-mail: shu@aps.anl.gov [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States); Lee, Wah-Keat; Liu, Wenjun [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States); Ice, Gene E. [MST Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831-6132 (United States); Shvyd' ko, Yuri; Kim, Kwang-Je [Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439 (United States)

2011-09-01

In this paper, designs of a novel rotary weak-link stage for a vertical rotation axis and a two-dimensional tip-tilting system are presented. Applications of these new stage systems include: an advanced X-ray stereo imaging instrument for particle tracking velocimetry, an alignment stage system for hard X-ray nano-focusing Montel mirror optics, and an ultra-precision crystal manipulator for cryo-cooling optical cavities of an X-ray free-electron-laser oscillator (XFELO).

Application of two-stage biofilter system for the removal of odorous compounds.

Science.gov (United States)

Jeong, Gwi-Taek; Park, Don-Hee; Lee, Gwang-Yeon; Cha, Jin-Myeong

2006-01-01

Biofiltration is a biological process which is considered to be one of the more successful examples of biotechnological applications to environmental engineering, and is most commonly used in the removal of odoriferous compounds. In this study, we have attempted to assess the efficiency with which both single and complex odoriferous compounds could be removed, using one- or two-stage biofiltration systems. The tested single odor gases, limonene, alpha-pinene, and iso-butyl alcohol, were separately evaluated in the biofilters. Both limonene and alpha-pinene were removed by 90% or more EC (elimination capacity), 364 g/m3/h and 321 g/m3/h, respectively, at an input concentration of 50 ppm and a retention time of 30 s. The iso-butyl alcohol was maintained with an effective removal yield of more than 90% (EC 375 g/m3/h) at an input concentration of 100 ppm. The complex gas removal scheme was applied with a 200 ppm inlet concentration of ethanol, 70 ppm of acetaldehyde, and 70 ppm of toluene with residence time of 45 s in a one- or two-stage biofiltration system. The removal yield of toluene was determined to be lower than that of the other gases in the one-stage biofilter. Otherwise, the complex gases were sufficiently eliminated by the two-stage biofiltration system.

{sup 18}F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer

Energy Technology Data Exchange (ETDEWEB)

Ulaner, Gary A.; Castillo, Raychel; Riedl, Christopher C.; Jochelson, Maxine S. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Weill Cornell Medical College, Department of Radiology, New York, NY (United States); Goldman, Debra A.; Goenen, Mithat [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Wills, Jonathan [Memorial Sloan Kettering Cancer Center, Department of Information Systems, New York, NY (United States); Pinker-Domenig, Katja [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States)

2016-10-15

National Comprehensive Cancer Network guidelines recommend {sup 18}F-FDG-PET/CT, in addition to standard staging procedures, for systemic staging of newly diagnosed stage III breast cancer patients. However, factors in addition to stage may influence PET/CT utility. As breast cancers that are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor (triple-negative breast cancer, or TNBC) are more aggressive and metastasize earlier than other breast cancers, we hypothesized that receptor expression may be one such factor. This study assesses {sup 18}F-FDG-PET/CT for systemic staging of newly diagnosed TNBC. In this Institutional Review Board-approved retrospective study, our Healthcare Information System was screened for patients with TNBC who underwent {sup 18}F-FDG-PET/CT in 2007-2013 prior to systemic or radiation therapy. Initial stage was determined from mammography, ultrasound, magnetic resonance imaging, and/or surgery, if performed prior to {sup 18}F-FDG-PET/CT. {sup 18}F-FDG-PET/CT was evaluated to identify unsuspected extra-axillary regional nodal and distant metastases, as well as unsuspected synchronous malignancies. Kaplan Meier survival estimates were calculated for initial stage IIB patients stratified by whether or not stage 4 disease was detected by {sup 18}F-FDG-PET/CT. A total of 232 patients with TNBC met inclusion criteria. {sup 18}F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13 %): 0/23 initial stage I, 4/82 (5 %) stage IIA, 13/87 (15 %) stage IIB, 4/23 (17 %) stage IIIA, 8/14 (57 %) stage IIIB, and 1/3 (33 %) stage IIIC. Twenty-six of 30 patients upstaged to IV by {sup 18}F-FDG-PET/CT were confirmed by pathology, with the remaining four patients confirmed by follow-up imaging. In addition, seven unsuspected synchronous malignancies were identified in six patients. Initial stage 2B patients who were upstaged to 4 by {sup 18}F-FDG-PET/CT had significantly shorter survival compared to

Method and system for dual resolution translation stage

Science.gov (United States)

Halpin, John Michael

2014-04-22

A dual resolution translation stage includes a stage assembly operable to receive an optical element and a low resolution adjustment device mechanically coupled to the stage assembly. The dual resolution stage also includes an adjustable pivot block mechanically coupled to the stage assembly. The adjustable pivot block includes a pivot shaft. The dual resolution stage further includes a lever arm mechanically coupled to the adjustable pivot block. The lever arm is operable to pivot about the pivot shaft. The dual resolution stage additionally includes a high resolution adjustment device mechanically coupled to the lever arm and the stage assembly.

Performance study of a heat pump driven and hollow fiber membrane-based two-stage liquid desiccant air dehumidification system

International Nuclear Information System (INIS)

Zhang, Ning; Yin, Shao-You; Zhang, Li-Zhi

2016-01-01

Graphical abstract: A heat pump driven, hollow fiber membrane-based two-stage liquid desiccant air dehumidification system. - Highlights: • A two-stage hollow fiber membrane based air dehumidification is proposed. • It is heat pump driven liquid desiccant system. • Performance is improved 20% upon single stage system. • The optimal first to second stage dehumidification area ratio is 1.4. - Abstract: A novel compression heat pump driven and hollow fiber membrane-based two-stage liquid desiccant air dehumidification system is presented. The liquid desiccant droplets are prevented from crossing over into the process air by the semi-permeable membranes. The isoenthalpic processes are changed to quasi-isothermal processes by the two-stage dehumidification processes. The system is set up and a model is proposed for simulation. Heat and mass capacities in the system, including the membrane modules, the condenser, the evaporator and the heat exchangers are modeled in detail. The model is also validated experimentally. Compared with a single-stage dehumidification system, the two-stage system has a lower solution concentration exiting from the dehumidifier and a lower condensing temperature. Thus, a better thermodynamic system performance is realized and the COP can be increased by about 20% under the typical hot and humid conditions in Southern China. The allocations of heat and mass transfer areas in the system are also investigated. It is found that the optimal regeneration to dehumidification area ratio is 1.33. The optimal first to second stage dehumidification area ratio is 1.4; and the optimal first to second stage regeneration area ratio is 1.286.

Nitrogen removal and microbial communities in a three-stage system simulating a riparian environment.

Science.gov (United States)

Wang, Ziyuan; Wang, Zhixin; Pei, Yuansheng

2014-06-01

The riparian zone is an active interface for nitrogen removal, in which nitrogen transformations by microorganisms have not been valued. In this study, a three-stage system was constructed to simulate the riparian zone environments, and nitrogen removal as well as the microbial community was investigated in this 'engineered riparian system'. The results demonstrated that stage 1 of this system accounted for 41-51 % of total nitrogen removal. Initial ammonium loading and redox potential significantly impacted the nitrogen removal performances. Stages 1 and 2 were both composed of an anoxic/oxic (A/O) zone and an anaerobic column. The A/O zone removed most of the ammonium load (6.8 g/m(2)/day), while the anaerobic column showed a significant nitrate removal rate (11.1 g/m(2)/day). Molecular biological analysis demonstrated that bacterial diversity was high in the A/O zones, where ammonium-oxidizing bacteria and nitrite-oxidizing bacteria accounted for 8.42 and 3.32 % of the bacterial population, respectively. The denitrifying bacteria Acidovorax sp. and the nitrifying bacteria Nitrosospira/Nitrosomonas were the predominant microorganisms in this engineered riparian system. This three-stage system was established to achieve favorable nitrogen removal and the microbial community in the system was also retained. This investigation should deepen our understanding of biological nitrogen removal in engineered riparian zones.

STAGES : a system for generating strategic alternatives for forest management

NARCIS (Netherlands)

Bos, J.

1994-01-01

Strategic planning is important in forest management. However, it has never been described clearly in literature. In this study a framework for strategic planning was developed and based on this a STrategic Alternatives Generating System (STAGES) to support decision making in strategic

Gynecological brachytherapy - from low-dose-rate to high-tech. Gynaekologische Brachytherapie - von Low-dose-rate zu High-tech

Energy Technology Data Exchange (ETDEWEB)

Herrmann, T. (Abt. Strahlenthgerapie, Klinik und Poliklinik fuer Radiologie, Medizinische Akademie ' Carl Gustav Carus' , Dresden (Germany)); Christen, N. (Abt. Strahlenthgerapie, Klinik und Poliklinik fuer Radiologie, Medizinische Akademie ' Carl Gustav Carus' , Dresden (Germany)); Alheit, H.D. (Abt. Strahlenthgerapie, Klinik und Poliklinik fuer Radiologie, Medizinische Akademie ' Carl Gustav Carus' , Dresden (Germany))

1993-03-01

The transition from low-dose-rate (LDR) brachytherapy to high-dose-rate (HDR) afterloading treatment is in progress in most centres of radiation therapy. First reports of studies comparing HDR and LDR treatment in cervix cancer demonstrate nearly equal local control. In our own investigations on 319 patients with primary irradiated carcinoma of the cervix (125 HDR/194 LDR) we found the following control rates: Stage FIGO I 95.4%/82.9% (HDR versus LDR), stage FIGO II 71.4%/73.7%, stage FIGO III 57.9%/38.5%. The results are not significant. The side effects - scored after EORT/RTOG criteria - showed no significant differences between both therapies for serious radiogenic late effects on intestine, bladder and vagina. The study and findings from the literature confirm the advantage of the HDR-procedure for patient and radiooncologist and for radiation protection showing at least the same results as in the LDR-area. As for radiobiolgical point of view it is important to consider that the use of fractionation in the HDR-treatment is essential for the sparing of normal tissues and therefore a greater number of small fractionation doses in the brachytherapy should be desirable too. On the other hand the rules, which are true for fractionated percutaneous irradiation therapy (overall treatment time as short as possible to avoid reppopulation of tumor cells) should be taken into consideration in combined brachy-teletherapy regime in gynecologic tumors. The first step in this direction may be accelerated regime with a daily application of both treatment procedures. The central blocking of the brachytherapy region from the whole percutaneous treatment target volume should be critically reflected, especially in the case of advanced tumors. (orig.)

Prognostic value of lymph node-to-primary tumor standardized uptake value ratio in endometrioid endometrial carcinoma

Energy Technology Data Exchange (ETDEWEB)

Chung, Hyun Hoon; Kim, Jae-Weon; Park, Noh-Hyun; Song, Yong Sang [Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul (Korea, Republic of); Cheon, Gi Jeong [Seoul National University College of Medicine, Department of Nuclear Medicine, Cancer Research Institute, Seoul (Korea, Republic of)

2018-01-15

To determine whether the relative metabolic activity of pelvic or para-aortic LN compared with that of primary tumor measured by preoperative [{sup 18}F]FDG PET/CT scan has prognostic value in patients with endometrioid endometrial carcinoma. We retrospectively reviewed patients with endometrioid endometrial carcinoma who underwent preoperative [{sup 18}F]FDG PET/CT scans. Prognostic values of PET/CT-derived metabolic variables such as maximum standardized uptake value (SUV) of the primary endometrial carcinoma (SUV{sub Tumor}) and LN (SUV{sub LN}), and the LN-to-endometrial carcinoma SUV ratio (SUV{sub LN} / SUV{sub Tumor}) were assessed. Clinico-pathological data, imaging data, and treatment results were reviewed for 107 eligible patients. Median post-surgical follow-up was 23 months (range, 6-60), and 7 (6.5%) patients experienced recurrence. Regression analysis showed that SUV{sub LN} / SUV{sub Tumor} (P < 0.001), SUV{sub LN} (P = 0.003), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.006), and tumor grade (P = 0.011) were risk factors of recurrence. Multivariate regression analysis revealed that FIGO stage (P = 0.034) was the independent risk factor of recurrence. SUV{sub LN} / SUV{sub Tumor} showed significant correlation with FIGO stage (P < 0.001), LN metastasis (P < 0.001), lymphovascular space invasion (P < 0.001), recurrence (P = 0.001), tumor grade (P < 0.001), and deep myometrial invasion of tumor (P = 0.022). Patient groups categorized by SUV{sub LN} / SUV{sub Tumor} showed significant difference in progression-free survival (Log-rank test, P = 0.001). Preoperative SUV{sub LN} / SUV{sub Tumor} measured by [{sup 18}F]FDG PET/CT was significantly associated with recurrence, and may become a novel prognostic factor in patients with endometrioid endometrial carcinoma. (orig.)

Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania

Directory of Open Access Journals (Sweden)

Mfinanga Godfrey S

2009-04-01

Full Text Available Abstract Background Hemorrhage is the leading cause of obstetric mortality. Studies show that Active Management of Third Stage of Labor (AMTSL reduces Post Partum Hemorrhage (PPH. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Methods A nationally-representative sample of 251 facility-based vaginal deliveries was observed for the AMTSL practice. Standard Treatment Guidelines (STG, the Essential Drug List and medical and midwifery school curricula were reviewed. Drug availability and storage conditions were reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities. Interviews were conducted with hospital directors, pharmacists and 106 health care providers in 29 hospitals visited. Data were collected between November 10 and December 15, 2005. Results Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of 251 deliveries. When the definition of AMTSL was relaxed to allow administration of the uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to 17%. The most significant factor contributing to the low rate of AMTSL use was provision of the uterotonic drug after delivery of the placenta. The study also observed potentially-harmful practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct statements regarding the all three components of AMTSL. The national formulary recommends ergometrine (0.5 mg/IM or oxytocin (5 IU/IM on delivery of the anterior shoulder or immediately after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies. Uterotonic drugs were stored at room temperature in 28% of the facilities. Conclusion The knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used

Prawidłowa ciąża u pacjentki po operacji oszczędzającej płodność z powodu raka jajnika w stopniu IC i guza o granicznej złośliwości po stronie przeciwnej

OpenAIRE

Miłosz Wilczyński; Marian Szpakowski; Joanna Lutosławska; Stanisław Łukaszek; Marek Kucharski; Jacek R. Wilczyński2,6

2010-01-01

Serous ovarian cancer prevalence increases with age, and the highest morbidity is reached in women intheir seventies. However, this neoplasm is also diagnosed in women in reproductive age.Fertility sparing surgery is performed in women affected by early stage and low-grade ovarian cancer (IA accordingto FIGO). The patients’ desire to have children forces surgeons to attempt conservative surgery in moreadvanced stages of ovarian cancer. We present a case of a 19-year-old patient who underwent ...

Role of Surgical Versus Clinical Staging in Chemoradiated FIGO Stage IIB-IVA Cervical Cancer Patients—Acute Toxicity and Treatment Quality of the Uterus-11 Multicenter Phase III Intergroup Trial of the German Radiation Oncology Group and the Gynecologic Cancer Group

Energy Technology Data Exchange (ETDEWEB)

Marnitz, Simone, E-mail: simone.marnitz-schulze@uk-koeln.de [Department of Radiation Oncology, University of Cologne Medical Faculty, Cologne (Germany); Martus, Peter [Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-Universität Tübingen, Tübingen (Germany); Köhler, Christhardt [Department of Advanced Operative and Oncologic Gynecology, Asklepios Clinics, Hamburg (Germany); Stromberger, Carmen [Department of Radiation Oncology, University of Cologne Medical Faculty, Cologne (Germany); Asse, Elke [Department of Radiation Oncology, University Hospital Greifswald, Greifswald (Germany); Mallmann, Peter [Department of Gynecology and Obstetrics, University Hospital Cologne, Cologne (Germany); Schmidberger, Heinz [Department of Radiation Oncology, University of Mainz, Mainz (Germany); Affonso Júnior, Renato José [Department of Radiation Oncology, Hospital de Cãncer de Barretos, Barretos (Brazil); Nunes, João Soares [Department of Clinical Oncology, Hospital de Cãncer de Barretos, Barretos (Brazil); Sehouli, Jalid [Department of Gynecology, Charité–Universitätsmedizin Berlin, Berlin (Germany); Budach, Volker [Department of Radiation Oncology, University of Cologne Medical Faculty, Cologne (Germany)

2016-02-01

Purpose: The Uterus-11 trial was designed to evaluate the role of surgical staging in patients with cervical cancer before primary chemoradiation therapy (CRT). The present report provides the toxicity data stratified by the treatment arm and technique. Methods and Materials: A total of 255 patients with carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics stage IIB-IVA) were randomized to either surgical staging followed by CRT (arm A) or clinical staging followed by CRT (arm B). Patients with para-aortic metastases underwent extended field radiation therapy (RT). Brachytherapy was mandatory. The present report presents the acute therapy-related toxicities stratified by treatment arm and radiation technique. Results: A total of 240 patients were eligible (n=121 in arm A; n=119 in arm B). Of the 240 patients, 236 (98.3%) underwent external beam RT with a median total dose of 50.4 Gy. The mean treatment duration was 53 days. Of the patients, 60% underwent intensity modulated RT (IMRT). A total of 234 patients (97.5%) underwent chemotherapy, and 231 (96.3%) underwent brachytherapy, with a median single dose of 6 Gy covering the tumor to a median nominal total dose of 28 Gy. Treatment was well tolerated, with 0% grade ≥3 genitourinary and gastrointestinal toxicity, 6% grade 3 nausea, 3% grade 3 vomiting, and <2% grade 3 diarrhea. More patients after surgical staging experienced grade 2 anemia (54.3% in arm A vs 45.3% in arm B; P=.074) and grade 2 leukocytopenia (41.4% vs 31.6%; P=.56). Of the patients who received IMRT versus a 3-dimensional technique, 65.3% versus 33.7% presented with grade 2 anemia. Grade 3 gastrointestinal and grade 2 bladder toxicity were significantly reduced with the use of IMRT. Conclusions: The incidence and severity of acute therapy-related toxicity compared favorably with those from other randomized trials. Excellent adherence to treatment and treatment quality was achieved compared with patterns of

Scout fourth stage attitude and velocity control (AVC) system feasibility study

Science.gov (United States)

Byars, L. B.

1975-01-01

The feasibility of incorporating a guidance system in the Scout fourth stage to achieve a significant improvement in expected payload delivery accuracy is studied. The technical investigations included the determination of the AVC equipment performance requirements, establishment of qualification and acceptance test levels, generation of layouts illustrating design approaches for the upper D and payload transition sections to incorporate the hardware, and the preparation of a vendor bid package. Correction concepts, utilizing inertial velocity and attitude, were identified and evaluated. Fourth stage attitude adjustments as determined from inertial velocity variation through the first three stages and a final velocity correction based upon the measured in-plane component errors at injection were employed. Results show radical reductions in apogee-perigee deviations.

Pre-defined and optional staging for the deployment of enterprise systems: a case study and a framework

Science.gov (United States)

Lichtenstein, Yossi; Cucuy, Shy; Fink, Lior

2017-03-01

The effective deployment of enterprise systems has been a major challenge for many organisations. Customising the new system, changing business processes, and integrating multiple information sources are all difficult tasks. As such, they are typically done in carefully planned stages in a process known as phased implementation. Using ideas from Option Theory, this article critiques aspects of phased implementation. One customer relationship management (CRM) project and its phased implementation are described in detail and ten other enterprise system deployments are summarised as a basis for the observation that almost all deployment stages are pre-defined operational steps rather than decision points. However, Option Theory suggests that optional stages, to be used only when risk materialises, should be integral parts of project plans. Although such optional stages are often more valuable than pre-defined stages, the evidence presented in this article shows that they are only rarely utilised. Therefore, a simple framework is presented; it first identifies risks related to the deployment of enterprise systems, then identifies optional stages that can mitigate these risks, and finally compares the costs and benefits of both pre-defined and optional stages.

Evolution of International Space Station GN&C System Across ISS Assembly Stages

Science.gov (United States)

Lee, Roscoe; Frank, K. D. (Technical Monitor)

1999-01-01

The Guidance Navigation and Control (GN&C) system for the International Space Station is initially implemented by the Functional Cargo Block (FGB) which was built by the Khrunichev Space Center under direct contract to Boeing. This element (Stage 1A/R) was launched on 20 November 1998 and is currently operating on-orbit. The components and capabilities of the FGB Motion Control System (MCS) are described. The next ISS element, which has GN&C functionality will be the Service Module (SM) built by Rocket Space Corporation-Energia. This module is scheduled for launch (Stage 1R) in early 2000. Following activation of the SM GN&C system, the FGB MCS is deactivated and no longer used. The components and capabilities of the SM GN&C system are described. When a Progress vehicle is attached to the ISS it can be used for reboost operations, based on commands provided by the Mission Control Center-Moscow. When a data connection is implemented between the SM and the Progress, the SM can command the Progress thrusters for attitude control and reboosts. On Stage 5A, the U.S. GN&C system will become activated when the U.S. Laboratory is de loyed and installed (launch schedule is currently TBD). The U.S. GN&C system provides non-propulsive control capabilities to support micro-gravity operations and minimize the use of propellant for attitude control, and an independent capability for determining the ISS state vector, attitude, attitude rate. and time.. The components and capabilities of the U.S. GN&C system are described and the interactions between the U.S. and Russian Segment GN&C systems are also described.

System-level Reliability Assessment of Power Stage in Fuel Cell Application

DEFF Research Database (Denmark)

Zhou, Dao; Wang, Huai; Blaabjerg, Frede

2016-01-01

reliability. In a case study of a 5 kW fuel cell power stage, the parameter variations of the lifetime model prove that the exponential factor of the junction temperature fluctuation is the most sensitive parameter. Besides, if a 5-out-of-6 redundancy is used, it is concluded both the B10 and the B1 system......High efficient and less pollutant fuel cell stacks are emerging and strong candidates of the power solution used for mobile base stations. In the application of the backup power, the availability and reliability hold the highest priority. This paper considers the reliability metrics from...... the component-level to the system-level for the power stage used in a fuel cell application. It starts with an estimation of the annual accumulated damage for the key power electronic components according to the real mission profile of the fuel cell system. Then, considering the parameter variations in both...

Brachytherapy for stage IIIB squamous cell carcinoma of the uterine cervix: survival and toxicity

Energy Technology Data Exchange (ETDEWEB)

Zuliani, Antonio Carlos; Cunha, Maercio de Oliveira, E-mail: aczo.rt@gmail.co [Universidade Estadual de Campinas (UNICAMP), SP (Brazil); Esteves, Sergio C.B. [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Faculdade de Ciencias Medicas. Secao de Radioterapia; Teixeira, Julio Cesar [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Tocoginecologia

2010-07-01

Objective: to compare survival and toxicity of three different treatments for stage IIIB cervix cancer: low-dose-rate (LDR), high-dose-rate (HDR) brachytherapy and association of HDR and chemotherapy. Methods: between 1985 and 2005, 230 patients with FIGO stage IIIB squamous cell carcinoma of the uterine cervix received 4-field pelvic teletherapy at doses between 40 and 50.4 Gy, with a different complementation in each group. The LDRB group, with 42 patients, received one or two insertions of LDR, with Cesium-137, in a total dose of 80 to 100Gy at point A. The HDR group, 155 patients received HDR in 4 weekly 7 Gy fractions and 9 Gy to 14.4 Gy applied to the involved parametria. The CHT group, 33 patients, were given the same treatment as the HDR group and received 5 or 6 weekly cycles of cisplatin, 40 mg per m2. Results: the five-year progression-free survival (PFS) was 60% for the HDR group and 45% for the LDR group, and the two-year PFS for the CHT group was 65% (p = 0.02). The five-year Overall Survival (OS) was 65% for the HDR group and 49% for the LDR group. The two-year OS was 86% for the CHT group (p 0.02). Rectum toxicity grade II was 7% for the LDR group, 4% for the HDR group and 7% for the CHT group that had one case of rectum toxicity grade IV. Conclusion: patients that received HDR had better OS and PFS. The Chemotherapy-HDR association showed no benefit when compared to HDR only. Toxicity rates showed no difference between the three groups. (author)

Dynamic multi-stage dispatch of isolated wind–diesel power systems

DEFF Research Database (Denmark)

Hu, Yu; Morales González, Juan Miguel; Pineda, Salvador

2015-01-01

-stage decision-making model is proposed to determine the diesel power output that minimizes the cost of running and maintaining the wind–diesel power system. Optimized operational decisions for each time period are generated dynamically considering the path-dependent nature of the optimal dispatch policy, given......An optimal dispatch strategy is crucial for an isolated wind–diesel power system to save diesel fuel and maintain the system stability. The uncertainty associated with the stochastic character of the wind is, though, a challenging problem for this optimization. In this paper, a dynamic multi...

The clinical implications of hydronephrosis and the level of ureteral obstruction in stage IIIB cervical cancer

International Nuclear Information System (INIS)

Chao, K.S. Clifford; Leung, W.-M.; Grigsby, Perry W.; Mutch, David G.; Herzog, Thomas; Perez, Carlos A.

1998-01-01

Purpose: There are two criteria for the diagnosis of Stage IIIB cervical cancer in the FIGO staging system: tumor fixation to the pelvic side wall and/or the presence of hydronephrosis due to tumor. However, we often encounter hydronephrosis without tumor fixed to the pelvic side wall or the level of ureteral obstruction not corresponding to the main tumor mass in the pelvis. The clinical implication of these phenomena remains unclear. We investigated the Stage IIIB population treated at the Mallinckrodt Institute of Radiology and hypothesized that, if hydronephrosis presents without tumor fixation to the pelvic side wall or if the level of ureteral obstruction is above the main pelvic tumor mass, it most likely resulted from external compression of ureter(s) by enlarged lymph nodes and, consequently, a worse outcome is expected. Methods and Materials: From 1959 to 1989, there were 297 patients with Stage IIIB cervical cancer who received definitive radiation therapy at the Mallinckrodt Institute of Radiology and were assessable for the presence of hydronephrosis and the level of ureteral obstruction. There were 281 patients who presented with tumor fixed to the pelvic side wall, and 62 of them were associated with concurrent hydronephrosis. An additional 16 patients presented with hydronephrosis without tumor fixation to the pelvic side wall. Among these 78 documented cases of hydronephrosis, the level of ureteral obstruction was above the true pelvis in 39 patients, and below the true pelvis in the other 39. Radiation therapy was individualized according to tumor extension and configuration; para-aortic lymph nodes were not routinely treated except in patients with clinical evidence of nodal metastasis. Results: The progression-free survival (PFS) at 5 years was 35% in 62 patients with hydronephrosis and tumor fixed to the pelvic side wall vs. 43% in 213 patients with tumor fixed to the pelvic side wall only (p 0.12). However, PFS at 5 years decreased to 23% in

New J-STAGE system accelerates digitization and distribution of academic journals from Japan

Science.gov (United States)

Sato, Ryuichi; Kubota, Soichi; Aoyama, Kota; Tsuchiya, Eri; Miyagawa, Yoshiyuki

13 years have passed since J-STAGE was launched. At present no one could deny that its user interface and functions were already out of date comparing to foreign established e-journals. So JST has developed a new system called “J-STAGE3” in order to offer better usability and give powerful dissemination of academic papers from Japan. As the result of it, they will be able to enjoy the following things: 1) integration of two databases, Journal@rchive and J-STAGE, 2) new design/interface, 3) introduction of international standard XML format, 4) advanced subscription management, 5) saving cost of publishers, and 6) improving J-STAGE online submission and review system. At the end of March 2011, we conducted a market research on current status of digitization on Japanese society journals. The report told us that digitization ratio of those was 62% in total but it was 34% in humanities/social sciences. Or it was 92% in English journals and 55% in Japanese ones. It means that we need further promotion of digitization. In this paper, we discuss functions and direction of J-STAGE3 as well as our role in promotion of digitization of Japanese society journals.

B3GNT3 Expression Is a Novel Marker Correlated with Pelvic Lymph Node Metastasis and Poor Clinical Outcome in Early-Stage Cervical Cancer

Science.gov (United States)

Niu, Chunhao; Song, Libing; Zhang, Yanna

2015-01-01

Background The β1,3-N-acetylglucosaminyltransferase-3 gene (B3GNT3) encodes a member of the B3GNT family that functions as the backbone structure of dimeric sialyl-Lewis A and is involved in L-selectin ligand biosynthesis, lymphocyte homing and lymphocyte trafficking. B3GNT3 has been implicated as an important element in the development of certain cancers. However, the characteristics of B3GNT3 in the development and progression of cancer remain largely unknown. Thus, our study aimed to investigate the expression pattern and the prognostic value of B3GNT3 in patients with early-stage cervical cancer. Methods The mRNA and protein levels of B3GNT3 expression were examined in eight cervical cancer cell lines and ten paired cervical cancer tumors, using real-time PCR and western blotting, respectively. Immunohistochemistry (IHC) was used to analyze B3GNT3 protein expression in paraffin-embedded tissues from 196 early-stage cervical cancer patients. Statistical analyses were applied to evaluate the association between B3GNT3 expression scores and clinical parameters, as well as patient survival. Results B3GNT3 expression was significantly upregulated in cervical cancer cell lines and lesions compared with normal cells and adjacent noncancerous cervical tissues. In the 196 cases of tested early-stage cervical cancer samples, the B3GNT3 protein level was positively correlated with high risk TYPES of human papillomavirus (HPV) infection (P = 0.026), FIGO stage (P cervical cancer patients. Conclusions Our study demonstrated that elevated B3GNT3 expression is associated with pelvic lymph node metastasis and poor outcome in early-stage cervical cancer patients. B3GNT3 may be a novel prognostic marker and therapeutic target for the treatment of cervical cancer. PMID:26709519

Adaptive kanban control mechanism for a single-stage hybrid system

Science.gov (United States)

Korugan, Aybek; Gupta, Surendra M.

2002-02-01

In this paper, we consider a hybrid manufacturing system with two discrete production lines. Here the output of either production line can satisfy the demand for the same type of product without any penalties. The interarrival times for demand occurrences and service completions are exponentially distributed i.i.d. variables. In order to control this type of manufacturing system we suggest a single stage pull type control mechanism with adaptive kanbans and state independent routing of the production information.

A Sensorless Power Reserve Control Strategy for Two-Stage Grid-Connected PV Systems

DEFF Research Database (Denmark)

Sangwongwanich, Ariya; Yang, Yongheng; Blaabjerg, Frede

2017-01-01

Due to the still increasing penetration of grid-connected Photovoltaic (PV) systems, advanced active power control functionalities have been introduced in grid regulations. A power reserve control, where namely the active power from the PV panels is reserved during operation, is required for grid...... support. In this paper, a cost-effective solution to realize the power reserve for two-stage grid-connected PV systems is proposed. The proposed solution routinely employs a Maximum Power Point Tracking (MPPT) control to estimate the available PV power and a Constant Power Generation (CPG) control...... performed on a 3-kW two-stage single-phase grid-connected PV system, where the power reserve control is achieved upon demands....

New current control based MPPT technique for single stage grid connected PV systems

International Nuclear Information System (INIS)

Jain, Sachin; Agarwal, Vivek

2007-01-01

This paper presents a new maximum power point tracking algorithm based on current control for a single stage grid connected photovoltaic system. The main advantage of this algorithm comes from its ability to predict the approximate amplitude of the reference current waveform or power that can be derived from the PV array with the help of an intermediate variable β. A variable step size for the change in reference amplitude during initial tracking helps in fast tracking. It is observed that if the reference current amplitude is greater than the array capacity, the system gets unstable (i.e. moves into the positive slope region of the p-v characteristics of the array). The proposed algorithm prevents the PV system from entering the positive slope region of the p-v characteristics. It is also capable of restoring stability if the system goes unstable due to a sudden environmental change. The proposed algorithm has been tested on a new single stage grid connected PV configuration recently developed by the authors to feed sinusoidal current into the grid. The system is operated in a continuous conduction mode to realize advantages such as low device current stress, high efficiency and low EMI. A fast MPPT tracker with single stage inverter topology operating in CCM makes the overall system highly efficient. Specific cases of the system, operating in just discontinuous current mode and discontinuous current mode and their relative merits and demerits are also discussed

Optimisation of Refrigeration System with Two-Stage and Intercooler Using Fuzzy Logic and Genetic Algorithm

Directory of Open Access Journals (Sweden)

Bayram Kılıç

2017-04-01

Full Text Available Two-stage compression operation prevents excessive compressor outlet pressure and temperature and this operation provides more efficient working condition in low-temperature refrigeration applications. Vapor compression refrigeration system with two-stage and intercooler is very good solution for low-temperature refrigeration applications. In this study, refrigeration system with two-stage and intercooler were optimized using fuzzy logic and genetic algorithm. The necessary thermodynamic characteristics for optimization were estimated with Fuzzy Logic and liquid phase enthalpy, vapour phase enthalpy, liquid phase entropy, vapour phase entropy values were compared with actual values. As a result, optimum working condition of system was estimated by the Genetic Algorithm as -6.0449 oC for evaporator temperature, 25.0115 oC for condenser temperature and 5.9666 for COP. Morever, irreversibility values of the refrigeration system are calculated.

Treatment results of radical radiotherapy in uterine cervix cancer

Energy Technology Data Exchange (ETDEWEB)

Huh, Seung Jae; Kim, Bo Kyong; Lim, Do Hoon; Shin, Seong Soo; Lee, Jeong Eun; Kang, Min Kyu; Ahn, Yong Chan [Samsung Medical center, sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2002-09-15

This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radiotherapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range 30.6 {approx} 50.4 Gy to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of 24 {approx} 28 Gy with 6 {approx} 7 fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Early response of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was 82%, and 73%, and the disease free survival (DFS) rate was 72%, and 69%, at 3, and 5 years, respectively. The pelvic control rate (PCR) was 79% at both 3 and 5 years. According to the FIGO stage, 3 and 5 year OS were 100% and 50% in CIS/IA, 100% in 100% in IB, 83% and 69% in IIA, 87% and 80% in IIB, and 62% and 62% in III, respectively. The 3 year OS in 4 patients with stage IVA was 100%. Three-year DFS were 80% in CIS/IA, 88% in IB, 100% in IIA, 64% in IIB, 58% in III, and 75% in IVA. Three-year PCR were 100% in CIS/IA, 94% in IB, 100% in IIA, 84% in IIB, 69% in III, and 50% in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate

Critical Imperative for the Reform of British Interpretation of Fetal Heart Rate Decelerations: Analysis of FIGO and NICE Guidelines, Post-Truth Foundations, Cognitive Fallacies, Myths and Occam's Razor.

Science.gov (United States)

Sholapurkar, Shashikant L

2017-04-01

Cardiotocography (CTG) has disappointingly failed to show good predictability for fetal acidemia or neonatal outcomes in several large studies. A complete rethink of CTG interpretation will not be out of place. Fetal heart rate (FHR) decelerations are the most common deviations, benign as well as manifestation of impending fetal hypoxemia/acidemia, much more commonly than FHR baseline or variability. Their specific nomenclature is important (center-stage) because it provides the basic concepts and framework on which the complex "pattern recognition" of CTG interpretation by clinicians depends. Unfortunately, the discrimination of FHR decelerations seems to be muddled since the British obstetrics adopted the concept of vast majority of FHR decelerations being "variable" (cord-compression). With proliferation of confusing waveform criteria, "atypical variables" became the commonest cause of suspicious/pathological CTG. However, National Institute for Health and Care Excellence (NICE) (2014) had to disband the "typical" and "atypical" terminology because of flawed classifying criteria. This analytical review makes a strong case that there are major and fundamental framing and confirmation fallacies (not just biases) in interpretation of FHR decelerations by NICE (2014) and International Federation of Gynecology and Obstetrics (FIGO) (2015), probably the biggest in modern medicine. This "post-truth" approach is incompatible with scientific practice. Moreover, it amounts to setting oneself for failure. The inertia to change could be best described as "backfire effect". There is abundant evidence that head-compression (and other non-hypoxic mediators) causes rapid rather than shallow/gradual decelerations. Currently, the vast majority of decelerations are attributed to unproven cord compression underpinned by flawed disproven pathophysiological hypotheses. Their further discrimination based on abstract, random, trial and error criteria remains unresolved suggesting a

Clinical outcomes of adjuvant radiation therapy and prognostic factors in early stage uterine cervical cancer

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyun Ju; Rhee, Woo Joong; Choi, Seo Hee; Kim, Gwi Eon; Kim, Yong Bae [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of); Nam, EunJi; Kim, Sang Wun; Kim, Sung Hoon [Dept. of Radiation Oncology, Obstetrics and Gynecology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2015-06-15

To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic

Mechanisms important to later stages of streamer system development

Science.gov (United States)

Lehtinen, N. G.; Carlson, B.; Kochkin, P.; Østgaard, N.

2017-12-01

Typical streamer modeling focuses on the propagation of the streamer head and thus neglects processes such as electron detachment, electron energy relaxation, and thermalization of the electron energy distribution. These mechanisms, however, may become important at later stages of streamer system development, in particular following streamer collisions. We present a model of a later-stage streamer system development which includes these processes. A linear analysis suggests that these processes under some conditions can lead to new effects, such as excitation of waves similar to striations in the positive column of a glow discharge. Such instabilities do not occur if these mechanisms are neglected under the same conditions, although previous modeling suggested existence of wave-like phenomena during the streamer propagation [Luque et al, 2016, doi:10.1002/2015JA022234]. In the sea-level pressure air, the obtained striation-like waves may manifest as very high frequency range (>10 MHz) oscillations in plasma parameters and may have been detected in the electrode current and electromagnetic radiation measurements during laboratory spark experiments. We discuss whether the longitudinal electric field in such waves can efficiently transfer energy to charged particles, because such a process may play a role in production of x-rays.

Performance assessment and microbial diversity of two pilot scale multi-stage sub-surface flow constructed wetland systems.

Science.gov (United States)

Babatunde, A O; Miranda-CasoLuengo, Raul; Imtiaz, Mehreen; Zhao, Y Q; Meijer, Wim G

2016-08-01

This study assessed the performance and diversity of microbial communities in multi-stage sub-surface flow constructed wetland systems (CWs). Our aim was to assess the impact of configuration on treatment performance and microbial diversity in the systems. Results indicate that at loading rates up to 100gBOD5/(m(2)·day), similar treatment performances can be achieved using either a 3 or 4 stage configuration. In the case of phosphorus (P), the impact of configuration was less obvious and a minimum of 80% P removal can be expected for loadings up to 10gP/(m(2)·day) based on the performance results obtained within the first 16months of operation. Microbial analysis showed an increased bacterial diversity in stage four compared to the first stage. These results indicate that the design and configuration of multi-stage constructed wetland systems may have an impact on the treatment performance and the composition of the microbial community in the systems, and such knowledge can be used to improve their design and performance. Copyright © 2016. Published by Elsevier B.V.

Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort.

Directory of Open Access Journals (Sweden)

Mark op den Winkel

Full Text Available HCC is diagnosed in approximately half a million people per year, worldwide. Staging is a more complex issue than in most other cancer entities and, mainly due to unique geographic characteristics of the disease, no universally accepted staging system exists to date. Focusing on survival rates we analyzed demographic, etiological, clinical, laboratory and tumor characteristics of HCC-patients in our institution and applied the common staging systems. Furthermore we aimed at identifying the most suitable of the current staging systems for predicting survival.Overall, 405 patients with HCC were identified from an electronic medical record database. The following seven staging systems were applied and ranked according to their ability to predict survival by using the Akaike information criterion (AIC and the concordance-index (c-index: BCLC, CLIP, GETCH, JIS, Okuda, TNM and Child-Pugh. Separately, every single variable of each staging system was tested for prognostic meaning in uni- and multivariate analysis. Alcoholic cirrhosis (44.4% was the leading etiological factor followed by viral hepatitis C (18.8%. Median survival was 18.1 months (95%-CI: 15.2-22.2. Ascites, bilirubin, alkaline phosphatase, AFP, number of tumor nodes and the BCLC tumor extension remained independent prognostic factors in multivariate analysis. Overall, all of the tested staging systems showed a reasonable discriminatory ability. CLIP (closely followed by JIS was the top-ranked score in terms of prognostic capability with the best values of the AIC and c-index (AIC 2286, c-index 0.71, surpassing other established staging systems like BCLC (AIC 2343, c-index 0.66. The unidimensional scores TNM (AIC 2342, c-index 0.64 and Child-Pugh (AIC 2369, c-index 0.63 performed in an inferior fashion.Compared with six other staging systems, the CLIP-score was identified as the most suitable staging system for predicting prognosis in a large German cohort of predominantly non-surgical HCC-patients.

Design of a Scalable Modular Production System for a Two-stage Food Service Franchise System

OpenAIRE

Matt,; T., D.; Rauch,; E.,

2012-01-01

The geographically distributed production of fresh food poses unique challenges to the production system design because of their stringent industry and logistics requirements. The purpose of this research is to examine the case of a European fresh food manufacturer’s approach to introduce a scalable modular production concept for an international two‐stage gastronomy franchise system in order to identify best practice guidelines and to derive a framework for the design of distributed producti...

Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures

DEFF Research Database (Denmark)

Hansen, Henrik Villibald; Loft, Annika; Berthelsen, Anne Kiil

2015-01-01

PURPOSE: In cancer of the uterine cervix, lymph node metastases are associated with a poor prognosis. Even so, the International Federation of Gynecology and Obstetrics (FIGO) does not take into account diagnostic results of methods such as PET/CT, since these are not readily available everywhere....../CT. METHODS: This was a single-institution retrospective analysis of 301 patients with a histopathological diagnosis of cervical cancer. The patients were receiving chemoradiotherapy with curative intent according to the standard protocol of the department for patients without lymph node metastases...

Multi-Stage Admission Control for Load Balancing in Next Generation Systems

DEFF Research Database (Denmark)

Mihovska, Albena D.; Anggorojati, Bayu; Luo, Jijun

2008-01-01

This paper describes a load-dependent multi-stage admission control suitable for next generation systems. The concept uses decision polling in entities located at different levels of the architecture hierarchy and based on the load to activate a sequence of actions related to the admission...

Three-stage enzymatic digestive system for a gut-on-a-chip

NARCIS (Netherlands)

de Haan, Pim; Ianovska, Margaryta A.; Mathwig, Klaus; Bouwmeester, Hans; Verpoorte, Elisabeth

2017-01-01

In this work, we present the development of a three-stage microfluidic system as a cell-free model for digestion in the human gastrointestinal (GI) tract. Larger-scale digestion models are currently being used for pharmacological, toxicological and nutritional studies to determine the possible

A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients

International Nuclear Information System (INIS)

Cheng, S.-J.; Lee, J.-J.; Ting, L.-L.; Tseng, I.-Y.; Chang, H.-H.; Chen, H.-M.; Kuo, Y.-S.; Hahn, L.-J.; Kok, S.-H.

2006-01-01

Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes

Waterhammer modeling for the Ares I Upper Stage Reaction Control System cold flow development test article

Science.gov (United States)

Williams, Jonathan Hunter

The Upper Stage Reaction Control System provides in-flight three-axis attitude control for the Ares I Upper Stage. The system design must accommodate rapid thruster firing to maintain proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted at Marshall Space Flight Center in 2009 were performed using a water-flow test article to better understand fluid characteristics of the Upper Stage Reaction Control System. A subset of the tests examined the waterhammer pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

Waterhammer Modeling for the Ares I Upper Stage Reaction Control System Cold Flow Development Test Article

Science.gov (United States)

Williams, Jonathan H.

2010-01-01

The Upper Stage Reaction Control System provides three-axis attitude control for the Ares I launch vehicle during active Upper Stage flight. The system design must accommodate rapid thruster firing to maintain the proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted in the fall of 2009 at Marshall Space Flight Center were performed using a water-flow test article to better understand fluid performance characteristics of the Upper Stage Reaction Control System. A subset of the tests examined waterhammer along with the subsequent pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

Performance evaluation of a once-through multi-stage flash distillation system: Impact of brine heater fouling

International Nuclear Information System (INIS)

Baig, Hasan; Antar, Mohamed A.; Zubair, Syed M.

2011-01-01

Multi-stage flash distillation (MSF) system modeling involves a number of process variables. An estimation of all these process variables requires both analytical solutions and experimental/field analysis. However, the accurate estimate of variables related to the brine heater operation in a MSF system is very important for a reliable operation of the system. For example, steam operating conditions as well as the brine properties including fouling of the brine heater tubes have a significant effect on the heat transfer characteristics of the brine heater, which in turn influence the distillate output from the system. In this study, the effect of various design as well as operating conditions on the performance ratio (PR), brine temperature and salinity as it leaves the last flash stage are investigated in a once-through system. Increasing the number of stages from 24 to 32 has a significant effect on the PR, it ranges between 79% (for ΔT = 1.5) and 327% (for ΔT = 2.3) for a top-brine temperature of 106 o C. This value increase as the top-brine temperature increases. Increasing the stage-to-stage temperature difference increases the water salinity as it leaves the final stage and reduces its temperature that would imply better energy utilization within the plant. Results show that brine side heat exchanger fouling has a significant effect in decreasing the overall heat transfer coefficient, which reduces the production rate as the fouling increases with time. A sensitivity analysis to identify the key parameters, which can have a significant influence on the desalination plant performance, is carried out in an attempt to contribute a better understanding and operation of MSF desalination processes.

Analysis of stage and clinical/prognostic factors for colon and rectal cancer from SEER registries: AJCC and collaborative stage data collection system.

Science.gov (United States)

Chen, Vivien W; Hsieh, Mei-Chin; Charlton, Mary E; Ruiz, Bernardo A; Karlitz, Jordan; Altekruse, Sean F; Ries, Lynn A G; Jessup, J Milburn

2014-12-01

The Collaborative Stage (CS) Data Collection System enables multiple cancer registration programs to document anatomic and molecular pathology features that contribute to the Tumor (T), Node (N), Metastasis (M) - TNM - system of the American Joint Committee on Cancer (AJCC). This article highlights changes in CS for colon and rectal carcinomas as TNM moved from the AJCC 6th to the 7th editions. Data from 18 Surveillance, Epidemiology, and End Results (SEER) population-based registries were analyzed for the years 2004-2010, which included 191,361colon and 73,341 rectal carcinomas. Overall, the incidence of colon and rectal cancers declined, with the greatest decrease in stage 0. The AJCC's 7th edition introduction of changes in the subcategorization of T4, N1, and N2 caused shifting within stage groups in 25,577 colon and 10,150 rectal cancers diagnosed in 2010. Several site-specific factors (SSFs) introduced in the 7th edition had interesting findings: 1) approximately 10% of colon and rectal cancers had tumor deposits - about 30%-40% occurred without lymph node metastases, which resulted in 2.5% of colon and 3.3% of rectal cases becoming N1c (stage III A/B) in the AJCC 7th edition; 2) 10% of colon and 12% of rectal cases had circumferential radial margins Cancer Society.

[Home Daily Hemodialysis with NxStage System One: monocentric italian casistic results].

Science.gov (United States)

Brunati, Chiara; Cassaro, Franca; Cretti, Laura; Izzo, Michela; Pegoraro, Marisa; Negri, Daniela; Gervasi, Francesca; Colussi, Giacomo

2017-09-28

NxStage System One is a new dialytic technology based on easy setup, simplicity of use and reduced dimensions, which is increasingly in use worldwide for home hemodialysis treatments. The system utilizes a low amount of dialysate, usually 15-30 liters according to anthropometric patients' values. The dialysate is supplied at very low flux, generally about 1/3 of blood flow, in order to obtain an elevated saturation of dialysate for solutes. In these conditions the clearance of urea will be almost equal to dialysate flow rate. In order to achieve an obptimal weekly clearance evaluated by Std Kt/V the dialysis sessions are repeated six times a week. In this way a good control of blood voleme can be reached. In this paper we report our experience of treatment with NxStage System One in 12 patients from May 2011 to Dicember 2016. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

A two-stage optimal planning and design method for combined cooling, heat and power microgrid system

International Nuclear Information System (INIS)

Guo, Li; Liu, Wenjian; Cai, Jiejin; Hong, Bowen; Wang, Chengshan

2013-01-01

Highlights: • A two-stage optimal method is presented for CCHP microgrid system. • Economic and environmental performance are considered as assessment indicators. • Application case demonstrates its good economic and environmental performance. - Abstract: In this paper, a two-stage optimal planning and design method for combined cooling, heat and power (CCHP) microgrid system was presented. The optimal objective was to simultaneously minimize the total net present cost and carbon dioxide emission in life circle. On the first stage, multi-objective genetic algorithm based on non-dominated sorting genetic algorithm-II (NSGA-II) was applied to solve the optimal design problem including the optimization of equipment type and capacity. On the second stage, mixed-integer linear programming (MILP) algorithm was used to solve the optimal dispatch problem. The approach was applied to a typical CCHP microgrid system in a hospital as a case study, and the effectiveness of the proposed method was verified

Single stage three level grid interactive MPPT inverter for PV systems

International Nuclear Information System (INIS)

Ozdemir, Saban; Altin, Necmi; Sefa, Ibrahim

2014-01-01

Highlights: • A three phase three-level NPC inverter for grid interactive PV systems is proposed. • A novel MPPT algorithm is introduced for single stage systems. • The proposed algorithm is robust with respect to parameter variations of PV system. • THD level is measured as 3.45% and it meets the international standards (<5%). • Total system efficiency is measured as 93.08%. - Abstract: In this study, three-phase, single stage neutral point clamped grid interactive inverter is designed and implemented. The reference current of the voltage source inverter is determined by maximum power point tracking sub-program in order to obtain maximum power from photovoltaic modules instantaneously. Proposed control is realized via TMS320F28335 32-bit floating point processor. The modified incremental conductance method is applied for maximum power point tracking; the PI regulator is used to control the inverter output current shape and level. Galvanic isolation is provided by a line frequency transformer that matches inverter output voltage to the grid voltage level and prevents DC current injection into the grid. Experimental results show that the designed inverter imports energy to the grid with unity power factor, total harmonic distortion level is 3.45% and this value is in the limits of the international standards. In addition, the total efficiency of the system is measured as 93.08%. The proposed system gets the maximum power from photovoltaic module and dispatches into the grid without using additional DC/DC converter

Structural integration of separation and reaction systems: I. Integration of stage-wise processes

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Mitrović Milan

2002-01-01

Full Text Available The structural integration of separation processes, using multifunctional equipment, has been studied on four stage-wise liquid-liquid separations extraction, absorption, distillation, adsorption and on some combinations of these processes. It was shown for stage - wise processes that the ultimate aim of equipment integration is 3-way integration (by components by steps and by stages and that membrane multiphase contactors present concerning the equipment optimal solutions in many cases. First, by using partially integrated equipment and, later by developing fully integrated systems it was experimentally confirmed that structural 3-way integration produces much higher degrees of component separations and component enrichments in compact and safe equipment.

Hyperfractionated external radiation therapy in stage IIIB carcinoma of uterine cervix: a prospective pilot study

International Nuclear Information System (INIS)

Faria, Sergio L.; Ferrigno, Robson

1997-01-01

Purpose: Brazil has one of the highest incidence of carcinoma of the cervix in the world. Half of the patients have advanced stages at the diagnosis. Due to this large number of patients we decided to conduct a prospective pilot study to investigate the tolerance to and survival rate with hyperfractionated external radiotherapy only in patients with Stage IIIB carcinoma of the uterine cervix. Methods and Materials: Between January 1991 and December 1993, 23 patients underwent hyperfractionated external beam radiotherapy without brachytherapy. All cases were biopsy proven squamous cell carcinoma of cervix clinically Staged as IIIB (FIGO). Hyperfractionation (HFX) was given with 1.2 Gy doses, twice daily at 6-h interval, 5 days/week, to the whole pelvis up to 72 Gy within 30 working days. Complications were evaluated by an adaptation of the RTOG Radiation Morbidity Scoring Table graded as 1 = none/mild; 2 = moderate, and 3 = severe. Results: Follow-up ranged from 27 to 50 months (median 40 months) on the 9 to 23 living patients at the time of the analysis in December 1995. There was no severe acute toxicity, but moderate acute reaction was high: 74%. The commonest site of complication was the intestine where severe late toxicity occurred in 2 of 23 (9%). Overall survival rate at 27 months was 48% and at 40 months was 43%. Discussion: There is little information in literature about HFX in carcinoma of the cervix. This is the third published study about it and the one that gave the highest total dose with external HFX of 60 x 1.2 Gy = 72 Gy. Theoretically, through the linear quadratic formula this schedule of HFX would be equivalent to 30 x 2 Gy = 60 Gy of standard fractionation, both treatments given in 30 working days. HFX schedules must be tested to establish their safety. Present results suggest being possible to further increase the total dose in the pelvis with hyperfractionated irradiation

Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer

International Nuclear Information System (INIS)

Sakuragi, Noriaki

2007-01-01

Lymph node metastasis (LNM), together with parametrial infiltration and positive surgical margins, is an important prognostic factor in cervical cancer. The incidence of LNM increases with International Federation of Gynecology and Obstetrics (FIGO) stage, with rates being 12%-22% in stage Ib, 10%-27% in stage IIa, and 34%-43% in stage IIb. Radical hysterectomy and pelvic lymphadenectomy are widely used treatments for early-stage (Ib to IIa) cervical cancer, as well as for stage IIb disease, in some European and Asian countries. In several types of cancer, the therapeutic significance of systematic lymphadenectomy has been demonstrated by recent reports showing that a larger number of lymph nodes removed relates to better survival. In cervical cancer, a significant relationship between the number of lymph nodes removed and disease-free survival has been reported in node-positive patients. Preoperative evaluation of nodal status with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) imaging techniques is not sensitive enough to replace the histological examination of dissected nodes. The sentinel node procedure may be an alternative to systematic lymphadenectomy to reduce treatment-related morbidity, but more work on this is needed. Although the presence of LNM does not change FIGO staging, it will modulate postoperative therapy. Progression-free and overall survivals were significantly improved by the addition of chemotherapy to adjuvant radiotherapy after radical hysterectomy and lymphadenectomy. Adjuvant chemotherapy combined solely with radical hysterectomy and systematic lymphadenectomy may also provide a survival benefit. In conclusion, efforts to establish more tailored surgical strategies, by introducing advanced imaging technologies and molecular diagnostic procedures, are needed for cervical cancer. (author)

Dilemmas in Lung Cancer Staging.

Science.gov (United States)

Vlahos, Ioannis

2018-05-01

The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Nitrogen and phosphorus removed from a subsurface flow multi-stage filtration system purifying agricultural runoff.

Science.gov (United States)

Zhao, Yaqi; Huang, Lei; Chen, Yucheng

2018-07-01

Agricultural nonpoint source pollution has been increasingly serious in China since the 1990s. The main causes were excessive inputs of nitrogen fertilizer and pesticides. A multi-stage filtration system was built to test the purification efficiencies and removal characteristics of nitrogen and phosphorus when treating agricultural runoff. Simulated runoff pollution was prepared by using river water as source water based on the monitoring of local agricultural runoff. Experimental study had been performed from September to November 2013, adopting 12 h for flooding and 12 h for drying. The results showed that the system was made adaptive to variation of inflow quality and quantity, and had good removal for dissolved total nitrogen, total nitrogen, dissolved total phosphorus (DTP), and total phosphorus, and the average removal rate was 27%, 36%, 32%, and 48%, respectively. Except nitrate ([Formula: see text]), other forms of nitrogen and phosphorus all decreased with the increase of stages. Nitrogen was removed mainly in particle form the first stage, and mostly removed in dissolved form the second and third stage. Phosphorus was removed mainly in particulate during the first two stages, but the removal of particulate phosphorus and DTP were almost the same in the last stage. An approximate logarithmic relationship between removal loading and influent loading to nitrogen and phosphorus was noted in the experimental system, and the correlation coefficient was 0.78-0.94. [Formula: see text]: ammonium; [Formula: see text]: nitrite; [Formula: see text]: nitrate; DTN: dissolved total nitrogen; TN: total nitrogen; DTP: dissolved total phosphorus; TP: total phosphorus; PN: particulate nitrogen; PP: particulate phosphorus.

Evaluation of high step-up power electronics stages in thermoelectric generator systems

DEFF Research Database (Denmark)

Sun, Kai; Ni, Longxian; Chen, Min

2013-01-01

To develop practical thermoelectric generator (TEG) systems, especially radioisotope thermoelectric power supplies for deep-space exploration, a power conditioning stage with high step-up gain is indispensable. This stage is used to step up the low output voltage of thermoelectric generators...... to the required high level. Furthermore, maximum power point tracking control for TEG modules needs to be implemented into the power electronics stages. In this paper, the temperature-dependent electrical characteristics of a thermoelectric generator are analyzed in depth. Three typical high step-up power...... converters suitable for TEG applications are discussed: an interleaved boost converter, a boost converter with a coupled inductor and an interleaved boost converter with an auxiliary transformer. A general comparison of the three high step-up converters is conducted to study the step-up gain, conversion...

Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2007 and 2011 staging systems

DEFF Research Database (Denmark)

Soriano, Joan B; Lamprecht, Bernd; Ramírez, Ana S

2015-01-01

BACKGROUND: There is no universal consensus on the best staging system for chronic obstructive pulmonary disease (COPD). Although documents (eg, the Global Initiative for Chronic Obstructive Lung Disease [GOLD] 2007) have traditionally used forced expiratory volume in 1 s (FEV1) for staging, clin...

Estadiamento cirúrgico do câncer de colo de útero localmente avançado Surgical staging of locally advanced uterine cervix cancer

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Heitor Ricardo Cosiski Marana

2005-12-01

controle locorregional da doença na pelve.PURPOSE: to assess to what extent the surgical staging differs from the clinical staging among cases of advanced uterine cervix carcinoma, and also to assess the percentage of cases with positive para-aortic ganglia in this group of patients. METHODS: this is a descriptive prospective study in which 36 patients with histological diagnosis of uterine cervix carcinoma considered locally advanced were included (stages IB2, IIB, IIIA and B, and IVA. The cases were submitted to clinical staging, according to FIGO criteria. All patients were to be treated with neoadjuvant chemotherapy. Age ranged from 40 to 73 years, with a mean of 56.2±7.9. The procedure started with pelvic lymphadenectomy followed by para-aortic lymphadenectomy, in case the pelvic lymph nodes were positive on surgical examination. Examination of the abdominal cavity and lymphadenectomy were done either through laparotomy or laparoscopy, chosen at random. In each case, the clinical staging was compared to the surgical staging, considered the gold standard. RESULTS: in the clinical staging (CS, 7 cases were classified as IB2 (tumors larger than 4 cm, 22 cases as CSII and 7 cases as CSIII. The surgical assessment changed the clinical staging as follows: the stage was decreased in six cases, and increased in 13. There was agreement only in 18 cases (50%. The para-aortic lymph nodes were affected in six cases. CONCLUSIONS: clinical staging of locally advanced uterine cervix carcinoma is incorrect in most of the cases. Such inconsistency may lead to excessive treatment in some cases, but about one fourth of the patients with positive para-aortic ganglia would not be adequately treated with the current standard treatment radiotherapy with chemosensitization, which aims at the local regional control of the pelvic disease.

∑∆ Modulator System-Level Considerations for Hearing-Aid Audio Class-D Output Stage Application

DEFF Research Database (Denmark)

Pracný, Peter; Bruun, Erik

2012-01-01

This paper deals with a system-level design of a digital sigma-delta (∑∆) modulator for hearing-aid audio Class D output stage application. The aim of this paper is to provide a thorough discussion on various possibilities and tradeoffs of ∑∆ modulator system-level design parameter combinations...... - order, oversampling ratio (OSR) and number of bits in the quantizer - including their impact on interpolation filter design as well. The system is kept in digital domain up to the input of the Class D power stage including the digital pulse width modulation (DPWM) block. Notes on the impact of the DPWM...

Juvenile nasopharyngeal angiofibroma staging: An overview.

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Alshaikh, Nada Ali; Eleftheriadou, Anna

2015-06-01

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

System and method for single-phase, single-stage grid-interactive inverter

Science.gov (United States)

Liu, Liming; Li, Hui

2015-09-01

The present invention provides for the integration of distributed renewable energy sources/storages utilizing a cascaded DC-AC inverter, thereby eliminating the need for a DC-DC converter. The ability to segment the energy sources and energy storages improves the maintenance capability and system reliability of the distributed generation system, as well as achieve wide range reactive power compensation. In the absence of a DC-DC converter, single stage energy conversion can be achieved to enhance energy conversion efficiency.

Clinicopathologic characteristics and prognostic factors of ovarian fibrosarcoma: the results of a multi-center retrospective study

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Liao Ling-Min

2010-10-01

Full Text Available Abstract Background Ovarian fibrosarcomas are very rare tumors, and therefore, few case studies have evaluated the prognostic factors of this disease. To our knowledge, this study represents the largest study to evaluate the clinical and pathologic factors associated with ovarian fibrosarcoma patients. Methods Thirty-one cases of ovarian fibrosarcoma were retrospectively reviewed, which included medical records for eight patients, and 23 published case reports from 1995 through 2009. Patient treatment regimens included total hysterectomy with bilateral adnexectomy and an omentectomy (BAO (n = 9, oophorectomy (OR (n = 8, chemotherapy (CT (n = 1, BAO followed by chemotherapy (BAO+CT (n = 11, BAO followed by radiotherapy (BAO+RT (n = 1, and oophorectomy followed by radiotherapy (OR + RT (n = 1. Results The patients of this cohort were staged according to the guidelines of the Federation of Gynecology and Obstetrics (FIGO, with 15, 6, 9, and 1 stage I-IV cases identified, respectively. Mitotic count values were also evaluated from 10 high-power fields (HPFs, and 3 cases had an average mitotic count P = 0.007 and treatment (P = 0.008 were predictive of poor prognosis. Furthermore, patients with stage I tumors that received BAO+CT were associated with a better prognosis. Conclusions Mitotic activity, and cells positive for Ki-67 were identified as important factors in the diagnosis of ovarian fibrosarcoma. Furthermore, FIGO stage and treatment modalities have the potential to be prognostic factors of survival, with BAO followed by adjuvant chemotherapy associated with an improved treatment outcome.

Experimental study on an innovative multifunction heat pipe type heat recovery two-stage sorption refrigeration system

International Nuclear Information System (INIS)

Li, T.X.; Wang, R.Z.; Wang, L.W.; Lu, Z.S.

2008-01-01

An innovative multifunction heat pipe type sorption refrigeration system is designed, in which a two-stage sorption thermodynamic cycle based on two heat recovery processes was employed to reduce the driving heat source temperature, and the composite sorbent of CaCl 2 and activated carbon was used to improve the mass and heat transfer performances. For this test unit, the heating, cooling and heat recovery processes between two reactive beds are performed by multifunction heat pipes. The aim of this paper is to investigate the cycled characteristics of two-stage sorption refrigeration system with heat recovery processes. The two sub-cycles of a two-stage cycle have different sorption platforms though the adsorption and desorption temperatures are equivalent. The experimental results showed that the pressure evolutions of two beds are nearly equivalent during the first stage, and desorption pressure during the second stage is large higher than that in the first stage while the desorption temperatures are same during the two operation stages. In comparison with conventional two-stage cycle, the two-stage cycle with heat recovery processes can reduce the heating load for desorber and cooling load for adsorber, the coefficient of performance (COP) has been improved more than 23% when both cycles have the same regeneration temperature of 103 deg. C and the cooling water temperature of 30 deg. C. The advanced two-stage cycle provides an effective method for application of sorption refrigeration technology under the condition of low-grade temperature heat source or utilization of renewable energy

Novel clinical staging for patients with end-stage gastrointestinal carcinoma.

Science.gov (United States)

Yasuda, Naokuni; Nakashima, Osamu; Ohnaka, Toru; Kamisaka, Koji; Tsunoda, Akira; Kusano, Mitsuo

2006-01-01

We created a new clinical staging system for end-stage gastrointestinal (GI) carcinoma to clarify the therapeutic goals for these patients. Data were obtained from a retrospective review of medical charts. Based on daily clinical observation of 144 patients with end-stage GI carcinoma, we classified the terminal stages as A, B, C, and D. The mean durations of terminal stages A, B, C, and D were 19, 16.6, 6.6, and 1.8 days, respectively, in patients with end-stage gastric cancer and 28.5, 9.1, 5.4, and 1.9 days, respectively, in patients with colorectal cancer. Moreover, 88.0% of patients with gastric carcinoma and 82.6% of patients with colorectal carcinoma passed through terminal stages A, B, C, and D sequentially. The patients in terminal stage B experienced temporary relief of symptoms, but those in terminal stage C did not (P terminal stages can easily be judged by clinical observation and may be an effective new tool with which to manage patients with end-stage GI carcinoma and their families.

Stage separation study of Nike-Black Brant V Sounding Rocket System

Science.gov (United States)

Ferragut, N. J.

1976-01-01

A new Sounding Rocket System has been developed. It consists of a Nike Booster and a Black Brant V Sustainer with slanted fins which extend beyond its nozzle exit plane. A cursory look was taken at different factors which must be considered when studying a passive separation system. That is, one separation system without mechanical constraints in the axial direction and which will allow separation due to drag differential accelerations between the Booster and the Sustainer. The equations of motion were derived for rigid body motions and exact solutions were obtained. The analysis developed could be applied to any other staging problem of a Sounding Rocket System.

Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

International Nuclear Information System (INIS)

Ariunbaatar, Javkhlan; Scotto Di Perta, Ester; Panico, Antonio; Frunzo, Luigi; Esposito, Giovanni; Lens, Piet N.L.; Pirozzi, Francesco

2015-01-01

Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC 50 of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid

Treatment of natural rubber processing wastewater using a combination system of a two-stage up-flow anaerobic sludge blanket and down-flow hanging sponge system.

Science.gov (United States)

Tanikawa, D; Syutsubo, K; Hatamoto, M; Fukuda, M; Takahashi, M; Choeisai, P K; Yamaguchi, T

2016-01-01

A pilot-scale experiment of natural rubber processing wastewater treatment was conducted using a combination system consisting of a two-stage up-flow anaerobic sludge blanket (UASB) and a down-flow hanging sponge (DHS) reactor for more than 10 months. The system achieved a chemical oxygen demand (COD) removal efficiency of 95.7% ± 1.3% at an organic loading rate of 0.8 kg COD/(m(3).d). Bacterial activity measurement of retained sludge from the UASB showed that sulfate-reducing bacteria (SRB), especially hydrogen-utilizing SRB, possessed high activity compared with methane-producing bacteria (MPB). Conversely, the acetate-utilizing activity of MPB was superior to SRB in the second stage of the reactor. The two-stage UASB-DHS system can reduce power consumption by 95% and excess sludge by 98%. In addition, it is possible to prevent emissions of greenhouse gases (GHG), such as methane, using this system. Furthermore, recovered methane from the two-stage UASB can completely cover the electricity needs for the operation of the two-stage UASB-DHS system, accounting for approximately 15% of the electricity used in the natural rubber manufacturing process.

Grid Integration of Single Stage Solar PV System using Three-level Voltage Source Converter

Science.gov (United States)

Hussain, Ikhlaq; Kandpal, Maulik; Singh, Bhim

2016-08-01

This paper presents a single stage solar PV (photovoltaic) grid integrated power generating system using a three level voltage source converter (VSC) operating at low switching frequency of 900 Hz with robust synchronizing phase locked loop (RS-PLL) based control algorithm. To track the maximum power from solar PV array, an incremental conductance algorithm is used and this maximum power is fed to the grid via three-level VSC. The use of single stage system with three level VSC offers the advantage of low switching losses and the operation at high voltages and high power which results in enhancement of power quality in the proposed system. Simulated results validate the design and control algorithm under steady state and dynamic conditions.

Low cryogen inventory, forced flow Ne cooling system with room temperature compression stage and heat recuperation

CERN Document Server

Shornikov, A; Wolf, A

2014-01-01

We present design and commissioning results of a forced flow cooling system utilizing neon at 30 K. The cryogen is pumped through the system by a room-temperature compression stage. To decouple the cold zone from the compression stage a recuperating counterflow tube-in-tube heat exchanger is used. Commissioning demonstrated successful condensation of neon and transfer of up to 30 W cooling power to the load at 30 K using only 30 g of the cryogen circulating in the system at pressures below 170 kPa.

Two-stage simplified swarm optimization for the redundancy allocation problem in a multi-state bridge system

International Nuclear Information System (INIS)

Lai, Chyh-Ming; Yeh, Wei-Chang

2016-01-01

The redundancy allocation problem involves configuring an optimal system structure with high reliability and low cost, either by alternating the elements with more reliable elements and/or by forming them redundantly. The multi-state bridge system is a special redundancy allocation problem and is commonly used in various engineering systems for load balancing and control. Traditional methods for redundancy allocation problem cannot solve multi-state bridge systems efficiently because it is impossible to transfer and reduce a multi-state bridge system to series and parallel combinations. Hence, a swarm-based approach called two-stage simplified swarm optimization is proposed in this work to effectively and efficiently solve the redundancy allocation problem in a multi-state bridge system. For validating the proposed method, two experiments are implemented. The computational results indicate the advantages of the proposed method in terms of solution quality and computational efficiency. - Highlights: • Propose two-stage SSO (SSO_T_S) to deal with RAP in multi-state bridge system. • Dynamic upper bound enhances the efficiency of searching near-optimal solution. • Vector-update stages reduces the problem dimensions. • Statistical results indicate SSO_T_S is robust both in solution quality and runtime.

18F-FDG PET/CT prediction of malignant versus benign lesion in patients presenting with adnexal mass

DEFF Research Database (Denmark)

Frost, Majbritt; Iyer, Victor Vishwanath; Fisker, Rune Vincents

2011-01-01

classified as benign or malignant and the results were compared with the registered intra-operative findings and the final histopathological examination. Preoperative 18F-FDG PET/CT-based staging was compared to the final histopathological staging according to FIGO 2003. Results: The preliminary results......%] and a specificity of 76 % CI: [63; 87%]. Conclusions: 18F-FDG PET/CT-scanning can be useful for preoperative differentiation between benign and malignant adnexal masses. Furthermore, as a whole-body examination with intravenous contrast, it gives useful information of metastasis extent of malignant diseases...

Magnetic Resonance Imaging Features of the Nigrostriatal System: Biomarkers of Parkinson’s Disease Stages?

Science.gov (United States)

Hopes, Lucie; Grolez, Guillaume; Moreau, Caroline; Lopes, Renaud; Ryckewaert, Gilles; Carrière, Nicolas; Auger, Florent; Laloux, Charlotte; Petrault, Maud; Devedjian, Jean-Christophe; Bordet, Regis; Defebvre, Luc; Jissendi, Patrice; Delmaire, Christine; Devos, David

2016-01-01

Introduction Magnetic resonance imaging (MRI) can be used to identify biomarkers in Parkinson’s disease (PD); R2* values reflect iron content related to high levels of oxidative stress, whereas volume and/or shape changes reflect neuronal death. We sought to assess iron overload in the nigrostriatal system and characterize its relationship with focal and overall atrophy of the striatum in the pivotal stages of PD. Methods Twenty controls and 70 PD patients at different disease stages (untreated de novo patients, treated early-stage patients and advanced-stage patients with L-dopa-related motor complications) were included in the study. We determined the R2* values in the substantia nigra, putamen and caudate nucleus, together with striatal volume and shape analysis. We also measured R2* in an acute MPTP mouse model and in a longitudinal follow-up two years later in the early-stage PD patients. Results The R2* values in the substantia nigra, putamen and caudate nucleus were significantly higher in de novo PD patients than in controls. Early-stage patients displayed significantly higher R2* values in the substantia nigra (with changes in striatal shape), relative to de novo patients. Measurements after a two-year follow-up in early-stage patients and characterization of the acute MPTP mouse model confirmed that R2* changed rapidly with disease progression. Advanced-stage patients displayed significant atrophy of striatum, relative to earlier disease stages. Conclusion Each pivotal stage in PD appears to be characterized by putative nigrostriatal MRI biomarkers: iron overload at the de novo stage, striatal shape changes at early-stage disease and generalized striatal atrophy at advanced disease. PMID:27035571

Space Launch System, Core Stage, Structural Test Design and Implementation

Science.gov (United States)

Shaughnessy, Ray

2017-01-01

As part of the National Aeronautics and Space Administration's (NASA) Space Launch System (SLS) Program, engineers at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama are working to design, develop and implement the SLS Core Stage structural testing. The SLS will have the capability to return humans to the Moon and beyond and its first launch is scheduled for December of 2017. The SLS Core Stage consist of five major elements; Forward Skirt, Liquid Oxygen (LOX) tank, Intertank (IT), Liquid Hydrogen (LH2) tank and the Engine Section (ES). Structural Test Articles (STA) for each of these elements are being designed and produced by Boeing at Michoud Assembly Facility located in New Orleans, La. The structural test for the Core Stage STAs (LH2, LOX, IT and ES) are to be conducted by the MSFC Test Laboratory. Additionally, the MSFC Test Laboratory manages the Structural Test Equipment (STE) design and development to support the STAs. It was decided early (April 2012) in the project life that the LH2 and LOX tank STAs would require new test stands and the Engine Section and Intertank would be tested in existing facilities. This decision impacted schedules immediately because the new facilities would require Construction of Facilities (C of F) funds that require congressional approval and long lead times. The Engine Section and Intertank structural test are to be conducted in existing facilities which will limit lead times required to support the first launch of SLS. With a SLS launch date of December, 2017 Boeing had a need date for testing to be complete by September of 2017 to support flight certification requirements. The test facilities were required to be ready by October of 2016 to support test article delivery. The race was on to get the stands ready before Test Article delivery and meet the test complete date of September 2017. This paper documents the past and current design and development phases and the supporting processes, tools, and

Diagnostic and prognostic potential of serum miR-7, miR-16, miR-25, miR-93, miR-182, miR-376a and miR-429 in ovarian cancer patients.

Science.gov (United States)

Meng, Xiaodan; Joosse, Simon A; Müller, Volkmar; Trillsch, Fabian; Milde-Langosch, Karin; Mahner, Sven; Geffken, Maria; Pantel, Klaus; Schwarzenbach, Heidi

2015-11-03

Owing to late diagnosis in advanced disease stages, prognosis of patients with epithelial ovarian cancer (EOC) is poor. The quantification of deregulated levels of microRNAs could facilitate earlier diagnosis and improve prognosis of EOC. Seven microRNAs (miR-7, miR-16, miR-25, miR-93, miR-182, miR-376a and miR-429) were quantified in the serum of 180 EOC patients and 66 healthy women by TaqMan PCR microRNA assays. Median follow-up time was 21 months. The effects of miR-7 and miR-429 on apoptosis, cell proliferation, migration and invasion were investigated in two (EOC) cell lines. Serum levels of miR-25 (P=0.0001) and miR-93 (P=0.0001) were downregulated, whereas those of miR-7 (P=0.001) and miR-429 (P=0.0001) were upregulated in EOC patients compared with healthy women. The four microRNAs discriminated EOC patients from healthy women with a sensitivity of 93% and a specificity of 92%. The levels of miR-429 positively correlated with CA125 values (P=0.0001) and differed between FIGO I-II and III-IV stages (P=0.001). MiR-429 was an independent predictor of overall survival (P=0.011). Overexpressed miR-429 in SKOV3 cells led to suppression of cell migration (P=0.037) and invasion (P=0.011). Increased levels of miR-7 were associated with lymph node metastases (P=0.0001) and FIGO stages III-IV (P=0.0001). Overexpressed miR-7 in SKOV3 cells resulted in increased cell migration (P=0.001) and invasion (P=0.011). Additionally, the increased levels of miR-376a correlated with FIGO stages III-IV (P=0.02). Our data indicate the diagnostic potential of miR-7, miR-25, miR-93 and miR-429 in EOC and the prognostic potential of miR-429. This microRNA panel may be promising molecules to be targeted in the treatment of EOC.

Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients

Directory of Open Access Journals (Sweden)

Tejerizo-García A

2013-09-01

Full Text Available Álvaro Tejerizo-García,1 Jesús S Jiménez-López,1 José L Muñoz-González,1 Sara Bartolomé-Sotillos,1 Laura Marqueta-Marqués,1 Gregorio López-González,1 José F Pérez-Regadera Gómez21Service of Obstetrics and Gynecology, 2Radiation Oncology Service, Hospital Universitario 12 de Octubre, Madrid, SpainObjective: The aim of the study reported here was to assess the disease-free survival and overall survival of patients with endometrial cancer and to determine independent factors affecting the prognosis.Materials and methods: This was a retrospective study of a single-center clinical series of 276 patients (mean age 64 years with histologically confirmed cancer of the corpus uteri. The standard treatments were extrafascial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic/para-aortic node dissection, according to risk for recurrence. Actuarial overall survival and disease-free survival were estimated according to the Kaplan–Meier method. Univariate and multivariate Cox proportional hazards analyses were used to assess the prognostic significance of the different variables.Results: The estimated median follow-up, determined using the inverse Kaplan–Meier method, was 45 months (95% confidence interval [CI] 41.2–48.8 for disease-free survival and 46 months (95% CI 43.0–49.0 for overall survival. The statistically significant variables affecting disease-free survival and overall survival were age, serous-papillary and clear-cell histological types, outer-half myometrial invasion, advanced International Federation of Gynecology and Obstetrics (FIGO stage, tumor grades G2 and G3, incomplete surgical resection, positive lymph nodes, lymphovascular space invasion, tumor remnants of >1 cm after surgery, and high-risk group. In the multivariate Cox regression model, predictors of tumor recurrence included advanced FIGO stage (hazard ratio [HR] 4.90, 95% CI 2.57–9.36, P < 0.001 and tumor grades G2 (HR 4.79, 95

Validation of the Hong Kong Liver Cancer Staging System in Determining Prognosis of the North American Patients Following Intra-arterial Therapy

Science.gov (United States)

Sohn, Jae Ho; Duran, Rafael; Zhao, Yan; Fleckenstein, Florian; Chapiro, Julius; Sahu, Sonia P.; Schernthaner, Rüdiger E.; Qian, Tianchen; Lee, Howard; Zhao, Li; Hamilton, James; Frangakis, Constantine; Lin, MingDe; Salem, Riad; Geschwind, Jean-Francois

2018-01-01

Background & Aims There is debate over the best way to stage hepatocellular carcinoma (HCC). We attempted to validate the prognostic and clinical utility of the recently developed Hong Kong Liver Cancer (HKLC) staging system, a hepatitis B-based model, and compared data with that from the Barcelona Clinic Liver Cancer (BCLC) staging system in a North American population who underwent intra-arterial therapy (IAT). Methods We performed a retrospective analysis of data from 1009 patients with HCC who underwent intra-arterial therapy from 2000 through 2014. Most patients had hepatitis C or unresectable tumors; all patients underwent IAT, with or without resection, transplantation, and/or systemic chemotherapy. We calculated HCC stage for each patient using 5-stage HKLC (HKLC-5) and 9-stage HKLC (HKLC-9) system classifications, as well as the BCLC system. Survival information was collected up until end of 2014 at which point living or unconfirmed patients were censored. We compared performance of the BCLC, HKLC-5, and HKLC-9 systems in predicting patient outcomes using Kaplan-Meier estimates, calibration plots, c-statistic, Akaike information criterion, and the likelihood ratio test. Results Median overall survival time, calculated from first IAT until date of death or censorship, for the entire cohort (all stages) was 9.8 months. The BCLC and HKLC staging systems predicted patient survival times with significance (P<.001). HKLC-5 and HKLC-9 each demonstrated good calibration. The HKLC-5 system outperformed the BCLC system in predicting patient survival times (HKLC c=0.71, Akaike information criterion=6242; BCLC c=0.64, Akaike information criterion=6320), reducing error in predicting survival time (HKLC reduced error by 14%, BCLC reduced error by 12%), and homogeneity (HKLC χ2=201; P<.001; BCLC χ2=119; P<.001) and monotonicity (HKLC linear trend χ2=193; P<.001; BCLC linear trend χ2=111; P<.001). Small proportions of patients with HCC of stages IV or V, according to

Application of preference selection index method for decision making over the design stage of production system life cycle

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Rajesh Attri

2015-07-01

Full Text Available The life cycle of production system shows the progress of production system from the inception to the termination of the system. During each stage, mainly in the design stage, certain strategic decisions have to be taken. These decisions are more complex as the decision makers have to assess a wide range of alternatives based on a set of conflicting criteria. As the decision making process is found to be unstructured, characterized by domain dependent knowledge, there is a need to apply an efficient multi-criteria decision making (MCDM tool to help the decision makers in making correct decisions. This paper explores the application of a novel MCDM method i.e. Preference selection index (PSI method to solve various decision-making problems that are generally encountered in the design stage of production system life cycle. To prove the potentiality, applicability and accuracy of PSI method in solving decision making problem during the design stage of production system life cycle, five examples are cited from the literature and are compared with the results obtained by the past researchers.

An adaptive three-stage extended Kalman filter for nonlinear discrete-time system in presence of unknown inputs.

Science.gov (United States)

Xiao, Mengli; Zhang, Yongbo; Wang, Zhihua; Fu, Huimin

2018-04-01

Considering the performances of conventional Kalman filter may seriously degrade when it suffers stochastic faults and unknown input, which is very common in engineering problems, a new type of adaptive three-stage extended Kalman filter (AThSEKF) is proposed to solve state and fault estimation in nonlinear discrete-time system under these conditions. The three-stage UV transformation and adaptive forgetting factor are introduced for derivation, and by comparing with the adaptive augmented state extended Kalman filter, it is proven to be uniformly asymptotically stable. Furthermore, the adaptive three-stage extended Kalman filter is applied to a two-dimensional radar tracking scenario to illustrate the effect, and the performance is compared with that of conventional three stage extended Kalman filter (ThSEKF) and the adaptive two-stage extended Kalman filter (ATEKF). The results show that the adaptive three-stage extended Kalman filter is more effective than these two filters when facing the nonlinear discrete-time systems with information of unknown inputs not perfectly known. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

Health system delay and its effect on clinical stage of breast cancer: Multicenter study.

Science.gov (United States)

Unger-Saldaña, Karla; Miranda, Alfonso; Zarco-Espinosa, Gelasio; Mainero-Ratchelous, Fernando; Bargalló-Rocha, Enrique; Miguel Lázaro-León, Jesús

2015-07-01

The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. This was a cross-sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Two-Stage orders sequencing system for mixed-model assembly

Science.gov (United States)

Zemczak, M.; Skolud, B.; Krenczyk, D.

2015-11-01

In the paper, the authors focus on the NP-hard problem of orders sequencing, formulated similarly to Car Sequencing Problem (CSP). The object of the research is the assembly line in an automotive industry company, on which few different models of products, each in a certain number of versions, are assembled on the shared resources, set in a line. Such production type is usually determined as a mixed-model production, and arose from the necessity of manufacturing customized products on the basis of very specific orders from single clients. The producers are nowadays obliged to provide each client the possibility to determine a huge amount of the features of the product they are willing to buy, as the competition in the automotive market is large. Due to the previously mentioned nature of the problem (NP-hard), in the given time period only satisfactory solutions are sought, as the optimal solution method has not yet been found. Most of the researchers that implemented inaccurate methods (e.g. evolutionary algorithms) to solving sequencing problems dropped the research after testing phase, as they were not able to obtain reproducible results, and met problems while determining the quality of the received solutions. Therefore a new approach to solving the problem, presented in this paper as a sequencing system is being developed. The sequencing system consists of a set of determined rules, implemented into computer environment. The system itself works in two stages. First of them is connected with the determination of a place in the storage buffer to which certain production orders should be sent. In the second stage of functioning, precise sets of sequences are determined and evaluated for certain parts of the storage buffer under certain criteria.

Optics of two-stage photovoltaic concentrators with dielectric second stages

Science.gov (United States)

Ning, Xiaohui; O'Gallagher, Joseph; Winston, Roland

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Optics of two-stage photovoltaic concentrators with dielectric second stages.

Science.gov (United States)

Ning, X; O'Gallagher, J; Winston, R

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

Energy Technology Data Exchange (ETDEWEB)

Ariunbaatar, Javkhlan, E-mail: jaka@unicas.it [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Scotto Di Perta, Ester [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy); Panico, Antonio [Telematic University PEGASO, Piazza Trieste e Trento, 48, 80132 Naples (Italy); Frunzo, Luigi [Department of Mathematics and Applications Renato Caccioppoli, University of Naples Federico II, Via Claudio, 21, 80125 Naples (Italy); Esposito, Giovanni [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); Lens, Piet N.L. [UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Pirozzi, Francesco [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy)

2015-04-15

Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC{sub 50} of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid.

Organic semiconductor wastewater treatment using a four-stage Bardenpho with membrane system.

Science.gov (United States)

Chung, Jinwook; Fleege, Daniel; Ong, Say Kee; Lee, Yong-Woo

2014-01-01

Electronic wastewater from a semiconductor plant was treated with a pilot-scale four-stage Bardenpho process with membrane system. The system was operated over a 14-month period with an overall hydraulic retention time (HRT) ranging from 9.5 to 30 h. With a few exceptions, the pilot plant consistently treated the electronic wastewater with an average removal efficiency of chemical oxygen demand (COD) and total nitrogen of 97% and 93%, respectively, and achieving effluent quality of COD<15 mg/L, turbidity<1, and silt density index<1. Based on removal efficiencies of the pilot plant, it is possible to lower the HRT to less than 9.5 h to achieve comparable removal efficiencies. An energy-saving configuration where an internal recycle line was omitted and the biomass recycle was rerouted to the pre-anoxic tank, can reduce energy consumption by 8.6% and gave removal efficiencies that were similar to the Bardenpho process. The system achieved pre-anoxic and post-anoxic specific denitrification rate values with a 95% confidence interval of 0.091 ± 0.011 g NO₃-N/g MLVSS d and 0.087 ± 0.016 g NO₃-N/g MLVSS d, respectively. The effluent from the four-stage Bardenpho with membrane system can be paired with a reverse osmosis system to provide further treatment for reuse purposes.

Two-stage open-loop velocity compensating method applied to multi-mass elastic transmission system

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Zhang Deli

2014-02-01

Full Text Available In this paper, a novel vibration-suppression open-loop control method for multi-mass system is proposed, which uses two-stage velocity compensating algorithm and fuzzy I + P controller. This compensating method is based on model-based control theory in order to provide a damping effect on the system mechanical part. The mathematical model of multi-mass system is built and reduced to estimate the velocities of masses. The velocity difference between adjacent masses is calculated dynamically. A 3-mass system is regarded as the composition of two 2-mass systems in order to realize the two-stage compensating algorithm. Instead of using a typical PI controller in the velocity compensating loop, a fuzzy I + P controller is designed and its input variables are decided according to their impact on the system, which is different from the conventional fuzzy PID controller designing rules. Simulations and experimental results show that the proposed velocity compensating method is effective in suppressing vibration on a 3-mass system and it has a better performance when the designed fuzzy I + P controller is utilized in the control system.

Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

NARCIS (Netherlands)

Heijdenrijk, Kees

2002-01-01

The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

Computerized breast cancer analysis system using three stage semi-supervised learning method.

Science.gov (United States)

Sun, Wenqing; Tseng, Tzu-Liang Bill; Zhang, Jianying; Qian, Wei

2016-10-01

A large number of labeled medical image data is usually a requirement to train a well-performed computer-aided detection (CAD) system. But the process of data labeling is time consuming, and potential ethical and logistical problems may also present complications. As a result, incorporating unlabeled data into CAD system can be a feasible way to combat these obstacles. In this study we developed a three stage semi-supervised learning (SSL) scheme that combines a small amount of labeled data and larger amount of unlabeled data. The scheme was modified on our existing CAD system using the following three stages: data weighing, feature selection, and newly proposed dividing co-training data labeling algorithm. Global density asymmetry features were incorporated to the feature pool to reduce the false positive rate. Area under the curve (AUC) and accuracy were computed using 10 fold cross validation method to evaluate the performance of our CAD system. The image dataset includes mammograms from 400 women who underwent routine screening examinations, and each pair contains either two cranio-caudal (CC) or two mediolateral-oblique (MLO) view mammograms from the right and the left breasts. From these mammograms 512 regions were extracted and used in this study, and among them 90 regions were treated as labeled while the rest were treated as unlabeled. Using our proposed scheme, the highest AUC observed in our research was 0.841, which included the 90 labeled data and all the unlabeled data. It was 7.4% higher than using labeled data only. With the increasing amount of labeled data, AUC difference between using mixed data and using labeled data only reached its peak when the amount of labeled data was around 60. This study demonstrated that our proposed three stage semi-supervised learning can improve the CAD performance by incorporating unlabeled data. Using unlabeled data is promising in computerized cancer research and may have a significant impact for future CAD system

Strengthening power generation efficiency utilizing liquefied natural gas cold energy by a novel two-stage condensation Rankine cycle (TCRC) system

International Nuclear Information System (INIS)

Bao, Junjiang; Lin, Yan; Zhang, Ruixiang; Zhang, Ning; He, Gaohong

2017-01-01

Highlights: • A two-stage condensation Rankine cycle (TCRC) system is proposed. • Net power output and thermal efficiency increases by 45.27% and 42.91%. • The effects of the condensation temperatures are analyzed. • 14 working fluids (such as propane, butane etc.) are compared. - Abstract: For the low efficiency of the traditional power generation system with liquefied natural gas (LNG) cold energy utilization, by improving the heat transfer characteristic between the working fluid and LNG, this paper has proposed a two-stage condensation Rankine cycle (TCRC) system. Using propane as working fluid, compared with the combined cycle in the conventional LNG cold energy power generation method, the net power output, thermal efficiency and exergy efficiency of the TCRC system are respectively increased by 45.27%, 42.91% and 52.31%. Meanwhile, the effects of the first-stage and second-stage condensation temperature and LNG vaporization pressure on the performance and cost index of the TCRC system (net power output, thermal efficiency, exergy efficiency and UA) are analyzed. Finally, using the net power output as the objective function, with 14 organic fluids (such as propane, butane etc.) as working fluids, the first-stage and second-stage condensation temperature at different LNG vaporization pressures are optimized. The results show that there exists a first-stage and second-stage condensation temperature making the performance of the TCRC system optimal. When LNG vaporization pressure is supercritical pressure, R116 has the best economy among all the investigated working fluids, and while R150 and R23 are better when the vaporization pressure of LNG is subcritical.

Performance evaluation of a piezoactuator-based single-stage valve system subjected to high temperature

Science.gov (United States)

Jeon, Juncheol; Han, Chulhee; Chung, Jye Ung; Choi, Seung-Bok

2015-01-01

In this paper, a novel single-stage valve system activated by a piezostack actuator is proposed and experimentally evaluated at both room temperature (20 °C) and high temperature (100 °C) conditions. A hinge-lever displacement amplifier is adopted in the valve system to magnify the displacement generated from the piezostack actuator. After explaining the operating principle of the proposed piezostack-driven single-stage valve system, the geometric dimensions and mechanical properties of the valve components are discussed in details. An experimental apparatus is then manufactured to evaluate the performances of the valve system such as flow rate. The experimental apparatus consists of a heat chamber, which can regulate the temperature of the valve system and oil, pneumatic-hydraulic cylinders, a hydraulic circuit, a pneumatic circuit, electronic devices, an interface card, and a high voltage amplifier. The pneumatic-hydraulic cylinder transforms the pneumatic pressure into hydraulic pressure. The performances of the valve system regarding spool response, pressure drop, and flow rate are evaluated and presented. In addition, the performance of the valve system under high temperature condition is compared with that under room temperature condition. The experimental results are plotted in both frequency and time domains.

Performance evaluation of a piezoactuator-based single-stage valve system subjected to high temperature

International Nuclear Information System (INIS)

Jeon, Juncheol; Han, Chulhee; Ung Chung, Jye; Choi, Seung-Bok

2015-01-01

In this paper, a novel single-stage valve system activated by a piezostack actuator is proposed and experimentally evaluated at both room temperature (20 °C) and high temperature (100 °C) conditions. A hinge-lever displacement amplifier is adopted in the valve system to magnify the displacement generated from the piezostack actuator. After explaining the operating principle of the proposed piezostack-driven single-stage valve system, the geometric dimensions and mechanical properties of the valve components are discussed in details. An experimental apparatus is then manufactured to evaluate the performances of the valve system such as flow rate. The experimental apparatus consists of a heat chamber, which can regulate the temperature of the valve system and oil, pneumatic-hydraulic cylinders, a hydraulic circuit, a pneumatic circuit, electronic devices, an interface card, and a high voltage amplifier. The pneumatic-hydraulic cylinder transforms the pneumatic pressure into hydraulic pressure. The performances of the valve system regarding spool response, pressure drop, and flow rate are evaluated and presented. In addition, the performance of the valve system under high temperature condition is compared with that under room temperature condition. The experimental results are plotted in both frequency and time domains. (paper)

Two-Stage Battery Energy Storage System (BESS in AC Microgrids with Balanced State-of-Charge and Guaranteed Small-Signal Stability

Directory of Open Access Journals (Sweden)

Bing Xie

2018-02-01

Full Text Available In this paper, a two-stage battery energy storage system (BESS is implemented to enhance the operation condition of conventional battery storage systems in a microgrid. Particularly, the designed BESS is composed of two stages, i.e., Stage I: integration of dispersed energy storage units (ESUs using parallel DC/DC converters, and Stage II: aggregated ESUs in grid-connected operation. Different from a conventional BESS consisting of a battery management system (BMS and power conditioning system (PCS, the developed two-stage architecture enables additional operation and control flexibility in balancing the state-of-charge (SoC of each ESU and ensures the guaranteed small-signal stability, especially in extremely weak grid conditions. The above benefits are achieved by separating the control functions between the two stages. In Stage I, a localized power sharing scheme based on the SoC of each particular ESU is developed to manage the SoC and avoid over-charge or over-discharge issues; on the other hand, in Stage II, an additional virtual impedance loop is implemented in the grid-interactive DC/AC inverters to enhance the stability margin with multiple parallel-connected inverters integrating at the point of common coupling (PCC simultaneously. A simulation model based on MATLAB/Simulink is established, and simulation results verify the effectiveness of the proposed BESS architecture and the corresponding control diagram.

Dynamic solar-powered multi-stage direct contact membrane distillation system: Concept design, modeling and simulation

KAUST Repository

Lee, Jung Gil; Kim, Woo-Seung; Choi, June-Seok; Ghaffour, NorEddine; Kim, Young-Deuk

2017-01-01

This paper presents a theoretical analysis of the monthly average daily and hourly performances of a solar-powered multi-stage direct contact membrane distillation (SMDCMD) system with an energy recovery scheme and dynamic operating system. Mid

High dose rate brachytherapy for carcinoma of the cervix: risk factors for late rectal complications

International Nuclear Information System (INIS)

Uno, Takashi; Itami, Jun; Aruga, Moriyo; Kotaka, Kikuo; Fujimoto, Hajime; Minoura, Shigeki

1996-01-01

Purpose/Objective: To determine the incidence of late rectal complications in patients treated with high dose rate brachytherapy for FIGO stage IIB, IIIB carcinoma of the uterine cervix, and to evaluate the treatment factors associated with an increased probability of treatment complications. Materials and Methods: Records of 100 patients with FIGO IIB or IIIB cervical carcinoma treated with definitive irradiation using high dose rate intracavitary brachytherapy (HDR-ICR) between 1977 and 1994 were retrospectively reviewed. For each HDR-ICR session, 6 Gy isodose volume was reconstructed three dimensionally and the following three parameters were determined to represent this isodose volume, length (L); maximum longitudinal distance of 6 Gy isodose area in an oblique frontal plane containing the intrauterine applicator, width (W); maximum width of 6 Gy isodose area in the same plane, height (H); maximum dimension of 6 Gy isodose area perpendicular to the intrauterine applicator determined in the oblique sagittal plane. Point P/Q (2 cm ventral/dorsal from the proximal retention point of the intrauterine source) and point R/S (2 cm ventral/dorsal from the midpoint of the ovoid sources) were also defined retrospectively and HDR-ICR dose at these points were calculated. Statistical analyses were performed to determine the treatment factors predictive of late rectal complications. Results: The 5-year cumulative cause-specific disease-free survival rate was 50% for all, 74% for Stage IIB, and 38% for Stage IIIB, with a significant difference between two FIGO Stages (p=0.0004). Of patients treated for both stages, 30% and 36% had experienced moderate to severe (Grade 2-4) complications at 3 and 5 years, respectively. Average H value (p=0.013) and cumulative point S dose by HDR-ICR (p=0.020) were significantly correlated with the incidence of late rectal complications (Student's t-test), whereas these factors did not significantly affect the probability of pelvic control. No

Seasonal thermal energy storage in shallow geothermal systems: thermal equilibrium stage

Directory of Open Access Journals (Sweden)

Nowamooz Hossein

2016-01-01

Full Text Available This paper is dedicated to the study of seasonal heat storage in shallow geothermal installations in unsaturated soils for which hydrothermal properties such as degree of saturation and thermal conductivity vary with time throughout the profile. In the model, a semi-analytical model which estimates time-spatial thermal conductivity is coupled with a 2D cylindrical heat transfer modeling using finite difference method. The variation of temperature was obtained after 3 heating and cooling cycles for the different types of loads with maximum thermal load of qmax = 15 W.m−1 with variable angular frequency (8 months of heating and 4 months of cooling.and constant angular frequency (6 months of heating and 6 months of cooling to estimate the necessary number of cycles to reach the thermal equilibrium stage. The results show that we approach a thermal equilibrium stage where the same variation of temperature can be observed in soils after several heating and cooling cycles. Based on these simulations, the necessary number of cycles can be related to the total applied energy on the system and the minimum number of cycles is for a system with the total applied energy of 1.9qmax.

[Integrative management using Ayurvedic medicine in a patient with advanced malignant mixed Muellerian tumor - a case report].

Science.gov (United States)

Kronpaß, Ludwig; Krampol, Stefan; Brattinger, Petra; Stapelfeldt, Elmar; Kessler, Christian

2014-01-01

Carcinosarcoma of the uterus is a rare malignant tumor with an extremely poor prognosis. Because there are just a few cases described, there is little evidence on possible treatment options. An improvement in the overall unsatisfactory therapeutic situation is required. The management of an advanced stage uterine carcinosarcoma, at the time of primary diagnosis in FIGO stage 4, in a 67-year-old woman is described, including multiple surgical interventions, radiotherapy, chemotherapy, and the complementary use of elements of Ayurvedic medicine. To this date, the 3-year follow-up revealed no evidence of distant metastasis. A high quality of life could be ensured continuously. Even with poor prognosis, tumor entities can be controlled by using all the available medical resources, enabling a satisfactory quality of life over a longer period of time. For this reason, the complementary use of the traditional medical system Ayurveda could be helpful.

ABC transporters and xenobiotic defense systems in early life stages of rainbow trout (Oncorhynchus mykiss).

Science.gov (United States)

Kropf, Christian; Segner, Helmut; Fent, Karl

2016-01-01

Embryos of oviparous fish, in contrast to (ovo) viviparous species, develop in the aquatic environment, and therefore need solute transport systems at their body surfaces for maintaining internal homeostasis and defending against potentially harmful substances. We hypothesized that solute transporters undergo changes in tissue distribution from the embryo to the larval stage. We therefore studied the mRNA profiles of eight ABC transporters (abcb1a, abcb1b, abcc1, abcc2, abcc3, abcc4, abcc5, abcg2) and three solute carriers (oatp1d, putative oatp2 putative, mate1) in different body regions (head, yolk sac epithelium, abdominal viscera, skin/muscles) of developing rainbow trout. Additionally, we investigated mRNA levels of phase I (cyp1a, cyp3a) and phase II (gstp, putative ugt1, putative ugt2) biotransformation enzymes. The study covered the developmental period from the eleuthero-embryo stage to the first-feeding larval stage (1-20days post-hatch, dph). At 1dph, transcripts of abcc2, abcc4, abcg2, cyp3a, gstp, putative mate1, and putative oatp2 occurred primarily in the yolk sac epithelium, whereas at later stages expression of these genes was predominantly observed in the abdominal viscera. The functional activity of ABC transporters in fish early life stages was assessed by rhodamine B accumulation assays. Finally, we investigated the potential impact of xenobiotics (clotrimazole, clofibric acid) on the ABC and biotransformation systems of trout early life stages. While clofibric acid had no effect, clotrimazole lead to an increased rhodamine B accumulation. The results provide evidence that the transition from the eleuthero-embryo to the larval stage is accompanied by a major alteration in tissue expression of ABC transporters. Copyright © 2016 Elsevier Inc. All rights reserved.

Adaptive fuzzy trajectory control for biaxial motion stage system

Directory of Open Access Journals (Sweden)

Wei-Lung Mao

2016-04-01

Full Text Available Motion control is an essential part of industrial machinery and manufacturing systems. In this article, the adaptive fuzzy controller is proposed for precision trajectory tracking control in biaxial X-Y motion stage system. The theoretical analyses of direct fuzzy control which is insensitive to parameter uncertainties and external load disturbances are derived to demonstrate the feasibility to track the reference trajectories. The Lyapunov stability theorem has been used to testify the asymptotic stability of the whole system, and all the signals are bounded in the closed-loop system. The intelligent position controller combines the merits of the adaptive fuzzy control with robust characteristics and learning ability for periodic command tracking of a servo drive mechanism. The simulation and experimental results on square, triangle, star, and circle reference contours are presented to show that the proposed controller indeed accomplishes the better tracking performances with regard to model uncertainties. It is observed that the convergence of parameters and tracking errors can be faster and smaller compared with the conventional adaptive fuzzy control in terms of average tracking error and tracking error standard deviation.

Plasma gasification of refuse derived fuel in a single-stage system using different gasifying agents.

Science.gov (United States)

Agon, N; Hrabovský, M; Chumak, O; Hlína, M; Kopecký, V; Masláni, A; Bosmans, A; Helsen, L; Skoblja, S; Van Oost, G; Vierendeels, J

2016-01-01

The renewable evolution in the energy industry and the depletion of natural resources are putting pressure on the waste industry to shift towards flexible treatment technologies with efficient materials and/or energy recovery. In this context, a thermochemical conversion method of recent interest is plasma gasification, which is capable of producing syngas from a wide variety of waste streams. The produced syngas can be valorized for both energetic (heat and/or electricity) and chemical (ammonia, hydrogen or liquid hydrocarbons) end-purposes. This paper evaluates the performance of experiments on a single-stage plasma gasification system for the treatment of refuse-derived fuel (RDF) from excavated waste. A comparative analysis of the syngas characteristics and process yields was done for seven cases with different types of gasifying agents (CO2+O2, H2O, CO2+H2O and O2+H2O). The syngas compositions were compared to the thermodynamic equilibrium compositions and the performance of the single-stage plasma gasification of RDF was compared to that of similar experiments with biomass and to the performance of a two-stage plasma gasification process with RDF. The temperature range of the experiment was from 1400 to 1600 K and for all cases, a medium calorific value syngas was produced with lower heating values up to 10.9 MJ/Nm(3), low levels of tar, high levels of CO and H2 and which composition was in good agreement to the equilibrium composition. The carbon conversion efficiency ranged from 80% to 100% and maximum cold gas efficiency and mechanical gasification efficiency of respectively 56% and 95%, were registered. Overall, the treatment of RDF proved to be less performant than that of biomass in the same system. Compared to a two-stage plasma gasification system, the produced syngas from the single-stage reactor showed more favourable characteristics, while the recovery of the solid residue as a vitrified slag is an advantage of the two-stage set-up. Copyright �

System-Level Optimization of a DAC for Hearing-Aid Audio Class D Output Stage

DEFF Research Database (Denmark)

Pracný, Peter; Jørgensen, Ivan Harald Holger; Bruun, Erik

2013-01-01

This paper deals with system-level optimization of a digital-to-analog converter (DAC) for hearing-aid audio Class D output stage. We discuss the ΣΔ modulator system-level design parameters – the order, the oversampling ratio (OSR) and the number of bits in the quantizer. We show that combining...... by comparing two ΣΔ modulator designs. The proposed optimization has impact on the whole hearing-aid audio back-end system including less hardware in the interpolation filter and half the switching rate in the digital-pulse-width-modulation (DPWM) block and Class D output stage...... a reduction of the OSR with an increase of the order results in considerable power savings while the audio quality is kept. For further savings in the ΣΔ modulator, overdesign and subsequent coarse coefficient quantization are used. A figure of merit (FOM) is introduced to confirm this optimization approach...

Dynamic multi-stage dispatch of isolated wind–diesel power systems

International Nuclear Information System (INIS)

Hu, Yu; Morales, Juan M.; Pineda, Salvador; Sánchez, María Jesús; Solana, Pablo

2015-01-01

Highlights: • Optimal decision-making model for isolated hybrid wind–diesel power system is proposed. • Wind power uncertainty and conditional operating cost are considered. • Battery wear cost of the energy storage system is included in the model. • The results are compared with deterministic dispatch strategies. - Abstract: An optimal dispatch strategy is crucial for an isolated wind–diesel power system to save diesel fuel and maintain the system stability. The uncertainty associated with the stochastic character of the wind is, though, a challenging problem for this optimization. In this paper, a dynamic multi-stage decision-making model is proposed to determine the diesel power output that minimizes the cost of running and maintaining the wind–diesel power system. Optimized operational decisions for each time period are generated dynamically considering the path-dependent nature of the optimal dispatch policy, given the plausible future realizations of the wind power production. A numerical case study is analyzed and it is demonstrated that the proposed stochastic dynamic optimization model significantly outperforms the traditional deterministic dispatch strategies

The inflammation-based Glasgow Prognostic Score predicts survival in patients with cervical cancer.

Science.gov (United States)

Polterauer, Stephan; Grimm, Christoph; Seebacher, Veronika; Rahhal, Jasmin; Tempfer, Clemens; Reinthaller, Alexander; Hefler, Lukas

2010-08-01

The Glasgow Prognostic Score (GPS) is known to reflect the degree of tumor-associated cachexia and inflammation and is associated with survival in various malignancies. We investigated the value of the GPS in patients with cervical cancer. We included 244 consecutive patients with cervical cancer in our study. The pretherapeutic GPS was calculated as follows: patients with elevated C-reactive protein serum levels (>10 mg/L) and hypoalbuminemia (L) were allocated a score of 2, and patients with 1 or no abnormal value were allocated a score of 1 or 0, respectively. The association between GPS and survival was evaluated by univariate log-rank tests and multivariate Cox regression models. The GPS was correlated with clinicopathologic parameters as shown by performing chi2 tests. In univariate analyses, GPS (P GPS (P = 0.03, P = 0.04), FIGO stage (P = 0.006, P = 0.006), and lymph node involvement (P = 0.003, P = 0.002), but not patients' age (P = 0.5, P = 0.5), histological grade (P = 0.7, P = 0.6), and histological type (P = 0.4, P = 0.6) were associated with disease-free and overall survival, respectively. The GPS was associated with FIGO stage (P GPS can be used as an inflammation-based predictor for survival in patients with cervical cancer.

A translating stage system for µ-PIV measurements surrounding the tip of a migrating semi-infinite bubble.

Science.gov (United States)

Smith, B J; Yamaguchi, E; Gaver, D P

2010-01-01

We have designed, fabricated and evaluated a novel translating stage system (TSS) that augments a conventional micro particle image velocimetry (µ-PIV) system. The TSS has been used to enhance the ability to measure flow fields surrounding the tip of a migrating semi-infinite bubble in a glass capillary tube under both steady and pulsatile reopening conditions. With conventional µ-PIV systems, observations near the bubble tip are challenging because the forward progress of the bubble rapidly sweeps the air-liquid interface across the microscopic field of view. The translating stage mechanically cancels the mean bubble tip velocity, keeping the interface within the microscope field of view and providing a tenfold increase in data collection efficiency compared to fixed-stage techniques. This dramatic improvement allows nearly continuous observation of the flow field over long propagation distances. A large (136-frame) ensemble-averaged velocity field recorded with the TSS near the tip of a steadily migrating bubble is shown to compare well with fixed-stage results under identical flow conditions. Use of the TSS allows the ensemble-averaged measurement of pulsatile bubble propagation flow fields, which would be practically impossible using conventional fixed-stage techniques. We demonstrate our ability to analyze these time-dependent two-phase flows using the ensemble-averaged flow field at four points in the oscillatory cycle.

Critical Imperative for the Reform of British Interpretation of Fetal Heart Rate Decelerations: Analysis of FIGO and NICE Guidelines, Post-Truth Foundations, Cognitive Fallacies, Myths and Occam’s Razor

Science.gov (United States)

Sholapurkar, Shashikant L.

2017-01-01

Cardiotocography (CTG) has disappointingly failed to show good predictability for fetal acidemia or neonatal outcomes in several large studies. A complete rethink of CTG interpretation will not be out of place. Fetal heart rate (FHR) decelerations are the most common deviations, benign as well as manifestation of impending fetal hypoxemia/acidemia, much more commonly than FHR baseline or variability. Their specific nomenclature is important (center-stage) because it provides the basic concepts and framework on which the complex “pattern recognition” of CTG interpretation by clinicians depends. Unfortunately, the discrimination of FHR decelerations seems to be muddled since the British obstetrics adopted the concept of vast majority of FHR decelerations being “variable” (cord-compression). With proliferation of confusing waveform criteria, “atypical variables” became the commonest cause of suspicious/pathological CTG. However, National Institute for Health and Care Excellence (NICE) (2014) had to disband the “typical” and “atypical” terminology because of flawed classifying criteria. This analytical review makes a strong case that there are major and fundamental framing and confirmation fallacies (not just biases) in interpretation of FHR decelerations by NICE (2014) and International Federation of Gynecology and Obstetrics (FIGO) (2015), probably the biggest in modern medicine. This “post-truth” approach is incompatible with scientific practice. Moreover, it amounts to setting oneself for failure. The inertia to change could be best described as “backfire effect”. There is abundant evidence that head-compression (and other non-hypoxic mediators) causes rapid rather than shallow/gradual decelerations. Currently, the vast majority of decelerations are attributed to unproven cord compression underpinned by flawed disproven pathophysiological hypotheses. Their further discrimination based on abstract, random, trial and error criteria remains

Quantitative Resilience Assessment under a Tri-Stage Framework for Power Systems

Directory of Open Access Journals (Sweden)

Han Zhang

2018-06-01

Full Text Available The frequent occurrence of natural disasters and malicious attacks has exerted unprecedented disturbances on power systems, accounting for the extensive attention paid to power system resilience. Combined with the evolving nature of general disasters, this paper proposes resilience assessment approaches for power systems under a tri-stage framework. The pre-disaster toughness is proposed to quantify the robustness of power systems against potential disasters, where the thinking of area division and partitioned multi-objective risk method (PMRM is introduced. In the case of information deficiency caused by disasters, the during-disaster resistance to disturbance is calculated to reflect the real-time system running state by state estimation (SE. The post-disaster restoration ability consists of response ability, restoration efficiency and restoration economy, which is evaluated by Sequential Monte-Carlo Simulation to simulate the system restoration process. Further, a synthetic metric system is presented to quantify the resilience performance of power systems from the above three aspects. The proposed approaches and framework are validated on the IEEE RTS 79 system, and helpful conclusions are drawn from extensive case studies.

Evaluation of the AJCC 8th Edition Staging System for Pathologically Versus Clinically Staged Intrahepatic Cholangiocarcinoma (iCCA): a Time to Revisit a Dogma? A Surveillance, Epidemiology, and End Results (SEER) Analysis.

Science.gov (United States)

Kamarajah, Sivesh K

2018-03-07

Recently, the AJCC has released its 8th edition changes to the staging system for intrahepatic cholangiocarcinoma (iCCA). This study sought to validate the proposed changes to the 8th edition of AJCC system for T and N classification of iCCA using a population-based data set. Using the Surveillance, Epidemiology, and End Results (SEER) database (1998-2013), patients undergoing resection or non-surgical management for non-metastatic iCCA were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-indices) calculated from Cox proportional hazards models were calculated to evaluate discriminatory power. The study included 2630 patients resected (37%) or non-surgically managed (63%) for iCCA. Nodal staging was performed in 56%, of whom 31% had positive nodes. For all patients with iCCA, the median 5-year survival by AJCC T classification for T1a, T1b, T2, T3, and T4 was 32, 21, 14, 10, and 10 months, respectively (p < 0.001). The concordance index for the staging system was 0.57 for all patients, 0.62 for those who underwent resection, and 0.54 for patients who did not undergo resection. In summary, the new AJCC 8th edition staging system is comparable to the 7th edition and valid in stratifying patients with iCCA. However, the performance of the staging system is better in patients undergoing surgical resection than those undergoing non-surgical management. These findings further highlight the need for improved accuracy of radiological imaging in clinically staging patients to guide prognosis.

76 FR 18930 - Medicare Programs: Changes to the End-Stage Renal Disease Prospective Payment System Transition...

Science.gov (United States)

2011-04-06

... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...

Glycoprotein CD44 expression in normal, hyperplasic and neoplastic endometrium. An immunohistochemical study including correlations with p53, steroid receptor status and proliferative indices (PCNA, MIB1).

Science.gov (United States)

Zagorianakou, N; Ioachim, E; Mitselou, A; Kitsou, E; Zagorianakou, P; Stefanaki, S; Makrydimas, G; Agnantis, N J

2003-01-01

We have studied by immunohistochemistry the presence and localization of CD44, estrogen and progesterone receptors, p53 and proliferative associated indices (MIB1, PCNA) in archival endometrial tissue, in order to determine their diagnostic and prognostic value as well as the possible correlations between them. We examined 186 samples of endometrial tissue (100 endometrial carcinomas of endometrioid type, 40 cases of hyperplasia and 46 of normal endometrium). Patient records were examined for FIGO stage, grade, and depth of myometrial invasion, histology, and lympho-vascular space invasion. Strong membranous immunostaining (> 10% of neoplastic cells) was observed in 45% of the carcinomas. A statistically significant correlation was found in the expression of protein in stromal cells, when compared with epithelial cells (p failed to show any statistical correlation with tumor grade or with vessel invasion. The expression of the protein was lower in FIGO Stage II compared with Stage I (p = 0.03). A positive relation of CD44 expression with progesterone receptor status (p = 0.02) was detected. CD44 expression was also positively associated with the proliferation associated with the proliferative index MIB1 (p = 0.001). CD44 is closely related to the secretory phase of the normal menstrual cycle and its expression is decreased in hyperplasia (simple or complex with or without atypia) and in cancer cases. These observations suggest that decreased CD44 expression might be functionally involved in the multiple mechanisms of the development and progression of endometrial lesions.

Low morbidity following 9,000-rad intracavitary endocurietherapy (ECT) using the Kumar cervical applicator and external-beam radiotherapy (EXRT) in the management of carcinoma of the uterine cervix

International Nuclear Information System (INIS)

Kumar, P.P.; Good, R.R.; Scott, J.C.; Jones, E.O.; Lynch, G.; McCaul, G.F.

1988-01-01

The Kumar Cervical Applicator minimizes patient discomfort and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. Patients with previously untreated invasive carcinoma of the uterine cervix, F.I.G.O. stages IB-IVA, were treated with two Kumar intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point ''A,'' and 4,000 rad external-beam radiotherapy (EXRT) to midplane, for a total dose of 9,000 rad. The major complication rate was 2.7 %, and the local control rate was 85 % (22/26 patients) for stage I and II, and 91 % (10/11 patients) for stage III and IVA. (author)

Validation of the CPS+EG and Neo-Bioscore staging systems after preoperative systemic therapy for breast cancer in a single center in China.

Science.gov (United States)

Xu, Ling; Duan, Xuening; Zhou, Bin; Liu, Yinhua; Ye, Jingming; Liu, Zhaorui; Ma, Chao; Zhang, Hong; Zhang, Shuang; Zhang, Lanbo; Zhao, Jianxin; Cheng, Yuanjia

2018-04-17

Prognostic assessment after preoperative systemic therapy (PST) plays a vital role in determining treatment in breast cancer patients. Many researchers have sought to develop a system to quantitate residual tumor and its correlation with prognosis after PST. This retrospective study validated the CPS + EG staging system and Neo-Bioscore in a single center in China. Data from patients with non-metastatic primary breast cancer who were treated with PST and surgery from Jan. 2008 to Dec. 2014 at the Breast Disease Center of Peking University First Hospital, China, were reviewed. DFS, DSS and OS were calculated using the K-M curve and AUC. Multivariate analysis was used for a Cox proportional hazards model. All calculations were performed with SAS 9.4. A total of 403 patients were enrolled in this study. The median follow-up period was 45 (range 11-107) months. The five-year DFS, DSS and OS rates were 86.4%, 91.2% and 90.5%, respectively. The CS, PS, CPS + EG staging system and Neo-Bioscore stratified patients according to DFS, DSS, and OS after PST, with all P values < 0.0001. The CPS + EG staging system and Neo-Bioscore stratified prognosis after PST better than CS. HER2-positive patients without trastuzumab treatment had obviously worse DFS and OS than other subgroups with different HER2 statuses that scored a 3 in the Neo-Bioscore system. The CPS + EG staging system and Neo-Bioscore can improve prognostic prediction in non-pCR breast cancer patients after PST and, provided unfavorable prognostic factors such as insufficient treatment are incorporated, will have broader clinical applicability. Copyright © 2018 Elsevier Ltd. All rights reserved.

Edmonton obesity staging system among pediatric patients: a validation and obesogenic risk factor analysis.

Science.gov (United States)

Grammatikopoulou, M G; Chourdakis, M; Gkiouras, K; Roumeli, P; Poulimeneas, D; Apostolidou, E; Chountalas, I; Tirodimos, I; Filippou, O; Papadakou-Lagogianni, S; Dardavessis, T

2018-01-08

The Edmonton Obesity Staging System for Pediatrics (EOSS-P) is a useful tool, delineating different obesity severity tiers associated with distinct treatment barriers. The aim of the study was to apply the EOSS-P on a Greek pediatric cohort and assess risk factors associated with each stage, compared to normal weight controls. A total of 361 children (2-14 years old), outpatients of an Athenian hospital, participated in this case-control study by forming two groups: the obese (n = 203) and the normoweight controls (n = 158). Anthropometry, blood pressure, blood and biochemical markers, comorbidities and obesogenic lifestyle parameters were recorded and the EOSS-P was applied. Validation of EOSS-P stages was conducted by juxtaposing them with IOTF-defined weight status. Obesogenic risk factors' analysis was conducted by constructing gender-and-age-adjusted (GA) and multivariate logistic models. The majority of obese children were stratified at stage 1 (46.0%), 17.0% were on stage 0, and 37.0% on stage 2. The validation analysis revealed that EOSS-P stages greater than 0 were associated with diastolic blood pressure and levels of glucose, cholesterol, LDL and ALT. Reduced obesity odds were observed among children playing outdoors and increased odds for every screen time hour, both in the GA and in the multivariate analyses (all P  2 times/week was associated with reduced obesity odds in the GA analysis (OR = 0.57, 95% CI = 0.33-0.98, P linear = 0.047), it lost its significance in the multivariate analysis (P linear = 0.145). Analogous results were recorded in the analyses of the abovementioned physical activity risk factors for the EOSS-P stages. Linear relationships were observed for fast-food consumption and IOTF-defined obesity and higher than 0 EOSS-P stages. Parental obesity status was associated with all EOSS-P stages and IOTF-defined obesity status. Few outpatients were healthy obese (stage 0), while the majority exhibited several comorbidities

Survival and Complication Rate of Radiation Therapy in Stage I and II Carcinoma of uterine Cervix

International Nuclear Information System (INIS)

Ma, Sun Young; Cho, Heung Lea; Sohn, Seung Chang

1995-01-01

Purpose : To analyze survival rate and late rectal and bladder complication for patients with stage with stage I and II carcinoma of uterine cervix treated by radiation alone or combined with chemotherapy. Materials and Methods : Between November 1984 and December 1993, 127 patients with stage I and II carcinoma of uterine cervix treated by radiation alone or combined therapy of radiation and chemotherapy. Retrospective analysis for survival rate was carried out on eligible 107 patients and review for complication was possible in 91 patients. The median follow-up was 47 months (range 3-118) and the median age of patients was 56 years (range 31-76). 26 patients were stage IB by FIGO classification. 40 were stage IIA and 41 were stage IIB. 86 cases were treated by radiation alone and 21 were treated by radiation and chemotherapy. 101 patients were treated with intracavitary radiation therapy (ICRT), of these, 80 were received low dose rate (LDR) ICRT and 21 were received high dose rate (HDR) ICRT. Of the patients who received LDR ICRT, 63 were treated by 1 intracavitary insertion and 17 were underwent 2 insertions. And we evaluated the external radiation dose and midline shield. Results : Acturial survival rate at 5 years was 92% for stage IB, 75% for stage IIA, 53% for stage IIB and 69% in all patients. Grade 1 rectal complications were developed in 20 cases(22%), grade 2 were in 22 cases (24%), 22 cases (24%) of grade 1 urinary complications and 17 cases (19%) of grade 2 urinary complications were observed But no patients had severe complications that needed surgical management or admission care. Maximum bladder dose for the group of patients with urinary complications was higher than that for the patients without urinary complications(7608cGy v 6960cGy, p<0.01). Maximum rectal dose for the group of patients with rectal complications was higher than that for the patients without urinary complications (7041cGy v 6269cGy, p<0.01). While there was no significant

Grating exchange system of independent mirror supported by floating rotary stage

Science.gov (United States)

Zhang, Jianhuan; Tao, Jin; Liu, Yan; Nan, Yan

2015-10-01

The performance of The Grating Exchange System can satisfy the Thirty Meter Telescope - TMT for astronomical observation WFOS index requirements and satisfy the requirement of accuracy in the grating exchange. It is used to install in the MOBIE and a key device of MOBIE. The Wide Field Optical Spectrograph (WFOS) is one of the three first-light observing capabilities selected by the TMT Science Advisory Committee. The Multi-Object Broadband Imaging Echellette (MOBIE) instrument design concept has been developed to address the WFOS requirements as described in the TMT Science-Based Requirements Document (SRD). The Grating Exchange System uses a new type of separate movement way of three grating devices and a mirror device. Three grating devices with a mirror are able to achieve independence movement. This kind of grating exchange system can effectively solve the problem that the volume of the grating change system is too large and that the installed space of MOBIE instruments is too limit. This system adopts the good stability, high precision of rotary stage - a kind of using air bearing (Air bearing is famous for its ultra-high precision, and can meet the optical accuracy requirement) and rotation positioning feedback gauge turntable to support grating device. And with a kind of device which can carry greater weight bracket fixed on the MOBIE instrument, with two sets of servo motor control rotary stage and the mirror device respectively. And we use the control program to realize the need of exercising of the grating device and the mirror device. Using the stress strain analysis software--SolidWorks for stress and strain analysis of this structure. And then checking the structure of the rationality and feasibility. And prove that this system can realize the positioning precision under different working conditions can meet the requirements of imaging optical grating diffraction efficiency and error by the calculation and optical performance analysis.

Design of decoupled dual servo stage with voice coil motor and linear motor for XY long stroke ultra-precision scanning system

Science.gov (United States)

Kim, Ki-Hyun; Choi, Young-Man; Gweon, Dae-Gab; Hong, Dong-Pyo; Kim, Koung-Suk; Lee, Suk-Won; Lee, Moon-Gu

2005-12-01

A decoupled dual servo (DDS) stage for ultra-precision scanning system is introduced in this paper. The proposed DDS consists of a 3 axis fine stage for handling and carrying workpieces and a XY coarse stage. Especially, the DDS uses three voice coil motors (VCM) as a planar actuation system of the fine stage to reduce the disturbances due to any mechanical connections with its coarse stage. VCMs are governed by Lorentz law. According to the law and its structure, there are no mechanical connections between coils and magnetic circuits. Moreover, the VCM doesn't have force ripples due to imperfections of commutation components of linear motor systems - currents and flux densities. However, due to the VCM's mechanical constraints the working range of the fine is about 5mm2. To break that hurdle, the coarse stage with linear motors is used for the fine stage to move about 200mm2. Because of the above reasons, the proposed DDS can achieve higher precision scanning than other stages with only one servo. Using MATLAB's Sequential Quadratic Programming (SQP), the VCMs are optimally designed for the highest force under conditions and constraints such as thermal dissipations due to its coil, its size, and so on. For linear motors, Halbach magnet linear motor is proposed and optimally designed in this paper. In addition, for their smooth movements without any frictions, guide systems of the DDS are composed of air bearings. And then, precisely to get their positions, linear scales with 0.1um resolution are used for the coarse's XY motions and plane mirror laser interferometers with 20nm for the fine's XYθz. On scanning, the two stages have same trajectories and are controlled. The control algorithm is Parallel method. The embodied ultra-precision scanning system has about 100nm tracking error and in-positioning stability.

A new system for assessment of growth using mandibular canine calcification stages and its correlation with modified MP3 stages.

Science.gov (United States)

Hegde, Gautham; Hegde, Nanditha; Kumar, Anil; Keshavaraj

2014-07-01

Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. A total of 160 periapical radiographs, of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian's stages of dental calcification and the modified MP3 stages. The correlation coefficient between MP3 stages and developmental stages of mandibular canine was found to be significant in both male and female groups. When the canine calcification stages were compared with the MP3 stages it was found that with the exception of the D stage of canine calcification the remaining stages showed a very high correlation with the modified MP3 stages. The correlation between the mandibular canine calcification stages, and the MP3 stages was found to be significant. The canine calcification could be used as a sole indicator for assessment of skeletal maturity.

Stage measurement at gaging stations

Science.gov (United States)

Sauer, Vernon B.; Turnipseed, D. Phil

2010-01-01

Stream and reservoir stage are critical parameters in the computation of stream discharge and reservoir volume, respectively. In addition, a record of stream stage is useful in the design of structures that may be affected by stream elevation, as well as for the planning for various uses of flood plains. This report describes equipment and methodology for the observation, sensing, and recording of stage in streams and reservoirs. Although the U.S. Geological Survey (USGS) still uses the traditional, basic stilling-well float system as a predominant gaging station, modern electronic stage sensors and water-level recorders are now commonly used. Bubble gages coupled with nonsubmersible pressure transducers eliminate the need for stilling wells. Submersible pressure transducers have become common in use for the measurement of stage in both rivers and lakes. Furthermore, noncontact methods, such as radar, acoustic, and laser methods of sensing water levels, are being developed and tested, and in the case of radar, are commonly used for the measurement of stage. This report describes commonly used gaging-station structures, as well as the design and operation of gaging stations. Almost all of the equipment and instruments described in this report will meet the accuracy standard set by the USGS Office of Surface Water (OSW) for the measurement of stage for most applications, which is ±0.01 foot (ft) or 0.2 percent of the effective stage. Several telemetry systems are used to transmit stage data from the gaging station to the office, although satellite telemetry has become the standard. These telemetry systems provide near real-time stage data, as well as other information that alerts the hydrographer to extreme or abnormal events, and instrument malfunctions.

Vibration characteristics of two-stage planetary transmission system with thin-walled ring gear on elastic supports

Science.gov (United States)

Li, JianYing; Hu, QingChun; Zong, ChangFu; Zhu, TianJun; Zhang, ZeXing

2018-03-01

A dual-clutch and dual-speed planetary gears mechanism of a hybrid car coupled-system is taken as research subject, in which the ring gear of planet set II is a thin-walled structure and the clutch friction plates of planet set II are used as its elastic supports. Based on the lumped parameter-rigid elastic coupled dynamic model of two-stage planetary transmission system with thin-walled ring gear on elastic supports, the motion differential equations are established and the dynamic responses are solved by the Runge-Kutta method considering each stage internal and external time-varying mesh stiffness. The vibration displacements of each stage ring gear have been affected differently in time-domain, the translational vibration displacement of the ring gear of planet set I are obviously more than the torsional vibration displacement, but it is opposite for the ring gear of planet set II; The translational and torsional vibration responses of each stage ring gear arrive the peak in low-frequency. The analysis results of this paper can enrich the theoretical research of multistage planetary transmission and provide guidance for dynamic design.

A new system for assessment of growth using mandibular canine calcification stages and its correlation with modified MP3 stages

Directory of Open Access Journals (Sweden)

Gautham Hegde

2014-01-01

Full Text Available Objective: Orthodontic diagnosis and treatment planning for growing children must involve growth prediction, especially in the treatment of skeletal problems. Studies have shown that a strong association exists between skeletal maturity and dental calcification stages. The present study was therefore taken up to provide a simple and practical method for assessing skeletal maturity using a dental periapical film and standard dental X-ray machine, to compare the developmental stages of the mandibular canine with that of developmental stages of modified MP3 and to find out if any correlation exists, to determine if the developmental stages of the mandibular canine alone can be used as a reliable indicator for assessment of skeletal maturity. Materials and Methods: A total of 160 periapical radiographs, of the mandibular right canine and the MP3 region was taken and assessed according to the Dermirjian′s stages of dental calcification and the modified MP3 stages. Results and Discussion: The correlation coefficient between MP3 stages and developmental stages of mandibular canine was found to be significant in both male and female groups. When the canine calcification stages were compared with the MP3 stages it was found that with the exception of the D stage of canine calcification the remaining stages showed a very high correlation with the modified MP3 stages. Conclusion: The correlation between the mandibular canine calcification stages, and the MP3 stages was found to be significant. The canine calcification could be used as a sole indicator for assessment of skeletal maturity.

A two-stage approach for multi-objective decision making with applications to system reliability optimization

International Nuclear Information System (INIS)

Li Zhaojun; Liao Haitao; Coit, David W.

2009-01-01

This paper proposes a two-stage approach for solving multi-objective system reliability optimization problems. In this approach, a Pareto optimal solution set is initially identified at the first stage by applying a multiple objective evolutionary algorithm (MOEA). Quite often there are a large number of Pareto optimal solutions, and it is difficult, if not impossible, to effectively choose the representative solutions for the overall problem. To overcome this challenge, an integrated multiple objective selection optimization (MOSO) method is utilized at the second stage. Specifically, a self-organizing map (SOM), with the capability of preserving the topology of the data, is applied first to classify those Pareto optimal solutions into several clusters with similar properties. Then, within each cluster, the data envelopment analysis (DEA) is performed, by comparing the relative efficiency of those solutions, to determine the final representative solutions for the overall problem. Through this sequential solution identification and pruning process, the final recommended solutions to the multi-objective system reliability optimization problem can be easily determined in a more systematic and meaningful way.

Design and modelling of an innovative three-stage thermal storage system for direct steam generation CSP plants

Science.gov (United States)

Garcia, Pierre; Vuillerme, Valéry; Olcese, Marco; El Mourchid, Nadim

2016-05-01

Thermal Energy Storage systems (TES) for a Direct Steam Generation (DSG) solar plant feature preferably three stages in series including a latent heat storage module so that steam can be recovered with a limited temperature loss. The storage system designed within the Alsolen Sup project is characterized by an innovative combination of sensible and latent modules. A dynamic model of this three-stage storage has been developed and applied to size the storage system of the Alsolen Sup® plant demonstrator at CEA Cadarache. Results of this simulation show that this promising concept is an efficient way to store heat in DSG solar plants.

DNA repair systems and the pathogenesis of Mycobacterium tuberculosis: varying activities at different stages of infection.

Science.gov (United States)

Gorna, Alina E; Bowater, Richard P; Dziadek, Jaroslaw

2010-05-25

Mycobacteria, including most of all MTB (Mycobacterium tuberculosis), cause pathogenic infections in humans and, during the infectious process, are exposed to a range of environmental insults, including the host's immune response. From the moment MTB is exhaled by infected individuals, through an active and latent phase in the body of the new host, until the time they reach the reactivation stage, MTB is exposed to many types of DNA-damaging agents. Like all cellular organisms, MTB has efficient DNA repair systems, and these are believed to play essential roles in mycobacterial pathogenesis. As different stages of infection have great variation in the conditions in which mycobacteria reside, it is possible that different repair systems are essential for progression to specific phases of infection. MTB possesses homologues of DNA repair systems that are found widely in other species of bacteria, such as nucleotide excision repair, base excision repair and repair by homologous recombination. MTB also possesses a system for non-homologous end-joining of DNA breaks, which appears to be widespread in prokaryotes, although its presence is sporadic within different species within a genus. However, MTB does not possess homologues of the typical mismatch repair system that is found in most bacteria. Recent studies have demonstrated that DNA repair genes are expressed differentially at each stage of infection. In the present review, we focus on different DNA repair systems from mycobacteria and identify questions that remain in our understanding of how these systems have an impact upon the infection processes of these important pathogens.

Two-Stage Series-Resonant Inverter

Science.gov (United States)

Stuart, Thomas A.

1994-01-01

Two-stage inverter includes variable-frequency, voltage-regulating first stage and fixed-frequency second stage. Lightweight circuit provides regulated power and is invulnerable to output short circuits. Does not require large capacitor across ac bus, like parallel resonant designs. Particularly suitable for use in ac-power-distribution system of aircraft.

A Sensorless Power Reserve Control Strategy for Two-Stage Grid-Connected PV Systems

OpenAIRE

Sangwongwanich, Ariya; Yang, Yongheng; Blaabjerg, Frede

2017-01-01

Due to the still increasing penetration of grid-connected Photovoltaic (PV) systems, advanced active power control functionalities have been introduced in grid regulations. A power reserve control, where namely the active power from the PV panels is reserved during operation, is required for grid support. In this paper, a cost-effective solution to realize the power reserve for two-stage grid-connected PV systems is proposed. The proposed solution routinely employs a Maximum Power Point Track...

Morphogenesis of the rhea (Rhea americana respiratory system in different embryonic and foetal stages

Directory of Open Access Journals (Sweden)

Renata P. Sousa

Full Text Available ABSTRACT: The rhea (Rhea americana is an important wild species that has been highlighted in national and international livestock. This research aims to analyse embryo-foetal development in different phases of the respiratory system of rheas. Twenty-three embryos and foetuses were euthanized, fixed and dissected. Fragments of the respiratory system, including the nasal cavity, larynx, trachea, syrinx, bronchi and lungs, were collected and processed for studies using light and scanning electron microscopy. The nasal cavity presented cubic epithelium in the early stages of development. The larynx exhibited typical respiratory epithelium between 27 and 31 days. The trachea showed early formation of hyaline cartilage after 15 days. Syrinx in the mucous membrane of 18-day foetuses consisted of ciliated epithelium in the bronchial region. The main bronchi had ciliated epithelium with goblet cells in the syringeal region. In the lung, the parabronchial stage presented numerous parabronchi between 15 and 21 days. This study allowed the identification of normal events that occur during the development of the rhea respiratory system, an important model that has not previously been described. The information generated here will be useful for the diagnosis of pathologies that affect this organic system, aimed at improving captive production systems.

THE EVALUATION SYSTEM OF DESIGN SOLUTIONS FOR RESIDENTIAL PROPERTY ON THE PRE-INVESTMENT STAGE THROUGH NEURAL NETWORK TECHNOLOGY

Directory of Open Access Journals (Sweden)

G. D. Kostsikava

2016-01-01

Full Text Available Ever since the Soviet Union design solutions were evaluated according to different criteria and indicators. At the present stage of evaluation systems of design solutions stands systemengineering doctrine is allocated. It is complemented by the theory of efficiency and financial sustainability investment project in view of the general market concept. Also great attention is paid to the virtual object modeling. It is urgent to include the behavior prediction of an investment construction project model at each stage of its life cycle. The high cost of all phases of this life cycle makes it necessary to calculate the feasibility of the investment. Very urgent to do it as accurately as possible and before we start of design works on the stage of the investment plan evaluation. Belarus has legislated pre-investment stage of construction project development. To evaluate the design solution at this stage is necessary to develop an investment justification, a project management plan and a business plan. They will evaluate and will compare several options for future objects by the complex. This requires not only time, but considerable financial costs. In order to optimize the process to develop an evaluation system design solutions based on existing projects. It allows the customer (investor choose design solutions to build the object without developing of pre-design documentations for several options. This system it is advisable to try out the example of apartment house building with the assistance of the national fund of project documentation and objects-analogues data bank. The developed evaluation system of design solutions for residential real estate objects in the pre-investment stage is supposed to use the theory of neural networks and neyroprogramming. This system bases on the input parameters projects. The hidden layer neurons are trained to choose suitable projects of apartment houses with their classification. The projects will be classified

Frequent hemodialysis with NxStage system in pediatric patients receiving maintenance hemodialysis.

Science.gov (United States)

Goldstein, Stuart L; Silverstein, Douglas M; Leung, Jocelyn C; Feig, Daniel I; Soletsky, Beth; Knight, Cathy; Warady, Bradley A

2008-01-01

Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate 1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.

[Evaluation of mortality after the analysis of the screening history in women diagnosed with infiltrating cervical cancer].

Science.gov (United States)

Castillo, Marta; Astudillo, Aurora; Clavero, Omar; Velasco, Julio; Ibáñez, Raquel; de Sanjosé, Silvia

2018-03-01

To assess the impact of screening history on the incidence of cervical cancer from 2000 to 2010 in Asturias. Retrospective study. All public hospitals in Asturias. From 374 women diagnosed with cervical cancer were retrieved. Clinical information, FIGO stage and all previous cytological data were extracted from clinical and histopathological records. Proportional differences were assessed using chi-square tests. Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals. Women between 25 and 70years had no records of a previous cytology within 5.5years of cancer diagnosis in 65.6%. This proportion was related with older age, presence of symptoms and an advance tumor stage at diagnosis. Women over 70years old had no records of a previous cytology in 83.3%. An organized cervical cancer screening program and optimal quality of the system, monitored through audits, could help to reduce cervical cancer incidence and mortality in Asturias. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Lot-sizing for a single-stage single-product production system with rework of perishable production defectives

NARCIS (Netherlands)

Teunter, R.; Flapper, S.D.P.

2003-01-01

We consider a single-stage single-product production system. Produced units may be non-defective, reworkable defective, or non-reworkable defective. The system switches between production and rework. After producing a fixed number (N) of units, all reworkable defective units are reworked. Reworkable

Influence of Shaft Torsional Stiffness on Dynamic Response of Four-Stage Main Transmission System

Directory of Open Access Journals (Sweden)

Yuan Chen

2018-01-01

Full Text Available Dynamic response analysis has potential for increasing fatigue life of the components in the transmission of a multistage main transmission system. The calculated data can demonstrate the influence of shaft torsional stiffness on dynamic characteristics of the system. Detecting key shafts of the system and analyzing their sensitivity are important for the design of four-stage helicopter gear box. Lumped mass method is applied for dynamic modeling and Fourier method is used to solve differential equation of the system. Results of the analysis indicate that key shafts can be designed carefully to improve the performance of the transmission system.

Two-stage single-phase grid-connected photovoltaic system with reduced complexity

Science.gov (United States)

da Silva, Cintia S.; Motta, Filipe R.; Tofoli, Fernando L.

2011-06-01

This article presents a grid-connected photovoltaic (PV) system using the classical DC-DC buck converter, which is responsible for stepping down the resulting voltage from several series-connected panels. Besides, the structure provides high power factor operation by injecting a quasi-sinusoidal current into the grid, with near no displacement in relation to the line voltage at the point of common coupling among the PV system and the loads. A CSI employing thyristors is cascaded with the DC-DC stage so that AC voltage results. The inverter output voltage level is adjusted by using a low-frequency transformer, which also provides galvanic isolation. The proposed system is described as mathematical approach and design guidelines are presented, providing an overview of the topology. An experimental prototype is also implemented, and relevant results to validate the proposal are discussed.

Method for simulating predictive control of building systems operation in the early stages of building design

DEFF Research Database (Denmark)

Petersen, Steffen; Svendsen, Svend

2011-01-01

A method for simulating predictive control of building systems operation in the early stages of building design is presented. The method uses building simulation based on weather forecasts to predict whether there is a future heating or cooling requirement. This information enables the thermal...... control systems of the building to respond proactively to keep the operational temperature within the thermal comfort range with the minimum use of energy. The method is implemented in an existing building simulation tool designed to inform decisions in the early stages of building design through...... parametric analysis. This enables building designers to predict the performance of the method and include it as a part of the solution space. The method furthermore facilitates the task of configuring appropriate building systems control schemes in the tool, and it eliminates time consuming manual...

Predicting prognosis in hepatocellular carcinoma; comparison of staging system in pakistani cohort

International Nuclear Information System (INIS)

Sarwar, S.; Khan, A.A.

2015-01-01

To determine the clinical, biochemical and radiological prognostic indicators and to compare the performance of six staging systems in patients of hepatocellular carcinoma (HCC). Study Design:Descriptive study. Place and Duration of Study: Department of Gastroenterology, Doctors Hospital, Lahore, from October 2007 to December 2013. Methodology:Patients with HCC were included. Baseline clinical, hematological and radiological variables were noted. Patients were followed for 5 years or till death. Survival predictors were identified using Cox proportional hazard analysis and 6 prognostic staging systems were evaluated by determining homogeneity, discriminatory ability and monotonicity. Results: Of the 228 patients included, male to female ratio was 2.6/1 (165/63) and mean age was 56.5 ± 10.4 years. Majority of patients 189 (82.9%) were anti-HCV positive. Solitary HCC lesion was seen in 121 (53.1%) patients, 16 (7%) had 2 lesions while 73 (32%) had 3 or more lesions. Only 36 (15.8%) patients had palliative therapy for HCC. Survival rate was 45.2%, 25%, 12.3%, 7%, 2.2% and 1% for 6 months, 1, 2, 3, 4 and 5 years respectively. Male gender, portal vein thrombosis, serum albumin < 3.5 g/dl, tumor size =6 cm and alpha fetoprotein (AFP) =147 U/ml were bad prognostic indicators. OKUDA, GRETCH and early stages of CLIP had better homogeneity while CLIP showed superior discriminatory ability and monotonicity for predicting survival. Conclusion: Male gender, presence of portal vein thrombosis, low serum albumin, large tumor size and high AFP level are poor prognostic indicators in patients of HCC. CLIP has better performance in predicting mortality. (author)

Experimental investigation of two-stage thermoelectric generator system integrated with phase change materials

DEFF Research Database (Denmark)

Ahmadi Atouei, Saeed; Ranjbar, Ali Akbar; Rezaniakolaei, Alireza

2017-01-01

this amount of voltage just for 2100 s. Therefore, the proposed design makes TEG systems more suitable for wireless sensor applications when the heat source does not provide steady thermal energy. In this study, four different patterns of thermal power applied to the TTEG system are considered. These patterns...... experimentally. In the first stage, a TEG module installed between a phase change material (PCM) heat sink, as cooling system, and an electrical heater, as the heat source. Because of the inherent characteristics of PCMs to save the thermal energy as latent heat, the PCM heat sink is used as the heat source...

Stage-by-Stage and Parallel Flow Path Compressor Modeling for a Variable Cycle Engine

Science.gov (United States)

Kopasakis, George; Connolly, Joseph W.; Cheng, Larry

2015-01-01

This paper covers the development of stage-by-stage and parallel flow path compressor modeling approaches for a Variable Cycle Engine. The stage-by-stage compressor modeling approach is an extension of a technique for lumped volume dynamics and performance characteristic modeling. It was developed to improve the accuracy of axial compressor dynamics over lumped volume dynamics modeling. The stage-by-stage compressor model presented here is formulated into a parallel flow path model that includes both axial and rotational dynamics. This is done to enable the study of compressor and propulsion system dynamic performance under flow distortion conditions. The approaches utilized here are generic and should be applicable for the modeling of any axial flow compressor design.

A Two-Stage Queue Model to Optimize Layout of Urban Drainage System considering Extreme Rainstorms

OpenAIRE

He, Xinhua; Hu, Wenfa

2017-01-01

Extreme rainstorm is a main factor to cause urban floods when urban drainage system cannot discharge stormwater successfully. This paper investigates distribution feature of rainstorms and draining process of urban drainage systems and uses a two-stage single-counter queue method M/M/1→M/D/1 to model urban drainage system. The model emphasizes randomness of extreme rainstorms, fuzziness of draining process, and construction and operation cost of drainage system. Its two objectives are total c...

Bioremediation of storage tank bottom sludge by using a two-stage composting system: Effect of mixing ratio and nutrients addition.

Science.gov (United States)

Koolivand, Ali; Rajaei, Mohammad Sadegh; Ghanadzadeh, Mohammad Javad; Saeedi, Reza; Abtahi, Hamid; Godini, Kazem

2017-07-01

The effect of mixing ratio and nutrients addition on the efficiency of a two-stage composting system in removal of total petroleum hydrocarbons (TPH) from storage tank bottom sludge (STBS) was investigated. The system consisted of ten windrow piles as primary composting (PC) followed by four in-vessel reactors as secondary composting (SC). Various initial C/N/P and mixing ratios of STBS to immature compost (IC) were examined in the PC and SC for 12 and 6weeks, respectively. The removal rates of TPH in the two-stage system (93.72-95.24%) were higher than those in the single-stage one. Depending on the experiments, TPH biodegradation fitted to the first- and second-order kinetics with the rate constants of 0.051-0.334d -1 and 0.002-0.165gkg -1 d -1 , respectively. The bacteria identified were Pseudomonas sp., Bacillus sp., Klebsiella sp., Staphylococcus sp., and Proteus sp. The study verified that a two-stage composting system is effective in treating the STBS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Uterine sarcomas-Recent progress and future challenges

International Nuclear Information System (INIS)

Seddon, Beatrice M.; Davda, Reena

2011-01-01

Uterine sarcomas are a group of rare tumours that provide considerable challenges in their treatment. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made post-operatively. Current staging systems have been unsatisfactory, although a new FIGO staging system specifically for uterine sarcomas has now been introduced, and may allow better grouping of patients according to expected prognosis. While the mainstay of treatment of early disease is a total abdominal hysterectomy, it is less clear whether routine oophorectomy or lymphadenectomy is necessary. Adjuvant pelvic radiotherapy may improve local tumour control in high risk patients, but is not associated with an overall survival benefit. Similarly there is no good evidence for the routine use of adjuvant chemotherapy. For advanced leiomyosarcoma, newer chemotherapy agents including gemcitabine and docetaxel, and trabectedin, offer some promise, while hormonal therapies appear to be more useful in endometrial stromal sarcoma. Novel targeted agents are now being introduced for sarcomas, and uterine sarcomas, and show some indications of activity. Non-pharmacological treatments, including surgical metastatectomy, radiofrequency ablation, and CyberKnife radiotherapy, are important additions to systemic therapy for advanced metastatic disease.

Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems

Directory of Open Access Journals (Sweden)

Rowe Krista L

2008-11-01

earlier stage of CRC diagnosis. Multiple factors, perhaps including increased interactions with the healthcare system due to comorbidity, might contribute to this finding. Such increased interactions are seen among patients within a healthcare system like the VA system in the US versus sporadic interactions which may be seen with FFS healthcare.

A critic of maternal mortality reduction efforts in Nigeria | Adinma ...

African Journals Online (AJOL)

Journal Home > Vol 28, No 1 (2011) > ... factors and health systems/health services factors. ... Gynecology (FIGO) in partnership with Society of Obstetrics and Gynecology of Nigeria (SOGON) using funds obtained from Packard Foundation.

Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

Science.gov (United States)

Winston, R.; Welford, W. T.

1980-02-01

The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

Design of nonimaging concentrators as second stages in tandem with image-forming first-stage concentrators

Science.gov (United States)

Winston, R.; Welford, W. T.

1980-01-01

The paper discusses the paraboloidal mirror as a tracking solar concentrator, fitting a nonimaging second stage to the paraboloidal mirror, other image-forming systems as first stages, and tracking systems in two-dimensional geometry. Because of inherent aberrations, the paraboloidal mirror cannot achieve the thermodynamic limit. It is shown how paraboloidal mirrors of short focal ratio and similar systems can have their flux concentration enhanced to near the thermodynamic limit by the addition of nonimaging compound elliptical concentrators.

America's Next Great Ship: Space Launch System Core Stage Transitioning from Design to Manufacturing

Science.gov (United States)

Birkenstock, Benjamin; Kauer, Roy

2014-01-01

The Space Launch System (SLS) Program is essential to achieving the Nation's and NASA's goal of human exploration and scientific investigation of the solar system. As a multi-element program with emphasis on safety, affordability, and sustainability, SLS is becoming America's next great ship of exploration. The SLS Core Stage includes avionics, main propulsion system, pressure vessels, thrust vector control, and structures. Boeing manufactures and assembles the SLS core stage at the Michoud Assembly Facility (MAF) in New Orleans, LA, a historical production center for Saturn V and Space Shuttle programs. As the transition from design to manufacturing progresses, the importance of a well-executed manufacturing, assembly, and operation (MA&O) plan is crucial to meeting performance objectives. Boeing employs classic techniques such as critical path analysis and facility requirements definition as well as innovative approaches such as Constraint Based Scheduling (CBS) and Cirtical Chain Project Management (CCPM) theory to provide a comprehensive suite of project management tools to manage the health of the baseline plan on both a macro (overall project) and micro level (factory areas). These tools coordinate data from multiple business systems and provide a robust network to support Material & Capacity Requirements Planning (MRP/CRP) and priorities. Coupled with these tools and a highly skilled workforce, Boeing is orchestrating the parallel buildup of five major sub assemblies throughout the factory. Boeing and NASA are transforming MAF to host state of the art processes, equipment and tooling, the most prominent of which is the Vertical Assembly Center (VAC), the largest weld tool in the world. In concert, a global supply chain is delivering a range of structural elements and component parts necessary to enable an on-time delivery of the integrated Core Stage. SLS is on plan to launch humanity into the next phase of space exploration.

Multifunctional Solar Systems Based On Two-Stage Regeneration Absorbent Solution

Directory of Open Access Journals (Sweden)

Doroshenko A.V.

2015-04-01

Full Text Available The concepts of multifunctional dehumidification solar systems, heat supply, cooling, and air conditioning based on the open absorption cycle with direct absorbent regeneration developed. The solar systems based on preliminary drainage of current of air and subsequent evaporated cooling. The solar system using evaporative coolers both types (direct and indirect. The principle of two-stage regeneration of absorbent used in the solar systems, it used as the basis of liquid and gas-liquid solar collectors. The main principle solutions are designed for the new generation of gas-liquid solar collectors. Analysis of the heat losses in the gas-liquid solar collectors, due to the mechanism of convection and radiation is made. Optimal cost of gas and liquid, as well as the basic dimensions and configuration of the working channel of the solar collector identified. Heat and mass transfer devices, belonging to the evaporative cooling system based on the interaction between the film and the gas stream and the liquid therein. Multichannel structure of the polymeric materials used to create the tip. Evaporative coolers of water and air both types (direct and indirect are used in the cooling of the solar systems. Preliminary analysis of the possibilities of multifunctional solar absorption systems made reference to problems of cooling media and air conditioning on the basis of experimental data the authors. Designed solar systems feature low power consumption and environmental friendliness.

Definitive radiation therapy for squamous cell carcinoma of the vagina

International Nuclear Information System (INIS)

Frank, Steven J.; Jhingran, Anuja; Levenback, Charles; Eifel, Patricia J.

2005-01-01

Purpose: To evaluate outcome and describe clinical treatment guidelines for patients with primary squamous cell carcinoma of the vagina treated with definitive radiation therapy. Methods and Materials: Between 1970 and 2000, a total of 193 patients were treated with definitive radiation therapy for squamous cell carcinoma of the vagina at The University of Texas M. D. Anderson Cancer Center. The patients' medical records were reviewed to obtain information about patient, tumor, and treatment characteristics, as well as outcome and patterns of recurrence. Surviving patients were followed for a median of 137 months. Survival rates were calculated using the Kaplan-Meier method, with differences assessed using log-rank tests. Results: Disease-specific survival (DSS) and pelvic disease control rates correlated with International Federation of Gynecology and Obstetrics (FIGO) stage and tumor size. At 5 years, DSS rates were 85% for the 50 patients with Stage I, 78% for the 97 patients with Stage II, and 58% for the 46 patients with Stage III-IVA disease (p = 0.0013). Five-year DSS rates were 82% and 60% for patients with tumors ≤4 cm or >4 cm, respectively (p = 0.0001). At 5 years, pelvic disease control rates were 86% for Stage I, 84% for Stage II, and 71% for Stage III-IVA (p = 0.027). The predominant mode of relapse after definitive radiation therapy was local-regional (68% and 83%, respectively, for patients with stages I-II or III-IVA disease). The incidence of major complications was correlated with FIGO stage; at 5 years, the rates of major complications were 4% for Stage I, 9% for Stage II, and 21% for Stage III-IVA (p < 0.01). Conclusions: Excellent outcomes can be achieved with definitive radiation therapy for invasive squamous cell carcinoma of the vagina. However, to achieve these results, treatment must be individualized according to the site and size of the tumor at presentation and the response to initial external-beam radiation therapy. Brachytherapy

A predator-prey system with stage-structure for predator and nonlocal delay

DEFF Research Database (Denmark)

Lin, Z.G.; Pedersen, Michael; Zhang, Lai

2010-01-01

This paper deals with the behavior of solutions to the reaction-diffusion system under homogeneous Neumann boundary condition, which describes a prey-predator model with nonlocal delay. Sufficient conditions for the global stability of each equilibrium are derived by the Lyapunov functional...... and the results show that the introduction of stage-structure into predator positively affects the coexistence of prey and predator. Numerical simulations are performed to illustrate the results....

Setting safety stocks in multi-stage inventory systems under rolling horizon mathematical programming models

NARCIS (Netherlands)

Boulaksil, Y.; Fransoo, J.C.; van Halm, E.N.G.

2009-01-01

This paper considers the problem of determining safety stocks in multi-item multi-stage inventory systems that face demand uncertainties. Safety stocks are necessary to make the supply chain, which is driven by forecasts of customer orders, responsive to (demand) uncertainties and to achieve

Identification and Fibrosis Staging of Hepatitis C Patients Using the Electronic Medical Record System.

Science.gov (United States)

Anand, Vijay; Hyun, Christian; Khan, Qasim M; Hall, Curtis; Hessefort, Norbert; Sonnenberg, Amnon; Fimmel, Claus J

2016-09-01

The aim of this study was to noninvasively assess the severity of chronic hepatitis C virus (HCV) in large patient populations. It would be helpful if fibrosis scores could be calculated solely on the basis of data contained in the patients' electronic medical records (EMR). We performed a pilot study to identify all HCV-infected patients in a large health care system, and predict their fibrosis stage on the basis of demographic and laboratory data using common data from their EMR. HCV-infected patients were identified using the EMR. The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index, and Vira-HepC. In total, 869 HCV-infected patients were identified from a population of over 1 million. In the subgroup of patients with liver biopsies, all 7 algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60. For the detection of advanced fibrosis (Metavir 3 or 4), the areas under the receiver operating characteristic curve ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages. Our study demonstrates that HCV-infected patients can be identified and their fibrosis staged using commonly available EMR-based algorithms.

Illumination uniformity issue explored via two-stage solar concentrator system based on Fresnel lens and compound flat concentrator

International Nuclear Information System (INIS)

Yeh, Naichia

2016-01-01

This paper illustrates details about the solar radiation distribution on the target of a two-stage solar concentrator that combines the Fresnel lens (FL) and the compound flat concentrator (CFC). The paper starts with a review of some FL development milestones such as the two-stage systems and the comparisons of flat vs. curved lenses in addition to the most noteworthy FL-based solar energy application, concentration photovoltaic (CPV). Through the review of the FL based CPV and two-stage concentrators, this study leads to the development of an algorithm to explore the spectrum distribution insight on the receiver of a two-stage (FL plus CFC) solar concentration system. It established the potential for using a correctly positioned 2nd stage reflector of right dimension to selectively redirect the desired spectrum on the target area so as to enhance the concentration flux intensity and uniformity at the same time. The study also helped to chart out the approximate locations of certain spectrum segments on the FL's target area, which is useful for exploring the spectrum control mechanism via the Fresnel lenses. - Highlights: • Map out the approximate locations of spectrum segments on FL's focal area. • Use the 2nd stage reflector to selectively reflect the desired spectrum on target. • Explore the spectrum distribution insight on FL solar concentrators' target area.

Optimal design of distributed energy resource systems based on two-stage stochastic programming

International Nuclear Information System (INIS)

Yang, Yun; Zhang, Shijie; Xiao, Yunhan

2017-01-01

Highlights: • A two-stage stochastic programming model is built to design DER systems under uncertainties. • Uncertain energy demands have a significant effect on the optimal design. • Uncertain energy prices and renewable energy intensity have little effect on the optimal design. • The economy is overestimated if the system is designed without considering the uncertainties. • The uncertainty in energy prices has the significant and greatest effect on the economy. - Abstract: Multiple uncertainties exist in the optimal design of distributed energy resource (DER) systems. The expected energy, economic, and environmental benefits may not be achieved and a deficit in energy supply may occur if the uncertainties are not handled properly. This study focuses on the optimal design of DER systems with consideration of the uncertainties. A two-stage stochastic programming model is built in consideration of the discreteness of equipment capacities, equipment partial load operation and output bounds as well as of the influence of ambient temperature on gas turbine performance. The stochastic model is then transformed into its deterministic equivalent and solved. For an illustrative example, the model is applied to a hospital in Lianyungang, China. Comparative studies are performed to evaluate the effect of the uncertainties in load demands, energy prices, and renewable energy intensity separately and simultaneously on the system’s economy and optimal design. Results show that the uncertainties in load demands have a significant effect on the optimal system design, whereas the uncertainties in energy prices and renewable energy intensity have almost no effect. Results regarding economy show that it is obviously overestimated if the system is designed without considering the uncertainties.

A theoretical analysis of price elasticity of energy demand in multi-stage energy conversion systems

International Nuclear Information System (INIS)

Lowe, Robert

2003-01-01

The objective of this paper is an analytical exploration of the problem of price elasticity of energy demand in multi-stage energy conversion systems. The paper describes in some detail an analytical model of energy demand in such systems. Under a clearly stated set of assumptions, the model makes it possible to explore both the impacts of the number of sub-systems, and of varying sub-system elasticities on overall system elasticity. The analysis suggests that overall price elasticity of energy demand for such systems will tend asymptotically to unity as the number of sub-systems increases

A four stage approach for ontology-based health information system design.

Science.gov (United States)

Kuziemsky, Craig E; Lau, Francis

2010-11-01

To describe and illustrate a four stage methodological approach to capture user knowledge in a biomedical domain area, use that knowledge to design an ontology, and then implement and evaluate the ontology as a health information system (HIS). A hybrid participatory design-grounded theory (GT-PD) method was used to obtain data and code them for ontology development. Prototyping was used to implement the ontology as a computer-based tool. Usability testing evaluated the computer-based tool. An empirically derived domain ontology and set of three problem-solving approaches were developed as a formalized model of the concepts and categories from the GT coding. The ontology and problem-solving approaches were used to design and implement a HIS that tested favorably in usability testing. The four stage approach illustrated in this paper is useful for designing and implementing an ontology as the basis for a HIS. The approach extends existing ontology development methodologies by providing an empirical basis for theory incorporated into ontology design. Copyright © 2010 Elsevier B.V. All rights reserved.

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Science.gov (United States)

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system... prospective payment system described in § 413.215 through § 413.235 of this part. (a) Qualifications for...

Experimental study on two-stage compression refrigeration/heat pump system with dual-cylinder rolling piston compressor

International Nuclear Information System (INIS)

Shuxue, Xu; Guoyuan, Ma

2014-01-01

A thermodynamically analytical model on the two-stage compression refrigeration/heat pump system with vapor injection was derived. The optimal volume ratio of the high-pressure cylinder to the low-pressure one has been discussed under both cooling and heating conditions. Based on the above research, the prototype was developed and its experimental setup established. A comprehensive experiments for the prototype have been conducted, and the results show that, compared with the single-stage compression heat pump system, the cooling capacity and cooling COP can increase 5%–15% and 10–12%, respectively. Also, the heating capacity with the evaporating temperature ranging from 0.3 to 3 °C is 92–95% of that under the rate condition with the evaporating temperature of 7 °C, and 58% when the evaporation temperature is between −28 °C and −24 °C. -- Highlights: • The volume ratio of the compressor is between 0.65 and 0.78 and the relative vapor injection mass ranges from 15% to 20%. • The cooling capacity and COP of the two-stage compression system can improve 5%–15% and 10%–12%. • The heating capacity can also be improved under low temperature condition

Integrated Circuit Design of 3 Electrode Sensing System Using Two-Stage Operational Amplifier

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Rani, S.; Abdullah, W. F. H.; Zain, Z. M.; N, Aqmar N. Z.

2018-03-01

This paper presents the design of a two-stage operational amplifier(op amp) for 3-electrode sensing system readout circuits. The designs have been simulated using 0.13μm CMOS technology from Silterra (Malaysia) with Mentor graphics tools. The purpose of this projects is mainly to design a miniature interfacing circuit to detect the redox reaction in the form of current using standard analog modules. The potentiostat consists of several op amps combined together in order to analyse the signal coming from the 3-electrode sensing system. This op amp design will be used in potentiostat circuit device and to analyse the functionality for each module of the system.

Many-Objective Particle Swarm Optimization Using Two-Stage Strategy and Parallel Cell Coordinate System.

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Hu, Wang; Yen, Gary G; Luo, Guangchun

2017-06-01

It is a daunting challenge to balance the convergence and diversity of an approximate Pareto front in a many-objective optimization evolutionary algorithm. A novel algorithm, named many-objective particle swarm optimization with the two-stage strategy and parallel cell coordinate system (PCCS), is proposed in this paper to improve the comprehensive performance in terms of the convergence and diversity. In the proposed two-stage strategy, the convergence and diversity are separately emphasized at different stages by a single-objective optimizer and a many-objective optimizer, respectively. A PCCS is exploited to manage the diversity, such as maintaining a diverse archive, identifying the dominance resistant solutions, and selecting the diversified solutions. In addition, a leader group is used for selecting the global best solutions to balance the exploitation and exploration of a population. The experimental results illustrate that the proposed algorithm outperforms six chosen state-of-the-art designs in terms of the inverted generational distance and hypervolume over the DTLZ test suite.

The interrater and intrarater reliability of the Philpott-Javer staging system based on level of training.

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Parhar, Harman S; Thamboo, Andrew; Habib, Al-Rahim; Chang, Brent; Gan, Eng Cern; Javer, Amin R

2014-04-01

The Philpott-Javer postoperative endoscopic mucosal staging system for allergic fungal rhinosinusitis has previously demonstrated acceptable interrater reliability among rhinologists. There are, however, numerous learners involved in patient care at tertiary centers. This study aims to analyze the interrater and intrarater reliability of this system among learners in otolaryngology at different stages in training. A prospective analysis of retrospectively collected endoscopic photographs. A tertiary care teaching hospital (January 2013). Fifty patients undergoing routine follow-up. Three photographs from each of 50 patients undergoing routine postsurgical nasoendoscopy were reviewed. Images were played twice, 1 week apart, in 2 differently randomized cycles and scored according to Philpott-Javer criteria by a rhinologist, a rhinology fellow, a senior otolaryngology resident, a junior otolaryngology resident, and a medical student. Interobserver reliability was assessed using the intraclass correlation coefficient, while intrarater reliability was assessed by Shrout-Fleiss κ values. Agreement between each learner and the rhinologist was also assessed using κ values. The interclass correlation among the 5 raters was 0.7600 (95% confidence interval, 0.6917-0.8161) for the Philpott-Javer scoring system, suggesting substantial reliability. Intrarater data showed substantial to almost-perfect reliability (κ values between 0.668 and 0.815) among all raters using this system. There was also moderate to substantial agreement between the learners and the rhinologist (κ values between 0.534 and 0.710). Results suggest that the Philpott-Javer staging system has acceptable intrarater and interrater reliability among learners of differing levels of clinical experience and is suitable for evaluating progress following surgery.

Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System.

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Wingate, Jonathan T; Etzioni, Ruth; Macdonald, Dusten M; Brand, Timothy C

2016-10-01

The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population. Published by Elsevier Inc.

A two-stage predictive model to simultaneous control of trihalomethanes in water treatment plants and distribution systems: adaptability to treatment processes.

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Domínguez-Tello, Antonio; Arias-Borrego, Ana; García-Barrera, Tamara; Gómez-Ariza, José Luis

2017-10-01

The trihalomethanes (TTHMs) and others disinfection by-products (DBPs) are formed in drinking water by the reaction of chlorine with organic precursors contained in the source water, in two consecutive and linked stages, that starts at the treatment plant and continues in second stage along the distribution system (DS) by reaction of residual chlorine with organic precursors not removed. Following this approach, this study aimed at developing a two-stage empirical model for predicting the formation of TTHMs in the water treatment plant and subsequently their evolution along the water distribution system (WDS). The aim of the two-stage model was to improve the predictive capability for a wide range of scenarios of water treatments and distribution systems. The two-stage model was developed using multiple regression analysis from a database (January 2007 to July 2012) using three different treatment processes (conventional and advanced) in the water supply system of Aljaraque area (southwest of Spain). Then, the new model was validated using a recent database from the same water supply system (January 2011 to May 2015). The validation results indicated no significant difference in the predictive and observed values of TTHM (R 2 0.874, analytical variance distribution systems studied, proving the adaptability of the new model to the boundary conditions. Finally the predictive capability of the new model was compared with 17 other models selected from the literature, showing satisfactory results prediction and excellent adaptability to treatment processes.

Nuclear TK1 expression is an independent prognostic factor for survival in pre-malignant and malignant lesions of the cervix

International Nuclear Information System (INIS)

Chen, Gang; He, Cheng; Li, Ling; Lin, An; Zheng, Xiongwei; He, Ellen; Skog, Sven

2013-01-01

Thymidine kinase 1 (TK1) is a proliferation biomarker that has been found useful for prognostication in cancer patients. Here we investigate for the first time the use of TK1 expression as a prognostic factor for patients with premalignant and malignant lesions of the uterine cervix. TK1 expression was determined by immunohistochemistry in cervical lesions (cervical intraepithelial neoplasia (CIN), n = 216; invasive cervical carcinoma, n = 84). TK1 and Ki-67 expressions and pathological/FIGO stages and age were correlated with 5-year survival by Kaplan-Meier, log rank and COX hazard uni- and multivariate analyses. TK1 labeling index (LI) was significantly correlated with CIN grades and invasive cervical carcinoma stages, while TK1 labeling intensity was only correlated to CIN grades. TK1 LI was significantly higher compared with Ki-67 LI. TK1 LI correlated significantly to 5-year survival in patients with invasive cervical carcinoma, particularly nuclear TK1 LI. In a multivariate analysis, nuclear TK1 expression was independent prognostic factor in patients with in situ/invasive cervical carcinoma or in invasive cervical carcinoma alone. Interestingly, in invasive cervical carcinoma patients with advanced tumors, nuclear TK1 expression could identify patients with significantly better survival rates (80%), while Ki-67 could not. Nuclear TK1 expression in early grade CIN predicts risk for progression to malignancy. Nuclear TK1 expression is also a prognostic factor for treatment outcome, particularly in patients with advanced cervical carcinomas. Nuclear TK1 expression is more useful than Ki-67 and pathological/FIGO stages

[Ovarian cancer. II. Procedures, histology, and complications].

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Szpakowski, M; Nowak, M; Malinowski, A; Romanowicz, H; Wieczorek, A; Szpakowski, A; Raczkowska, Z; Władziński, J; Wilczyński, J R; Kamiński, T; Maciołek-Blewniewska, G

2000-09-01

The purpose of our study was to analyse the operative procedures and complications in patients operated for the first time for ovarian cancer. A retrospective review of patients' charts with ovarian cancer operated at the Department of Gynaecological Surgery of Polish Mother's Memorial Hospital-Research Institute in 1990-1999 was conducted. We analysed the data of women operated for the first time for this disease. In every case we tried to perform radical operation consisted of hysterectomy with bilateral adnexectomy, omentectomy, appendectomy (if needed), and additionally optimal debulking in advanced cancer. Between January 1990 and December 1999, 107 patients were operated for the first time for ovarian cancer. FIGO staging was as follows: I--13.1%, II--14.95%, III--59.8%, IV--12.15%. The most frequent findings on histology were serous (39.3%), endometrioid (26.2%), undifferentiated (11.2%) and clear cell cancers (10.7%). In 60.7% of cases we performed hysterectomy with bilateral adnexectomy, in 15.0% bilateral adnexectomy, in 4.7% of patients cytoreductive tumorectomy, and in 19.6% of cases only excisions for histology were taken. 69.0% of patients underwent also omentectomy and 42.6% appendectomy. In 58.9% of patients we performed radical operation; its incidence significantly decreased with the increase of FIGO staging: I--100%, II--87.5%, III--51.6%, IV--15.4% (p serous and endometrioid ovarian cancer. The great majority of patients was diagnosed to late and operated in III and IV stage of the disease, but in almost 60% of cases radical operation was performed.

Evaluation of the prognostic value of Okuda, Cancer of the Liver Italian Program, and Japan Integrated Staging systems for hepatocellular carcinoma patients undergoing radiotherapy

International Nuclear Information System (INIS)

Seong, Jinsil; Shim, Su Jung; Lee, Ik Jae; Han, Kwang Hyub; Chon, Chae Yoon; Ahn, Sang Hoon

2007-01-01

Purpose: The purpose of this study was to compare the validity of staging systems, as well as to identify the staging system with the best prognostic value, in hepatocellular carcinoma (HCC) patients treated with radiotherapy. Methods and Materials: From 1992 to 2003, a total of 305 patients undergoing radiotherapy for HCC were evaluated retrospectively. All patients were classified before radiation therapy by the following systems: tumor-node-metastasis (TNM), Okuda, Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) score. Cumulative survival rates were obtained using the Kaplan-Meier method, and were statistically compared using the log-rank test. Results: Median survival time was 11 months. The 1-, 2-, 3-, 4-, and 5-year survival rates were 45.1%, 24.5%, 14.7%, 10.3%, and 6.4%, respectively. Significant differences in survival were observed between all TNM stages, between CLIP scores 2, 3 and 5, 6, as well as between JIS scores 1, 2, and 2, 3. Conclusions: Among the systems studied, the TNM staging approach appeared to be the best predictor of prognosis. Staging systems that reflect liver disease status (Okuda stage, CLIP, and JIS score) showed limitations in stratifying patients undergoing radiotherapy into different prognostic groups

Optimal dynamic performance for high-precision actuators/stages

International Nuclear Information System (INIS)

Preissner, C.; Lee, S.-H.; Royston, T. J.; Shu, D.

2002-01-01

System dynamic performance of actuator/stage groups, such as those found in optical instrument positioning systems and other high-precision applications, is dependent upon both individual component behavior and the system configuration. Experimental modal analysis techniques were implemented to determine the six degree of freedom stiffnesses and damping for individual actuator components. These experimental data were then used in a multibody dynamic computer model to investigate the effect of stage group configuration. Running the computer model through the possible stage configurations and observing the predicted vibratory response determined the optimal stage group configuration. Configuration optimization can be performed for any group of stages, provided there is stiffness and damping data available for the constituent pieces

Preventive measures of water hammer in the design stage of mine drainage system

International Nuclear Information System (INIS)

Wu Dongyan

2012-01-01

The mechanisms and types of water hammer accident in mine drainage system are introduced. Through calculating water hammer pressure head of pump-failure water hammer, the extent of the harm caused by water hammer can be displayed visually, therefore,the preventive measures to be taken in the design stage are put forward in order to reduce water hammer accident. (author)

Silicon concentrator cells in a two-stage photovoltaic system with a concentration factor of 300x

Energy Technology Data Exchange (ETDEWEB)

Mohr, A.

2005-06-15

In this work a rear contacted silicon concentrator cell was developed for an application in a two stage concentrator photovoltaic system. This system was developed at Fraunhofer ISE some years ago. The innovation of this one-axis tracked system is that it enables a high geometrical concentration of 300x in combination with a high optical efficiency (around 78%) and a large acceptance angle of {+-}23.5 all year through. For this, the system uses a parabolic mirror (40.4x) and a three dimensional second stage consisting of compound parabolic concentrators (CPCs, 7.7x). For the concentrator concept and particularly for an easy cell integration, the rear line contacted concentrator (RLCC) cells with a maximum efficiency of 25% were developed and a hybrid mounting concept for the RLCC cells is presented. The optical performance of different CPC materials was tested and analysed in this work. Finally, small modules consisting of six series interconnected RLCC cells and six CPCs were integrated into the concentrator system and tested outdoor. A system efficiency of 16.2% was reached at around 800 W/m2 direct irradiance under realistic outdoor conditions. (orig.)

Disturbance estimation and compensation for planar motors on the long-stroke stage of a wafer stage

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Bizhong Xia

2015-04-01

Full Text Available This article presents a data-based method to estimate and compensate low-frequency disturbance in planar motors on the long-stroke stage of a wafer stage, which is a typical multiple-input multiple-output system. First, a data-based method is introduced to decouple the multiple-input multiple-output system into multi-single-input single-output system, which is crucial for the design of controller and the correction of disturbance estimation in the scanning direction. Second, dominant low-frequency disturbances in the long-stroke stage are analyzed. Third, estimation and compensation method under moving condition is proposed. The compensation method is based on three feedforward tables, and the tables are indexed by trajectory parameters, including velocity and position instead of time in the iterative learning control method. Finally, experiments are performed on the long-stroke stage of a wafer stage to verify the proposed method. Experimental results show that the proposed method can effectively improve the servo performance by reducing the tracking errors by nearly 1/2 in the forward direction and 1/3 in the backward direction and lowering error difference between the forward and backward directions from 5.1 to 1.2 µm.

Assessment of capabilities in persons with advanced stage of dementia: Validation of The Montessori Assessment System (MAS).

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Erkes, Jérôme; Camp, Cameron J; Raffard, Stéphane; Gély-Nargeot And, Marie-Christine; Bayard, Sophie

2017-01-01

This study evaluated the validity and reliability of the Montessori Assessment System. The Montessori Assessment System assesses preserved abilities in persons with moderate to severe dementia. In this respect, this instrument provides crucial information for the development of effective person-centered care plans. A total of 196 persons with a diagnosis of dementia in the moderate to severe stages of dementia were recruited in 10 long-term care facilities in France. All participants completed the Montessori Assessment System, the Clinical Dementia Rating Scale and/or the Mini Mental State Examination and the Severe Impairment Battery-short form. The internal consistency and temporal stability of the Montessori Assessment System were high. Additionally, good construct and divergent validity were demonstrated. Factor analysis showed a one-factor structure. The Montessori Assessment System demonstrated satisfactory psychometric properties while being a useful instrument to assess capabilities in persons with advanced stages of dementia and hence to develop person-centered plans of care.

Proposal for the construction of the staged Scyllac prototype

International Nuclear Information System (INIS)

Nunnally, W.C.; McDonald, T.E.

1975-07-01

After the completion of the present feedback experiment on Scyllac, the machine will be reconfigured into a toroidal staged theta pinch. A 0.9-m prototype of the Staged Scyllac experiment is proposed which will be used to test the components required for the implosion-heating and staging circuits in a system environment. In addition, various systems of the Staged Scyllac, such as the trigger system and the gap-monitoring system, can be developed on the prototype before installation on the full experiment. (auth)

Evaluation on prognosis of esophageal squamous cell carcinoma patients after three-dimensional conformal radiotherapy with different clinical stage system

International Nuclear Information System (INIS)

Wang Yuxiang; Zhu Shuchai; Qiu Rong; Liu Zhikun; Shen Wenbin

2011-01-01

Objective: To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods: From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT. Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer, Concordance was better in T stage (Kappa = 0.271) than in TNM stage (Kappa = 0.167) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0.261) than between UICCT and Zhu's T stage (Kappa = 0.045) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage (Kappa = 0.597) than between UICC-TNM and cooperation group' TNM stage (Kappa =0.299). With multivariate analysis, T (χ 2 value is 11.58, 26.00 and 51.05, all P 2 value is 15.28, 16.10 and 16.10, all P 2 value is 5.59, 27.78 and 27.78, all P 2 value is 15.77, 34, 35 and 51.10, all P 1 - T 3 was difficult to definite and the prognosis was not significantly different in T 1 - T 3 stage. Conclusions: In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy; cooperation group' stage and Zhu's stage need further application, with further accuracy needed. (authors)

Solar Thermal Upper Stage Cryogen System Engineering Checkout Test

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