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Sample records for optimal stage iii

  1. A proteomics panel for predicting optimal primary cytoreduction in stage III/IV ovarian cancer

    DEFF Research Database (Denmark)

    Risum, Signe; Høgdall, Estrid; Engelholm, Svend A;

    2009-01-01

    The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed...

  2. Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

    Science.gov (United States)

    2014-12-29

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  3. Bevacizumab, Cisplatin, Radiation Therapy, and Fluorouracil in Treating Patients With Stage IIB, Stage III, Stage IVA, or Stage IVB Nasopharyngeal Cancer

    Science.gov (United States)

    2014-04-21

    Stage II Squamous Cell Carcinoma of the Nasopharynx; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx

  4. Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer

    Science.gov (United States)

    2016-02-09

    Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

  5. GLASS COMPOSITION AND SOLUTION SPECIATION EFFECTS ON STAGE III DISSOLUTION

    Energy Technology Data Exchange (ETDEWEB)

    Pantano, Carlo G; Trivelpiece, Cory L; Rice, Jarret A

    2017-10-03

    To understand and mitigate the onset of Stage III corrosion of multicomponent oxides waste glasses. Stage III refers to a resumption of the high initial rate of glass dissolution in some glass samples that have otherwise exhibited dissolution at the much lower residual rate for a long time (Stage II). Although the onset of Stage III is known to occur concurrently with the precipitation of particular alteration products, the root cause of the transition is still unknown. Certain glass compositions (notably AFCI) and high pH environmental conditions are also associated with this observed transition.

  6. Utility-based optimization of phase II/III programs.

    Science.gov (United States)

    Kirchner, Marietta; Kieser, Meinhard; Götte, Heiko; Schüler, Armin

    2016-01-30

    Phase II and phase III trials play a crucial role in drug development programs. They are costly and time consuming and, because of high failure rates in late development stages, at the same time risky investments. Commonly, sample size calculation of phase III is based on the treatment effect observed in phase II. Therefore, planning of phases II and III can be linked. The performance of the phase II/III program crucially depends on the allocation of the resources to phases II and III by appropriate choice of the sample size and the rule applied to decide whether to stop the program after phase II or to proceed. We present methods for a program-wise phase II/III planning that aim at determining optimal phase II sample sizes and go/no-go decisions in a time-to-event setting. Optimization is based on a utility function that takes into account (fixed and variable) costs of the drug development program and potential gains after successful launch. The proposed methods are illustrated by application to a variety of scenarios typically met in oncology drug development.

  7. Gene expression profiles in stages II and III colon cancers

    DEFF Research Database (Denmark)

    Thorsteinsson, Morten; Kirkeby, Lene T; Hansen, Raino;

    2012-01-01

    were retrieved from the Gene Expression Omnibus (GEO) (n¿=¿111) in addition to a Danish data set (n¿=¿37). All patients had stages II and III colon cancers. A Prediction Analysis of Microarray classifier, based on the 128-gene signature and the original training set of stage I (n¿=¿65) and stage IV (n......¿=¿76) colon cancers, was reproduced. The stages II and III colon cancers were subsequently classified as either stage I-like (good prognosis) or stage IV-like (poor prognosis) and assessed by the 36 months cumulative incidence of relapse. RESULTS: In the GEO data set, results were reproducible in stage...... correctly predicted as stage IV-like, and the remaining patients were predicted as stage I-like and unclassifiable, respectively. Stage II patients could not be stratified. CONCLUSIONS: The 128-gene signature showed reproducibility in stage III colon cancer, but could not predict recurrence in stage II...

  8. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy

    DEFF Research Database (Denmark)

    Eggermont, Alexander M M; Chiarion-Sileni, Vanna; Grob, Jean-Jacques;

    2016-01-01

    Background On the basis of data from a phase 2 trial that compared the checkpoint inhibitor ipilimumab at doses of 0.3 mg, 3 mg, and 10 mg per kilogram of body weight in patients with advanced melanoma, this phase 3 trial evaluated ipilimumab at a dose of 10 mg per kilogram in patients who had...... undergone complete resection of stage III melanoma. Methods After patients had undergone complete resection of stage III cutaneous melanoma, we randomly assigned them to receive ipilimumab at a dose of 10 mg per kilogram (475 patients) or placebo (476) every 3 weeks for four doses, then every 3 months...... patients (1.1%) died owing to immune-related adverse events. Conclusions As adjuvant therapy for high-risk stage III melanoma, ipilimumab at a dose of 10 mg per kilogram resulted in significantly higher rates of recurrence-free survival, overall survival, and distant metastasis-free survival than placebo...

  9. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy

    DEFF Research Database (Denmark)

    Eggermont, Alexander M M; Chiarion-Sileni, Vanna; Grob, Jean-Jacques

    2016-01-01

    Background On the basis of data from a phase 2 trial that compared the checkpoint inhibitor ipilimumab at doses of 0.3 mg, 3 mg, and 10 mg per kilogram of body weight in patients with advanced melanoma, this phase 3 trial evaluated ipilimumab at a dose of 10 mg per kilogram in patients who had...... undergone complete resection of stage III melanoma. Methods After patients had undergone complete resection of stage III cutaneous melanoma, we randomly assigned them to receive ipilimumab at a dose of 10 mg per kilogram (475 patients) or placebo (476) every 3 weeks for four doses, then every 3 months...... patients (1.1%) died owing to immune-related adverse events. Conclusions As adjuvant therapy for high-risk stage III melanoma, ipilimumab at a dose of 10 mg per kilogram resulted in significantly higher rates of recurrence-free survival, overall survival, and distant metastasis-free survival than placebo...

  10. Evaluation of lymph node numbers for adequate staging of Stage II and III colon cancer

    Directory of Open Access Journals (Sweden)

    Bumpers Harvey L

    2011-05-01

    Full Text Available Abstract Background Although evaluation of at least 12 lymph nodes (LNs is recommended as the minimum number of nodes required for accurate staging of colon cancer patients, there is disagreement on what constitutes an adequate identification of such LNs. Methods To evaluate the minimum number of LNs for adequate staging of Stage II and III colon cancer, 490 patients were categorized into groups based on 1-6, 7-11, 12-19, and ≥ 20 LNs collected. Results For patients with Stage II or III disease, examination of 12 LNs was not significantly associated with recurrence or mortality. For Stage II (HR = 0.33; 95% CI, 0.12-0.91, but not for Stage III patients (HR = 1.59; 95% CI, 0.54-4.64, examination of ≥20 LNs was associated with a reduced risk of recurrence within 2 years. However, examination of ≥20 LNs had a 55% (Stage II, HR = 0.45; 95% CI, 0.23-0.87 and a 31% (Stage III, HR = 0.69; 95% CI, 0.38-1.26 decreased risk of mortality, respectively. For each six additional LNs examined from Stage III patients, there was a 19% increased probability of finding a positive LN (parameter estimate = 0.18510, p Conclusions Thus, the 12 LN cut-off point cannot be supported as requisite in determining adequate staging of colon cancer based on current data. However, a minimum of 6 LNs should be examined for adequate staging of Stage II and III colon cancer patients.

  11. Acceptance and Commitment Therapy in Improving Well-Being in Patients With Stage III-IV Cancer and Their Partners

    Science.gov (United States)

    2017-09-21

    Malignant Female Reproductive System Neoplasm; Malignant Hepatobiliary Neoplasm; Partner; Stage III Breast Cancer; Stage III Cervical Cancer; Stage III Colorectal Cancer; Stage III Lung Cancer; Stage III Prostate Cancer; Stage III Skin Melanoma; Stage III Uterine Corpus Cancer; Stage IIIA Breast Cancer; Stage IIIA Cervical Cancer; Stage IIIA Colorectal Cancer; Stage IIIA Lung Carcinoma; Stage IIIA Skin Melanoma; Stage IIIA Uterine Corpus Cancer; Stage IIIB Breast Cancer; Stage IIIB Cervical Cancer; Stage IIIB Colorectal Cancer; Stage IIIB Lung Carcinoma; Stage IIIB Skin Melanoma; Stage IIIB Uterine Corpus Cancer; Stage IIIC Breast Cancer; Stage IIIC Colorectal Cancer; Stage IIIC Skin Melanoma; Stage IIIC Uterine Corpus Cancer; Stage IV Breast Cancer; Stage IV Cervical Cancer; Stage IV Colorectal Cancer; Stage IV Lung Cancer; Stage IV Prostate Cancer; Stage IV Skin Melanoma; Stage IV Uterine Corpus Cancer; Stage IVA Cervical Cancer; Stage IVA Colorectal Cancer; Stage IVA Uterine Corpus Cancer; Stage IVB Cervical Cancer; Stage IVB Colorectal Cancer; Stage IVB Uterine Corpus Cancer

  12. Outcomes of patients with unresected stage III and stage IV non-small cell lung cancer: A single institution experience

    Directory of Open Access Journals (Sweden)

    Manpreet Singh Tiwana

    2013-01-01

    Full Text Available Introduction: To report on the demographic profile and survival outcomes of North Indian population affected with stage III and stage IV non-small cell lung cancer (NSCLC. Materials and Methods: From November 2008 to January 2012, 138 consecutively diagnosed NSCLC patients were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS, Kaplan-Meier survival plots, t-test, Cox proportional hazards models were generated by multivariate analysis [MVA] and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL. Results: Median OS of stage III patients was 9.26 ± 1.85 months and 2-year survival rate of 13% while stage IV patients had median OS of 5 ± 1.5 months with a 2-year survival rate of 8%. Cox regression modeling for MVA demonstrated higher biologically equivalent dose (BED ( P = 0.01 in stage III while in stage IV non-squamous histology ( P = 0.01, administration of chemotherapy ( P = 0.02, partial responders to chemotherapy ( P = 0.001, higher BED ( P = 0.02, and those with skeletal metastasis alone ( P = 0.17 showed a better OS. Conclusion: Our data showed that a higher BED is associated with favorable outcomes, indicating a role of dose escalated radiation therapy to the primary lesion in both stage III and essentially in stage IV NSCLC. Additionally, optimal use of chemotherapy relates to better survival. The developing, resource restrained nations need to follow an economically feasible multimodality approach.

  13. Optimization, an Important Stage of Engineering Design

    Science.gov (United States)

    Kelley, Todd R.

    2010-01-01

    A number of leaders in technology education have indicated that a major difference between the technological design process and the engineering design process is analysis and optimization. The analysis stage of the engineering design process is when mathematical models and scientific principles are employed to help the designer predict design…

  14. 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

  15. Psychosexual Intervention in Patients With Stage I-III Gynecologic or Breast Cancer

    Science.gov (United States)

    2016-05-02

    Ovarian Sarcoma; Ovarian Stromal Cancer; Stage I Uterine Sarcoma; Stage I Vaginal Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IA Endometrial Carcinoma; Stage IA Fallopian Tube Cancer; Stage IA Ovarian Epithelial Cancer; Stage IA Ovarian Germ Cell Tumor; Stage IA Primary Peritoneal Cavity Cancer; Stage IB Cervical Cancer; Stage IB Endometrial Carcinoma; Stage IB Fallopian Tube Cancer; Stage IB Ovarian Epithelial Cancer; Stage IB Ovarian Germ Cell Tumor; Stage IB Primary Peritoneal Cavity Cancer; Stage IC Fallopian Tube Cancer; Stage IC Ovarian Epithelial Cancer; Stage IC Ovarian Germ Cell Tumor; Stage IC Primary Peritoneal Cavity Cancer; Stage II Endometrial Carcinoma; Stage II Gestational Trophoblastic Tumor; Stage II Uterine Sarcoma; Stage II Vaginal Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Ovarian Germ Cell Tumor; Stage IIA Primary Peritoneal Cavity Cancer; Stage IIB Cervical Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Ovarian Germ Cell Tumor; Stage IIB Primary Peritoneal Cavity Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage IIC Primary Peritoneal Cavity Cancer; Stage III Gestational Trophoblastic Tumor; Stage III Uterine Sarcoma; Stage III Vaginal Cancer; Stage III Vulvar Cancer; Stage IIIA Cervical Cancer; Stage IIIA Endometrial Carcinoma; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Cervical Cancer; Stage IIIB Endometrial Carcinoma; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Endometrial Carcinoma; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell

  16. Cetuximab and Radiation Therapy in Treating Patients With Stage III-IV Head and Neck Cancer

    Science.gov (United States)

    2017-09-21

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Tongue Cancer

  17. Exercise in Targeting Metabolic Dysregulation in Stage I-III Breast or Prostate Cancer Survivors

    Science.gov (United States)

    2017-09-12

    Cancer Survivor; No Evidence of Disease; Obesity; Overweight; Prostate Carcinoma; Sedentary Lifestyle; Stage I Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage III Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  18. Immunochemotherapy with levamisole for stage III gastric cancer patients.

    Directory of Open Access Journals (Sweden)

    Miwa,Hiroaki

    1983-12-01

    Full Text Available Levamisole (LMS was given to stage III gastric cancer patients starting three days before gastrectomy, at a does of 150 mg/day for three consecutive days every other week. Survival rates of these patients were compared with those of stage III gastric cancer patients previously operated in our Department who had not received levamisole. The background factors of both groups were matched as closely as possible. Both groups were concomitantly treated with mitomycin C and FT-207. The survival rate of the LMS group was significantly higher than that of the control group when the tumor had a diameter of 4.0-8.0 cm, cancer cells infiltrated to the gastric serosa, there were metastases within the regional lymph nodes, cancer cells slightly invaded the venous capillaren and there was moderate infiltration of the stroma.

  19. Imatinib Mesylate in Treating Patients With Progressive, Refractory, or Recurrent Stage II or Stage III Testicular or Ovarian Cancer

    Science.gov (United States)

    2013-01-15

    Ovarian Dysgerminoma; Recurrent Malignant Testicular Germ Cell Tumor; Recurrent Ovarian Germ Cell Tumor; Stage II Malignant Testicular Germ Cell Tumor; Stage II Ovarian Germ Cell Tumor; Stage III Malignant Testicular Germ Cell Tumor; Stage III Ovarian Germ Cell Tumor; Testicular Seminoma

  20. Cisplatin, Radiation Therapy, and Pembrolizumab in Treating Patients With Stage III-IV Head and Neck Squamous Cell Carcinoma

    Science.gov (United States)

    2016-05-16

    Stage III Hypopharyngeal Squamous Cell Carcinoma; Stage III Laryngeal Squamous Cell Carcinoma; Stage III Oral Cavity Squamous Cell Carcinoma; Stage III Oropharyngeal Squamous Cell Carcinoma; Stage IVA Hypopharyngeal Squamous Cell Carcinoma; Stage IVA Laryngeal Squamous Cell Carcinoma; Stage IVA Oral Cavity Squamous Cell Carcinoma; Stage IVA Oropharyngeal Squamous Cell Carcinoma; Stage IVB Hypopharyngeal Squamous Cell Carcinoma; Stage IVB Laryngeal Squamous Cell Carcinoma; Stage IVB Oral Cavity Squamous Cell Carcinoma; Stage IVB Oropharyngeal Squamous Cell Carcinoma

  1. Upgrading a Stage III A engine for Stage IV; Ertuechtigung eines Stufe-III-A-Motors fuer Stufe IV

    Energy Technology Data Exchange (ETDEWEB)

    Schrewe, Klaus; Lamotte, Dominik; Zirka, Ingo [HJS Emission Technology GmbH und Co. KG, Menden (Germany)

    2013-07-15

    In the field of construction and agricultural machinery proven simple technique is estimated especially in countries with lower development standards as in Central Europe. A 4.4 l, 65 to 95 kW diesel engine that is certified in line with Stage III A, equipped with a fully mechanical injection system and open loop-controlled exhaust-gas recirculation system has now been upgraded from HJS through a low-maintenance and fully autarkic exhaust aftertreatment system that complies with the Stage IV standard. The reduction of nitrogen oxides by selective catalytic reduction is carried out with a NO{sub x} reduction greater than 90 %. The particulate emissions are reduced by a maintenance-free bypass filter with a particle reduction rate exceeds by more than 60 %. (orig.)

  2. The development and validation of a CT-based radiomics signature for the preoperative discrimination of stage I-II and stage III-IV colorectal cancer

    Science.gov (United States)

    He, Lan; Chen, Xin; Ma, Zelan; Dong, Di; Tian, Jie; Liang, Changhong; Liu, Zaiyi

    2016-01-01

    Objectives To investigative the predictive ability of radiomics signature for preoperative staging (I-IIvs.III-IV) of primary colorectal cancer (CRC). Methods This study consisted of 494 consecutive patients (training dataset: n=286; validation cohort, n=208) with stage I–IV CRC. A radiomics signature was generated using LASSO logistic regression model. Association between radiomics signature and CRC staging was explored. The classification performance of the radiomics signature was explored with respect to the receiver operating characteristics(ROC) curve. Results The 16-feature-based radiomics signature was an independent predictor for staging of CRC, which could successfully categorize CRC into stage I-II and III-IV (p <0.0001) in training and validation dataset. The median of radiomics signature of stage III-IV was higher than stage I-II in the training and validation dataset. As for the classification performance of the radiomics signature in CRC staging, the AUC was 0.792(95%CI:0.741-0.853) with sensitivity of 0.629 and specificity of 0.874. The signature in the validation dataset obtained an AUC of 0.708(95%CI:0.698-0.718) with sensitivity of 0.611 and specificity of 0.680. Conclusions A radiomics signature was developed and validated to be a significant predictor for discrimination of stage I-II from III-IV CRC, which may serve as a complementary tool for the preoperative tumor staging in CRC. PMID:27120787

  3. Erlotinib Hydrochloride and Radiation Therapy in Stage III-IV Squamous Cell Cancer of the Head and Neck

    Science.gov (United States)

    2012-10-30

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity

  4. Interactive Tailored Website to Promote Sun Protection and Skin Self-Check Behaviors in Patients With Stage 0-III Melanoma

    Science.gov (United States)

    2017-02-15

    Stage 0 Skin Melanoma; Stage I Skin Melanoma; Stage IA Skin Melanoma; Stage IB Skin Melanoma; Stage II Skin Melanoma; Stage IIA Skin Melanoma; Stage IIB Skin Melanoma; Stage IIC Skin Melanoma; Stage III Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma

  5. Palliative Care in Improving Quality of Life and Symptoms in Patients With Stage III-IV Pancreatic or Ovarian Cancer

    Science.gov (United States)

    2014-12-18

    Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Pancreatic Cancer; Stage III Pancreatic Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Pancreatic Cancer

  6. The relation between lymph node status and survival in Stage I-III colon cancer

    DEFF Research Database (Denmark)

    Lykke, J.; Roikjær, Ole; Jess, P.

    2013-01-01

    Aim: This study involved a large nationwide Danish cohort to evaluate the hypothesis that a high lymph node harvest has a positive effect on survival in curative resected Stage I-III colon cancer and a low lymph node ratio has a positive effect on survival in Stage III colon cancer. Method......: Analysis of overall survival was conducted using a nationwide Danish cohort of patients treated with curative resection of Stage I-III colon cancer. All 8901 patients in Denmark diagnosed with adenocarcinoma of the colon and treated with curative resection in the period 2003-2008 were identified from...... independent prognostic factors in multivariate analysis. Conclusion: High lymph node count was associated with improved overall survival in colon cancer. Lymph node ratio was superior to N-stage in differentiating overall survival in Stage III colon cancer. Stage migration was observed....

  7. Extended Cancer Education for Longer-Term Survivors in Primary Care for Patients With Stage I-II Breast or Prostate Cancer or Stage I-III Colorectal Cancer

    Science.gov (United States)

    2017-08-01

    Stage I Breast Cancer; Stage I Colorectal Cancer AJCC v6 and v7; Stage I Prostate Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage II Colorectal Cancer AJCC v7; Stage II Prostate Cancer; Stage IIA Breast Cancer; Stage IIA Colorectal Cancer AJCC v7; Stage IIA Prostate Cancer; Stage IIB Breast Cancer; Stage IIB Colorectal Cancer AJCC v7; Stage IIB Prostate Cancer; Stage IIC Colorectal Cancer AJCC v7; Stage III Colorectal Cancer AJCC v7; Stage IIIA Colorectal Cancer AJCC v7; Stage IIIB Colorectal Cancer AJCC v7; Stage IIIC Colorectal Cancer AJCC v7

  8. Optimization Studies of a Single-Stage Magnetic Field Accelerator

    Science.gov (United States)

    Bedrosian, Paul

    1996-05-01

    The use of electromagnetic propulsion as a method of energy conversion is the subject of much current research. A single-stage magnetic field accelerator (MFA) was designed and built to investigate design parameters of the system. Using a ballistic pendulum, the efficieny of energy transfer was looked at for a number of physical and electrical parameters. The resulting optimization of a single-stage MFA will be helpful in the design and development of future multi-stage MFA's.

  9. Radiotherapy Improves Survival in Unresected Stage I-III Bronchoalveolar Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Urban, Damien [Department of Oncology, Sheba Medical Center, Ramat Gan (Israel); Mishra, Mark [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Onn, Amir [Department of Oncology, Sheba Medical Center, Ramat Gan (Israel); Dicker, Adam P. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Symon, Zvi; Pfeffer, M. Raphael [Department of Oncology, Sheba Medical Center, Ramat Gan (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Lawrence, Yaacov Richard, E-mail: yaacovla@gmail.com [Department of Oncology, Sheba Medical Center, Ramat Gan (Israel); Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2012-11-01

    Purpose: To test the hypothesis that radiotherapy (RT) improves the outcome of patients with unresected, nonmetastatic bronchoalveolar carcinoma (BAC) by performing a population-based analysis within the Surveillance, Epidemiology, and End Results (SEER) registry. Methods and Materials: Inclusion criteria were as follows: patients diagnosed with BAC, Stage I-III, between 2001 and 2007. Exclusion criteria included unknown stage, unknown primary treatment modality, Stage IV disease, and those diagnosed at autopsy. Demographic data, treatment details, and overall survival were retrieved from the SEER database. Survival was analyzed using the Kaplan-Meier method and log-rank test. Results: A total of 6933 patients with Stage I-III BAC were included in the analysis. The median age at diagnosis was 70 years (range, 10-101 years). The majority of patients were diagnosed with Stage I (74.4%); 968 patients (14%) did not undergo surgical resection. Unresected patients were more likely to be older (p < 0.0001), male (p = 0.001), black (p < 0.0001), and Stage III (p < 0.0001). Within the cohort of unresected patients, 300 (31%) were treated with RT. The estimated 2-year overall survival for patients with unresected, nonmetastatic BAC was 58%, 44%, and 27% in Stage I, II, and III, respectively. Factors associated with improved survival included female sex, earlier stage at diagnosis, and use of RT. Median survival in those not receiving RT vs. receiving RT was as follows: Stage I, 28 months vs. 33 months (n = 364, p = 0.06); Stage II, 18 months vs. not reached (n = 31, nonsignificant); Stage III, 10 months vs. 17 months (n = 517, p < 0.003). Conclusions: The use of RT is associated with improved prognosis in unresected Stage I-III BAC. Less than a third of patients who could have potentially benefited from RT received it, suggesting that the medical specialists involved in the care of these patients underappreciate the importance of RT.

  10. 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.

  11. Theory of work-hardening applied to stages III and IV

    Science.gov (United States)

    Kuhlmann-Wilsdorf, D.; Hansen, N.

    1989-11-01

    Stage IV has become the accepted name for that work-hardening stage within which large plastic strains can occur at a very low, virtually constant work-hardening rate, as exemplified by cold rolling and wire drawing. By contrast, in the preceding stage III, the work-hardening rate decreases sharply with strain, whereas in the still earlier stage II, the work-hardening rate is also almost constant but has a high value. The classical paper by Langford and Cohen on drawn iron wire is now recognized as one of the earliest studies of stage IV. Already in 1970, a detailed theoretical analysis of that work based on the mesh length theory was presented[2] which has stood the test of time, although in it the Langford and Cohen experiments were considered to represent stage II on account of the operation of similitude and the almost constant work-hardening rate. The present paper re-examines the 1970 theoretical interpretation in terms of stage IV behavior, which necessitates reinterpretation of stage III. Included in the present interpretation are more recent insights regarding dislocation behavior in so-called LEDS, low-energy dislocation structures. It is concluded that stages II and IV differ, because in stage II, cross slip is insignificant, while in stage IV, it is unlimited. Accordingly, cross slip is gradually established in the course of stage III. However, similitude appears to operate in all three stages. By extension of the argument regarding stages III and IV, it is seen that stages V and VI could follow, including similitude, through the establishment of climb.

  12. Advanced-stage III/IV follicular lymphoma. Treatment strategies for individual patients

    Energy Technology Data Exchange (ETDEWEB)

    Heinzelmann, Frank; Bamberg, Michael; Weinmann, Martin [Dept. of Radiation Oncology, Univ. of Tuebingen (Germany); Ottinger, Hellmut [Dept. of Bone Marrow Transplantation, Univ. of Essen (Germany); Engelhard, Marianne [Dept. of Radiation Oncology, Univ. of Essen (Germany); Soekler, Martin [Dept. of Internal Medicine II, Univ. of Tuebingen (Germany)

    2010-05-15

    Background: in patients with advanced-stage III/IV follicular lymphoma (FL), there are many treatment options available. The current challenge is to choose the optimal strategy for the individual patient. Methods: the literature was reviewed with respect to treatment strategies in patients with advanced FL by screening the PubMed databank. Results: in advanced-stage III/IV FL, median survival may approach 8-10 years. Treatment strategies include a watch-and-wait strategy, chemoimmunotherapy, monotherapy with rituximab, and - as an experimental approach so far - radioimmunotherapy. The use of autologous hematopoietic stem cell transplantation (HSCT) for patients in first remission or chemosensitive relapse prolongs progression-free survival while the effect on overall survival remains unclear compared to standard chemotherapy. However, long-term results are flawed by high relapse rates and risk of secondary malignancies. In patients with relapsed/chemoresistant disease, allogeneic HSCT constitutes the only curative approach but is associated with high treatment-related mortality. In the palliative setting, low-dose involved-field irradiation constitutes an effective treatment option in order to control local symptoms with potential long-lasting response. Conclusion: in case of advanced-disease FL, asymptomatic patients can be managed expectantly. In symptomatic patients, chemoimmunotherapy is regarded as standard therapy. In symptomatic elderly patients with relevant comorbidities, rituximab {+-} single-agent chemotherapy, or low-dose involved-field radiotherapy might be appropriate. For younger patients with chemoresistant/relapsed disease, allogeneic HSCT might be considered, since advances in supportive care and better patient selection have resulted in improved outcomes. (orig.)

  13. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    Science.gov (United States)

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  14. Entolimod in Treating Patients With Stage III-IV Squamous Cell Head and Neck Cancer Receiving Cisplatin and Radiation Therapy

    Science.gov (United States)

    2013-12-10

    Mucositis; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVC Verrucous Carcinoma of the Larynx; Stage IVC Verrucous Carcinoma of the Oral

  15. Walking Versus Jogging in Stages III and IV of the Bruce Treadmill Test.

    Science.gov (United States)

    Cundiff, D.; Schwane, J.

    Observations during research involving the Bruce Treadmill Test (BTMT) indicating that Stage III for females and Stage IV for males represented speeds which are intermediate between comfortable walking and confortable jogging for many subjects, prompted this study to determine ways to obtain more consistent group results. Twenty-eight subjects…

  16. Risk of recurrence in patients with colon cancer stage II and III

    DEFF Research Database (Denmark)

    Bockelman, C.; Engelmann, Bodil E.; Kaprio, T.;

    2015-01-01

    Background. Adjuvant chemotherapy is established routine therapy for colon cancer (CC) patients with radically resected stage III and 'high-risk' stage II disease. The decision on recommending adjuvant chemotherapy, however, is based on data from older patient cohorts not reflecting improvements...

  17. A prognostic analysis of 895 cases of stage III colon cancer in different colon subsites.

    Science.gov (United States)

    Zhang, Yan; Ma, Junli; Zhang, Sai; Deng, Ganlu; Wu, Xiaoling; He, Jingxuan; Pei, Haiping; Shen, Hong; Zeng, Shan

    2015-09-01

    Stage III colon cancer is currently treated as an entity with a unified therapeutic principle. The aim of the retrospective study is to explore the clinicopathological characteristics and outcomes of site-specific stage III colon cancers and the influences of tumor location on prognosis. Eight hundred ninety-five patients with stage III colon cancer treated with radical operation and subsequent adjuvant chemotherapy (5-fluorouracil/oxaliplatin) were divided into seven groups according to colon segment (cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, and sigmoid colon). Expression of excision repair cross-complementing group 1 (ERCC1) and thymidylate synthase (TS) was examined by immunohistochemistry. We assessed if differences exist in patient characteristics and clinic outcomes between the seven groups. There were significant differences in tumor differentiation (P Cancer (AJCC) tumor-node-metastasis (TNM) stage (P colon. Cox regression analyses identified that tumor location was an independent prognostic factor for RFS and OS. Stage III colon cancer located proximally carried a poorer survival than that located distally. Different efficacies of FOLFOX adjuvant chemotherapy may be an important factor affecting survival of site-specific stage III colon cancers.

  18. Modified cervicopexy: a novel, less-invasive technique for Stages III and IV uterine prolapse.

    Science.gov (United States)

    Elsaman, Ali M; Salem, Hosam T; Amin, Magdy; Fetih, Ahmed N; Othman, Essam-Edin R; Zahran, Kamal M

    2014-12-01

    To evaluate modified anterior abdominal wall cervicopexy (AWC) as a less invasive (via 3-cm minilaparotomy) and more augmented (via securing posterior vaginal wall to uterosacral ligaments) technique. Case series of 30 women with Stages III and IV apical uterine prolapse assessed by the pelvic organ prolapse quantification system. The modified AWC procedure was performed successfully for 17 cases with Stage III uterovaginal prolapse and 13 cases with Stage IV uterovaginal prolapse. The procedure was conducted safely with no operative or postoperative complications, apart from two cases with postoperative urinary retention. Operative time ranged from 45 to 70min. Follow-up was available for 1-3 years. Overall, 27 cases were satisfied with the procedure, and three cases developed recurrence after caesarean section due to cutting the supporting sutures. The modified AWC procedure is less invasive, simple and effective for Stages III and IV uterine prolapse. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Radiation Therapy With or Without Cisplatin in Treating Patients With Stage III-IV Squamous Cell Carcinoma of the Head and Neck Who Have Undergone Surgery

    Science.gov (United States)

    2017-07-07

    Head and Neck Squamous Cell Carcinoma; Laryngeal Squamous Cell Carcinoma, Spindle Cell Variant; Stage III Hypopharyngeal Squamous Cell Carcinoma; Stage III Laryngeal Squamous Cell Carcinoma; Stage III Laryngeal Verrucous Carcinoma; Stage III Oral Cavity Squamous Cell Carcinoma; Stage III Oral Cavity Verrucous Carcinoma; Stage III Oropharyngeal Squamous Cell Carcinoma; Stage IVA Hypopharyngeal Squamous Cell Carcinoma; Stage IVA Laryngeal Squamous Cell Carcinoma; Stage IVA Laryngeal Verrucous Carcinoma; Stage IVA Oral Cavity Squamous Cell Carcinoma; Stage IVA Oral Cavity Verrucous Carcinoma; Stage IVA Oropharyngeal Squamous Cell Carcinoma

  20. AERODYNAMIC OPTIMIZATION DESIGN OF LOW ASPECT RATIO TRANSONIC TURBINE STAGE

    Institute of Scientific and Technical Information of China (English)

    SONG Liming; LI Jun; FENG Zhenping

    2006-01-01

    The advanced optimization method named as adaptive range differential evolution (ARDE)is developed. The optimization performance of ARDE is demonstrated using a typical mathematical test and compared with the standard genetic algorithm and differential evolution. Combined with parallel ARDE, surface modeling method and Navier-Stokes solution, a new automatic aerodynamic optimization method is presented. A low aspect ratio transonic turbine stage is optimized for the maximization of the isentropic efficiency with forty-one design variables in total. The coarse-grained parallel strategy is applied to accelerate the design process using 15 CPUs. The isentropic efficiency of the optimum design is 1.6% higher than that of the reference design. The aerodynamic performance of the optimal design is much better than that of the reference design.

  1. A modified varying-stage adaptive phase II/III clinical trial design.

    Science.gov (United States)

    Dong, Gaohong; Vandemeulebroecke, Marc

    2016-07-01

    Conventionally, adaptive phase II/III clinical trials are carried out with a strict two-stage design. Recently, a varying-stage adaptive phase II/III clinical trial design has been developed. In this design, following the first stage, an intermediate stage can be adaptively added to obtain more data, so that a more informative decision can be made. Therefore, the number of further investigational stages is determined based upon data accumulated to the interim analysis. This design considers two plausible study endpoints, with one of them initially designated as the primary endpoint. Based on interim results, another endpoint can be switched as the primary endpoint. However, in many therapeutic areas, the primary study endpoint is well established. Therefore, we modify this design to consider one study endpoint only so that it may be more readily applicable in real clinical trial designs. Our simulations show that, the same as the original design, this modified design controls the Type I error rate, and the design parameters such as the threshold probability for the two-stage setting and the alpha allocation ratio in the two-stage setting versus the three-stage setting have a great impact on the design characteristics. However, this modified design requires a larger sample size for the initial stage, and the probability of futility becomes much higher when the threshold probability for the two-stage setting gets smaller. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma

    NARCIS (Netherlands)

    A.M.M. Eggermont (Alexander); S. Suciu (Stefan); A. Testori (Alessandro); M. Santinami (Mario); W.H.J. Kruit (Wim); J. Marsden; C.J.A. Punt (Cornelis); F. Salès (François); R. Dummer (Reinhard); C. Robert (Caroline); D. Schadendorf (Dirk); P. Patel (Poulam); G. de Schaetzen (Gaetan); A. Spatz (Alan); U. Keilholz (Ulrich)

    2012-01-01

    textabstractPurpose: Adjuvant pegylated interferon alfa-2b (PEG-IFN-α-2b) was approved for treatment of resected stage III melanoma in 2011. Here, we present long-term follow-up results of this pivotal trial. Patients and Methods: In all, 1,256 patients with resected stage III melanoma were randomly

  3. Optimization Strategies for Single-Stage, Multi-Stage and Continuous ADRs

    Science.gov (United States)

    Shirron, Peter J.

    2014-01-01

    Adiabatic Demagnetization Refrigerators (ADR) have many advantages that are prompting a resurgence in their use in spaceflight and laboratory applications. They are solid-state coolers capable of very high efficiency and very wide operating range. However, their low energy storage density translates to larger mass for a given cooling capacity than is possible with other refrigeration techniques. The interplay between refrigerant mass and other parameters such as magnetic field and heat transfer points in multi-stage ADRs gives rise to a wide parameter space for optimization. This paper first presents optimization strategies for single ADR stages, focusing primarily on obtaining the largest cooling capacity per stage mass, then discusses the optimization of multi-stage and continuous ADRs in the context of the coordinated heat transfer that must occur between stages. The goal for the latter is usually to obtain the largest cooling power per mass or volume, but there can also be many secondary objectives, such as limiting instantaneous heat rejection rates and producing intermediate temperatures for cooling of other instrument components.

  4. Prognostic classification of Hodgkin disease in pathologic stage III, based on anatomic considerations

    Energy Technology Data Exchange (ETDEWEB)

    Desser, R.K.; Golomb, H.M.; Ultmann, J.E.; Ferguson, D.J.; Moran, E.M.; Griem, M.L.; Vardiman, J.; Miller, B.; Oetzel, N.; Sweet, D.

    1977-06-01

    Fifty-two patients with pathologic stage III Hodgkin's disease were studied in an effort to determine whether location of involved abdominal nodes influenced survival. Treatment consisted of total nodal radiotherapy with or without subsequent combination chemotherapy. The initial radiation field was the ''extended mantle,'' which included supradiaphragmatic nodes, the splenic hilar area, and paraaortic nodes to the level of L2-L4. Subsequently, lower paraaortic and iliac regions were treated (''lower inverted Y''). Patients with disease limited to the spleen and/or splenic, celiac, or portal nodes (''anatomic substage'' III/sub 1/) had a more favorable 5-yr survival than did patients with involvement of paraaortic, iliac, or mesenteric nodes (''anatomic substage'' III/sub 2/) : 93% versus 57%, respectively (p < 0.05). The addition of combination chemotherapy to total nodal irradiation was associated with improved survival of patients in stage III/sub 2/, but not of those in stage III/sub 1/.

  5. Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer

    Science.gov (United States)

    2017-08-23

    Endometrial Clear Cell Adenocarcinoma; Endometrial Serous Adenocarcinoma; Stage IA Uterine Corpus Cancer; Stage IB Uterine Corpus Cancer; Stage II Uterine Corpus Cancer; Stage IIIA Uterine Corpus Cancer; Stage IIIB Uterine Corpus Cancer; Stage IIIC Uterine Corpus Cancer; Stage IVA Uterine Corpus Cancer

  6. Cost analysis of surgically treated pressure sores stage III and IV.

    NARCIS (Netherlands)

    Filius, A.; Damen, T.H.; Schuijer-Maaskant, K.P.; Polinder, S.; Hovius, S.E.; Walbeehm, E.T.

    2013-01-01

    Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart

  7. Impact of Weight Changes After the Diagnosis of Stage III Colon Cancer on Survival Outcomes.

    Science.gov (United States)

    Vergidis, Joanna; Gresham, Gillian; Lim, Howard J; Renouf, Daniel J; Kennecke, Hagen F; Ruan, Jenny Y; Chang, Jennifer T; Cheung, Winson Y

    2016-03-01

    Weight modification after a diagnosis of colon cancer and its impact on outcomes remain unclear. Thus we aimed to examine the association of obesity and weight changes from baseline oncology consultation with recurrence-free survival (RFS) and overall survival (OS) in patients with stage III colon cancer. Patients aged ≥ 18 years who were diagnosed with stage III colon cancer in British Columbia from 2008 to 2010 and who received adjuvant chemotherapy were included in the study. Cox proportional hazards regression models were fitted to evaluate the impact of different body compositions and degree of weight changes from baseline assessment with outcomes while controlling for potentially confounding covariates, such as age and sex. A total of 539 patients with stage III colon cancer were included: median age was 69 years (range, 26-94 years), 52% were men, and 53% had Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. Those with weight gains of ≥ 10% had a median RFS of 37 months compared with 49 months in those with weight gains of  .05). Weight losses of ≥ 10% from baseline evaluation bodes a worse prognosis among patients with stage III colon cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Cost analysis of surgically treated pressure sores stage III and IV.

    NARCIS (Netherlands)

    Filius, A.; Damen, T.H.; Schuijer-Maaskant, K.P.; Polinder, S.; Hovius, S.E.; Walbeehm, E.T.

    2013-01-01

    Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart

  9. [Update to the recommendations for management of melanoma stages I to III].

    Science.gov (United States)

    Guillot, B; Dalac, S; Denis, M G; Dupuy, A; Emile, J-F; De La Fouchardière, A; Hindie, E; Jouary, T; Lassau, N; Mirabel, X; Piperno Neumann, S; De Raucourt, S; Vanwijck, R

    2016-10-01

    As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3years) is recommended for patients, but with greater emphasis on imaging.

  10. Protein signatures correspond to survival outcomes of AJCC stage III melanoma patients.

    Science.gov (United States)

    Mactier, Swetlana; Kaufman, Kimberley L; Wang, Penghao; Crossett, Ben; Pupo, Gulietta M; Kohnke, Philippa L; Thompson, John F; Scolyer, Richard A; Yang, Jean Y; Mann, Graham J; Christopherson, Richard I

    2014-11-01

    Outcomes for melanoma patients with stage III disease differ widely even within the same subcategory. Molecular signatures that more accurately predict prognosis are needed to stratify patients according to risk. Proteomic analyses were used to identify differentially abundant proteins in extracts of surgically excised samples from patients with stage IIIc melanoma lymph node metastases. Analysis of samples from patients with poor (n = 14, 4 yr) survival outcomes identified 84 proteins that were differentially abundant between prognostic groups. Subsequent selected reaction monitoring analysis verified 21 proteins as potential biomarkers for survival. Poor prognosis patients are characterized by increased levels of proteins involved in protein metabolism, nucleic acid metabolism, angiogenesis, deregulation of cellular energetics and methylation processes, and decreased levels of proteins involved in apoptosis and immune response. These proteins are able to classify stage IIIc patients into prognostic subgroups (P < 0.02). This is the first report of potential prognostic markers from stage III melanoma using proteomic analyses. Validation of these protein markers in larger patient cohorts should define protein signatures that enable better stratification of stage III melanoma patients.

  11. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome.

    Science.gov (United States)

    Ried, Michael; Potzger, Tobias; Sziklavari, Zsolt; Diez, Claudius; Neu, Reiner; Schalke, Berthold; Hofmann, Hans-Stefan

    2014-03-01

    Extended thymoma resections including adjacent structures and pleurectomy/decortication (P/D) with hyperthermic intrathoracic chemotherapy (HITHOC) perfusion were performed in a multidisciplinary treatment regime. Between July 2000 and February 2012, 22 patients with Masaoka stage III (n = 9; 41%) and Masaoka stage IVa (n = 13; 59%) thymic tumors were included. Mean age was 55 years (25-84 years) and 50% (11 out of 22) of patients were female. World Health Organization histological classification was as follows: B2 (n = 15), A (n = 1), B1 (n = 1), B3 (n = 2), and thymic carcinoma (C; n = 3). Radical thymectomy and partial resection of the mediastinal pleura and pericardium were performed. Of the 13, 9 patients with pleural involvement (stage IVa) received radical P/D followed by HITHOC (cisplatin). Macroscopic complete resection (R0/R1) was achieved in 19 (86%) patients. All patients received multimodality treatment depending on tumor stage, histology, and completeness of resection. Thirty-day mortality was 0% and three (13.6%) patients needed operative revision. Recurrence of thymoma was documented in five (22.7%) patients (stage III, n = 1; stage IVa, n = 4). Mean disease-free interval of patients with complete resection (n = 14 out of 22) was 30.2 months. After a mean follow-up of 29 months, 18 out of the 22 (82%) patients are alive. After P/D and HITHOC, 89% (8 out of 9 patients) are alive (current median survival is 25 months) without recurrence. Extended surgical resection of advanced thymic tumors infiltrating adjacent structures (stage III) or with pleural metastases (stage IVa) is safe and feasible. It provides a low recurrence rate and an acceptable survival. Additional HITHOC in patients with pleural thymoma spread seems to offer a better local tumor control. Georg Thieme Verlag KG Stuttgart · New York.

  12. Radiation Therapy With Cisplatin, Docetaxel, or Cetuximab After Surgery in Treating Patients With Stage III-IV Squamous Cell Head and Neck Cancer

    Science.gov (United States)

    2017-05-18

    Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Tongue Cancer

  13. Control and optimization of a staged laser-wakefield accelerator

    Science.gov (United States)

    Golovin, G.; Banerjee, S.; Chen, S.; Powers, N.; Liu, C.; Yan, W.; Zhang, J.; Zhang, P.; Zhao, B.; Umstadter, D.

    2016-09-01

    We report results of an experimental study of laser-wakefield acceleration of electrons, using a staged device based on a double-jet gas target that enables independent injection and acceleration stages. This novel scheme is shown to produce stable, quasi-monoenergetic, and tunable electron beams. We show that optimal accelerator performance is achieved by systematic variation of five critical parameters. For the injection stage, we show that the amount of trapped charge is controlled by the gas density, composition, and laser power. For the acceleration stage, the gas density and the length of the jet are found to determine the final electron energy. This independent control over both the injection and acceleration processes enabled independent control over the charge and energy of the accelerated electron beam while preserving the quasi-monoenergetic character of the beam. We show that the charge and energy can be varied in the ranges of 2-45 pC, and 50-450 MeV, respectively. This robust and versatile electron accelerator will find application in the generation of high-brightness and controllable x-rays, and as the injector stage for more conventional devices.

  14. Control and optimization of a staged laser-wakefield accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Golovin, G.; Banerjee, S.; Chen, S.; Powers, N.; Liu, C.; Yan, W.; Zhang, J.; Zhang, P.; Zhao, B.; Umstadter, D., E-mail: donald.umstadter@unl.edu

    2016-09-11

    We report results of an experimental study of laser-wakefield acceleration of electrons, using a staged device based on a double-jet gas target that enables independent injection and acceleration stages. This novel scheme is shown to produce stable, quasi-monoenergetic, and tunable electron beams. We show that optimal accelerator performance is achieved by systematic variation of five critical parameters. For the injection stage, we show that the amount of trapped charge is controlled by the gas density, composition, and laser power. For the acceleration stage, the gas density and the length of the jet are found to determine the final electron energy. This independent control over both the injection and acceleration processes enabled independent control over the charge and energy of the accelerated electron beam while preserving the quasi-monoenergetic character of the beam. We show that the charge and energy can be varied in the ranges of 2–45 pC, and 50–450 MeV, respectively. This robust and versatile electron accelerator will find application in the generation of high-brightness and controllable x-rays, and as the injector stage for more conventional devices.

  15. Optimizing millisecond time scale near-infrared emission in polynuclear chrome(III)-lanthanide(III) complexes.

    Science.gov (United States)

    Aboshyan-Sorgho, Lilit; Nozary, Homayoun; Aebischer, Annina; Bünzli, Jean-Claude G; Morgantini, Pierre-Yves; Kittilstved, Kevin R; Hauser, Andreas; Eliseeva, Svetlana V; Petoud, Stéphane; Piguet, Claude

    2012-08-01

    This work illustrates a simple approach for optimizing long-lived near-infrared lanthanide-centered luminescence using trivalent chromium chromophores as sensitizers. Reactions of the segmental ligand L2 with stoichiometric amounts of M(CF(3)SO(3))(2) (M = Cr, Zn) and Ln(CF(3)SO(3))(3) (Ln = Nd, Er, Yb) under aerobic conditions quantitatively yield the D(3)-symmetrical trinuclear [MLnM(L2)(3)](CF(3)SO(3))(n) complexes (M = Zn, n = 7; M = Cr, n = 9), in which the central lanthanide activator is sandwiched between the two transition metal cations. Visible or NIR irradiation of the peripheral Cr(III) chromophores in [CrLnCr(L2)(3)](9+) induces rate-limiting intramolecular intermetallic Cr→Ln energy transfer processes (Ln = Nd, Er, Yb), which eventually produces lanthanide-centered near-infrared (NIR) or IR emission with apparent lifetimes within the millisecond range. As compared to the parent dinuclear complexes [CrLn(L1)(3)](6+), the connection of a second strong-field [CrN(6)] sensitizer in [CrLnCr(L2)(3)](9+) significantly enhances the emission intensity without perturbing the kinetic regime. This work opens novel exciting photophysical perspectives via the buildup of non-negligible population densities for the long-lived doubly excited state [Cr*LnCr*(L2)(3)](9+) under reasonable pumping powers.

  16. Optimizing ETL by a Two-level Data Staging Method

    DEFF Research Database (Denmark)

    Iftikhar, Nadeem

    2016-01-01

    In data warehousing, the data from source systems are populated into a central data warehouse (DW) through extraction, transformation and loading (ETL). The standard ETL approach usually uses sequential jobs to process the data with dependencies, such as dimension and fact data. It is a non......-/late-arriving data, and fast-/slowly-changing data. The introduced additional staging area decouples loading process from data extraction and transformation, which improves ETL flexibility and minimizes intervention to the data warehouse. This paper evaluates the proposed method empirically, which shows......-trivial task to process the so-called early-/late-arriving data, which arrive out of order. This paper proposes a two-level data staging area method to optimize ETL. The proposed method is an all-in-one solution that supports processing different types of data from operational systems, including early...

  17. Optimal developmental stage for vitrification of parthenogenetically activated porcine embryos

    DEFF Research Database (Denmark)

    Li, Rong; Li, Juan; Liu, Ying;

    2012-01-01

    The objective of this experiment was to determine the optimal developmental stage to vitrify in-vitro cultured porcine parthenogenetically activated (PA) embryos. Embryos were vitrified by Cryotop on Day 4, 5 or 6 after oocyte activation (Day 0), and immediately after warming they were either time......-lapse monitored for 24 h or analyzed by diffential staining. After warming, the embryos had to be cultured for at least 8 h before their survival rates were stabilized. Both the survival rate and 8 h and the hatching rate at 24 h of Day 4 embryos were significantly higher than those vitrified on Day5 or Day 6 (P...

  18. Prognostic and predictive value of YKL-40 in stage IIB-III melanoma

    DEFF Research Database (Denmark)

    Krogh, Merete; Christensen, Ib; Bouwhuis, Marna

    2016-01-01

    This study investigates the prognostic and predictive value of YKL-40 in stage IIB-III melanoma patients who were randomized to adjuvant interferon α-2b (IFN) or observation. Serum YKL-40 was determined postoperatively in patients from the Nordic IFN Trial (n=602), EORTC 18952 (n=246), and EORTC...... 18991 (n=386) (EORTC, European Organisation for Research and Treatment of Cancer). YKL-40 protein expression was determined in 300 tissue sections of primary melanoma or lymph node metastases from 204 Danish patients from the Nordic IFN Trial. Multivariate Cox analysis (including sex, age, stage...

  19. Intraovarian transplantation of stage I-II follicles results in viable zebrafish embryos.

    Science.gov (United States)

    Csenki, Zsolt; Zaucker, Andreas; Kovács, Balázs; Hadzhiev, Yavor; Hegyi, Arpád; Lefler, Katalin-Kinga; Müller, Tamás; Kovács, Robert; Urbányi, Béla; Váradi, László; Müller, Ferenc

    2010-01-01

    Maternal gene products drive early embryogenesis almost exclusively until the mid blastula transition (MBT) in many animal models including fish. However, the maternal contribution to embryogenesis does not stop at MBT, but continues to be an essential regulator of key developmental processes. The extent to which maternal effects contribute to embryonic and larval development is hard to estimate due to the technical difficulty of interfering with maternal gene products by conventional forward and reverse genetic tools. Therefore, novel methods to manipulate maternal factors in oocytes need to be developed. Here, we provide a proof of principle protocol for transplanting stage I-II zebrafish follicles into recipient mothers where donor stage I oocytes can develop to stage IV in 2 weeks and in 3 weeks they develop into mature eggs and produce viable offspring. Moreover, we show that simple microinjection of stage I-II follicles with RNA results in reporter gene expression in oocytes and paves the way for developing tools for interfering with maternal gene activity. This early stage oocyte transplantation protocol provides a means to study cellular and molecular aspects of oocyte development in the zebrafish.

  20. Survival after Pneumonectomy for Stage III Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Sibu P. Saha

    2014-01-01

    Full Text Available Objectives: Stage III non-small cell lung cancer (NSCLC has a poor prognosis. Reports suggest that five-year survival after current treatment is between 14 to 24 percent. The purpose of this retrospective study was to investigate the morbidity and mortality of patients diagnosed with stage III NSCLC and treated with pneumonectomy at the University of Kentucky Medical Center in Lexington, KY. Methods: We reviewed the medical record and tumor registry follow-up data on 100 consecutive patients who underwent pneumonectomy for lung cancer at the University of Kentucky. Results: We identified thirty-six patients in stage III who underwent pneumonectomy. Ten patients had surgery only, eight patients received adjuvant chemotherapy, and eighteen patients received neoadjuvant therapy. There was one surgical death in this series. Mean follow-up was 2.9 years. One-, three-, and five-year survival was 66%, 38%, and 38%, respectively. Five-year survival for the group with adjuvant therapy was 60%. Conclusion: Most lung cancer patients present with advanced disease and the prognosis remains poor. Our experience indicates resection offers an above average chance of long-term survival when supplemented with neoadjuvant and/or adjuvant therapy.

  1. Standard treatment option in stage III non-small-cell lung cancer: case against trimodal therapy and consolidation drug therapy.

    Science.gov (United States)

    Jeremić, Branislav

    2015-03-01

    Prospective randomized trials and meta-analyses established concurrent radiochemotherapy (RT-CHT) as standard treatment approach in patients with inoperable, locally advanced (stage IIIA and B) non-small-cell lung cancer (NSCLC). In patients with either clinically (c) or pathologically (p) staged disease (stage IIIA), including those with pN2 disease, trimodal therapy was also frequently practiced in the past and is currently still advocated by large cooperative groups and organizations. Similarly, consolidation CHT provided after concurrent RT-CHT was suggested to be feasible and effective in inoperable stage III NSCLC. Contrasting these practices and suggestions, there is no evidence that trimodal therapy in stage IIIA (clinically or pathologically staged) or consolidation CHT in inoperable stage III NSCLC plays any role in its treatment. In both cases, evidence clearly demonstrates that concurrent RT-CHT is of similar efficacy and less toxic, and it should be considered a standard treatment option for all patients with stage III NSCLC.

  2. Numerical analysis and optimization of the inlet stage of a multi-stage high pressure compressor

    Institute of Scientific and Technical Information of China (English)

    XU Quan-yong; HOU An-ping; XIONG Jin-song; ZHOU Sheng

    2007-01-01

    An optimization process is used to redesign blades of a high-pressure compressor. An artificial neural network (ANN) method is coupled to Navier-Stokes solvers and is applied to three different redesigns. A new rotor blade of a transonic compressor is designed by modifying thick, stacking line and inlet angle using a 3D approach, with a significant efficiency improvement at the design point. The off-design behavior of this new compressor is also checked afterwards, which shows that the whole performance of the inlet stage is improved over a wide range of mass flow. The losses are reduced, proving the good performance of the optimum. The whole results indicate that the optimization method can find improved design and can be integrated in a design procedure.

  3. Dosimetric Feasibility of Dose Escalation Using SBRT Boost for Stage III Non-Small Cell Lung Cancer

    Science.gov (United States)

    Hepel, Jaroslaw T.; Peter, Justin; Hiatt, Jessica R.; Patel, Salil; Osibanjo, Oluwademilade; Safran, Howard; Curran, Bruce; DiPetrillo, Thomas

    2012-01-01

    Purpose: Standard chemoradiation therapy for stage III non-small cell lung cancer (NSCLCa) results in suboptimal outcomes with a high rate of local failure and poor overall survival. We hypothesize that dose escalation using stereotactic body radiotherapy (SBRT) boost could improve upon these results. We present here a study evaluating the dosimetric feasibility of such an approach. Methods: Anonymized CT data sets from five randomly selected patients with stage III NSCLCa undergoing definitive chemoradiation therapy in our department with disease volumes appropriate for SBRT boost were selected. Three-dimensional conformal radiation therapy (3D-CRT) plans to 50.4 Gy in 28 fractions were generated follow by SBRT plans to two dose levels, 16 Gy in two fractions and 28 Gy in two fractions. SBRT plans and total composite (3D-CRT and SBRT) were optimized and evaluated for target coverage and dose to critical structures; lung, esophagus, cord, and heart. Results: All five plans met predetermined target coverage and normal tissue dose constraints. PTV V95 was equal to or greater than 95% in all cases. The cumulative lung V20 and V5 of the combined 3D-CRT and SBRT plans were less than or equal to 30 and 55%, respectively. The 5 cc esophageal dose was less than 12 Gy for all low and high dose SBRT plans. The cumulative dose to the esophagus was also acceptable with less than 10% of the esophagus receiving doses in excess of 50 Gy. The cumulative spinal cord dose was less than 33 Gy and heart V25 was less than 5%. Conclusion: The combination of chemoradiation to 50.4 Gy followed by SBRT boost to gross disease at the primary tumor and involved regional lymph nodes is feasible with respect to normal tissue dose constraints in this dosimetric pilot study. A phase I/II trial to evaluate the clinical safety and efficacy of this approach is being undertaken. PMID:23057009

  4. The optimal cut-off value of the preoperative prognostic nutritional index for the survival differs according to the TNM stage in hepatocellular carcinoma.

    Science.gov (United States)

    Okamura, Yukiyasu; Sugiura, Teiichi; Ito, Takaaki; Yamamoto, Yusuke; Ashida, Ryo; Uesaka, Katsuhiko

    2017-08-01

    To establish the optimal cut-off value of the preoperative prognostic nutritional index (PNI) for prognosis according to the Tumor Node Metastasis (TNM) stage of hepatocellular carcinoma (HCC) after curative resection. This retrospective study reviewed the records of 375 patients. The optimal cut-off value of the PNI was established according to the TNM stage, and overall survival was compared between the low and high PNI groups. The optimal cut-off value of the PNI decreased with increasing TNM stage, with 52, 47, and 43 patients having stage I, II, and III HCC, respectively. A low preoperative PNI predicted a poorer overall survival than did a high PNI for stage I (P TNM stages and that the preoperative PNI is a favorable prognostic factor for stage I HCC.

  5. Radiotherapy for stage II and stage III breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy.

    Science.gov (United States)

    Le Scodan, Romuald; Selz, Jessica; Stevens, Denise; Bollet, Marc A; de la Lande, Brigitte; Daveau, Caroline; Lerebours, Florence; Labib, Alain; Bruant, Sarah

    2012-01-01

    To evaluate the effect of postmastectomy radiotherapy (PMRT) in Stage II-III breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy (NAC). Of 1,054 breast cancer patients treated with NAC at our institution between 1990 and 2004, 134 had pN0 status after NAC and mastectomy. The demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The effect of PMRT on locoregional recurrence-free survival and overall survival (OS) was evaluated by multivariate analysis, including known prognostic factors. Of the 134 eligible patients, 78 (58.2%) received PMRT and 56 (41.8%) did not. At a median follow-up time of 91.4 months, the 5-year locoregional recurrence-free survival and OS rate was 96.2% and 88.3% with PMRT and 92.5% and 94.3% without PMRT, respectively (p = NS). The corresponding values at 10 years were 96.2% and 77.2% with PMRT and 86.8% and 87.7% without PMRT (p = NS). On multivariate analysis, PMRT had no effect on either locoregional recurrence-free survival (hazard ratio, 0.37; 95% confidence interval, 0.09-1.61; p = .18) or OS (hazard ratio, 2.06; 95% confidence interval, 0.71-6; p = .18). This remained true in the subgroups of patients with clinical Stage II or Stage III disease at diagnosis. A trend was seen toward poorer OS among patients who had not had a pathologic complete in-breast tumor response after NAC (hazard ratio, 6.65; 95% confidence interval, 0.82-54.12; p = .076). The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Changes in soluble CEA and TIMP-1 levels during adjuvant chemotherapy for stage III colon cancer

    DEFF Research Database (Denmark)

    Aldulaymi, Bahir; Christensen, Ib Jarle; Sölétormos, György

    2010-01-01

    Tissue inhibitor of metalloproteinases-1 (TIMP-1) has been suggested to be a valuable marker in colorectal cancer (CRC), but the effects of chemotherapy on TIMP-1 levels are unknown. The present study evaluated the effect of chemotherapy on TIMP-1 levels in comparison with carcinoembryonic antige...... (CEA) levels in patients with stage III colon cancer.......Tissue inhibitor of metalloproteinases-1 (TIMP-1) has been suggested to be a valuable marker in colorectal cancer (CRC), but the effects of chemotherapy on TIMP-1 levels are unknown. The present study evaluated the effect of chemotherapy on TIMP-1 levels in comparison with carcinoembryonic antigen...

  7. Improved survival with early adjuvant chemotherapy after colonic resection for stage III colonic cancer

    DEFF Research Database (Denmark)

    Klein, Mads; Azaquoun, Najah; Jensen, Benny Vittrup

    2015-01-01

    BACKGROUND AND OBJECTIVES: In stage III colonic cancer, time from surgery to start of adjuvant chemotherapy may influence survival. In this study, we evaluated the effect of timing of adjuvant therapy on survival. METHODS: Database study from the Danish Colorectal Cancer Group's national database....... RESULTS: The final population included 1,827 patients scheduled for adjuvant chemotherapy. Adjuvant therapy started within 4 and 8 weeks improved survival when compared to start later than 8 weeks (HR [95%CI]: 1.7 [1.1-2.6]; P = 0.024 and 1.4 [1.07-1.8]; P = 0.013, respectively), whereas...

  8. Changes in soluble CEA and TIMP-1 levels during adjuvant chemotherapy for stage III colon cancer

    DEFF Research Database (Denmark)

    Aldulaymi, Bahir; Christensen, Ib J; Sölétormos, György;

    2010-01-01

    Tissue inhibitor of metalloproteinases-1 (TIMP-1) has been suggested to be a valuable marker in colorectal cancer (CRC), but the effects of chemotherapy on TIMP-1 levels are unknown. The present study evaluated the effect of chemotherapy on TIMP-1 levels in comparison with carcinoembryonic antige...... (CEA) levels in patients with stage III colon cancer.......Tissue inhibitor of metalloproteinases-1 (TIMP-1) has been suggested to be a valuable marker in colorectal cancer (CRC), but the effects of chemotherapy on TIMP-1 levels are unknown. The present study evaluated the effect of chemotherapy on TIMP-1 levels in comparison with carcinoembryonic antigen...

  9. Stage III-IV Uterine Prolapse Risk Factors: Sacrouterine Ligaments High Estrogen Receptor Alpha and Collagen III Expression and Low Elastin Expression

    Directory of Open Access Journals (Sweden)

    I Wayan Megadhana

    2016-08-01

    Full Text Available Background: Uterine prolapse is common, non-life-threatening, but has a negative impact on women psychosocial and economic life. Damage to levator ani muscle is the early onset of uterine prolapse, while the damage of sacrouterine ligaments aggravates the stage. The strength of sacrouterine ligament depends on tissue cellularity, the formation of collagen I/III ratio, and the decreased expression of elastin. The lower the ratio of collagen I/III, the higher the risk of stage III-IV uterine prolapse. The ratio of collagen I/III formation is allegedly influencing through the expression of estrogen receptor alpha, by increasing collagen III synthesis and decreasing the degradation. Objective: We aimed to investigate whether high estrogen receptor alpha and collagen III expression, and the low elastin expression in the sacrouterine ligaments were stage III-IV uterine prolapse risk factors. Method: In March to August 2014, a non-matching case control study was conducted in 3 hospitals in Denpasar, and the materials were processed in the Faculty of Veterinary Medicine Laboratory of Udayana University. The case was uterine prolapse stage III-IV, the control was the non-uterine prolapse. We collected 1.5 cm residual sacrouterine ligaments from the edge of the cervix fixed with 10% buffered formalin from patients who underwent a total hysterectomy. They were examined immunohistochemically to identify estrogen receptor alpha expression, collagen III, and elastin. Results: Our sample was 44, divided equally between the case and control group. Compared to the control, in the case group, the proportion was significantly higher for the high estrogen receptor alpha expression (OR=5.71, 95%CI 1.56-20.93, p=0.007, high collagen III (OR=6.50, 95% CI 1.64- 25.76, p=0.005, and low elastin (OR=5.40, 95%CI 1.37-21.26, p=0.012. Conclusion: the high expression of estrogen receptor alpha and collagen III and low expressions of elastin in sacrouterine ligaments served as

  10. Paclitaxel and Carboplatin Before Radiation Therapy With Paclitaxel in Treating HPV-Positive Patients With Stage III-IV Oropharynx, Hypopharynx, or Larynx Cancer

    Science.gov (United States)

    2017-04-19

    Human Papilloma Virus Infection; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Verrucous Carcinoma of the Larynx

  11. Survival after recurrence of stage I-III breast, colorectal, or lung cancer.

    Science.gov (United States)

    Hassett, Michael J; Uno, Hajime; Cronin, Angel M; Carroll, Nikki M; Hornbrook, Mark C; Fishman, Paul; Ritzwoller, Debra P

    2017-08-01

    The experiences of patients with recurrent cancer are assumed to reflect those of patients with de novo stage IV disease; yet, little is truly known because most registries lack recurrence status. Using two databases with excellent recurrence and death information, we examined determinants of survival duration after recurrence of breast (BC), colorectal (CRC), and lung cancers (LC). Recurrence status was abstracted from the medical records of patients who participated in the Cancer Care Outcomes Research and Surveillance study and who received care at two Cancer Research Network sites-the Colorado and Northwest regions of Kaiser Permanente. The analysis included 1653 patients who developed recurrence after completing definitive therapy for stages I-III cancer. Multivariable modeling identified independent determinants of survival duration after recurrence, controlling for other factors. Through 60 months' average follow-up, survival after recurrence for BC, CRC, and LC were 28.4, 23.1 and 16.1 months, respectively. Several factors were independently associated with shorter survival for all three cancers, including higher initial stage (III vs. I: BC -9.9 months; CRC -6.9 months; LC -7.4 months; P≤0.01). Factors associated with shorter survival for selected cancers included: distant/regional recurrence for BC and CRC; current/former smoker for LC; high grade for CRC; and recurrence for BC. Initial stage predicts survival duration after recurrence, whereas time-to-recurrence usually does not. The impact of biologic characteristics (e.g., grade, hormone-receptor status) on survival duration after recurrence needs further study. Predictors of survival duration after recurrence may help facilitate patient decision-making. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Statistical optimization of synthesis procedure and characterization of europium (III) molybdate nano-plates

    Energy Technology Data Exchange (ETDEWEB)

    Pourmortazavi, Seied Mahdi [Malek Ashtar University of Technology, Faculty of Material and Manufacturing Technologies, P. O. Box 16765-3454, Tehran (Iran, Islamic Republic of); Rahimi-Nasrabadi, Mehdi [Imam Hossein University, Nano Science Center, Tehran (Iran, Islamic Republic of); Fazli, Yousef [Islamic Azad University, Department of Chemistry, Faculty of Science, Arak Branch, Arak (Iran, Islamic Republic of); Mohammad-Zadeh, Mohammad [Sabzevar University of Medical Sciences, Department of Physiology and Pharmacology, School of Medicine, Sabzevar (Iran, Islamic Republic of)

    2015-06-15

    Europium (III) molybdate nano-plates were synthesized in this work via chemical precipitation route involving adding of europium (III) ion solution to the aqueous solution of molybdate reagent. Effects of some reaction variables such as concentrations of europium and molybdate ions, flow rate of europium reagent, and reactor temperature on the diameter of the synthesized europium (III) molybdate nano-plates were experimentally investigated by orthogonal array design. The results showed that the size of europium (III) molybdate nano-plates can be optimized by adjusting the concentrations of europium (III) and molybdate ions, as well as the reactional temperature. Europium (III) molybdate nano-plates prepared under the optimum conditions were characterized by X-ray powder diffraction, scanning electron microscopy, and Fourier transform infrared spectroscopy. (orig.)

  13. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Robert eMeier

    2015-04-01

    Full Text Available Abstract: Stereotactic body radiotherapy (SBRT is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I dose escalation should yield improved rates of cancer control; (II the unique radiobiology of prostate cancer favors hypofractionation and (III the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity modulated radiotherapy (IMRT. Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife. Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low dose rate (LDR brachytherapy. Patient-reported quality of life (QOL outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After five years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I-II prostate cancer.

  14. [STT arthrodesis for treatment of stage III semilunar bone necrosis: functional outcome].

    Science.gov (United States)

    Tränkle, M; Sauerbier, M; Linsner, G; Bickert, B; Germann, G

    2000-11-01

    Scapho-trapezio-trapezoid arthrodesis for the treatment of Kienböck's disease is recommended as a salvage procedure for Stage III A and B in the Lichtman classification. This study reviews the results of 26 patients with stage III of Kienböck's disease treated by STT-arthrodesis. 26 patients (16 male, 10 female) were treated by STT-arthrodesis between 1993 and 1998. Fusion was established after seven weeks average. All patients were examined, the mean follow-up time was 35 (10 to 72) months. Active range of motion showed 63% of extension/flexion and 51% of radial/ulnar deviation on average, compared to the uninjured hand. Mean preoperative and postoperative pain scores were 58.4 (non-stress) vs. 82.5 (stress) and 16.4 (non-stress) vs. 33.7 (stress), eight patients claimed complete pain relief. Grip strength improved to 71% of the opposite side. Total DASH score reached 24.8. 20 of the 26 patients were satisfied with the final result and would undergo the operation again. We found a significant reduction of pain, a slightly reduced grip strength and a satisfying functional wrist mobility after STT-arthrodesis. Carpal height was unchanged and the carpal collapse did not progress. The mid-term data support that STT-arthrodesis will stand the test of time.

  15. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer.

    Science.gov (United States)

    Meier, Robert

    2015-01-01

    Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose-escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation; and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately adjacent organs, potentially reducing complications. This approach is also more convenient for patients, and is cheaper than intensity-modulated radiotherapy (IMRT). Several external beam platforms are capable of delivering SBRT for early-stage prostate cancer, although most of the mature reported series have employed a robotic non-coplanar platform (i.e., CyberKnife). Several large studies report 5-year biochemical relapse rates which compare favorably to IMRT. Rates of late GU toxicity are similar to those seen with IMRT, and rates of late rectal toxicity may be less than with IMRT and low-dose rate brachytherapy. Patient-reported quality of life (QOL) outcomes appear similar to IMRT in the urinary domain. Bowel QOL may be less adversely affected by SBRT than with other radiation modalities. After 5 years of follow-up, SBRT delivered on a robotic platform is yielding outcomes at least as favorable as IMRT, and may be considered appropriate therapy for stage I-II prostate cancer.

  16. Optimization of Rowing Specific Training by Studying the Stages Evaluation

    Directory of Open Access Journals (Sweden)

    Sanda T Urichianu

    2011-01-01

    Full Text Available Problem statement: We intended to analyze and systematize the most valuable ways through which is achieved the optimization in rowing training by the evaluation of control norms, trials and tests during some stages of the training plan. We consider that the sports performances can become better and better thanks to a continuous improvement of the working methodology during the main periods of training. Approach: The study was conducted over a period of 10 months (December 1, 2009-September 1, 2010 within the Sports Clubs, Juniors Department, men, of Falticeni and Iasi and it was made during the pre-competitive and competitive training period. The subjects of our research represent a group of 24 athletes from the two clubs: CS Falticeni and CS Iasi, out of which only 9 subjects have been able to obtained significant results. The study emphasizes the performances achieved during the control tests on ergometer rowing machines and on water (6000 and 2000 m events. Results: The study results confirmed that there is a significant relationship of the control tests results, erg and the competitive performance. The athletes’ performance is determined by the level of physical training specific to the rowing. Conclusion: To further enhance the performances, one should not neglect the study of any side which could help coaches and methods specialists in their work with the athletes.

  17. METAHEURISTICS FOR OPTIMIZING SAFETY STOCK IN MULTI STAGE INVENTORY SYSTEM

    Directory of Open Access Journals (Sweden)

    Gordan Badurina

    2013-02-01

    Full Text Available Managing the right level of inventory is critical in order to achieve the targeted level of customer service, but it also carries significant cost in supply chain. In majority of cases companies define safety stock on the most downstream level, i.e. the finished product level, using different analytical methods. Safety stock on upstream level, however, usually covers only those problems which companies face on that particular level (uncertainty of delivery, issues in production, etc.. This paper looks into optimizing safety stock in a pharmaceutical supply considering the three stages inventory system. The problem is defined as a single criterion mixed integer programming problem. The objective is to minimize the inventory cost while the service level is predetermined. In order to coordinate inventories at all echelons, the variable representing the so-called service time is introduced. Because of the problem dimensions, metaheuristics based on genetic algorithm and simulated annealing are constructed and compared, using real data from a Croatian pharmaceutical company. The computational results are presented evidencing improvements in minimizing inventory costs.

  18. Heterogeneity of Disease Classified as Stage III in Wilms Tumor: A Report From the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP)

    Energy Technology Data Exchange (ETDEWEB)

    Spreafico, Filippo, E-mail: filippo.spreafico@istitutotumori.mi.it [Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Gandola, Lorenza [Department of Radiology/Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); D' Angelo, Paolo [Pediatric Oncology, Ospedale dei Bambini G. di Cristina, Palermo (Italy); Terenziani, Monica [Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Collini, Paola [Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Bianchi, Maurizio [Pediatric Department, Ospedale Infantile Regina Margherita, Torino (Italy); Provenzi, Massimo [Pediatric Unit, Ospedali Riuniti Bergamo, Bergamo (Italy); Indolfi, Paolo [Pediatric Oncology, Pediatric Department, II University, Napoli (Italy); Pession, Andrea [Pediatric Hematology and Oncology Unit ' Lalla Seragnoli' , Bologna University, Bologna (Italy); Nantron, Marilina [Department of Hematology and Oncology, Istituto G. Gaslini, Genova (Italy); Di Cataldo, Andrea [Pediatric Hematology and Oncology, Catania University, Catania (Italy); Marchiano, Alfonso [Department of Radiology/Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Catania, Serena; Fossati Bellani, Franca [Pediatric Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Piva, Luigi [Pediatric Surgery Unit, Urology, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy)

    2012-01-01

    Purpose: We analyzed whether the prognosis can differ among Wilms tumors (WT) labeled as Stage III according to currently adopted classification systems. Methods and Materials: Patients with nonanaplastic Stage III WT consecutively registered in two Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) trials (CNR-92, TW-2003) were the subjects in the present analysis. The steady mainstay of therapy was primary nephrectomy, followed by three-drug chemotherapy with vincristine, dactinomycin, doxorubicin, and abdominal radiotherapy (RT). Results: Ninety-nine WT patients met the criteria for classification as Stage III according to a revised version of the National Wilms Tumor Study-3 staging system (51 patients in CNR-92, 48 patients in TW-2003). Regional lymph nodes (LN) were not biopsied in 16 patients. After a median follow-up of 66 months, the 4-year disease-free survival (DFS) and overall survival (OS) rates were 85% {+-} 4% and 92% {+-} 3%, respectively, for the whole group. For 38 children with positive LN, the 4-year DFS rate was 73% {+-} 7%, as opposed to 98% {+-} 2% for the 45 children with Stage III WT according to the other criteria but with negative biopsied LN (p = 0.001). The subgroup with the worst prognosis consisted of children more than 2 years old with positive LN (DFS 67% {+-} 8%). A delay between surgery and RT > 30 days had an adverse impact on the abdominal tumor relapse rate. Conclusions: This study provides further evidence that Stage III tumors with LN metastases might be distinguished from WTs meeting the other criteria for classification as Stage III. The worse outcome of the former may warrant a prospective study on the effects of intensified therapy. A subclassification of Stage III tumors is discussed.

  19. Heterogeneity of disease classified as stage III in Wilms tumor: a report from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP).

    Science.gov (United States)

    Spreafico, Filippo; Gandola, Lorenza; D'Angelo, Paolo; Terenziani, Monica; Collini, Paola; Bianchi, Maurizio; Provenzi, Massimo; Indolfi, Paolo; Pession, Andrea; Nantron, Marilina; Di Cataldo, Andrea; Marchianò, Alfonso; Catania, Serena; Fossati Bellani, Franca; Piva, Luigi

    2012-01-01

    We analyzed whether the prognosis can differ among Wilms tumors (WT) labeled as Stage III according to currently adopted classification systems. Patients with nonanaplastic Stage III WT consecutively registered in two Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) trials (CNR-92, TW-2003) were the subjects in the present analysis. The steady mainstay of therapy was primary nephrectomy, followed by three-drug chemotherapy with vincristine, dactinomycin, doxorubicin, and abdominal radiotherapy (RT). Ninety-nine WT patients met the criteria for classification as Stage III according to a revised version of the National Wilms Tumor Study-3 staging system (51 patients in CNR-92, 48 patients in TW-2003). Regional lymph nodes (LN) were not biopsied in 16 patients. After a median follow-up of 66 months, the 4-year disease-free survival (DFS) and overall survival (OS) rates were 85% ± 4% and 92% ± 3%, respectively, for the whole group. For 38 children with positive LN, the 4-year DFS rate was 73% ± 7%, as opposed to 98% ± 2% for the 45 children with Stage III WT according to the other criteria but with negative biopsied LN (p = 0.001). The subgroup with the worst prognosis consisted of children more than 2 years old with positive LN (DFS 67% ± 8%). A delay between surgery and RT > 30 days had an adverse impact on the abdominal tumor relapse rate. This study provides further evidence that Stage III tumors with LN metastases might be distinguished from WTs meeting the other criteria for classification as Stage III. The worse outcome of the former may warrant a prospective study on the effects of intensified therapy. A subclassification of Stage III tumors is discussed. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Neoadjuvant chemotherapy versus cystectomy in management of stages II, and III urinary bladder cancer

    Directory of Open Access Journals (Sweden)

    Mohammed A. Osman

    2014-12-01

    Full Text Available Purpose: This phase III trial was de - signed to compare the survival benefit, surgical respectability, and toxicities among patients treated by neoadjuvant chemotherapy followed by radical cystectomy (arm A, with those treated by radical cystectomy (arm B in the management of stage II, III urinary bladder cancer. Patients and Methods: For inclusion, patients should have pathologically proven urothelial carcinoma in urinary bladder, clinical stages from T2N0M0 to T4aN0M0, patient age less than 65 years, and performance state ≤ 2. Additionally, patients should have adequate hematological, renal, and liver functions. Arm A patients underwent 3 cycles of neoadjuvant cisplatin and gemcitabine followed by radical cystectomy, while arm B patients underwent radical cystectomy directly. Results: Thirty patients had been enrolled in each arm between September 2009 and April 2014 in 3 educational institutes in Egypt. The 3 year OS (overall survival for arm A, and B were 60% and 50% respectively. The median OS for arm A was 36+ months and that for arm B was 32.5 months. The 3 year progression-free survival (PFS for arm A, and B were 57% and 43% respectively. The median PFS for arm A was 36+ months and for arm B was 28 months. A subgroup analysis was performed to correlate between 3 year OS and predetermined prognostic factors including age, tumor size, pathological stage, and the response to neoadjuvant chemotherapy. The later was performed only in arm A. Both treatment arms were tolerated well with mild toxicities profiles. Conclusion: Neoadjuvant chemotherapy achieved better survival, surgical respectability, with nearly equivalent toxicities when compared with radical cystectomy.

  1. [Cytological finding in the pre- and early stages of cervix carcinoma--a contribution to the evaluation of Papanicolau III].

    Science.gov (United States)

    Bader, G; Büttner, H H; Neumann, H G; Rhode, E; Beust, M

    1977-01-01

    Cytologic findings and the histologic diagnosis are compared in 326 cervical cones. We have found following ratio of the groups Papanicolaou (Pap) III: Pap IV--in dysplasia 1: 1: 1, in "more dysplasia than carcinoma in situ (CIS)" 1:2:2. The Pap IV dominates in "pure" CIS and in cones with "more CIS than dysplasia". We take out of the Pap III ("with cytologic control") cases named "Pap III with necessity for histologic diagnosis". We have found in this subgroup of Pap III prestages or early stages of cervical carcinoma.

  2. Proposal of new classification for stage III colon cancer based on the lymph node ratio: analysis of 4,172 patients from multi-institutional database in Japan.

    Science.gov (United States)

    Sugimoto, Kiichi; Sakamoto, Kazuhiro; Tomiki, Yuichi; Goto, Michitoshi; Kotake, Kenjiro; Sugihara, Kenichi

    2015-02-01

    We retrospectively examined the optimal lymph node ratio (LNR) cutoff value and attempted to construct a new classification using the LNR in stage III colon cancer. The clinical and pathological data of 4,172 patients with histologically proven lymph node metastasis who underwent curative surgery for primary colon cancer at multiple institutions between 1995 and 2004 were derived from the multi-institutional database of the Japanese Society for Cancer of the Colon and Rectum (JSCCR). We determined independent prognostic factors and constructed a new classification using these factors. Finally, we compared the discriminatory ability between the new classification and the TNM seventh edition (TNM 7th) classification. The optimal LNR cutoff value was 0.18. Multivariate analysis revealed that year of surgery, age, gender, histological type, TNM 7th T category, lymphatic invasion, venous invasion, TNM 7th N category, and LNR were found to be significant independent prognostic factors. We attempted to construct a new classification based on the combination of TNM 7th T category and LNR. As a result, the cancer-specific survivals were well stratified (P TNM 7th classification with respect to both a better fit and lower complexity. The optimal LNR cutoff value that was found using the Japanese multi-institutional database and the new classification using LNR are considered to be extremely significant. Therefore, these findings strongly support the application of LNR in the stage classification in stage III colon cancer.

  3. A lymph node ratio of 10% is predictive of survival in stage III colon cancer: a French regional study.

    Science.gov (United States)

    Sabbagh, Charles; Mauvais, François; Cosse, Cyril; Rebibo, Lionel; Joly, Jean-Paul; Dromer, Didier; Aubert, Christine; Carton, Sophie; Dron, Bernard; Dadamessi, Innocenti; Maes, Bernard; Perrier, Guillaume; Manaouil, David; Fontaine, Jean-François; Gozy, Michel; Panis, Xavier; Foncelle, Pierre Henri; de Fresnoy, Hugues; Leroux, Fabien; Vaneslander, Pierre; Ghighi, Caroline; Regimbeau, Jean-Marc

    2014-01-01

    Lymph node ratio (LNR) (positive lymph nodes/sampled lymph nodes) is predictive of survival in colon cancer. The aim of the present study was to validate the LNR as a prognostic factor and to determine the optimum LNR cutoff for distinguishing between "good prognosis" and "poor prognosis" colon cancer patients. From January 2003 to December 2007, patients with TNM stage III colon cancer operated on with at least of 3 years of follow-up and not lost to follow-up were included in this retrospective study. The two primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS) as a function of the LNR groups and the cutoff. One hundred seventy-eight patients were included. There was no correlation between the LNR group and 3-year OS (P=0.06) and a significant correlation between the LNR group and 3-year DFS (P=0.03). The optimal LNR cutoff of 10% was significantly correlated with 3-year OS (P=0.02) and DFS (P=0.02). The LNR was not an accurate prognostic factor when fewer than 12 lymph nodes were sampled. Clarification and simplification of the LNR classification are prerequisites for use of this system in randomized control trials. An LNR of 10% appears to be the optimal cutoff.

  4. Mn(II) Oxidation by the Multicopper Oxidase Complex Mnx: A Coordinated Two-Stage Mn(II)/(III) and Mn(III)/(IV) Mechanism.

    Science.gov (United States)

    Soldatova, Alexandra V; Romano, Christine A; Tao, Lizhi; Stich, Troy A; Casey, William H; Britt, R David; Tebo, Bradley M; Spiro, Thomas G

    2017-08-23

    The bacterial manganese oxidase MnxG of the Mnx protein complex is unique among multicopper oxidases (MCOs) in carrying out a two-electron metal oxidation, converting Mn(II) to MnO2 nanoparticles. The reaction occurs in two stages: Mn(II) → Mn(III) and Mn(III) → MnO2. In a companion study , we show that the electron transfer from Mn(II) to the low-potential type 1 Cu of MnxG requires an activation step, likely forming a hydroxide bridge at a dinuclear Mn(II) site. Here we study the second oxidation step, using pyrophosphate (PP) as a Mn(III) trap. PP chelates Mn(III) produced by the enzyme and subsequently allows it to become a substrate for the second stage of the reaction. EPR spectroscopy confirms the presence of Mn(III) bound to the enzyme. The Mn(III) oxidation step does not involve direct electron transfer to the enzyme from Mn(III), which is shown by kinetic measurements to be excluded from the Mn(II) binding site. Instead, Mn(III) is proposed to disproportionate at an adjacent polynuclear site, thereby allowing indirect oxidation to Mn(IV) and recycling of Mn(II). PP plays a multifaceted role, slowing the reaction by complexing both Mn(II) and Mn(III) in solution, and also inhibiting catalysis, likely through binding at or near the active site. An overall mechanism for Mnx-catalyzed MnO2 production from Mn(II) is presented.

  5. Multivariate Analysis of Prognostic Factors Among 2,313 Patients With Stage III Melanoma: Comparison of Nodal Micrometastases Versus Macrometastases

    Science.gov (United States)

    Balch, Charles M.; Gershenwald, Jeffrey E.; Soong, Seng-jaw; Thompson, John F.; Ding, Shouluan; Byrd, David R.; Cascinelli, Natale; Cochran, Alistair J.; Coit, Daniel G.; Eggermont, Alexander M.; Johnson, Timothy; Kirkwood, John M.; Leong, Stanley P.; McMasters, Kelly M.; Mihm, Martin C.; Morton, Donald L.; Ross, Merrick I.; Sondak, Vernon K.

    2010-01-01

    Purpose To determine the survival rates and independent predictors of survival using a contemporary international cohort of patients with stage III melanoma. Patients and Methods Complete clinicopathologic and follow-up data were available for 2,313 patients with stage III disease in an updated and expanded American Joint Committee on Cancer (AJCC) melanoma staging database. Kaplan-Meier and Cox multivariate survival analyses were performed. Results Among all 2,313 patients with stage III disease, 81% had micrometastases, and 19% had clinically detectable macrometastases. The 5-year overall survival was 63%; it was 67% for patients with nodal micrometastases, and it was 43% for those with nodal macrometastases (P Multivariate analysis demonstrated that in patients with nodal micrometastases, number of tumor-containing lymph nodes, primary tumor thickness, patient age, ulceration, and anatomic site of the primary independently predicted survival (all P < .01). When added to the model, primary tumor mitotic rate was the second-most powerful predictor of survival after the number of tumor-containing nodes. In contrast, for patients with nodal macrometastases, the number of tumor-containing nodes, primary ulceration, and patient age independently predicted survival (P < .01). Conclusion In this multi-institutional analysis, we demonstrated remarkable heterogeneity of prognosis among patients with stage III melanoma, especially among those with nodal micrometastases. These results should be incorporated into the design and interpretation of future clinical trials involving patients with stage III melanoma. PMID:20368546

  6. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomised phase III trial.

    NARCIS (Netherlands)

    Eggermont, A.M.; Suciu, S.; Santinami, M.; Testori, A.; Kruit, W.H.; Marsden, J.; Punt, C.J.A.; Sales, F.; Gore, M.; Mackie, R.; Kusic, Z.; Dummer, R.; Hauschild, A.; Musat, E.; Spatz, A.; Keilholz, U.

    2008-01-01

    BACKGROUND: Any benefit of adjuvant interferon alfa-2b for melanoma could depend on dose and duration of treatment. Our aim was to determine whether pegylated interferon alfa-2b can facilitate prolonged exposure while maintaining tolerability. METHODS: 1256 patients with resected stage III melanoma

  7. Concretes with ternary composite cements. Part III: multicriteria optimization

    Directory of Open Access Journals (Sweden)

    Irassar, E. F.

    2007-06-01

    Full Text Available Optimization methods are tools of vital importance in composite material design, where large numbers of components and design criteria must be taken into account. The formulation of today’s separately milled custommade cements is a clear example of just such a case, for the components must be proportioned to yield mortars and concretes with the proper balance of durability, strength, financial and environmental features. Multicriteria optimization has been used to develop many materials, although its application in cement formulation has yet to be explored. The present paper discusses the use of an objective function to jointly optimize sorptivity and compressive strength in limestone- (up to 20% and/or granulated blast furnace slag- (up to 20% additioned Portland cement concrete.Los métodos de optimización constituyen una herramienta de vital importancia en el diseño de materiales compuestos, donde la cantidad de componentes de la mezcla y los criterios de diseño que deben tenerse en cuenta en el proceso de fabricación son numerosos. En la actualidad, la formulación de un cemento a medida (tailor made a partir del proceso de molienda separada es un claro ejemplo de ello, pues las proporciones relativas de las componentes de la mezcla deben permitir luego obtener morteros y hormigones con el equilibrio justo entre los requerimientos durables, mecánicos, económicos y ecológicos que se soliciten. La optimización por multicriterios ha sido empleada en el desarrollo de diversos materiales, sin embargo, su aplicación en la formulación del cemento no ha sido aún explorada. En este trabajo se presenta la optimización conjunta de la capacidad de absorción y la resistencia a compresión de hormigones elaborados con cemento Portland con caliza (hasta un 20% y/o escoria granulada de alto horno (hasta un 20% utilizando la función objetivo.

  8. Corneal cross-linking in a 10-year-old child with stage III keratoconus.

    Science.gov (United States)

    Abbondanza, Marco; Felice, Valentina De; Abbondanza, Gabriele

    2016-07-01

    Keratoconus is a corneal dystrophy characterized by progressive thinning, conical shape of the cornea and irregular astigmatism. It is particularly insidious when it occurs in very young patients. We report the case of a 10-year-old child with an aggressive stage III keratoconus, who was suggested to undergo a Penetrating Keratoplasty. We performed Corneal Collagen Cross-linking with epithelium removal instead, which was successful in arresting the rapid progression of keratoconus. Eighteen months later, Kmax had decreased by 1.3 D, astigmatism by 0.8 D, thinnest pachimetry had improved by 69 μm and CDVA was 20/32. This case confirms that Corneal Collagen Cross-linking is a safe and effective procedure for the treatment of keratoconus even in its aggressive forms. We encourage ophthalmic surgeons to favor conservative treatments when dealing with very young patients. © NEPjOPH.

  9. Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer.

    Science.gov (United States)

    Kobayashi, Hirotoshi; Ueno, Hideki; Hashiguchi, Yojiro; Mochizuki, Hidetaka

    2006-04-01

    In the TNM classification of colorectal carcinoma, N-staging is dependent on the number of metastases; in the Japanese classification system, staging usually has been based on the distribution of metastases (N1, paracolic; N2, along the major vessels; N3, at the root of major vessels). The aim of our study was to examine whether the concept of the distribution of nodal metastasis could improve the TNM classification for colorectal cancer. We studied the survival rates of 485 and 136 patients with stage III colonic and rectal cancer, respectively, who underwent curative surgery between 1979 and 1998. The patients were categorized into 4 groups: group 1, TNM-N1 classified in J-N1; group 2, TNM-N2 in J-N1; group 3, TNM-N1 in J-N2-3; and group 4, TNM-N2 in J-N2-3. In the colon cancer arm, the 5-year survival rates of the patients in groups 1 to 4 were 74%, 51%, 52%, and 54%, respectively. There was a significant difference in survival rate between groups 1 and 3 (P = .0002). Thus, in colon cancer, nodal metastasis along the major vessels was a bad prognostic factor, even though the number of nodes that were involved was cancer arm, the 5-year survival rates of the patients in each group were 65%, 39%, 60%, and 32%, respectively. Only the number of nodal metastases was an independently significant prognostic variable. This study suggests that adding the concept of nodal distribution to the conventional TNM staging of colon cancer will improve the accuracy in the evaluation of the nodal status.

  10. Coffee Intake, Recurrence, and Mortality in Stage III Colon Cancer: Results From CALGB 89803 (Alliance)

    Science.gov (United States)

    Guercio, Brendan J.; Sato, Kaori; Niedzwiecki, Donna; Ye, Xing; Saltz, Leonard B.; Mayer, Robert J.; Mowat, Rex B.; Whittom, Renaud; Hantel, Alexander; Benson, Al; Atienza, Daniel; Messino, Michael; Kindler, Hedy; Venook, Alan; Hu, Frank B.; Ogino, Shuji; Wu, Kana; Willett, Walter C.; Giovannucci, Edward L.; Meyerhardt, Jeffrey A.; Fuchs, Charles S.

    2015-01-01

    Purpose Observational studies have demonstrated increased colon cancer recurrence in states of relative hyperinsulinemia, including sedentary lifestyle, obesity, and increased dietary glycemic load. Greater coffee consumption has been associated with decreased risk of type 2 diabetes and increased insulin sensitivity. The effect of coffee on colon cancer recurrence and survival is unknown. Patients and Methods During and 6 months after adjuvant chemotherapy, 953 patients with stage III colon cancer prospectively reported dietary intake of caffeinated coffee, decaffeinated coffee, and nonherbal tea, as well as 128 other items. We examined the influence of coffee, nonherbal tea, and caffeine on cancer recurrence and mortality using Cox proportional hazards regression. Results Patients consuming 4 cups/d or more of total coffee experienced an adjusted hazard ratio (HR) for colon cancer recurrence or mortality of 0.58 (95% CI, 0.34 to 0.99), compared with never drinkers (Ptrend = .002). Patients consuming 4 cups/d or more of caffeinated coffee experienced significantly reduced cancer recurrence or mortality risk compared with abstainers (HR, 0.48; 95% CI, 0.25 to 0.91; Ptrend = .002), and increasing caffeine intake also conferred a significant reduction in cancer recurrence or mortality (HR, 0.66 across extreme quintiles; 95% CI, 0.47 to 0.93; Ptrend = .006). Nonherbal tea and decaffeinated coffee were not associated with patient outcome. The association of total coffee intake with improved outcomes seemed consistent across other predictors of cancer recurrence and mortality. Conclusion Higher coffee intake may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer. PMID:26282659

  11. Chemical analysis of simulated high level waste glasses to support stage III sulfate solubility modeling

    Energy Technology Data Exchange (ETDEWEB)

    Fox, K. M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2016-03-17

    The U.S. Department of Energy (DOE), Office of Environmental Management (EM) is sponsoring an international, collaborative project to develop a fundamental model for sulfate solubility in nuclear waste glass. The solubility of sulfate has a significant impact on the achievable waste loading for nuclear waste forms within the DOE complex. These wastes can contain relatively high concentrations of sulfate, which has low solubility in borosilicate glass. This is a significant issue for low-activity waste (LAW) glass and is projected to have a major impact on the Hanford Tank Waste Treatment and Immobilization Plant (WTP). Sulfate solubility has also been a limiting factor for recent high level waste (HLW) sludge processed at the Savannah River Site (SRS) Defense Waste Processing Facility (DWPF). The low solubility of sulfate in glass, along with melter and off-gas corrosion constraints, dictate that the waste be blended with lower sulfate concentration waste sources or washed to remove sulfate prior to vitrification. The development of enhanced borosilicate glass compositions with improved sulfate solubility will allow for higher waste loadings and accelerate mission completion.The objective of the current scope being pursued by SHU is to mature the sulfate solubility model to the point where it can be used to guide glass composition development for DWPF and WTP, allowing for enhanced waste loadings and waste throughput at these facilities. A series of targeted glass compositions was selected to resolve data gaps in the model and is identified as Stage III. SHU fabricated these glasses and sent samples to SRNL for chemical composition analysis. SHU will use the resulting data to enhance the sulfate solubility model and resolve any deficiencies. In this report, SRNL provides chemical analyses for the Stage III, simulated HLW glasses fabricated by SHU in support of the sulfate solubility model development.

  12. Metamodeling and Optimization of a Blister Copper Two-Stage Production Process

    Science.gov (United States)

    Jarosz, Piotr; Kusiak, Jan; Małecki, Stanisław; Morkisz, Paweł; Oprocha, Piotr; Pietrucha, Wojciech; Sztangret, Łukasz

    2016-06-01

    It is often difficult to estimate parameters for a two-stage production process of blister copper (containing 99.4 wt.% of Cu metal) as well as those for most industrial processes with high accuracy, which leads to problems related to process modeling and control. The first objective of this study was to model flash smelting and converting of Cu matte stages using three different techniques: artificial neural networks, support vector machines, and random forests, which utilized noisy technological data. Subsequently, more advanced models were applied to optimize the entire process (which was the second goal of this research). The obtained optimal solution was a Pareto-optimal one because the process consisted of two stages, making the optimization problem a multi-criteria one. A sequential optimization strategy was employed, which aimed for optimal control parameters consecutively for both stages. The obtained optimal output parameters for the first smelting stage were used as input parameters for the second converting stage. Finally, a search for another optimal set of control parameters for the second stage of a Kennecott-Outokumpu process was performed. The optimization process was modeled using a Monte-Carlo method, and both modeling parameters and computed optimal solutions are discussed.

  13. Adjuvant 5FU plus levamisole in colonic or rectal cancer: improved survival in stage II and III.

    Science.gov (United States)

    Taal, B G; Van Tinteren, H; Zoetmulder, F A

    2001-11-16

    Based on the first favourable results of adjuvant therapy of 5FU plus levamisole in Dukes C colonic cancer in 1990, we conducted a prospective trial. 1029 patients were randomised to receive one year 5FU plus levamisole or no further treatment following curative surgery for stage II or III colon (n = 730) or rectal cancer (n = 299). 45% were in stage II and 55% in stage III. With a median follow-up of 4 years and 9 months a significant reduction in odds of death (25%, SD 9%, P = 0.007) was observed for those with adjuvant treatment (65% at 5 year) compared to the observation group (55%). Improved relative survival was present in stage III (56% vs 44%), and in stage II patients (78% vs 70%). In rectal cancer a non-significant difference in disease-free or overall survival was observed. Distant metastases developed in 76%, while local recurrence alone occurred in 14%. An early start of adjuvant treatment (5FU plus levamisole was 69%. Severe toxicity did not occur. In conclusion, one year 5FU plus levamisole was of benefit in stage II and III colonic cancer; in rectal cancer a significant positive effect could not be demonstrated.

  14. [Is there alternative to FOLFOX adjuvant chemotherapy for stage III colorectal cancer patients?].

    Science.gov (United States)

    Esch, Anouk; Coriat, Romain; Perkins, Géraldine; Brezault, Catherine; Chaussade, Stanislas

    2012-01-01

    Being the second cancer for men and the third cancer for women in France, colorectal cancer represents a serious public health issue. Its incidence has increased these last years and despite new therapeutics being developed, it still has a bad prognostic. Thanks in part to Hemoccult national mass screening program, its diagnosis is made possible at an earlier stage, which makes a surgical curative resection and the carrying out of adjuvant chemotherapy possible. For stage III colic cancer that has been surgically removed, adjuvant chemotherapy by FOLFOX 4 has to be offered. Nevertheless, because of its toxicities, the patient's high age, important comorbidities or post-surgical complications, this chemotherapy occasionally cannot be done. What are the colorectal cancer prognostic factors which would guide the chemotherapy? TNM classification, number of examined lymph nodes, MSI status, and presence or not of a perforation or a perinervous, lymphatic or venous invasion is recognized prognostic factors. Also, what are the alternatives of FOLFOX 4 regimen as colorectal cancer adjuvant treatment?

  15. A Multi-Stage Optimization Model With Minimum Energy Consumption-Wireless Mesh Networks

    Directory of Open Access Journals (Sweden)

    S. Krishnakumar

    2012-09-01

    Full Text Available Optimization models related with routing, bandwidth utilization and power consumption are developed in the wireless mesh computing environment using the operations research techniques such as maximal flow model, transshipment model and minimax optimizing algorithm. The Path creation algorithm is used to find the multiple paths from source to destination.A multi-stage optimization model is developed by combining the multi-path optimization model, optimization model in capacity utilization and energy optimization model and minimax optimizing algorithm. The input to the multi-stage optimization model is a network with many source and destination. The optimal solution obtained from this model is a minimum energy consuming path from source to destination along with the maximum data rate over each link. The performance is evaluated by comparing the data rate values of superimposed algorithm and minimax optimizing algorithm. The main advantage of this model is the reduction of traffic congestion in the network.

  16. Management of stage III colon cancer in the elderly: Practice patterns and outcomes in the general population.

    Science.gov (United States)

    Merchant, Shaila J; Nanji, Sulaiman; Brennan, Kelly; Karim, Safiya; Patel, Sunil V; Biagi, James J; Booth, Christopher M

    2017-08-01

    Clinical trials have established surgical resection and adjuvant chemotherapy (ACT) as the standard management for stage III colon cancer; however, the extent to which these results apply to elderly patients in routine practice is unclear. This article describes the management and outcomes of elderly patients with stage III colon cancer. All cases of surgically resected colon cancer from 2002 to 2008 were identified with the population-based Ontario Cancer Registry. Pathology reports were obtained for a random sample (25% of all cases); those with stage III disease constituted the study population. The utilization of ACT, cancer-specific survival (CSS), and overall survival (OS) in elderly patients (≥70 years) and nonelderly patients (colon cancer do not receive ACT. Although the effect size is smaller than that in younger patients, ACT is associated with improved long-term survival. Cancer 2017;123:2840-49. © 2017 American Cancer Society. © 2017 American Cancer Society.

  17. Validated Competing Event Model for the Stage I-II Endometrial Cancer Population

    Energy Technology Data Exchange (ETDEWEB)

    Carmona, Ruben; Gulaya, Sachin; Murphy, James D. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Rose, Brent S. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts (United States); Wu, John; Noticewala, Sonal [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); McHale, Michael T. [Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California (United States); Yashar, Catheryn M. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Vaida, Florin [Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California (United States); Mell, Loren K., E-mail: lmell@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

    2014-07-15

    Purpose/Objectives(s): Early-stage endometrial cancer patients are at higher risk of noncancer mortality than of cancer mortality. Competing event models incorporating comorbidity could help identify women most likely to benefit from treatment intensification. Methods and Materials: 67,397 women with stage I-II endometrioid adenocarcinoma after total hysterectomy diagnosed from 1988 to 2009 were identified in Surveillance, Epidemiology, and End Results (SEER) and linked SEER-Medicare databases. Using demographic and clinical information, including comorbidity, we sought to develop and validate a risk score to predict the incidence of competing mortality. Results: In the validation cohort, increasing competing mortality risk score was associated with increased risk of noncancer mortality (subdistribution hazard ratio [SDHR], 1.92; 95% confidence interval [CI], 1.60-2.30) and decreased risk of endometrial cancer mortality (SDHR, 0.61; 95% CI, 0.55-0.78). Controlling for other variables, Charlson Comorbidity Index (CCI) = 1 (SDHR, 1.62; 95% CI, 1.45-1.82) and CCI >1 (SDHR, 3.31; 95% CI, 2.74-4.01) were associated with increased risk of noncancer mortality. The 10-year cumulative incidences of competing mortality within low-, medium-, and high-risk strata were 27.3% (95% CI, 25.2%-29.4%), 34.6% (95% CI, 32.5%-36.7%), and 50.3% (95% CI, 48.2%-52.6%), respectively. With increasing competing mortality risk score, we observed a significant decline in omega (ω), indicating a diminishing likelihood of benefit from treatment intensification. Conclusion: Comorbidity and other factors influence the risk of competing mortality among patients with early-stage endometrial cancer. Competing event models could improve our ability to identify patients likely to benefit from treatment intensification.

  18. The role of induction chemotherapy before radiation therapy in non-operative management of stage III NSCLC.

    Science.gov (United States)

    Green, M R

    1994-11-01

    Radiation therapy alone has been 'standard' management of patients with Stage III non-small cell lung cancer for several decades. Palliative benefits are routinely achieved but significant survival benefits have not been documented. Patterns of failure in Stage III patients emphasize the need to pursue better treatment for both local macroscopic disease and distant micrometastatic sites. Improved control in both areas will be necessary to meaningfully enhance outcome for the universe of Stage III NSCLC patients. Several randomized trials show a significant survival benefit when cisplatin-containing induction chemotherapy is administered prior to locoregional treatment. In the favorable subset of Stage III patients selected for study by CALGB, the surviving fraction at 2-5 years post-therapy was > or = 2-fold larger in the chemoradiation group than in the cohort treated with radiation alone. The French trial documented a significant decrease in distant metastases rate among the chemotherapy treated patients. In all the trials where patterns of failure are discussed, local disease persistence is the overwhelming rule. Future trials must evaluate improved induction chemotherapy approaches. Stage III patients are an ethical population in which to test induction therapy with new drug combinations randomized against already 'active' regimens for comparative efficacy. End points would be initial response rates, patterns of failure, and overall survival. The feasibility of high-dose chemotherapy regimens with growth factor and hematopoietic support followed by aggressive radiation must be tested. If feasible, trials randomizing high dose versus conventional dose induction programs within the context of sequential multimodality therapy should follow. Intensified radiation approaches such as hyperfractionation or CHART should be paired with active concurrent chemotherapy following induction chemotherapy alone. Pursuit of these approaches over the next several years will

  19. Macrophage markers in serum and tumor have prognostic impact in American Joint Committee on Cancer stage I/II melanoma

    DEFF Research Database (Denmark)

    Jensen, T.O.; Schmidt, H.; Moller, H.J.;

    2009-01-01

    PURPOSE: To evaluate the prognostic role of soluble CD163 (sCD163) in serum and macrophage infiltration in primary melanomas from patients with American Joint Committee on Cancer (AJCC) stage I/II melanoma. The scavenger receptor CD163 is associated with anti-inflammatory macrophages, and it is s......PURPOSE: To evaluate the prognostic role of soluble CD163 (sCD163) in serum and macrophage infiltration in primary melanomas from patients with American Joint Committee on Cancer (AJCC) stage I/II melanoma. The scavenger receptor CD163 is associated with anti-inflammatory macrophages...

  20. Accelerated hyperfractionated radiation, concurrent paclitaxel/cisplatin chemotherapy and surgery for stage III non-small cell lung cancer.

    Science.gov (United States)

    Adelstein, David J; Rice, Thomas W; Rybicki, Lisa A; Greskovich, John F; Ciezki, Jay P; Carroll, Marjorie A; DeCamp, Malcolm M

    2002-05-01

    The low surgical cure rate in patients with stage III non-small cell lung cancer has prompted an exploration of multimodality treatment strategies. Mature results are presented from a phase II trial of accelerated hyperfractionated radiation therapy, concurrent paclitaxel/cisplatin chemotherapy and surgery for these patients. Between 1994 and 1997, 45 patients with surgically demonstrated stage III non-small cell lung cancer underwent induction treatment with a 96 h continuous cisplatin infusion (20 mg/m(2) per day) and a 24 h infusion of paclitaxel (175 mg/m(2)) given concurrently with accelerated hyperfractionated radiation therapy (1.5 Gy twice daily) to a total dose of 30 Gy. Induction was completed in ten treatment (12 total) days. Surgical resection was scheduled 4 weeks later with a second identical course of chemoradiotherapy given 4-6 weeks post-operatively, to a total radiation dose of 60-63 Gy. Thirty-five patients had stage III(A) disease and ten had stage III(B) disease (eight with N(3) tumors). Induction toxicity included nausea in 89%, dysphagia in 89%, and neutropenia tolerable despite significant myelosuppression. Locoregional control is excellent and survival is better than historical expectations. Patients downstaged to mediastinal node negativity have a prognosis similar to those with de novo stage I(B) and II disease. Distant metastases are the major cause of treatment failure.

  1. High-Dose Recombinant Interferon Alfa-2B, Ipilimumab, or Pembrolizumab in Treating Patients With Stage III-IV High Risk Melanoma That Has Been Removed by Surgery

    Science.gov (United States)

    2016-10-10

    Metastatic Non-Cutaneous Melanoma; Non-Cutaneous Melanoma; Recurrent Melanoma of the Skin; Recurrent Non-Cutaneous Melanoma; Stage III Mucosal Melanoma of the Head and Neck; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Skin Melanoma; Stage IVA Mucosal Melanoma of the Head and Neck; Stage IVB Mucosal Melanoma of the Head and Neck; Stage IVC Mucosal Melanoma of the Head and Neck

  2. On the interplay effects with proton scanning beams in stage III lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Li, Yupeng [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Applied Research, Varian Medical Systems, Palo Alto, California 94304 (United States); Kardar, Laleh; Liao, Li; Lim, Gino [Department of Industrial Engineering, The University of Houston, Houston, Texas 77204 (United States); Li, Xiaoqiang; Li, Heng; Zhu, Ronald X.; Sahoo, Narayan; Gillin, Michael; Zhang, Xiaodong, E-mail: xizhang@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Cao, Wenhua [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Department of Industrial Engineering, The University of Houston, Houston, Texas 77204 (United States); Chang, Joe Y.; Liao, Zhongxing; Komaki, Ritsuko; Cox, James D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States)

    2014-02-15

    Purpose: To assess the dosimetric impact of interplay between spot-scanning proton beam and respiratory motion in intensity-modulated proton therapy (IMPT) for stage III lung cancer. Methods: Eleven patients were sampled from 112 patients with stage III nonsmall cell lung cancer to well represent the distribution of 112 patients in terms of target size and motion. Clinical target volumes (CTVs) and planning target volumes (PTVs) were defined according to the authors' clinical protocol. Uniform and realistic breathing patterns were considered along with regular- and hypofractionation scenarios. The dose contributed by a spot was fully calculated on the computed tomography (CT) images corresponding to the respiratory phase that the spot is delivered, and then accumulated to the reference phase of the 4DCT to generate the dynamic dose that provides an estimation of what might be delivered under the influence of interplay effect. The dynamic dose distributions at different numbers of fractions were compared with the corresponding 4D composite dose which is the equally weighted average of the doses, respectively, computed on respiratory phases of a 4DCT image set. Results: Under regular fractionation, the average and maximum differences in CTV coverage between the 4D composite and dynamic doses after delivery of all 35 fractions were no more than 0.2% and 0.9%, respectively. The maximum differences between the two dose distributions for the maximum dose to the spinal cord, heart V40, esophagus V55, and lung V20 were 1.2 Gy, 0.1%, 0.8%, and 0.4%, respectively. Although relatively large differences in single fraction, correlated with small CTVs relative to motions, were observed, the authors' biological response calculations suggested that this interfractional dose variation may have limited biological impact. Assuming a hypofractionation scenario, the differences between the 4D composite and dynamic doses were well confined even for single fraction. Conclusions

  3. Outcome of patients with stage II and III nonseminomatous germ cell tumors: Results of a single center

    OpenAIRE

    Ataergin S; Ozet A; Arpaci F; Kilic S; Beyzadeoglu M; Komurcu S

    2007-01-01

    Background: The prognostic factors in nonseminomatous germ cell tumors have been mainly derived from the analysis of stage I tumors. Aims: The aim of this study was to evaluate some prognostic factors and the outcome of patients with stage II and III nonseminomatous germ cell tumors according to risk groups treated between 1993 and 2002. Settings and Design: Patients were retrospectively classified as good, intermediate and poor risk groups according to International Germ Cell Cancer Con...

  4. Identification of differentially expressed genes using an annealing control primer system in stage III serous ovarian carcinoma

    Directory of Open Access Journals (Sweden)

    Bae Dong-Han

    2010-10-01

    Full Text Available Abstract Background Most patients with ovarian cancer are diagnosed with advanced stage disease (i.e., stage III-IV, which is associated with a poor prognosis. Differentially expressed genes (DEGs in stage III serous ovarian carcinoma compared to normal tissue were screened by a new differential display method, the annealing control primer (ACP system. The potential targets for markers that could be used for diagnosis and prognosis, for stage III serous ovarian cancer, were found by cluster and survival analysis. Methods The ACP-based reverse transcriptase polymerase chain reaction (RT PCR technique was used to identify DEGs in patients with stage III serous ovarian carcinoma. The DEGs identified by the ACP system were confirmed by quantitative real-time PCR. Cluster analysis was performed on the basis of the expression profile produced by quantitative real-time PCR and survival analysis was carried out by the Kaplan-Meier method and Cox proportional hazards multivariate model; the results of gene expression were compared between chemo-resistant and chemo-sensitive groups. Results A total of 114 DEGs were identified by the ACP-based RT PCR technique among patients with stage III serous ovarian carcinoma. The DEGs associated with an apoptosis inhibitory process tended to be up-regulated clones while the DEGs associated with immune response tended to be down-regulated clones. Cluster analysis of the gene expression profile obtained by quantitative real-time PCR revealed two contrasting groups of DEGs. That is, a group of genes including: SSBP1, IFI6 DDT, IFI27, C11orf92, NFKBIA, TNXB, NEAT1 and TFG were up-regulated while another group of genes consisting of: LAMB2, XRCC6, MEF2C, RBM5, FOXP1, NUDCP2, LGALS3, TMEM185A, and C1S were down-regulated in most patients. Survival analysis revealed that the up-regulated genes such as DDAH2, RNase K and TCEAL2 might be associated with a poor prognosis. Furthermore, the prognosis of patients with chemo

  5. [Analysis of prognostic factors after radical resection in 628 patients with stage II or III colon cancer].

    Science.gov (United States)

    Qin, Qiong; Yang, Lin; Zhou, Ai-ping; Sun, Yong-kun; Song, Yan; DU, Feng; Wang, Jin-wan

    2013-03-01

    To analyze the clinicopathologic factors related to recurrence and metastasis of stage II or III colon cancer after radical resection. The clinical and pathological data of 628 patients with stage II or III colon cancer after radical resection from Jan. 2005 to Dec. 2008 in our hospital were retrospectively reviewed and analyzed. The overall recurrence and metastasis rate was 28.5% (179/628). The 5-year disease-free survival (DFS) rate was 70.3% and 5-year overall survival (OS) rate was 78.5%. Univariate analysis showed that age, smoking intensity, depth of tumor invasion, lymph node metastasis, TNM stage, gross classification, histological differentiation, blood vessel tumor embolus, tumor gross pathology, multiple primary tumors, preoperative and postoperative serum concentration of CEA and CA19-9, and the regimen of adjuvant chemotherapy were correlated to recurrence and metastasis of colon cancer after radical resection. Multivariate analysis showed that regional lymph node metastasis, TNM stage, the regimen of postoperative adjuvant chemotherapy, and preoperative serum concentration of CEA and CA19-9 were independent factors affecting the prognosis of colon cancer patients. Regional lymph node metastasis, TNM stage, elevated preoperative serum concentration of CEA and CA19-9, the regimen of postoperative adjuvant chemotherapy with single fluorouracil type drug are independent risk factors of recurrence and metastasis in patients with stage II-III colon cancer after radical resection.

  6. Late Closure of a Stage III Idiopathic Macular Hole after Pars Plana Vitrectomy

    Directory of Open Access Journals (Sweden)

    Filiz Afrashi

    2015-12-01

    Full Text Available A 57-year-old female presented to our hospital with decreased vision in her right eye. Detailed ocular examination was performed, and a macular hole was detected in the right eye. The presence of a full-thickness stage III macular hole was confirmed with optical coherence tomography (OCT imaging. Pars plana vitrectomy followed by long-acting gas tamponade (C3F8 was performed as treatment. One month after surgery, clinical examination revealed a persistent macular hole, confirmed by an OCT scan. Although the patient was scheduled for reoperation, the surgery was postponed due to personal reasons of the patient. Surprisingly, after five months, a closure pattern with accompanying epiretinal membrane was observed in the macular hole area. The closure of the macular hole was completed without any further intervention 8 months post-surgery. In cases of unclosed macular hole after the first surgery, if a second surgery cannot be performed, follow-up with OCT recommended due to the possibility of spontaneous closure. However, spontaneous closure of a persistent macular hole following PPV is rare, so early diagnosis and surgical repair of unclosed macular holes must remain the primary goal.

  7. Trace elements and heavy metals in hair of stage III breast cancer patients.

    Science.gov (United States)

    Benderli Cihan, Yasemin; Sözen, Selim; Oztürk Yıldırım, Sema

    2011-12-01

    This prospective study was designed to compare the hair levels of 36 elements in 52 patients with stage III breast cancer to those of an equal number of healthy individuals. Principal component and cluster analysis were used for source of identification and apportionment of heavy metals and trace elements in these two groups. A higher average level of iron was found in samples from patients while controls had higher levels of calcium. Both patients and controls had elevated levels of tin, magnesium, zinc, and sodium. Almost all element values in cancer patients showed higher dispersion and asymmetry than in healthy controls. Between the two groups, there were statistically significant differences in the concentrations of silver, arsenic, gold, boron, barium, beryllium, calcium, cadmium, cerium, cobalt, cesium, gadolinium, manganese, nickel, lead, antimony, scandium, selenium, and zinc (p cancer group and between palladium and cobalt (r = 0.945) in the healthy individuals. Our results show that there are distinct patterns of heavy metals and trace elements in the hair of breast cancer patients in comparison to healthy controls. These results could be of significance in the diagnosis of breast cancer.

  8. Evaluation of NEXRDA Stage III precipitation data over Sevilleta National Wildlife Refuge: a semiarid region in Central New Mexico

    Science.gov (United States)

    Xie, H.; Zhou, X.; Hendrickx, J.; Guan, H.

    2006-05-01

    This study examines NEXRAD Stage III product (hourly, cell size 4 km by 4 km) for its ability in estimating precipitation over Sevilleta National Wildlife Refuge: a semiarid region in Central New Mexico. A GIS-based NEXRAD data processing and visualization method is also presented. A comparison between Stage III and a network of gauge precipitation estimates during 1995 to 2001 indicates that Stage III (1) overestimates the hourly conditional mean precipitation (CM) by 33 percent in monsoon season and 55 percent in non-monsoon season; (2) overestimates the hourly CM for concurrent radar-gauge pairs (non-zero value) by 13 percent in monsoon season and 6 percent in non-monsoon season; (3) overestimates the seasonal precipitation accumulation by 11 to 88 percent in monsoon season and underestimates by 18 to 89 percent in non- monsoon season; and (4) either overestimates annual precipitation accumulation up to 28.2 percent or underestimates it up to 11.9 percent. More caution is suggested in using Stage III data for nonmonsoonal (stratiform) rainfall events (prior to the truncation fixed algorithm deployed in 2002), as the truncation error can be a significant drawback. While overestimates may suppress the truncation caused underestimates in the monsoon seasons.

  9. Desmoplasia Influenced Recurrence of Disease and Mortality in Stage III Colorectal Cancer within Five Years after Surgery and Adjuvant Therapy

    Science.gov (United States)

    Zippi, Maddalena; De Toma, Giorgio; Minervini, Giovanni; Cassieri, Claudio; Pica, Roberta; Colarusso, Diodoro; Stock, Simon; Crispino, Pietro

    2017-01-01

    Background/Aims: In patients with colon cancer who undergo resection for potential cure, 40–60% have advanced locoregional disease (stage III). Those who are suitable for adjuvant treatment had a definite disease-free-survival benefit. The aim of the present study was to demonstrate whether the presence of desmoplasia influenced the mortality rate of stage III colorectal cancer (CRC) within 5 years from the surgery and adjuvant therapy. Patients and Methods: Sixty-five patients with stage III CRC underwent resection and adjuvant therapy. Qualitative categorization of desmoplasia was obtained using Ueno's stromal CRC classification. Desmoplasia was related to mortality using Spearman correlation and stratified with other histological variables (inflammation, grading) that concurred to the major determinant of malignancy (venous invasion and lymph nodes) using the Chi-square test. Result: The 5-year survival rate was 65% and the relapse rate was 37%. The mortality rate in patients with immature desmoplasia was 86%, 27% in intermediate desmoplasia, and 0% in mature desmoplasia (Spearman correlation coefficient: −0.572, P = 0.05). Conclusion: Immature desmoplasia appears to be associated with disease recurrence and mortality in stage III CRC patients. PMID:28139499

  10. Desmoplasia influenced recurrence of disease and mortality in stage III colorectal cancer within five years after surgery and adjuvant therapy

    Directory of Open Access Journals (Sweden)

    Maddalena Zippi

    2017-01-01

    Full Text Available Background/Aims: In patients with colon cancer who undergo resection for potential cure, 40–60% have advanced locoregional disease (stage III. Those who are suitable for adjuvant treatment had a definite disease-free-survival benefit. The aim of the present study was to demonstrate whether the presence of desmoplasia influenced the mortality rate of stage III colorectal cancer (CRC within 5 years from the surgery and adjuvant therapy. Patients and Methods: Sixty-five patients with stage III CRC underwent resection and adjuvant therapy. Qualitative categorization of desmoplasia was obtained using Ueno's stromal CRC classification. Desmoplasia was related to mortality using Spearman correlation and stratified with other histological variables (inflammation, grading that concurred to the major determinant of malignancy (venous invasion and lymph nodes using the Chi-square test. Result: The 5-year survival rate was 65% and the relapse rate was 37%. The mortality rate in patients with immature desmoplasia was 86%, 27% in intermediate desmoplasia, and 0% in mature desmoplasia (Spearman correlation coefficient: −0.572,P= 0.05. Conclusion: Immature desmoplasia appears to be associated with disease recurrence and mortality in stage III CRC patients.

  11. TS Gene Polymorphisms Are Not Good Markers of Response to 5-FU Therapy in Stage III Colon Cancer Patients

    Directory of Open Access Journals (Sweden)

    A. Fariña-Sarasqueta

    2010-01-01

    Full Text Available Aim: Although the predictive and prognostic value of thymidylate synthase (TS expression and gene polymorphism in colon cancer has been widely studied, the results are inconclusive probably because of methodological differences. With this study, we aimed to elucidate the role of TS gene polymorphisms genotyping in therapy response in stage III colon carcinoma patients treated with 5-FU adjuvant chemotherapy.

  12. Desmoplasia influenced recurrence of disease and mortality in stage III colorectal cancer within five years after surgery and adjuvant therapy.

    Science.gov (United States)

    Zippi, Maddalena; De Toma, Giorgio; Minervini, Giovanni; Cassieri, Claudio; Pica, Roberta; Colarusso, Diodoro; Stock, Simon; Crispino, Pietro

    2017-01-01

    In patients with colon cancer who undergo resection for potential cure, 40-60% have advanced locoregional disease (stage III). Those who are suitable for adjuvant treatment had a definite disease-free-survival benefit. The aim of the present study was to demonstrate whether the presence of desmoplasia influenced the mortality rate of stage III colorectal cancer (CRC) within 5 years from the surgery and adjuvant therapy. Sixty-five patients with stage III CRC underwent resection and adjuvant therapy. Qualitative categorization of desmoplasia was obtained using Ueno's stromal CRC classification. Desmoplasia was related to mortality using Spearman correlation and stratified with other histological variables (inflammation, grading) that concurred to the major determinant of malignancy (venous invasion and lymph nodes) using the Chi-square test. The 5-year survival rate was 65% and the relapse rate was 37%. The mortality rate in patients with immature desmoplasia was 86%, 27% in intermediate desmoplasia, and 0% in mature desmoplasia (Spearman correlation coefficient: -0.572,P= 0.05). Immature desmoplasia appears to be associated with disease recurrence and mortality in stage III CRC patients.

  13. Mortgage Loan Portfolio Optimization Using Multi-Stage Stochastic Programming

    DEFF Research Database (Denmark)

    Rasmussen, Kourosh Marjani; Clausen, Jens

    2007-01-01

    reduction and LP relaxation are used to obtain near optimal solutions for large problem instances. Our results show that the standard Danish mortgagor should hold a more diversified portfolio of mortgage loans, and that he should rebalance the portfolio more frequently than current practice....

  14. [Stage III cancer of the cervix. The diagnosis, treatment and prognosis in a series of 92 patients (author's transl)].

    Science.gov (United States)

    Heintz, J

    1980-01-01

    This study is of 92 patients who were treated for Stage III carcinoma of the cervix in the Henri Becquerel Centre. We have ruled out the 11 patients who refused to complete their treatment or who died before treatment started. The average age was 63 years. The Stage III cases were divided into 40 Stage III A and 41 Stage III B, with 10 who had urinary tract involvement. These were epidermoid carcinomata. The treatment was by external radiotherapy followed by superimposed radium therapy in 66 cases. 15 patients were treated by external radiotherapy alone. The lumboartic nodes were treated in the area that was irradiated in 5 patients. The actuarial figures for survival work out at 51 per cent at 5 years for Stage III A cases and 34 per cent for Stage III B cases. Pelvic recurrences were responsible for 87 per cent of the failures. In fact, in almost 87 per cent of the cases the area was not completely sterilised. The percentage of failures was higher in the group that had altered lymphograms. The prognosis was worst when the upper urinary tract was affected. All patients who had positive lymphograms or those that were suspicious of having lumboaortic nodes involved died. In the 15 patients who did not have added radium therapy there were 13 cases who were not sterilised and 1 that recurred at 13 months. In 32 per cent of cases the failures in the pelvis were associated with pathology in distant lymph nodes and/or with visceral metastases. We found 13 per cent of solitary metastases. Between 5 and 10 years the failure rate is 9 per cent with a level of 6.3 per cent of pelvic recurrences associated or not associated with metastases or even with complications. Our patients had 8 rectosigmoid complications of which 2 needed a diversion colostomy. There were 7 cases of cystitis after X-ray, in the majority of a benign nature, and 2 bony complications that recovered spontaneously. After a study of the diagnosis and treatment of Stage III cancer of the cervix, the

  15. Site and Timing of First Relapse in Stage III Melanoma Patients: Implications for Follow-Up Guidelines

    Science.gov (United States)

    Romano, Emanuela; Scordo, Michael; Dusza, Stephen W.; Coit, Daniel G.; Chapman, Paul B.

    2010-01-01

    Purpose Stage III melanoma is associated with a high risk of relapse and mortality. Nevertheless, follow-up guidelines have largely been empirical rather than evidence-based. Patients and Methods Clinical records of stage III patients with no evidence of disease seen at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1992 and 2004, who ultimately relapsed, were reviewed retrospectively to evaluate date of first relapse, time to first relapse, method of first relapse detection, and survival. We also determined overall 5-year relapse-free survival (RFS) of all stage III patients seen at MSKCC during this period. Results The overall 5-year RFS for stage IIIA, IIIB, and IIIIC patients was 63%, 32%, and 11%, respectively. Among relapsing patients, 340 had adequate follow-up to be evaluable for all parameters. Site of first relapse was local/in-transit (28%), regional nodal (21%), or systemic (51%). First relapses were detected by the patient or family, physician, or by screening radiologic tests in 47%, 21%, and 32% of patients, respectively. Multivariate analysis revealed that better overall survival was associated with younger age and first relapse being local/in-transit or nodal, asymptomatic, or resectable. For each substage, we estimated site-specific risk of first relapse. Conclusion Patients detected almost half of first relapses. Our data suggest that routine physical examinations beyond 3 years for stage IIIA, 2 years for stage IIIB, and 1 year for stage IIIC patients and radiologic imaging beyond 3 years for stages IIIA and IIIB and 2 years for stage IIIC patients would be expected to detect few first systemic relapses. PMID:20479405

  16. Lymphadenectomy in locally advanced cervical cancer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stages IB2-IVA cervical cancer.

    Science.gov (United States)

    Frumovitz, Michael; Querleu, Denis; Gil-Moreno, Antonio; Morice, Philippe; Jhingran, Anuja; Munsell, Mark F; Macapinlac, Homer A; Leblanc, Eric; Martinez, Alejandra; Ramirez, Pedro T

    2014-01-01

    Radiation treatment planning for women with locally advanced cervical cancer (stages IB2-IVA) is often based on positron emission tomography (PET). PET, however, has poor sensitivity in detecting metastases in aortocaval nodes. We have initiated a study with the objective of determining whether pre-therapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/computed tomography (CT) radiologic staging alone followed by chemoradiation. This international, multicenter phase III trial will enroll 600 women with stages IB2-IVA cervical cancer and PET/CT findings showing fluorodeoxyglucose-avid pelvic nodes and fluorodeoxyglucose-negative para-aortic nodes. Eligible patients will be randomized to undergo either pelvic radiotherapy with chemotherapy (standard-of-care arm) or surgical staging via a minimally invasive extraperitoneal approach followed by tailored radiotherapy with chemotherapy (experimental arm). The primary end point is overall survival. Secondary end points are disease-free survival, short- and long-term morbidity with pre-therapeutic surgical staging, and determination of anatomic locations of metastatic para-aortic nodes in relationship to the inferior mesenteric artery. We believe this study will show that tailored chemoradiation after pre-therapeutic surgical staging improves survival as compared with chemoradiation based on PET/CT in women with stages IB2-IVA cervical cancer.

  17. Direct variable cost of the topical treatment of stages III and IV pressure injuries incurred in a public university hospital.

    Science.gov (United States)

    Chacon, Julieta M F; Blanes, Leila; Borba, Luis G; Rocha, Luis R M; Ferreira, Lydia M

    2017-05-01

    to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time. Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses. The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834). The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37. Copyright © 2016. Published by Elsevier Ltd.

  18. Epidermal growth factor receptor targeted therapy in stages III and IV head and neck cancer.

    Science.gov (United States)

    Cripps, C; Winquist, E; Devries, M C; Stys-Norman, D; Gilbert, R

    2010-06-01

    What are the benefits associated with the use of anti-epidermal growth factor receptor (anti-EGFR) therapies in squamous cell carcinoma of the head and neck (HNSCC)? Anti-EGFR therapies of interest included cetuximab, gefitinib, lapatinib, zalutumumab, erlotinib, and panitumumab. Head-and-neck cancer includes malignant tumours arising from a variety of sites in the upper aerodigestive tract. The most common histologic type is squamous cell carcinoma, and most common sites are the oral cavity, the oropharynx, the hypopharynx, and the larynx. Worldwide, HNSCC is the sixth most common neoplasm, and despite advances in therapy, long-term survival in HNSCC patients is poor. Primary surgery followed by chemoradiation, or primary chemoradiation, are the standard treatment options for patients with locally advanced (stages III-IVB) HNSCC; however, meta-analytic data indicate that the benefit of concurrent platinum-based chemotherapy disappears in patients over the age of 70 years. Cetuximab is a monoclonal antibody approved for use in combination with radiation in the treatment of patients with untreated locally advanced HNSCC and as monotherapy for patients with recurrent or metastatic (stage IVC) HNSCC who have progressed on platinum-based therapy. Given the interest in anti-EGFR agents in advanced HNSCC, the Head and Neck Cancer Disease Site Group (DSG) of Cancer Care Ontario's Program in Evidence-Based Care (PEBC) chose to systematically review the literature pertaining to this topic so as to develop evidence-based recommendations for treatment. Outcomes of interest included overall and progression-free survival, quality of life, tumour response rate and duration, and the toxicity associated with the use of anti-EGFR therapies. The medline, embase, and Cochrane Library databases, the American Society of Clinical Oncology online conference proceedings, the Canadian Medical Association InfoBase, and the National Guidelines Clearinghouse were systematically searched to

  19. Adjuvant systemic chemotherapy for stages II and III colon cancer after complete resection: a clinical practice guideline

    Science.gov (United States)

    Meyers, B.M.; Cosby, R.; Quereshy, F.; Jonker, D.

    2016-01-01

    Background Updated practice guidelines on adjuvant chemotherapy for completely resected colon cancer are lacking. In 2008, Cancer Care Ontario’s Program in Evidence-Based Care developed a guideline on adjuvant therapy for stages ii and iii colon cancer. With newer regimens being assessed in this patient population and older agents being either abandoned because of non-effectiveness or replaced by agents that are more efficacious, a full update of the original guideline was undertaken. Methods Literature searches (January 1987 to August 2015) of medline, embase, and the Cochrane Library were conducted; in addition, abstracts from the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress were reviewed (the latter for January 2007 to August 2015). A practice guideline was drafted that was then scrutinized by internal and external reviewers whose comments were incorporated into the final guideline. Results Twenty-six unique reports of eighteen randomized controlled trials and thirteen unique reports of twelve meta-analyses or pooled analyses were included in the evidence base. The 5 recommendations developed included 3 for stage ii colon cancer and 2 for stage iii colon cancer. Conclusions Patients with completely resected stage iii colon cancer should be offered adjuvant 5-fluorouracil (5fu)–based chemotherapy with or without oxaliplatin (based on definitive data for improvements in survival and disease-free survival). Patients with resected stage ii colon cancer without “high-risk” features should not receive adjuvant chemotherapy. For patients with “high-risk” features, 5fu-based chemotherapy with or without oxaliplatin should be offered, although no clinical trials have been conducted to conclusively demonstrate the same benefits seen in stage iii colon cancer. PMID:28050138

  20. Early postoperative 18F-FDG PET/CT in high-risk stage III colorectal cancer.

    Science.gov (United States)

    Wasserberg, Nir; Purim, Ofer; Bard, Vyacheslav; Kundel, Yulia; Gordon, Noa; Groshar, David; Goldberg, Natalia; Kashtan, Hanoch; Sulkes, Aaron; Brenner, Baruch

    2015-04-01

    PET/CT may contribute to staging modification in different phases of colorectal cancer (CRC) management. However, it is not routinely indicated for stage III CRC. This study sought to determine the role of early postoperative PET/CT in patients with high-risk stage III CRC. The tumor registry of a tertiary medical center was searched (2004-2011) for all patients with stage III CRC who underwent early postoperative PET/CT because of the presence of high-risk factors for systemic disease. Demographic and clinicopathological characteristics were compared between patients found/not found to have metastatic disease. The cohort included 91 patients with a median age of 67 years (range, 29-90 years). Pathological FDG uptake was observed in 38 (41%). Of these, 14 (15% of the whole cohort) were upstaged with alteration of their treatment protocol, 10 (11%) had local postoperative changes, and 14 (15%) had false-positive findings. The sensitivity and specificity of PET/CT for detecting metastatic disease were 100% and 69%, respectively. Elevated postoperative carcinoembryonic antigen and CA-19.9 levels correlated with a positive PET/CT (P = 0.05 and P = 0.03, respectively). The median follow-up time was 34 months (range, 4-85 months). The estimated 5-year survival rate was significantly higher in patients with a negative than a positive scan (70% vs 42%, P postoperative PET/CT may influence staging and treatment in 15% of selected patients with high-risk stage III CRC. Postoperative levels of carcinoembryonic antigen and CA-19.9 may serve as indications for PET/CT scanning in this setting. Prospective validation is warranted.

  1. Application of multi-stage Monte Carlo method for solving machining optimization problems

    Directory of Open Access Journals (Sweden)

    Miloš Madić

    2014-08-01

    Full Text Available Enhancing the overall machining performance implies optimization of machining processes, i.e. determination of optimal machining parameters combination. Optimization of machining processes is an active field of research where different optimization methods are being used to determine an optimal combination of different machining parameters. In this paper, multi-stage Monte Carlo (MC method was employed to determine optimal combinations of machining parameters for six machining processes, i.e. drilling, turning, turn-milling, abrasive waterjet machining, electrochemical discharge machining and electrochemical micromachining. Optimization solutions obtained by using multi-stage MC method were compared with the optimization solutions of past researchers obtained by using meta-heuristic optimization methods, e.g. genetic algorithm, simulated annealing algorithm, artificial bee colony algorithm and teaching learning based optimization algorithm. The obtained results prove the applicability and suitability of the multi-stage MC method for solving machining optimization problems with up to four independent variables. Specific features, merits and drawbacks of the MC method were also discussed.

  2. Optimizing ETL by a Two-level Data Staging Method

    DEFF Research Database (Denmark)

    Liu, Xiufeng; Iftikhar, Nadeem; Nielsen, Per Sieverts

    2016-01-01

    In data warehousing, the data from source systems are populated into a central data warehouse (DW) through extraction, transformation and loading (ETL). The standard ETL approach usually uses sequential jobs to process the data with dependencies, such as dimension and fact data. It is a non......-/late-arriving data, and fast-/slowly-changing data. The introduced additional staging area decouples loading process from data extraction and transformation, which improves ETL flexibility and minimizes intervention to the data warehouse. This paper evaluates the proposed method empirically, which shows...

  3. Compromised margins following mastectomy for stage I-III invasive breast cancer.

    Science.gov (United States)

    Yu, Jennifer; Al Mushawah, Fatema; Taylor, Marie E; Cyr, Amy E; Gillanders, William E; Aft, Rebecca L; Eberlein, Timothy J; Gao, Feng; Margenthaler, Julie A

    2012-09-01

    We investigated factors associated with positive margins following mastectomy and the impact on outcomes. We identified 240 patients with stage I-III invasive breast cancer who underwent mastectomy from 1999 to 2009. Data included patient and tumor characteristics, pathologic margin assessment, and outcomes. Margin positivity was defined as the presence of in situ or invasive malignancy at any margin. Descriptive statistics were used for data summary and were compared using χ(2). Of the 240 patients, 132 (55%) had a simple mastectomy with sentinel lymph node biopsy and 108 (45%) had a modified radical mastectomy. Overall, 21 patients (9%) had positive margins, including 12 (57%) with one positive margin, 3 (14%) with two positive margins, and 6 (29%) with three or more positive margins. The most commonly affected margin was the deep margin (48% of patients). Eight of the 21 patients (38%) received adjuvant chest wall irradiation. There were no differences between patients who had a positive margin and those who did not with respect to patient age, race, percentage of in situ component, tumor size, tumor grade, lymphovascular invasion, or immunostain profile (P > 0.05 for all). None of the patients with positive margins experienced a local recurrence. Positive margins following mastectomy occurred in nearly 10% of our patients. No specific patient or tumor characteristics predicted a risk for having a positive margin. Despite the finding that only approximately 40% of patients received adjuvant radiation in the setting of a positive margin, no local recurrences have been observed. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Surgical management and outcome analysis of stage III pediatric empyema thoracis

    Directory of Open Access Journals (Sweden)

    Menon Prema

    2010-01-01

    Full Text Available Aim: Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response to surgical intervention and follow-up. Materials and Methods: All the children who underwent open decortication for stage III empyema thoracis during the study period were included. Preoperative workup included hemogram, serum protein, chest radiographs and contrast-enhanced computed tomographic (CECT scan of the chest. Results: One hundred and twenty-five patients (81 males, 44 females (age 3 months-12 years, mean 4.9 years were operated during a 4.5-year period. Among them, two children underwent bilateral thoracotomies. Also, 81.6% patients were referred 3 weeks after the onset of disease (mean duration 9 weeks. Intercostal chest drainage (ICD had been inserted in (119 95% cases. Thickened pleura, multiloculated pus and lung involvement were invariably seen on CECT scan. Bronchopleural fistula was present in 10 patients and empyema necessitatis in 2. Decortication, removal of necrotic tissue and closure of air leaks was performed in all the patients. Necrotizing pneumonia was seen in (35 27.5% cases. Mean duration of postoperative ICD was 7 days. Follow-up ranged from 3 months to 4 years (mean 12 months. There was no mortality. Six patients had proven tuberculosis. Conclusions: The duration of the disease had a direct relationship with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery. Only 18% presented within the early period of the disease. Meticulous open surgical debridement gives gratifying results. The status of the lung at the end of surgery is a major prognostic factor.

  5. Roles of chemoradio therapy for stage III or IV advanced head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Tachikawa, Takuya; Iwai, Hiroshi; Tsuji, Hiroyuki; Minamino, Masayuki; Yamamoto, Takashi; Yukawa, Hisaya; Inoue, Toshiya; Yamashita, Toshio [Kansai Medical School, Moriguchi, Osaka (Japan)

    2002-03-01

    The effectiveness of chemoradio therapy (CRT), which was performed on 31 patients with advanced head and neck cancers of stage III or IV at Kansai Medical University between September 1999 and December 2000, was examined. The CRT consisted of continuous infusion of 5FU (500 mg/m{sup 2}) for 120 hours, prior to drip infusion of CDDP (50 mg/m{sup 2}) for 2 hours and conventional radiotherapy (2 Gy/day, 5 days/w). The 31 patients with these cancers were divided into two groups; a non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group underwent CRT (60-70 Gy of total radiation dose and two courses of chemotherapy) without surgery. The patients in the operative group received surgical treatment followed by CRT (40 Gy of total radiation dose and one course of chemotherapy). The results of CRT indicated 87.1% of the response rate (RR), and 29.0% of the complete response rate (CR) in the group. The CR rate was lower than in other reports. However, the combination of CRT and the subsequent operation indicated a disease-free survival rate of 61.3% and reduction of the recurrence rate to 17.4%. Eight of 9 patients of CR after CRT without surgery revealed NED. On the other hand, the results indicated that all 10 patients of PR after CRT showed tumor residue, 9 of 10 patients of PR showed NED after additional surgery. Therefore, it is likely that the patients of CR do not need the additional surgery, however, the patients of PR are strongly recommended the surgery to improve the local control rate as well as survival rate. Although adverse reactions of CRT on patients included mucositis, leucopenia, thrombopenia and dermatitis, the symptoms ranged within grade 3. (author)

  6. Establishment of a biomarker model for predicting bone metastasis in resected stage III non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Zhou Zhen

    2012-04-01

    Full Text Available Abstract Background This study was designed to establish a biomarker risk model for predicting bone metastasis in stage III non-small cell lung cancer (NSCLC. Methods The model consists of 105 cases of stage III NSCLC, who were treated and followed up. The patients were divided into bone metastasis group (n = 45 and non-bone metastasis group (other visceral metastasis and those without recurrence (n = 60. Tissue microarrays were constructed for immunohistochemical study of 10 molecular markers associated with bone metastasis, based on which a model was established via logistic regression analysis for predicting the risk of bone metastases. The model was prospectively validated in another 40 patients with stage III NSCLC. Results The molecular model for predicting bone metastasis was logit (P = − 2.538 + 2.808 CXCR4 +1.629 BSP +0.846 OPN-2.939 BMP4. ROC test showed that when P ≥ 0.408, the sensitivity was up to 71% and specificity of 70%. Model validation in the 40 cases in clinical trial (NCT 01124253 demonstrated that the prediction sensitivity of the model was 85.7%, specificity 66.7%, Kappa: 0.618, with a high degree of consistency. Conclusion The molecular model combining CXCR4, BSP, OPN and BMP4 could help predict the risk of bone metastasis in stage IIIa and IIIb resected NSCLC.

  7. Improved lymph node harvest from resected colon cancer specimens did not cause upstaging from TNM stage II to III.

    Science.gov (United States)

    Storli, Kristian; Søndenaa, Karl; Furnes, Bjørg; Leh, Sabine; Nesvik, Idunn; Bru, Tore; Gudlaugsson, Einar; Bukholm, Ida; Norheim-Andersen, Solveig; Eide, Geir

    2011-12-01

    The number of lymph nodes retrieved and examined from a resected colon cancer specimen may be crucial for correct staging. We examined if efforts to increase the lymph node harvest to more than 12 lymph nodes per specimen would upstage some patients from TNM stage II to III. Three hospitals compared results from 2000 with those of 2007 in 421 resected patients with stage II and III colon cancer. Hospital A endeavored to improve the surgical procedure while the pathologists enhanced the quality of lymph node sampling. Hospital B did not make any marked changes, while hospital C introduced the GEWF lymph node solvent (glacial acetic acid, ethanol, distilled water, and formaldehyde) in their pathology method. In 2000, 12 or more lymph nodes were harvested in 39.6, 45.0, and 21.1% of the specimens from the three hospitals, while the figures for 2007 were 85.7, 42.0, and 90.3%, respectively. The significant increase in lymph node harvest in two of the hospitals in 2007 compared to 2000 (p TNM stage II to III.

  8. Power Frequency Oscillation Suppression Using Two-Stage Optimized Fuzzy Logic Controller for Multigeneration System

    Directory of Open Access Journals (Sweden)

    Y. K. Bhateshvar

    2016-01-01

    Full Text Available This paper attempts to develop a linearized model of automatic generation control (AGC for an interconnected two-area reheat type thermal power system in deregulated environment. A comparison between genetic algorithm optimized PID controller (GA-PID, particle swarm optimized PID controller (PSO-PID, and proposed two-stage based PSO optimized fuzzy logic controller (TSO-FLC is presented. The proposed fuzzy based controller is optimized at two stages: one is rule base optimization and other is scaling factor and gain factor optimization. This shows the best dynamic response following a step load change with different cases of bilateral contracts in deregulated environment. In addition, performance of proposed TSO-FLC is also examined for ±30% changes in system parameters with different type of contractual demands between control areas and compared with GA-PID and PSO-PID. MATLAB/Simulink® is used for all simulations.

  9. Role of Postoperative Radiotherapy for Stage I/II/III Thymic Tumor - Results of the ChART Retrospective Database

    Directory of Open Access Journals (Sweden)

    Qianwen LIU

    2016-07-01

    Full Text Available Background and objective Postoperative radiotherapy (PORT for thymic tumor is still controversial. The object of the study is to evaluate the role of PORT for stage I/II/III thymic tumor. Methods The database of Chinese Alliance of Research for Thymomas (ChART was retrieved for patients with stage I/II/III thymic tumor who underwent surgical therapy without neoajuvant therapy between 1994 and 2012. Univariate and multivariate survival analyses were performed. Cox proportional hazard model was used to determine the hazard ratio for death. Results 1,546 stage I/II/III patients were identified from ChART database. Among these patients, 649 (41.98% underwent PORT. PORT was associated with gender, histologic type (World Health Organization, WHO, surgical extent, complete resection, Masaoka stage and adjuvant chemotherapy. The 5-yr and 10-yr overall survival (OS rates and disease-free survival (DFS rate for patients underwent surgery followed by PORT were 90% and 80%, 81% and 63%, comparing with 96% and 95%, 92% and 90% for patients underwent surgery alone (P=0.001, P<0.001 respectively. In univariate analysis, age, histologic type (WHO, Masaoka stage, completeness of resection, and PORT were associated with OS. Multivariable analysis showed that histologic type (WHO(P=0.001, Masaoka stage (P=0.029 and completeness of resection (P=0.003 were independently prognostic factors of OS. In univariate analysis, gender, myasthenia gravis, histologic type (WHO, Masaoka stage, surgical approach, PORT and completeness of resection were associated with DFS. Multivariable analysis showed that histologic type (WHO (P<0.001, Masaoka stage (P=0.005 and completeness of resection (P=0.006 were independently prognostic factors of DFS. Subgroup analysis showed that patients with incomplete resection underwent PORT achieved the better OS and DFS (P=0.010, 0.017, respectively. However, patients with complete resection underwent PORT had the worse OS and DFS (P<0.001, P<0

  10. Optimizing a three-stage Compton camera for measuring prompt gamma rays emitted during proton radiotherapy.

    Science.gov (United States)

    Peterson, S W; Robertson, D; Polf, J

    2010-11-21

    In this work, we investigate the use of a three-stage Compton camera to measure secondary prompt gamma rays emitted from patients treated with proton beam radiotherapy. The purpose of this study was (1) to develop an optimal three-stage Compton camera specifically designed to measure prompt gamma rays emitted from tissue and (2) to determine the feasibility of using this optimized Compton camera design to measure and image prompt gamma rays emitted during proton beam irradiation. The three-stage Compton camera was modeled in Geant4 as three high-purity germanium detector stages arranged in parallel-plane geometry. Initially, an isotropic gamma source ranging from 0 to 15 MeV was used to determine lateral width and thickness of the detector stages that provided the optimal detection efficiency. Then, the gamma source was replaced by a proton beam irradiating a tissue phantom to calculate the overall efficiency of the optimized camera for detecting emitted prompt gammas. The overall calculated efficiencies varied from ∼ 10(-6) to 10(-3) prompt gammas detected per proton incident on the tissue phantom for several variations of the optimal camera design studied. Based on the overall efficiency results, we believe it feasible that a three-stage Compton camera could detect a sufficient number of prompt gammas to allow measurement and imaging of prompt gamma emission during proton radiotherapy.

  11. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

    OpenAIRE

    Salem, Mohamed A.; Hamza, Hesham M.; Sayd, Heba A.; Ali, Amany M.

    2011-01-01

    Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient include...

  12. The Dynamics of an Impulsive Predator-Prey System with Stage Structure and Holling Type III Functional Response

    Directory of Open Access Journals (Sweden)

    Zhixiang Ju

    2015-01-01

    Full Text Available Based on the biological resource management of natural resources, a stage-structured predator-prey model with Holling type III functional response, birth pulse, and impulsive harvesting at different moments is proposed in this paper. By applying comparison theorem and some analysis techniques, the global attractivity of predator-extinction periodic solution and the permanence of this system are studied. At last, examples and numerical simulations are given to verify the validity of the main results.

  13. Impact of stage III-IV endometriosis on recipients of sibling oocytes: matched case-control study.

    Science.gov (United States)

    Díaz, I; Navarro, J; Blasco, L; Simón, C; Pellicer, A; Remohí, J

    2000-07-01

    To evaluate the impact of severe endometriosis on IVF-ET outcome in women receiving oocytes from the-same donor. A matched case-control study. Oocyte donation program at the Instituto Valenciano de Infertilidad. Fifty-eight recipients were included in a matched case-control study of IVF-ET in our oocyte donation program. Twenty-five patients were diagnosed by laparoscopy with stage III-IV endometriosis (group I), while the remaining 33 were free of the disease (group II). On the day of retrieval, oocytes from a single donor were donated to recipients from both groups. Some of the donors supplied oocytes for more than 2 patients. Recipients received steroid replacement therapy for endometrial preparation. Ovarian stimulation and oocyte retrieval in donors. Uterine embryo transfer (ET) in recipients after appropriate exogenous hormone replacement therapy (HRT). Pregnancy, implantation, miscarriage, and live birth rates. The number of oocytes donated and fertilized, as well as the number of available and transferred embryos, was not statistically different between the two groups. Pregnancy, implantation, and miscarriage rates were not affected by stage III-IV endometriosis when compared with the control group. The live birth rate was 28.0% in the group with endometriosis and 27.2% in the control group. These results show that implantation is not affected by stage III-IV endometriosis. Given the contemporary methods of endometrial preparation for transfer of embryos derived from donor oocytes, any potential negative effect of severe endometriosis on the uterine environment is undetectable.

  14. The relation of presenting symptoms with staging, grading, and postoperative 3-year mortality in patients with stage I-III non-metastatic colon cancer.

    Science.gov (United States)

    Bedir, Osman; Kızıltaş, Şafak; Köstek, Osman; Özkanlı, Şeyma

    2016-05-01

    To evaluate the association of presenting symptoms with staging, grading, and postoperative 3-year mortality in patients with colon cancer. A total of 132 patients-with a mean (standard deviation; SD) age of 63.0 (10.0) years and of whom 56.0% were males-with non-metastatic stage I-III colon cancer were included. Symptoms prior to diagnosis were evaluated with respect to tumor localization, tumor node metastasis (TNM) stage, histological grade, and postoperative 3-year mortality. Constipation and abdominal pain were the two most common symptoms appearing first (29.5% and 16.7%, respectively) and remained most predominant (25.0% and 20.0%, respectively) up to diagnosis. The frequency of admission symptoms significantly differed with respect to tumor location, TNM stage and histological grade. The postoperative 3-year survival rate was 61.4%. Multivariate logistic regression revealed that melena and rectal bleeding increased the likelihood of 3-year mortality by 13.6-fold (p=0.001) and 4.08-fold (p=0.011), respectively. Our findings revealed differences in presenting symptom profiles with respect to the time of manifestation and predominance as well as to the TNM stage, histological grade, and tumor location. Given that melena and rectal bleeding increased the 3-year mortality risk by 13.6-fold and 4.08-fold, respectively, our findings indicate the association of admission symptoms with outcome among patients with colon cancer.

  15. Optimism, Symptom Distress, Illness Appraisal, and Coping in Patients With Advanced-Stage Cancer Diagnoses Undergoing Chemotherapy Treatment.

    Science.gov (United States)

    Sumpio, Catherine; Jeon, Sangchoon; Northouse, Laurel L; Knobf, M Tish

    2017-05-01

    To explore the relationships between optimism, self-efficacy, symptom distress, treatment complexity, illness appraisal, coping, and mood disturbance in patients with advanced-stage cancer.
. Cross-sectional study.
. Smilow Cancer Hospital at Yale New Haven in Connecticut, an outpatient comprehensive cancer center.
. A convenience sample of 121 adult patients with stages III-IV cancer undergoing active chemotherapy.
. Participants completed common self-report questionnaires to measure variables. Treatment hours and visits were calculated from data retrieved from medical record review. Mediation and path analysis were conducted to identify direct and indirect pathways from the significant antecedent variables to mood disturbance.
. Dispositional optimism, self-efficacy, social support, treatment complexity, symptom distress, illness appraisal, coping, and mood disturbance.
. Greater optimism and self-efficacy were associated with less negative illness appraisal, less avoidant coping, and decreased mood disturbance. Conversely, greater symptom distress was associated with greater negative illness appraisal, greater avoidant coping, and greater mood disturbance. In the final model, optimism and symptom distress had direct and indirect effects on mood disturbance. Indirect effects were partially mediated by illness appraisal.
. Mood disturbance resulted from an interaction of disease stressors, personal resources, and cognitive appraisal of illness. Avoidant coping was associated with greater disturbed mood, but neither avoidant nor active coping had a significant effect on mood in the multivariate model. 
. Illness appraisal, coping style, and symptom distress are important targets for intervention. Optimism is a beneficial trait and should be included, along with coping style, in comprehensive nursing assessments of patients with cancer.

  16. A pilot study (SWOG S0429 of weekly cetuximab and chest radiotherapy for poor-risk stage III non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Yuhchyau eChen

    2013-08-01

    Full Text Available Purpose: Stage III non-small cell lung cancer (NSCLC patients with poor performance status (PS or co-morbidities are often not candidates for standard chemoradiotherapy (chemoRT due to poor tolerance to treatments. A pilot study for poor-risk stage III NSCLC patients was conducted combining cetuximab, a chimeric monoclonal antibody targeting epidermal growth factor receptor (EGFR, with chest radiation (RT. Methods: Stage III NSCLC patients with Zubrod PS 2, or Zubrod PS 0-1 with poor pulmonary function and co-morbidities prohibiting chemoRT were eligible. A loading dose of cetuximab (400 mg/m2 was delivered week one, followed by weekly cetuximab (250 mg/m2/RT to 64.5 Gy in 1.8 Gy daily fractions, and maintenance weekly cetuximab (250 mg/m2 for two years or until disease progression. H-score for EGFR protein expression was conducted in available tumors.Results: Twenty-four patients were enrolled. Twenty two were assessed for outcome and toxicity. Median survival was 14 months and median progression-free survival was 8 months. The response rate was 47% and disease control rate was 74%. Toxicity assessment revealed 22.7% overall ≥ Grade 3 non-hematologic toxicities. Grade 3 esophagitis was observed in one patient (5%. The skin reactions were mostly Grade 1 or 2 except two of 22 (9% had Grade 3 acne and 1/22 (5% had Grade 3 radiation skin burn. Grade 3-4 hypomagnesemia was seen in 4 (18% patients. One patient (5% had elevated cardiac troponin and pulmonary emboli. H-score did not reveal prognostic significance. An initially planned second cohort of the study did not commence due to slow accrual, which would have added weekly docetaxel to cetuximab/RT after completion of the first cohort of patients. Conclusions: Concurrent weekly cetuximab/chest RT followed by maintenance cetuximab for poor-risk stage III NSCLC was well tolerated. Further studies with larger sample sizes will be useful to establish the optimal therapeutic ratio of this regimen.

  17. Software/hardware optimization for attenuation-based microtomography using SR at PETRA III (Conference Presentation)

    Science.gov (United States)

    Beckmann, Felix

    2016-10-01

    The Helmholtz-Zentrum Geesthacht, Germany, is operating the user experiments for microtomography at the beamlines P05 and P07 using synchrotron radiation produced in the storage ring PETRA III at DESY, Hamburg, Germany. In recent years the software pipeline, sample changing hardware for performing high throughput experiments were developed. In this talk the current status of the beamlines will be given. Furthermore, optimisation and automatisation of scanning techniques, will be presented. These are required to scan samples which are larger than the field of view defined by the X-ray beam. The integration into an optimized reconstruction pipeline will be shown.

  18. A prospective, randomized, multisite clinical evaluation of a transparent absorbent acrylic dressing and a hydrocolloid dressing in the management of Stage II and shallow Stage III pressure ulcers.

    Science.gov (United States)

    Brown-Etris, Marie; Milne, Catherine; Orsted, Heather; Gates, Judy L; Netsch, Debra; Punchello, Marion; Couture, Nancy; Albert, Martine; Attrell, Edie; Freyberg, Julie

    2008-04-01

    To compare clinical performance of a transparent absorbent acrylic dressing (3M Tegaderm Absorbent Clear Acrylic Dressing ]TAAD[; 3M Company, St Paul, MN) and a hydrocolloid dressing (HD ]DuoDERM CGF, ConvaTec, ER Squibb & Sons, Princeton, NJ[) in the management of Stage II and shallow Stage III pressure ulcers. Prospective, open-label, randomized, comparative, multisite clinical evaluation. Patients were followed up for a maximum of 56 days or until their ulcer healed. At weekly intervals, investigators conducted wound assessments and dressing performance evaluations. Wound care clinics, home care, and long-term care. Thirty-five patients received the TAAD, and 37 received the HD. Dressing performance assessments, patient comfort, dressing wear time, and wound healing were measured. The majority of investigator assessments favored the TAAD. Considerations given included the ability to center dressings over the ulcer (P = .005), ability to assess the ulcer before (P < .001) and after (P < .001) absorption, barrier properties (P = .039), patient comfort during removal (P < .001), overall patient comfort (P = .048), conformability before (P = .026) and after (P = .001) absorption, ease of removal (P < .001), nonadherence to wound bed (P < .001), residue in the wound (P = .002), residue on periwound skin (P < .001), and odor after absorption (P = .016). Overall satisfaction favored the TAAD (P < .001), and a high value was placed on its transparent feature (P < .001). Mean (SD) wear time for the TAAD was 5.7 (2.55) days compared with 4.7 (2.29) days for the HD (P = .086). This 1-day difference in wear time was clinically noticeable by the investigators (P = .035). Wound closure for the 2 dressing groups was nearly identical (P = .9627). Performance results favored the TAAD over the HD as standard treatment for Stage II and shallow Stage III pressure ulcers.

  19. Optimization of an industrial retrofitted heat exchanger network, using a stage-wise model

    Energy Technology Data Exchange (ETDEWEB)

    Kovac Kralj, Anita [Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova 17, Maribor 2000 (Slovenia)

    2010-12-15

    The heat exchanger network (HEN) can be optimized using the stage-wise model of superstructure representation, as proposed by Yee and Grossmann. This model can be easily solved regarding both trivial problems, and serious and complex new industrial design plants. In this paper, a stage-wise model for new designs is extended for retrofits by using a stage-wise model for a retrofitted HEN. This method using a stage-wise model is very general; it can be used in new designs as well as during existing process integration. The methodology of the stage-wise model for retrofitted HEN can be used to solve HENs easily and well enough, over a short time, and simultaneously. A mathematical model of stage-wise for retrofit HEN can include additional equations and limitations for retrofits. This model was tested by using a retrofitted methanol process generating an additional profit of 189,200 EUR/a. (author)

  20. Building energy optimization in the early design stages: A simplified method

    DEFF Research Database (Denmark)

    Negendahl, Kristoffer; Nielsen, Toke Rammer

    2015-01-01

    This paper presents the application of multi-objective genetic algorithms for holistic building design that considers multiple criteria; building energy use, capital cost, daylight distribution and thermal indoor environment. The optimization focus is related to building envelope parameters....... It is concluded, that quasi-steady-state methods implemented as part of integrated dynamic models are fast and flexible enough to support building energy-, indoor environment- and cost-optimization the early design stages........ To obtain relevant feedback from multi-objective optimizations in early design stages, evaluation speed is a key concern. The paper presents a fast evaluation method fit for the early design stages. It uses a combination of two different quasi-steady-state methods for energy and indoor environment...

  1. A nonlinear programming approach for optimizing two-stage lifting vehicle ascent to orbit

    Science.gov (United States)

    Kamm, J. L.; Johnson, I. L.

    1973-01-01

    An optimal atmospheric flight branched trajectory-shaping capability is presented based on the Davidon-Fletcher-Powell variable metric parameter optimization technique. Gradient information is generated using finite difference methods. A typical atmospheric flight branched optimization problem is analyzed which requires the determination of 31 parameters. This parameter set includes the three-dimensional description of vehicle attitude control angles for three branches of flight: first-stage ascent, second-stage ascent, and first-stage flyback. The important inflight inequality contraints required to maintain the integrity of the vehicles are considered. Some of the numerical methods employed are discussed, along with several new auxiliary techniques developed to improve the compatibility of the numerical gradient and iterator.

  2. Intratumoral Metabolic Heterogeneity for Prediction of Disease Progression After Concurrent Chemoradiotherapy in Patients with Inoperable Stage III Non-Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Saeryung; Song, Hochun; Byun, Byung Hyun and others

    2014-03-15

    We evaluated the value of variable {sup 18}F-FDG PET/CT parameters for the prediction of disease progression after concurrent chemoradiotherapy (CCRT) in patients with inoperable stage III non-small-cell lung cancer (NSCLC). One hundred sixteen pretreatment FDG PET/CT scans of inoperable stage III NSCLC were retrospectively reviewed (stage IIIA: 51; stage IIIB: 65). The volume of interest was automatically drawn for each primary lung tumor, and PET parameters were assessed as follows: maximum standardized uptake value (SUV{sub max}), metabolic tumor volume (MTV) using the boundaries presenting SUV intensity exceeding 3.0, and the area under the curve of the cumulative SUV-volume histograms (AUC-CSH), which is known to reflect the tumor heterogeneity. Progression-free survival (PFS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared with each PET and clinical parameters by univariate and multivariate survival analysis.In the ROC analysis, the optimal cutoff values of SUV{sub max}, MTV (cm{sup 3}), and AUC-CSH for prediction of PFS were determined as 21.5, 27.7, and 4,800, respectively. In univariate analysis, PFS was statistically significantly reduced in those with AUC-CSH<4,800 (p =0.004). In multivariate analysis, AUC-CSH and SUV{sub max} were statistically significant independent prognostic factors (HR 3.35, 95 % CI 1.79.6.28, p <0.001; HR 0.25, 95% CI 0.09.0.70, p =0.008, respectively). Multivariate analysis showed that AUC-CSH was the most significant independent prognostic factor for LRFS and DMFS (HR 3.27, 95 % CI 1.54.6.94, p =0.002; HR 2.79, 95 % CI 1.42.5.50, p =0.003). Intratumoral metabolic heterogeneity of primary lung tumor in {sup 18}F-FDG PET/CT can predict disease progression after CCRT in inoperable stage III NSCLC.

  3. Oncological safety of immediate rectus abdominis myocutaneous breast reconstruction in patients with locally advanced disease (stage IIb and III

    Directory of Open Access Journals (Sweden)

    Mushtaq Mir

    2013-01-01

    Full Text Available Background: The management of locally advanced (Stage IIb and III breast cancer is challenging. It often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate rectus abdominis musculo-cutaneous (TRAM/VRAM flap in 60 patients treated for Stage IIb and III breast cancer. Materials and Methods: Data were collected prospectively on 60 patients diagnosed with Stage IIb (32 patients and Stage III (28 patients breast cancer between May 2008 and May 2012. All patients had mastectomy and immediate rectus abdominis myocutaneous reconstruction (TRAM in 40 patients and VRAM in 20 patients. All patients received primary systemic therapy, and all patients received postoperative radiotherapy to the operative site. Results: Mean age was 40.13 (range 28-53 years, mean hospital stay was 8.86 days and mean follow-up for the group was 28 months. Neither of them developed local disease recurrence in the operative site till the last follow-up. Eight (13.3% patients had some delay in chemo-radiation therapy due to flap-related complications. Flap-related complications were present in eight patients (partial flap failure in four and superficial skin necrosis in four. There was no adverse effect of chemo-radiation therapy on reconstructed breast. Conclusion: Immediate TRAM/VRAM breast reconstruction for locally advanced breast cancer is not associated with a significant delay in adjuvant therapy or an increased risk of local relapse. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of locally advanced breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

  4. The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study

    Directory of Open Access Journals (Sweden)

    Kye Bong-Hyeon

    2012-05-01

    Full Text Available Abstract Background This retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. Methods From April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve. Results When groups I and II, and groups II and III were compared, overall survival (OS did not differ significantly whereas disease-free survival (DFS in groups I and III were statistically higher than in group II (P = 0.042 and P = 0.050. In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P = 0.2036 and DFS ( P = 0.2356 than open surgery. Also, the incidence of local recurrence in group III (2.6% was significantly lower than that in groups II (7.4% and I (12.1% ( P = 0.013. Conclusions Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.

  5. 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...

  6. 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 a...... 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...

  7. Optimization of magnetic field system for glass spherical tokamak GLAST-III

    Science.gov (United States)

    Ahmad, Zahoor; Ahmad, S.; Naveed, M. A.; Deeba, F.; Aqib Javeed, M.; Batool, S.; Hussain, S.; Vorobyov, G. M.

    2017-04-01

    GLAST-III (Glass Spherical Tokamak) is a spherical tokamak with aspect ratio A = 2. The mapping of its magnetic system is performed to optimize the GLAST-III tokamak for plasma initiation using a Hall probe. Magnetic field from toroidal coils shows 1/R dependence which is typical with spherical tokamaks. Toroidal field (TF) coils can produce 875 Gauss field, an essential requirement for electron cyclotron resonance assisted discharge. The central solenoid (CS) of GLAST-III is an air core solenoid and requires compensation coils to reduce unnecessary magnetic flux inside the vessel region. The vertical component of magnetic field from the CS in the vacuum vessel region is reduced to 1.15 Gauss kA-1 with the help of a differential loop. The CS of GLAST can produce flux change up to 68 mVs. Theoretical and experimental results are compared for the current waveform of TF coils using a combination of fast and slow capacitor banks. Also the magnetic field produced by poloidal field (PF) coils is compared with theoretically predicted values. It is found that calculated results are in good agreement with experimental measurement. Consequently magnetic field measurements are validated. A tokamak discharge with 2 kA plasma current and pulse length 1 ms is successfully produced using different sets of coils.

  8. Outcome of patients with stage II and III nonseminomatous germ cell tumors: Results of a single center

    Directory of Open Access Journals (Sweden)

    Ataergin S

    2007-01-01

    Full Text Available Background: The prognostic factors in nonseminomatous germ cell tumors have been mainly derived from the analysis of stage I tumors. Aims: The aim of this study was to evaluate some prognostic factors and the outcome of patients with stage II and III nonseminomatous germ cell tumors according to risk groups treated between 1993 and 2002. Settings and Design: Patients were retrospectively classified as good, intermediate and poor risk groups according to International Germ Cell Cancer Consensus Group. Materials and Methods: Biopsy specimens of 58 patients with stage II and III nonseminomatous germ cell tumors were analyzed by means of tumor histopathology, primary localization site of the tumor, relapse sites, initial serum tumor marker levels, the presence of persistent serum tumor marker elevation and the patients′ outcome. Statistical Analysis :0 Kruskall Wallis test and Mann-Whitney U test were used to determine the differences between the groups. Kaplan-Meier method was used for survival analysis and log rank test was used to compare the survival probabilities of groups. Cox proportional hazard analysis was used to determine the prognostic factors in univariate and multivariate analysis. Results: Five-year overall and disease-free survival rates were calculated as 85% and 75% in stage II; 44% and 29% in stage III cases, respectively. Fifty-seven percent of patients were classified in good risk, 9% in intermediate risk and 27% in poor risk groups. Five-year overall survival rates were 97%, 75% and 7% ( P < 0.001 and disease-free survival rates were 83%, 34% and 7% ( P < 0.001 in good, intermediate and poor risk groups, respectively. Analysis of the prognostic factors revealed that the localization site of the primary tumor ( P < 0.001, the initial stage of disease ( P < 0.001, the initial serum AFP level (p: 0.001, the initial β -HCG level (p: 0.0048, the presence of yolk sac and choriocarcinoma components in tumor (p: 0.003 and p: 0

  9. Dose-Response Relationship between Radiation Dose and Loco-regional Control in Patients with Stage II-III Esophageal Cancer Treated with Definitive Chemoradiotherapy.

    Science.gov (United States)

    Kim, Hyun Ju; Suh, Yang-Gun; Lee, Yong Chan; Lee, Sang Kil; Shin, Sung Kwan; Cho, Byung Chul; Lee, Chang Geol

    2017-07-01

    The correlation between radiation dose and loco-regional control (LRC) was evaluated in patients with stage II-III esophageal cancer treated with definitive concurrent chemoradiotherapy (CRT). Medical records of 236 stage II-III esophageal cancer patients treated with definitive CRT at Yonsei Cancer Center between 1994 and 2013 were retrospectively reviewed. Among these, 120 received a radiation dose of 60 Gy) is associated with increased LRC, PFS, and OS in patients with stage II-III esophageal cancer treated with definitive CRT.

  10. Mindfulness Meditation or Survivorship Education in Improving Behavioral Symptoms in Younger Stage 0-III Breast Cancer Survivors (Pathways to Wellness)

    Science.gov (United States)

    2017-03-21

    Cancer Survivor; Early-Stage Breast Carcinoma; Stage 0 Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  11. Body mass index and body surface area and their associations with outcomes in stage II and III colon cancer.

    Science.gov (United States)

    Alipour, Sina; Kennecke, Hagen F; Woods, Ryan; Lim, Howard J; Speers, Caroline; Brown, Carl J; Gill, Sharlene; Renouf, Daniel J; Cheung, Winson Y

    2013-06-01

    Our study aims were to measure the associations between body mass index (BMI) and body surface area (BSA) with outcomes for stage II and III colon cancer and to evaluate if the effect of obesity is modified by disease stage and receipt of adjuvant therapy. Using a prospective cohort of stage II and III colon cancer patients who were referred between 2001 and 2005, we compared 3-year relapse-free survival (3-year RFS), 5-year cancer-specific survival (5-year CSS), and 5-year overall survival (5-year OS) rates among different BMI and BSA categories. Cox proportional-hazards models were constructed to explore the relationships between different body compositions and outcomes while adjusting for confounders. Postoperative height and weight were used to classify 913 patients as normal weight (n = 424, BMI obese (n = 170, BMI >30 kg/m(2)). Using Mosteller formula, 684 subjects had normal BSA (≤ 2.0 m(2)) and 229 had high BSA (>2.0 m(2)). Obese subjects experienced similar 3-year RFS (61.9 vs. 66.5 vs. 63.6 %, p = 0.51), 5-year CSS (65.6 vs. 72.4 vs. 68.0 %, p = 0.22), and 5-year OS (60.8 vs. 64.0 vs. 62.2 %, p = 0.69) when compared to overweight subjects and those with normal BMIs, respectively. Likewise, individuals with high BSA had similar outcomes as those with normal BSA (66.2 vs. 63.6 %, p = 0.64 for 3-year RFS, 70.3 vs. 68.6 %, p = 0.62 for 5-year CSS, and 64.5 vs. 61.9 %, p = 0.48 for 5-year OS). In Cox models, advanced age, male gender, stage III disease, and poor performance status correlated with inferior RFS, CSS, and OS, but BMI and BSA did not. Obesity as measured by either BMI or BSA was not associated with differences in outcomes in stage II and III colon cancer.

  12. An Optimal Portfolio and Capital Management Strategy for Basel III Compliant Commercial Banks

    Directory of Open Access Journals (Sweden)

    Grant E. Muller

    2014-01-01

    Full Text Available We model a Basel III compliant commercial bank that operates in a financial market consisting of a treasury security, a marketable security, and a loan and we regard the interest rate in the market as being stochastic. We find the investment strategy that maximizes an expected utility of the bank’s asset portfolio at a future date. This entails obtaining formulas for the optimal amounts of bank capital invested in different assets. Based on the optimal investment strategy, we derive a model for the Capital Adequacy Ratio (CAR, which the Basel Committee on Banking Supervision (BCBS introduced as a measure against banks’ susceptibility to failure. Furthermore, we consider the optimal investment strategy subject to a constant CAR at the minimum prescribed level. We derive a formula for the bank’s asset portfolio at constant (minimum CAR value and present numerical simulations on different scenarios. Under the optimal investment strategy, the CAR is above the minimum prescribed level. The value of the asset portfolio is improved if the CAR is at its (constant minimum value.

  13. Optimal Harvesting and Stability for a Predator-prey System with Stage Structure

    Institute of Scientific and Technical Information of China (English)

    Xin-yu Song; Lan-sun Chen

    2002-01-01

    The dynamics of a predator-prey system, where prey population has two stages, an immature stage and a mature stage with harvesting, the growth of predator population is of Lotka-Volterra nature, are modelled by a system of retarded functional differential equations. We obtain conditions for global asymptotic stability of three nonnegative equilibria and a threshold of harvesting for the mature prey population. The effect of delay on the population at positive equilibrium and the optimal harvesting of the mature prey population are also considered.

  14. Intensity-modulated radiation therapy followed by GDP chemotherapy for newly diagnosed stage I/II extranodal natural killer/T cell lymphoma, nasal type.

    Science.gov (United States)

    Huang, Yu; Yang, Jianliang; Liu, Peng; Zhou, Shengyu; Gui, Lin; He, Xiaohui; Qin, Yan; Zhang, Changgong; Yang, Sheng; Xing, Puyuan; Sun, Yan; Shi, Yuankai

    2017-09-01

    Extranodal natural killer (NK)/T cell lymphoma, nasal type (ENKTL) is an aggressive non-Hodgkin lymphoma and the majority of ENKTL cases are diagnosed at the localized stage. Radiotherapy in combination with chemotherapy has been used for localized ENKTL, but the optimal combination treatment modality and the best first-line chemotherapy regimen have not been defined. In this retrospective study, 44 patients with newly diagnosed, stages I/II ENKTL were enrolled and received intensity-modulated radiation therapy (IMRT, 50-56 Gy) followed by GDP (gemcitabine, dexamethasone, and cisplatin) chemotherapy. The median number of chemotherapy cycles per patient was 4 (range, 2-6 cycles). At the end of treatment, the overall response rate was 95% (42/44), including 39 patients (89%) who attained complete response. Two patients developed systemic progression after IMRT. With a median follow-up of 37.5 months, the 3-year overall survival (OS) rate and progression-free survival (PFS) rate were 85% (95% CI, 74 to 96%) and 77% (95% CI, 64 to 91%), respectively. Locoregional and systemic failure rates for this treatment were 9% (4/44) and 14% (6/44), respectively. The most common grades 3 to 4 adverse events included leukopenia (37%), neutropenia (34%), and mucositis (25%). No treatment-related deaths were observed. This study suggested high efficacy and low toxicity of IMRT followed by GDP regimen chemotherapy for newly diagnosed stage I/II ENKTL patients. These results require further investigation in prospective trials.

  15. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

    Directory of Open Access Journals (Sweden)

    Mohamed A. Salem

    2011-03-01

    Full Text Available Abdominal Non-Hodgkin lymphomas (NHL are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI, Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15. Thirty patients (86% presented with abdominal pain, 23 patients (66% presented with abdominal mass and distention, 13 patients (34% presented with weight loss, and intestinal obstruction occurred in six patients (17%. The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively. Burkitt's lymphoma was the most common histological type in 29 patients (83%. Ten (28.5% stage II (group A and 25 (71.5% stage III (group B. Complete resections were performed in 10 (28.5%, debulking in 6 (17% and imaging guided biopsy in 19 (54%. A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months. The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

  16. Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience.

    Science.gov (United States)

    Ali, Amany M; Sayd, Heba A; Hamza, Hesham M; Salem, Mohamed A

    2011-03-29

    Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15). Thirty patients (86%) presented with abdominal pain, 23 patients (66%) presented with abdominal mass and distention, 13 patients (34%) presented with weight loss, and intestinal obstruction occurred in six patients (17%). The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively). Burkitt's lymphoma was the most common histological type in 29 patients (83%). Ten (28.5%) stage II (group A) and 25 (71.5%) stage III (group B). Complete resections were performed in 10 (28.5%), debulking in 6 (17%) and imaging guided biopsy in 19 (54%). A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months). The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

  17. An Enhanced Preventive Maintenance Optimization Model Based on a Three-Stage Failure Process

    Directory of Open Access Journals (Sweden)

    Ruifeng Yang

    2015-01-01

    Full Text Available Nuclear power plants are highly complex systems and the issues related to their safety are of primary importance. Probabilistic safety assessment is regarded as the most widespread methodology for studying the safety of nuclear power plants. As maintenance is one of the most important factors for affecting the reliability and safety, an enhanced preventive maintenance optimization model based on a three-stage failure process is proposed. Preventive maintenance is still a dominant maintenance policy due to its easy implementation. In order to correspond to the three-color scheme commonly used in practice, the lifetime of system before failure is divided into three stages, namely, normal, minor defective, and severe defective stages. When the minor defective stage is identified, two measures are considered for comparison: one is that halving the inspection interval only when the minor defective stage is identified at the first time; the other one is that if only identifying the minor defective stage, the subsequent inspection interval is halved. Maintenance is implemented immediately once the severe defective stage is identified. Minimizing the expected cost per unit time is our objective function to optimize the inspection interval. Finally, a numerical example is presented to illustrate the effectiveness of the proposed models.

  18. Influence of {sup 18}F-FDG PET/CT on therapy management in patients with stage III/IV malignant melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Schuele, Susann-Cathrin; Nikolaou, Konstantin; Pfannenberg, Christina [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Eigentler, Thomas Kurt; Garbe, Claus [Eberhard-Karls-University Tuebingen, Skin Cancer Programme, Department of Dermatology, Tuebingen (Germany); Fougere, Christian la [Eberhard-Karls-University Tuebingen, Department of Nuclear Medicine, Tuebingen (Germany)

    2016-03-15

    To evaluate the influence of {sup 18}F-FDG PET/CT in comparison to CT alone on treatment decisions in patients with advanced melanoma and to analyse the 5-year survival data in comparison to literature data. Therapy management in 64 consecutive patients (primary staging n = 52; surveillance n = 12) with stage III/IV melanoma who underwent {sup 18}F-FDG PET/CT between 2004 and 2005 in our department was retrospectively analysed. Treatment decisions were made by two dermatooncologists for each patient twice, first based on the CT results and then based on the PET/CT results. Therapy changes based on the PET/CT results were classified as ''major'' (e.g. change from metastasectomy to systemic therapy) or ''minor'' (e.g. change from first to second line chemotherapy). The 5-year survival data of different patient cohorts were calculated. In the 52 patients in the primary staging group, the results of {sup 18}F-FDG PET/CT led to therapy change in 59 % and a major therapy change in 52 %. {sup 18}F-FDG PET/CT led to the avoidance of futile operations in 13 patients with suspicious lesions on CT that were deemed nontumorous on PET/CT. In the 12 patients in the surveillance group, the results of {sup 18}F-FDG PET/CT led to therapy change in 33 % and a major change in 17 %. The 5-year survival rates were 30 % in the entire cohort, 34 % in the primary staging group, and 17 % in the surveillance group. A significant overall survival benefit was observed in patients in whom {sup 18}F-FDG PET/CT excluded metastases or in whom metastases could be completely removed compared with patients who were not eligible for surgery (41 % vs. 10 %). Primary staging of patients with stage III/IV melanoma should be performed with {sup 18}F-FDG PET/CT, leading to higher diagnostic accuracy and enabling individualized therapeutic management, especially optimal patient selection for metastasectomy. This strategy may extend long-term survival even in patients

  19. Dose-Escalated Robotic SBRT for Stage I-II Prostate Cancer

    OpenAIRE

    Robert eMeier

    2015-01-01

    Abstract: Stereotactic body radiotherapy (SBRT) is the precise external delivery of very high-dose radiotherapy to targets in the body, with treatment completed in one to five fractions. SBRT should be an ideal approach for organ-confined prostate cancer because (I) dose escalation should yield improved rates of cancer control; (II) the unique radiobiology of prostate cancer favors hypofractionation and (III) the conformal nature of SBRT minimizes high-dose radiation delivery to immediately a...

  20. Mitigation of effects of extreme drought during stage III of peach fruit development by summer pruning and fruit thinning.

    Science.gov (United States)

    Lopez, Gerardo; Mata, Mercè; Arbones, Amadeu; Solans, Josep R; Girona, Joan; Marsal, Jordi

    2006-04-01

    A water deficit during stage III of fruit growth was established with the aim of determining if it is possible to achieve an improvement in tree water status by summer pruning and fruit thinning. The experiment was set up as a randomized block split-plot design across trials (irrigation) where pruning was assigned to the main plot and fruit thinning to the sub-plots. The irrigation treatments were (1) standard full irrigation (FI), and (2) suppression of irrigation during stage III of fruit growth until leaves visibly withered (LWI); the pruning treatments were (1) experimental summer pruning (EP), and (2) standard summer pruning (CP); and three fruit thinning intensities were applied to facilitate analysis of the effects of the treatments in relation to fruit load. Changes in amount of light intercepted and in tree stem water potential (Psi stem) were evaluated. The EP treatment reduced the amount of light intercepted by the tree. In the FI treatment, there was a significant reduction in fruit growth measured as both water accumulation and dry mass accumulation. Under FI conditions, reductions in fruit load as a result of EP were not accompanied by a significant improvement in Psi stem. In the LWI treatment, EP produced a significant improvement of 0.17 MPa in Psi stem, but there was no improvement in fruit growth compared with CP trees. A reduction in fruit load from 350 (commercial load) to 150 per tree significantly improved Psi stem by 0.3 MPa at the end of stage III of fruit growth. These results indicate that improvements in water status in response to pruning may be insufficient to promote fruit growth if the pruned trees are unable to provide an adequate supply of assimilates to the developing fruits.

  1. [Postoperative Adjuvant Chemotherapy for Stage III Colon Cancer--Drug Selection, Tolerability, and Safety in Clinical Practice].

    Science.gov (United States)

    Okada, Kazutake; Sadahiro, Sotaro; Saito, Gota; Tanaka, Akira; Suzuki, Toshiyuki

    2016-05-01

    In the National Comprehensive Cancer Network (NCCN) guidelines, oxaliplatin (L-OHP)-based chemotherapeutic regimens, including 5-fluorouracil, Leucovorin (LV), and L-OHP (FOLFOX); capecitabine and L-OHP (CapeOX); and 5-fluorouracil, folinic acid, and L-OHP (FLOX) are designated as category 1 recommendations for postoperative adjuvant chemotherapy in Stage III colon cancer, followed by capecitabine and 5-fluorouracil plus LV as category 2A recommendations. We studied the selection of drugs for adjuvant chemotherapy and assessed the tolerability and safety of CapeOX and tegafur-uracil (UFT) plus LV (UFT/LV) in patients with Stage III colon cancer. The study group included 104 consecutive patients with Stage III colon cancer who underwent curative surgery. One patient changed hospitals immediately after surgery. Among the remaining 103 patients, 82 (80%) received adjuvant chemotherapy and 21 (20%) did not. CapeOX was administered to 32 patients (31%), UFT/LV to 49 patients (48%), and capecitabine to 1 patient (1%). In 59 patients, the treatment choice was determined according to the patient's preference; 32 patients (54%) selected CapeOX, 26 (44%) selected UFT/LV, and 1 (2%) selected no chemotherapy. The treatment completion rate was 80% for CapeOX and 84% for UFT/LV. Among patients who completed chemotherapy, dose reduction and drug withdrawal were not required in 22% of patients who received CapeOX and 80% of those who received UFT/LV. Neither CapeOX nor UFT/LV was associated with any serious adverse events. The tolerability and safety of CapeOX and UFT/LV were acceptable. However, CapeOX dose had to be carefully adjusted according to each patient's condition.

  2. Efficacy of Adjuvant 5-Fluorouracil Therapy for Patients with EMAST-Positive Stage II/III Colorectal Cancer.

    Directory of Open Access Journals (Sweden)

    Yasushi Hamaya

    Full Text Available Elevated Microsatellite Alterations at Selected Tetranucleotide repeats (EMAST is a genetic signature found in up to 60% of colorectal cancers (CRCs that is caused by somatic dysfunction of the DNA mismatch repair (MMR protein hMSH3. We have previously shown in vitro that recognition of 5-fluorouracil (5-FU within DNA and subsequent cytotoxicity was most effective when both hMutSα (hMSH2-hMSH6 heterodimer and hMutSβ (hMSH2-hMSH3 heterodimer MMR complexes were present, compared to hMutSα > hMutSβ alone. We tested if patients with EMAST CRCs (hMutSβ defective had diminished response to adjuvant 5-FU chemotherapy, paralleling in vitro findings. We analyzed 230 patients with stage II/III sporadic colorectal cancers for which we had 5-FU treatment and survival data. Archival DNA was analyzed for EMAST (>2 of 5 markers mutated among UT5037, D8S321, D9S242, D20S82, D20S85 tetranucleotide loci. Kaplan-Meier survival curves were generated and multivariate analysis was used to determine contribution to risk. We identified 102 (44% EMAST cancers. Ninety-four patients (41% received adjuvant 5-FU chemotherapy, and median follow-up for all patients was 51 months. Patients with EMAST CRCs demonstrated improved survival with adjuvant 5FU to the same extent as patients with non-EMAST CRCs (P<0.05. We observed no difference in survival between patients with stage II/III EMAST and non-EMAST cancers (P = 0.36. There is improved survival for stage II/III CRC patients after adjuvant 5-FU-based chemotherapy regardless of EMAST status. The loss of contribution of hMSH3 for 5-FU cytotoxicity may not adversely affect patient outcome, contrasting patients whose tumors completely lack DNA MMR function (MSI-H.

  3. Prognostic factors of melanoma patients with satellite or in-transit metastasis at the time of stage III diagnosis.

    Directory of Open Access Journals (Sweden)

    Benjamin Weide

    Full Text Available BACKGROUND: Prognosis of patients with loco-regional skin metastases has not been analyzed in detail and the presence or absence of concurrent lymph node metastasis represents the only established prognostic factor thus far. Most studies were limited to patients already presenting with skin lesions at the time of initial diagnosis. We aimed to analyze the impact of a broad penal of prognostic factors in patients with skin metastases at the time of first metastatic spread, including patients with synchronous lesions already present at the time of initial diagnosis, stage I/II patients with loco-regional recurrence and patients initially presenting with skin metastasis but unknown primary melanoma. PATIENTS AND METHODS: We investigated disease-specific survival of 380 patients treated at our department between 1996 and 2010 using Kaplan Meier survival probabilities and Cox-proportional hazard analysis. RESULTS: Five-year survival probability was 60.1% for patients with skin metastases only and 36.3% for those with synchronous nodal metastases. The number of involved nodes and a tumor thickness of at least 3 mm had independent negative impact on prognosis. A strong relationship was identified between the risk of death and the number of involved nodes. Neither ulceration nor the timing of the first occurrence of metastases as either in stage I/II patients, at the time of excision of the primary melanoma or initially in patients with unknown primary tumor, had additional effects on survival. CONCLUSION: Lymph node involvement was confirmed as the most important prognostic factor for melanoma patients with loco-regional skin metastasis including those with unknown primary tumor and stage I/II patients with skin recurrence. Consideration of the tumor thickness and of the number of involved lymph nodes instead of the exclusive differentiation into presence vs. absence of nodal disease may allow a more accurate prediction of prognosis for patients with

  4. A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Harris, Jeremy P. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Murphy, James D. [Department of Radiation Medicine and Applied Science, University of California– San Diego, Moores Cancer Center, La Jolla, California (United States); Hanlon, Alexandra L. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (United States); Le, Quynh-Thu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Loo, Billy W., E-mail: BWLoo@Stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Diehn, Maximilian, E-mail: diehn@Stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California (United States)

    2014-03-15

    Purpose: Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC. Methods and Materials: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT. Using Cox regression and propensity score matching, we compared survival and toxicities of these treatments. Results: The proportion of patients treated with IMRT increased from 2% in 2002 to 25% in 2009, and the use of 2D-RT decreased from 32% to 3%. In univariate analysis, IMRT was associated with improved overall survival (OS) (hazard ratio [HR] 0.90, P=.02) and cancer-specific survival (CSS) (HR 0.89, P=.02). After controlling for confounders, IMRT was associated with similar OS (HR 0.94, P=.23) and CSS (HR 0.94, P=.28) compared with 3D-CRT. Both techniques had superior OS compared with 2D-RT. IMRT was associated with similar toxicity risks on multivariate analysis compared with 3D-CRT. Propensity score matched model results were similar to those from adjusted models. Conclusions: In this population-based analysis, IMRT for stage III NSCLC was associated with similar OS and CSS and maintained similar toxicity risks compared with 3D-CRT.

  5. Efficacy of Adjuvant 5-Fluorouracil Therapy for Patients with EMAST-Positive Stage II/III Colorectal Cancer

    Science.gov (United States)

    Hamaya, Yasushi; Guarinos, Carla; Tseng-Rogenski, Stephanie S.; Iwaizumi, Moriya; Das, Ritabrata; Jover, Rodrigo; Castells, Antoni; Llor, Xavier; Andreu, Montserrat; Carethers, John M.

    2015-01-01

    Elevated Microsatellite Alterations at Selected Tetranucleotide repeats (EMAST) is a genetic signature found in up to 60% of colorectal cancers (CRCs) that is caused by somatic dysfunction of the DNA mismatch repair (MMR) protein hMSH3. We have previously shown in vitro that recognition of 5-fluorouracil (5-FU) within DNA and subsequent cytotoxicity was most effective when both hMutSα (hMSH2-hMSH6 heterodimer) and hMutSβ (hMSH2-hMSH3 heterodimer) MMR complexes were present, compared to hMutSα > hMutSβ alone. We tested if patients with EMAST CRCs (hMutSβ defective) had diminished response to adjuvant 5-FU chemotherapy, paralleling in vitro findings. We analyzed 230 patients with stage II/III sporadic colorectal cancers for which we had 5-FU treatment and survival data. Archival DNA was analyzed for EMAST (>2 of 5 markers mutated among UT5037, D8S321, D9S242, D20S82, D20S85 tetranucleotide loci). Kaplan-Meier survival curves were generated and multivariate analysis was used to determine contribution to risk. We identified 102 (44%) EMAST cancers. Ninety-four patients (41%) received adjuvant 5-FU chemotherapy, and median follow-up for all patients was 51 months. Patients with EMAST CRCs demonstrated improved survival with adjuvant 5FU to the same extent as patients with non-EMAST CRCs (P<0.05). We observed no difference in survival between patients with stage II/III EMAST and non-EMAST cancers (P = 0.36). There is improved survival for stage II/III CRC patients after adjuvant 5-FU-based chemotherapy regardless of EMAST status. The loss of contribution of hMSH3 for 5-FU cytotoxicity may not adversely affect patient outcome, contrasting patients whose tumors completely lack DNA MMR function (MSI-H). PMID:25996601

  6. Postmastectomy radiation in supraclavicular and internal mammary regions of patients with breast cancer of stage II/III

    Institute of Scientific and Technical Information of China (English)

    MEI Xin; GUO Xiao-mao; ZHANG Zhen; CHEN Jia-yi

    2009-01-01

    @@ Adjuvant radiotherapy plays a vital role in the treatment of breast cancer, but irradiated area was not standardized. The ipsilateral chest wall and supraclavicular regions with or without internal mammary lymph nodes were reported in patients receiving postmastectomy radiotherapy.1,2 In our study, 133 consecutive patients with breast cancer of stage II/III who had received postmastectomy radiotherapy of supraclavicular and internal mammary regions at Cancer Hospital of Fudan University were analyzed for their survival and locoregional control as well as their relative prognostic predicator.

  7. Multidisciplinary Design Optimization of a Morphing Wingtip Concept with Multiple Morphing Stages at Cruise

    Science.gov (United States)

    Leahy, Michael

    Morphing an aircraft wingtip can provide substantial performance improvement. Most civil transport aircraft are optimized for range but for other flight conditions such as take-off and climb they are used as constraints. These constraints could potentially reduce the performance of an aircraft at cruise. By altering the shape of the wingtip, we can force the load distribution to adapt to the required flight condition to improve performance. Using a Variable Geometry Truss Mechanism (VGTM) concept to morph the wingtip of an aircraft with a Multidisciplinary Design Optimization (MDO) framework, the current work will attempt to find an optimal wing and wingtip shape to minimize fuel consumption for multiple morphing stages during cruise. This optimization routine was conducted with a Particle Swarm Optimization (PSO) algorithm using different fidelity tools to analyze the aerodynamic and structural disciplines.

  8. multi-stage and multi-response process optimization in taguchi method

    African Journals Online (AJOL)

    Shewit`

    new model with its optimization procedure is proven to ensure the .... stage will enable the total system to operate. Process. X1, X2 ... developed and implemented ISO 9000 Quality. Management System and got certified. Among other things, it ...

  9. Development and optimization of a two-stage gasifier for heat and power production

    Science.gov (United States)

    Kosov, V. V.; Zaichenko, V. M.

    2016-11-01

    The major methods of biomass thermal conversion are combustion in excess oxygen, gasification in reduced oxygen, and pyrolysis in the absence of oxygen. The end products of these methods are heat, gas, liquid and solid fuels. From the point of view of energy production, none of these methods can be considered optimal. A two-stage thermal conversion of biomass based on pyrolysis as the first stage and pyrolysis products cracking as the second stage can be considered the optimal method for energy production that allows obtaining synthesis gas consisting of hydrogen and carbon monoxide and not containing liquid or solid particles. On the base of the two stage cracking technology, there was designed an experimental power plant of electric power up to 50 kW. The power plant consists of a thermal conversion module and a gas engine power generator adapted for operation on syngas. Purposes of the work were determination of an optimal operation temperature of the thermal conversion module and an optimal mass ratio of processed biomass and charcoal in cracking chamber of the thermal conversion module. Experiments on the pyrolysis products cracking at various temperatures show that the optimum cracking temperature is equal to 1000 °C. From the results of measuring the volume of gas produced in different mass ratios of charcoal and wood biomass processed, it follows that the maximum volume of the gas in the range of the mass ratio equal to 0.5-0.6.

  10. Positron emission tomography/computed tomography for optimized colon cancer staging and follow up

    DEFF Research Database (Denmark)

    Engelmann, Bodil Elisabeth; Loft, Annika; Kjær, Andreas;

    2014-01-01

    OBJECTIVES: Optimal management of colon cancer (CC) requires detailed assessment of extent of disease. This study prospectively investigates the diagnostic accuracy of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (PET/CT) for staging and detection of recurrence...

  11. Functional Magnetic Resonance Imaging in Assessing Affect Reactivity and Regulation in Patients With Stage 0-III Breast Cancer

    Science.gov (United States)

    2017-02-27

    Healthy Subject; Stage 0 Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  12. Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?

    NARCIS (Netherlands)

    Hendriks, L.E.; Brouns, A.J.; Amini, M.; Uyterlinde, W.; Wijsman, R.; Bussink, J.; Biesma, B.; Oei, S.B.; Stigt, J.A.; Bootsma, G.P.; Belderbos, J.S.; Ruysscher, D.K. De; Heuvel, M.M. Van den; Dingemans, A.C.

    2016-01-01

    OBJECTIVES: Symptomatic brain metastases (BM) occur frequently after chemoradiotherapy (CRT) for stage III NSCLC. Aim of the current study was to determine whether the specific chemotherapy used in a CRT regimen influences BM development. MATERIALS AND METHODS: Retrospective multicenter study

  13. Recurrences and toxicity after adjuvant vaginal brachytherapy in Stage I-II endometrial cancer: A monoinstitutional experience.

    Science.gov (United States)

    Perrucci, Elisabetta; Lancellotta, Valentina; Bini, Vittorio; Zucchetti, Claudio; Mariucci, Cristina; Montesi, Giampaolo; Saccia, Stefano; Palumbo, Isabella; Aristei, Cynthia

    2016-01-01

    To evaluate the incidences of vaginal recurrence and toxicity after vaginal brachytherapy in Stage I-II endometrial cancer. Between 2003 and 2012, 150 high-intermediate-risk Stage I and 7 Stage II patients, median age 64 years, underwent surgery, with or without lymphadenectomy, and 3D brachytherapy: 7 Gy, at 5 mm depth from applicator surface, for 3-week fractions. The effects of age, grading, number of excised lymph nodes and pathologic stage on loco-regional relapse (LRR), metastases, and tumor-related death were investigated. Vaginal toxicity was evaluated during followup visits. At 83 months of median followup, 144 patients were disease free, 2 in relapse, 7 deceased from disease, and 4 from other causes. One vaginal (0.6%), five nodal (3.2%), three pelvic over the vaginal cuff (1.9%), and one distant recurrences were seen (0.6%). The 5-year probability of LRR-free, distant metastasis-free and cause-specific survivals for all patients were 93.6% (95% confidence interval [CI]: 88.1-96.7), 97.8% (95% CI: 93.2-99.3), and 96.5% (95% CI: 93.5-99.5) and for Stage I 95.7% (95% CI: 92.2-9.1), 99.3% (95% CI: 98.0-100), and 97.7% (95% CI: 95.2-100), respectively. At multivariate analysis, Stage II disease and more than 12 lymph nodes sampled were associated with LRR (hazard ratio [HR]: 3.88; 95% CI: 1.390-10.878; p = 0.010 and HR: 6.952; 95% CI: 1.591-30.385; p = 0.010) and Stage II with metastasis and tumor-related death (HR: 23.057; 95% CI: 2.296-231.485; p = 0.008 and HR: 4.324; 95% CI: 1.223-15.290; p = 0.023). Vaginal acute and chronic toxicity was 16% and 55.4%, respectively, all only Grades 1-2. For high-to-intermediate-risk Stage I endometrial cancer, 3D vaginal brachytherapy achieved good local control and low toxicity. In Stage II, patients brachytherapy could be administered after complete surgical staging. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  14. Combined modality treatment for stage I-II non-Hodgkin's lymphomas: CVP versus BACOP chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bajetta, E.; Valagussa, P.; Bonadonna, G.; Lattuada, A.; Buzzoni, R.; Rilke, F.; Banfi, A.

    1988-07-01

    This paper reports the 5-year results of a prospective randomized study beginning in 1976 on 177 evaluable patients with pathologic Stage I-IE and II-IIE non-Hodgkin's lymphomas with diffuse histology according to the Rappaport classification. Treatment consisted of either CVP or BACOP chemotherapy (3 cycles) followed by regional radiotherapy (40 to 50 Gy) and further cycles of either combination. In both arms, complete remission at the end of combined treatment was high (CVP 93%, BACOP 98%) regardless of age, stage or bulky disease. At 5 years, the comparative freedom from first progression was 62% for CVP vs 78% for BACOP (p = 0.02), respectively. Clinically relevant differences favoring BACOP chemotherapy were essentially documented in patients with large cell lymphomas (International Working Formulation), those with Stage II having more than three involved anatomical sites, bulky disease and age over 60 years. Recurrence within radiation fields was documented in only 5% of complete responders. Combined treatment was, in general, well tolerated particularly when BACOP was used. In only 2 patients given CVP post radiation cutaneous fibrosis was documented. Second solid tumors were detected in 4 patients. One patient started on CVP died because of brain stem necrosis after 45 Gy. We conclude that in Stage I-II patients with nodal and extranodal diffuse non-Hodgkin's lymphomas, particularly large cell lymphomas, combined modality approach with primary Adriamycin and bleomycin containing regimen, such as BACOP, followed by adjuvant radiotherapy offers high chances of cure with minimal toxicity.

  15. The Formation of Population III Stars in Gas Accretion Stage: Effects of Magnetic Fields

    CERN Document Server

    Machida, Masahiro N

    2013-01-01

    The formation of Population III stars is investigated using resistive magnetohydrodynamic simulations. Starting from a magnetized primordial prestellar cloud, we calculate the cloud evolution several hundreds of years after first protostar formation, resolving the protostellar radius. When the natal minihalo field strength is weaker than B \\lesssim 10^-13 (n/1 cm^-3)^-2/3 G (n is the hydrogen number density), magnetic effects can be ignored. In this case, fragmentation occurs frequently and a stellar cluster forms, in which stellar mergers and mass exchange between protostars contribute to the mass growth of these protostars. During the early gas accretion phase, the most massive protostar remains near the cloud centre, whereas some of the less massive protostars are ejected. The magnetic field significantly affects Population III star formation when B_amb \\gtrsim 10^-12 (n/1 cm^-3)^-2/3 G. In this case, because the angular momentum around the protostar is effectively transferred by both magnetic braking and ...

  16. Improved five year survival after combined radiotherapy-chemotherapy for Stage I-II non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Monfardini, S.; Banfi, A.; Bonadonna, G.; Rilke, F.; Milani, F.; Valagussa, P.; Lattuada, A.

    1980-02-01

    In order to improve the prognosis of patients with localized non-Hodgkin's lymphomas (NHL) who are treated with radiotherapy (RT), a prospective controlled study utilizing a combined modality approach was carried out in patients with pathologic Stage I-II NHL. After treatment with regional RT, patients in complete remission were randomized to receive either no further therapy or 6 cycles of cyclophosphamide, vincristine and prednisolone (CVP). At 5 years from completion of irradiation, the relapse-free survival was 46.3% after RT and 72.1% after RT plus CVP (P=0.005). The corresponding findings for the overall survival calculated from the beginning of irradiation were 55.8 and 82.8% respectively (P=0.03). The favorable effects of adjuvant chemotherapy on relapse-free survival were statistically significant only in the subgroup with diffuse histology. In patients who relapsed after RT alone, the salvage therapy failed to induce a high incidence of second durable remission. Adjuvant chemotherapy is indicated to improve the curve rate in pathologic stage I-II NHL with diffuse histology when regional RT is utilized.

  17. ColoFinder: a prognostic 9-gene signature improves prognosis for 871 stage II and III colorectal cancer patients

    Directory of Open Access Journals (Sweden)

    Mingguang Shi

    2016-03-01

    Full Text Available Colorectal cancer (CRC is a heterogeneous disease with a high mortality rate and is still lacking an effective treatment. Our goal is to develop a robust prognosis model for predicting the prognosis in CRC patients. In this study, 871 stage II and III CRC samples were collected from six gene expression profilings. ColoFinder was developed using a 9-gene signature based Random Survival Forest (RSF prognosis model. The 9-gene signature recurrence score was derived with a 5-fold cross validation to test the association with relapse-free survival, and the value of AUC was gained with 0.87 in GSE39582(95% CI [0.83–0.91]. The low-risk group had a significantly better relapse-free survival (HR, 14.8; 95% CI [8.17–26.8]; P < 0.001 than the high-risk group. We also found that the 9-gene signature recurrence score contributed more information about recurrence than standard clinical and pathological variables in univariate and multivariate Cox analyses when applied to GSE17536(p = 0.03 and p = 0.01 respectively. Furthermore, ColoFinder improved the predictive ability and better stratified the risk subgroups when applied to CRC gene expression datasets GSE14333, GSE17537, GSE12945and GSE24551. In summary, ColoFinder significantly improves the risk assessment in stage II and III CRC patients. The 9-gene prognostic classifier informs patient prognosis and treatment response.

  18. Energy Optimization Modeling of Geothermal Power Plant (Case Study: Darajat Geothermal Field Unit III)

    Science.gov (United States)

    Sinaga, R. H. M.; Darmanto, P. S.

    2016-09-01

    Darajat unit III geothermal power plant is developed by PT. Chevron Geothermal Indonesia (CGI). The plant capacity is 121 MW and load 110%. The greatest utilization power is consumed by Hot Well Pump (HWP) and Cooling Tower Fan (CTF). Reducing the utility power can be attempted by utilizing the wet bulb temperature fluctuation. In this study, a modelling process is developed by using Engineering Equation Solver (EES) software version 9.430.The possibility of energy saving is indicated by Specific Steam Consumption (SSC) net in relation to wet bulb temperature fluctuation from 9°C up to 20.5°C. Result shows that the existing daily operation reaches its optimum condition. The installation of Variable Frequency Drive (VFD) could be applied to optimize both utility power of HWP and CTF. The highest gain is obtained by VFD HWP installation as much as 0.80% when wet bulb temperature 18.5 °C.

  19. Gamma-Secretase/Notch Signalling Pathway Inhibitor RO4929097, Paclitaxel, and Carboplatin Before Surgery in Treating Patients With Stage II or Stage III Triple-Negative Breast Cancer

    Science.gov (United States)

    2015-09-03

    Estrogen Receptor Negative; HER2/Neu Negative; Progesterone Receptor Negative; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Triple-Negative Breast Carcinoma

  20. Design and optimization of a single stage centrifugal compressor for a solar dish-Brayton system

    Science.gov (United States)

    Wang, Yongsheng; Wang, Kai; Tong, Zhiting; Lin, Feng; Nie, Chaoqun; Engeda, Abraham

    2013-10-01

    According to the requirements of a solar dish-Brayton system, a centrifugal compressor stage with a minimum total pressure ratio of 5, an adiabatic efficiency above 75% and a surge margin more than 12% needs to be designed. A single stage, which consists of impeller, radial vaned diffuser, 90° crossover and two rows of axial stators, was chosen to satisfy this system. To achieve the stage performance, an impeller with a 6:1 total pressure ratio and an adiabatic efficiency of 90% was designed and its preliminary geometry came from an in-house one-dimensional program. Radial vaned diffuser was applied downstream of the impeller. Two rows of axial stators after 90° crossover were added to guide the flow into axial direction. Since jet-wake flow, shockwave and boundary layer separation coexisted in the impeller-diffuser region, optimization on the radius ratio of radial diffuser vane inlet to impeller exit, diffuser vane inlet blade angle and number of diffuser vanes was carried out at design point. Finally, an optimized centrifugal compressor stage fulfilled the high expectations and presented proper performance. Numerical simulation showed that at design point the stage adiabatic efficiency was 79.93% and the total pressure ratio was 5.6. The surge margin was 15%. The performance map including 80%, 90% and 100% design speed was also presented.

  1. FDG PET evaluation of early axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Rousseau, Caroline [Comprehensive Cancer Center Rene Gauducheau, IRCNA, Nuclear Medicine Department, Saint Herblain (France); Nantes University, INSERM UMR 892, Cancer Research Center CRCNA, Nantes (France); Centre Rene Gauducheau, Service de Medecine Nucleaire, Saint Herblain Cedex (France); Devillers, Anne [Eugene Marquis Cancer Center, Nuclear Medicine Department, Rennes (France); Campone, Mario [Comprehensive Cancer Center Rene Gauducheau, Medical Oncology Department, Saint Herblain (France); Campion, Loic [Comprehensive Cancer Center Rene Gauducheau, Statistic Department, Saint Herblain (France); Ferrer, Ludovic [Comprehensive Cancer Center Rene Gauducheau, Medical Physics Department, Saint Herblain (France); Sagan, Christine [University Hospital, Pathology Department, Nantes (France); Ricaud, Myriam [Comprehensive Cancer Center Rene Gauducheau, Radiology Department, Saint Herblain (France); Bridji, Boumediene [Comprehensive Cancer Center Rene Gauducheau, IRCNA, Nuclear Medicine Department, Saint Herblain (France); Kraeber-Bodere, Francoise [Comprehensive Cancer Center Rene Gauducheau, IRCNA, Nuclear Medicine Department, Saint Herblain (France); Nantes University, INSERM UMR 892, Cancer Research Center CRCNA, Nantes (France)

    2011-06-15

    Regional axillary lymph node status has remained the single most independent variable to predict prognosis both in terms of disease recurrence and survival. This study aimed to prospectively assess sequential [{sup 18}F]fluorodeoxyglucose (FDG) positron emission tomography (PET) findings as early predictors of axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients. Images were acquired with a PET/CT scanner in 52 patients after administration of FDG (5 MBq/kg) at baseline and after the first, second, third and sixth course of chemotherapy before surgery. Clinical examination and ultrasound (US) were used to assess the size of axillary nodes. Decrease in the standardized uptake value (SUV) with PET corrected or not for partial volume effects was compared to the pathological response. The sensitivity, specificity and accuracy of axillary node staging was higher with PET (75, 87 and 80%) than with US (50, 83 and 65%), and even more so when PET images were corrected for partial volume effects (86, 83 and 84%). While FDG uptake did not vary much in non-responders, as confirmed by histopathological analysis, it markedly decreased to baseline levels in responders (p < 10{sup -5}). Fifty per cent of baseline SUV was considered the best cutoff value to distinguish responders from non-responders. The sensitivity, specificity, negative predictive value and accuracy of FDG PET after one course of chemotherapy were, respectively, 96, 75, 95 and 84%. The pathological status of regional axillary lymph nodes in stage II and III breast cancer patients could be accurately predicted after one course of neoadjuvant chemotherapy based on FDG PET images. (orig.)

  2. Clinical practice guidelines for the care and treatment of breast cancer: 15. Treatment for women with stage III or locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shenkier, T.; Weir, L.; Levine, M.; Olivotto, I.; Whelan, T.; Reyno, L. [Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer, Ontario (Canada)

    2004-03-01

    Locally advanced breast cancer (LABC) occurs relatively infrequently, but it poses a significant clinical challenge. LABC refers to large breast tumours (> 5 cm in diameter) associated with either skin or chest-wall involvement or with fixed (matted) axillary lymph nodes or with disease spread to the ipsilateral internal mammary or supraclavicular nodes. Inflammatory breast cancer, which manifests as a red swollen breast, is considered a type of LABC. The Tumour- Node-Metastasis (TNM) system is used to classify breast cancer into stages (Table 1). According to this system, LABC is stage III. During the last 60 years, the management of LABC has evolved considerably. Initially, patients with LABC were treated with radical mastectomy. Based on the disappointing results of surgery and radiotherapy in patients with LABC, and the early promising results of adjuvant systemic therapy in women with axillary node-positive breast cancer, systemic therapy was subsequently incorporated along with surgery and radiotherapy into the management of patients with LABC, termed 'combined modality therapy.' Even with such combined modality therapy, the long-term survival rate is approximately 50% among patients with LABC. The focus of this guideline is to determine the optimal therapeutic approach for patients who present with LABC. (author)

  3. A deterministic algorithm for generating optimal three-stage layouts of homogenous strip pieces

    Directory of Open Access Journals (Sweden)

    Jun Ji

    2014-10-01

    Full Text Available Purpose: The time required by the algorithms for general layouts to solve the large-scale two-dimensional cutting problems may become unaffordable. So this paper presents an exact algorithm to solve above problems.Design/methodology/approach: The algorithm uses the dynamic programming algorithm to generate the optimal homogenous strips, solves the knapsack problem to determine the optimal layout of the homogenous strip in the composite strip and the composite strip in the segment, and optimally selects the enumerated segments to compose the three-stage layout.Findings: The algorithm not only meets the shearing and punching process need, but also achieves good results within reasonable time.Originality/value: The algorithm is tested through 43 large-scale benchmark problems. The number of optimal solutions is 39 for this paper’s algorithm; the rate of the rest 4 problem’s solution value and the optimal solution is 99.9%, and the average consumed time is only 2.18 seconds. This paper’s pattern is used to simplify the cutting process. Compared with the classic three-stage, the two-segment and the T-shape algorithms, the solutions of the algorithm are better than that of the above three algorithms. Experimental results show that the algorithm to solve a large-scale piece packing quickly and efficiency.

  4. Learning representations for object classification using multi-stage optimal component analysis.

    Science.gov (United States)

    Wu, Yiming; Liu, Xiuwen; Mio, Washington

    2008-01-01

    Learning data representations is a fundamental challenge in modeling neural processes and plays an important role in applications such as object recognition. Optimal component analysis (OCA) formulates the problem in the framework of optimization on a Grassmann manifold and a stochastic gradient method is used to estimate the optimal basis. OCA has been successfully applied to image classification problems arising in a variety of contexts. However, as the search space is typically very high dimensional, OCA optimization often requires expensive computational cost. In multi-stage OCA, we first hierarchically project the data onto several low-dimensional subspaces using standard techniques, then OCA learning is performed hierarchically from the lowest to the highest levels to learn about a subspace that is optimal for data discrimination based on the K-nearest neighbor classifier. One of the main advantages of multi-stage OCA lies in the fact that it greatly improves the computational efficiency of the OCA learning algorithm without sacrificing the recognition performance, thus enhancing its applicability to practical problems. In addition to the nearest neighbor classifier, we illustrate the effectiveness of the learned representations on object classification used in conjunction with classifiers such as neural networks and support vector machines.

  5. CAT SWARM OPTIMIZATION FOR SINGLE STAGE SUPPLY CHAIN DISTRIBUTION SYSTEM WITH FIXED CHARGES

    Directory of Open Access Journals (Sweden)

    P. Manimaran

    2014-01-01

    Full Text Available In this paper, Cat Swarm Optimization (CSO Algorithm is proposed for single stage supply chain distribution system with a fixed cost. This paper considers two kinds of cost: a continuous cost, that linearly increases with the amount transported between a supplier and a customer and a fixed cost, which is incurred whenever a non-zero quantity is transported between a supplier and a customer and it is independent of the amount transported. The aim of this paper is to determine the quantities to be distributed to satisfy the customer demand with minimum cost. Since fixed costs results discontinuities in the objective function, solution procedures are become more difficult and are known to be non-deterministic polynomial (NP hard. In this paper Cat Swarm Optimization (CSO Algorithm is proposed for the optimization of single stage supply chain problem to provide optimal or near optimal solution. The results of the proposed model of this paper have been compared with a spanning tree-based Genetic Algorithm and binary coded Genetic Algorithm. Computational results show the superiority of CSO algorithm over other algorithms.

  6. Intravenous Chemotherapy or Oral Chemotherapy in Treating Patients With Previously Untreated Stage III-IV HIV-Associated Non-Hodgkin Lymphoma

    Science.gov (United States)

    2016-09-29

    AIDS-related Diffuse Large Cell Lymphoma; AIDS-related Diffuse Mixed Cell Lymphoma; AIDS-related Diffuse Small Cleaved Cell Lymphoma; AIDS-related Immunoblastic Large Cell Lymphoma; AIDS-related Lymphoblastic Lymphoma; AIDS-related Peripheral/Systemic Lymphoma; AIDS-related Small Noncleaved Cell Lymphoma; Stage III AIDS-related Lymphoma; Stage IV AIDS-related Lymphoma

  7. Factors Affecting the Risk of Brain Metastasis in Small Cell Lung Cancer With Surgery: Is Prophylactic Cranial Irradiation Necessary for Stage I-III Disease?

    Energy Technology Data Exchange (ETDEWEB)

    Gong Linlin; Wang, Q.I.; Zhao Lujun; Yuan Zhiyong; Li Ruijian [Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin (China); Wang Ping, E-mail: Doctorwang66@yahoo.cn [Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin (China)

    2013-01-01

    Purpose: The use of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC) with surgical resection has not been fully identified. This study undertook to assess the factors affecting the risk of brain metastases in patients with stage I-III SCLC after surgical resection. The implications of PCI treatment for these patients are discussed. Methods and Materials: One hundred twenty-six patients treated with surgical resection for stage I-III SCLC from January 1998-December 2009 were retrospectively analyzed to elucidate the risk factors of brain metastases. Log-rank test and Cox regression model were used to determine the risk factors of brain metastases. Results: The median survival time for this patient population was 34 months, and the 5-year overall survival rate was 34.9%. For the whole group, 23.0% (29/126) of the patients had evidence of metastases to brain. Pathologic stage not only correlated with overall survival but also significantly affected the risk of brain metastases. The 5-year survival rates for patients with pathologic stages I, II, and III were 54.8%, 35.6%, and 14.1%, respectively (P=.001). The frequency of brain metastases in patients with pathologic stages I, II, and III were 6.25% (2/32), 28.2% (11/39), and 29.1% (16/55) (P=.026), respectively. A significant difference in brain metastases between patients with complete resection and incomplete resection was also observed (20.5% vs 42.9%, P=.028). The frequency of brain metastases was not found to be correlated with age, sex, pathologic type, induction chemotherapy, adjuvant chemotherapy, or adjuvant radiation therapy. Conclusions: Stage I SCLC patients with complete resection had a low incidence of brain metastases and a favorable survival rate. Stage II-III disease had a higher incidence of brain metastases. Thus, PCI might have a role for stage II-III disease but not for stage I disease.

  8. Multi-Stage Optimization Based Automatic Voltage Control Systems Considering Wind Power Forecasting Errors

    DEFF Research Database (Denmark)

    Qin, Nan; Bak, Claus Leth; Abildgaard, Hans

    2017-01-01

    cost and the generator reactive power output cost. The problem is formulated in a multi-stage optimal reactive power flow (MORPF) framework, solved by the nonlinear programming techniques via a rolling process. The voltage uncertainty caused by wind power forecasting errors is considered in the optimal......This paper proposes an automatic voltage control (AVC) system for power systems with limited continuous voltage control capability. The objective is to minimize the operational cost over a period, which consists of the power loss in the grid, the shunt switching cost, the transformer tap change...

  9. A Two-stage Optimal Network Reconfiguration Approach for Minimizing Energy Loss of Distribution Networks Using Particle Swarm Optimization Algorithm

    Directory of Open Access Journals (Sweden)

    Wei-Tzer Huang

    2015-12-01

    Full Text Available This study aimed to minimize energy losses in traditional distribution networks and microgrids through a network reconfiguration and phase balancing approach. To address this problem, an algorithm composed of a multi-objective function and operation constraints is proposed. Network connection matrices based on graph theory and the backward/forward sweep method are used to analyze power flow. A minimizing energy loss approach is developed for network reconfiguration and phase balancing, and the particle swarm optimization (PSO algorithm is adopted to solve this optimal combination problem. The proposed approach is tested on the IEEE 37-bus test system and the first outdoor microgrid test bed established by the Institute of Nuclear Energy Research (INER in Taiwan. Simulation results demonstrate that the proposed two-stage approach can be applied in network reconfiguration to minimize energy loss.

  10. Multi-Objective Optimization of Two-Stage Helical Gear Train Using NSGA-II

    Directory of Open Access Journals (Sweden)

    R. C. Sanghvi

    2014-01-01

    Full Text Available Gears not only transmit the motion and power satisfactorily but also can do so with uniform motion. The design of gears requires an iterative approach to optimize the design parameters that take care of kinematics aspects as well as strength aspects. Moreover, the choice of materials available for gears is limited. Owing to the complex combinations of the above facts, manual design of gears is complicated and time consuming. In this paper, the volume and load carrying capacity are optimized. Three different methodologies (i MATLAB optimization toolbox, (ii genetic algorithm (GA, and (iii multiobjective optimization (NSGA-II technique are used to solve the problem. In the first two methods, volume is minimized in the first step and then the load carrying capacities of both shafts are calculated. In the third method, the problem is treated as a multiobjective problem. For the optimization purpose, face width, module, and number of teeth are taken as design variables. Constraints are imposed on bending strength, surface fatigue strength, and interference. It is apparent from the comparison of results that the result obtained by NSGA-II is more superior than the results obtained by other methods in terms of both objectives.

  11. Sequential chemoradiotherapy for stage I/II nasal natural killer/T cell lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Noh, Young Joo [Ulsan University Hospital, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Yong Chan; Kim, Won Seog; Ko, Young Hyeh [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2004-09-15

    Authors would report the results of sequential CHOP chemotherapy (cyclophosphamide, adriamycin, vincristine, and prednisone) and involved field radiotherapy (IFRT) for early stage nasal natural killer/T-cell lymphoma (NKTCL). Fourteen among 17 patients, who were registered at the Samsung Medical Center tumor registry with stage I and II nasal NKTCL from March 1995 to December 1999 received this treatment protocol. Three to four cycles of CHOP chemotherapy were given at 3 weeks' interval, which was followed by local IFRT including the known tumor extent and the adjacent draining lymphatics. Favorable responses after chemotherapy (before IFRT) were achievable only in seven patients (5 CR's + 2 PR's: 50%), while seven patients showed disease progression. There were six patients with local failures, two with distant relapses, and none with regional lymphatic failure. The actuarial overall survival and progression-free survival at 3 years were 50.0% and 42.9%. All the failures and deaths occurred within 13 months of the treatment start. The factors that correlated with the improved survival were the absence of 'B' symptoms, the favorable response to chemotherapy and overall treatment, and the low risk by international prognostic index on univariate analyses. Compared with the historic treatment results by IFRT either alone or followed by chemotherapy, the current trial failed to demonstrate advantages with respect to the failure pattern and survival. Development of new treatment strategy in combining IFRT and chemotherapy is required for improving outcomes.

  12. Evaluation of the Glasgow Prognostic Score in patients receiving chemoradiotherapy for stage III and IV esophageal cancer.

    Science.gov (United States)

    Kimura, J; Kunisaki, C; Makino, H; Oshima, T; Ota, M; Oba, M; Takagawa, R; Kosaka, T; Ono, H A; Akiyama, H; Endo, I

    2016-11-01

    High Glasgow Prognostic scores (GPSs) have been associated with poor outcomes in various tumors, but the values of GPS and modified GPS (mGPS) in patients with advanced esophageal cancer receiving chemoradiotherapy (CRT) has not yet been reported. We have evaluated these with respect to predicting responsiveness to CRT and long-term survival. Between January 2002 and December 2011, tumor responses in 142 esophageal cancer patients (131 men and 11 women) with stage III (A, B and C) and IV receiving CRT were assessed. We assessed the value of the GPS as a predictor of a response to definitive CRT and also as a prognostic indicator in patients with esophageal cancer receiving CRT. We found that independent predictors of CRT responsiveness were Eastern Cooperative Oncology Group (ECOG) performance status, GPS and cTNM stage. Independent prognostic factors were ECOG performance status and GPS for progression-free survival and ECOG performance status, GPS and cTNM stage IV for disease-specific survival. GPS may be a novel predictor of CRT responsiveness and a prognostic indicator for progression-free and disease-specific survival in patients with advanced esophageal cancer. However, a multicenter study as same regime with large number of patients will be needed to confirm these outcomes. © 2015 International Society for Diseases of the Esophagus.

  13. Building energy optimization in the early design stages: A simplified method

    DEFF Research Database (Denmark)

    Negendahl, Kristoffer; Nielsen, Toke Rammer

    2015-01-01

    This paper presents the application of multi-objective genetic algorithms for holistic building design that considers multiple criteria; building energy use, capital cost, daylight distribution and thermal indoor environment. The optimization focus is related to building envelope parameters....... To obtain relevant feedback from multi-objective optimizations in early design stages, evaluation speed is a key concern. The paper presents a fast evaluation method fit for the early design stages. It uses a combination of two different quasi-steady-state methods for energy and indoor environment...... evaluations, a Radiance implementation for daylight simulations and a scripted algorithm for capital cost evaluations. The application of the method is developed around an integrated dynamic model which allows visual design feedback from all evaluations to be an integrated part of the design tool experience...

  14. Raising yield potential of wheat. III. Optimizing partitioning to grain while maintaining lodging resistance.

    Science.gov (United States)

    Foulkes, M John; Slafer, Gustavo A; Davies, William J; Berry, Pete M; Sylvester-Bradley, Roger; Martre, Pierre; Calderini, Daniel F; Griffiths, Simon; Reynolds, Matthew P

    2011-01-01

    A substantial increase in grain yield potential is required, along with better use of water and fertilizer, to ensure food security and environmental protection in future decades. For improvements in photosynthetic capacity to result in additional wheat yield, extra assimilates must be partitioned to developing spikes and grains and/or potential grain weight increased to accommodate the extra assimilates. At the same time, improvement in dry matter partitioning to spikes should ensure that it does not increase stem or root lodging. It is therefore crucial that improvements in structural and reproductive aspects of growth accompany increases in photosynthesis to enhance the net agronomic benefits of genetic modifications. In this article, six complementary approaches are proposed, namely: (i) optimizing developmental pattern to maximize spike fertility and grain number, (ii) optimizing spike growth to maximize grain number and dry matter harvest index, (iii) improving spike fertility through desensitizing floret abortion to environmental cues, (iv) improving potential grain size and grain filling, and (v) improving lodging resistance. Since many of the traits tackled in these approaches interact strongly, an integrative modelling approach is also proposed, to (vi) identify any trade-offs between key traits, hence to define target ideotypes in quantitative terms. The potential for genetic dissection of key traits via quantitative trait loci analysis is discussed for the efficient deployment of existing variation in breeding programmes. These proposals should maximize returns in food production from investments in increased crop biomass by increasing spike fertility, grain number per unit area and harvest index whilst optimizing the trade-offs with potential grain weight and lodging resistance.

  15. Heavy Metal Exposure in Predicting Peripheral Neuropathy in Patients With Stage I-III Breast Cancer Undergoing Chemotherapy

    Science.gov (United States)

    2015-05-01

    Male Breast Cancer; Neurotoxicity; Peripheral Neuropathy; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  16. Interactive Gentle Yoga in Improving Quality of Life in Patients With Stage I-III Breast Cancer Undergoing Radiation Therapy

    Science.gov (United States)

    2017-07-28

    Anxiety Disorder; Depression; Ductal Breast Carcinoma in Situ; Fatigue; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  17. Intensity-modulated whole abdomen irradiation following adjuvant carboplatin/taxane chemotherapy for FIGO stage III ovarian cancer. Four-year outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Rochet, Nathalie; Lindel, Katja; Katayama, Sonja; Schubert, Kai; Herfarth, Klaus; Harms, Wolfgang; Debus, Juergen [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); University of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Schneeweiss, Andreas [University of Heidelberg, Nationales Centrum fuer Tumorerkrankungen (NCT), Heidelberg (Germany); Sohn, Christoph [University of Heidelberg, Department of Gynecology, Heidelberg (Germany)

    2015-07-15

    A prospective study to assess toxicity and survival outcomes after intensity-modulated whole-abdominal irradiation (IM-WAI) following surgery and adjuvant intravenous carboplatin/taxane chemotherapy in advanced FIGO stage III ovarian cancer. Between 2006 and 2009, 16 patients with optimally resected FIGO stage III ovarian cancer, who had received six cycles of adjuvant carboplatin/taxane chemotherapy were treated with consolidation IM-WAI. Radiotherapy was delivered to a total dose of 30 Gy in 1.5-Gy fractions, using step-and-shoot (n = 3) or helical tomotherapy (n = 13). The first 10 patients were treated within a phase I trial; the following patients received the same treatment modality. The target volume included the entire peritoneal cavity, the diaphragm, the liver capsule, and the pelvic and para-aortic node regions. Organs at risk were kidneys, liver, heart, and bone marrow. Median follow-up was 44 months (range 19.2-67.2 months). No grade 4 toxicities occurred during IM-WAI. Common Toxicity Criteria for Adverse Events (CTCAE) grade 3 toxicities were: diarrhea (25 %), leucopenia (19 %), nausea/vomiting (6 %), and thrombocytopenia (6 %). No toxicity-related treatment break was necessary. Small bowel obstruction occurred in a total of 6 patients: in 3 cases (19 %) due to postsurgical adhesions and in 3 cases due to local tumor recurrence (19 %). Median recurrence-free survival (RFS) was 27.6 months (95 % confidence interval, CI = 24-44 months) and median overall survival (OS) was 42.1 months (95 %CI = 17-68 months). The peritoneal cavity was the most frequent site of initial failure. Consolidation IM-WAI following surgery and adjuvant chemotherapy is feasible and can be performed with manageable acute and late toxicity. The favorable RFS outcome is promising and justifies further clinical trials. (orig.) [German] Es wurden Akut- und Langzeittoxizitaet sowie Ueberlebensdaten der konsolidierenden intensitaetsmodulierten Ganzabdomenbestrahlung (&apos

  18. Mathematical modeling of the heat treatment and combustion of a coal particle. III. Volatile escape stage

    Science.gov (United States)

    Enkhjargal, Kh.; Salomatov, V. V.

    2011-05-01

    The present paper is a continuation of previous publications of the authors in this journal in which two phases of the multistage process of combustion of a coal particle were considered in detail with the help of mathematical modeling: its radiation-convection heating and drying. In the present work, the escape dynamics of volatiles is investigated. The physico-mathematical model of the thermodestruction of an individual coal particle with a dominant influence of endothermal effects has been formulated. Approximate-analytical solutions of this model that are of paramount importance for detailed analysis of the influence of the physical and regime parameters on the escape dynamics of volatiles have been found. The results obtained form the basis for engineering calculations of the volatile escape stage and can be used successfully in the search for effective regimes of burning of various solid fuels, in particular, Shivé-Ovoos coal of Mongolia.

  19. Role of Postmastectomy Radiation After Neoadjuvant Chemotherapy in Stage II-III Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fowble, Barbara L., E-mail: bfowble@radonc.ucsf.edu [Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States); Einck, John P. [Department of Radiation Oncology, University of California, San Diego, CA (United States); Kim, Danny N. [Athena Breast Health Network, Program Management Office, San Francisco, CA (United States); McCloskey, Susan [Department of Radiation Oncology, University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA (United States); Mayadev, Jyoti [Department of Radiation Oncology, University of California, Davis Cancer Center, Sacramento, CA (United States); Yashar, Catheryn [Department of Radiation Oncology, University of California, San Diego, CA (United States); Chen, Steven L. [Department of Surgery, University of California, Davis Cancer Center, Sacramento, CA (United States); Hwang, E. Shelley [Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States)

    2012-06-01

    Purpose: To identify a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation therapy (PMRT) may be omitted according to the projected risk of local-regional failure (LRF). Methods and Materials: Seven breast cancer physicians from University of California cancer centers created 14 hypothetical clinical case scenarios, identified, reviewed, and abstracted the available literature (MEDLINE and Cochrane databases), and formulated evidence tables with endpoints of LRF, disease-free survival, and overall survival. Using the American College of Radiology appropriateness criteria methodology, appropriateness ratings for postmastectomy radiation were assigned for each scenario. Finally, an overall summary risk assessment table was developed. Results: Of 24 sources identified, 23 were retrospective studies from single institutions. Consensus on the appropriateness rating, defined as 80% agreement in a category, was achieved for 86% of the cases. Distinct LRF risk categories emerged. Clinical stage II (T1-2N0-1) patients, aged >40 years, estrogen receptor-positive subtype, with pathologic complete response or 0-3 positive nodes without lymphovascular invasion or extracapsular extension, were identified as having {<=}10% risk of LRF without radiation. Limited data support stage IIIA patients with pathologic complete response as being low risk. Conclusions: In the absence of randomized trial results, existing data can be used to guide the use of PMRT in the neoadjuvant chemotherapy setting. Using available studies to inform appropriateness ratings for clinical scenarios, we found a high concordance of treatment recommendations for PMRT and were able to identify a cohort of women with a low risk of LRF without radiation. These low-risk patients will form the basis for future planned studies within University of California Athena Breast Health Network.

  20. Circulating Tumor DNA in Predicting Outcomes in Patients With Stage IV Head and Neck Cancer or Stage III-IV Non-small Cell Lung Cancer

    Science.gov (United States)

    2017-08-18

    Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Salivary Gland Squamous Cell Carcinoma; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IV Non-small Cell Lung Cancer; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IVA Salivary Gland Cancer; Stage IVA Squamous Cell Carcinoma of the Larynx; Stage IVA Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVA Squamous Cell Carcinoma of the Oropharynx; Stage IVA Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVA Verrucous Carcinoma of the Larynx; Stage IVA Verrucous Carcinoma of the Oral Cavity; Stage IVB Salivary Gland Cancer; Stage IVB Squamous Cell Carcinoma of the Larynx; Stage IVB Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVB Squamous Cell Carcinoma of the Oropharynx; Stage IVB Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVB Verrucous Carcinoma of the Larynx; Stage IVB Verrucous Carcinoma of the Oral Cavity; Stage IVC Salivary Gland Cancer; Stage IVC Squamous Cell Carcinoma of the Larynx; Stage IVC Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IVC Squamous Cell Carcinoma of the Oropharynx; Stage IVC Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IVC Verrucous Carcinoma of the Larynx; Stage IVC Verrucous Carcinoma of the Oral Cavity; Tongue Cancer; Untreated Metastatic Squamous Neck Cancer With Occult Primary

  1. Double-stage Metamodel and Its Application in Aerodynamic Design Optimization

    Institute of Scientific and Technical Information of China (English)

    ZHANG Dehu; GAO Zhenghong; HUANG Likeng; WANG Mingliang

    2011-01-01

    Constructing metamodel with global high-fidelity in design space is significant in engineering design.In this paper,a dou ble-stage metamodel(DSM)which integrates advantages of both interpolation mctamodel and regression metamodel is constructed.It takes regression model as the first stage to fit overall distribution of the original model,and then interpolation model of regression model approximation error is used as the second stage to improve accuracy.Under the same conditions and with the same samples,DSM expresses higher fidelity and represents physical characteristics of original model better.Besides,in order to validate DSM characteristics,three examples including Ackley finction,airfoil aerodynamic analysis and wing aerodynamic analysis are investigated.In the end,airfoil and wing aerodynamic design optimizations using genetic algorithm are presented to verify the engineering applicability of DSM.

  2. A three-stage stochastic optimization model for the Brazilian biodiesel supply chain

    Directory of Open Access Journals (Sweden)

    Pedro Senna

    2016-01-01

    Full Text Available Abstract The Brazilian program for biodiesel use highlights the production of biodiesel from castor seeds. Biodiesel is a non-polluting energy source that has the potential to promote prosperity by creating jobs in poor regions of Brazil. However, the infrastructure, logistics, and proper facilities are lacking. A variety of approaches to optimizing the biodiesel supply chain have been proposed. The goal is to minimize the grain storage and transportation costs. This paper presents a comparison between a two-stage model and a multistage (three-stage stochastic model to optimize the biodiesel supply chain. The comparison between these formulations shows that the flexibility gain provided by the multistage model results in a lower total logistic cost. The optimum for the three-stage model was 7,700,019 (BRL, compared to 8,628,002 (BRL for the two-stage model, representing a savings of 927,983 (BRL. We highlight that this model offers a real solution for castor supply chain design (considering uncertainty in the Brazilian semiarid region, which is a poorer region of the country, thus making cost reduction mandatory.

  3. Optimal models with maximizing probability of first achieving target value in the preceding stages

    Institute of Scientific and Technical Information of China (English)

    林元烈; 伍从斌; 康波大

    2003-01-01

    Decision makers often face the need of performance guarantee with some sufficiently high proba-bility. Such problems can be modelled using a discrete time Markov decision process (MDP) with a probabilitycriterion for the first achieving target value. The objective is to find a policy that maximizes the probabilityof the total discounted reward exceeding a target value in the preceding stages. We show that our formula-tion cannot be described by former models with standard criteria. We provide the properties of the objectivefunctions, optimal value functions and optimal policies. An algorithm for computing the optimal policies forthe finite horizon case is given. In this stochastic stopping model, we prove that there exists an optimal deter-ministic and stationary policy and the optimality equation has a unique solution. Using perturbation analysis,we approximate general models and prove the existence of ε-optimal policy for finite state space. We give anexample for the reliability of the satellite systems using the above theory. Finally, we extend these results tomore general cases.

  4. Cooperative Hierarchical PSO With Two Stage Variable Interaction Reconstruction for Large Scale Optimization.

    Science.gov (United States)

    Ge, Hongwei; Sun, Liang; Tan, Guozhen; Chen, Zheng; Chen, C L Philip

    2017-09-01

    Large scale optimization problems arise in diverse fields. Decomposing the large scale problem into small scale subproblems regarding the variable interactions and optimizing them cooperatively are critical steps in an optimization algorithm. To explore the variable interactions and perform the problem decomposition tasks, we develop a two stage variable interaction reconstruction algorithm. A learning model is proposed to explore part of the variable interactions as prior knowledge. A marginalized denoising model is proposed to construct the overall variable interactions using the prior knowledge, with which the problem is decomposed into small scale modules. To optimize the subproblems and relieve premature convergence, we propose a cooperative hierarchical particle swarm optimization framework, where the operators of contingency leadership, interactional cognition, and self-directed exploitation are designed. Finally, we conduct theoretical analysis for further understanding of the proposed algorithm. The analysis shows that the proposed algorithm can guarantee converging to the global optimal solutions if the problems are correctly decomposed. Experiments are conducted on the CEC2008 and CEC2010 benchmarks. The results demonstrate the effectiveness, convergence, and usefulness of the proposed algorithm.

  5. TOP1 gene copy number and TOP1/CEN-20 ratio in stage III colorectal cancer samples

    DEFF Research Database (Denmark)

    Rømer, Maria Unni Koefoed; Nygård, Sune Boris; Christensen, Ib Jarle

    AIM OF STUDY To investigate if TOP1 gene copy number and/or the TOP1/CEN-20 ratio in colorectal cancer (CRC) areassociated with prognosis. BACKGROUND TOP1, localized on chromosome 20, encodes topoisomerase I (TOP1), which is the sole molecular target of irinotecan. TOP1 immunoreactivity in formalin...... analyses on 50 FFPE primary CRC tissues. When compared with results from normal colorectal mucosa, 80 % of the tumors showed increased TOP1 gene copy number and 2/3 had increased TOP1/CEN-20 ratio. MATERIALS AND METHODS FFPE samples from 154 stage III CRC patients not receiving adjuvant chemotherapy were...... included. For each patient TOP1 gene copy number and CEN-20 reference number were determined in 60 nuclei from the malignant tumor by FISH using a TOP1/CEN-20 probe mix. Similarly, the TOP1 gene copy number and and CEN-20 reference number were dertermined in the normal colorectal mucosa in 105 of the 154...

  6. Laparoscopic versus open colectomy for TNM stage III colon cancer: results of a prospective multicenter study in Italy.

    Science.gov (United States)

    Guerrieri, Mario; Campagnacci, Roberto; De Sanctis, Angelo; Lezoche, Giovanni; Massucco, Paolo; Summa, Massimo; Gesuita, Rosaria; Capussotti, Lorenzo; Spinoglio, Giuseppe; Lezoche, Emanuele

    2012-11-01

    There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3 years. The subjects of this prospective non-randomized multicentric study were 290 consecutive patients, who underwent open surgery (OS group; n = 164) or laparoscopic surgery (LS group; n = 126) between 1994 and 2005, at one of the four surgical centers. The same surgical techniques were used for the laparoscopic and open approaches to right and left colectomy. The distribution of TNM substages (III A, III B, IIIC) as well as the grading of carcinomas (G1, G2, G3) were similar in each arm of the study. The median follow-up periods were 76.9 and 58.0 months after OS and LS, respectively. There were 10 (6.1 %) versus 9 (7.1 %) deaths unrelated to cancer, 15 (9.1 %) versus 5 (4 %) cases of local recurrence, 7 (4.2 %) versus 5 (4 %) cases of peritoneal carcinosis, and 37 (22.5 %) versus 14 (11.1 %) cases of metastases in the OS and LS groups, respectively. There was also one case of port-site recurrence after LS (0.8 %). The OS group had a significantly higher probability of local recurrence and metastases (p cancer-related death (p = 0.001) than the LS group. These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better long-term outcome than the OS group, further investigations are needed to draw a definitive conclusion.

  7. Prediction of overall survival in stage II and III colon cancer beyond TNM system: a retrospective, pooled biomarker study.

    Science.gov (United States)

    Dienstmann, R; Mason, M J; Sinicrope, F A; Phipps, A I; Tejpar, S; Nesbakken, A; Danielsen, S A; Sveen, A; Buchanan, D D; Clendenning, M; Rosty, C; Bot, B; Alberts, S R; Milburn Jessup, J; Lothe, R A; Delorenzi, M; Newcomb, P A; Sargent, D; Guinney, J

    2017-05-01

    TNM staging alone does not accurately predict outcome in colon cancer (CC) patients who may be eligible for adjuvant chemotherapy. It is unknown to what extent the molecular markers microsatellite instability (MSI) and mutations in BRAF or KRAS improve prognostic estimation in multivariable models that include detailed clinicopathological annotation. After imputation of missing at random data, a subset of patients accrued in phase 3 trials with adjuvant chemotherapy (n = 3016)-N0147 (NCT00079274) and PETACC3 (NCT00026273)-was aggregated to construct multivariable Cox models for 5-year overall survival that were subsequently validated internally in the remaining clinical trial samples (n = 1499), and also externally in different population cohorts of chemotherapy-treated (n = 949) or -untreated (n = 1080) CC patients, and an additional series without treatment annotation (n = 782). TNM staging, MSI and BRAFV600E mutation status remained independent prognostic factors in multivariable models across clinical trials cohorts and observational studies. Concordance indices increased from 0.61-0.68 in the TNM alone model to 0.63-0.71 in models with added molecular markers, 0.65-0.73 with clinicopathological features and 0.66-0.74 with all covariates. In validation cohorts with complete annotation, the integrated time-dependent AUC rose from 0.64 for the TNM alone model to 0.67 for models that included clinicopathological features, with or without molecular markers. In patient cohorts that received adjuvant chemotherapy, the relative proportion of variance explained (R2) by TNM, clinicopathological features and molecular markers was on an average 65%, 25% and 10%, respectively. Incorporation of MSI, BRAFV600E and KRAS mutation status to overall survival models with TNM staging improves the ability to precisely prognosticate in stage II and III CC patients, but only modestly increases prediction accuracy in multivariable models that include

  8. The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute⊕ Study

    Directory of Open Access Journals (Sweden)

    Pruijt Hans FM

    2011-05-01

    Full Text Available Abstract Background The presence of lymph node metastases remains the most reliable prognostic predictor and the gold indicator for adjuvant treatment in colon cancer (CC. In spite of a potentially curative resection, 20 to 30% of CC patients testing negative for lymph node metastases (i.e. pN0 will subsequently develop locoregional and/or systemic metastases within 5 years. The presence of occult nodal isolated tumor cells (ITCs and/or micrometastases (MMs at the time of resection predisposes CC patients to high risk for disease recurrence. These pN0micro+ patients harbouring occult micrometastases may benefit from adjuvant treatment. The purpose of the present study is to delineate the subset of pN0 patients with micrometastases (pN0micro+ and evaluate the benefits from adjuvant chemotherapy in pN0micro+ CC patients. Methods/design EnRoute+ is an open label, multicenter, randomized controlled clinical trial. All CC patients (age above 18 years without synchronous locoregional lymph node and/or systemic metastases (clinical stage I-II disease and operated upon with curative intent are eligible for inclusion. All resected specimens of patients are subject to an ex vivo sentinel lymph node mapping procedure (SLNM following curative resection. The investigation for micrometastases in pN0 patients is done by extended serial sectioning and immunohistochemistry for pan-cytokeratin in sentinel lymph nodes which are tumour negative upon standard pathological examination. Patients with ITC/MM-positive sentinel lymph nodes (pN0micro+ are randomized for adjuvant chemotherapy following the CAPOX treatment scheme or observation. The primary endpoint is 3-year disease free survival (DFS. Discussion The EnRoute+ study is designed to improve prognosis in high-risk stage I/II pN0 micro+ CC patients by reducing disease recurrence by adjuvant chemotherapy. Trial Registration ClinicalTrials.gov: NCT01097265

  9. TP53 Mutational Status and Prediction of Benefit from Adjuvant 5-Fluorouracil in Stage III Colon Cancer Patients.

    Science.gov (United States)

    Kandioler, Daniela; Mittlböck, Martina; Kappel, Sonja; Puhalla, Harald; Herbst, Friedrich; Langner, Cord; Wolf, Brigitte; Tschmelitsch, Jörg; Schippinger, Walter; Steger, Günther; Hofbauer, Friedrich; Samonigg, Hellmut; Gnant, Michael; Teleky, Bela; Kührer, Irene

    2015-08-01

    We investigated the hypothesis that the varying treatment efficacy of adjuvant 5-fluorouracil (5FU) in stage III colon cancer is linked to the TP53 mutational status. ABCSG-90 was a prospective randomized trial in which effect of adjuvant 5FU was studied in stage III colon cancer patients. Tumor material of 70% of these patients (389/572) was available for analysis of the biomarker TP53 using a TP53-gene-specific Sanger sequencing protocol. Median follow-up was 88 months. TP53 mutation frequency was 33%. A significant interaction between TP53 status, outcomes and nodal category was found (P = 0.0095). In the N1 category, TP53 wildtype patients had significantly better overall survival than TP53 mutated (81.0% vs. 62.0% overall survival at 5 years; HR = 2.131; 95% CI: 1.344-3.378; P = 0.0010). In the N2 category, the TP53 status did not affect survival (P = 0.4992). In TP53 wildtype patients, the prognostic significance of N category was significantly enhanced (P = 0.0002). In TP53 mutated patients, survival curves of N1 and N2 patients overlapped and nodal category was no longer prognostic. The biomarker TP53 independently predicted effect of adjuvant 5FU in N1 colon cancer patients. TP53 was not predictive in N2 patients, in whom 5FU is known to have no effect.

  10. A predictive genetic signature for response to fluoropyrimidine-based neoadjuvant chemoradiation in clinical Stage II and III rectal cancer

    Directory of Open Access Journals (Sweden)

    Jason eChan

    2013-11-01

    Full Text Available PurposePreoperative chemoradiation is currently the standard of care for patients with clinical stage II and III rectal cancer but only about 45% of patients achieve tumor downstaging and less than 20% of patients achieve a pathologic complete response. Better methods to stratify patients according to potential neoadjuvant treatment response are needed. We used microarray analysis to identify a genetic signature that correlates with a pathological complete response to neoadjuvant chemoradiation. We performed a gene network analysis to identify potential signaling pathways involved in determining response to neoadjuvant treatment.Patients and MethodsWe identified 31 T3-4 N0-1 rectal cancer patients who were treated with neoadjuvant fluorouracil-based chemoradiation. 8 patients were identified to have achieved a pathological complete response to treatment while 23 patients did not. mRNA expression was analyzed using cDNA microarrays. The correlation between mRNA expression and pathological complete response from pre-treatment tumor biopsies was determined. Gene network analysis was performed for the genes represented by the predictive signature.ResultsA genetic signature represented by expression levels of the 3 genes EHBP1, STAT1, and GAPDH was found to correlate with a pathological complete response to neoadjuvant treatment. The difference in expression levels between patients who achieved a pathological complete response and those who did not was greatest for EHBP1. Gene network analysis showed that the 3 genes can be connected by the gene UBC. ConclusionThis study identifies a 3-gene signature expressed in pre-treatment tumor biopsies that correlates with a pathological complete response to neoadjuvant chemoradiation in patients with clinical stage II and III rectal cancer. These 3 genes can be connected by the gene UBC, suggesting that ubiquination is a molecular mechanism involved in determining response to treatment. Validating this genet

  11. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pinkham, Mark B., E-mail: mark.pinkham@health.qld.gov.au [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Foote, Matthew C. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Diamantina Institute, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Elizabeth [Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane (Australia); Research Centre for Clinical and Community Practice, Griffith University, Brisbane (Australia); Thomas, Janine [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Meakin, Janelle [Clinical Trials Research Unit, Princess Alexandra Hospital, Brisbane (Australia); Smithers, B. Mark [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Bryan H. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia)

    2013-07-15

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy.

  12. Treatment patterns of advanced malignant melanoma (stage III-IV) - A review of current standards in Europe.

    Science.gov (United States)

    Harries, Mark; Malvehy, Josep; Lebbe, Céleste; Heron, Louise; Amelio, Justyna; Szabo, Zsolt; Schadendorf, Dirk

    2016-06-01

    With the recent emergence of immunotherapies and novel targeted treatments for advanced and metastatic melanoma such as selective B-Raf inhibitors and checkpoint inhibitors, the treatment landscape in Europe has changed considerably. The aim of this review was to provide an overview of current treatment pathways in Europe for the treatment of advanced melanoma, unresectable stage III-IV. A literature search of four databases was conducted to identify publications reporting on the treatment patterns of advanced and metastatic melanoma (stage III-IV) in European populations. Seven full-text publications and two conference abstracts reported on observational studies of melanoma treatment practices in France, Italy and the United Kingdom. Treatment patterns were identified for two time periods: 2005-2009 and 2011-2012. Common treatments reported for both periods included chemotherapy with dacarbazine, fotemustine or temozolomide. The main differences between the two periods were the introduction and prescription of immunotherapy ipilimumab and targeted therapy vemurafenib between 2011 and 2012. Across the three countries studied, the types of treatments prescribed between 2005 and 2009 were relatively similar, however, with noticeable differences in the frequency and priority of administration. Treatment practices for advanced melanoma vary markedly across different European countries and continue to evolve with the introduction of new therapies. The results of this review highlight a considerable evidence gap with regards to recent treatment patterns for advanced melanoma in Europe, especially post-2011 after the introduction of novel therapeutic agents, and more recently with the introduction of programmed cell death 1 inhibitors. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Telomere Length in Predicting Toxicity in Older Patients With Stage III-IV Colorectal Cancer Undergoing Chemotherapy

    Science.gov (United States)

    2017-01-25

    Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer; Stage IV Colon Cancer; Stage IV Rectal Cancer

  14. A randomised phase III study comparing high-dose chemotherapy to conventionally dosed chemotherapy for stage III ovarian cancer: the Finnish Ovarian Cancer (FINOVA) study.

    Science.gov (United States)

    Grénman, Seija; Wiklund, Tom; Jalkanen, Jyrki; Kuoppala, Tapio; Mäenpää, Johanna; Kuronen, Arja; Leminen, Arto; Puistola, Ulla; Vuolo-Merilä, Päivi; Salmi, Tuula; Vuento, Maarit; Yliskoski, Merja; Itälä, Maija; Helenius, Hans; Joensuu, Heikki; Lehtovirta, Pentti

    2006-09-01

    Women with stage III ovarian cancer and with < or = 2 cm residual tumour were randomly assigned to receive either conventionally dosed chemotherapy (group A) or HDCT (group B). Patients allocated to group A received 6 cycles of paclitaxel (T) 135 mg/m2 and cisplatin (P) 75 mg/m2 every 3 weeks, and those allocated to HDCT received 3 TP cycles followed by peripheral blood stem cell mobilisation with cyclophosphamide (C) 3000 mg/m2 and T 175 mg/m2, and subsequently HDCT with carboplatin 1500 mg/m2, C 120 mg/kg, and mitoxantrone 75 mg/m2. The trial was closed early after 42 patients were entered due to slow accrual. The median follow-up time of patients who were alive was 81 months. The median progression-free survival time was 15.9 and 16.6 months (hazard ratio, HR 0.83; 95% CI 0.41-1.69, P = 0.61) and the median overall survival time was 43.7 and 64.3 months (HR, 0.74; 95% CI 0.34-1.61, P = 0.44) in groups A and B, respectively. Although one patient died of HDCT-related toxicity, the regimen was otherwise relatively well tolerated. We conclude that the HDCT regimen used was feasible, but did not result in significantly improved survival in this prematurely closed trial. A clinically important survival benefit cannot be excluded due to the small sample size.

  15. OPTIMAL TRACK SEEKING CONTROL OF DUAL-STAGE ACTUATOR FOR HIGH DENSITY HARD DISK DRIVES

    Institute of Scientific and Technical Information of China (English)

    Zhou Haomiao; Wang Jie; Zhou Youhe; Zheng Xiaojing

    2006-01-01

    Based on generalized the variation method, by introducing Hamilton function and Lagrange multiplier, this paper proposed a linear quadratic optimal control strategy for an incomplete controllable system with fixed terminal state and time. Applying the proposed optimal control to the simple two-input dual-stage actuator magnetic head positioning system with three degrees-of-freedom, the simulation results show that the system has no residual vibration at the terminal position and time, which can reduce the total access time during head positioning process.To verify the validation of the optimal control strategy of three degrees-of-freedom spring-mass models in actual magnetic head positioning of hard disk drives, a finite element model of an actual magnetic head positioning system is presented. Substituting the optimal control force from simple three degrees-of-freedom spring-mass models into the finite element model, the simulation results show that the magnetic head also has no residual vibration at the end of track-to-track travel.That is to say, the linear quadratic optimal control technique based on simple two-input dualstage actuator system with three degrees-of-freedom proposed in this paper is of high reliability for the industrial application of an actual magnetic head positioning system.

  16. Using Complete Squares Method to Optimize Replenishment Policies in a Four-Stage Supply Chain with Planned Backorders

    OpenAIRE

    M. E. Seliaman

    2011-01-01

    We develop a four-stage, serial supply chain inventory model with planned backorders. This supply chain model is formulated for the integer multipliers coordination mechanism, where firms at the same stage of the supply chain use the same cycle time and the cycle time at each stage is an integer multiplier of the cycle time used at the adjacent downstream stage. We develop an optimal replenishment policy using a simple algebraic method to solve the problem without the use of differential calc...

  17. Staged cost optimization of urban storm drainage systems based on hydraulic performance in a changing environment

    Directory of Open Access Journals (Sweden)

    M. Maharjan

    2008-06-01

    Full Text Available Urban flooding causes large economic losses, property damage and loss of lives. The impact of environmental changes mainly, the urbanization and the climatic change leads to increased runoff and increased peak flows which the drainage system must be able to cope with to overcome possible damage and inconveniences caused by the induced flooding. Allowing for detention storage to compliment the capacity of the drainage system network is one of the approaches to reduce urban floods. The traditional practice was to design systems against stationary environmental forcings – including design rainfall, landuse, etc. Due to the rapid change in climate-environment, this approach is no longer economically viable and safe, and explicit consideration of changes that gradually take place during the life-time of the drainage system is warranted. In this paper, a staged cost optimization tool based on the hydraulic performance of the drainage system is presented. A one dimensional hydraulic model is used for hydraulic evaluation of the network together with a genetic algorithm based optimization tool to determine optimal intervention timings and amounts throughout the lifespan of the drainage network. The model was applied in a case study area in the city of Porto Alegre, Brazil. It was concluded that considerable financial savings and/or additional level of flood-safety can be achieved by approaching the design problem as a staged plan rather than one-off scheme.

  18. Staged cost optimization of urban storm drainage systems based on hydraulic performance in a changing environment

    Science.gov (United States)

    Maharjan, M.; Pathirana, A.; Gersonius, B.; Vairavamoorthy, K.

    2009-04-01

    Urban flooding causes large economic losses, property damage and loss of lives. The impact of environmental changes, mainly urbanization and climatic change, leads to increased runoff and peak flows which the drainage system must be able to cope with to reduce potential damage and inconvenience. Allowing for detention storage to compliment the conveyance capacity of the drainage system network is one of the approaches to reduce urban floods. Contemporary practice is to design systems against stationary environmental forcings - including design rainfall, landuse, etc. Due to the rapid change in the climate- and the urban environment, this approach is no longer appropriate, and explicit consideration of gradual changes during the life-time of the drainage system is warranted. In this paper, a staged cost optimization tool based on the hydraulic performance of the drainage system is presented. A one dimensional hydraulic model is used for hydraulic evaluation of the network together with a genetic algorithm based optimization tool to determine optimal intervention timings and responses over the analysis period. The model was applied in a case study area in the city of Porto Alegre, Brazil. It was concluded that considerable financial savings and/or additional level of flood-safety can be achieved by approaching the design problem as a staged plan rather than one-off scheme.

  19. Population balance modelling and multi-stage optimal control of a pulsed spray fluidized bed granulation.

    Science.gov (United States)

    Liu, Huolong; Li, Mingzhong

    2014-07-01

    In this work, one-dimensional population balance models (PBMs) have been developed to model a pulsed top-spray fluidized bed granulation. The developed PBMs have linked the key binder solution spray operating factors of the binder spray rate, atomizing air pressure and pulsed frequency of spray with the granule properties to predict granule growth behaviour in the pulsed spray fluidized bed granulation process at different operating conditions with accuracy. A multi-stage open optimal control strategy based on the developed PBMs was proposed to reduce the model mismatch, in which through adjusting the trajectory of the evolution of the granule size distribution at predefined sample intervals, to determine the optimal operating variables related to the binder spray including the spray rate of binding liquid, atomizing air pressure and pulsed frequency of spray. The effectiveness of the proposed modelling and multi-stage open optimal control strategies has been validated by experimental and simulation tests. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Staged cost optimization of urban storm drainage systems based on hydraulic performance in a changing environment

    Directory of Open Access Journals (Sweden)

    M. Maharjan

    2009-04-01

    Full Text Available Urban flooding causes large economic losses, property damage and loss of lives. The impact of environmental changes, mainly urbanization and climatic change, leads to increased runoff and peak flows which the drainage system must be able to cope with to reduce potential damage and inconvenience. Allowing for detention storage to compliment the conveyance capacity of the drainage system network is one of the approaches to reduce urban floods. Contemporary practice is to design systems against stationary environmental forcings – including design rainfall, landuse, etc. Due to the rapid change in the climate- and the urban environment, this approach is no longer appropriate, and explicit consideration of gradual changes during the life-time of the drainage system is warranted. In this paper, a staged cost optimization tool based on the hydraulic performance of the drainage system is presented. A one dimensional hydraulic model is used for hydraulic evaluation of the network together with a genetic algorithm based optimization tool to determine optimal intervention timings and responses over the analysis period. The model was applied in a case study area in the city of Porto Alegre, Brazil. It was concluded that considerable financial savings and/or additional level of flood-safety can be achieved by approaching the design problem as a staged plan rather than one-off scheme.

  1. Adaptive multi-stage integrators for optimal energy conservation in molecular simulations

    CERN Document Server

    Fernández-Pendás, Mario; Sanz-Serna, J M

    2015-01-01

    We introduce a new Adaptive Integration Approach (AIA) to be used in a wide range of molecular simulations. Given a simulation problem and a step size, the method automatically chooses the optimal scheme out of an available family of numerical integrators. Although we focus on two-stage splitting integrators, the idea may be used with more general families. In each instance, the system-specific integrating scheme identified by our approach is optimal in the sense that it provides the best conservation of energy for harmonic forces. The AIA method has been implemented in the BCAM-modified GROMACS software package. Numerical tests in molecular dynamics and hybrid Monte Carlo simulations of constrained and unconstrained physical systems show that the method successfully realises the fail-safe strategy. In all experiments, and for each of the criteria employed, the AIA is at least as good as, and often significantly outperforms the standard Verlet scheme, as well as fixed parameter, optimized two-stage integrator...

  2. Adaptive multi-stage integrators for optimal energy conservation in molecular simulations

    Science.gov (United States)

    Fernández-Pendás, Mario; Akhmatskaya, Elena; Sanz-Serna, J. M.

    2016-12-01

    We introduce a new Adaptive Integration Approach (AIA) to be used in a wide range of molecular simulations. Given a simulation problem and a step size, the method automatically chooses the optimal scheme out of an available family of numerical integrators. Although we focus on two-stage splitting integrators, the idea may be used with more general families. In each instance, the system-specific integrating scheme identified by our approach is optimal in the sense that it provides the best conservation of energy for harmonic forces. The AIA method has been implemented in the BCAM-modified GROMACS software package. Numerical tests in molecular dynamics and hybrid Monte Carlo simulations of constrained and unconstrained physical systems show that the method successfully realizes the fail-safe strategy. In all experiments, and for each of the criteria employed, the AIA is at least as good as, and often significantly outperforms the standard Verlet scheme, as well as fixed parameter, optimized two-stage integrators. In particular, for the systems where harmonic forces play an important role, the sampling efficiency found in simulations using the AIA is up to 5 times better than the one achieved with other tested schemes.

  3. A three-stage strategy for optimal price offering by a retailer based on clustering techniques

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoudi-Kohan, N.; Shayesteh, E. [Islamic Azad University (Garmsar Branch), Garmsar (Iran); Moghaddam, M. Parsa; Sheikh-El-Eslami, M.K. [Tarbiat Modares University, Tehran (Iran)

    2010-12-15

    In this paper, an innovative strategy for optimal price offering to customers for maximizing the profit of a retailer is proposed. This strategy is based on load profile clustering techniques and includes three stages. For the purpose of clustering, an improved weighted fuzzy average K-means is proposed. Also, in this paper a new acceptance function for increasing the profit of the retailer is proposed. The new method is evaluated by implementation on a group of 300 customers of a 20 kV distribution network. (author)

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

    OpenAIRE

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

    2013-01-01

    Part 21: Electronics: Applications; International audience; 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 a reduction of the OSR with an increase of the order results in considerable power savings while the audio quality is kept. For further savin...

  5. Two-Stage Chaos Optimization Search Application in Maximum Power Point Tracking of PV Array

    Directory of Open Access Journals (Sweden)

    Lihua Wang

    2014-01-01

    Full Text Available In order to deliver the maximum available power to the load under the condition of varying solar irradiation and environment temperature, maximum power point tracking (MPPT technologies have been used widely in PV systems. Among all the MPPT schemes, the chaos method is one of the hot topics in recent years. In this paper, a novel two-stage chaos optimization method is presented which can make search faster and more effective. In the process of proposed chaos search, the improved logistic mapping with the better ergodic is used as the first carrier process. After finding the current optimal solution in a certain guarantee, the power function carrier as the secondary carrier process is used to reduce the search space of optimized variables and eventually find the maximum power point. Comparing with the traditional chaos search method, the proposed method can track the change quickly and accurately and also has better optimization results. The proposed method provides a new efficient way to track the maximum power point of PV array.

  6. Optimal phasing of district heating network investments using multi-stage stochastic programming

    Directory of Open Access Journals (Sweden)

    Romain Stephane Claude Lambert

    2016-06-01

    Full Text Available Most design optimisation studies for district heating systems have focused on the optimal sizing of network assets and on the location of production units. However, the strategic value of the flexibility in phasing of the inherently modular heat networks, which is an important aspect in many feasibility studies for district heating schemes in the UK, is almost always neglected in the scientific literature. This paper considers the sequential problem faced by a decision-maker in the phasing of long-term investments into district heating networks and their expansions. The problem is formulated as a multi-stage stochastic programme to determine the annual capital expenditure that maximises the expected net present value of the project. The optimisation approach is illustrated by applying it to the hypothetical case of the UK’s Marston Vale eco town. It was found that the approach is capable of simulating the optimal growth of a network, from both a single heat source or separate islands of growth, as well as the optimal marginal expansion of an existing district heating network. The proposed approach can be used by decision makers as a framework to determine both the optimal phasing and extension of district heating networks and can be adapted simply to various, more complex real-life situations by introducing additional constraints and parameters. The versatility of the base formulation also makes it a powerful approach regardless of the size of the network and also potentially applicable to cooling networks.

  7. [Comparative estimation of results of remote and combined radiotherapy in patients with cancer of the cervix uteri of the III-IV stages of disease].

    Science.gov (United States)

    Pereslegin, I A; Makarov, O V; Semko, V F; Frolova, E L

    2000-01-01

    The paper presents a procedure of teleradiotherapy in patients with stages III-IV cancer of the cervix uteri with significant concurrent pathology. Control patients with the similar disease stages underwent combined radiation therapy. If there are contraindications to combined radiation therapy, teleradiotherapy is possible and required as an independent treatment that prolongs and improves the patients' like quality irrespective of the extent of a tumorous process.

  8. Evaluation of the effectiveness of diabetic nephropathy stage III in patients with type 2 diabetes mellitus therapy with sulodexide

    Directory of Open Access Journals (Sweden)

    V. G. Kadzharyan

    2013-08-01

    Full Text Available Introduction. Diabetes mellitus (DM - takes the main place in the structure of endocrine diseases, and the third after cardiovascular and cancer pathology. In Ukraine 1.2 million of people suffer from diabetes and type 2 diabetes occurs in 85-90% of them. In 2004, 3.4 million of people died from diabetes complications. Diabetic nephropathy (DN is a serious chronic complication of diabetes that leads to the formation of nodular or diffuse glomerulosclerosis. It is the most frequent cause of terminal chronic renal failure (CRF in the world, accounting for over 25% of all cases of CRF. The generally accepted classification is Moggensen`s classification (1983, WHO, according to which five stages of diabetic nephropathy are identified, the first two stages of them are preclinical. Leading role in the pathogenesis of DN takes hyperglycemia, which is implemented by the phenomenon of glucosetoxicity. A lot of facts underscore the importance of inflammatory mechanisms triggered by cytokines. There's immune and non-immune theory of DN. The basis of non-immune theory is a violation of the synthesis of glycosaminoglycans (GAGs that are a major component of the glomerular basement membrane (GMB. GAGs create its negative charge, which prevents the passage through the renal filter small negatively charged molecules, including albumin. In hemodynamic regulation leading role belongs to the renin-angiotensin-aldosterone system (RAAS. The blockade of the RAAS system with ACE inhibitors is the basis of a treatment strategy of DN. All mentioned above became a reason for study of the possibility of a new direction in the treatment of DN using the drug sulodexid, which is a natural mixture of GAGs. Objective of the research. Evaluating the effectiveness of sulodexide therapy of DN stage III in patients with type 2 diabetes. Materials and methods. The patients were divided into 2 groups. Group I consisted of 24 patients aged 40 to 68 years. 5 of them were women and 19

  9. Low-Dose Acetylsalicylic Acid in Treating Patients With Stage I-III Non-Small Cell Lung Cancer

    Science.gov (United States)

    2016-06-28

    Adenocarcinoma of the Lung; Recurrent Non-small Cell Lung Cancer; Stage IA Non-small Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer

  10. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    Directory of Open Access Journals (Sweden)

    Becker Heinz

    2010-04-01

    Full Text Available Abstract Background Response to preoperative radiochemotherapy (RCT in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3, treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0 total mesorectal excision (TME in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS and overall survival (OS. Results Residual tumor transgression into the mesorectal compartment (ypT3 did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively. Nodal involvement after preoperative RCT (ypN1/2 turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively. Persistent tumor infiltration of the mesorectum (ypT3 and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0 resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters.

  11. {sup 99m}Tc-3PRGD{sub 2} SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Bin; Chen, Bin; Wang, Ting; Chen, Minglong; Ji, Tiefeng; Gao, Shi; Ma, Qingjie [China-Japan Union Hospital of Jilin University, Department of Nuclear Medicine, Changchun (China); Song, Yan [China-Japan Union Hospital of Jilin University, Department of Breast Surgery, Changchun (China); Wang, Xueju [China-Japan Union Hospital of Jilin University, Department of Pathology, Changchun (China)

    2015-08-15

    Monitoring of response to neoadjuvant chemotherapy (NCT) is important for optimal management of patients with breast cancer. {sup 99m}Tc-3PRGD{sub 2} SPECT is a newly developed imaging modality for evaluating tumor vascular status. In this study, we investigated the application of {sup 99m}Tc-3PRGD{sub 2} SPECT in evaluating therapy response to NCT in patients with stage II or III breast cancer. Thirty-three patients were scheduled to undergo {sup 99m}Tc-3PRGD{sub 2} SPECT at baseline, after the first and second cycle of NCT. Four patients had extremely low {sup 99m}Tc-3PRGD{sub 2} uptake at baseline, and were not included in the subsequent studies. Changes in tumor to nontumor (T/N) ratio were compared with pathological tumor responses classified using the residual cancer burden system. Receiver operator characteristic analysis was used to compare the power to identify responders between the end of the first and the end of the second cycle of NCT. The impact of breast cancer subtype on {sup 99m}Tc-3PRGD{sub 2} uptake was evaluated. The correlation between {sup 99m}Tc-3PRGD{sub 2} uptake and pathological tumor response was also evaluated in each breast cancer subtype. Surgery was performed after four cycles of NCT and pathological analysis revealed 18 responders and 15 nonresponders. In patients with clearly visible {sup 99m}Tc-3PRGD{sub 2} uptake at baseline, the sensitivity, specificity, and negative predictive value of {sup 99m}Tc-3PRGD{sub 2} SPECT were 86.7 %, 85.7 % and 86.7 % after the first cycle of NCT, and 92.9 %, 93.3 % and 93.3 % after the second cycle, respectively. Among these patients, the HER-2-positive group demonstrated both higher T/N ratios and a greater change in T/N ratio than patients with other breast cancer subtypes (P < 0.05). A strong correlation was found between changes in T/N ratio and pathological tumor response in the HER-2-positive group (P < 0.03). {sup 99m}Tc-3PRGD{sub 2} SPECT seems to be useful for determining the pathological

  12. Shape Optimization of the Assisted Bi-directional Glenn surgery for stage-1 single ventricle palliation

    Science.gov (United States)

    Verma, Aekaansh; Shang, Jessica; Esmaily-Moghadam, Mahdi; Wong, Kwai; Marsden, Alison

    2016-11-01

    Babies born with a single functional ventricle typically undergo three open-heart surgeries starting as neonates. The first of these stages (BT shunt or Norwood) has the highest mortality rates of the three, approaching 30%. Proceeding directly to a stage-2 Glenn surgery has historically demonstrated inadequate pulmonary flow (PF) & high mortality. Recently, the Assisted Bi-directional Glenn (ABG) was proposed as a promising means to achieve a stable physiology by assisting the PF via an 'ejector pump' from the systemic circulation. We present preliminary parametrization and optimization results for the ABG geometry, with the goal of increasing PF. To limit excessive pressure increases in the Superior Vena Cava (SVC), the SVC pressure is included as a constraint. We use 3-D finite element flow simulations coupled with a single ventricle lumped parameter network to evaluate PF & the pressure constraint. We employ a derivative free optimization method- the Surrogate Management Framework, in conjunction with the OpenDIEL framework to simulate multiple simultaneous evaluations. Results show that nozzle diameter is the most important design parameter affecting ABG performance. The application of these results to patient specific situations will be discussed. This work was supported by an NSF CAREER award (OCI1150184) and by the XSEDE National Computing Resource.

  13. A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer.

    Science.gov (United States)

    Ho, Maria Y; McBride, Mary L; Gotay, Carolyn; Grunfeld, Eva; Earle, Craig C; Relova, Sharon; Tsonis, Miranda; Ruan, Jenny Y; Chang, Jennifer T; Cheung, Winson Y

    2016-12-01

    Prior survivorship research has largely focused on issues faced by survivors of childhood tumors, breast cancers, or hematologic malignancies. Relatively little is known about the needs of other prevalent survivor groups. Our aim was to identify the specific concerns of colorectal cancer (CRC) survivors in the key domains of physical functioning, psychological wellbeing, and social relationships. We conducted focus groups with stage II and III CRC survivors who had completed their primary active anti-cancer treatments. Patients were asked to describe how their diagnosis and treatment impacted their lives, to outline deficiencies in the care that they received, and to suggest ways of addressing any unmet needs. A content analysis was subsequently conducted to identify major themes. Thirty CRC survivors participated in six focus groups. Individuals reported some degree of dissatisfaction with the amount and type of diagnostic and treatment information they received at their initial clinic visit. Distress from toxicities, such as peripheral neuropathy, was also common among the survivors. Similarly, the majority faced challenges adjusting to their lives and daily activities, especially in caring for their colostomy. Having survived CRC, many survivors expressed an interest in advocacy and health promotion of CRC. CRC survivors face many barriers after their cancer treatment. Issues with colostomy are unique to this survivor group. Interventions to improve CRC survivorship care should also incorporate opportunities for patient advocacy. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  14. Adjuvant Autologous Melanoma Vaccine for Macroscopic Stage III Disease: Survival, Biomarkers, and Improved Response to CTLA-4 Blockade

    Directory of Open Access Journals (Sweden)

    Michal Lotem

    2016-01-01

    Full Text Available Background. There is not yet an agreed adjuvant treatment for melanoma patients with American Joint Committee on Cancer stages III B and C. We report administration of an autologous melanoma vaccine to prevent disease recurrence. Patients and Methods. 126 patients received eight doses of irradiated autologous melanoma cells conjugated to dinitrophenyl and mixed with BCG. Delayed type hypersensitivity (DTH response to unmodified melanoma cells was determined on the vaccine days 5 and 8. Gene expression analysis was performed on 35 tumors from patients with good or poor survival. Results. Median overall survival was 88 months with a 5-year survival of 54%. Patients attaining a strong DTH response had a significantly better (p=0.0001 5-year overall survival of 75% compared with 44% in patients without a strong response. Gene expression array linked a 50-gene signature to prognosis, including a cluster of four cancer testis antigens: CTAG2 (NY-ESO-2, MAGEA1, SSX1, and SSX4. Thirty-five patients, who received an autologous vaccine, followed by ipilimumab for progressive disease, had a significantly improved 3-year survival of 46% compared with 19% in nonvaccinated patients treated with ipilimumab alone (p=0.007. Conclusion. Improved survival in patients attaining a strong DTH and increased response rate with subsequent ipilimumab suggests that the autologous vaccine confers protective immunity.

  15. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse

    DEFF Research Database (Denmark)

    Raemaekers, John M M; André, Marc P E; Federico, Massimo

    2014-01-01

    PURPOSE: Combined-modality treatment is standard treatment for patients with clinical stage I/II Hodgkin lymphoma (HL). We hypothesized that an early positron emission tomography (PET) scan could be used to adapt treatment. Therefore, we started the randomized EORTC/LYSA/FIL Intergroup H10 trial ...

  16. Absence of TGF-βRII predicts bone and lung metastasis and is associated with poor prognosis in stage III breast tumors

    DEFF Research Database (Denmark)

    Paiva, Carlos Eduardo; Serrano, Sérgio Vicente; Paiva, Bianca Sakamoto Ribeiro

    2012-01-01

    of TGF-βRII in BC samples. TGF-βRII protein expression was evaluated using immunohistochemistry on a tissue microarray containing 110 TNM stage III BC samples obtained prior to doxorubicin-based neoadjuvant chemotherapy (NAC). Our results demonstrate that TGF-βRII did not predict the response to NAC...

  17. DPYD Genotyping to Predict Adverse Events Following Treatment With Flourouracil-Based Adjuvant Chemotherapy in Patients With Stage III Colon Cancer

    DEFF Research Database (Denmark)

    Boige, Valérie; Vincent, Marc; Alexandre, Philippe;

    2016-01-01

    , Setting, and Participants: Pharmacogenetic substudy of 1545 patients who participated from December 2005 to November 2009 in the European Pan-European Trials in Alimentary Tract Cancer (PETACC)-8 randomized phase 3 clinical trial. Interventions: Patients with resected stage III CC were randomized...

  18. Validating NEXRAD MPE and Stage III precipitation products for uniform rainfall on the Upper Guadalupe River Basin of the Texas Hill Country

    Science.gov (United States)

    Wang, Xianwei; Xie, Hongjie; Sharif, Hatim; Zeitler, Jon

    2008-01-01

    SummaryThis study examines the performance of the Next Generation Weather Radar (NEXRAD) Multisensor Precipitation Estimator (MPE) and Stage III precipitation products, using a high-density rain gauge network located on the Upper Guadalupe River Basin of the Texas Hill Country. As point-area representativeness error of gauge rainfall is a major concern in assessment of radar rainfall estimation, this study develops a new method to automatically select uniform rainfall events based on coefficient of variation criterion of 3 by 3 radar cells. Only gauge observations of those uniform rainfall events are used as ground truth to evaluate radar rainfall estimation. This study proposes a new parameter probability of rain detection (POD) instead of the conditional probability of rain detection (CPOD) commonly used in previous studies to assess the capability that a radar or gauge detects rainfall. Results suggest that: (1) gauge observations of uniform rainfall better represent ground truth of a 4 × 4 km 2 radar cell than non-uniform rainfall; (2) the MPE has higher capability of rain detection than either gauge-only or Stage III; (3) the MPE has much higher linear correlation and lower mean relative difference with gauge measurements than the Stage III does; (4) the Stage III tends to overestimate precipitation (20%), but the MPE tends to underestimate (7%).

  19. The value of pre operative S-100B and SUV in clinically stage III melanoma patients undergoing therapeutic lymph node dissection

    NARCIS (Netherlands)

    Kruijff, S.; Bastiaannet, E.; Speijers, M. J.; Kobold, A. C. M.; Brouwers, A. H.; Hoekstra, H. J.

    2011-01-01

    Introduction: High preoperative serum S-100B values and Standardized Uptake Values (SUV) of Fluorodeoxyglucose (FDG) in PET for clinically stage III melanoma patients could be indicators of recurrence after surgical treatment. Aim was to assess the correlation and the prognostic value of these marke

  20. Accelerated split-course (Type B) thoracic radiation therapy plus vinorelbine/carboplatin combination chemotherapy in Stage III inoperable non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Iaffaioli, R.V.; Tortoriello, A.; Facchini, G.; Maccauro, M.; Dimitri, P. [Cagliari Univ. (Italy). Ist. Medicina Interna; Caponigro, F. [Istituto Medico Legale, Milan (Italy); Ravo, V.; Muto, P. [Naples Univ. (Italy). Ist. Scienze Radiologiche; Crovella, F. [Ospedale Oliveto, Citra (Italy). Div. Chirurgia Generale

    1996-10-01

    43 patients with stage III NSCLC (non-small cell lung cancer) entered a phase II study aimed at evaluating the toxicity and the activity of a combined modality programme including an accelerated split-course schedule (type B) of thoracic radiation therapy and a combination chemotherapy with vinorelbine and carboplatin. An objective response was achieved in 18/42 evaluable patients (5 complete and 13 partial responses), for an overall response rate of 43% (95% confidence interval, 28-58%). Four complete responses had a duration which exceeded 16 months. Treatment was well tolerated; grade III myelotoxicity occurred in only 14% of patients and treatment was delayed in only 2 cases because of grade 3 oesophagitis. Both tolerability and efficacy data suggest that this regimen holds promise for the treatment of patients with stage III NSCLC. (author).

  1. Fleet Planning Decision-Making: Two-Stage Optimization with Slot Purchase

    Directory of Open Access Journals (Sweden)

    Lay Eng Teoh

    2016-01-01

    Full Text Available Essentially, strategic fleet planning is vital for airlines to yield a higher profit margin while providing a desired service frequency to meet stochastic demand. In contrast to most studies that did not consider slot purchase which would affect the service frequency determination of airlines, this paper proposes a novel approach to solve the fleet planning problem subject to various operational constraints. A two-stage fleet planning model is formulated in which the first stage selects the individual operating route that requires slot purchase for network expansions while the second stage, in the form of probabilistic dynamic programming model, determines the quantity and type of aircraft (with the corresponding service frequency to meet the demand profitably. By analyzing an illustrative case study (with 38 international routes, the results show that the incorporation of slot purchase in fleet planning is beneficial to airlines in achieving economic and social sustainability. The developed model is practically viable for airlines not only to provide a better service quality (via a higher service frequency to meet more demand but also to obtain a higher revenue and profit margin, by making an optimal slot purchase and fleet planning decision throughout the long-term planning horizon.

  2. Optimal control for predicting customized drug dosage for superovulation stage of in vitro fertilization.

    Science.gov (United States)

    Yenkie, Kirti M; Diwekar, Urmila

    2014-08-21

    in vitro fertilization (IVF) is one of the most highly pursued assisted reproductive technologies (ART) worldwide. IVF procedure is divided into four stages: Superovulation, Egg-retrieval, Insemination/Fertilization and Embryo transfer. Among these superovulation is the most crucial stage since it involves external injection of hormones to stimulate development and maturation of multiple follicles or oocytes. Although numerous advancements have been made in IVF procedures, little attention has been given to modifying the existing protocols based on a 'patient specific' predictive model. A model for follicle growth and number change as a function of the injected hormones and patient characteristics has been developed and validated for data available on 50 superovulation cycles. The model has 9 patient specific parameters which can be determined from the initial 2 days of observation and can help in projecting the superovulation outcome for the ongoing cycle. Based on this model, the dosage of the hormones to stimulate multiple ovulation or follicle growth is predicted by using the theory of optimal control. The objective of successful superovulation is to obtain maximum number of mature oocytes/follicles within a particular size range. Using the mathematical model of follicle growth dynamics and optimal control theory, optimal dose and frequency of medication customized for each patient (n=5) is predicted for obtaining the desired result. The results indicate a better final day follicle size distribution when the dosage of the hormones is varied by some amounts as compared to the actual dosage given to the patient in the existing cycles. This ensures a better success rate for the superovulation cycles and reduces the costs of excess medication and daily monitoring. The idea is to provide the medical practitioners with a guideline for planned treatment, for a procedure currently based on trial and error in order to get better success rates. Copyright © 2014 Elsevier

  3. The D-Optimality Item Selection Criterion in the Early Stage of CAT: A Study with the Graded Response Model

    Science.gov (United States)

    Passos, Valeria Lima; Berger, Martijn P. F.; Tan, Frans E. S.

    2008-01-01

    During the early stage of computerized adaptive testing (CAT), item selection criteria based on Fisher"s information often produce less stable latent trait estimates than the Kullback-Leibler global information criterion. Robustness against early stage instability has been reported for the D-optimality criterion in a polytomous CAT with the…

  4. Frontostriatal Cognitive Staging in Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Raúl de la Fuente-Fernández

    2012-01-01

    Full Text Available Cognitive impairment and behavioural disorders are often encountered in subjects with Parkinson's disease (PD. A simple PD-related frontostriatal cognitive dysfunction (PDFCD staging is proposed. Executive dysfunction and mental fatigue (stage I, depression/anxiety (stage IIa, apathy/pain (stage IIb, and dementia (stage III reflect a sequential process of dopamine depletion occurring in different regions of the striatum (stages I and II and the frontal cortex (stage III. In addition to these nonmotor manifestations present in the unmedicated (OFF state, the PDFCD model also predicts a number of complications related to dopaminergic treatment (ON state, from impulse control disorders (stages I and IIa to hallucinations (stage IIb and psychosis (stage III. Although the model admittedly needs further refinements, it provides a framework for hypothesis testing and may help clinicians optimize therapeutic strategies.

  5. Coupling Optimization Design and Experimental Study on Stable Isotope 13C Separation of the Double-stage Cascade

    OpenAIRE

    TIAN Ye-sheng;LI Hu-lin;JIANG Yong-yue;LONG Lei;JI Yong-zhe;ZHOU Jian-yue

    2016-01-01

    A coupling optimization design and experimental study method with uniform experimental and Aspen process simulation was established in this paper, which was used for stable isotope 13C separation of the double-stage cascade. Based on the above method, the optimization operating parameters were received. The coupling optimization simulation value showed good agreement with the experimental dates, and the average relative error was only 6.5%. On the other hand, compared with the initial test re...

  6. Oncotype DX(®) colon cancer assay for prediction of recurrence risk in patients with stage II and III colon cancer: A review of the evidence.

    Science.gov (United States)

    You, Y Nancy; Rustin, Rudolph B; Sullivan, James D

    2015-06-01

    Advances in molecular biology have enabled identification of tumor biomarkers that allow for individualized risk assessment for patients with cancer. Molecular predictors of clinical outcome can help inform discussion regarding the role of adjuvant chemotherapy in patients with resected colon cancer, such as those with stage II colon cancer in which the benefit of adjuvant therapy is controversial or those with stage III colon cancer who may have a lower risk of recurrence and less absolute benefit from oxaliplatin therapy. This article summarizes the data surrounding the development, validation, and clinical and economic utility of the Oncotype DX(®) colon cancer assay, a multigene expression assay validated to independently predict recurrence risk in patients with stage II and III colon cancer beyond traditional factors.

  7. Radiotherapy alone for stage I-III low grade follicular lymphoma: long-term outcome and comparison of extended field and total nodal irradiation

    Directory of Open Access Journals (Sweden)

    Guckenberger Matthias

    2012-06-01

    Full Text Available Abstract Background To analyze long-term results of radiotherapy alone for stage I-III low grade follicular lymphoma and to compare outcome after extended field irradiation (EFI and total nodal irradiation (TNI. Methods and materials Between 1982 and 2007, 107 patients were treated with radiotherapy alone for low grade follicular lymphoma at Ann Arbor stage I (n = 50, II (n = 36 and III (n = 21; 48 and 59 patients were treated with EFI and TNI, respectively. The median total dose in the first treatment series of the diaphragmatic side with larger lymphoma burden was 38 Gy (25 Gy – 50 Gy and after an interval of median 30 days, a total dose of 28 Gy (12.6 Gy – 45 Gy was given in the second treatment series completing TNI. Results After a median follow-up of 14 years for living patients, 10-years and 15-years overall survival (OS were 64% and 50%, respectively. Survival was not significantly different between stages I, II and III. TNI and EFI resulted in 15-years OS of 65% and 34% but patients treated with TNI were younger, had better performance status and higher stage of disease compared to patients treated with EFI. In multivariate analysis, only age at diagnosis (p  Conclusions Radiotherapy alone for stage I and II follicular lymphoma resulted in long-term OS with high rates of disease control; no benefit of TNI over EFI was observed. For stage III follicular lymphoma, TNI achieved promising OS and FFP and should be considered as a potentially curative treatment option.

  8. Trypanosoma cruzi alkaline 2-DE: Optimization and application to comparative proteome analysis of flagellate life stages

    Directory of Open Access Journals (Sweden)

    Santana Jaime M

    2008-09-01

    Full Text Available Abstract Background Trypanosoma cruzi, a flagellate protozoan, is the etiological agent of Chagas disease, a chronic illness that causes irreversible damage to heart and digestive tract in humans. Previous 2-DE analyses of T. cruzi proteome have not focused on basic proteins, possibly because of inherent difficulties for optimizing 2-DE in the alkaline pH range. However, T. cruzi wide pH range 2-DE gels have shown few visible spots in the alkaline region, indicating that the parasite either did not have an appreciable amount of alkaline proteins or that these proteins were underrepresented in the 2-DE gels. Results Different IEF conditions using 6–11 pH gradient strips were tested for separation of T. cruzi alkaline proteins. The optimized methodology described here was performed using anodic "paper bridge" sample loading supplemented by increased concentration of DTT and Triton X-100 on Multiphor II (GE Healthcare equipment and an electrode pad embedded in DTT- containing solution near the cathode in order to avoid depletion of reducing agent during IEF. Landmark proteins were identified by peptide mass fingerprinting allowing the production of an epimastigote 2-DE map. Most identified proteins corresponded to metabolic enzymes, especially those related to amino acid metabolism. The optimized 2-DE protocol was applied in combination with the "two-in-one gel" method to verify the relative expression of the identified proteins between samples from epimastigote and trypomastigote life stages. Conclusion High resolution 2-DE gels of T. cruzi life forms were achieved using the optimized methodology and a partial epimastigote alkaline 2-DE map was built. Among 700 protein spots detected, 422 were alkaline with a pI above 7.0. The "two-in-one gel" method simplified the comparative analysis between T. cruzi life stages since it minimized variations in spot migration and silver-stained spot volumes. The comparative data were in agreement with

  9. SWOG S0221: A Phase III Trial Comparing Chemotherapy Schedules in High-Risk Early-Stage Breast Cancer

    Science.gov (United States)

    Budd, George T.; Barlow, William E.; Moore, Halle C.F.; Hobday, Timothy J.; Stewart, James A.; Isaacs, Claudine; Salim, Muhammad; Cho, Jonathan K.; Rinn, Kristine J.; Albain, Kathy S.; Chew, Helen K.; Burton, Gary V.; Moore, Timothy D.; Srkalovic, Gordan; McGregor, Bradley A.; Flaherty, Lawrence E.; Livingston, Robert B.; Lew, Danika L.; Gralow, Julie R.; Hortobagyi, Gabriel N.

    2015-01-01

    Purpose To determine the optimal dose and schedule of anthracycline and taxane administration as adjuvant therapy for early-stage breast cancer. Patients and Methods A 2 × 2 factorial design was used to test two hypotheses: (1) that a novel continuous schedule of doxorubicin-cyclophosphamide was superior to six cycles of doxorubicin-cyclophosphamide once every 2 weeks and (2) that paclitaxel once per week was superior to six cycles of paclitaxel once every 2 weeks in patients with node-positive or high-risk node-negative early-stage breast cancer. With 3,250 patients, a disease-free survival (DFS) hazard ratio of 0.82 for each randomization could be detected with 90% power with two-sided α = .05. Overall survival (OS) was a secondary outcome. Results Interim analyses crossed the futility boundaries for demonstrating superiority of both once-per-week regimens and once-every-2-weeks regimens. After a median follow-up of 6 years, a significant interaction developed between the two randomization factors (DFS P = .024; OS P = .010) in the 2,716 patients randomly assigned in the original design, which precluded interpretation of the two factors separately. Comparing all four arms showed a significant difference in OS (P = .040) but not in DFS (P = .11), with all treatments given once every 2 weeks associated with the highest OS. This difference in OS seemed confined to patients with hormone receptor–negative/human epidermal growth factor receptor 2 (HER2) –negative tumors (P = .067), with no differences seen with hormone receptor–positive/HER2-negative (P = .90) or HER2-positive tumors (P = .40). Conclusion Patients achieved a similar DFS with any of these regimens. Subset analysis suggests the hypothesis that once-every-2-weeks dosing may be best for patients with hormone receptor–negative/HER2-negative tumors. PMID:25422488

  10. Using Complete Squares Method to Optimize Replenishment Policies in a Four-Stage Supply Chain with Planned Backorders

    Directory of Open Access Journals (Sweden)

    M. E. Seliaman

    2011-01-01

    Full Text Available We develop a four-stage, serial supply chain inventory model with planned backorders. This supply chain model is formulated for the integer multipliers coordination mechanism, where firms at the same stage of the supply chain use the same cycle time and the cycle time at each stage is an integer multiplier of the cycle time used at the adjacent downstream stage. We develop an optimal replenishment policy using a simple algebraic method to solve the problem without the use of differential calculus.

  11. Multi-stage approach for structural damage detection problem using basis pursuit and particle swarm optimization

    Science.gov (United States)

    Gerist, Saleheh; Maheri, Mahmoud R.

    2016-12-01

    In order to solve structural damage detection problem, a multi-stage method using particle swarm optimization is presented. First, a new spars recovery method, named Basis Pursuit (BP), is utilized to preliminarily identify structural damage locations. The BP method solves a system of equations which relates the damage parameters to the structural modal responses using the sensitivity matrix. Then, the results of this stage are subsequently enhanced to the exact damage locations and extents using the PSO search engine. Finally, the search space is reduced by elimination of some low damage variables using micro search (MS) operator embedded in the PSO algorithm. To overcome the noise present in structural responses, a method known as Basis Pursuit De-Noising (BPDN) is also used. The efficiency of the proposed method is investigated by three numerical examples: a cantilever beam, a plane truss and a portal plane frame. The frequency response is used to detect damage in the examples. The simulation results demonstrate the accuracy and efficiency of the proposed method in detecting multiple damage cases and exhibit its robustness regarding noise and its advantages compared to other reported solution algorithms.

  12. Hydraulic design to optimize the treatment capacity of Multi-Stage Filtration units

    Science.gov (United States)

    Mushila, C. N.; Ochieng, G. M.; Otieno, F. A. O.; Shitote, S. M.; Sitters, C. W.

    2016-04-01

    Multi-Stage Filtration (MSF) can provide a robust treatment alternative for surface water sources of variable water quality in rural communities at low operation and maintenance costs. MSF is a combination of Slow Sand Filters (SSFs) and Pre-treatment systems. The general objective of this research was to optimize the treatment capacity of MSF. A pilot plant study was undertaken to meet this objective. The pilot plant was monitored for a continuous 98 days from commissioning till the end of the project. Three main stages of MSF namely: The Dynamic Gravel Filter (DGF), Horizontal-flow Roughing Filter (HRF) and SSF were identified, designed and built. The response of the respective MSF units in removal of selected parameters guiding drinking water quality such as microbiological (Faecal and Total coliform), Suspended Solids, Turbidity, PH, Temperature, Iron and Manganese was investigated. The benchmark was the Kenya Bureau (KEBS) and World Health Organization (WHO) Standards for drinking water quality. With respect to microbiological raw water quality improvement, MSF units achieved on average 98% Faecal and 96% Total coliform removal. Results obtained indicate that implementation of MSF in rural communities has the potential to increase access to portable water to the rural populace with a probable consequent decrease in waterborne diseases. With a reduced down time due to illness, more time would be spent in undertaking other economic activities.

  13. Two-stage transcriptional reprogramming in Saccharomyces cerevisiae for optimizing ethanol production from xylose.

    Science.gov (United States)

    Cao, Limin; Tang, Xingliang; Zhang, Xinyuan; Zhang, Jingtao; Tian, Xuelei; Wang, Jingyu; Xiong, Mingyong; Xiao, Wei

    2014-07-01

    Conversion of lignocellulosic material to ethanol is a major challenge in second generation bio-fuel production by yeast Saccharomyces cerevisiae. This report describes a novel strategy named "two-stage transcriptional reprogramming (TSTR)" in which key gene expression at both glucose and xylose fermentation phases is optimized in engineered S. cerevisiae. Through a combined genome-wide screening of stage-specific promoters and the balancing of the metabolic flux, ethanol yields and productivity from mixed sugars were significantly improved. In a medium containing 50g/L glucose and 50g/L xylose, the top-performing strain WXY12 rapidly consumed glucose within 12h and within 84h it consistently achieved an ethanol yield of 0.48g/g total sugar, which was 94% of the theoretical yield. WXY12 utilizes a KGD1 inducible promoter to drive xylose metabolism, resulting in much higher ethanol yield than a reference strain using a strong constitutive PGK1 promoter. These promising results validate the TSTR strategy by synthetically regulating the xylose assimilation pathway towards efficient xylose fermentation.

  14. A two-stage method to determine optimal product sampling considering dynamic potential market.

    Science.gov (United States)

    Hu, Zhineng; Lu, Wei; Han, Bing

    2015-01-01

    This paper develops an optimization model for the diffusion effects of free samples under dynamic changes in potential market based on the characteristics of independent product and presents a two-stage method to figure out the sampling level. The impact analysis of the key factors on the sampling level shows that the increase of the external coefficient or internal coefficient has a negative influence on the sampling level. And the changing rate of the potential market has no significant influence on the sampling level whereas the repeat purchase has a positive one. Using logistic analysis and regression analysis, the global sensitivity analysis gives a whole analysis of the interaction of all parameters, which provides a two-stage method to estimate the impact of the relevant parameters in the case of inaccuracy of the parameters and to be able to construct a 95% confidence interval for the predicted sampling level. Finally, the paper provides the operational steps to improve the accuracy of the parameter estimation and an innovational way to estimate the sampling level.

  15. OPTIMAL POSITION OF THE HEEL FOLLOWING RECONSTRUCTION OF THE STAGE II ADULT ACQUIRED FLATFOOT DEFORMITY

    Science.gov (United States)

    Conti, Matthew S.; Ellis, Scott J.; Chan, Jeremy Y.; Do, Huong T.; Deland, Jonathan T.

    2016-01-01

    Background While previous work has demonstrated a linear relationship between the amount of medializing calcaneal osteotomy (MCO) and the change in radiographic hindfoot alignment following reconstruction, an ideal postoperative hindfoot alignment has yet to be reported. The aim of this study was to identify an optimal postoperative hindfoot alignment by correlating radiographic alignment with patient outcomes. Methods Fifty-five feet in 55 patients underwent flatfoot reconstruction for stage II AAFD by two fellowship-trained foot and ankle orthopedic surgeons. Hindfoot alignment was determined as previously described by Saltzman and El-Khoury. Changes in pre- and postoperative scores in each FAOS subscale were calculated for patients in postoperative hindfoot valgus (≥0 mm valgus, n=18), mild varus (>0 to 5 mm varus, n=17), and moderate varus (>5 mm varus, n=20). Analysis of variance and post-hoc Tukey’s tests were used to compare the change in FAOS scores between these three groups. Results At 22 months or more postoperatively, patients corrected to mild hindfoot varus showed a significantly greater improvement in the FAOS pain subscale compared to patients in valgus (p=0.04) and symptoms subscale compared to patients in moderate varus (p=0.03). Although mild hindfoot varus did not differ significantly from moderate varus or valgus in the other subscales, mild hindfoot varus did not perform worse than these alignments in any FAOS subscale. No statistically significant correlations between intraoperative MCO slide distances and FAOS subscales were found. Conclusions Our study indicates that correction of hindfoot alignment to between 0 and 5 mm of varus on the hindfoot alignment view (clinically a straight heel) following stage II flatfoot reconstruction was associated with the greatest improvement in clinical outcomes following hindfoot reconstruction in stage II AAFD. PMID:25948692

  16. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan; Blomqvist, Lennart; Swift, Ian; Sebag-Montefiore, David J; Tekkis, Paris; Brown, Gina

    2011-04-01

    To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy. Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined "good" prognosis tumors. "Good" prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated. Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.

  17. Short-Term Multi-Stage Stochastic Optimization of Hydropower Reservoirs Under Meteorological Uncertainty

    Science.gov (United States)

    Schwanenberg, D.; Naumann, S.; Allen, C.

    2014-12-01

    Hydroelectric power systems are characterized by variability and uncertainty in yield and water resources obligations. Market volatility and the growing number of operational constraints for flood control, navigation, environmental obligations and ancillary services (including load balancing requirements for renewable resources) further the need to quantify sources of uncertainty. This research presents an integrated framework to handle several sources of uncertainty. Main focus is on the meteorological forecast uncertainty based on deterministic and probabilistic Numerical Weather Predictions (NWP), its consistent propagation through load and streamflow forecasts, and the generation of scenario trees with novel multi-dimensional distance metrics. The scenario trees enable us to extend a deterministic optimization setup to a multi-stage stochastic optimization approach as the mathematical formulation of the short-term system management. The Federal Columbia River Power System (FCRPS), managed by the Bonneville Power Administration, the US Army Corps of Engineers and the Bureau of Reclamation, serves as a large-scale test case for the application of the new framework. We proof the feasibility of the new approach and verify the operational applicability within a real-time environment.

  18. Maximizing DNA profiling success from sub-optimal quantities of DNA: a staged approach.

    Science.gov (United States)

    Roeder, Amy D; Elsmore, Paul; Greenhalgh, Matt; McDonald, Andrew

    2009-03-01

    Obtaining genetic profiles from samples containing minimal amounts of DNA can be difficult. In forensic science, the vast majority of genetic profiles are generated using commercial kits that have been optimized for the amplification of a specific range of DNA concentrations. DNA extracted from many forensic samples falls below the kit manufacturers' specified concentrations either because there is not enough total DNA in the extract or the extract is so dilute that not enough volume of the extract can be added to the PCR. In order to develop a method to maximize SGM Plus and Identifiler profiling success from samples with sub-optimal quantities of DNA, thermocycle numbers and/or the amount of PCR product injected during capillary electrophoresis (termed Enhancement) of PCR products were increased. Increasing the number of thermocycles from 28 to 30 and/or two phases of Enhancement of both 28 and 30 thermocycle PCR products resulted in an increased number of scorable peaks. As expected with low template amounts of DNA, many of the samples showed allelic drop-out, heterozygote imbalances and sporadic, large stutter peaks. Enhancement decreased the amount of allelic drop-out observed and did not affect stutter peak or heterozygous peak height ratios. Although the PCR reactions from these samples should always be replicated before a reportable consensus profile is reached, Phase 1 and 2 Enhancement can maximize the profiling success from each reaction. Finally, a flexible, staged approach using 28 or 30 thermocycle PCR in combination with the Enhancement techniques described here is proposed for processing samples with sub-optimal quantities of DNA.

  19. A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients

    Energy Technology Data Exchange (ETDEWEB)

    Oberije, Cary, E-mail: cary.oberije@maastro.nl [Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht (Netherlands); De Ruysscher, Dirk [Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht (Netherlands); Universitaire Ziekenhuizen Leuven, KU Leuven (Belgium); Houben, Ruud [Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht (Netherlands); Heuvel, Michel van de; Uyterlinde, Wilma [Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands); Deasy, Joseph O. [Memorial Sloan Kettering Cancer Center, New York (United States); Belderbos, Jose [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands); Dingemans, Anne-Marie C. [Department of Pulmonology, University Hospital Maastricht, Research Institute GROW of Oncology, Maastricht (Netherlands); Rimner, Andreas; Din, Shaun [Memorial Sloan Kettering Cancer Center, New York (United States); Lambin, Philippe [Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht (Netherlands)

    2015-07-15

    Purpose: Although patients with stage III non-small cell lung cancer (NSCLC) are homogeneous according to the TNM staging system, they form a heterogeneous group, which is reflected in the survival outcome. The increasing amount of information for an individual patient and the growing number of treatment options facilitate personalized treatment, but they also complicate treatment decision making. Decision support systems (DSS), which provide individualized prognostic information, can overcome this but are currently lacking. A DSS for stage III NSCLC requires the development and integration of multiple models. The current study takes the first step in this process by developing and validating a model that can provide physicians with a survival probability for an individual NSCLC patient. Methods and Materials: Data from 548 patients with stage III NSCLC were available to enable the development of a prediction model, using stratified Cox regression. Variables were selected by using a bootstrap procedure. Performance of the model was expressed as the c statistic, assessed internally and on 2 external data sets (n=174 and n=130). Results: The final multivariate model, stratified for treatment, consisted of age, gender, World Health Organization performance status, overall treatment time, equivalent radiation dose, number of positive lymph node stations, and gross tumor volume. The bootstrapped c statistic was 0.62. The model could identify risk groups in external data sets. Nomograms were constructed to predict an individual patient's survival probability ( (www.predictcancer.org)). The data set can be downloaded at (https://www.cancerdata.org/10.1016/j.ijrobp.2015.02.048). Conclusions: The prediction model for overall survival of patients with stage III NSCLC highlights the importance of combining patient, clinical, and treatment variables. Nomograms were developed and validated. This tool could be used as a first building block for a decision support system.

  20. Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Jegadeesh, Naresh; Rajpara, Raj; Esiashvili, Natia; Shi, Zheng [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Liu, Yuan [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia (United States); Okwan-Duodu, Derrick [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Flowers, Christopher R. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2015-05-01

    Purpose: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials: Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. Results: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV≥15 (P=.10). Conclusions: Advanced-stage DLBCL patients with stage III disease or with disease ≥5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy.

  1. The effect of optimal space allowance on growth performance and physiological responses of pigs at different stages of growth.

    Science.gov (United States)

    Kim, K H; Kim, K S; Kim, J E; Kim, D W; Seol, K H; Lee, S H; Chae, B J; Kim, Y H

    2017-03-01

    This study was conducted to determine the optimal space allowance for maximizing the growth performance of pigs at each of the following five growth stages (based on BW ranges): stage 1, 11 to 25 kg BW; stage 2, 25 to 45 kg BW; stage 3, 45 to 65 kg BW; stage 4, 65 to 85 kg BW; and stage 5, 85 to 110 kg BW. A total of 1590 crossbred (Landrace×Yorkshire×Duroc) pigs were assigned to one of four treatments at each growth stage, with three replicates each. Pen areas at each growth stage were 6, 11, 16, 19.5 and 20 m2 for stages 1 to 5, respectively. Space allowances for the four treatments at each growth stage were modified by varying the number of pigs per pen (22, 25, 28 and 31 pigs in T1, T2, T3 and T4, respectively). Blood samples were collected on the final day of each growth stage. The average daily gain (ADG) decreased significantly with decreased space allowances at all growth stages, except at stage 2. Average daily feed intake (ADFI) was not significantly affected by space allowances at stages 1 to 4; however, at stage 5, there was a linear effect of space allowance on ADFI. Thus, the feed conversion ratio showed results similar to those for ADG. Serum cortisol concentrations, indicating the level of stress response, increased as space allowances decreased. The highest serum cortisol concentrations were observed in T3 at stages 2 to 5. Serum tumor necrosis factor-α levels were significantly higher in association with a small space allowance than with at large space allowance at stages 2, 4 and 5. Serum interleukin-1β levels also increased in a significant linear manner at every growth stage in pigs reared at a low space allowance, except at stage 4 (P=0.068). This study found that limited space allowance decreases the growth performance of pigs and induces stress and inflammatory responses. We confirmed that no significant effect of space allowance on growth performance and serum cortisol concentrations are observed between T1 and T2 across all growth

  2. Adaptive Urban Stormwater Management Using a Two-stage Stochastic Optimization Model

    Science.gov (United States)

    Hung, F.; Hobbs, B. F.; McGarity, A. E.

    2014-12-01

    In many older cities, stormwater results in combined sewer overflows (CSOs) and consequent water quality impairments. Because of the expense of traditional approaches for controlling CSOs, cities are considering the use of green infrastructure (GI) to reduce runoff and pollutants. Examples of GI include tree trenches, rain gardens, green roofs, and rain barrels. However, the cost and effectiveness of GI are uncertain, especially at the watershed scale. We present a two-stage stochastic extension of the Stormwater Investment Strategy Evaluation (StormWISE) model (A. McGarity, JWRPM, 2012, 111-24) to explicitly model and optimize these uncertainties in an adaptive management framework. A two-stage model represents the immediate commitment of resources ("here & now") followed by later investment and adaptation decisions ("wait & see"). A case study is presented for Philadelphia, which intends to extensively deploy GI over the next two decades (PWD, "Green City, Clean Water - Implementation and Adaptive Management Plan," 2011). After first-stage decisions are made, the model updates the stochastic objective and constraints (learning). We model two types of "learning" about GI cost and performance. One assumes that learning occurs over time, is automatic, and does not depend on what has been done in stage one (basic model). The other considers learning resulting from active experimentation and learning-by-doing (advanced model). Both require expert probability elicitations, and learning from research and monitoring is modelled by Bayesian updating (as in S. Jacobi et al., JWRPM, 2013, 534-43). The model allocates limited financial resources to GI investments over time to achieve multiple objectives with a given reliability. Objectives include minimizing construction and O&M costs; achieving nutrient, sediment, and runoff volume targets; and community concerns, such as aesthetics, CO2 emissions, heat islands, and recreational values. CVaR (Conditional Value at Risk) and

  3. Neoadjuvant Doxorubicin/Cyclophosphamide Followed by Ixabepilone or Paclitaxel in Early Stage Breast Cancer and Evaluation of βIII-Tubulin Expression as a Predictive Marker

    Science.gov (United States)

    Tseng, Ling-Ming; Chan, Stephen; Chacko, Raju T.; Campone, Mario; Manikhas, Alexy; Nag, Shona M.; Leichman, Cynthia G.; Dasappa, Lokanatha; Fasching, Peter A.; Hurtado de Mendoza, Fernando; Symmans, W. Fraser; Liu, David; Mukhopadhyay, Pralay; Horak, Christine; Xing, Guan; Pusztai, Lajos

    2013-01-01

    Background. This randomized phase II trial was designed to compare the rate of pathologic complete response (pCR) induced by neoadjuvant cyclophosphamide plus doxorubicin (AC) followed by ixabepilone or paclitaxel in women with early stage breast cancer (BC). Expression of βIII-tubulin as a predictive marker was also evaluated. Patients and Methods. Women with untreated, histologically confirmed primary invasive breast adenocarcinoma received four cycles of AC followed by 1:1 randomization to either ixabepilone 40 mg/m2 (3-hour infusion) every 3 weeks for four cycles (n = 148) or weekly paclitaxel 80 mg/m2 (1-hour infusion) for 12 weeks (n = 147). All patients underwent a core needle biopsy of the primary cancer for molecular marker analysis prior to chemotherapy. βIII-Tubulin expression was assessed using immunohistochemistry. Results. There was no significant difference in the rate of pCR in the ixabepilone treatment arm (24.3%; 90% confidence interval [CI], 18.6–30.8) and the paclitaxel treatment arm (25.2%; 90% CI, 19.4–31.7). βIII-Tubulin-positive patients obtained higher pCR rates compared with βIII-tubulin-negative patients in both treatment arms; however, βIII-tubulin expression was not significantly associated with a differential response to ixabepilone or paclitaxel. The safety profiles of both regimens were generally similar, although neutropenia occurred more frequently in the ixabepilone arm (grade 3/4: 41.3% vs. 8.4%). The most common nonhematologic toxicity was peripheral neuropathy. Conclusions. Neoadjuvant treatment of early stage BC with AC followed by ixabepilone every 3 weeks or weekly paclitaxel was well tolerated with no significant difference in efficacy. Higher response rates were observed among βIII-tubulin-positive patients. PMID:23853246

  4. Rapidly alternating combination of cisplatin-based chemotherapy and hyperfractionated accelerated radiotherapy in split course for Stage IIIA and Stage IIIB non-small cell lung cancer: results of a Phase I-II study by the GOTHA group

    Energy Technology Data Exchange (ETDEWEB)

    Alberto, P.; Mermillod, B. [Hopital Cantonal Geneve, Geneva (Switzerland); Mirimanoff, R.O.; Leyvraz, S.; Nagy-Mignotte, H.; Bolla, M.; Wellmann, D.; Moro, D.; Brambilla, E. [Hopital Cantonal Universitaire, Lausanne (Switzerland)

    1995-08-01

    The prognosis of stage III non-small cell lung cancer (NSCLC) can be improved by a combination of radiotherapy (RT) and chemotherapy (CT). In this study, the GOTHA group evaluated the feasibility, tolerance, tumour response, pattern of failure and effect on survival of a combination alternating accelerated hyperfractionated (AH) RT and CT in patients with tumour stage III NSCLC. Toxic effects were leucopenia, nausea and vomiting, mucositis, diarrhoea, alopecia and peripheral neuropathy. Alternating CT and AHRT, as used in this study, were well tolerated and allowed full dose delivery within less than 12 weeks. Initial response was not predictive of survival. The survival curve is encouraging and the 5 year survival is superior to the 5% generally observed with conventionally fractionated radiotherapy. (author).

  5. Concurrent pemetrexed and radiation therapy in the treatment of patients with inoperable stage III non-small cell lung cancer: a systematic review of completed and ongoing studies.

    Science.gov (United States)

    Choy, Hak; Gerber, David E; Bradley, Jeffrey D; Iyengar, Puneeth; Monberg, Matthew; Treat, Joseph; Govindan, Ramaswamy; Koustensis, Andrew; Barker, Scott; Obasaju, Coleman

    2015-03-01

    Current standard for locally advanced non-small cell lung cancer (NSCLC) is combined concurrent therapy with a platinum-based regimen. Preclinical synergistic activity of pemetrexed with radiation therapy (RT) and favorable toxicity profile has led to clinical trials evaluating pemetrexed in chemoradiation regimens. This literature search of concurrent pemetrexed and RT treatment of patients with stage III NSCLC included MEDLINE database, meeting abstracts, and the clinical trial registry database. Nineteen unique studies were represented across all databases including 11 phase I studies and eight phase II studies. Of the six phase II trials with mature data available, median overall survival ranged from 18.7 to 34 months. Esophagitis and pneumonitis occurred in 0-16% and 0-23% of patients, respectively. Of the ongoing trials, there is one phase III and four phase II trials with pemetrexed in locally advanced NSCLC. Pemetrexed can be administered safely at full systemic doses with either cisplatin or carboplatin concomitantly with radical doses of thoracic radiation therapy. While results from the ongoing phase III PROCLAIM trial are needed to address definitively the efficacy of pemetrexed-cisplatin plus RT in stage III NSCLC, available results from phase II trials suggest that this regimen has promising activity with an acceptable toxicity profile.

  6. Semi-longitudinal Study of the Mcnamara Cephalometric Triangle in Class II and Class III Subjects Grouped by Cervical Vertebrae Maturation Stage.

    Science.gov (United States)

    Arriola-Guillén, Luis E; Fitzcarrald, Fernando D; Flores-Mir, Carlos

    2015-12-01

    The aim was to compare the McNamara cephalometric triangle values in untreated normodivergent Class II and Class III malocclusion subjects of Latin American origin grouped by cervical vertebrae maturation stage to an untreated Class I malocclusion normodivergent control group. The study was conducted on a sample of 610 pretreatment lateral cephalograms (250 male, 360 female), examined and grouped according to their anteroposterior skeletal relationship (Class I, II or III), cervical vertebrae maturation stage (Pre Pubertal Peak P1 = CS1 and CS2, Pubertal Peak P2= CS3 and CS4, and Post Pubertal Peak P3 = CS5 and CS6) and sex. Co-A, Co-Gn and ENA-Me were measured in each lateral cephalogram. ANOVA and Tukey HSD post-hoc tests were performed to determine differences between the groups. The results showed that in males, the greatest maxillary and mandibular dimensional increases occurred during the P3 stage (CS5 to CS6), while in females, they occurred in the P2 stage (CS3 to CS4). The Co-A and Co-Gn showed significant differences between the malocclusion classes (pClass II subjects and the mandibular lengths in Class III subjects were already higher at the beginning of the period evaluated (P1). A worsening trend for the Class II and III malocclusions was identified during the period evaluated. Finally, changes in the McNamara cephalometric triangle values were markedly different in the three normodivergent skeletal malocclusion classes. In these Latin American subjects the pubertal growth spurt occurred at different times with respect to the Caucasian and Asian norms.

  7. Detailed stratification of TNM stage III rectal cancer based on the presence/absence of extracapsular invasion of the metastatic lymph nodes.

    Science.gov (United States)

    Komori, Koji; Kanemitsu, Yukihide; Kimura, Kenya; Sano, Tsuyoshi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Shimizu, Yasuhiro

    2013-06-01

    The presence/absence of extracapsular invasion in metastatic lymph nodes has been reported as being significantly correlated with the prognosis in a wide variety of cancers. However, the influence of extracapsular invasion in the metastatic lymph nodes on the prognosis in patients with stage III rectal cancer has not yet been investigated. We investigated the presence/absence of extracapsular invasion in the metastatic nodes of the relevant main/lateral lymph node group in patients with rectal cancer to determine the usefulness of this parameter for stratifying the prognosis of patients with stage III rectal cancer. This was a single-institution study. This study was conducted at a single institution. We enrolled 101 consecutive patients with stage III rectal cancer who had undergone curative surgery with extended lymph node dissection and investigated the presence/absence of extracapsular invasion in the regional metastatic lymph nodes to determine the usefulness of such stratification for a more precise prediction of the patient prognosis. The main outcomes measured were the disease-free and overall survival rates. Univariate analysis revealed a significantly poorer prognosis, in terms of both the disease-free survival rate (p = 0.003) and overall survival rate (p = 0.008), of the pN3-extracapsular invasion-positive cases in comparison with the pN3-extracapsular invasion-negative cases. Multivariate analysis revealed the presence/absence of extracapsular invasion in the metastatic lymph nodes as the only variable that was statistically significantly associated with the disease-free survival rate (p = 0.011). This was a retrospective study in a small number of patients from a single institution. There were no comparator groups. Detailed stratification of pN3 cases based on the presence/absence of extracapsular invasion in metastatic lymph nodes has the potential to contribute significantly to more available prediction of the prognosis of patients with stage III

  8. INFLUENCE OF AXIAL COMPRESSOR STAGE SPATIAL OPTIMIZATION ON THRUST-ECONOMICAL CHARACTERISTICS OF CARGO AIRCRAFT GAS TURBINE ENGINE

    Directory of Open Access Journals (Sweden)

    L.G. Volyanskaya

    2005-02-01

    Full Text Available  The article considers the research results of D-27 gas turbine engine thrust-economical characteristics change due to of axial compressor flow path optimization. The applied procedure of optimization takes into account a difference in the shapes of axial compressor stage blades at rest and design mode, redistribution of kinetic energy losses along the blade height. The estimation of parameters of a gas flow in the stage flow path is made by the solution of Navier-Stokes equation complete set.

  9. The influence of Thomson effect in the performance optimization of a two stage thermoelectric cooler

    Science.gov (United States)

    Kaushik, S. C.; Manikandan, S.

    2015-12-01

    The exoreversible and irreversible thermodynamic models of a two stage thermoelectric cooler (TTEC) considering Thomson effect in conjunction with Peltier, Joule and Fourier heat conduction effects have been investigated using exergy analysis. New expressions for the interstage temperature, optimum current for the maximum cooling power, energy and exergy efficiency conditions, energy efficiency and exergy efficiency of a TTEC are derived as well. The number of thermocouples in the first and second stages of a TTEC for the maximum cooling power, energy and exergy efficiency conditions are optimized. The results show that the exergy efficiency is lower than the energy efficiency e.g., in an irreversible TTEC with total 30 thermocouples, heat sink temperature (TH) of 300 K and heat source temperature (TC) of 280 K, the obtained maximum cooling power, maximum energy and exergy efficiency are 20.37 W, 0.7147 and 5.10% respectively. It has been found that the Thomson effect increases the cooling power and energy efficiency of the TTEC system e.g., in the exoreversible TTEC the cooling power and energy efficiency increased from 14.87 W to 16.36 W and from 0.4079 to 0.4998 respectively for ΔTC of 40 K when Thomson effect is considered. It has also been found that the heat transfer area at the hot side of an irreversible TTEC should be higher than the cold side for maximum performance operation. This study will help in the designing of the actual multistage thermoelectric cooling systems.

  10. A Three-Stage Optimization Algorithm for the Stochastic Parallel Machine Scheduling Problem with Adjustable Production Rates

    Directory of Open Access Journals (Sweden)

    Rui Zhang

    2013-01-01

    Full Text Available We consider a parallel machine scheduling problem with random processing/setup times and adjustable production rates. The objective functions to be minimized consist of two parts; the first part is related with the due date performance (i.e., the tardiness of the jobs, while the second part is related with the setting of machine speeds. Therefore, the decision variables include both the production schedule (sequences of jobs and the production rate of each machine. The optimization process, however, is significantly complicated by the stochastic factors in the manufacturing system. To address the difficulty, a simulation-based three-stage optimization framework is presented in this paper for high-quality robust solutions to the integrated scheduling problem. The first stage (crude optimization is featured by the ordinal optimization theory, the second stage (finer optimization is implemented with a metaheuristic called differential evolution, and the third stage (fine-tuning is characterized by a perturbation-based local search. Finally, computational experiments are conducted to verify the effectiveness of the proposed approach. Sensitivity analysis and practical implications are also discussed.

  11. Hard to heal pressure ulcers (stage III-IV): efficacy of injected activated macrophage suspension (AMS) as compared with standard of care (SOC) treatment controlled trial.

    Science.gov (United States)

    Zuloff-Shani, Adi; Adunsky, Abraham; Even-Zahav, Aviva; Semo, Haim; Orenstein, Arie; Tamir, Jeremy; Regev, Eli; Shinar, Eilat; Danon, David

    2010-01-01

    The objective of this study was to compare local injections of AMS with SOC treatments for stage III and IV pressure ulcers in elderly patients. It was designed as historically prospective 2-arms non-parallel open controlled trial, and conducted in a department of geriatric medicine and rehabilitation of a university affiliated tertiary hospital. We studied 100 consecutive elderly patients with a total of 216 stage III or IV pressure ulcers, 66 patients were assigned to the AMS group and had their wounds injected, while 38 patients were assigned to the SOC group. Primary outcome was rate of complete wound closure. Time to complete wound closure and 1-year mortality served as secondary outcomes. Statistical analyses were performed at both patient and wound levels. Percentage of completely closed wounds (wound level and patient level) were significantly better (pAMS, as well as in the subset of diabetic patients (pAMS proved significantly better for the subset of those with leg ulcers and with baseline wounds ≤15 cm(2), compared with SOC. There were no statistically significant differences with regard to time to complete closure or 1-year mortality rates in the two groups. It is concluded that there is a significant difference in favor of stage III and IV wound closure rates by AMS, as compared with SOC treatments.

  12. Predictors for locoregional recurrence for clinical stage III-N2 non-small cell lung cancer with nodal downstaging after induction chemotherapy and surgery.

    Science.gov (United States)

    Amini, Arya; Lou, Feiran; Correa, Arlene M; Baldassarre, Randall; Rimner, Andreas; Huang, James; Roth, Jack A; Swisher, Stephen G; Vaporciyan, Ara A; Lin, Steven H

    2013-06-01

    Pathologic downstaging following chemotherapy for stage III-N2 NSCLC is a well-known positive prognostic indicator. However, the predictive factors for locoregional recurrence (LRR) in these patients are largely unknown. Between 1998 and 2008, 153 patients with clinically or pathologically staged III-N2 NSCLC from two cancer centers in the United States were treated with induction chemotherapy and surgery. All had pathologic N0-1 disease, and none received postoperative radiotherapy. LRR were defined as recurrence at the surgical site, lymph nodes (levels 1-14 including supraclavicular), or both. Median follow-up was 39.3 months. Pretreatment N2 status was confirmed pathologically (18.2 %) or by PET/CT (81.8 %). Overall, the 5-year LRR rate was 30.8 % (n = 38), with LRR being the first site of failure in 51 % (22/+99877943). Five-year overall survival for patients with LRR compared with those without was 21 versus 60.1 % (p recurrence (p = 0.021, HR 1.91, 95 % CI 1.1-3.3) but only trended for poorer survival (p = 0.123, HR 1.48, 95 % CI 0.9-2.44). LRR remains high in resected stage III-N2 NSCLC patients after induction chemotherapy and nodal downstaging, particularly in patients with persistent N1 disease.

  13. THERAPEUTIC DIFFICULTIES IN ACHIEVEMENT OF OPTIMAL ROOT COVERAGE AND AESTHETIC IN CLASS III GINGIVAL RECESSION.

    Directory of Open Access Journals (Sweden)

    Christina Popova

    2013-07-01

    Full Text Available The width of the attached gingiva is defined as a distance between the depth of the gingival sulcus or gingival/periodontal pocket to the mucogingival junction. Authors suggest that a minimal amount of attached gingiva is necessary to ensure the gingival health. When the buccal bone plate and gingival tissues are thin and the position of the tooth is too vestibular gingival margin often displaces apically, and gingival recession develops. In the presence of gingival recession and reduced vestibular depth oral hygiene procedures are embarrassed.The definition of class III gingival recession is marginal lack of tissue extended to/or beyond the mucogingival junction with bone and soft tissue loss interdentally or malpositioning of the tooth.Prognosis for class III and IV gingival recession is that only partial coverage can be expected after root coverage procedures - FGG (free gingival graft or connective tissue graft (CTG. Adjunctive surgical techniques would be helpful to achieve better aesthetic outcomes.

  14. Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Evangelista, Laura; Cervino, Anna Rita [Veneto Institute of Oncology IOV - IRCCS, Radiotherapy and Nuclear Medicine Unit, Padua (Italy); Ghiotto, Cristina; Guarneri, Valentina; Conte, Pierfranco [Veneto Institute of Oncology IOV - IRCCS, Medical Oncology 2 Unit, Padua (Italy); Saibene, Tania; Michieletto, Silvia; Fernando, Bozza [Veneto Institute of Oncology IOV - IRCCS, Breast Unit, Padua (Italy); Orvieto, Enrico [University Hospital of Padua, Department of Pathology, Padua (Italy)

    2015-10-15

    We investigated whether maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG) and whole-body (WB) SUVmax, WB MTV and WB TLG measured by {sup 18}F-FDG PET/CT could improve prognostic stratification in patients with stage II/III breast cancer (BC). We prospectively enrolled 99 consecutive women (median age 50 years, range 27 - 77 years) with pathologically proven stage II/III BC who underwent pretreatment FDG PET/CT. WB SUVmax, WB MTV and WB TLG were measured in all malignant lesions. Survival was analysed using the Kaplan-Meier method. Cox proportional hazards models were constructed to test for relationships among WB SUVmax, WB MTV, WB TLG, and overall survival (OS) and disease-free survival (DFS), after adjustment for age, and histopathological and immunohistochemical features (oestrogen/progesterone and HER2 expression, proliferation index and grade). The median values of WB SUVmax, WB MTV and WB TLG were 16.2 (range 1.5 - 33.1), 14 cm{sup 3} (range 0.03 - 708.6 cm{sup 3}) and 62.5 (0.06 - 3869.4), respectively. All WB semiquantitative values were higher in patients with higher TNM stage, although not significantly (all p > 0.05). The median follow-up for surviving patients was 30 months, with a range of 13 - 45 months. Both PFS and OS of patients with low WB SUVmax, WB MTV and WB TLG were longer than that of patients with high WB values for progression, although not statistically significant. However, stratifying the patients in accordance with the stage of disease, both PFS and OS were significantly lower in patients with high WB TLG and stage III than in patients with stage II (p < 0.05). In multivariate analyses, WB MTV and WB TLG were independent prognostic factors for PFS (hazard ratio 1.004, 95 % confidence interval 1.002 - 1.006, p < 0.001, and hazard ratio 1.001, 95 % confidence interval 1.000 - 1.001, p = 0.011, respectively). The addition of WB TLG to clinical data may provide a more detailed

  15. Two-stage collaborative global optimization design model of the CHPG microgrid

    Science.gov (United States)

    Liao, Qingfen; Xu, Yeyan; Tang, Fei; Peng, Sicheng; Yang, Zheng

    2017-06-01

    With the continuous developing of technology and reducing of investment costs, renewable energy proportion in the power grid is becoming higher and higher because of the clean and environmental characteristics, which may need more larger-capacity energy storage devices, increasing the cost. A two-stage collaborative global optimization design model of the combined-heat-power-and-gas (abbreviated as CHPG) microgrid is proposed in this paper, to minimize the cost by using virtual storage without extending the existing storage system. P2G technology is used as virtual multi-energy storage in CHPG, which can coordinate the operation of electric energy network and natural gas network at the same time. Demand response is also one kind of good virtual storage, including economic guide for the DGs and heat pumps in demand side and priority scheduling of controllable loads. Two kinds of storage will coordinate to smooth the high-frequency fluctuations and low-frequency fluctuations of renewable energy respectively, and achieve a lower-cost operation scheme simultaneously. Finally, the feasibility and superiority of proposed design model is proved in a simulation of a CHPG microgrid.

  16. Optimizing culture conditions for free-living stages of the nematode parasite Strongyloides ratti.

    Science.gov (United States)

    Dulovic, Alex; Puller, Vadim; Streit, Adrian

    2016-09-01

    The rat parasitic nematode Strongyloides ratti (S. ratti) has recently emerged as a model system for various aspects of parasite biology and evolution. In addition to parasitic parthenogenetic females, this species can also form facultative free-living generations of sexually reproducing adults. These free-living worms are bacteriovorous and grow very well when cultured in the feces of their host. However, in fecal cultures the worms are rather difficult to find for observation and experimental manipulation. Therefore, it has also been attempted to raise S. ratti on Nematode Growth Media (NGM) plates with Escherichia coli OP50 as food, exactly as described for the model nematode Caenorhabditis elegans. Whilst worms did grow on these plates, their longevity and reproductive output compared to fecal cultures were dramatically reduced. In order to improve the culture success we tested other plates occasionally used for C. elegans and, starting from the best performing one, systematically varied the plate composition, the temperature and the food in order to further optimize the conditions. Here we present a plate culturing protocol for free-living stages of S. ratti with strongly improved reproductive success and longevity.

  17. High direct drive illumination uniformity achieved by multi-parameter optimization approach: a case study of Shenguang III laser facility.

    Science.gov (United States)

    Tian, Chao; Chen, Jia; Zhang, Bo; Shan, Lianqiang; Zhou, Weimin; Liu, Dongxiao; Bi, Bi; Zhang, Feng; Wang, Weiwu; Zhang, Baohan; Gu, Yuqiu

    2015-05-04

    The uniformity of the compression driver is of fundamental importance for inertial confinement fusion (ICF). In this paper, the illumination uniformity on a spherical capsule during the initial imprinting phase directly driven by laser beams has been considered. We aim to explore methods to achieve high direct drive illumination uniformity on laser facilities designed for indirect drive ICF. There are many parameters that would affect the irradiation uniformity, such as Polar Direct Drive displacement quantity, capsule radius, laser spot size and intensity distribution within a laser beam. A novel approach to reduce the root mean square illumination non-uniformity based on multi-parameter optimizing approach (particle swarm optimization) is proposed, which enables us to obtain a set of optimal parameters over a large parameter space. Finally, this method is applied to improve the direct drive illumination uniformity provided by Shenguang III laser facility and the illumination non-uniformity is reduced from 5.62% to 0.23% for perfectly balanced beams. Moreover, beam errors (power imbalance and pointing error) are taken into account to provide a more practical solution and results show that this multi-parameter optimization approach is effective.

  18. Optimal III-nitride HEMTs: from materials and device design to compact model of the 2DEG charge density

    Science.gov (United States)

    Li, Kexin; Rakheja, Shaloo

    2017-02-01

    In this paper, we develop a physically motivated compact model of the charge-voltage (Q-V) characteristics in various III-nitride high-electron mobility transistors (HEMTs) operating under highly non-equilibrium transport conditions, i.e. high drain-source current. By solving the coupled Schrödinger-Poisson equation and incorporating the two-dimensional electrostatics in the channel, we obtain the charge at the top-of-the-barrier for various applied terminal voltages. The Q-V model accounts for cutting off of the negative momenta states from the drain terminal under high drain-source bias and when the transmission in the channel is quasi-ballistic. We specifically focus on AlGaN and AlInN as barrier materials and InGaN and GaN as the channel material in the heterostructure. The Q-V model is verified and calibrated against numerical results using the commercial TCAD simulator Sentaurus from Synopsys for a 20-nm channel length III-nitride HEMT. With 10 fitting parameters, most of which have a physical origin and can easily be obtained from numerical or experimental calibration, the compact Q-V model allows us to study the limits and opportunities of III-nitride technology. We also identify optimal material and geometrical parameters of the device that maximize the carrier concentration in the HEMT channel in order to achieve superior RF performance. Additionally, the compact charge model can be easily integrated in a hierarchical circuit simulator, such as Keysight ADS and CADENCE, to facilitate circuit design and optimization of various technology parameters.

  19. Performance of 15-Stage Experimental J71 Axial-Flow Compressor. III - Effects of Inlet-Guide-Vane Adjustment

    Science.gov (United States)

    Lucas, James G.; Filippi, Richard E.

    1955-01-01

    The stall-limit line at low speeds was improved somewhat by closing the inlet guide vanes 6 deg, while the design-speed maximum flow and pressure ratio were reduced. The first-stage characteristic curve was moved to lower values of both flog coefficient and equivalent pressure ratio. The second-stage pressure ratio was decreased slightly at high speeds, while the later stages were unaffected.

  20. Coupling Optimization Design and Experimental Study on Stable Isotope 13C Separation of the Double-stage Cascade

    Directory of Open Access Journals (Sweden)

    TIAN Ye-sheng;LI Hu-lin;JIANG Yong-yue;LONG Lei;JI Yong-zhe;ZHOU Jian-yue

    2016-08-01

    Full Text Available A coupling optimization design and experimental study method with uniform experimental and Aspen process simulation was established in this paper, which was used for stable isotope 13C separation of the double-stage cascade. Based on the above method, the optimization operating parameters were received. The coupling optimization simulation value showed good agreement with the experimental dates, and the average relative error was only 6.5%. On the other hand, compared with the initial test result, the 13C abundance of optimized experimental was 14.1%, and the actual growth rate of 13C abundance was more than 25%. More importantly, The optimization experimental did not increase energy consumption. The method confirmed by the experiment could provide a solid foundation for the cascade process of 13C industrialization, and it could also be applied to other traditional distillation industry.

  1. Research on Operation Strategy for Bundled Wind-thermal Generation Power Systems Based on Two-Stage Optimization Model

    Science.gov (United States)

    Sun, Congcong; Wang, Zhijie; Liu, Sanming; Jiang, Xiuchen; Sheng, Gehao; Liu, Tianyu

    2017-05-01

    Wind power has the advantages of being clean and non-polluting and the development of bundled wind-thermal generation power systems (BWTGSs) is one of the important means to improve wind power accommodation rate and implement “clean alternative” on generation side. A two-stage optimization strategy for BWTGSs considering wind speed forecasting results and load characteristics is proposed. By taking short-term wind speed forecasting results of generation side and load characteristics of demand side into account, a two-stage optimization model for BWTGSs is formulated. By using the environmental benefit index of BWTGSs as the objective function, supply-demand balance and generator operation as the constraints, the first-stage optimization model is developed with the chance-constrained programming theory. By using the operation cost for BWTGSs as the objective function, the second-stage optimization model is developed with the greedy algorithm. The improved PSO algorithm is employed to solve the model and numerical test verifies the effectiveness of the proposed strategy.

  2. Reduced expression of cyclin D2 is associated with poor recurrence-free survival independent of cyclin D1 in stage III non-small cell lung cancer.

    Science.gov (United States)

    Ko, Eunkyung; Kim, Yujin; Park, Seong-Eun; Cho, Eun Yoon; Han, Jungho; Shim, Young Mog; Park, Joobae; Kim, Duk-Hwan

    2012-08-01

    Compared to well-known function of cyclin D1 in lung cancer, the role of cyclin D2 is not clear. This study was aimed at understanding the clinicopathological significance of cyclin D2 in primary non-small cell lung cancer (NSCLC). We retrospectively analyzed expression statuses of cyclin D1, cyclin D2, p16, p21, p27, Ki-67, and phospho-pRb (Ser-807/811) using immunohistochemistry in 626 NSCLCs. Cyclin D2 was expressed in normal lung tissue, and its expression was reduced in 170 (27%) of 626 NSCLCs with a median duration of follow-up of 64 months. Mean phospho-pRb (Ser-807/811) levels were not associated with expression levels of cyclin D2 (P=0.15). The relationship between recurrence and the reduced expression of cyclin D2 was not homogenous by stage (Breslow-Day test for homogeneity, P=0.04). Reduced expression of cyclin D2 was not associated with patient's prognosis in 370 stage I, 112 stage II, and 18 stage IV NSCLCs. However, for 126 stage III NSCLCs, reduced expression of cyclin D2 was adversely associated with recurrence-free survival (RFS) (hazard ratio [HR]=3.71, 95% CI=1.54-13.17; P=0.01), independent of histology and expression of cyclin D1. The reduced expression of cyclin D2 was not associated with the overexpression of cyclin D1 (P=0.65). The present study suggests that reduced expression of cyclin D2 in stage III NSCLC may be associated with poor RFS. And, cyclin D2 may have a distinct role from cyclin D1 in NSCLC. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Impact of Consolidation Radiation Therapy in Stage III-IV Diffuse Large B-cell Lymphoma With Negative Post-Chemotherapy Radiologic Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Dorth, Jennifer A., E-mail: jennifer.dorth@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Broadwater, Gloria [Cancer Statistical Center, Duke University Medical Center, Durham, North Carolina (United States); Diehl, Louis F.; Beaven, Anne W. [Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina (United States); Coleman, R. Edward [Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, North Carolina (United States); Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-11-01

    Purpose: While consolidation radiation therapy (i.e., RT administered after chemotherapy) is routine treatment for patients with early-stage diffuse large B-cell lymphoma (DLBCL), the role of consolidation RT in stage III-IV DLBCL is controversial. Methods and Materials: Cases of patients with stage III-IV DLBCL treated from 1991 to 2009 at Duke University, who achieved a complete response to chemotherapy were reviewed. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model. Results: Seventy-nine patients were identified. Chemotherapy (median, 6 cycles) consisted of anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 65%); cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP; 22%); or other (13%). Post-chemotherapy imaging consisted of positron emission tomography (PET)/computed tomography (CT) (73%); gallium with CT (14%); or CT only (13%). Consolidation RT (median, 25 Gy) was given to involved sites of disease in 38 (48%) patients. Receipt of consolidation RT was associated with improved in-field control (92% vs. 69%, respectively, p = 0.028) and event-free survival (85% vs. 65%, respectively, p = 0.014) but no difference in overall survival (85% vs. 78%, respectively, p = 0.15) when compared to patients who did not receive consolidation RT. On multivariate analysis, no RT was predictive of increased risk of in-field failure (hazard ratio [HR], 8.01, p = 0.014) and worse event-free survival (HR, 4.3, p = 0.014). Conclusions: Patients with stage III-IV DLBCL who achieve negative post-chemotherapy imaging have improved in-field control and event-free survival with low-dose consolidation RT.

  4. Outcome Study of Cobalt Based Stereotactic Body Radiation Therapy for Patients with Inoperable Stage III Non-small Cell Lung Cancer.

    Science.gov (United States)

    Wang, Yingjie; Lan, Fengming; Kang, Xiaoli; Shao, Yinjian; Li, Hongqi; Li, Ping; Wu, Weizhang; Wang, Jidong; Chang, Dongshu; Wang, Yong; Xia, Tingyi

    2015-10-01

    Aim of this paper is to retrospectively evaluate the efficacy and toxicity of specialized Body Cobalt based system (BCBS) treatment in the senior patients group (.65 years) with Stage III non-small cell lung carcinoma (NSCLC). A total of 49 patients (41 males and 8 females) with Stage III NSCLC according to UICC TNM classification (6(th) edition) were treated using OUR-QGD™ BCBS which was designed and manufactured in China. Post treatment evaluation with follow-up information was collected from April 2001 to December 2006 in our department. Median age of enrolled patients was 71 years old (65-85). Among those patients, 36 patients were pathologically identified with squamous cell carcinoma, and the other 13 patients were confirmed as adenocarcinoma. All patients were immobilized by vacuum based immobilization mold and then performed slow CT scan without any respiration gating devices. The daily radiation prescription dose was defined at 50% isodose line covering primary lesions and metastatic lymph nodes with doses from 2.5 to 6 Gy in 5 fractions per week according to the tumor stage and internally approved treatment protocols by the Institutional Review Board (IRB). Median daily dose and total delivery dose of 50% isodose line were 4 Gy and 41 Gy, respectively. In this study group, total of 3 patients received neoadjuvant cisplatin-based chemotherapy. Tumor response evaluated 12 weeks after radiation has demonstrated 13 complete responses (26.5%), 21 partial responses (42.9%). The overall survival (OS) rate of 1-year, 2-year and 3-year was 63.3%, 40.8% and 20.4%, respectively. The median and mean survival time was 22 and 24 months. All 49 patients tolerated the treatment well and have completed the planned therapy regiment. Body Cobalt based system treatment of those over 65 years old patients with Stage III NSCLC had reasonable and superior curative effect as well as local control, and at the same time without severe radiation side effects.

  5. A Two-Stage Robust Optimization for Centralized-Optimal Dispatch of Photovoltaic Inverters in Active Distribution Networks

    DEFF Research Database (Denmark)

    Ding, Tao; Li, Cheng; Yang, Yongheng

    2017-01-01

    Optimally dispatching Photovoltaic (PV) inverters is an efficient way to avoid overvoltage in active distribution networks, which may occur in the case of PV generation surplus load demand. Typically, the dispatching optimization objective is to identify critical PV inverters that have the most...... significant impact on the network voltage level. Following, it ensures the optimal set-points of both active power and reactive power for the selected inverters, guaranteeing the entire system operating constraints (e.g., the network voltage magnitude) within reasonable ranges. However, the intermittent...... against any possible realization within the uncertain PV outputs. In addition, the conic relaxation-based branch flow formulation and second-order cone programming based column-and-constraint generation algorithm are employed to deal with the proposed robust optimization model. Case studies on a 33-bus...

  6. Optimizing two- and three-stage designs for spatial inventories of natural resources by simulated annealing

    NARCIS (Netherlands)

    Brus, D.J.; Jansen, M.J.W.; Gruijter, de J.J.

    2002-01-01

    This paper reviews design-based estimators for two-stage and three-stage sampling designs to estimate the mean of finite populations. This theory is then extended to spatial populations with continuous, infinite populations of sampling units at the latter stages. We then assume that the spatial patt

  7. Optimizing two- and three-stage designs for spatial inventories of natural resources by simulated annealing

    NARCIS (Netherlands)

    Brus, D.J.; Jansen, M.J.W.; Gruijter, de J.J.

    2002-01-01

    This paper reviews design-based estimators for two-stage and three-stage sampling designs to estimate the mean of finite populations. This theory is then extended to spatial populations with continuous, infinite populations of sampling units at the latter stages. We then assume that the spatial

  8. A randomized phase III trial of adjuvant chemotherapy with irinotecan, leucovorin and fluorouracil versus leucovorin and fluorouracil for stage II and III colon cancer: A Hellenic Cooperative Oncology Group study

    Directory of Open Access Journals (Sweden)

    Efstratiou Ioannis

    2011-01-01

    Full Text Available Abstract Background Colon cancer is a public health problem worldwide. Adjuvant chemotherapy after surgical resection for stage III colon cancer has been shown to improve both progression-free and overall survival, and is currently recommended as standard therapy. However, its value for patients with stage II disease remains controversial. When this study was designed 5-fluorouracil (5FU plus leucovorin (LV was standard adjuvant treatment for colon cancer. Irinotecan (CPT-11 is a topoisomerase I inhibitor with activity in metastatic disease. In this multicenter adjuvant phase III trial, we evaluated the addition of irinotecan to weekly 5FU plus LV in patients with stage II or III colon cancer. Methods The study included 873 eligible patients. The treatment consisted of weekly administration of irinotecan 80 mg/m2 intravenously (IV, LV 200 mg/m2 and 5FU 450 mg/m2 bolus (Arm A versus LV 200 mg/m2 and 5FU 500 mg/m2 IV bolus (Arm B. In Arm A, treatments were administered weekly for four consecutive weeks, followed by a two-week rest, for a total of six cycles, while in Arm B treatments were administered weekly for six consecutive weeks, followed by a two-week rest, for a total of four cycles. The primary end-point was disease-free survival (DFS at three years. Results The probability of overall survival (OS at three years was 0.88 for patients in Arm A and 0.86 for those in Arm B, while the five-year OS probability was 0.78 and 0.76 for patients in Arm A and Arm B, respectively (P = 0.436. Furthermore, the probability of DFS at three years was 0.78 and 0.76 for patients in Arm A and Arm B, respectively (P = 0.334. With the exception of leucopenia and neutropenia, which were higher in patients in Arm A, there were no significant differences in Grades 3 and 4 toxicities between the two regimens. The most frequently recorded Grade 3/4 toxicity was diarrhea in both treatment arms. Conclusions Irinotecan added to weekly bolus 5FU plus LV did not result

  9. Detection of internal mammary lymph node metastasis with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Min Jung; Lee, Jong Jin; Kim, Hye Ok; Chae, Sun-Young; Ryu, Jin-Sook; Moon, Dae Hyuk [University of Ulsan College of Medicine, Asan Medical Center, Department of Nuclear Medicine, Songpa-gu, Seoul (Korea, Republic of); Park, Seol Hoon [Ulsan University Hospital, Department of Nuclear Medicine, Ulsan (Korea, Republic of); Ahn, Sei Hyun; Lee, Jong Won; Son, Byung Ho [University of Ulsan College of Medicine, Asan Medical Center, Department of Surgery, Seoul (Korea, Republic of); Gong, Gyung-Yub [University of Ulsan College of Medicine, Asan Medical Center, Department of Pathology, Seoul (Korea, Republic of)

    2014-03-15

    The present study assessed the positive predictive value (PPV) of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of internal mammary node (IMN) metastasis in patients with clinical stage III breast cancer. Patients who were diagnosed with clinical stage III breast cancer and underwent pretreatment {sup 18}F-FDG PET/CT were retrospectively analyzed. The {sup 18}F-FDG PET/CT scans were prospectively reviewed by two board-certified nuclear medicine physicians in a blinded manner. The intensities of IMNs were graded into four categories (no activity and lower, similar, and higher activities than that of the mediastinal blood pool). IMNs were measured from the combined CT (largest diameter of the short axis). Histologic data of the IMNs were obtained by ultrasonography-guided fine-needle aspiration biopsy or surgical excision. The PPV was calculated for pathologically confirmed IMNs. Visual grade, maximum standardized uptake values (SUV{sub max}), and sizes were analyzed according to the pathology results. There were 249 clinical stage III breast cancer patients (age 48.0 ± 10.1 years, range 26-79 years) who had undergone initial {sup 18}F-FDG PET/CT prior to treatment. Excluding 33 cases of stage IV breast cancer, 62 of 216 patients had visible IMNs on {sup 18}F-FDG PET/CT, and histologic confirmation was obtained in 31 patients. There were 27 metastatic and four nonmetastatic nodes (PPV 87.1 %). Metastatic nodes mostly presented with visual grade 3 (83.9 %), and SUV{sub max} and size were 3.5 ± 4.3 and 5.6 ± 2.0 mm, respectively. {sup 18}F-FDG PET/CT has a high PPV for IMN metastasis in clinical stage III breast cancer, indicating the possibility of metastasis in IMNs with FDG uptake similar to/lower than that of the blood pool or small-sized nodes. (orig.)

  10. Gadolinium(III)-hydroxy ladders trapped in succinate frameworks with optimized magnetocaloric effect.

    Science.gov (United States)

    Chen, Yan-Cong; Guo, Fu-Sheng; Zheng, Yan-Zhen; Liu, Jun-Liang; Leng, Ji-Dong; Tarasenko, Róbert; Orendáč, Martin; Prokleška, Jan; Sechovský, Vladimír; Tong, Ming-Liang

    2013-09-27

    Two kinds of inorganic gadolinium(III)-hydroxy "ladders", [2×n] and [3×n], were successfully trapped in succinate (suc) coordination polymers, [Gd2(OH)2(suc)2(H2O)]n·2nH2O (1) and [Gd6(OH)8(suc)5(H2O)2 ]n·4n H2O (2), respectively. Such coordination polymers could be regarded as alternating inorganic-organic hybrid materials with relatively high density. Magnetic and heat capacity studies reveal a large cryogenic magnetocaloric effect (MCE) in both compounds, namely (ΔH=70 kG) 42.8 J kg(-1) K(-1) for complex 1 and 48.0 J kg(-1) K(-1) for complex 2. The effect of the high density is evident, which gives very large volumetric MCEs up to 120 and 144 mJ cm(-3) K(-1) for complexes 1 and 2, respectively.

  11. Concurrent radiotherapy and chemotherapy with carboplatin in patients with unresectable advanced head and neck tumors stages III and IV; Simultane Radiochemotherapie mit Carboplatin bei Patienten mit inoperablen fortgeschrittenen Kopf-Hals-Tumoren der Stadien UICC III und IV

    Energy Technology Data Exchange (ETDEWEB)

    Muecke, R.; Ziegler, P.G.; Libera, T.; Fietkau, R. [Rostock Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie; Blynow, M.; Dommerich, S.; Kramp, B. [Rostock Univ. (Germany). HNO-Klinik und Poliklinik; Kundt, G. [Rostock Univ. (Germany). Inst. fuer Medizinische Informatik und Biometrie

    1999-05-01

    Background: The results of treating advanced tumors in the head and neck region with radiotherapy alone are disappointing. Concurrent radiotherapy and chemotherapy may improve this situation. The treatment results of concurrent radiochemotherapy at the University of Rostock were analyzed retrospectively. Results: Six weeks after radiochemotherapy 56.5% of patients had a complete remission, 36% a partial remission and 7.5% `no change`. With a median follow-up of 42 months (6 to 74 months) overall survival, disease-free survival and local control were 24.3%, 28.9%, 18.0% 5 years after treatment. All these criteria were significantly better in patients with palliative tumor resection compared to no surgical treatment (uni- and multivariate) and in patients with Stage III than in patients with Stage IV carcinomas (univariate), overall survival was significantly better in patients with Stage III (multivariate). A pretherapeutic Hb level below 7.0 mmol/l (11.27 g/dl) reduced the local control significantly (uni- and multivariate). Grade III and IV mucositis was detected in 10%, Grade III leucopenia in 12% of treated patients. Grade IV leucopenia and Grade III thrombopenia were observed in 1 patient each. Conclusion: The toxicity of this treatment is tolerable. However, additional trials must be conducted before considering the palliative tumor resection as standard therapy. (orig./AJ) [Deutsch] Hintergrund: Die Therapieergebnisse der Behandlung fortgeschrittener Tumoren der Kopf-Hals-Region mit alleiniger Bestrahlung sind unbefriedigend. Eine simultane Radiochemotherapie verbessert diese Resultate vermutlich. In einer retrospektiven Analyse wurden Ergebnisse nach simultaner Radiochemotherapie an der Universitaet Rostock ausgewertet. Ergebnisse: Sechs Wochen nach Radiochemotherapie erreichten 56,5% der Patienten eine komplette und 36% der Patienten eine partielle Remission, ein `no change` war bei 7,5% der Patienten festzustellen. Bei einer medianen Beobachtungszeit von

  12. Tools for the analysis of dose optimization: III. Pointwise sensitivity and perturbation analysis.

    Science.gov (United States)

    Sobotta, B; Söhn, M; Pütz, M; Alber, M

    2008-11-21

    The major challenge in intensity-modulated radiotherapy planning is to find the right balance between tumor control and normal tissue sparing. The most desirable solution is never physically feasible, and a compromise has to be found. One possible way to approach this problem is constrained optimization. In this context, it is worthwhile to quantitatively predict the impact of adjustments of the constraints on the optimum dose distribution. This has been dealt with in regard to cost functions in a previous paper. The aim of the present paper is to introduce spatial resolution to this formalism. Our method reveals the active constraints in a target subvolume that was previously selected by the practitioner for its insufficient dose. This is useful if a multitude of constraints can be the cause of a cold spot. The response of the optimal dose distribution to an adjustment of constraints (perturbation) is predicted. We conclude with a clinical example.

  13. Tools for the analysis of dose optimization: III. Pointwise sensitivity and perturbation analysis

    Energy Technology Data Exchange (ETDEWEB)

    Sobotta, B; Soehn, M; Puetz, M; Alber, M [Abt. Medizinische Physik, Radiologische Uniklinik, Universitaet Tuebingen, 72076 Tuebingen (Germany)], E-mail: benjamin.sobotta@med.uni-tuebingen.de

    2008-11-21

    The major challenge in intensity-modulated radiotherapy planning is to find the right balance between tumor control and normal tissue sparing. The most desirable solution is never physically feasible, and a compromise has to be found. One possible way to approach this problem is constrained optimization. In this context, it is worthwhile to quantitatively predict the impact of adjustments of the constraints on the optimum dose distribution. This has been dealt with in regard to cost functions in a previous paper. The aim of the present paper is to introduce spatial resolution to this formalism. Our method reveals the active constraints in a target subvolume that was previously selected by the practitioner for its insufficient dose. This is useful if a multitude of constraints can be the cause of a cold spot. The response of the optimal dose distribution to an adjustment of constraints (perturbation) is predicted. We conclude with a clinical example.

  14. Automatic Sleep Stage Determination by Multi-Valued Decision Making Based on Conditional Probability with Optimal Parameters

    Science.gov (United States)

    Wang, Bei; Sugi, Takenao; Wang, Xingyu; Nakamura, Masatoshi

    Data for human sleep study may be affected by internal and external influences. The recorded sleep data contains complex and stochastic factors, which increase the difficulties for the computerized sleep stage determination techniques to be applied for clinical practice. The aim of this study is to develop an automatic sleep stage determination system which is optimized for variable sleep data. The main methodology includes two modules: expert knowledge database construction and automatic sleep stage determination. Visual inspection by a qualified clinician is utilized to obtain the probability density function of parameters during the learning process of expert knowledge database construction. Parameter selection is introduced in order to make the algorithm flexible. Automatic sleep stage determination is manipulated based on conditional probability. The result showed close agreement comparing with the visual inspection by clinician. The developed system can meet the customized requirements in hospitals and institutions.

  15. Prognostic impact of clinicopathologic parameters in stage II/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer

    Directory of Open Access Journals (Sweden)

    Kim Dong-Wan

    2007-11-01

    Full Text Available Abstract Background Prognostic factors in locally advanced breast cancer treated with neoadjuvant chemotherapy differ from those of early breast cancer. The purpose of this study was to identify the clinical significance of potential predictive and prognostic factors in breast cancer patients treated by neoadjuvant chemotherapy. Methods A total of 145 stage II and III breast cancer patients received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. We examined the clinical and biological factors (ER, PR, p53, c-erbB2, bcl-2, and Ki-67 by immunohistochemistry. We analyzed clinical outcome and their correlation with clinicopathologic parameters. Results Among the clinicopathologic parameters investigated, none of the marker was correlated with response rate (RR except triple negative phenotype. Patients with triple negative phenotype showed higher RR (83.0% in triple negative vs. 62.2% in non-triple negative, p = 0.012 and pathologic complete RR (17.0% in triple negative vs. 3.1% in non-triple negative, p = 0.005. However, relapse free survival (RFS and overall survival (OS were significantly shorter in triple negative breast cancer patients (p p = 0.021, respectively. Low histologic grade, positive hormone receptors, positive bcl-2 and low level of Ki-67 were associated with prolonged RFS. In addition, positive ER and positive bcl-2 were associated with prolonged OS. In our homogeneous patient population, initial clinical stage reflects RFS and OS more precisely than pathologic stage. In multivariate analysis, initial clinical stage was the only significant independent prognostic factor to impact on OS (hazard ratio 3.597, p = 0.044. Conclusion Several molecular markers provided useful predictive and prognostic information in stage II and III breast cancer patients treated with neoadjuvant docetaxel/doxorubicin chemotherapy. Triple negative phenotype was associated with shorter survival, even though it was associated

  16. Cause-specific effects of radiotherapy and lymphadenectomy in stage I-II endometrial cancer: a population-based study.

    Science.gov (United States)

    Mell, Loren K; Carmona, Ruben; Gulaya, Sachin; Lu, Tina; Wu, John; Saenz, Cheryl C; Vaida, Florin

    2013-11-06

    Radiotherapy and lymphadenectomy have been associated with improved survival in population-based studies of endometrial cancer, which is in contrast with findings from randomized trials and meta-analyses. The primary study aim was to estimate the cause-specific effects of adjuvant radiotherapy and lymphadenectomy on competing causes of mortality. We analyzed Surveillance, Epidemiology, and End Results (SEER) data from 1988 to 2006. The sample comprised 58172 patients with stage I and II endometrial adenocarcinoma. Patients were risk stratified by stage, grade, and age. Cumulative incidences and cause-specific hazards of competing causes of mortality were estimated according to treatment. All statistical tests were two-sided. Pelvic radiotherapy was associated with statistically significantly increased endometrial cancer mortality (hazard ratio [HR] = 1.66; 95% confidence interval [CI] = 1.52 to 1.82) in all stage I and II patients and decreased noncancer mortality in intermediate and high-risk stage I and II patients (HR = 0.82; 95% CI = 0.77 to 0.89). Lymphadenectomy was associated with increased endometrial cancer mortality in stage I patients (HR = 1.27; 95% CI = 1.16 to 1.39), decreased endometrial cancer mortality in stage II patients (HR = 0.61; 95% CI = 0.52 to 0.72), and decreased noncancer mortality in both stage I and II patients (HR = 0.84; 95% CI = 0.80 to 0.88). Effects of radiotherapy and lymphadenectomy on second cancer mortality varied according to risk strata. Radiotherapy and lymphadenectomy are associated with statistically significantly reduced noncancer mortality in stage I and II endometrial cancer. The improved overall survival associated with these treatments reported from SEER studies is largely attributable to their selective application in healthier patients rather than their effects on endometrial cancer.

  17. Predictive value of PET-CT for pathological response in stages II and III breast cancer patients following neoadjuvant chemotherapy with docetaxel.

    Science.gov (United States)

    García García-Esquinas, Marta A; Arrazola García, Juan; García-Sáenz, José A; Furió-Bacete, V; Fuentes Ferrer, Manuel E; Ortega Candil, Aída; Cabrera Martín, María N; Carreras Delgado, José L

    2014-01-01

    To prospectively study the value of PET-CT with fluorine-18 fluorodeoxyglucose (FDG) to predict neoadjuvant chemotherapy (NAC) response of locoregional disease of stages II and III breast cancer patients. A written informed consent and approval were obtained from the Ethics Committee. PET-CT accuracy in the prediction of pathologic complete response (pCR) after NAC was studied in primary tumors and lymph node metastasis in 43 women (mean age: 50 years: range: 27-71 years) with histologically proven breast cancer between December 2009 and January 2011. PET-CT was performed at baseline and after NAC. SUV(max) percentage changes (ΔSUV(max)) were compared with pathology findings at surgery. Receiver-operator characteristic (ROC) analysis was used to discriminate between locoregional pCR and non-pCR. In patients not achieving pCR, it was investigated if ΔSUV(max) could accurately identify the residual cancer burden (RCB) classes: RCB-I (minimal residual disease (MRD)), RCB-II (moderate RD), and RCB-III (extensive RD). pCR was obtained in 11 patients (25.6%). Residual disease was found in 32 patients (74.4%): 16 (37.2%) RCB-I, 15 (35.6%) RCB-II and 2 (4.7%) RCB-III. Sensitivity, specificity, and accuracy to predict pCR were 90.9%, 90.6%, and 90.7%, respectively. Specificity was 94.1% in the identification of a subset of patients who had either pCR or MRD. Accuracy of ΔSUV(max) in the locoregional disease of stages II and III breast cancer patients after NAC is high for the identification of pCR cases. Its specificity is potentially sufficient to identify a subgroup of patients who could be managed with conservative surgery. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  18. [Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament at stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V].

    Science.gov (United States)

    Hu, Wen-yue; Yu, Chong; Huang, Zhong-ming; Han, Lei

    2015-06-01

    To explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V . From January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects. All patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up. Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

  19. Optimization of two-stage production/inventory systems under order base stock policy with advance demand information

    Science.gov (United States)

    Nakade, Koichi; Yokozawa, Shiori

    2016-08-01

    It is important to share demand information among the members in supply chains. In recent years, production and inventory systems with advance demand information (ADI) have been discussed, where advance demand information means the information of demand which the decision maker obtains before the corresponding actual demand arrives. Appropriate production and inventory control using demand information leads to the decrease of inventory and backlog costs. For a single stage system, the optimal base stock and release lead time have been discussed in the literature. In practical production systems the manufacturing system has multiple processes. The multiple stage production and inventory system with ADI, however, has been analyzed by simulation or assuming exponential processing time. That is, their theoretical analysis and optimization of release lead time and base stock level have little been obtained because of its difficulty. In this paper, theoretical analysis of a two-stage production inventory system with advance demand information is developed, where the processing time is assumed deterministic and identical; demand arrival process is Poisson, and an order base stock policy is adopted. Using the analytical results, optimal release lead time and optimal base stock levels for minimizing the average cost on the holding and backlog costs are explicitly derived.

  20. Multi-stage optimization of decision and inhibitory trees for decision tables with many-valued decisions

    KAUST Repository

    Azad, Mohammad

    2017-06-16

    We study problems of optimization of decision and inhibitory trees for decision tables with many-valued decisions. As cost functions, we consider depth, average depth, number of nodes, and number of terminal/nonterminal nodes in trees. Decision tables with many-valued decisions (multi-label decision tables) are often more accurate models for real-life data sets than usual decision tables with single-valued decisions. Inhibitory trees can sometimes capture more information from decision tables than decision trees. In this paper, we create dynamic programming algorithms for multi-stage optimization of trees relative to a sequence of cost functions. We apply these algorithms to prove the existence of totally optimal (simultaneously optimal relative to a number of cost functions) decision and inhibitory trees for some modified decision tables from the UCI Machine Learning Repository.

  1. Lymphography and computed tomography of abdominal nodes in newly diagnosed patients with Hodgkin's disease in clinical stage I-III

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, C.H.

    1986-10-01

    Between 1978 and 1983, 80 patients with Hodgkin's disease (HD) in clinical Stage I-III had computed tomography (CT) of the abdomen and pelvis and lymphography (LAG) prior to staging laparatomy with multiple lymph node biopsies at Stanford University Medical Center. There were 224 biopsied nodal sites. The sensitivity and specificity for CT to determine the status of biopsied paraortic and iliac nodes was .61 and .91 vs. .94 and .90 for LAG. CT appeared of even lower sensitivity (.13) in evaluating splenic hilar, celiac axis and portal nodes. Including all biopsy proven subdiaphragmatic nodal sites, CT's sensitivity to diagnose the presence of subdiaphragmatic adenopathy was .38 vs. .52 in LAG. Assessment of the final pathological stage was more successful by LAG (.61) than by CT (.49). Positive and negative predictive values of both tests indicate higher reliability of LAG results as regards individual intraabdominal nodes (LAG .71, .98 vs. CT .58, .86), the entire subdiaphragmatic nodal area (LAG .79, .77 vs. CT .61, .71) and prediction of final pathological stage. LAG appeared to be the more useful test during initial staging of newly diagnosed and untreated patients with HD. None of the test for itself or in combination can replace laparatomy when exact information is necessary for further clinical decisions.

  2. Two-Stage Separation of V(IV) and Al(III) by Crystallization and Solvent Extraction from Aluminum-Rich Sulfuric Acid Leaching Solution of Stone Coal

    Science.gov (United States)

    Shi, Qihua; Zhang, Yimin; Liu, Tao; Huang, Jing; Liu, Hong

    2016-12-01

    To improve separation of V(IV) and Al(III) from aluminum-rich sulfuric acid leaching solution of stone coal, the two-stage separation by crystallization and solvent extraction methods have been developed. A co-extraction coefficient (k) was put forward to evaluate comprehensively co-extraction extent in different solutions. In the crystallization stage, 68.2% of aluminum can be removed from the solution. In the solvent extraction stage, vanadium was selectively extracted using di-2-ethylhexyl phosphoric acid/tri-n-butyl phosphate from the crystalline mother solution, followed by H2SO4 stripped efficiently. A V2O5 product with purity of 98.39% and only 0.10% Al was obtained after oxidation, precipitation, and calcination. Compared with vanadium extraction from solution without crystallization, the counter-current extraction stage of vanadium can be decreased from 6 to 3 and co-extraction coefficient (k) decreased from 2.51 to 0.58 with two-stage separation. It is suggested that the aluminum removal by crystallization can evidently weaken the influence of aluminum co-extraction on vanadium extraction and improve the selectivity of solvent extraction for vanadium.

  3. Long-term outcomes following post-operative radiotherapy for Stage I/II testicular seminoma - an Australasian single-institution experience.

    Science.gov (United States)

    Ong, Wee Loon; Nazareth, Lester; Hindson, Benjamin; Matheson, Bronwyn; Millar, Jeremy L

    2016-09-01

    The aim of the study is to review the long-term oncological outcomes and adverse effects of post-operative radiotherapy (PORT) for Stage I/II seminoma patients in an Australian radiation treatment centre. This is a retrospective study of 125 patients with Stage I/II seminoma treated with PORT at the Alfred Health Radiation Oncology Service between 1992 and 2013. Patients were linked to the Victorian Cancer Registry to enable confirmation of survival and diagnosis of secondary malignancies (SM). The relapse-free survival (RFS), testicular-cancer-specific survival (TCSS), overall survival (OS) and SM-free survival (SMFS) were estimated with Kaplan-Meier methods. The median age at diagnosis was 36 (range 20-62). The median time between diagnosis and PORT was 1.6 months (range: 0.5-4.5). Fifty patients (40%) had PORT to the para-aortic (PA) target alone, while the remaining had PORT to PA and ipsilateral or bilateral iliac lymph nodes. There were no acute adverse effects requiring admission. The median follow-up after PORT was 7.8 years (range = 0.1-19.1). There were two relapses, both of which occurred within 1 year of PORT (estimated 10-year RFS = 98.4%). Five deaths were reported, none of which were testicular cancer-related death (estimated 10-year TCSS = 100%, 10-year OS = 97.3%). There were seven SM (one lower lip cancer, one upper shoulder melanoma, one mesothelioma, two prostate cancer, one acute myeloid leukaemia and one contralateral testicular seminoma) reported in six patients, with estimated 10-year SMFS of 92.9%. Our series confirms excellent oncological outcomes among patients with Stage I/II seminoma treated with PORT, with uncommon occurrence of SM.

  4. Survival Benefit of Surgery after Chemoradiotherapy for Stage III (N0-2) Non-Small-Cell Lung Cancer Is Dependent on Pathologic Nodal Response.

    Science.gov (United States)

    Ziel, Ellis; Hermann, Gregory; Sen, Neilayan; Bonomi, Philip; Liptay, Michael J; Fidler, Mary Jo; Batus, Marta; Warren, William H; Chmielewski, Gary; Sher, David J

    2015-10-01

    The benefit of surgery (trimodality therapy [TMT]) after chemoradiotherapy (CRT) for patients with stage III non-small-cell lung cancer (NSCLC) is controversial, but nodal pathologic complete response (N-PCR) is accepted as a strong predictor of overall survival (OS). We compared the outcomes of patients treated with TMT versus CRT, focusing on the importance of N-PCR. Patients with stage III NSCLC treated with CRT or TMT from December 2004 through December 2012 were included; patients with N3 disease were excluded. Pathologic nodal response dichotomized surgical patients into N-PCR versus residual nodal disease (RND) groups. Actuarial OS, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were compared between patients treated with CRT and TMT and between CRT and N-PCR/RND. The cohort was composed of 138 patients (52% CRT and 48% TMT). The median OS was significantly higher after TMT than after CRT (81 versus 31.8 mo, p = 0.0068). This benefit was restricted to N-PCR (n = 50, 83.2 versus 31.8 mo, p = 0.0004), as RND (n = 19) experienced poor OS (16.1 mo). On multivariable analyses, N-PCR had superior OS (hazard ratio [HR], 0.38; p = 0.0012), PFS (HR, 0.42; p = 0.0005), and DMFS (HR, 0.42; p = 0.0007) compared with CRT. Conversely, there were trends for worse OS and PFS for RND versus CRT, although only inferior DMFS was significant (HR, 1.83; p = 0.04). Surgical patients with complete nodal clearance experienced superior survival, but those with RND fared no better than CRT alone. Mediastinal response may play an important role in the decision to proceed with surgical resection after CRT for stage III NSCLC.

  5. A Prospective Study of Comparing Multi-Gene Biomarker Chip and Serum Carcinoembryonic Antigen in the Postoperative Surveillance for Patients with Stage I-III Colorectal Cancer.

    Science.gov (United States)

    Chang, Yu-Tang; Huang, Ming-Yii; Yeh, Yung-Sung; Huang, Ching-Wen; Tsai, Hsiang-Lin; Cheng, Tian-Lu; Wang, Jaw-Yuan

    2016-01-01

    Circulating biomarkers can predict clinical outcomes in colorectal cancer patients. The aim of the study was to evaluate the feasibility of our multigene biomarker chip for detecting circulating tumor cells for postoperative surveillance of stage I-III colorectal cancer patients. In total, 298 stage I-III colorectal cancer patients were analyzed after curative resection between June 2010 and October 2014. During each follow-up, a postoperative surveillance strategy, including ESMO Guidelines Working Group recommendations and the biochip, was used. After a 28.4-month median follow-up, 48 (16.1%) patients had postoperative relapse. Univariate analysis revealed that the postoperative relapse risk factors were rectal tumor, perineural invasion, elevated preoperative and postoperative serum carcinoembryonic antigen levels, and positive biochip results (all P postoperative relapse correlated significantly with elevated postoperative serum carcinoembryonic antigen levels (odds ratio = 4.136, P = 0.008) and positive biochip results (odds ratio = 66.878, P sensitivity (P = 0.003), specificity (P = 0.003), positive (P = 0.002) and negative (P = 0.006) predictive values, and accuracy (P postoperative relapse were significantly higher than those of elevated postoperative serum carcinoembryonic antigen levels. Moreover, the median lead time between positive biochip result and postoperative relapse detection was significantly earlier than that between elevated postoperative serum carcinoembryonic antigen level and postoperative relapse detection (10.7 vs. 2.8 months, P postoperative relapse during stage I-III colorectal cancer patient surveillance. In clinical practice, this biochip may facilitate early postoperative relapse diagnosis in colorectal cancer patients.

  6. DNA Topoisomerase I Gene Copy Number and mRNA Expression Assessed as Predictive Biomarkers for Adjuvant Irinotecan in Stage II/III Colon Cancer

    DEFF Research Database (Denmark)

    Nygård, Sune Boris; Vainer, Ben; Nielsen, Signe L;

    2016-01-01

    (PETACC3) where patients were randomized to 5-fluorouracil/folinic acid with or without additional irinotecan. TOP1 copy number status was analyzed by fluorescence in situ hybridization (FISH) using a TOP1/CEN20 dual-probe combination. TOP1 mRNA data were available from previous analyses. RESULTS: TOP1......RNA data were available from 580 patients with stage III disease. Benefit of irinotecan was restricted to patients characterized by TOP1 mRNA expression ≥ 3rd quartile (RFS: HRadjusted, 0.59; P = .09; OS: HRadjusted, 0.44; P = 0.03). The treatment by TOP1 mRNA interaction was not statistically significant...

  7. The Impact of Extent and Location of Mediastinal Lymph Node Involvement on Survival in Stage III Non-Small Cell Lung Cancer Patients Treated With Definitive Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, Annemarie T. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Mitra, Nandita [Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA (United States); Xanthopoulos, Eric [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Evans, Tracey; Stevenson, James; Langer, Corey [Department of Medical Oncology, University of Pennsylvania, Philadelphia, PA (United States); Kucharczuk, John C. [Department of Thoracic Surgery, University of Pennsylvania, Philadelphia, PA (United States); Lin, Lilie; Rengan, Ramesh [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

    2012-05-01

    Purpose: Several surgical series have identified subcarinal, contralateral, and multilevel nodal involvement as predictors of poor overall survival in patients with Stage III non-small-cell lung cancer (NSCLC) treated with definitive resection. This retrospective study evaluates the impact of extent and location of mediastinal lymph node (LN) involvement on survival in patients with Stage III NSCLC treated with definitive radiotherapy. Methods and Materials: We analyzed 106 consecutive patients with T1-4 N2-3 Stage III NSCLC treated with definitive radiotherapy at University of Pennsylvania between January 2003 and February 2009. For this analysis, mediastinal LN stations were divided into four mutually exclusive groups: supraclavicular, ipsilateral mediastinum, contralateral mediastinum, and subcarinal. Patients' conditions were then analyzed according to the extent of involvement and location of mediastinal LN stations. Results: The majority (88%) of patients received sequential or concurrent chemotherapy. The median follow-up time for survivors was 32.6 months. By multivariable Cox modeling, chemotherapy use (hazard ratio [HR]: 0.21 [95% confidence interval (CI): 0.07-0.63]) was associated with improved overall survival. Increasing primary tumor [18F]-fluoro-2-deoxy-glucose avidity (HR: 1.11 [CI: 1.06-1.19]), and subcarinal involvement (HR: 2.29 [CI: 1.11-4.73]) were significant negative predictors of overall survival. On univariate analysis, contralateral nodal involvement (HR: 0.70 [CI: 0.33-1.47]), supraclavicular nodal involvement (HR: 0.78 [CI: 0.38-1.67]), multilevel nodal involvement (HR: 0.97 [CI: 0.58-1.61]), and tumor size (HR: 1.04 [CI: 0.94-1.14]) did not predict for overall survival. Patients with subcarinal involvement also had lower rates of 2-year nodal control (51.2% vs. 74.9%, p = 0.047) and 2-year distant control (28.4% vs. 61.2%, p = 0.043). Conclusions: These data suggest that the factors that determine oncologic outcome in Stage III

  8. Optimization of an in vitro system to study the exo-erythrocytic stage of the human malaria parasite, Plasmodium falciparum

    CSIR Research Space (South Africa)

    Rossouw, C

    2010-02-01

    Full Text Available scaffold and harvesting cells via the temperature change is currently being scaled up and a prototype bioreactor has been developed. Optimization of an in vitro system to study the exo-erythrocytic stage of the human Malaria Parasite, Plasmodium... hepatocyte line that supports in vitro development of the exo-erythrocytic stages of the malaria parasites Plasmodium falciparum and P. vivax. American Journal of Tropical Medicine and Hygeine 74:708-715. [4] Shor L, Güçeri S, Wen X, Gandhi M, Sun W. 2007...

  9. Phase II proof-of-concept study of pazopanib monotherapy in treatment-naive patients with stage I/II resectable non-small-cell lung cancer.

    Science.gov (United States)

    Altorki, Nasser; Lane, Maureen E; Bauer, Thomas; Lee, Paul C; Guarino, Michael J; Pass, Harvey; Felip, Enriqueta; Peylan-Ramu, Nili; Gurpide, Alfonso; Grannis, Frederic W; Mitchell, John D; Tachdjian, Sabrina; Swann, R Suzanne; Huff, Anne; Roychowdhury, Debasish F; Reeves, Anthony; Ottesen, Lone H; Yankelevitz, David F

    2010-07-01

    Patients with early-stage, resectable, non-small-cell lung cancer (NSCLC) are at risk for recurrent disease, and 5-year survival rates do not exceed 75%. Angiogenesis inhibitors have shown clinical activity in patients with late-stage NSCLC, raising the possibility that targeting the vascular endothelial growth factor pathway in earlier-stage disease may be beneficial. This proof-of-concept study examined safety and efficacy of short-term, preoperative pazopanib monotherapy in patients with operable stage I/II NSCLC. Patients scheduled for resection received oral pazopanib 800 mg/d for 2 to 6 weeks preoperatively. Tumor response was measured by high-resolution computed tomography, permitting estimation of change in tumor volume and diameter. Gene-expression profiling was performed on 77 pre- and post-treatment lung samples from 34 patients. Of 35 patients enrolled, 33 (94%) had clinical stage I NSCLC and two (6%) had clinical stage II NSCLC. Median treatment duration was 16 days (range, 3 to 29 days). Thirty patients (86%) achieved tumor-volume reduction after pazopanib treatment. Two patients achieved tumor-volume reduction > or = 50%, and three patients had partial response according to Response Evaluation Criteria in Solid Tumors. Pazopanib was generally well tolerated. The most common adverse events included grade 2 hypertension, diarrhea, and fatigue. One patient developed pulmonary embolism 11 days after surgery. Several pazopanib target genes and other angiogenic factors were dysregulated post-treatment. Short-duration pazopanib was generally well tolerated and demonstrated single-agent activity in patients with early-stage NSCLC. Several target genes were dysregulated after pazopanib treatment, validating target-specific response and indicating a persistent pazopanib effect on lung cancer tissue. Further clinical evaluation of pazopanib in NSCLC is planned.

  10. Optimization of the reflux ratio for a stage distillation column based on an improved particle swarm algorithm

    DEFF Research Database (Denmark)

    Ren, Jingzheng; Tan, Shiyu; Dong, Lichun

    2010-01-01

    the searching ability of basic particle swarm algorithm significantly. An example of utilizing the improved algorithm to solve the mathematical model was demonstrated; the result showed that it is efficient and convenient to optimize the reflux ratio for a distillation column by using the mathematical model......A mathematical model relating operation profits with reflux ratio of a stage distillation column was established. In order to optimize the reflux ratio by solving the nonlinear objective function, an improved particle swarm algorithm was developed and has been proved to be able to enhance...

  11. SU-E-T-57: A Novel Method to Improve Dose Heterogeneity of Target and Organs at Risk Sparing in the Intensity-Modulated Radiotherapy for Stage III Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Huang, B-T; Lu, J-Y [Cancer Hospital of Shantou University Medical College, Shantou (China)

    2015-06-15

    Purpose: Intensity-modulated radiotherapy (IMRT) treatment for lung cancer is difficult due to the heterogeneous dose distribution and excessive dose to the organs at risk (OARs). We introduce a simple method based on the base dose function (BDF) in Eclipse treatment planning system to overcome the difficulties. Methods: Thirteen patients suffered from stage III non-small cell lung cancer (NSCLC) were enrolled in the study. Three kinds of approaches were applied to obtain clinically acceptable treatment plans: 1) conventionally optimizing method with hot and cold spots re-optimization (CO); 2) target-divided optimizing method (TDO) in which the optimization objective in the lung density of planning target volume (PTV) was set to 2 to 4 Gy higher than in the soft tissue density; 3) base dose function (BDF) in which the treatment plan was produced based on the original plan for re-optimization. CO, TDO and BDF methods were then compared in terms of conformity index (CI), homogeneity index (HI), OARs sparing and monitor units (MUs). Additionally, delta4, portal dosimetry and IMSure were used to measure the dose delivering accuracy. Results: The BDF technique provided more superior CI and HI than the other two methods. Moreover, the new method also reduced the lung, esophagus, heart and spinal cord dose. However, the BDF plans needed extra 15% and 10% MUs than the CO and TDO methods. Dose verification results demonstrated good and comparable γ pass rates among the three methods. Conclusion: The proposed BDF method greatly improves the dose homogeneity and OARs sparing in the IMRT treatment for lung cancer.

  12. Stochastic multi-stage optimization at the crossroads between discrete time stochastic control and stochastic programming

    CERN Document Server

    Carpentier, Pierre; Cohen, Guy; De Lara, Michel

    2015-01-01

    The focus of the present volume is stochastic optimization of dynamical systems in discrete time where - by concentrating on the role of information regarding optimization problems - it discusses the related discretization issues. There is a growing need to tackle uncertainty in applications of optimization. For example the massive introduction of renewable energies in power systems challenges traditional ways to manage them. This book lays out basic and advanced tools to handle and numerically solve such problems and thereby is building a bridge between Stochastic Programming and Stochastic Control. It is intended for graduates readers and scholars in optimization or stochastic control, as well as engineers with a background in applied mathematics.

  13. The Optimality of Different Strategies for Supplemental Staging of Non–Small-Cell Lung Cancer

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Fischer, Barbara Malene B; Mortensen, Jann;

    2013-01-01

    To assess the expected costs and outcomes of alternative strategies for staging of lung cancer to inform a Danish National Health Service perspective about the most cost-effective strategy.......To assess the expected costs and outcomes of alternative strategies for staging of lung cancer to inform a Danish National Health Service perspective about the most cost-effective strategy....

  14. Study protocol of the SACURA trial: a randomized phase III trial of efficacy and safety of UFT as adjuvant chemotherapy for stage II colon cancer

    Directory of Open Access Journals (Sweden)

    Ishiguro Megumi

    2012-07-01

    Full Text Available Abstract Background Adjuvant chemotherapy for stage III colon cancer is internationally accepted as standard treatment with established efficacy, but the usefulness of adjuvant chemotherapy for stage II colon cancer remains controversial. The major Western guidelines recommend adjuvant chemotherapy for “high-risk stage II” cancer, but this is not clearly defined and the efficacy has not been confirmed. Methods/design SACURA trial is a multicenter randomized phase III study which aims to evaluate the superiority of 1-year adjuvant treatment with UFT to observation without any adjuvant treatment after surgery for stage II colon cancer in a large population, and to identify “high-risk factors of recurrence/death” in stage II colon cancer and predictors of efficacy and adverse events of the chemotherapy. Patients aged between 20 and 80 years with curatively resected stage II colon cancer are randomly assigned to a observation group or UFT adjuvant therapy group (UFT at 500–600 mg/day as tegafur in 2 divided doses after meals for 5 days, followed by 2-day rest. This 1-week treatment cycle is repeated for 1 year. The patients are followed up for 5 years until recurrence or death. Treatment delivery and adverse events are entered into a web-based case report form system every 3 months. The target sample size is 2,000 patients. The primary endpoint is disease-free survival, and the secondary endpoints are overall survival, recurrence-free survival, and incidence and severity of adverse events. In an additional translational study, the mRNA expression of 5-FU-related enzymes, microsatellite instability and chromosomal instability, and histopathological factors including tumor budding are assessed to evaluate correlation with recurrences, survivals and adverse events. Discussion A total of 2,024 patients were enrolled from October 2006 to July 2010. The results of this study will provide important information that help to improve the

  15. Analysis of six stages supply chain management in inventory optimization for warehouse with artificial bee colony algorithm using genetic algorithm

    Directory of Open Access Journals (Sweden)

    Ajay Singh Yadav

    2017-09-01

    Full Text Available The purpose of the proposed study is to give a new dimension on warehouse with Artificial bee colony algorithm using genetic algorithm processes in six stages - 11 member supply chain in inventory optimization to describe the certain and uncertain market demand which is based on supply reliability and to develop more realistic and more flexible models. we hope that the proposed study has a great potential to solve various practical tribulations related to the warehouse using genetic algorithm processes in six stages - 11 member supply chain in inventory optimization and also provide a general review for the application of soft computing techniques like genetic algorithms to use for improve the effectiveness and efficiency for various aspect of warehouse with Artificial bee colony algorithm using genetic algorithm.

  16. Prognostic value of BRAF and KRAS mutation status in stage II and III microsatellite instable colon cancers

    NARCIS (Netherlands)

    de Cuba, E. M. V.; Snaebjornsson, P.; Heideman, D. A. M.; van Grieken, N. C. T.; Bosch, L.J.W.; Fijneman, R. J. A.; Belt, E.; Bril, H.; Stockmann, H. B. A. C.; Hooijberg, E.; Punt, C. J. A.; Koopman, M.; Nagtegaal, I. D.; Coupe, V. H. M.; Carvalho, B.; Meijer, G. A.

    2016-01-01

    Microsatellite instability (MSI) has been associated with favourable survival in early stage colorectal cancer (CRC) compared to microsatellite stable (MSS) CRC. The BRAF V600E mutation has been associated with worse survival in MSS CRC. This mutation occurs in 40% of MSI CRC and it is unclear wheth

  17. Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III

    NARCIS (Netherlands)

    Belt, E.J.T.; van Stijn, M.F.M.; Bril, H.; de Lange-de Klerk, E.S.M.; Meijer, G.A.; Meijer, S.; Stockmann, H.B.A.C.

    2010-01-01

    BACKGROUND: The prognostic role of pericolic or perirectal isolated tumor deposits (ITDs) in node-negative colorectal cancer (CRC) patients is unclear. Rules to define ITDs as regional lymph node metastases changed in subsequent editions of the TNM staging without substantial evidence. Aim of this

  18. Multidisciplinary management of non small cell lung cancer (NSCLC in stage III: clinical case description. Recommendations and state of the art

    Directory of Open Access Journals (Sweden)

    Simona Carnio

    2013-03-01

    Full Text Available Lung cancer is the leading cause of cancer death in industrialized countries with progressive increase of its mortality rate. Non Small Cell Lung Cancer (NSCLC is approximately 80-85% of all lung cancers, being adenocarcinoma and squamous cell carcinoma the most common histologies. The majority of the patients with stage III clinical stage, presents a mediastinal lymph node involvement described with computed tomography (TC and/or positron emission tomography (PET. The current approach to patients with NSCLC is multidisciplinary, especially for those staged as potentially operable, both for staging and for a correct definition of best treatment strategy. Updated international and national Guidelines and recommendations can provide valuable support to the clinician.The case described concerns the accidental detection of a tumour in the lung in a 58-year-old man with arterial hypertension controlled with ACE inhibitors. The treatments agreed after a multidisciplinary approach are cisplatin and docetaxel, the surgical resection, and the radiotherapy. After three months the patient has neither metastasis nor relapse.

  19. The bacteriophage P1 hot gene, encoding a homolog of the E. coli DNA polymerase III theta subunit, is expressed during both lysogenic and lytic growth stages.

    Science.gov (United States)

    Chikova, Anna K; Schaaper, Roel M

    2007-11-01

    The bacteriophage P1 hot gene product is a homolog of the theta subunit of E. coli DNA polymerase III. Previous studies with hot cloned on a plasmid have shown that Hot protein can substitute for theta, as evidenced by its stabilizing effect on certain dnaQ mutator mutants carrying an unstable pol III proofreading subunit (epsilon subunit). These results are consistent with Hot, like theta, being a replication protein involved in stabilizing the intrinsically unstable epsilon proofreading function. However, the function of hot for the viral life cycle is less clear. In the present study, we show that the hot gene is not essential. Based on its promoter structure, hot has been previously classified as a "late" phage gene, a property that is not easily reconciled with a presumed replication function. Here, we clarify this issue by demonstrating that P1 hot is actively expressed both during the lysogenic state and in the early stages of a lytic induction, in addition to its expression in the late stage of phage development. The results indicate that P1 hot has a complex expression pattern, compatible with a model in which Hot may affect the host replication machinery to benefit overall phage replication.

  20. Dissection of immune gene networks in primary melanoma tumors critical for antitumor surveillance of patients with stage II-III resectable disease.

    Science.gov (United States)

    Sivendran, Shanthi; Chang, Rui; Pham, Lisa; Phelps, Robert G; Harcharik, Sara T; Hall, Lawrence D; Bernardo, Sebastian G; Moskalenko, Marina M; Sivendran, Meera; Fu, Yichun; de Moll, Ellen H; Pan, Michael; Moon, Jee Young; Arora, Sonali; Cohain, Ariella; DiFeo, Analisa; Ferringer, Tammie C; Tismenetsky, Mikhail; Tsui, Cindy L; Friedlander, Philip A; Parides, Michael K; Banchereau, Jacques; Chaussabel, Damien; Lebwohl, Mark G; Wolchok, Jedd D; Bhardwaj, Nina; Burakoff, Steven J; Oh, William K; Palucka, Karolina; Merad, Miriam; Schadt, Eric E; Saenger, Yvonne M

    2014-08-01

    Patients with resected stage II-III cutaneous melanomas remain at high risk for metastasis and death. Biomarker development has been limited by the challenge of isolating high-quality RNA for transcriptome-wide profiling from formalin-fixed and paraffin-embedded (FFPE) primary tumor specimens. Using NanoString technology, RNA from 40 stage II-III FFPE primary melanomas was analyzed and a 53-immune-gene panel predictive of non-progression (area under the curve (AUC)=0.920) was defined. The signature predicted disease-specific survival (DSS P<0.001) and recurrence-free survival (RFS P<0.001). CD2, the most differentially expressed gene in the training set, also predicted non-progression (P<0.001). Using publicly available microarray data from 46 primary human melanomas (GSE15605), a coexpression module enriched for the 53-gene panel was then identified using unbiased methods. A Bayesian network of signaling pathways based on this data identified driver genes. Finally, the proposed 53-gene panel was confirmed in an independent test population of 48 patients (AUC=0.787). The gene signature was an independent predictor of non-progression (P<0.001), RFS (P<0.001), and DSS (P=0.024) in the test population. The identified driver genes are potential therapeutic targets, and the 53-gene panel should be tested for clinical application using a larger data set annotated on the basis of prospectively gathered data.

  1. Dissection of Immune Gene Networks in Primary Melanoma Tumors Critical for Antitumor Surveillance of Patients with Stage II–III Resectable Disease

    Science.gov (United States)

    Sivendran, Shanthi; Chang, Rui; Pham, Lisa; Phelps, Robert G.; Harcharik, Sara T.; Hall, Lawrence D.; Bernardo, Sebastian G.; Moskalenko, Marina M.; Sivendran, Meera; Fu, Yichun; de Moll, Ellen H.; Pan, Michael; Moon, Jee Young; Arora, Sonali; Cohain, Ariella; DiFeo, Analisa; Ferringer, Tammie C.; Tismenetsky, Mikhail; Tsui, Cindy L.; Friedlander, Philip A.; Parides, Michael K.; Banchereau, Jacques; Chaussabel, Damien; Lebwohl, Mark G.; Wolchok, Jedd D.; Bhardwaj, Nina; Burakoff, Steven J.; Oh, William K.; Palucka, Karolina; Merad, Miriam; Schadt, Eric E.; Saenger, Yvonne M.

    2014-01-01

    Patients with resected stage II–III cutaneous melanomas remain at high risk for metastasis and death. Biomarker development has been limited by the challenge of isolating high-quality RNA for transcriptome-wide profiling from formalin-fixed and paraffin-embedded (FFPE) primary tumor specimens. Using NanoString technology, RNA from 40 stage II–III FFPE primary melanomas was analyzed and a 53-immune-gene panel predictive of non-progression (area under the curve (AUC)=0.920) was defined. The signature predicted disease-specific survival (DSS P<0.001) and recurrence-free survival (RFS P<0.001). CD2, the most differentially expressed gene in the training set, also predicted non-progression (P<0.001). Using publicly available microarray data from 46 primary human melanomas (GSE15605), a coexpression module enriched for the 53-gene panel was then identified using unbiased methods. A Bayesian network of signaling pathways based on this data identified driver genes. Finally, the proposed 53-gene panel was confirmed in an independent test population of 48 patients (AUC=0.787). The gene signature was an independent predictor of non-progression (P<0.001), RFS (P<0.001), and DSS (P=0.024) in the test population. The identified driver genes are potential therapeutic targets, and the 53-gene panel should be tested for clinical application using a larger data set annotated on the basis of prospectively gathered data. PMID:24522433

  2. Optimization and design of inter-stage amplifier with wide output swing,high speed and high accuracy

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yi-qiang; SUN Quan; GAO Jing

    2008-01-01

    To satisfy the design requirements of analog-to-digital converter (ADC) of high speed sampling sys-tem in an infrared focal plane array tester with 1024 × 1024 pixels, a first inter-stage amplifier of 12-bit 40-Msample/s pipelined ADC was designed with 0.35 μm CMOS technology. On the basis of traditional two-stage amplifier, the cross-coupled class AB output stage and cascode compensation were adopted to improve the out-put voltage swing and bandwidth. Power dissipation was optimized with math tools. Circuit and layout design were completed. Simulation results show that the designed amplifier has good performance of 95 dB de gain, ±2 V output voltage swing, 190 MHz bandwidth and 63° phase margin with feedback factor 1/4, 33 mW pow-er dissipation and so on, which can meet the system requirements.

  3. FLT PET in Measuring Treatment Response in Patients With Newly Diagnosed Estrogen Receptor-Positive, HER2-Negative Stage I-III Breast Cancer

    Science.gov (United States)

    2016-06-02

    Estrogen Receptor Positive; HER2/Neu Negative; Male Breast Carcinoma; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  4. Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2011-06-01

    Full Text Available Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options. We excluded from the study cases with: i thoracoscopic intervention and fibrinolytic agent were contraindicated; ii immunosuppression or additional infection focus; iii concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6% in stage II, and 31 (57.4% cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS. The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001. In 19 of 27 cases (70.37% in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77% in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533. The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic

  5. Multi-Objective Optimization of Two-Stage Helical Gear Train Using NSGA-II

    OpenAIRE

    Sanghvi, R. C.; Vashi, A. S.; Patolia, H. P.; R. G. Jivani

    2014-01-01

    Gears not only transmit the motion and power satisfactorily but also can do so with uniform motion. The design of gears requires an iterative approach to optimize the design parameters that take care of kinematics aspects as well as strength aspects. Moreover, the choice of materials available for gears is limited. Owing to the complex combinations of the above facts, manual design of gears is complicated and time consuming. In this paper, the volume and load carrying capacity are optimized. ...

  6. Predicting Individualized Postoperative Survival for Stage II/III Colon Cancer Using a Mobile Application Derived from the National Cancer Data Base

    Science.gov (United States)

    Gabriel, Emmanuel; Attwood, Kristopher; Thirunavukarasu, Pragatheeshwar; Al-Sukhni, Eisar; Boland, Patrick; Nurkin, Steven

    2017-01-01

    BACKGROUND Prediction calculators estimate postoperative survival and assist the decision-making process for adjuvant treatment. The objective of this study was to create a postoperative overall survival (OS) calculator for patients with stage II/III colon cancer. Factors that influence OS, including comorbidity and postoperative variables, were included. STUDY DESIGN The National Cancer Data Base was queried for patients with stage II/III colon cancer, diagnosed between 2004 and 2006, who had surgical resection. Patients were randomly divided to a testing (nt) cohort comprising 80% of the dataset and a validation (nv) cohort comprising 20%. Multivariable Cox proportional hazards regression of nt was performed to identify factors associated with 5-year OS. These were used to build a prediction model. The performance was assessed using the nv cohort and translated into mobile software. RESULTS A total of 129,040 patients had surgery. After exclusion of patients with carcinoma in situ, non-adenocarcinoma histology, more than 1 malignancy, stage I or IV disease, or missing data, 34,176 patients were used in the development of the calculator. Independent predictors of OS included patient-specific characteristics, pathologic factors, and treatment options, including type of surgery and adjuvant therapy. Length of postoperative stay and unplanned readmission rates were also incorporated as surrogates for postoperative complications (1-day increase in postoperative stay, hazard ratio [HR] 1.019, 95% CI 1.018 to 1.021, p cancer. This prediction model uses nationwide data, culminating in a highly comprehensive, clinically useful tool. PMID:26922599

  7. Effect of CXCR4 and CD133 co-expression on the prognosis of patients with stage II~III colon cancer.

    Science.gov (United States)

    Li, Xiao-Feng; Guo, Xiao-Guang; Yang, Yong-Yan; Liu, Ai-Yong

    2015-01-01

    To explore the relationship between CXCR4, CD133 co-expression and clinicopathological features as well as prognosis of patients with phase II~III colon cancer. Forty-nine paraffin-embedded samples of tumor tissue and epithelial tissue adjacent to cancer were collected from patients with colon cancer undergoing radical surgery in Baotou Cancer Hospital from January, 2010 to June, 2011. CXCR4 and CD133 expression was detected using immunohistochemistry and its relationship with clinicopathological features and the 3-year survival rate was analyzed. In the tumor tissue and colonic epithelial tissue adjacent to cancer, the positive expression rates of CXCR4 were respectively 61.2% (30/49) and 8.16% (4/49), while those of CD133 being 36.7% (18/49) and 6.12% (3/49). CXCR4 and CD133 expression in tumor tissue was not related to patient age, gender, primary focal sites, tumor size, TNM staging, histological type, tumor infiltration depth and presence or absence of lymphatic metastasis, but CXCR4 and CD133 co-expression was associated with TNM staging and lymphatic metastasis. The 3-year survival rate of patients with CXCR4 and CD133 co-expression was 27.3% (3/11), and that of the remainderwas 76.3% (29/38), the difference being significant (χ2=7.0206, p=0.0081). CXCR4 and CD133 co-expression may be a risk factor for poor prognosis of patients with stage II~III colon cancer.

  8. The Impact of Skin-Sparing Mastectomy With Immediate Reconstruction in Patients With Stage III Breast Cancer Treated With Neoadjuvant Chemotherapy and Postmastectomy Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Roshan; Godette, Karen [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); Carlson, Grant; Losken, Albert; Gabram, Sheryl [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Surgery, Emory University, Atlanta, GA (United States); Fasola, Carolina [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States); O' Regan, Ruth; Zelnak, Amelia [Winship Cancer Institute, Emory University, Atlanta, GA (United States); Department of Hematology and Medical Oncology, Emory University, Atlanta, GA (United States); Torres, Mylin, E-mail: matorre@emory.edu [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Winship Cancer Institute, Emory University, Atlanta, GA (United States)

    2012-03-15

    Purpose: The safety and efficacy of skin-sparing mastectomy (SSM) with immediate reconstruction (IR) in patients with locally advanced breast cancer are unclear. The purpose of this study is to compare the outcomes of women with noninflammatory Stage III SSM with IR vs. non-SSM-treated women who underwent neoadjuvant chemotherapy and adjuvant radiation therapy (XRT). Methods and Materials: Between October 1997 and March 2010, 100 consecutive patients (40 SSM with IR vs. 60 non-SSM) with Stage III breast cancer received anthracycline- and/or taxane-based neoadjuvant chemotherapy, mastectomy, and adjuvant XRT. Clinical stage (SSM with IR vs. for non-SSM) was IIIA (75% vs. 67%), IIIB (8% vs. 18%), and IIIC (8% vs. 8%). Tumors greater than 5 cm were found in 74% vs. 69%; 97% of patients in both groups were clinically node positive; and 8% vs. 18% had T4b disease. Results: The time from initial biopsy to XRT was prolonged for SSM-IR patients (274 vs. 254 days, p = 0.04), and there was a trend toward XRT delay of more than 8 weeks (52% vs. 31%, p = 0.07) after surgery. The rate of complications requiring surgical intervention was higher in the SSM-IR group (37.5% vs. 5%, p < 0.001). The 2-year actuarial locoregional control, breast cancer-specific survival, and overall survival rates for SSM with IR vs. non-SSM were 94.7% vs. 97.4%, 91.5% vs. 86.3%, and 87.4% vs. 84.8%, respectively (p = not significant). Conclusions: In our small study with limited follow-up, SSM with IR prolonged overall cancer treatment time and trended toward delaying XRT but did not impair oncologic outcomes. Complication rates were significantly higher in this group. Longer follow-up is needed.

  9. Comparison of NEXRAD Stage III and MPE precipitation products with constraints from high quality and density of raingauge networks in the Upper Guadalupe River Basin, Central Texas

    Science.gov (United States)

    Xie, H.; Wang, X.

    2006-05-01

    NEXRAD's Multisensor Precipitation Estimator (MPE) product replaced the Stage III product started in October 2003 at the West Gulf River Forecast Center (WGRFC) where includes most of the Texas and New Mexico. The MPE is an integrated product of rain gauge, NEXRAD, and satellite (GOES) precipitation estimates. The main objective of MPE is to reduce both areal-mean bias error and local bias error. The overall improved quality of MPE over Stage 3 is evident at the WGRFC. However, so far, there is no quantitative evaluation in a relative long period (one year or more) of a large area. In this study, high quality and density of 50 raingauge networks (6 minutes temporal resolution) in the Upper Guadalupe River Basin, Central Texas are used to evaluate both the Stage III (years 2001 and 2002) and MPE (year 2004) products. In this study, we propose two types of comparison (1) directly compare collocated radar cell and gauge of all rainfall events and (2) only compare collocated radar cell and gauge of homogeneous/uniform rainfall events. To find uniform rainfall events, 6-mintutes raingauge rainfall were used to calculate the correlation coefficient (CC) and coefficient of variation (CV) of a hour among one central gauge and its surrounding gauges (>= 4). For a particular rainfall hour, when CV is 0.5, or CV is <0.1, the rainfall event of this hour is thus selected as a uniform or homogeneous rainfall event. Our preliminary results of CC from all rainfall events and homogeneous rainfall events for year 2004 (MPE) are 0.79 and 0.96, respectively. This indicates an overall good quality of MPE product in comparison with raingauge rainfall, especially for the homogeneous rainfall events. Work is in progress.

  10. CD uniformity optimization at volume ramp up stage for new product introduction

    Science.gov (United States)

    Kim, Jin-Soo; Ma, Won-Kwang; Kim, Young-Sik; Kim, Myoung-Soo; Kwon, Won-Taik; Park, Sung-Ki; Nikolsky, Peter; Otter, Marian; Marun, Maryana Escalante; Anunciado, Roy; Sun, Kyu-Tae; Storms, Greet; van West, Ewould

    2014-04-01

    In this paper we describe the joint development and optimization of the critical dimension uniformity (CDU) at an advanced 300 mm ArFi semiconductor facility of SK Hynix in the high volume device. As the ITRS CDU specification shrinks, semiconductor companies still need to maintain high wafer yield and high performance (hence market value) even during the introduction phase of a new product. This cannot be achieved without continuous improvement of the on-product CDU as one of the main drivers for yield improvement. ASML Imaging Optimizer is one of the most efficient tools to reach this goal. This paper presents experimental results of post-etch CDU improvement by ASML imaging optimizer for immature photolithography and etch processes on critical features of 20nm node. We will show that CDU improvement potential and measured CDU strongly depend on CD fingerprint stability through wafers, lots and time. However, significant CDU optimization can still be achieved, even for variable CD fingerprints. In this paper we will review point-to-point correlation of CD fingerprints as one of the main indicators for CDU improvement potential. We will demonstrate the value of this indicator by comparing CD correlation between wafers used for Imaging Optimizer dose recipe development, predicted and measured CDU for wafers and lots exposed with various delays ranging from a few days to a month. This approach to CDU optimization helps to achieve higher yield earlier in the new product introduction cycle, enables faster technology ramps and thereby improves product time to market.

  11. Optimized Volumetric Modulated Arc Therapy Versus 3D-CRT for Early Stage Mediastinal Hodgkin Lymphoma Without Axillary Involvement: A Comparison of Second Cancers and Heart Disease Risk

    Energy Technology Data Exchange (ETDEWEB)

    Filippi, Andrea Riccardo, E-mail: andreariccardo.filippi@unito.it [Department of Oncology, Radiation Oncology, University of Torino, Torino (Italy); Ragona, Riccardo; Piva, Cristina; Scafa, Davide; Fiandra, Christian [Department of Oncology, Radiation Oncology, University of Torino, Torino (Italy); Fusella, Marco; Giglioli, Francesca Romana [Medical Physics, AOU Città della Salute e della Scienza Hospital, Torino (Italy); Lohr, Frank [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Ricardi, Umberto [Department of Oncology, Radiation Oncology, University of Torino, Torino (Italy)

    2015-05-01

    Purpose: The purpose of this study was to evaluate the risks of second cancers and cardiovascular diseases associated with an optimized volumetric modulated arc therapy (VMAT) planning solution in a selected cohort of stage I/II Hodgkin lymphoma (HL) patients treated with either involved-node or involved-site radiation therapy in comparison with 3-dimensional conformal radiation therapy (3D-CRT). Methods and Materials: Thirty-eight patients (13 males and 25 females) were included. Disease extent was mediastinum alone (n=8, 21.1%); mediastinum plus unilateral neck (n=19, 50%); mediastinum plus bilateral neck (n=11, 29.9%). Prescription dose was 30 Gy in 2-Gy fractions. Only 5 patients had mediastinal bulky disease at diagnosis (13.1%). Anteroposterior 3D-CRT was compared with a multiarc optimized VMAT solution. Lung, breast, and thyroid cancer risks were estimated by calculating a lifetime attributable risk (LAR), with a LAR ratio (LAR{sub VMAT}-to-LAR{sub 3D-CRT}) as a comparative measure. Cardiac toxicity risks were estimated by calculating absolute excess risk (AER). Results: The LAR ratio favored 3D-CRT for lung cancer induction risk in mediastinal alone (P=.004) and mediastinal plus unilateral neck (P=.02) presentations. LAR ratio for breast cancer was lower for VMAT in mediastinal plus bilateral neck presentations (P=.02), without differences for other sites. For thyroid cancer, no significant differences were observed, regardless of anatomical presentation. A significantly lower AER of cardiac (P=.038) and valvular diseases (P<.0001) was observed for VMAT regardless of disease extent. Conclusions: In a cohort of patients with favorable characteristics in terms of disease extent at diagnosis (large prevalence of nonbulky presentations without axillary involvement), optimized VMAT reduced heart disease risk with comparable risks of thyroid and breast cancer, with an increase in lung cancer induction probability. The results are however strongly influenced by

  12. Optimized volumetric modulated arc therapy versus 3D-CRT for early stage mediastinal Hodgkin lymphoma without axillary involvement: a comparison of second cancers and heart disease risk.

    Science.gov (United States)

    Filippi, Andrea Riccardo; Ragona, Riccardo; Piva, Cristina; Scafa, Davide; Fiandra, Christian; Fusella, Marco; Giglioli, Francesca Romana; Lohr, Frank; Ricardi, Umberto

    2015-05-01

    The purpose of this study was to evaluate the risks of second cancers and cardiovascular diseases associated with an optimized volumetric modulated arc therapy (VMAT) planning solution in a selected cohort of stage I/II Hodgkin lymphoma (HL) patients treated with either involved-node or involved-site radiation therapy in comparison with 3-dimensional conformal radiation therapy (3D-CRT). Thirty-eight patients (13 males and 25 females) were included. Disease extent was mediastinum alone (n=8, 21.1%); mediastinum plus unilateral neck (n=19, 50%); mediastinum plus bilateral neck (n=11, 29.9%). Prescription dose was 30 Gy in 2-Gy fractions. Only 5 patients had mediastinal bulky disease at diagnosis (13.1%). Anteroposterior 3D-CRT was compared with a multiarc optimized VMAT solution. Lung, breast, and thyroid cancer risks were estimated by calculating a lifetime attributable risk (LAR), with a LAR ratio (LAR(VMAT)-to-LAR(3D-CRT)) as a comparative measure. Cardiac toxicity risks were estimated by calculating absolute excess risk (AER). The LAR ratio favored 3D-CRT for lung cancer induction risk in mediastinal alone (P=.004) and mediastinal plus unilateral neck (P=.02) presentations. LAR ratio for breast cancer was lower for VMAT in mediastinal plus bilateral neck presentations (P=.02), without differences for other sites. For thyroid cancer, no significant differences were observed, regardless of anatomical presentation. A significantly lower AER of cardiac (P=.038) and valvular diseases (Pdisease extent. In a cohort of patients with favorable characteristics in terms of disease extent at diagnosis (large prevalence of nonbulky presentations without axillary involvement), optimized VMAT reduced heart disease risk with comparable risks of thyroid and breast cancer, with an increase in lung cancer induction probability. The results are however strongly influenced by the different anatomical presentations, supporting an individualized approach. Copyright © 2015 Elsevier

  13. Optimization of Two-Stage Peltier Modules: Structure and Exergetic Efficiency

    Directory of Open Access Journals (Sweden)

    Cesar Ramirez-Lopez

    2012-08-01

    Full Text Available In this paper we undertake the theoretical analysis of a two-stage semiconductor thermoelectric module (TEM which contains an arbitrary and different number of thermocouples, n1 and n2, in each stage (pyramid-styled TEM. The analysis is based on a dimensionless entropy balance set of equations. We study the effects of n1 and n2, the flowing electric currents through each stage, the applied temperatures and the thermoelectric properties of the semiconductor materials on the exergetic efficiency. Our main result implies that the electric currents flowing in each stage must necessarily be different with a ratio about 4.3 if the best thermal performance and the highest temperature difference possible between the cold and hot side of the device are pursued. This fact had not been pointed out before for pyramid-styled two stage TEM. The ratio n1/n2 should be about 8.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    Chernyshova, A. L.; Kolomiets, L. A.; Sinilkin, I. G.; Chernov, V. I.; Lyapunov, A. Yu.

    2016-08-01

    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.

  16. LINE-1 Methylation Status Correlates Significantly to Post-Therapeutic Recurrence in Stage III Colon Cancer Patients Receiving FOLFOX-4 Adjuvant Chemotherapy.

    Directory of Open Access Journals (Sweden)

    Yun-Ting Lou

    Full Text Available Methylation levels of long interspersed nucleotide elements (LINE-1 are representative of genome-wide methylation status and crucial in maintaining genomic stability and expression. Their prognostic impact on colon cancer patients receiving adjuvant chemotherapy has not been well established. We evaluated the association between LINE-1 methylation status and clinicopathologic features and postoperative oncological outcomes in stage III colon cancer patients.129 UICC stage III colon cancer patients who had received radical resection and FOLFOX adjuvant chemotherapy were enrolled. Global methylation was estimated by analyzing tumor LINE-1 methylation status using bisulfite-polymerase chain reaction (PCR and pyrosequencing assay. Demographics, clinicopathological data, and postoperative outcomes were recorded by trained abstractors. Outcome measurements included postoperative recurrence and disease-free survival. Univariate, multivariate, and survival analyses were conducted to identify prognostic factors of oncological outcomes.The LINE-1 methylation of all 129 patients was measured on a 0-100 scale (mean 63.3; median 63.7, standard deviation 7.1, LINE-1 hypomethylation was more common in patients aged 65 years and above (61.7%±7.6% vs. 64.6±6.4, p=0.019 and those with post-therapeutic recurrence (61.7±7.4 vs 64.3±6.7, p=0.041. Considering risk adjustment, LINE-1 hypomethylation was found to be an independent risk factor of post-therapeutic recurrence (Adjusted OR=14.1, p=0.012. Kaplan-Meier analysis indicated that patients in the low methylation group had shorter period of disease free survival (p=0.01. In a stratified analysis that included 48 patients with post-therapeutic recurrence, it was found that those who experienced shorter period of disease free survival (≦6 months appeared to have lower LINE-1 methylation levels than patients who reported of recurrence after 6 months (56.68±15.75 vs. 63.55±7.57, p=0.041.There was a

  17. Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: Analysis of the National Cancer Data base.

    Science.gov (United States)

    Cassidy, Richard J; Liu, Yuan; Patel, Kirtesh; Zhong, Jim; Steuer, Conor E; Kooby, David A; Russell, Maria C; Gillespie, Theresa W; Landry, Jerome C

    2017-03-01

    Stage II and III rectal cancers have been effectively treated with neoadjuvant chemoradiotherapy (NCRT) followed by definitive resection. Advancements in surgical technique and systemic therapy have prompted investigation of neoadjuvant multiagent chemotherapy (NMAC) regimens with the elimination of radiation (RT). The objective of the current study was to investigate factors that predict for the use of NCRT versus NMAC and compare outcomes using the National Cancer Data Base (NCDB) for select stage II and III rectal cancers. In the NCDB, 21,707 patients from 2004 through 2012 with clinical T2N1 (cT2N1), cT3N0, or cT3N1 rectal cancers were identified who had received NCRT or NMAC followed by low anterior resection. Kaplan-Meier analyses, log-rank tests, and Cox-proportional hazards regression analyses were conducted along with propensity score matching analysis to reduce treatment selection bias. The 5-year actuarial overall survival (OS) rate was 75% for patients who received NCRT versus 67.2% for those who received NMAC (P < .01). On MVA, those who received NCRT had improved OS (hazard ratio, 0.77. P < .01), and this effect was confirmed on propensity score matching analysis (hazard ratio, 0.72; P = .01). In the same model, the following variables improved OS: age < 65 years, having private insurance, treatment at an academic center, living in an affluent zip code, a low comorbidity score, receipt of adjuvant chemotherapy, and a shorter interval before surgery (all P < .05). African Americans, men, patients with high-grade tumors, those with cT3N1 tumors, and those who underwent incomplete (R1) resection had worse OS (all P < .05). In this series, the elimination of neoadjuvant RT for select patients with stage II and III rectal adenocarcinoma was associated with worse OS and should not be recommended outside of a clinical trial. Cancer 2017;123:783-93. © 2016 American Cancer Society. © 2016 American Cancer Society.

  18. Concurrent chemoradiotherapy with low-dose weekly docetaxel followed by consolidation chemotherapy with docetaxel and cisplatin in the treatment of stage III non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Tianlin XIAO

    2008-02-01

    Full Text Available Background and objective Concurrent chemoradiotherapy is regarded as the standard care for locally advanced non-small cell lung cancer at present. This paper is designed to evaluate the efficacy and toxicity of low-dose weekly docetaxel (DTX with concurrent chemoradiotherapy followed by consolidation chemotherapy with DTX and cisplatin for unresectable stage III non-small cell lung cancer(NSCLC. Methods 44 previously untreated patients with stage III NSCLC were randomized into low-dose weekly DTX group and control group concomitant with radiotherapy. Both groups were treated by the standard fractionation schedule with three-dimensional conformal radiotherapy. An involved-field irradiation technique was performed. Gross tumor and metastatic lymph nodes were irradiated to a total dose of 66 Gy~70 Gy. Patients in the former group received chemotherapy with DTX 20mg. m-2.w-1,and the other group patients received DTX 60 mg/m2 on day 1 and DDP 30 mg/m2 on day 1~3 every 21 days. All patients received consolidation chemotherapy with DP regime after chemoradiotherapy for no more than 4 cycles. Results The overall response rates of patients in the low-dose weekly DTX group and control group were 81.8% with 27.3% CR(complete response and 86.4% with 27.3% CR respectively (Chisquare=0.120, P=0.942. After a median follow-up of 20months, the median survival time was 20 months and 17 months respectively. The 1-, 2- year survival rates of patients in low-dose weekly DTX group and control group were 69.8%, 48.1% versus 66.5%, 40.2% respectively;there was no difference between two groups. Grade 3 or 4 neutropenia and esophagitis occurred in 26.3%, 14.3% and 15.8%, 28.6% respectively (Chiquare=0.765,P =0.382(Chiquare=1.108,P =0.292.Grade 3 and 4 pulmonary toxicity was unusual.Conclusion Concurrent chemoradiotherapy with low-dose weekly docetaxel followed by consolidation chemotherapy with docetaxel and cisplatin is highly active with manageable toxicity in patients

  19. Designing a Multistage Supply Chain in Cross-Stage Reverse Logistics Environments: Application of Particle Swarm Optimization Algorithms

    Directory of Open Access Journals (Sweden)

    Tzu-An Chiang

    2014-01-01

    Full Text Available This study designed a cross-stage reverse logistics course for defective products so that damaged products generated in downstream partners can be directly returned to upstream partners throughout the stages of a supply chain for rework and maintenance. To solve this reverse supply chain design problem, an optimal cross-stage reverse logistics mathematical model was developed. In addition, we developed a genetic algorithm (GA and three particle swarm optimization (PSO algorithms: the inertia weight method (PSOA_IWM, VMax method (PSOA_VMM, and constriction factor method (PSOA_CFM, which we employed to find solutions to support this mathematical model. Finally, a real case and five simulative cases with different scopes were used to compare the execution times, convergence times, and objective function values of the four algorithms used to validate the model proposed in this study. Regarding system execution time, the GA consumed more time than the other three PSOs did. Regarding objective function value, the GA, PSOA_IWM, and PSOA_CFM could obtain a lower convergence value than PSOA_VMM could. Finally, PSOA_IWM demonstrated a faster convergence speed than PSOA_VMM, PSOA_CFM, and the GA did.

  20. Designing a multistage supply chain in cross-stage reverse logistics environments: application of particle swarm optimization algorithms.

    Science.gov (United States)

    Chiang, Tzu-An; Che, Z H; Cui, Zhihua

    2014-01-01

    This study designed a cross-stage reverse logistics course for defective products so that damaged products generated in downstream partners can be directly returned to upstream partners throughout the stages of a supply chain for rework and maintenance. To solve this reverse supply chain design problem, an optimal cross-stage reverse logistics mathematical model was developed. In addition, we developed a genetic algorithm (GA) and three particle swarm optimization (PSO) algorithms: the inertia weight method (PSOA_IWM), V(Max) method (PSOA_VMM), and constriction factor method (PSOA_CFM), which we employed to find solutions to support this mathematical model. Finally, a real case and five simulative cases with different scopes were used to compare the execution times, convergence times, and objective function values of the four algorithms used to validate the model proposed in this study. Regarding system execution time, the GA consumed more time than the other three PSOs did. Regarding objective function value, the GA, PSOA_IWM, and PSOA_CFM could obtain a lower convergence value than PSOA_VMM could. Finally, PSOA_IWM demonstrated a faster convergence speed than PSOA_VMM, PSOA_CFM, and the GA did.

  1. A Decomposition-Based Two-Stage Optimization Algorithm for Single Machine Scheduling Problems with Deteriorating Jobs

    Directory of Open Access Journals (Sweden)

    Yueyue Liu

    2015-01-01

    Full Text Available This paper studies a production scheduling problem with deteriorating jobs, which frequently arises in contemporary manufacturing environments. The objective is to find an optimal sequence of the set of jobs to minimize the total weighted tardiness, which is an indicator of service quality. The problem belongs to the class of NP-hard. When the number of jobs increases, the computational time required by an optimization algorithm to solve the problem will increase exponentially. To tackle large-scale problems efficiently, a two-stage method is presented in this paper. We partition the set of jobs into a few subsets by applying a neural network approach and thereby transform the large-scale problem into a series of small-scale problems. Then, we employ an improved metaheuristic algorithm (called GTS which combines genetic algorithm with tabu search to find the solution for each subproblem. Finally, we integrate the obtained sequences for each subset of jobs and produce the final complete solution by enumeration. A fair comparison has been made between the two-stage method and the GTS without decomposition, and the experimental results show that the solution quality of the two-stage method is much better than that of GTS for large-scale problems.

  2. MAIN ENGINE SELECTION OPTIMIZATION ANALYSIS OF THE SHIP CARAKA JAYA III BASED ON ENGINEERING AND ECONOMY COSIDERATIONS

    Directory of Open Access Journals (Sweden)

    Jamlean Faustinus

    2013-06-01

    Full Text Available Caraka Jaya III, as sister ships, built in Indonesia in the era 1990, devided into three building phases. Each phase had the different main engine. Especially for the second phase used the MAN B&W 5S26MC as main engine. After several years later,  some of the engines were going to have the problems, especially for the pistons and its rings. The selected engine was not  the only one that should be used. In accordance with selection the engine, the optimization procrdure offer best solution as compromise. Selecting the main engine is a complicated and time consuming task. The application of Analytic Hierarchy Process (AHP, one of the Multi Criteria Decision Making (MCDM, would promise a powerful tool for main engine selection as well as usual engineering design process. To select the candidate of the main engine it needs more criteria to obtain satisfactory solution. The criteria therefore are developed as pair wise coparison matrix leading to the mathematic solution. Analysis procedure is devided into three levels, namely, (1 criteria, (2 sub-criteria and (3 alternative of the selected engine. A consistency ratio needed as the acceptance criteria to check the solution of the pair wise comparison matrix. The final result obtained from multiplication of all matrixs on analysis, namely, SKL Diesel 8VD29/24AL- 0.149; MaK 9M20 – 0.190; Wartsila 9L20 – 0.088; Wartsila 6SW28 – 0.121; NIIGATA 8PA5L – 0.098; MAN B&W 5S26MC-0.354. According to the result, optimation solution will be MAN B&W 5S26MC or MaK 9M20

  3. A Multi-Stage Optimization Model for Air Force Reserve Officer Training Corps Officer Candidate Selection

    Science.gov (United States)

    2012-03-01

    57 A. LINGO Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 viii Page B...applicants, and POC slots available. 21 Stage two is examined using LINGO software. LINGO is a comprehensive opti- mization software package developed by LINDO...formulated and implemented in LINGO . 24 An integer program is used to find a solution to the d-KP, with the objective of maximizing the total quality. Once

  4. Thermodynamic Analysis and Optimization Based on Exergy Flow for a Two-Staged Pulse Tube Refrigerator

    Science.gov (United States)

    2010-01-01

    and magnetostriction Rev. Sci. Instrum. 83, 095102 (2012) Compact radio-frequency resonator for cryogenic ion traps Rev. Sci. Instrum. 83, 084705...Vol. 55, edited by J. G. Weisend II 2010 American Institute of Physics 978-0-7354-0761-9/10/$30.00 INTRODUCTION Multi-stage Pulse Tube

  5. Optimized lymph node staging in breast cancer in the era of sentinel node biopsy

    NARCIS (Netherlands)

    Madsen, E.V.E.

    2012-01-01

    SLNB has revolutionized staging and treatment in breast cancer patients, several issues provoked renewed attention. If small lymph node metastases are relevant, the pathologist should detect them. The current Dutch pathology guideline is not sensitive enough to detect them. To obtain a 95% detection

  6. OPTIMIZING THE PRECISION OF TOXICITY THRESHOLD ESTIMATION USING A TWO-STAGE EXPERIMENTAL DESIGN

    Science.gov (United States)

    An important consideration for risk assessment is the existence of a threshold, i.e., the highest toxicant dose where the response is not distinguishable from background. We have developed methodology for finding an experimental design that optimizes the precision of threshold mo...

  7. IMPROVING THE DIAGNOSIS AND TREATMENT OF RETENTION DISORDERS OF THE UPPER URINARY TRACT IN PATIENTS WITH STAGES IIB–III CANCER OF THE CERVIX UTERI

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2014-08-01

    Full Text Available Study investigates the prevalence, diagnosis and treatment in patients with retention disorders upper urinary tract cervical cancer stage IIB III after more than 3 months after combined radiotherapy. In the apartment complex to the diagnosis of renal ultrasound and radioisotope study of renal excretory function added to the study ureteral emissions by color Doppler sonography. Information on ureteral emissions revealed a violation of the early passage of urine in 23.1 % of patients with renal ultrasound revealed no pathology. On the basis of violations ureteral emissions increase in the number of patients, respectively, are assigned to nonoperative treatment (anti-inflammatory, spasmolytic therapy. As a result, decreased by 14.2 % (p = 0.034, female patients, which showed drainage of the upper urinary tract.

  8. IMPROVING THE DIAGNOSIS AND TREATMENT OF RETENTION DISORDERS OF THE UPPER URINARY TRACT IN PATIENTS WITH STAGES IIB–III CANCER OF THE CERVIX UTERI

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2012-01-01

    Full Text Available Study investigates the prevalence, diagnosis and treatment in patients with retention disorders upper urinary tract cervical cancer stage IIB III after more than 3 months after combined radiotherapy. In the apartment complex to the diagnosis of renal ultrasound and radioisotope study of renal excretory function added to the study ureteral emissions by color Doppler sonography. Information on ureteral emissions revealed a violation of the early passage of urine in 23.1 % of patients with renal ultrasound revealed no pathology. On the basis of violations ureteral emissions increase in the number of patients, respectively, are assigned to nonoperative treatment (anti-inflammatory, spasmolytic therapy. As a result, decreased by 14.2 % (p = 0.034, female patients, which showed drainage of the upper urinary tract.

  9. An explorative analysis of ERCC1-19q13 copy number aberrations in a chemonaive stage III colorectal cancer cohort

    DEFF Research Database (Denmark)

    Smith, David Hersi; Christensen, Ib Jarle; Jensen, Niels Frank

    2013-01-01

    investigation is to determine the presence, frequency and prognostic impact of ERCC1 or ERCC4 gene copy number alterations in colorectal cancer (CRC). Methods: Fluorescent in situ hybridization probes directed at ERCC1 and ERCC4 with relevant reference probes were constructed. Probes were tested in a CRC cell...... line panel and in tumor sections from 152 stage III CRC chemonaive patients. Relationships between biomarker status and clinical endpoints (overall survival, time to recurrence, and local recurrence in rectal cancer) were analyzed by survival statistics. Results: ERCC1-19q13 copy number alterations...... were observed in a single cell line metaphase (HT29). In patient material, ERCC1-19q13 copy number gains (ERCC1-19q13/CEN-2 ≥ 1.5) were detected in 27.0% of specimens, whereas ERCC1-19q13 deletions (ERCC1-19q13/CEN-2

  10. Human papillomavirus genotyping and p16 expression as prognostic factors for patients with American Joint Committee on Cancer stages I to III carcinoma of the anal canal

    DEFF Research Database (Denmark)

    Serup-Hansen, Eva; Linnemann, Dorte; Skovrider-Ruminski, Wojciech

    2014-01-01

    PURPOSE: Carcinomas of the anal canal are strongly associated with the human papillomavirus (HPV). Expression of p16 is used as a surrogate marker of HPV infection. In a retrospective study, we evaluated HPV genotyping and p16 expression as prognostic markers of overall survival (OS) and disease......-specific survival (DSS) in patients diagnosed with American Joint Committee on Cancer (AJCC) stages I to III carcinoma of the anal canal. PATIENTS AND METHODS: HPV genotyping polymerase chain reaction (high-risk subtypes 16, 18, 31, 33, 45, 52, and 58) and immunohistochemical expression of p16 were analyzed...... by using paraffin-embedded tumor biopsies from 143 anal carcinomas. The patients were treated with combined chemoradiotherapy or radiotherapy alone. RESULTS: HPV16 was detected in 81.0% of the tumors, followed by HPV33 (5.1%), HPV18 (2.2%), and HPV58 (0.7%). p16 positivity was found in 92.9% of the tumors...

  11. Long-term outcome of phase I/II prospective study of dose-escalated proton therapy for early-stage non-small cell lung cancer.

    Science.gov (United States)

    Chang, Joe Y; Zhang, Wencheng; Komaki, Ritsuko; Choi, Noah C; Chan, Shen; Gomez, Daniel; O'Reilly, Michael; Jeter, Melenda; Gillin, Michael; Zhu, Xiaorong; Zhang, Xiaodong; Mohan, Radhe; Swisher, Stephen; Hahn, Stephen; Cox, James D

    2017-02-01

    The aim of this phase I/II study was to assess the long-term clinical benefits and toxicities of proton beam therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). From June 2006 to September 2011, 35 patients with medically inoperable T1N0M0 (central or superior location, 12 patients) or T2-3N0M0 (any location, 23 patients) NSCLC were treated with 87.5Gy at 2.5Gy/fraction of proton therapy. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 4.0. The median follow-up time was 83.1months (95% CI: 69.2-97.1months). For all 35 patients, the 1, 3, and 5-year overall survival rates were 85.7%, 42.9%, and 28.1%, respectively. The 5-year local recurrence-free, regional recurrence-free, and distant metastasis-free survival rates were 85.0%, 89.2%, and 54.4%, respectively. Different T stages had no effect on local and regional recurrence (p=0.499, p=1.00). However, with the increase in T stages, the distant metastasis rate increased significantly (p=0.006). The most common adverse effects were dermatitis (grade 2, 51.4%; grade 3, 2.9%) and radiation pneumonitis (grade 2, 11.4%; grade 3, 2.9%). Other grade 2 toxicities included esophagitis (2.9%), rib fracture (2.9%), heart toxicities (5.7%), and chest wall pain (2.9%). According to our long-term follow-up data, proton therapy with ablative doses is well tolerated and effective in medically inoperable early-stage NSCLC. Systemic therapy should be considered to reduce the rate of distant metastasis in cases of T2 and T3 lesions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Macrophage Inhibitory Cytokine-1 (MIC-1 as A Biomarker for Diagnosis 
and Prognosis of Stage I-II Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yuning LIU

    2016-04-01

    Full Text Available Background and objective Increased macrophage inhibitory cytokine-1 (MIC-1, member of transforming growth factor-β (TGF-β superfamily, was found in patients serum with epithelial tumors. Therefore, our aim was to delineate the diagnostic and prognostic value of serum MIC-1 in patients with stage I-II non-small cell lung cancer (NSCLC. Methods A total of 152 consecutive patients with stage I–II NSCLC were prospectively enrolled and underwent follow up after total resection of tumor. Serum MIC-1 level was detected in lung cancer patients by ELISA, 48 benign pulmonary disease patients and 105 healthy controls, and was correlated with clinical features and prognosis of patients. Results The level of MIC-1 of NSCLC patients was significantly higher than that of controls (P<0.001 and benign pulmonary disease patients (P<0.001. A threshold of 1,000 pg/mL could be used to diagnose early-stage NSCLC with 70.4% sensitivity and 99.0% specificity. The level of MIC-1 was associated with elder age (P=0.001, female (P=0.03 and T2 (P=0.022. A threshold of 1,465 pg/mL could identify patients with early poor outcome with 72.2% sensitivity and 66.1% specificity. The overall 3-year survival rate in patients with high level of MIC-1 (≥1,465 pg/mL was significantly lower than that of patients with low MIC-1 level (77.6% vs 94.8%. Multivariable Cox regression revealed that a high level of MIC-1 was an independent risk factor for compromised overall survival (HR=3.37, 95%CI: 1.09-10.42, P=0.035. Conclusion High level of serum MIC-1 could be served as a potential biomarker for diagnosis and poorer outcome in patients with early-stage NSCLC.

  13. Optimization of Realistic Multi-Stage Hybrid Flow Shop Scheduling Problems with Missing Operations Using Meta-Heuristics

    Directory of Open Access Journals (Sweden)

    M. Saravanan

    2014-03-01

    Full Text Available A Hybrid flow shop scheduling is characterized ‘n’ jobs ‘m’ machines with ‘M’ stages by unidirectional flow of work with a variety of jobs being processed sequentially in a single-pass manner. The paper addresses the multi-stage hybrid flow shop scheduling problems with missing operations. It occurs in many practical situations such as stainless steel manufacturing company. The essential complexity of the problem necessitates the application of meta-heuristics to solve hybrid flow shop scheduling. The proposed Simulated Annealing algorithm (SA compared with Particle Swarm Optimization (PSO with the objective of minimization of makespan. It is show that the SA algorithm is efficient in finding out good quality solutions for the hybrid flow shop problems with missing operations.

  14. Combined detection of the expression of Nm23-H1 and p53 is correlated with survival rates of patients with stage II and III colorectal cancer.

    Science.gov (United States)

    Wu, Yinying; Li, Yi; Zhao, Xiaoai; Dong, Danfeng; Tang, Chunhui; Li, Enxiao; Geng, Qianqian

    2017-01-01

    Molecular tumor markers hold considerable promise for accurately predicting the recurrence and progression of colorectal cancer (CRC) in patients. However, in the majority of cases, single marker analysis has been found to have low accuracy, and is of little practical use in clinical practice. The present study investigated the prognostic value of the combined detection of the protein expression of metastasis suppressor 23-H1 (Nm23-H1) and p53 using immunohistochemical analysis, and the mRNA expression levels were analyzed using reverse transcription-quantitative polymerase chain reaction in 110 cases of stage II and III CRC. The results revealed that the expression levels of Nm23-H1 in CRC tissues were lower, compared with those in normal tissues (χ(2)=18.249; Pp53 were higher in the CRC tissues (χ(2)=23.940; Pp53 presented with the same trend. The protein expression of Nm23-H1 was correlated with lymph node metastases (χ(2)=11.847; P=0.001) and pathological patterns (χ(2)=6.911; P=0.032). However, it did not correlate with patient gender or age, or with tumor World Health Organization classification or invasive depth (P>0.05). No significant correlation was observed between the expression of p53 and clinicopathological features (P>0.05). Patients with CRC with Nm23-H1(+)/p53(-) tumors had increased survival rates, with a five-year overall survival rate of 83.8% and a five-year disease-free survival rate of 70.2%. The five-year overall survival rates in other study cohorts were lower, compared with the Nm23-H1(+)/p53(-) group (Pdisease-free survival rate (Pp53 was associated with the long term survival rates of patients with stage II and III CRC; and this may offer potential for use as a predictor of survival rates in patients with CRC.

  15. Genetic variants within obesity-related genes are associated with tumor recurrence in patients with stages II/III colon cancer.

    Science.gov (United States)

    Sebio, Ana; Gerger, Armin; Matsusaka, Satoshi; Yang, Dongyun; Zhang, Wu; Stremitzer, Stefan; Stintzing, Sebastian; Sunakawa, Yu; Yamauchi, Shinichi; Ning, Yan; Fujimoto, Yoshiya; Ueno, Masashi; Lenz, Heinz-Josef

    2015-01-01

    Obesity is an established risk factor for colorectal cancer (CRC) incidence and it is also linked to CRC recurrence and survival. Polymorphisms located in obesity-related genes are associated with an increased risk of developing several cancer types including CRC. We evaluated whether single-nucleotide polymorphisms in obesity-related genes may predict tumor recurrence in colon cancer patients. Genotypes were obtained from germline DNA from 207 patients with stage II or III colon cancer at the Norris Comprehensive Cancer Center. Nine polymorphisms in eight obesity-related genes (PPAR, LEP, NFKB, CD36, DRG1, NGAL, REGIA, and DSCR1) were evaluated. The primary endpoint of the study was the 3-year recurrence rate. Positive associations were also tested in an independent Japanese cohort of 350 stage III CRC patients. In univariate analysis, for PPARrs1801282, patients with a CC genotype had significantly lower recurrence probability (29 ± 4% SE) compared with patients with a CG genotype (48 ± 8% SE) [hazard ratio (HR): 1.77; 95% confidence interval (CI), 1.01-3.10; P = 0.040]. For DSCR1rs6517239, patients with an AA genotype had higher recurrence probability than patients carrying at least one allele G (37 ± 4% SE vs. 15 ± 6% SE) (HR: 0.51; 95% CI, 0.27-0.94; P = 0.027). This association was stronger in the patients bearing a left-sided tumor (HR: 0.34; 95% CI, 0.13-0.88; P = 0.018). In the Japanese cohort, no associations were found. This hypothesis-generating study suggests a potential influence of polymorphisms within obesity-related genes in the recurrence probability of colon cancer. These interesting results should be evaluated further.

  16. Genetic variants within obesity-related genes are associated with tumor recurrence in patients with stages II/III colon cancer

    Science.gov (United States)

    Sebio, Ana; Gerger, Armin; Matsusaka, Satoshi; Yang, Dongyun; Zhang, Wu; Stremitzer, Stefan; Stintizing, Sebastian; Sunakawa, Yu; Yamauchi, Shinichi; Ning, Yan; Fujimoto, Yoshiya; Ueno, Masashi; Lenz, Heinz-Josef

    2014-01-01

    Objective Obesity is an established risk factor for colorectal cancer (CRC) incidence and it is also linked to CRC recurrence and survival. Polymorphisms located in obesity-related genes are associated with increased risk of developing several cancer types including colorectal cancer. We evaluated whether SNPs in obesity-related genes may predict tumor recurrence in colon cancer patients. Methods Genotypes were obtained from germline DNA from 207 patients with stage II or III colon cancer at the Norris Comprehensive Cancer Center. Nine polymorphisms in eight obesity-related genes (PPAR, LEP, NFKB, CD36, DRG1, NGAL, REGIA and DSCR1) were evaluated. The primary endpoint of the study was 3-year recurrence rate. Positive associations were also tested in an independent Japanese cohort of 350 stage III CRC patients. Results In univariate analysis, for PPAR rs1801282, patients with a CC genotype had significantly lower recurrence probability (29± 4% standard error, SE) compared to patients with a CG genotype (48% ± 8% SE), HR: 1.77; 95%CI, 1.01-3.10; p=0.040. For DSCR1 rs6517239, patients with an AA genotype had higher recurrence probability than patients carrying at least one allele G (37% ± 4% SE vs 15% ± 6% SE), HR: 0.51, 95% CI, 0.27-0.94; p=0.027. This association was stronger in the patients bearing a left-sided tumor (HR: 0.34; 95%CI, 0.13-0.88; p=0.018). In the Japanese cohort no associations were found. Conclusion This hypothesis generating study suggests a potential influence of polymorphisms within obesity-related genes in the recurrence probability of colon cancer. These interesting results should be further evaluated. PMID:25379721

  17. The role of consolidation therapy for stage III non-small cell lung cancer with persistent N2 disease after induction chemotherapy.

    Science.gov (United States)

    Amini, Arya; Correa, Arlene M; Komaki, Ritsuko; Chang, Joe Y; Tsao, Anne S; Roth, Jack A; Swisher, Stephen G; Rice, David C; Vaporciyan, Ara A; Lin, Steven H

    2012-09-01

    Persistent pathologic mediastinal nodal involvement after induction chemotherapy and surgical resection is a negative prognostic factor for stage III-N2 non-small cell lung cancer patients. This population has high rates of local-regional failure and distant failure, yet the effectiveness of additional therapies is not clear. We assessed the role of consolidative therapies (postoperative radiation therapy and chemotherapy) for such patients. In all, 179 patients with stage III-N2 non-small cell lung cancer at MD Anderson Cancer Center were treated with induction chemotherapy followed by surgery from 1998 through 2008; 61 patients in this cohort had persistent, pathologically confirmed, mediastinal nodal disease, and were treated with postoperative radiation therapy. Local-regional failure was defined as recurrence at the surgical site or lymph nodes (levels 1 to 14, including supraclavicular), or both. Overall survival was calculated using the Kaplan-Meier method, and survival outcomes were assessed by log rank tests. Univariate and multivariate Cox proportional hazards models were used to identify factors influencing local-regional failure, distant failure, and overall survival. All patients received postoperative radiation therapy after surgery, but approximately 25% of the patients also received additional chemotherapy: 9 (15%) with concurrent chemotherapy, 4 (7%) received adjuvant sequential chemotherapy, and 2 (3%) received both. Multivariate analysis indicated that additional postoperative chemotherapy significantly reduced distant failure (hazard ratio 0.183, 95% confidence interval: 0.052 to 0.649, p=0.009) and improved overall survival (hazard ratio 0.233, 95% confidence interval: 0.089 to 0.612, p=0.003). However, additional postoperative chemotherapy had no affect on local-regional failure. Aggressive consolidative therapies may improve outcomes for patients with persistent N2 disease after induction chemotherapy and surgery. Copyright © 2012 The

  18. Combined detection of the expression of Nm23-H1 and p53 is correlated with survival rates of patients with stage II and III colorectal cancer

    Science.gov (United States)

    Wu, Yinying; Li, Yi; Zhao, Xiaoai; Dong, Danfeng; Tang, Chunhui; Li, Enxiao; Geng, Qianqian

    2017-01-01

    Molecular tumor markers hold considerable promise for accurately predicting the recurrence and progression of colorectal cancer (CRC) in patients. However, in the majority of cases, single marker analysis has been found to have low accuracy, and is of little practical use in clinical practice. The present study investigated the prognostic value of the combined detection of the protein expression of metastasis suppressor 23-H1 (Nm23-H1) and p53 using immunohistochemical analysis, and the mRNA expression levels were analyzed using reverse transcription-quantitative polymerase chain reaction in 110 cases of stage II and III CRC. The results revealed that the expression levels of Nm23-H1 in CRC tissues were lower, compared with those in normal tissues (χ2=18.249; PWorld Health Organization classification or invasive depth (P>0.05). No significant correlation was observed between the expression of p53 and clinicopathological features (P>0.05). Patients with CRC with Nm23-H1(+)/p53(−) tumors had increased survival rates, with a five-year overall survival rate of 83.8% and a five-year disease-free survival rate of 70.2%. The five-year overall survival rates in other study cohorts were lower, compared with the Nm23-H1(+)/p53(−) group (P<0.0125), and this was the same for the five-year disease-free survival rate (P<0.0125). In conclusion, the present study demonstrated that the combined detection of the protein expression of Nm23-H1 and p53 was associated with the long term survival rates of patients with stage II and III CRC; and this may offer potential for use as a predictor of survival rates in patients with CRC.

  19. Comparison of toxicity and outcomes of concurrent radiotherapy with carboplatin/paclitaxel or cisplatin/etoposide in stage III non-small cell lung cancer.

    Science.gov (United States)

    Liew, Mun Sem; Sia, Joseph; Starmans, Maud H W; Tafreshi, Ali; Harris, Sam; Feigen, Malcolm; White, Shane; Zimet, Allan; Lambin, Philippe; Boutros, Paul C; Mitchell, Paul; John, Thomas

    2013-12-01

    Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). The comparative merits of two widely used regimens: carboplatin/paclitaxel (PC) and cisplatin/etoposide (PE), each with concurrent radiotherapy, remain largely undefined. Records for consecutive patients with stage III NSCLC treated with PC or PE and ≥60 Gy chest radiotherapy between 2000 and 2011 were reviewed for outcomes and toxicity. Survival was estimated using the Kaplan-Meier method and Cox modeling with the Wald test. Comparison across groups was done using the student's t and chi-squared tests. Seventy-five (PC: 44, PE: 31) patients were analyzed. PC patients were older (median 71 vs. 63 years; P = 0.0006). Other characteristics were comparable between groups. With PE, there was significantly increased grade ≥3 neutropenia (39% vs. 14%, P = 0.024) and thrombocytopenia (10% vs. 0%, P = 0.039). Radiation pneumonitis was more common with PC (66% vs. 38%, P = 0.033). Five treatment-related deaths occurred (PC: 3 vs. PE: 2, P = 1.000). With a median follow-up of 51.6 months, there were no significant differences in relapse-free survival (median PC 12.0 vs. PE 11.5 months, P = 0.700) or overall survival (median PC 20.7 vs. PE 13.7 months; P = 0.989). In multivariate analyses, no factors predicted for improved survival for either regimen. PC was more likely to be used in elderly patients. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes as PE. PC is an acceptable CCRT regimen, especially in older patients with multiple comorbidities.

  20. Staged optimization algorithms based MAC dynamic bandwidth allocation for OFDMA-PON

    Science.gov (United States)

    Liu, Yafan; Qian, Chen; Cao, Bingyao; Dun, Han; Shi, Yan; Zou, Junni; Lin, Rujian; Wang, Min

    2016-06-01

    Orthogonal frequency division multiple access passive optical network (OFDMA-PON) has being considered as a promising solution for next generation PONs due to its high spectral efficiency and flexible bandwidth allocation scheme. In order to take full advantage of these merits of OFDMA-PON, a high-efficiency medium access control (MAC) dynamic bandwidth allocation (DBA) scheme is needed. In this paper, we propose two DBA algorithms which can act on two different stages of a resource allocation process. To achieve higher bandwidth utilization and ensure the equity of ONUs, we propose a DBA algorithm based on frame structure for the stage of physical layer mapping. Targeting the global quality of service (QoS) of OFDMA-PON, we propose a full-range DBA algorithm with service level agreement (SLA) and class of service (CoS) for the stage of bandwidth allocation arbitration. The performance of the proposed MAC DBA scheme containing these two algorithms is evaluated using numerical simulations. Simulations of a 15 Gbps network with 1024 sub-carriers and 32 ONUs demonstrate the maximum network throughput of 14.87 Gbps and the maximum packet delay of 1.45 ms for the highest priority CoS under high load condition.

  1. Mathematical modeling and optimization of flow structure in stage of francis turbine of micro gas turbine power plant

    Science.gov (United States)

    Kartashev, A. L.; Vaulin, S. D.; Kartasheva, M. A.; Martynov, A. A.; Safonov, E. V.

    2016-06-01

    This article presents information about the main distinguishing features of microturbine power plants. The justification of the use of Francis turbine in microturbine power plants with rated power of 100 kW is given. Initial analytical engineering calculations of the turbine (without using computational fluid dynamics) with appropriate calculation methods are considered. The parametric study of nozzle blade and whole turbine stage using ANSYS CFX is descripted. The calculations determined the optimal geometry on the criterion of maximizing efficiency at total pressure ratio. The calculation results are presented in graphical form, as well as the velocity and pressure fields at the interscapular channels of nozzle unit and the impeller.

  2. Infinite horizon optimal control of affine nonlinear discrete switched systems using two-stage approximate dynamic programming

    Science.gov (United States)

    Cao, Ning; Zhang, Huaguang; Luo, Yanhong; Feng, Dezhi

    2012-09-01

    In this article, a novel iteration algorithm named two-stage approximate dynamic programming (TSADP) is proposed to seek the solution of nonlinear switched optimal control problem. At each iteration of TSADP, a multivariate optimal control problem is transformed to be a certain number of univariate optimal control problems. It is shown that the value function at each iteration can be characterised pointwisely by a set of smooth functions recursively obtained from TSADP, and the associated control policy, continuous control and switching control law included, is explicitly provided in a state-feedback form. Moreover, the convergence and optimality of TSADP is strictly proven. To implement this algorithm efficiently, neural networks, critic and action networks, are utilised to approximate the value function and continuous control law, respectively. Thus, the value function is expressed by the weights of critic networks pointwise. Besides, redundant weights are ruled out at each iteration to simplify the exponentially increasing computation burden. Finally, a simulation example is provided to demonstrate its effectiveness.

  3. High Ki-67 and Vascular Endothelial Growth Factor (VEGF Protein Expression as Negative Predictive Factor for Combined Neoadjuvant Chemotherapy in Young Age Stage III Breast Cancer

    Directory of Open Access Journals (Sweden)

    I Wayan Sudarsa

    2016-05-01

    Full Text Available Background: Breast cancer was, in general, a heterogeneous disease with diverse biological characteristics, types, subtypes and clinical behavior. Its treatment and management need to be personalized and individualized. Breast cancer in young ages, although rare, is usually a unique and more aggressive cancer associated with poorer prognosis. The combination of young age and advanced stages of breast cancer would make this particular breast cancer harder to treat and cure. Unfortunately, majority of Breast Cancer Patients in Bali were in younger ages, and at advanced stages, that the mainstay of treatment was neo-adjuvant chemotherapy followed by other treatment modalities. Improve prognosis only, those patients who had had a complete pathological response involving primary tumor and regional lymph nodes in the axilla. Several factors had been studied and contributed to breast cancer response to combined neo-adjuvant chemotherapy. Usually, younger patients, was associated with high proliferation rate represented by Ki-67 and early distant metastasis represented by VEGF, which also had role as prognostic markers. The purpose of this study was to determine whether high Ki-67 and VEGF expression correlate with response to NAC and hence, they would be important predictive factors for response to NAC. Method: This study was a cross-sectional and a nested case-control study of stage III breast cancers affecting patients 40 years of age or less, at Sanglah General Hospital and Prima Medika Hospital, conducted from September 1st, 2012 until March 31st, 2014. Clinical and pathology reports were traced and recorded from both hospitals; routine Immunohistochemistry (IHC examinations were performed by both pathology labs. Statistical analysis was performed using Chi-Square test, Odds Ratio (OR, and logistic regression analysis with p<0.05. Results: There were 66 Stage III young breast cancer patients, where 35 (53% showed no or negative response and 31 (47

  4. Georgetown University Integrated Community Energy System (GU-ICES). Phase III, Stage I. Feasibility analysis. Final report. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-10-01

    This Feasibility Analysis covers a wide range of studies and evaluations. The Report is divided into five parts. Section 1 contains all material relating to the Institutional Assessment including consideration of the requirements and position of the Potomac Electric Co. as they relate to cogeneration at Georgetown in parallel with the utility (Task 1). Sections 2 through 7 contain all technical information relating to the Alternative Subsystems Analysis (Task 4). This includes the energy demand profiles upon which the evaluations were based (Task 3). It further includes the results of the Life-Cycle-Cost Analyses (Task 5) which are developed in detail in the Appendix for evaluation in the Technical Report. Also included is the material relating to Incremental Savings and Optimization (Task 6) and the Conceptual Design for candidate alternate subsystems (Task 7). Section 8 contains all material relating to the Environmental Impact Assessment (Task 2). The Appendix contains supplementary material including the budget cost estimates used in the life-cycle-cost analyses, the basic assumptions upon which the life-cycle analyses were developed, and the detailed life-cycle-cost anlysis for each subsystem considered in detail.

  5. OPTIMIZATION PROCEDURE FOR PRELIMINARY DESIGN STAGE OF CAIRO-DAMIETTA SELF-PROPELLED GRAIN BULK SHIPS

    Directory of Open Access Journals (Sweden)

    M.M. Moustafa

    2016-01-01

    Full Text Available The global logistics center for the storage and handling of grain which will be constructed at Damietta port will extremely increase the annual movement of grain through Cairo-Damietta waterway. Therefore, the demand for inland grain bulk ships has increased significantly in the recent years. This paper introduces a procedure to find out the fleet size and optimum characteristics of self-propelled grain bulk ships working between Cairo and Damietta through River Nile. The characteristics of the Cairo–Damietta waterway are investigated to define the constraints on dimensions and speed for such ship type. Also, mathematical model for the objective function was developed considering: powering, voyage, weight, stability and cost calculation. In this research, Specific cost (Sc, cost of transporting one ton of cargo a distance of one kilometre, is considered as the objective function for this optimization process. This optimization problem is handled as a single objective nonlinear constrained optimization problem using a specially developed computer program. Solutions are generated by varying design variables systematically in certain steps. The best of these solutions is then taken as the estimated optimum. Finally, the problem is presented, the main constrains analyzed and the optimum solution shown.

  6. Design Optimization for the Measurement Accuracy Improvement of a Large Range Nanopositioning Stage

    Directory of Open Access Journals (Sweden)

    Marta Torralba

    2016-01-01

    Full Text Available Both an accurate machine design and an adequate metrology loop definition are critical factors when precision positioning represents a key issue for the final system performance. This article discusses the error budget methodology as an advantageous technique to improve the measurement accuracy of a 2D-long range stage during its design phase. The nanopositioning platform NanoPla is here presented. Its specifications, e.g., XY-travel range of 50 mm × 50 mm and sub-micrometric accuracy; and some novel designed solutions, e.g., a three-layer and two-stage architecture are described. Once defined the prototype, an error analysis is performed to propose improvement design features. Then, the metrology loop of the system is mathematically modelled to define the propagation of the different sources. Several simplifications and design hypothesis are justified and validated, including the assumption of rigid body behavior, which is demonstrated after a finite element analysis verification. The different error sources and their estimated contributions are enumerated in order to conclude with the final error values obtained from the error budget. The measurement deviations obtained demonstrate the important influence of the working environmental conditions, the flatness error of the plane mirror reflectors and the accurate manufacture and assembly of the components forming the metrological loop. Thus, a temperature control of ±0.1 °C results in an acceptable maximum positioning error for the developed NanoPla stage, i.e., 41 nm, 36 nm and 48 nm in X-, Y- and Z-axis, respectively.

  7. Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III Non–Small-Cell Lung Cancer Beneficial? A Multi-Institutional Propensity Score Matched Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca [London Health Sciences Centre, London, Ontario (Canada); Oberije, Cary [MAASTRO Clinic, Maastricht (Netherlands); Senan, Suresh [VU University Medical Center, Amsterdam (Netherlands); Tsujino, Kayoko [Hyogo Cancer Center, Akashi (Japan); Wiersma, Terry [MAASTRO Clinic, Maastricht (Netherlands); Moreno-Jimenez, Marta [Universidad de Navarra, Pamplona (Spain); Kim, Tae Hyun [National Cancer Center, Goyang-si, Gy eonggi (Korea, Republic of); Marks, Lawrence B. [University of North Carolina, Chapel Hill, North Carolina (United States); Rengan, Ramesh [University of Washington, Seattle, Washington (United States); De Petris, Luigi [Karolinska University Hospital, Stockholm (Sweden); Ramella, Sara [Campus Bio-Medico University, Rome (Italy); DeRuyck, Kim [Ghent University, Ghent (Belgium); De Dios, Núria Rodriguez [Universidad Pompeu Fabra, Barcelona (Spain); Warner, Andrew [London Health Sciences Centre, London, Ontario (Canada); Bradley, Jeffrey D. [Washington University School of Medicine, St. Louis, Missouri (United States); Palma, David A. [London Health Sciences Centre, London, Ontario (Canada)

    2015-01-01

    Purpose: The clinical benefits and risks of dose escalation (DE) for stage III non–small-cell lung cancer (NSCLC) remain uncertain despite the results from Radiation Therapy Oncology Group (RTOG) protocol 0617. There is significant heterogeneity of practice, with many clinicians prescribing intermediate dose levels between the 0617 study arms of 60 and 74 Gy. This study investigated whether this strategy is associated with any survival benefits/risks by analyzing a large multi-institutional database. Methods and Materials: An individual patient database of stage III NSCLC patients treated with radical intent concurrent chemoradiation therapy was created (13 institutions, n=1274 patients). Patients were divided into 2 groups based on tumor Biological Effective Dose at 10 Gy (BED 10): those receiving standard dose (SD; n=552), consisting of 72Gy ≤ BED 10 ≤ 76.8 Gy (eg 60-64 Gy/30-32 fractions [fr]), and those receiving intermediate dose (ID; n=497), consisting of 76.8Gy < BED 10 < 100.8 Gy (eg >64 Gy/32 fr and <74 Gy/37 fr), with lower-dose patients (n=225) excluded from consideration. Patients were then matched using propensity scores, leading to 2 matched groups of 196 patients. Outcomes were compared using various statistics including interquartile range (IQR), Kaplan-Meier curves, and adjusted Cox regression analysis. Results: Matched groups were found to be balanced except for N stage (more N3 disease in SD), median treatment year (SD in 2003; ID in 2007), platinum and taxane chemotherapy (SD in 28%; ID in 39%), and median follow-up (SD were 89 months; ID were 40 months). Median dose fractionation was 60 Gy/30 fr in SD (BED 10 IQR: 72.0-75.5 Gy) and 66 Gy/33 fr (BED 10 IQR: 78.6-79.2 Gy) in ID. Survival curves for SD and ID matched cohorts were statistically similar (P=.27); however, a nonstatistically significant trend toward better survival for ID was observed after 15 months (median survival SD: 19.3 months; ID: 21.0

  8. IORT and external beam irradiation (EBI) in clinical stage I-II NSCLC patients with severely compromised pulmonary function: an 52-patient single-institutional experience

    Energy Technology Data Exchange (ETDEWEB)

    Jakse, G.; Kapp, K.S.; Geyer, E.; Oechs, A. [Dept. of Therapeutic Radiology and Oncology, Dept. of Surgery, Medical Univ. of Graz (Austria); Maier, A.; Gabor, S.; Juettner, F.M. [Div. of Thoracic and Hyperbaric Surgery, Medical Univ. of Graz (Austria)

    2007-12-15

    In limited stage NSCLC surgery offers the best chance for cure. However, patients who would not tolerate a radical surgical procedure such as lobectomy on the basis of severely compromised pulmonary function or cardio respiratory impairment are also poor candidates for radical external beam irradiation. These patients may benefit from alternative procedures that allow maximum sparing of adjacent lung tissue such as brachytherapy, stereotactic radiotherapy or IORT. There is clear evidence that loco-regional control in lung cancer is dose related, but neighboring normal tissues such as ipsilateral or collateral lung, heart, spinal cord are limiting factors for delivering doses necessary to eradicate the primary or loco-regional metastases. The rational of IORT, builds on the observation that only patients in whom local control has been achieved had a prolonged survival. IORT permits to selectively deliver high single doses to the tumor or the tumor bed with maximum sparing of adjacent normal tissue and has been applied with curative and palliative intent in a variety of tumors. Experience with IORT in lung cancer is still very limited. The current study evaluates the outcome of combined IORT and EBI in a highly selected cohort of patients with clinical stage I-II NSCLC who were fit to undergo thoracotomy and lymph node sampling but unable to undergo lobectomy or conventional high dose EBI due to severely compromised pulmonary function. (orig.)

  9. Safety of zoledronic acid and incidence of osteonecrosis of the jaw (ONJ) during adjuvant therapy in a randomised phase III trial (AZURE: BIG 01-04) for women with stage II/III breast cancer.

    Science.gov (United States)

    Coleman, R; Woodward, E; Brown, J; Cameron, D; Bell, R; Dodwell, D; Keane, M; Gil, M; Davies, C; Burkinshaw, R; Houston, S J; Grieve, R J; Barrett-Lee, P J; Thorpe, H

    2011-06-01

    The AZURE trial is an ongoing phase III, academic, multi-centre, randomised trial designed to evaluate the role of zoledronic acid (ZOL) in the adjuvant therapy of women with stage II/III breast cancer. Here, we report the safety and tolerability profile of ZOL in this setting. Eligible patients received (neo)adjuvant chemotherapy and/or endocrine therapy and were randomised to receive neither additional treatment nor intravenous ZOL 4 mg. ZOL was administered after each chemotherapy cycle to exploit potential sequence-dependent synergy. ZOL was continued for 60 months post-randomisation (six doses in the first 6 months, eight doses in the following 24 months and five doses in the final 30 months). Serious (SAE) and non-serious adverse event (AE) data generated during the first 36 months on study were analysed for the safety population. 3,360 patients were recruited to the AZURE trial. The safety population comprised 3,340 patients (ZOL 1,665; control 1,675). The addition of ZOL to standard treatment did not significantly impact on chemotherapy delivery. SAE were similar in both treatment arms. No significant safety differences were seen apart from the occurrence of osteonecrosis of the jaw (ONJ) in the ZOL group (11 confirmed cases; 0.7%; 95% confidence interval 0.3-1.1%). ZOL in the adjuvant setting is well tolerated, and can be safely administered in addition to adjuvant therapy including chemotherapy. The adverse events were consistent with the known safety profile of ZOL, with a low incidence of ONJ.

  10. Ethanol mediated As(III) adsorption onto Zn-loaded pinecone biochar: Experimental investigation, modeling, and optimization using hybrid artificial neural network-genetic algorithm approach.

    Science.gov (United States)

    Zafar, Mohd; Van Vinh, N; Behera, Shishir Kumar; Park, Hung-Suck

    2017-04-01

    Organic matters (OMs) and their oxidization products often influence the fate and transport of heavy metals in the subsurface aqueous systems through interaction with the mineral surfaces. This study investigates the ethanol (EtOH)-mediated As(III) adsorption onto Zn-loaded pinecone (PC) biochar through batch experiments conducted under Box-Behnken design. The effect of EtOH on As(III) adsorption mechanism was quantitatively elucidated by fitting the experimental data using artificial neural network and quadratic modeling approaches. The quadratic model could describe the limiting nature of EtOH and pH on As(III) adsorption, whereas neural network revealed the stronger influence of EtOH (64.5%) followed by pH (20.75%) and As(III) concentration (14.75%) on the adsorption phenomena. Besides, the interaction among process variables indicated that EtOH enhances As(III) adsorption over a pH range of 2 to 7, possibly due to facilitation of ligand-metal(Zn) binding complexation mechanism. Eventually, hybrid response surface model-genetic algorithm (RSM-GA) approach predicted a better optimal solution than RSM, i.e., the adsorptive removal of As(III) (10.47μg/g) is facilitated at 30.22mg C/L of EtOH with initial As(III) concentration of 196.77μg/L at pH5.8. The implication of this investigation might help in understanding the application of biochar for removal of various As(III) species in the presence of OM. Copyright © 2016. Published by Elsevier B.V.

  11. Randomised controlled trial evaluating the efficacy of wrap therapy for wound healing acceleration in patients with NPUAP stage II and III pressure ulcer

    Science.gov (United States)

    Mizuhara, Akihiro; Oonishi, Sandai; Takeuchi, Kensuke; Suzuki, Masatsune; Akiyama, Kazuhiro; Kobayashi, Kazuyo; Matsunaga, Kayoko

    2012-01-01

    Objectives To evaluate if ‘wrap therapy’ using food wraps, which is widely used in Japanese clinical sites, is not inferior when compared to guideline adhesion treatments. Design Multicentre, prospective, randomised, open, blinded endpoint clinical trial. Setting 15 hospitals in Japan. Patients 66 older patients with new National Pressure Ulcer Advisory Panel stage II or III pressure ulcers. Interventions Of these 66 patients, 31 were divided into the conventional treatment guidelines group and 35 into the wrap therapy group. Main outcome measures The primary end point was the period until the pressure ulcers were cured. The secondary end point was a comparison of the speed of change in the Pressure Ulcer Scale for Healing score. Results 64 of the 66 patients were analysed. The estimated mean period until healing was 57.5 days (95% CI 45.2 to 69.8) in the control group as opposed to 59.8 days (95% CI 49.7 to 69.9) in the wrap therapy group. By the extent of pressure ulcer infiltration, the mean period until healing was 16.0 days (95% CI 8.1 to 23.9) in the control group as opposed to 18.8 days (95% CI 10.3 to 27.2) in the wrap therapy group with National Pressure Ulcer Advisory Panel stage II ulcers, and 71.8 days (95% CI 61.4 to 82.3) as opposed to 63.2 days (95% CI 53.0 to 73.4), respectively, with stage III ulcers. There is no statistical significance in difference in Pressure Ulcer Scale for Healing scores. Conclusions It might be possible to consider wrap therapy as an alternative choice in primary care settings as a simple and inexpensive dressing care. Clinical Trial registration UMIN Clinical Trials Registry UMIN000002658. Summary protocol is available on https://upload.umin.ac.jp/cgi-bin/ctr/ctr.cgi?function=brows&action=brows&type=detail&recptno=R000003235&admin=0&language=J PMID:22223842

  12. Granisetron, Aprepitant, and Dexamethasone in Preventing Nausea and Vomiting in Patients Receiving Chemotherapy for Stage II, III, or IV Ovarian Cancer

    Science.gov (United States)

    2016-03-16

    Malignant Ovarian Mixed Epithelial Tumor; Nausea and Vomiting; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

  13. Neoadjuvant letrozole in postmenopausal estrogen and/or progesterone receptor positive breast cancer: A phase IIb/III trial to investigate optimal duration of preoperative endocrine therapy

    Directory of Open Access Journals (Sweden)

    Bastert Gunther

    2008-02-01

    Full Text Available Abstract Background In recent years, preoperative volume reduction of locally advanced breast cancers, resulting in higher rates of breast-conserving surgery (BCS, has become increasingly important also in postmenopausal women. Clinical interest has come to center on the third-generation nonsteroidal aromatase inhibitors (AIs, including letrozole, for such neoadjuvant endocrine treatment. This usually lasts 3–4 months and has been extended to up to 12 months, but optimal treatment duration has not been fully established. Methods This study was designed as a multicenter, open-label, single-arm, exploratory phase IIb/III clinical trial of letrozole 2.5 mg, one tablet daily, for 4–8 months. The primary objective was to investigate the effect of neoadjuvant treatment duration on tumor regression and BCS eligibility to identify optimal treatment duration. Tumor regression (by clinical examination, mammography, and ultrasound, shift towards BCS eligibility, and safety assessments were the main outcome measures. Standard parametric and nonparametric descriptive statistics were performed. Results Letrozole treatment was received by 32 of the enrolled 33 postmenopausal women (median (range: 67.0 (56–85 years with unilateral, initially BCS-ineligible primary breast cancer (clinical stage ≥ T2, N0, M0. Letrozole treatment duration in the modified intent-to-treat (ITT; required 4 months' letrozole treatment analysis population (29 patients was 4 months in 14 patients and > 4 months in 15 patients. The respective per-protocol (PP subgroup sizes were 14 and 11. The majority of partial or complete responses were observed at 4 months, though some beneficial responses occurred during prolonged letrozole treatment. Compared with baseline, median tumor size in the ITT population was reduced by 62.5% at Month 4 and by 70.0% at final study visit (Individual End. Similarly, in the PP population, respective reductions were 64.0% and 67.0%. Whereas initially

  14. Optimization of Peltier current lead for applied superconducting systems with optimum combination of cryo-stages

    Science.gov (United States)

    Kawahara, Toshio; Emoto, Masahiko; Watanabe, Hirofumi; Hamabe, Makoto; Sun, Jian; Ivanov, Yury; Yamaguchi, Satarou

    2012-06-01

    The reduction of electric power consumption of the cryo-cooler during the working conditions of applied superconducting systems is important, as superconductivity can only be stored at low temperature and the power required for the cooling determines the efficiency of the systems employed. Use of Peltier current leads (PCLs) represents one key solution to effect heat load reduction on the terminals in systems. On the other hand, the performance of cryo-coolers generally increases as the temperature increases given the higher Carnot efficiency. Therefore, combination with suitable mid-stage temperatures represents one possible approach since the thermal anchor can enhance the performance of the system by reducing the electric power consumption of the cryo-coolers. In this paper, we discuss this possibility utilizing an advanced configuration of PCL with a commercially available high temperature cooler. Over 50% enhancement of the performance is estimated.

  15. Optimization of Adaboost Algorithm for Sonar Target Detection in a Multi-Stage ATR System

    Science.gov (United States)

    Lin, Tsung Han (Hank)

    2011-01-01

    JPL has developed a multi-stage Automated Target Recognition (ATR) system to locate objects in images. First, input images are preprocessed and sent to a Grayscale Optical Correlator (GOC) filter to identify possible regions-of-interest (ROIs). Second, feature extraction operations are performed using Texton filters and Principal Component Analysis (PCA). Finally, the features are fed to a classifier, to identify ROIs that contain the targets. Previous work used the Feed-forward Back-propagation Neural Network for classification. In this project we investigate a version of Adaboost as a classifier for comparison. The version we used is known as GentleBoost. We used the boosted decision tree as the weak classifier. We have tested our ATR system against real-world sonar images using the Adaboost approach. Results indicate an improvement in performance over a single Neural Network design.

  16. Prolonged antigen presentation is required for optimal CD8+ T cell responses against malaria liver stage parasites.

    Directory of Open Access Journals (Sweden)

    Ian A Cockburn

    2010-05-01

    Full Text Available Immunization with irradiated sporozoites is currently the most effective vaccination strategy against liver stages of malaria parasites, yet the mechanisms underpinning the success of this approach are unknown. Here we show that the complete development of protective CD8+ T cell responses requires prolonged antigen presentation. Using TCR transgenic cells specific for the malaria circumsporozoite protein, a leading vaccine candidate, we found that sporozoite antigen persists for over 8 weeks after immunization--a remarkable finding since irradiated sporozoites are incapable of replication and do not differentiate beyond early liver stages. Persisting antigen was detected in lymphoid organs and depends on the presence of CD11c+ cells. Prolonged antigen presentation enhanced the magnitude of the CD8+ T cell response in a number of ways. Firstly, reducing the time primed CD8+ T cells were exposed to antigen in vivo severely reduced the final size of the developing memory population. Secondly, fully developed memory cells expanded in previously immunized mice but not when transferred to naïve animals. Finally, persisting antigen was able to prime naïve cells, including recent thymic emigrants, to become functional effector cells capable of eliminating parasites in the liver. Together these data show that the optimal development of protective CD8+ T cell immunity against malaria liver stages is dependent upon the prolonged presentation of sporozoite-derived antigen.

  17. Contemporary design development and stage parameter optimization possibilities of reciprocating compressors for refinery application

    Science.gov (United States)

    Prilutskii, A. I.; Prilutskii, I. K.; Makoveeva, A. S.; Prilutskii, A. A.

    2017-08-01

    The article deals with some improper performance reasons of reciprocating compressors which are in year-round operation. The possibilities and recommendations for design optimization of some details and components and compressor operating parameters under existing industry conditions by means of the upgraded volumetric machine calculation program KOMDET-M designed for analyzing processes occurring in volumetric machines are represented. The calculation result agreement with parameters claimed by vendor and actual ones of gas reciprocating compressors which are in operation is shown. The scientific and practical value of the research for any designed, upgradable or operating unit is demonstrated. Necessary calculations have been performed by means of the application calculation program. Some examples of volumetric machine reliability and efficiency improvement are represented.

  18. Relevance of philosophy of life and optimism for psychological distress among individuals in a stage where death is approaching.

    Science.gov (United States)

    Winterling, Jeanette; Wasteson, Elisabet; Sidenvall, Birgitta; Sidenvall, Erik; Glimelius, Bengt; Sjödén, Per-Olow; Nordin, Karin

    2006-04-01

    The purpose was to investigate the relevance of philosophy of life as well as optimism for the psychological distress among Swedish individuals in a stage where death is approaching. Sixty-nine persons were included; of these were 42 patients newly diagnosed with advanced gastrointestinal cancer and 26 were partners to these patients. The participants' philosophy of life was studied through a semi-structured interview. The interview statements were subjected to content analysis. Optimism was measured by the Life Orientation Test and psychological distress by the Hospitality and Depression Scale. The results showed that optimistic respondents had less psychological distress. Two aspects of philosophy of life had relevance for such distress. These were wondering about why the cancer had occurred and having a feeling of being able to live a good life having or living near a person with advanced cancer. In conclusion, the above-mentioned aspects of philosophy of life as well as optimism have relevance for psychological distress among these individuals, which stress the importance that health-care staff address both patients' and their partners' concerns about their philosophy of life.

  19. GILT - A randomised phase III study of oral vinorelbine and cisplatin with concomitant radiotherapy followed by either consolidation therapy with oral vinorelbine and cisplatin or best supportive care alone in stage III non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Flentje, Michael [University Hospital Wuerzburg, Dept. of Radiotherapy, Wuerzburg (Germany); Huber, Rudolf M. [University Hospital Munich, Member of the German Center for Lung Research (DZL CPC-M), Munich (Germany); Engel-Riedel, Walburga [University Hospital Merheim, Dept. of Pneumonology, Cologne (Germany); Andreas, Stefan [Dept. of Pneumonology, Immenhausen (Germany); Kollmeier, Jens [Helios Emil-von-Behring Hospital, Berlin (Germany); Staar, Susanne [Municipal Hospital Bremen-Mitte, Bremen (Germany); Dickgreber, Nicolas [University Hospital Hannover, Hannover (Germany); Vaissiere, Nathalie; Almeida, Cecilia de [Institut de Recherche Pierre Fabre, Boulogne (France); Edlich, Birgit [Pierre Fabre Pharma GmbH, Freiburg (Germany); Fietkau, Rainer [University Hospital Erlangen, Erlangen (Germany)

    2016-04-15

    Concurrent chemoradiotherapy (CRT) is considered standard for inoperable stage III non-small cell lung cancer (NSCLC). Consolidation chemotherapy (CC) following CRT is intended to further improve outcomes, yet studies have shown discordant results. This phase III study assessed CRT followed by best supportive care (BSC) or consolidation with oral vinorelbine and cisplatin. Patients received two cycles of oral vinorelbine (50 mg/m{sup 2} days 1, 8 and 15) + cisplatin (20 mg/m{sup 2} days 1-4) q4w + radiotherapy (RT; 66 Gy). Patients with at least stable disease (SD) were randomised to either two cycles oral vinorelbine (60-80 mg/m{sup 2} days 1 and 8) + cisplatin (80 mg/m{sup 2} day 1) q3w + BSC or BSC alone. Primary endpoint was progression-free survival (PFS). A total of 279 patients were enrolled for CRT and 201 patients were randomised to CC or BSC. Both CRT and CC were well tolerated, with limited radiation-mediated grade 3/4 toxicities (CRT/CC/BSC: oesophagitis-related events 12.9 %/3.1 %/0 %; grade 3 pneumonitis 0 %/0 %/2 %) and chemotherapy-mediated grade 3/4 toxicities (CRT/CC: neutropenia 11.2 %/22.1 %; leukopenia 18.3 %/26.7 %; grade 3 nausea 5.0 %/2.3 %, grade 3 vomiting 3.2 %/3.5 %). Median PFS from randomisation was 6.4 (5.0-8.7) and 5.5 (3.8-7.4) months in the CC and BSC arms (hazard ratio, HR = 0.93 [0.69-1.26]; p = 0.63), respectively; median overall survival (OS) 20.8 (13.5-25.3) and 18.5 (13.6-24.7) months, respectively. Consolidation chemotherapy after concurrent CRT did not prolong PFS or OS. Concurrent RT with oral vinorelbine and cisplatin demonstrated a favourable safety profile and represents a suitable treatment regimen for inoperable stage III NSCLC. (orig.) [German] Simultane Radiochemotherapie (CRT) wird als Standardtherapie beim inoperablen Stadium III des nicht-kleinzelligen Lungenkarzinoms (NSCLC) angesehen. Konsolidierende Chemotherapie (CC) nach der CRT zielt darauf ab, das Therapieergebnis zu verbessern, allerdings zeigen Studien

  20. Adjuvant post-operative radiotherapy vs radiotherapy plus 5-FU and levamisole in patients with TNM stage II-III resectable rectal cancer. A phase III randomized clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Cafiero, F.; Gipponi, M.; Di Somma, C. [Istituto Nazionale per la Ricerca sul Cancro, Geneo (Italy). Istituto di Oncologia Clinica] [and others

    1995-08-01

    Loco-regional and distant relapses contribute to impair the outcome of rectal cancer patients. As to the former, either pre-or post-operative radiation therapy (RT) significantly reduce loco-regional recurrence; post-operative chemotherapy (CT), alone or in different combinations with RT, is effective in improving both disease-free survival and survival. However, many drawbacks still exist regarding the method of RT delivery as well as the toxicity of combination adjuvant chemotherapy. The aim of this trial is to assess the effectiveness and toxicity of adjuvant post-operative RT vs combined RT and CT (5-FU plus levamisole) in patients with TNM stage II-III resectable rectal cancer (pT3-4, pN0, M0; pT1-4, pN1-3, M0). The primary endpoint is overall survival; secondary endpoints are disease-free survival rate of loco-regional recurrence, and treatment-related toxicity/morbidity. (author).

  1. A Two-Stage Queue Model to Optimize Layout of Urban Drainage System considering Extreme Rainstorms

    Directory of Open Access Journals (Sweden)

    Xinhua He

    2017-01-01

    Full Text Available 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 cost of construction and operation and overall sojourn time of stormwater. An improved genetic algorithm is redesigned to solve this complex nondeterministic problem, which incorporates with stochastic and fuzzy characteristics in whole drainage process. A numerical example in Shanghai illustrates how to implement the model, and comparisons with alternative algorithms show its performance in computational flexibility and efficiency. Discussions on sensitivity of four main parameters, that is, quantity of pump stations, drainage pipe diameter, rainstorm precipitation intensity, and confidence levels, are also presented to provide guidance for designing urban drainage system.

  2. Consolidation chemotherapy improves progression-free survival in stage III small-cell lung cancer following concurrent chemoradiotherapy: a retrospective study

    Directory of Open Access Journals (Sweden)

    Chen XR

    2016-09-01

    for PFS. Multivariate analysis for OS also showed that having undergone PCI (P<0.001 and having received CCT (P=0.006 were independent significant prognostic factors. Conclusion: CCT can improve PFS for patients with stage IIIA and IIIB SCLC following CCRT without significantly increasing treatment-related toxicities. Keywords: stage III, small-cell lung cancer, consolidation chemotherapy, survival analysis, prognosis, toxicities 

  3. A Comparative Analysis Between Optimized and Baseline High Pressure Compressor Stages Using Tridimensional Computational Fluid Dynamics

    Directory of Open Access Journals (Sweden)

    V. Dragan

    2016-08-01

    Full Text Available Re-vamping of industrial turbo-machinery is commonplace in the oil and gas industry in applications where subterranean combustion is used for oil extraction. The current case study refers to such an industrial compressor re-vamping, using a state of the art 3D fully viscous CFD methodology coupled with artificial neural networks (ANNs and genetic algorithms (GA. The ANN is used to establish correlations within a database of CFD simulations of geometrical variations of the original rotor and the GA uses those correlations to estimate an optimum. The estimate is then tested with the same CFD method and the results are fed back into the database, increasing the accuracy of the ANN correlations. The process is reiterated until the optimum estimated by the GA is confirmed with the CFD simulations. The resulting geometry is superior to the original in terms of efficiency and pressure ratio as well as the range of stabile operation, as confirmed by the successful implementation in the field. In this paper we present an analysis of why the optimized geometry achieves superior performances to the original one. Further work will present comparison between the detailed experimental data and CFD.

  4. Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?

    Science.gov (United States)

    She, Wong Hoi; Chan, Albert Chi Yan; Poon, Ronnie Tung Ping; Cheung, Tan To; Chok, Kenneth Siu Ho; Chan, See Ching; Lo, Chung Mau

    2015-11-01

    We aimed to assess if simultaneous resection conferred any survival benefit in resection of synchronous colorectal liver metastases. From January 1990 to December 2008, 116 patients with synchronous colorectal liver metastases were identified. Among these 116 patients, 88 underwent staged resection (SR), while the remaining 28 patients underwent simultaneous resection (SIMR). Patients' follow-up data were reviewed. There were no significant differences between the groups in terms of patient and tumour characteristics. Major hepatectomy was performed in 54 patients (61%) undergoing SR, and 12 patients (43%) undergoing SIMR (P = 0.09). The median blood loss (SR 0.7 L versus SIMR 0.8 L) was similar. Post-operative morbidity rates and hospital mortality rates were not statistically different. The total length of hospital stay was shorter in SIMR patients (18.0 versus 11.5 days, P = 0.009). The 1-, 3- and 5-year overall survival for SR were 90.7%, 47.1% and 33.3%, whilst the corresponding survival rates for SIMR were 75.0%, 25.0% and 0%, respectively (P = 0.003). However, when the disease-free survival (DFS) was stratified according to the number of hepatic metastases, the survival benefit of SR and SIMR for solitary CRM were similar (3-year DFS: 28.3% versus 11.1%, P = 0.089). Our study showed that an operative strategy of SR generally offered better survival outcome than SIMR in the surgical management of CRM. © 2014 Royal Australasian College of Surgeons.

  5. A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a "Sandwich" method for stage III, IV, and recurrent endometrial cancer.

    Science.gov (United States)

    Geller, Melissa A; Ivy, Joseph J; Ghebre, Rahel; Downs, Levi S; Judson, Patricia L; Carson, Linda F; Jonson, Amy L; Dusenbery, Kathryn; Vogel, Rachel Isaksson; Boente, Matthew P; Argenta, Peter A

    2011-04-01

    To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer. Patients with surgically staged III-IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75 mg/m²) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS). Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age=58 years (range: 21-81 years). 78% (32/41)=endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Seven patients died following treatment with a median follow-up of 28 months (range: 7-70 months). KM estimates and 95% confidence intervals for OS at 1 year were 95% (82-99%), at 3 years 90% (75-96%), and at 5 years 71% (45-86%). Of the 39 with primary disease, 11 progressed or died within 5 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 87% (72-94%), at 3 years 71% (51-83%), and at 5 years 64% (42-80%). "Sandwiching" radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS. Copyright © 2010 Elsevier Inc. All rights reserved.

  6. Fibroblast Growth Factor 2-A Predictor of Outcome for Patients Irradiated for Stage II-III Non-Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk, E-mail: Rades.Dirk@gmx.net [Department of Radiation Oncology, University of Lubeck, Lubeck (Germany); Setter, Cornelia [Department of Radiation Oncology, University of Lubeck, Lubeck (Germany); Dahl, Olav [Section of Oncology, Institute of Medicine, University of Bergen, Bergen (Norway); Department of Oncology, Haukeland University Hospital, Bergen (Norway); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, Arizona (United States); Noack, Frank [Institute of Pathology, University of Lubeck, Lubeck (Germany)

    2012-01-01

    Purpose: The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. Methods and Materials: The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years, smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. Results: On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. Conclusions: Tumor cell expression of FGF-2 appeared to be an independent negative predictor

  7. Radiation Therapy Administration and Survival in Stage I/II Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue

    Energy Technology Data Exchange (ETDEWEB)

    Olszewski, Adam J., E-mail: adam_olszewski@brown.edu; Desai, Amrita

    2014-03-01

    Purpose: To determine the factors associated with the use of radiation therapy and associated survival outcomes in early-stage marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT). Methods and Materials: We extracted data on adult patients with stage I/II MALT lymphoma diagnoses between 1998 and 2010 recorded in the Surveillance, Epidemiology, and End Results (SEER) database. We studied factors associated with radiation therapy administration in a logistic regression model and described the cumulative incidence of lymphoma-related death (LRD) according to receipt of the treatment. The association of radiation therapy with survival was explored in multivariate models with adjustment for immortal time bias. Results: Of the 7774 identified patients, 36% received radiation therapy as part of the initial course of treatment. Older patients; black or Hispanic men; white, Hispanic, and black women; and socioeconomically disadvantaged and underinsured patients had a significantly lower chance of receiving radiation therapy. Radiation therapy administration was associated with a lower chance of LRD in most sites. In cutaneous, ocular, and salivary MALT lymphomas, the 5-year estimate of LRD after radiation therapy was 0%. The association of radiation therapy with overall survival in different lymphoma sites was heterogeneous, and statistically significant in cutaneous (hazard ratio 0.45, P=.009) and ocular (hazard ratio 0.47, P<.0001) locations after multivariate adjustment. Conclusions: Demographic factors are associated with the use of radiation therapy in MALT lymphoma. Clinicians should be sensitive to those disparities because the administration of radiation therapy may be associated with improved survival, particularly in cutaneous and ocular lymphomas.

  8. A phase II prospective study of the "Sandwich" protocol, L-asparaginase, cisplatin, dexamethasone and etoposide chemotherapy combined with concurrent radiation and cisplatin, in newly diagnosed, I/II stage, nasal type, extranodal natural killer/T-cell lymphoma.

    Science.gov (United States)

    Jiang, Ming; Zhang, Li; Xie, Li; Zhang, Hong; Jiang, Yu; Liu, Wei-Ping; Zhang, Wen-Yan; Tian, Rong; Deng, Yao-Tiao; Zhao, Sha; Zou, Li-Qun

    2017-07-25

    Nasal-type, extranodal NK/T cell lymphoma (ENKTCL) is a special type of lymphomas with geographic and racial specificity. Up to now, the standard first-line treatment is still not unified. In our previous report, the "sandwich" protocol produced good results. Continuing to use the "sandwich" mode, a new chemotherapy composed of L-asparaginase, cisplatin, etoposide and dexamethasone (LVDP) plus concurrent chemoradiotherapy (CCRT) was conducted in more patients with newly diagnosed, I/II stage ENKTCL. The results showed that 66 patients were enrolled. Overall response rate was 86.4% including 83.3% complete response and 3.0% partial remission. With the median follow-up of 23.5 months, 3-year overall survival and 3-year progression-free survival were 70.1% and 67.4%, respectively. The survival rate in stage II and extra-cavity stage I was significantly less than that in limited stage I (p < 0.05). Therefore, we thought that the "sandwich" mode was worthy of being generalized and LVDP combined with CCRT was an effective protocol for I/II stage ENKTCL. But this regimen was not suitable for all stage I/II patients and warrants larger sample and layering investigation. This study was a registered clinical trial with number ChiCTR-TNC-12002353.

  9. Structural optimization of quinolon-4(1H)-imines as dual-stage antimalarials: toward increased potency and metabolic stability.

    Science.gov (United States)

    Ressurreição, Ana S; Gonçalves, Daniel; Sitoe, Ana R; Albuquerque, Inês S; Gut, Jiri; Góis, Ana; Gonçalves, Lídia M; Bronze, Maria R; Hanscheid, Thomas; Biagini, Giancarlo A; Rosenthal, Philip J; Prudêncio, Miguel; O'Neill, Paul; Mota, Maria M; Lopes, Francisca; Moreira, Rui

    2013-10-10

    Discovery of novel effective and safe antimalarials has been traditionally focused on targeting erythrocytic parasite stages that cause clinical symptoms. However, elimination of malaria parasites from the human population will be facilitated by intervention at different life-cycle stages of the parasite, including the obligatory developmental phase in the liver, which precedes the erythrocytic stage. We have previously reported that N-Mannich-based quinolon-4(1H)-imines are potent antiplasmodial agents but present several stability liabilities. We now report our efforts to optimize quinolon-4(1H)-imines as dual-stage antiplasmodial agents endowed with chemical and metabolic stability. We report compounds active against both the erythrocytic and exoerythrocytic forms of malaria parasites, such as the quinolon-4(1H)-imine 5p (IC50 values of 54 and 710 nM against the erythrocytic and exoerythrocytic forms), which constitute excellent starting points for further lead optimization as dual-stage antimalarials.

  10. Expression of Ribonucleotide Reductase Subunit-2 and Thymidylate Synthase Correlates with Poor Prognosis in Patients with Resected Stages I–III Non-Small Cell Lung Cancer

    Science.gov (United States)

    Grossi, Francesco; Dal Bello, Maria Giovanna; Salvi, Sandra; Puzone, Roberto; Pfeffer, Ulrich; Fontana, Vincenzo; Alama, Angela; Rijavec, Erika; Barletta, Giulia; Genova, Carlo; Sini, Claudio; Ratto, Giovanni Battista; Taviani, Mario; Truini, Mauro; Merlo, Domenico Franco

    2015-01-01

    Biomarkers can help to identify patients with early-stages or locally advanced non-small cell lung cancer (NSCLC) who have high risk of relapse and poor prognosis. To correlate the expression of seven biomarkers involved in DNA synthesis and repair and in cell division with clinical outcome, we consecutively collected 82 tumour tissues from radically resected NSCLC patients. The following biomarkers were investigated using IHC and qRT-PCR: excision repair cross-complementation group 1 (ERCC1), breast cancer 1 (BRCA1), ribonucleotide reductase subunits M1 and M2 (RRM1 and RRM2), subunit p53R2, thymidylate synthase (TS), and class III beta-tubulin (TUBB3). Gene expression levels were also validated in an available NSCLC microarray dataset. Multivariate analysis identified the protein overexpression of RRM2 and TS as independent prognostic factors of shorter overall survival (OS). Kaplan-Meier analysis showed a trend in shorter OS for patients with RRM2, TS, and ERCC1, BRCA1 overexpressed tumours. For all of the biomarkers except TUBB3, the OS trends relative to the gene expression levels were in agreement with those relative to the protein expression levels. The NSCLC microarray dataset showed RRM2 and TS as biomarkers significantly associated with OS. This study suggests that high expression levels of RRM2 and TS might be negative prognostic factors for resected NSCLC patients. PMID:26663950

  11. Circulating tumor cells correlate with recurrence in stage III small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation.

    Science.gov (United States)

    Fu, Lei; Liu, Fang; Fu, Hui; Liu, Liqing; Yuan, Shuanghu; Gao, Yongsheng; Fu, Zheng; Yu, Jinming

    2014-10-01

    We investigated the correlation between circulating tumor cells and the incidence of brain metastases as a first site of recurrence among patients with small-cell lung cancer after systemic chemoradiotherapy and prophylactic cranial irradiation. In addition, we assessed the contribution of circulating tumor cells for planning the appropriate total dose of prophylactic cranial irradiation for small-cell lung cancer. Patients (n = 112) with diagnosed Stage III small-cell lung cancer were treated with four cycles of platinum-based regimen and concurrent chest irradiation, and then prophylactic cranial irradiation. Blood samples for circulating tumor cell analysis were obtained before the initiation of chemotherapy and after the first and fourth cycle of chemotherapy. Circulating tumor cells after the first cycle of chemotherapy correlated with tumor response after completion of chemotherapy (P = 0.012). Patients with brain as the first site suffered a higher rate of further metastases to other organs, and local recurrence, compared with those whose first site was the other organs (P lung cancer. For patients with circulating tumor cells >218, prophylactic cranial irradiation at a total dose of 30 Gy in 15 fractions is insufficient. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Patterns of Sociodemographic and Clinicopathologic Characteristics of Stages II and III Colorectal Cancer Patients by Age: Examining Potential Mechanisms of Young-Onset Disease

    Directory of Open Access Journals (Sweden)

    Caitlin C. Murphy

    2017-01-01

    Full Text Available Background and Aims. As a first step toward understanding the increasing incidence of colorectal cancer (CRC in younger (age < 50 populations, we examined demographic, clinicopathologic, and socioeconomic characteristics and treatment receipt in a population-based sample of patients newly diagnosed with stages II and III CRC. Methods. Patients were sampled from the National Cancer Institute’s Patterns of Care studies in 1990/91, 1995, 2000, 2005, and 2010 (n=6,862. Tumor characteristics and treatment data were obtained through medical record review and physician verification. We compared sociodemographic and clinicopathologic characteristics and treatment patterns of younger (age < 50 and older (age 50–69, age ≥ 70 CRC patients. Results. Younger patients were more likely to be black (13% and Hispanic (15% than patients aged 50–69 years (11% and 10%, resp. and ≥70 years (7% each. A larger proportion of young white (41% and Hispanic (33% patients had rectal tumors, whereas tumors in the right colon were the most common in young black patients (39%. The majority of younger patients received chemotherapy and radiation therapy, although receipt of microsatellite instability testing was suboptimal (27%. Conclusion. Characteristics of patients diagnosed with young-onset CRC differ considerably by race/ethnicity, with a higher proportion of black and Hispanic patients diagnosed at the age of < 50 years.

  13. Mid-radiotherapy PET/CT for prognostication and detection of early progression in patients with stage III non-small cell lung cancer.

    Science.gov (United States)

    Gensheimer, Michael F; Hong, Julian C; Chang-Halpenny, Christine; Zhu, Hui; Eclov, Neville C W; To, Jacqueline; Murphy, James D; Wakelee, Heather A; Neal, Joel W; Le, Quynh-Thu; Hara, Wendy Y; Quon, Andrew; Maxim, Peter G; Graves, Edward E; Olson, Michael R; Diehn, Maximilian; Loo, Billy W

    2017-08-19

    Pre- and mid-radiotherapy FDG-PET metrics have been proposed as biomarkers of recurrence and survival in patients treated for stage III non-small cell lung cancer. We evaluated these metrics in patients treated with definitive radiation therapy (RT). We also evaluated outcomes after progression on mid-radiotherapy PET/CT. Seventy-seven patients treated with RT with or without chemotherapy were included in this retrospective study. Primary tumor and involved nodes were delineated. PET metrics included metabolic tumor volume (MTV), total lesion glycolysis (TLG), and SUVmax. For mid-radiotherapy PET, both absolute value of these metrics and percentage decrease were analyzed. The influence of PET metrics on time to death, local recurrence, and regional/distant recurrence was assessed using Cox regression. 91% of patients had concurrent chemotherapy. Median follow-up was 14months. None of the PET metrics were associated with overall survival. Several were positively associated with local recurrence: pre-radiotherapy MTV, and mid-radiotherapy MTV and TLG (p=0.03-0.05). Ratio of mid- to pre-treatment SUVmax was associated with regional/distant recurrence (p=0.02). 5/77 mid-radiotherapy scans showed early out-of-field progression. All of these patients died. Several PET metrics were associated with risk of recurrence. Progression on mid-radiotherapy PET/CT was a poor prognostic factor. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Comparative analysis of BRAF, NRAS and c-KIT mutation status between tumor tissues and autologous tumor cell-lines of stage III/IV melanoma.

    Science.gov (United States)

    Knol, Anne-Chantal; Pandolfino, Marie-Christine; Vallée, Audrey; Nguyen, Frédérique; Lella, Virginie; Khammari, Amir; Denis, Marc; Puaux, Anne-Laure; Dréno, Brigitte

    2015-01-01

    In the last decade, advances in molecular biology have provided evidence of the genotypic heterogeneity of melanoma. We analysed BRAF, NRAS and c-KIT alterations in tissue samples from 63 stage III/IV melanoma patients and autologous cell-lines, using either allele-specific or quantitative PCR. The expression of BRAF V600E protein was also investigated using an anti-BRAF antibody in the same tissue samples. 81% of FFPE samples and tumor cell-lines harboured a genetic alteration in either BRAF (54%) or NRAS (27%) oncogenes. There was a strong concordance (100%) between tissue samples and tumor cell-lines. The BRAF V600E mutant-specific antibody showed high sensitivity (96%) and specificity (100%) for detecting the presence of a BRAF V600E mutation. The correlation was of 98% between PCR and immunohistochemistry results for BRAF mutation. These results suggest that BRAF and NRAS mutation status of tumor cells is not affected by culture conditions.

  15. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lung cancer during multimodality treatment.

    Science.gov (United States)

    van der Meij, Barbara S; Langius, Jacqueline A E; Smit, Egbert F; Spreeuwenberg, Marieke D; von Blomberg, B Mary E; Heijboer, Annemieke C; Paul, Marinus A; van Leeuwen, Paul A M

    2010-10-01

    Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), (n-3) fatty acids from fish oil, have immune-modulating effects and may improve nutritional status in cancer. The objective of this study was to investigate the effects of an oral nutritional supplement containing (n-3) fatty acids on nutritional status and inflammatory markers in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomly assigned to receive 2 cans/d of a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids (2.0 g EPA + 0.9 g DHA/d) or an isocaloric control supplement. EPA in plasma phospholipids, energy intake, resting energy expenditure (REE), body weight, fat free mass (FFM), mid-upper arm circumference (MUAC), and inflammatory markers were assessed. Effects of intervention were analyzed by generalized estimating equations and expressed as regression coefficients (B). The intervention group (I) had a better weight maintenance than the control (C) group after 2 and 4 wk (B = 1.3 and 1.7 kg, respectively; P nutritional supplement containing (n-3) fatty acids beneficially affects nutritional status during multimodality treatment in patients with NSCLC.

  16. Lack of XAGE-1b and NY-ESO-1 in metastatic lymph nodes may predict the potential survival of stage III melanoma patients.

    Science.gov (United States)

    Mori, Mariko; Funakoshi, Takeru; Kameyama, Kaori; Kawakami, Yutaka; Sato, Eiichi; Nakayama, Eiichi; Amagai, Masayuki; Tanese, Keiji

    2017-06-01

    The cancer-testis antigens (CTA) are a large family of tumor-associated antigens expressed by a variety of cancer cells and primitive germ cells of the adult testis and placenta. These tumor-restricted expressing patterns suggest that CTA would be ideal targets for tumor-specific immunotherapy. XAGE-1 is a CTA that was originally identified by computer-based screening, and four transcription variants, XAGE-1a, -1b, -1c and -1d, have been characterized to date. Although the presence of XAGE-1 transcripts has been reported in various cancers, the expression of XAGE-1b in melanoma has not been fully characterized. In this study, we performed immunohistochemical staining of XAGE-1b together with NY-ESO-1, a well-known CTA, in 113 melanoma samples obtained from 84 patients and evaluated their expression in tumor cells. The effects of expression on tumor progression and patient prognosis were analyzed. Both XAGE-1b and NY-ESO-1 were expressed at high levels in lymph node metastasis and skin metastasis samples compared with the primary site (P ESO-1). In a subgroup analysis of 22 patients with stage III lymph node metastasis, overall survival was significantly higher in the XAGE-1b and NY-ESO-1 double-negative group than in the other groups (P ESO-1 expression could have a positive influence on clinical outcome in patients with melanoma. © 2017 Japanese Dermatological Association.

  17. Low frontal assessment battery score as a risk factor for falling in patients with Hoehn-Yahr Stage III Parkinson's disease: a 2-year prospective study.

    Science.gov (United States)

    Kataoka, Hiroshi; Tanaka, Noriyuki; Saeki, Keigo; Kiriyama, Takao; Ueno, Satoshi

    2014-01-01

    Recently, we evaluated factors responsible for falling, including walking speed evaluated with the use of originally designed, suddenly narrowed paths, in patients with Hoehn-Yahr stage III PD. We prospectively studied the same cohort of patients with PD who were followed up for 2 years, to determine predictors of future falls. We performed clinical assessments and evaluated balance in 26 patients. A total of 19 variables including PD-related independent variables, balance investigation-related independent variables and gait independent-related variables were evaluated. The Frontal Assessment Battery (FAB) score (p = 0.002), Tinetti balance (p = 0.009), and gait velocity (p = 0.001) were higher in fallers than in non-fallers. On multiple logistic regression analysis, the FAB score was related to falling (odds ratio = 3.328, p = 0.033, 95% confidence interval = 1.104-10.03). On the FAB, the scores of 'inhibitory control' and 'sensitivity to interference' were significantly lower in fallers than in non-fallers. The use of the originally designed, suddenly narrowed path was the primary reason for demonstrating for the first time that a low FAB score is a risk factor for future falls. Calculation of the FAB score may be useful for predicting the risk of future falls. © 2014 S. Karger AG, Basel.

  18. Expression of Ribonucleotide Reductase Subunit-2 and Thymidylate Synthase Correlates with Poor Prognosis in Patients with Resected Stages I–III Non-Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Francesco Grossi

    2015-01-01

    Full Text Available Biomarkers can help to identify patients with early-stages or locally advanced non-small cell lung cancer (NSCLC who have high risk of relapse and poor prognosis. To correlate the expression of seven biomarkers involved in DNA synthesis and repair and in cell division with clinical outcome, we consecutively collected 82 tumour tissues from radically resected NSCLC patients. The following biomarkers were investigated using IHC and qRT-PCR: excision repair cross-complementation group 1 (ERCC1, breast cancer 1 (BRCA1, ribonucleotide reductase subunits M1 and M2 (RRM1 and RRM2, subunit p53R2, thymidylate synthase (TS, and class III beta-tubulin (TUBB3. Gene expression levels were also validated in an available NSCLC microarray dataset. Multivariate analysis identified the protein overexpression of RRM2 and TS as independent prognostic factors of shorter overall survival (OS. Kaplan-Meier analysis showed a trend in shorter OS for patients with RRM2, TS, and ERCC1, BRCA1 overexpressed tumours. For all of the biomarkers except TUBB3, the OS trends relative to the gene expression levels were in agreement with those relative to the protein expression levels. The NSCLC microarray dataset showed RRM2 and TS as biomarkers significantly associated with OS. This study suggests that high expression levels of RRM2 and TS might be negative prognostic factors for resected NSCLC patients.

  19. Clinicopathologic Comparison of High-Dose-Rate Endorectal Brachytherapy versus Conventional Chemoradiotherapy in the Neoadjuvant Setting for Resectable Stages II and III Low Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Jessica A. Smith

    2012-01-01

    Full Text Available Purpose. To assess for differences in clinical, radiologic, and pathologic outcomes between patients with stage II-III rectal adenocarcinoma treated neoadjuvantly with conventional external beam radiotherapy (3D conformal radiotherapy (3DRT or intensity-modulated radiotherapy (IMRT versus high-dose-rate endorectal brachytherapy (EBT. Methods. Patients undergoing neoadjuvant EBT received 4 consecutive daily 6.5 Gy fractions without chemotherapy, while those undergoing 3DRT or IMRT received 28 daily 1.8 Gy fractions with concurrent 5-fluorouracil. Data was collected prospectively for 7 EBT patients and retrospectively for 25 historical 3DRT/IMRT controls. Results. Time to surgery was less for EBT compared to 3DRT and IMRT (P<0.001. There was a trend towards higher rate of pathologic CR for EBT (P=0.06. Rates of margin and lymph node positivity at resection were similar for all groups. Acute toxicity was less for EBT compared to 3DRT and IMRT (P=0.025. Overall and progression-free survival were noninferior for EBT. On MRI, EBT achieved similar complete response rate and reduction in tumor volume as 3DRT and IMRT. Histopathologic comparison showed that EBT resulted in more localized treatment effects and fewer serosal adhesions. Conclusions. EBT offers several practical benefits over conventional radiotherapy techniques and appears to be at least as effective against low rectal cancer as measured by short-term outcomes.

  20. Clinical efficacy of concurrent carboplatin, etoposide, and definitive radiotherapy for stage III non-small-cell lung cancer. Consideration as to therapeutic outcomes and morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Kodaira, Takeshi; Yamakawa, Kouji; Taniguchi, Hiroyuki [Tosei General Hospital, Seto, Aichi (Japan); Matsubara, Kazuhito; Ishigaki, Takeo

    1998-08-01

    To improve the therapeutic outcome for inoperable non-small-cell lung cancer, we applied definitive thoracic radiotherapy combined with concurrent administration of carboplatin and etoposide. We retrospectively analyzed 55 eligible patients with Stage III disease. The one-year rate of overall survival (OAS) and distant metastasis-free survival (DMFS) of the total group were 46.1% and 36.1%, respectively. Twenty-nine patients developed thoracic failures (52.7%) and 23 (41.8%) distant failures. Using univariate and multivariate analyses, radiation dose, performance status and LDH were revealed as significant prognostic factors of OAS, and LDH had a strong adverse effect on DMFS. Leucopenia of Grade 3 or higher was noted in 75.9%, anemia in 55.6%, thrombocytopenia in 59.3%, esophagitis in 20.4%, and lung injury in 10.9%. Sufficient gain was not obtained by out strategy, and higher morbidity, especially of lung, was noted than was expected. It was suspected that simultaneous use of oral etoposide might increase radiation pneumonitis, so one should take special care of unexpected toxicity in concurrent chemoradiotherapy. Both the hyperfractionated technique of radiotherapy and the time-dose modification of anti-tumor drugs should be considered in further steps. (author)

  1. Phase III intergroup study of fludarabine phosphate compared with cyclophosphamide, vincristine, and prednisone chemotherapy in newly diagnosed patients with stage II and IV low-grade malignant non-Hodgkin's lymphoma

    NARCIS (Netherlands)

    A. Hagenbeek; H. Eghbali; S. Monfardini; U. Viloto; P.J. Hoskin; C. de Wolf-Peeters; K. MacLennan; E. Staab-Renner; J. Kalmus; A. Schott; I. Teodorovic; A. Negrouk; M. van Glabbeke; R. Marcus

    2006-01-01

    Purpose To compare the efficacy and safety of fludarabine phosphate with cyclophosphamide, vincristine, and prednisone (CVP) in 381 previously untreated, advanced-stage, low-grade (lg) non-Hodgkin's lymphoma (NHL) patients in a phase III, multicenter study. Patients and Methods Between 1993 and 1997

  2. Oncological outcomes from trimodality therapy receiving definitive doses of neoadjuvant chemoradiation (≥60 Gy and factors influencing consideration for surgery in stage III non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Melissa A.L. Vyfhuis, MD PhD

    2017-07-01

    Conclusions: Trimodality treatment significantly improves survival and FFR in patients with LA-NSCLC when definitive doses of radiation with neoadjuvant chemotherapy are employed. We identified important demographic features that predict the use of surgical intervention in patients with stage III NSCLC.

  3. A two-stage optimization model for emergency material reserve layout planning under uncertainty in response to environmental accidents.

    Science.gov (United States)

    Liu, Jie; Guo, Liang; Jiang, Jiping; Jiang, Dexun; Liu, Rentao; Wang, Peng

    2016-06-05

    In the emergency management relevant to pollution accidents, efficiency emergency rescues can be deeply influenced by a reasonable assignment of the available emergency materials to the related risk sources. In this study, a two-stage optimization framework is developed for emergency material reserve layout planning under uncertainty to identify material warehouse locations and emergency material reserve schemes in pre-accident phase coping with potential environmental accidents. This framework is based on an integration of Hierarchical clustering analysis - improved center of gravity (HCA-ICG) model and material warehouse location - emergency material allocation (MWL-EMA) model. First, decision alternatives are generated using HCA-ICG to identify newly-built emergency material warehouses for risk sources which cannot be satisfied by existing ones with a time-effective manner. Second, emergency material reserve planning is obtained using MWL-EMA to make emergency materials be prepared in advance with a cost-effective manner. The optimization framework is then applied to emergency management system planning in Jiangsu province, China. The results demonstrate that the developed framework not only could facilitate material warehouse selection but also effectively provide emergency material for emergency operations in a quick response.

  4. Design and optimization of a gas-puff nozzle for staged Z-pinch experiments using computational fluid dynamics simulations

    Science.gov (United States)

    Valenzuela, J. C.; Krasheninnikov, I.; Beg, F. N.; Wessel, F.; Rahman, H.; Ney, P.; Presura, R.; McKee, E.; Darling, T.; Covington, A.

    2015-11-01

    Previous experimental work on staged Z-pinches demonstrated that gas liners can efficiently couple energy and implode uniformly a target-plasma. A 1.5 MA, 1 μs current driver was used to implode a magnetized, Kr liner onto a D + target, producing 1010 neutrons per shot and providing clear evidence of enhanced pinch stability. Time-of-flight data suggest that primary and secondary neutrons were produced. MHD simulations show that in Zebra, a 1.5MA and 100ns rise-time current driver, high fusion gain can be attained when the optimum liner and plasma target conditions are used. In this work we present the design and optimization of a liner-on-target nozzle to be fielded in Zebra and demonstrate high fusion gain at 1 MA current level. The nozzle is composed of an annular high atomic number gas-puff and an on-axis plasma gun that will deliver the ionized deuterium target. The nozzle optimization was carried out using the computational fluid dynamics (CFD) code fluent and the MHD code Mach2. The CFD simulation produces density and temperature profiles, as a function of the nozzle shapes and gas conditions, which are then used in Mach2 to find the optimum plasma liner implosion-pinch conditions. Funded by the US Department of Energy, ARPA-E, Control Number 1184-1527.

  5. ERCC2 2251A>C genetic polymorphism was highly correlated with early relapse in high-risk stage II and stage III colorectal cancer patients: A preliminary study

    Directory of Open Access Journals (Sweden)

    Lee Su-Chen

    2008-02-01

    Full Text Available Abstract Background Early relapse in colorectal cancer (CRC patients is attributed mainly to the higher malignant entity (such as an unfavorable genotype, deeper tumor invasion, lymph node metastasis and advance cancer stage and poor response to chemotherapy. Several investigations have demonstrated that genetic polymorphisms in drug-targeted genes, metabolizing enzymes, and DNA-repairing enzymes are all strongly correlated with inter-individual differences in the efficacy and toxicity of many treatment regimens. This preliminary study attempts to identify the correlation between genetic polymorphisms and clinicopathological features of CRC, and evaluates the relationship between genetic polymorphisms and chemotherapeutic susceptibility of Taiwanese CRC patients. To our knowledge, this study discusses, for the first time, early cancer relapse and its indication by multiple genes. Methods Six gene polymorphisms functional in drug-metabolism – GSTP1 Ile105Val, ABCB1 Ile1145Ile, MTHFR Ala222Val, TYMS double (2R or triple (3R tandem repeat – and DNA-repair genes – ERCC2 Lys751Gln and XRCC1 Arg399Gln – were assessed in 201 CRC patients using a polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP technique and DNA sequencing. Patients were diagnosed as either high-risk stage II (T2 and 3 N0 M0 or III (any T N1 and 2 M0 and were administered adjuvant chemotherapy regimens that included 5-fluorouracil (5FU and leucovorin (LV. The correlations between genetic polymorphisms and patient clinicopathological features and relapses were investigated. Results In this study, the distributions of GSTP1 (P = 0.003, ABCB1 (P = 0.001, TYMS (P ERCC2 (P XRCC1 (P = 0.006 genotypes in the Asian population, with the exception of MTHFR (P = 0.081, differed significantly from their distributions in a Caucasian population. However, the unfavorable genotype ERCC2 2251A>C (P = 0.006, tumor invasion depth (P = 0.025, lymph node metastasis (P = 0

  6. Pegylated Liposomal Doxorubicin Hydrochloride and Carboplatin Followed by Surgery and Paclitaxel in Treating Patients With Triple Negative Stage II-III Breast Cancer

    Science.gov (United States)

    2017-01-19

    Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Triple-negative Breast Cancer

  7. The construction and use of bacterial DNA microarrays based on an optimized two-stage PCR strategy

    Directory of Open Access Journals (Sweden)

    Pesta David

    2003-06-01

    Full Text Available Abstract Background DNA microarrays are a powerful tool with important applications such as global gene expression profiling. Construction of bacterial DNA microarrays from genomic sequence data using a two-stage PCR amplification approach for the production of arrayed DNA is attractive because it allows, in principal, the continued re-amplification of DNA fragments and facilitates further utilization of the DNA fragments for additional uses (e.g. over-expression of protein. We describe the successful construction and use of DNA microarrays by the two-stage amplification approach and discuss the technical challenges that were met and resolved during the project. Results Chimeric primers that contained both gene-specific and shared, universal sequence allowed the two-stage amplification of the 3,168 genes identified on the genome of Synechocystis sp. PCC6803, an important prokaryotic model organism for the study of oxygenic photosynthesis. The gene-specific component of the primer was of variable length to maintain uniform annealing temperatures during the 1st round of PCR synthesis, and situated to preserve full-length ORFs. Genes were truncated at 2 kb for efficient amplification, so that about 92% of the PCR fragments were full-length genes. The two-stage amplification had the additional advantage of normalizing the yield of PCR products and this improved the uniformity of DNA features robotically deposited onto the microarray surface. We also describe the techniques utilized to optimize hybridization conditions and signal-to-noise ratio of the transcription profile. The inter-lab transportability was demonstrated by the virtual error-free amplification of the entire genome complement of 3,168 genes using the universal primers in partner labs. The printed slides have been successfully used to identify differentially expressed genes in response to a number of environmental conditions, including salt stress. Conclusions The technique detailed

  8. Evaluating enhanced sulfate reduction and optimized volatile fatty acids (VFA) composition in anaerobic reactor by Fe (III) addition.

    Science.gov (United States)

    Liu, Yiwen; Zhang, Yaobin; Ni, Bing-Jie

    2015-02-17

    Anaerobic reactors with ferric iron addition have been experimentally demonstrated to be able to simultaneously improve sulfate reduction and organic matter degradation during sulfate-containing wastewater treatment. In this work, a mathematical model is developed to evaluate the impact of ferric iron addition on sulfate reduction and organic carbon removal as well as the volatile fatty acids (VFA) composition in anaerobic reactor. The model is successfully calibrated and validated using independent long-term experimental data sets from the anaerobic reactor with Fe (III) addition under different operational conditions. The model satisfactorily describes the sulfate reduction, organic carbon removal and VFA production. Results show Fe (III) addition induces the microbial reduction of Fe (III) by iron reducing bacteria (IRB), which significantly enhances sulfate reduction by sulfate reducing bacteria (SRB) and subsequently changes the VFA composition to acetate-dominating effluent. Simultaneously, the produced Fe (II) from IRB can alleviate the inhibition of undissociated H2S on microorganisms through iron sulfide precipitation, resulting in further improvement of the performance. In addition, the enhancement on reactor performance by Fe (III) is found to be more significantly favored at relatively low organic carbon/SO4(2-) ratio (e.g., 1.0) than at high organic carbon/SO4(2-) ratio (e.g., 4.5). The Fe (III)-based process of this work can be easily integrated with a commonly used strategy for phosphorus recovery, with the produced sulfide being recovered and then deposited into conventional chemical phosphorus removal sludge (FePO4) to achieve FeS precipitation for phosphorus recovery while the required Fe (III) being acquired from the waste ferric sludge of drinking water treatment process, to enable maximum resource recovery/reuse while achieving high-rate sulfate removal.

  9. Orchiectomy and radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function.

    Science.gov (United States)

    Wortel, Ruud C; Ghidey Alemayehu, Wendim; Incrocci, Luca

    2015-01-01

    Orchiectomy followed by infradiaphragmatic radiotherapy is a common treatment for stage I-II testicular seminoma. Long-term effects of orchiectomy and radiotherapy for testicular seminomas on body image and sexual function have been reported; however, few data are available on short-term effects. Patients are usually of reproductive age and sexually active; therefore, short-term effects on body image and sexual function should also be studied. To prospectively evaluate short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients. Questionnaires on body image and sexual function were prospectively distributed to all testicular seminoma patients treated between 1999 and 2013. The questionnaire distributed prior to radiotherapy was returned by 161 patients; 133 (82%) returned the second after 3 months, and 120 (75%) completed the questionnaire after 6 months. Body image and sexual function as assessed by a Dutch questionnaire on body image and sexuality after radiotherapy and orchiectomy. Median age was 36 years (range 18-70). After orchiectomy, 48% expressed fertility concerns, and 61% reported their body had changed. Six months after treatment, erectile rigidity was significantly decreased compared with prior to radiotherapy (P = 0.016), and 23% reported decreased sexual interest, activity, and pleasure. Changes in body image were significantly associated with decreased sexual interest, pleasure, and erectile function. Even though 45% reported that treatment negatively affected their sexual life, the number of sexually active patients remained stable at 91%. [Correction added on 12 November 2014, after first online publication: 'prior radiotherapy' was corrected to 'prior to radiotherapy'.] Short-term effects of treatment included fertility concerns and changes in body image. Reported erectile rigidity was significantly decreased after 6 months, as were sexual interest, activity, and pleasure. Disease and

  10. Phase 2 Study of Docetaxel, Cisplatin, and Concurrent Radiation for Technically Resectable Stage III-IV Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Inohara, Hidenori, E-mail: hinohara@ent.med.osaka-u.ac.jp [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Takenaka, Yukinori; Yoshii, Tadashi; Nakahara, Susumu; Yamamoto, Yoshifumi; Tomiyama, Yoichiro [Department of Otorhinolaryngology—Head and Neck Surgery, Osaka University Faculty of Medicine, Suita, Osaka (Japan); Seo, Yuji; Isohashi, Fumiaki; Suzuki, Osamu; Yoshioka, Yasuo; Sumida, Iori; Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Faculty of Medicine, Suita, Osaka (Japan)

    2015-04-01

    Purpose: We investigated the efficacy and safety of weekly low-dose docetaxel and cisplatin therapy concurrent with conventionally fractionated radiation in patients with technically resectable stage III-IV squamous cell carcinoma of the head and neck. Methods and Materials: Between March 2004 and October 2011, we enrolled 117 patients, of whom 116 were analyzable (43 had oropharyngeal cancer, 54 had hypopharyngeal cancer, and 19 had laryngeal cancer), and 85 (73%) had stage IV disease. Radiation consisted of 66 Gy in 33 fractions. Docetaxel, 10 mg/m{sup 2}, followed by cisplatin, 20 mg/m{sup 2}, administered on the same day were given once a week for 6 cycles. The primary endpoint was overall complete response (CR) rate after chemoradiation therapy. Human papillomavirus (HPV) DNA in oropharyngeal cancer was examined by PCR. Results: Of 116 patients, 82 (71%) completed treatment per protocol; 102 (88%) received the full radiation therapy dose; and 90 (78%) and 12 (10%) patients received 6 and 5 chemotherapy cycles, respectively. Overall CR rate was 71%. After median follow-up of 50.9 months (range: 15.6-113.9 months for surviving patients), 2-year and 4-year overall survival rates were 82% and 68%, respectively. Cumulative 2-year and 4-year local failure rates were 27% and 28%, respectively, whereas distant metastasis rates were 15% and 22%, respectively. HPV status in oropharyngeal cancer was not associated with treatment efficacy. Acute toxicity included grade 3 and 4 in-field mucositis in 73% and 5% of patients, respectively, whereas myelosuppression and renal injury were minimal. No patients died of toxicity. Feeding tube dependence in 8% and tracheostomy in 1% of patients were evident at 2 years postchemoradiation therapy in patients who survived without local treatment failure. Conclusions: Local control and survival with this regimen were satisfactory. Although acute toxicity, such as mucositis, was common, late toxicity, such as laryngoesophageal

  11. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I-II cervical cancer: A review.

    Science.gov (United States)

    Takekuma, Munetaka; Kasamatsu, Yuka; Kado, Nobuhiro; Kuji, Shiho; Tanaka, Aki; Takahashi, Nobutaka; Abe, Masakazu; Hirashima, Yasuyuki

    2017-04-01

    The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical

  12. Acute Toxicity Profile and Compliance to Accelerated Radiotherapy Plus Carbogen and Nicotinamide for Clinical Stage T2-4 Laryngeal Cancer: Results of a Phase III Randomized Trial

    Energy Technology Data Exchange (ETDEWEB)

    Janssens, Geert O., E-mail: g.janssens@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Terhaard, Chris H. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Doornaert, Patricia A. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Bijl, Hendrik P. [Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands); Ende, Piet van den [Department of Radiation Oncology, Maastricht University Medical Centre, Maastricht (Netherlands); Chin, Alim [Department of Clinical Oncology, Leiden University Medical Centre, Leiden (Netherlands); Pop, Lucas A.; Kaanders, Johannes H. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2012-02-01

    Purpose: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. Methods and Materials: From April 2001 to February 2008, 345 patients with cT2-4 squamous cell laryngeal cancer were randomized to AR (n = 174) and ARCON (n = 171). Acute toxicity was scored weekly until Week 8 and every 2-4 weeks thereafter. Compliance to carbogen and nicotinamide was reported. Results: Between both treatment arms (AR vs. ARCON) no statistically significant difference was observed for incidence of acute skin reactions (moist desquamation: 56% vs. 58%, p = 0.80), acute mucosal reactions (confluent mucositis: 79% vs. 85%, p = 0.14), and symptoms related to acute mucositis (severe pain on swallowing: 53% vs. 58%, p = 0.37; nasogastric tube feeding: 28% vs. 28%, p = 0.98; narcotic medicines required: 58% vs. 58%, p = 0.97). There was a statistically significant difference in median duration of confluent mucositis in favor of AR (2.0 vs 3.0 weeks, p = 0.01). There was full compliance with carbogen breathing and nicotinamide in 86% and 80% of the patients, with discontinuation in 6% and 12%, respectively. Adjustment of antiemesis prophylaxis was needed in 42% of patients. Conclusion: With the exception of a slight increase in median duration of acute confluent mucositis, the present data reveal a similar acute toxicity profile between both regimens and a good compliance with ARCON for clinical stage T2-4 laryngeal cancers. Treatment outcome and late morbidity will determine the real therapeutic benefit.

  13. Association of obesity with DNA mismatch repair status and clinical outcome in patients with stage II or III colon carcinoma participating in NCCTG and NSABP adjuvant chemotherapy trials.

    Science.gov (United States)

    Sinicrope, Frank A; Foster, Nathan R; Yoon, Harry H; Smyrk, Thomas C; Kim, George P; Allegra, Carmen J; Yothers, Greg; Nikcevich, Daniel A; Sargent, Daniel J

    2012-02-01

    Although the importance of obesity in colon cancer risk and outcome is recognized, the association of body mass index (BMI) with DNA mismatch repair (MMR) status is unknown. BMI (kg/m(2)) was determined in patients with TNM stage II or III colon carcinomas (n = 2,693) who participated in randomized trials of adjuvant chemotherapy. The association of BMI with MMR status and survival was analyzed by logistic regression and Cox models, respectively. Overall, 427 (16%) tumors showed deficient MMR (dMMR), and 630 patients (23%) were obese (BMI ≥ 30 kg/m(2)). Obesity was significantly associated with younger age (P = .021), distal tumor site (P = .012), and a lower rate of dMMR tumors (10% v 17%; P Obesity remained associated with lower rates of dMMR (odds ratio, 0.57; 95% CI, 0.41 to 0.79; P obese patients, rates of dMMR were lower in men compared with women (8% v 13%; P = .041). Obesity was associated with higher recurrence rates (P = .0034) and independently predicted worse disease-free survival (DFS; hazard ratio [HR], 1.37; 95% CI, 1.14 to 1.64; P = .0010) and overall survival (OS), whereas dMMR predicted better DFS (HR, 0.59; 95% CI, 0.47 to 0.74; P obese patients. Colon cancers from obese patients are less likely to show dMMR, suggesting obesity-related differences in the pathogenesis of colon cancer. Although obesity was independently associated with adverse outcome, the favorable prognostic impact of dMMR was maintained among obese patients.

  14. Analysis of Molecular Markers by Anatomic Tumor Site in Stage III Colon Carcinomas from Adjuvant Chemotherapy Trial NCCTG N0147 (Alliance)

    Science.gov (United States)

    Sinicrope, Frank A.; Mahoney, Michelle R.; Yoon, Harry H.; Smyrk, Thomas C.; Thibodeau, Stephen N.; Goldberg, Richard M.; Nelson, Garth D.; Sargent, Daniel J.; Alberts, Steven R.

    2015-01-01

    PURPOSE To determine the frequency and prognostic association of molecular markers by anatomic tumor site in patients with stage III colon carcinomas. Experimental Design In a randomized trial of adjuvant FOLFOX + cetuximab, BRAFV600E and KRAS (exon 2) mutations and DNA mismatch repair (MMR) proteins were analyzed in tumors (N=3,018) in relationship to tumor location including subsite. Cox models were used to assess clinical outcome including overall survival (OS). RESULTS KRAS codon 12 mutations were most frequent at the splenic flexure and cecum; codon 13 mutations were evenly distributed. BRAF mutation frequency sharply increased from transverse colon to cecum in parallel with deficient (d) MMR. Non-mutated BRAF or KRAS tumors progressively decreased from sigmoid to transverse (all p<0.0001). Significantly poorer OS was found for mutant KRAS in distal [HR, 1.98 (1.49–2.63); p<.0001] vs proximal [1.25 (0.97–1.60), p=.079] cancers. BRAF status and outcome were not significantly associated with tumor site. Proximal vs distal dMMR tumors had significantly better outcome. An interaction test was significant for tumor site by KRAS (padjusted=.043) and MMR (padjusted=.010) for OS. Significant prognostic differences for biomarkers by tumor site were maintained in the FOLFOX arm. Tumor site was independently prognostic with a stepwise improvement from cecum to sigmoid (OS: padjusted=0.001). CONCLUSIONS Mutations in BRAF or KRAS codon 12 were enriched in proximal cancers whereas non-mutated BRAF/KRAS were increased in distal tumors. Significant differences in outcome for KRAS mutations and dMMR were found by tumor site, indicating that their interpretation should occur in the context of tumor location. PMID:26187617

  15. Acute toxicity profile and compliance to accelerated radiotherapy plus carbogen and nicotinamide for clinical stage T2-4 laryngeal cancer: results of a phase III randomized trial.

    Science.gov (United States)

    Janssens, Geert O; Terhaard, Chris H; Doornaert, Patricia A; Bijl, Hendrik P; van den Ende, Piet; Chin, Alim; Pop, Lucas A; Kaanders, Johannes H

    2012-02-01

    To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. From April 2001 to February 2008, 345 patients with cT2-4 squamous cell laryngeal cancer were randomized to AR (n = 174) and ARCON (n = 171). Acute toxicity was scored weekly until Week 8 and every 2-4 weeks thereafter. Compliance to carbogen and nicotinamide was reported. Between both treatment arms (AR vs. ARCON) no statistically significant difference was observed for incidence of acute skin reactions (moist desquamation: 56% vs. 58%, p = 0.80), acute mucosal reactions (confluent mucositis: 79% vs. 85%, p = 0.14), and symptoms related to acute mucositis (severe pain on swallowing: 53% vs. 58%, p = 0.37; nasogastric tube feeding: 28% vs. 28%, p = 0.98; narcotic medicines required: 58% vs. 58%, p = 0.97). There was a statistically significant difference in median duration of confluent mucositis in favor of AR (2.0 vs 3.0 weeks, p = 0.01). There was full compliance with carbogen breathing and nicotinamide in 86% and 80% of the patients, with discontinuation in 6% and 12%, respectively. Adjustment of antiemesis prophylaxis was needed in 42% of patients. With the exception of a slight increase in median duration of acute confluent mucositis, the present data reveal a similar acute toxicity profile between both regimens and a good compliance with ARCON for clinical stage T2-4 laryngeal cancers. Treatment outcome and late morbidity will determine the real therapeutic benefit. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Effects of atorvastatin on systemic and renal NO dependency in patients with non-diabetic stage II–III chronic kidney disease

    Science.gov (United States)

    Mose, Frank Holden; Larsen, Thomas; Jensen, Janni Majgaard; Hansen, Annebirthe Bo; Bech, Jesper Nørgaard; Pedersen, Erling Bjerregaard

    2014-01-01

    Aims Clinical trials suggest that statins have beneficial effects on the cardiovascular system independent from their cholesterol lowering properties. In patients with chronic kidney disease stage II–III, we tested the hypothesis that atorvastatin increased systemic and renal nitric oxide (NO) availability using L-NG-monomethyl arginine (L-NMMA) as an inhibitor of NO production. Methods In a randomized, placebo-controlled, crossover study patients were treated with atorvastatin for 5 days with standardized diet and fluid intake. Glomerular filtration reate (GFR), fractional excretions of sodium (FENa), urinary excretion of aquaporin-2 (u-AQP2) and epithelial sodium channels (u-ENaCγ), vasoactive hormones (renin, angiotensin II, aldosterone, arginine vasopressin, endothelin-1 and brain natriuretic peptide) and central blood pressure (BP) estimated by applanation tonometry were measured before and after systemic administration of the NO inhibitor L-NMMA. Results Atorvastatin caused a significant reduction in U-ENaCγ, but sodium excretion, , FENa and u-AQP2 were not changed by atorvastatin. L-NMMA reduced renal effect variables, including GFR, FENa and u-ENaCγ and increased brachial BP and central BP to a similar extent during both treatments. Vasoactive hormones were changed in the same way by L-NMMA during atorvastatin and placebo treatment. Conclusion During, atorvastatin and placebo treatment, inhibition of nitric oxide synthesis induced the same response in brachial and central blood pressure, GFR, renal tubular function and vasoactive hormones. Thus, the data do not support that atorvastatin changes nitric oxide availability in patients with mild nephropathy. The reduced u-ENaC may reflect changes in sodium absorption in the nephron induced by atorvastatin. PMID:24697877

  17. Mature Results of a Prospective Randomized Trial Comparing 5-Flourouracil with Leucovorin to 5-Flourouracil with Levamisole as Adjuvant Therapy of Stage II and III Colorectal Cancer- The Israel Cooperative Oncology Group (ICOG Study

    Directory of Open Access Journals (Sweden)

    Arie Figer, Aviram Nissan, Adi Shani, Riva Borovick, Mariana Stiener, Mario Baras, Herbert R. Freund, Aaron Sulkes, Alexander Stojadinovic, Tamar Peretz

    2011-01-01

    Full Text Available Objective: Survival benefit with adjuvant therapy was shown in patients with Stage III colorectal cancer (CRC. This study evaluates long-term (10-year outcome in patients with CRC randomly assigned to adjuvant 5-Fluorouracil/Leucovorin (5FU+LV or 5-FU/Levamisole (5FU+LEV.Methods: Between 1990 and 1995, 398 patients with curatively resected Stage II-III CRC were randomly assigned to adjuvant 5FU+LV or 5FU+LEV for 12 months.Results: No difference was evident in 10-year relapse-free or overall survival between study groups. Grade III toxicity was similar between groups; however, neurotoxicity was significantly greater with 5FU+LEV (p=0.02 and gastrointestinal toxicity with 5FU+LV (p=0.03. Female patients treated with 5FU+LEV had improved overall survival.Conclusions: Adjuvant treatment of CRC is still based on leucovorin modulated fluorouracil. The long-term follow-up results of this trial indicate that the adjuvant treatment of Stage II-III CRC with 5FU+LV or 5FU+LEV is equally effective. The finding of improved survival in female subjects treated with 5FU+LEV warrants further study to determine if Levamisole is a better modulator of 5-FU than Leucovorin in this patient subset.

  18. Mature Results of a Prospective Randomized Trial Comparing 5-Flourouracil with Leucovorin to 5-Flourouracil with Levamisole as Adjuvant Therapy of Stage II and III Colorectal Cancer- The Israel Cooperative Oncology Group (ICOG) Study

    Science.gov (United States)

    Figer, Arie; Nissan, Aviram; Shani, Adi; Borovick, Riva; Stiener, Mariana; Baras, Mario; Freund, Herbert R.; Sulkes, Aaron; Stojadinovic, Alexander; Peretz, Tamar

    2011-01-01

    Objective: Survival benefit with adjuvant therapy was shown in patients with Stage III colorectal cancer (CRC). This study evaluates long-term (10-year) outcome in patients with CRC randomly assigned to adjuvant 5-Fluorouracil/Leucovorin (5FU+LV) or 5-FU/Levamisole (5FU+LEV). Methods: Between 1990 and 1995, 398 patients with curatively resected Stage II-III CRC were randomly assigned to adjuvant 5FU+LV or 5FU+LEV for 12 months. Results: No difference was evident in 10-year relapse-free or overall survival between study groups. Grade III toxicity was similar between groups; however, neurotoxicity was significantly greater with 5FU+LEV (p=0.02) and gastrointestinal toxicity with 5FU+LV (p=0.03). Female patients treated with 5FU+LEV had improved overall survival. Conclusions: Adjuvant treatment of CRC is still based on leucovorin modulated fluorouracil. The long-term follow-up results of this trial indicate that the adjuvant treatment of Stage II-III CRC with 5FU+LV or 5FU+LEV is equally effective. The finding of improved survival in female subjects treated with 5FU+LEV warrants further study to determine if Levamisole is a better modulator of 5-FU than Leucovorin in this patient subset. PMID:21475636

  19. User's guide for the BNW-III optimization code for modular dry/wet-cooled power plants

    Energy Technology Data Exchange (ETDEWEB)

    Braun, D.J.; Faletti, D.W.

    1984-09-01

    This user's guide describes BNW-III, a computer code developed by the Pacific Northwest Laboratory (PNL) as part of the Dry Cooling Enhancement Program sponsored by the US Department of Energy (DOE). The BNW-III code models a modular dry/wet cooling system for a nuclear or fossil fuel power plant. The purpose of this guide is to give the code user a brief description of what the BNW-III code is and how to use it. It describes the cooling system being modeled and the various models used. A detailed description of code input and code output is also included. The BNW-III code was developed to analyze a specific cooling system layout. However, there is a large degree of freedom in the type of cooling modules that can be selected and in the performance of those modules. The costs of the modules are input to the code, giving the user a great deal of flexibility.

  20. Rapid near-optimal trajectory generation and guidance law development for single-stage-to-orbit airbreathing vehicles

    Science.gov (United States)

    Calise, A. J.; Flandro, G. A.; Corban, J. E.

    1990-01-01

    General problems associated with on-board trajectory optimization, propulsion system cycle selection, and with the synthesis of guidance laws were addressed for an ascent to low-earth-orbit of an air-breathing single-stage-to-orbit vehicle. The NASA Generic Hypersonic Aerodynamic Model Example and the Langley Accelerator aerodynamic sets were acquired and implemented. Work related to the development of purely analytic aerodynamic models was also performed at a low level. A generic model of a multi-mode propulsion system was developed that includes turbojet, ramjet, scramjet, and rocket engine cycles. Provisions were made in the dynamic model for a component of thrust normal to the flight path. Computational results, which characterize the nonlinear sensitivity of scramjet performance to changes in vehicle angle of attack, were obtained and incorporated into the engine model. Additional trajectory constraints were introduced: maximum dynamic pressure; maximum aerodynamic heating rate per unit area; angle of attack and lift limits; and limits on acceleration both along and normal to the flight path. The remainder of the effort focused on required modifications to a previously derived algorithm when the model complexity cited above was added. In particular, analytic switching conditions were derived which, under appropriate assumptions, govern optimal transition from one propulsion mode to another for two cases: the case in which engine cycle operations can overlap, and the case in which engine cycle operations are mutually exclusive. The resulting guidance algorithm was implemented in software and exercised extensively. It was found that the approximations associated with the assumed time scale separation employed in this work are reasonable except over the Mach range from roughly 5 to 8. This phenomenon is due to the very large thrust capability of scramjets in this Mach regime when sized to meet the requirement for ascent to orbit. By accounting for flight path

  1. A DNA nanomachine based on rolling circle amplification-bridged two-stage exonuclease III-assisted recycling strategy for label-free multi-amplified biosensing of nucleic acid.

    Science.gov (United States)

    Xue, Qingwang; Lv, Yanqin; Cui, Hui; Gu, Xiaohong; Zhang, Shuqiu; Liu, Jifeng

    2015-01-26

    An autonomous DNA nanomachine based on rolling circle amplification (RCA)-bridged two-stage exonuclease III (Exo III)-induced recycling amplification (Exo III-RCA-Exo III) was developed for label-free and highly sensitive homogeneous multi-amplified detection of DNA combined with sensitive fluorescence detection technique. According to the configuration, the analysis of DNA is accomplished by recognizing the target to a unlabeled molecular beacon (UMB) that integrates target-binding and signal transducer within one multifunctional design, followed by the target-binding of UMB in duplex DNA removed stepwise by Exo III accompanied by the releasing of target DNA for the successive hybridization and cleavage process and autonomous generation of the primer that initiate RCA process with a rational designed padlock DNA. The RCA products containing thousands of repeated catalytic sequences catalytically hybridize with a hairpin reporter probe that includes a "caged" inactive G-quadruplex sequence (HGP) and were then detected by Exo III-assisted recycling amplification, liberating the active G-quadruplex and generating remarkable ZnPPIX/G-quadruplex fluorescence signals with the help of zinc(II)-protoporphyrin IX (ZnPPIX). The proposed strategy showed a wide dynamic range over 7 orders of magnitude with a low limit of detection of 0.51 aM. In addition, this designed protocol can discriminate mismatched DNA from perfectly matched target DNA, and holds a great potential for early diagnosis in gene-related diseases.

  2. Effects of induction docetaxel, platinum, and fluorouracil chemotherapy in patients with stage III or IVA/B nasopharyngeal cancer treated with concurrent chemoradiation therapy: Final results of 2 parallel phase 2 clinical trials.

    Science.gov (United States)

    Kong, Lin; Zhang, Youwang; Hu, Chaosu; Guo, Ye; Lu, Jiade J

    2017-06-15

    The effects of docetaxel, platinum, and fluorouracil (TPF) induction chemotherapy plus concurrent chemoradiotherapy (CCRT) on locoregionally advanced nasopharyngeal cancer (NPC) are unclear. This study examined the long-term outcomes of the addition of this regimen to CCRT for stage III and IVA/B NPC. Two parallel, single-arm phase 2 trials were performed synchronously to evaluate the efficacy and toxicity of TPF-based induction chemotherapy in patients with stage III or IVA/B NPC. The induction chemotherapy, which preceded standard intensity-modulated radiation therapy/platinum-based chemoradiation, consisted of 3 cycles of docetaxel (75 mg/m(2) on day 1), cisplatin (75 mg/m(2) on day 1), and a continuous infusion of fluorouracil (500 mg/m(2) /d on days 1-5) every 4 weeks. The primary endpoint for both trials was 5-year overall survival (OS). Between January 2007 and July 2010, 52 eligible patients with stage III NPC and 64 eligible patients with nonmetastatic stage IV NPC were accrued to the 2 trials. With a median follow-up of 67 months, the 5-year OS, progression-free survival, distant metastasis-free survival, and local progression-free survival (LPFS) rates were all improved in comparison with historical benchmarks for patients with stage III or IVA/IVB NPC. Multivariate analyses indicated that T and N classifications (T1/T2 vs T3/T4 and N3 vs N0-N2) were the only significant prognosticators for OS. The number of induction chemotherapy cycles was the only significant prognostic factor for predicting LPFS. TPF-based induction chemotherapy appears to significantly improve outcomes in comparison with historical data when it is administered before CCRT for locoregionally advanced NPC. A phase 3 trial is currently being performed to confirm this benefit. Cancer 2017;123:2258-2267. © 2017 American Cancer Society. © 2017 American Cancer Society.

  3. Optimization of a Fuzzy-Logic-Control-Based Five-Stage Battery Charger Using a Fuzzy-Based Taguchi Method

    Directory of Open Access Journals (Sweden)

    Yeh-Hsiang Ho

    2013-07-01

    Full Text Available Lithium ion (Li-ion batteries have been widely used in various kinds of applications, including consumer electronics, green energy systems and electrical vehicles. Since the charging method has a significant influence on the performance and lifetime of Li-ion batteries, an intelligent charging algorithm which can properly determine the charging current is essential. In this study, a fuzzy-logic-control-based (FLC-based five-stage Li-ion battery charger is proposed. The proposed charger takes the temperature rise and the gradient of temperature rise of battery into account, and adjusts the charging current accordingly. To further improve the performance of the proposed FLC, the fuzzy-based Taguchi method is utilized to determine the optimal output membership functions (MFs. Comparing with the conventional constant current-constant voltage (CC-CV method, the charging time, charging efficiency, average temperature rise and the obtained cycle life of the Li-ion battery are improved by about 58.3%, 1.65%, 26.7% and 59.3%, respectively.

  4. Successive ion layer adsorption and reaction (SILAR) technique synthesis of Al(III)-8-hydroxy-5-nitrosoquinolate nano-sized thin films: characterization and factors optimization.

    Science.gov (United States)

    Haggag, Sawsan M S; Farag, A A M; Abdel Refea, M

    2013-02-01

    Nano Al(III)-8-hydroxy-5-nitrosoquinolate [Al(III)-(HNOQ)(3)] thin films were synthesized by the rapid, direct, simple and efficient successive ion layer adsorption and reaction (SILAR) technique. Thin film formation optimized factors were evaluated. Stoichiometry and structure were confirmed by elemental analysis and FT-IR. The particle size (27-71 nm) was determined using scanning electron microscope (SEM). Thermal stability and thermal parameters were determined by thermal gravimetric analysis (TGA). Optical properties were investigated using spectrophotometric measurements of transmittance and reflectance at normal incidence. Refractive index, n, and absorption index, k, were determined. Spectral behavior of the absorption coefficient in the intrinsic absorption region revealed a direct allowed transition with 2.45 eV band gap. The current-voltage (I-V) characteristics of [Al(III)-(HNOQ)(3)]/p-Si heterojunction was measured at room temperature. The forward and reverse I-V characteristics were analyzed. The calculated zero-bias barrier height (Φ(b)) and ideality factor (n) showed strong bias dependence. Energy distribution of interface states (N(ss)) was obtained.

  5. Successive ion layer adsorption and reaction (SILAR) technique synthesis of Al(III)-8-hydroxy-5-nitrosoquinolate nano-sized thin films: Characterization and factors optimization

    Science.gov (United States)

    Haggag, Sawsan M. S.; Farag, A. A. M.; Abdel Refea, M.

    2013-02-01

    Nano Al(III)-8-hydroxy-5-nitrosoquinolate [Al(III)-(HNOQ)3] thin films were synthesized by the rapid, direct, simple and efficient successive ion layer adsorption and reaction (SILAR) technique. Thin film formation optimized factors were evaluated. Stoichiometry and structure were confirmed by elemental analysis and FT-IR. The particle size (27-71 nm) was determined using scanning electron microscope (SEM). Thermal stability and thermal parameters were determined by thermal gravimetric analysis (TGA). Optical properties were investigated using spectrophotometric measurements of transmittance and reflectance at normal incidence. Refractive index, n, and absorption index, k, were determined. Spectral behavior of the absorption coefficient in the intrinsic absorption region revealed a direct allowed transition with 2.45 eV band gap. The current-voltage (I-V) characteristics of [Al(III)-(HNOQ)3]/p-Si heterojunction was measured at room temperature. The forward and reverse I-V characteristics were analyzed. The calculated zero-bias barrier height (Φb) and ideality factor (n) showed strong bias dependence. Energy distribution of interface states (Nss) was obtained.

  6. Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer. A retrospective study of elderly patients with stage III disease

    Energy Technology Data Exchange (ETDEWEB)

    Franceschini, D. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Istituto Clinico Humanitas Cancer Center, Rozzano (Milan) (Italy); De Rose, F.; Navarria, P.; Clerici, E.; Franzese, C.; Comito, T.; Tozzi, A.; Iftode, C.; D' Agostino, G. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Cozzi, L.; Sorsetti, M. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Humanitas University, Department of Biomedical Sciences, Milan (Italy)

    2017-05-15

    This study aimed to analyse the feasibility and acute toxicity of radical hypo-fractionated radiotherapy (RT) for elderly patients with non-small-cell lung cancer (NSCLC). We conducted a retrospective evaluation of treatment with volumetric modulated arc therapy (VMAT) of elderly patients affected by stage III inoperable NSCLC. The dose prescription was 56 Gy in 20 fractions, 55 Gy in 22 fractions, or 50 Gy in 20 fractions. Target volume included only the primary lesion and the infiltrated lymph nodes. The primary end point was acute and late toxicity, while secondary end points were progression-free survival (PFS), and overall survival (OS). In all, 41 patients were included in this analysis. The mean age of the patients was 78.6 years, and 22 patients had staged IIIA while 19 patients had stage IIIB disease. All but one patient had pathological nodal involvement; 15 patients received chemotherapy before RT. Acute grade 1-2 toxicity was recorded in 25 (61%) patients. Late toxicity was recorded in 13 (32%) patients. No cases of G3 or G4 toxicity were recorded. Complete response was obtained in two (5%) patients, 26 (63%) showed a partial response, and two (5%) experience disease progression. At a mean follow-up of 9.9 months (range, 1.1-25.4), 17 patients had died from disease progression, one died from other causes, and 23 were alive. Median OS was 13.7 ± 1.5 months (95% CI: 10.7-16.7), OS at 12 and 18 months was 51.3 ± 9.5% and 35.1 ± 10.1%, respectively. Median PFS was 13.7 ± 2.3 months (95% CI: 9.1-18.2), and PFS at 12 and 18 months was 50.1 ± 9.9% and 38.9 ± 10.4%, respectively. Radical hypo-fractionated VMAT is a promising treatment for locally advanced NSCLC in the elderly. The use of hypo-fractionated radiotherapy for lung cancer in older patients can be considered a valuable approach, particularly for patients with poor performance status or refusing other treatment approaches. (orig.) [German] Durchfuehrbarkeit und Nebenwirkungen der radikalen

  7. Use of Methanation for Optimization of a Hybrid Plant Combining Two-Stage Biomass Gasification, SOFCs and a Micro Gas Turbine

    DEFF Research Database (Denmark)

    Bang-Møller, Christian; Rokni, Masoud; Elmegaard, Brian

    2011-01-01

    A hybrid plant producing combined heat and power (CHP) from biomass by use of the two-stage gasification concept, solid oxide fuel cells (SOFCs) and a micro gas turbine (MGT) was considered for optimization. The hybrid plant is a sustainable and efficient alternative to conventional decentralized...

  8. The impact of cancer incidence and stage on optimal utilization of radiotherapy. Methodology of a population based analysis by the ESTRO-HERO project

    DEFF Research Database (Denmark)

    Borras, Josep M; Barton, Michael; Grau, Cai;

    2015-01-01

    BACKGROUND AND PURPOSE: The impact of differences in the distribution of major cancer sites and stages at diagnosis among 4 European countries on the optimal utilization proportion (OUP) of patients who should receive external beam radiotherapy was assessed within the framework of the ESTRO-HERO ...

  9. On the employment of lambda carrageenan in a matrix system. III. Optimization of a lambda carrageenan-HPMC hydrophilic matrix

    NARCIS (Netherlands)

    Bonferoni, MC; Rossi, S; Ferrari, F; Bertoni, M; Bolhuis, GK; Caramella, C

    1998-01-01

    The lambda carrageenan/HPMC ratio in matrix tablets has been optimized in order to obtain pH-independent release profiles of chlorpheniramine maleate, a freely soluble drug. Release profiles in acidic (pH 1.2) and neutral (pH 6.8) media were fitted according to the Weibull and the power law models.

  10. Modeling and optimization of integrated exhaust gas recirculation and multi-stage waste heat recovery in marine engines

    DEFF Research Database (Denmark)

    Kyriakidis, Fotis; Sørensen, Kim; Singh, Shobhana

    2017-01-01

    is optimized to utilize the maximum waste heat recovery. The Genetic algorithm and fmincon active-set algorithm are used to optimize the design and operation parameters for the two steam cycles. The optimization aims to find the theoretically optimal combination of the pressure levels and pinch......Waste heat recovery combined with exhaust gas recirculation is a promising technology that can address both the issue of NOx (nitrogen oxides) reduction and fuel savings by including a pressurized boiler. In the present study, a theoretical optimization of the performance of two different...

  11. Optimization of the preform shape in the three-stage forming process of the shielded slot plate in fuel cell manufacturing

    Science.gov (United States)

    Yang, Dong-Yol; Lee, Chang-Whan; Kang, Dong-Woo; Chang, In-Gab; Lee, Tae-Won

    2013-05-01

    The shielded slot plate, a repeated structure of high sheared protrusions, is a major component of metallic bipolar plates for the molten carbonate fuel cell (MCFC). In order to increase the efficiency of the MCFC and long-term operation capability, the sheared protrusion should have a relatively large flat contact area. In addition, defects from the forming process such as local thinning should be minimized. In this work, the preform shape in the three-stage forming process that integrates the slitting process, the preforming process, and the final forming process was optimized to minimize the effective plastic strain. In the simulation of the forming process, the ductile fracture criterion was employed to the user material subroutine VUMAT in ABAQUS/Explicit. Steepest descent method was utilized in the design of the forming process to minimize equivalent plastic strain. High sheared protrusions were manufactured without defects from the three-stage forming process using the optimized preform shape. The minimum thickness of one sheared protrusion was increased by 25% over that of the two-stage forming process. The three-stage forming process using the optimized preform shape enables more uniformly distributed deformation and reduces localized deformation.

  12. Optimization of a carbon-based hybrid energy storage device with cerium (III) sulfate as redox electrolyte

    Science.gov (United States)

    Díaz, Patricia; González, Zoraida; Santamaría, Ricardo; Granda, Marcos; Menéndez, Rosa; Blanco, Clara

    2016-03-01

    The electrochemical performance of a carbon-based hybrid energy storage system, with Ce2(SO4)3/H2SO4 as inorganic redox electrolyte, was enhanced by optimizing several parameters of the device. A mass balance of the two electrodes forming the system together with the selection of a suitable activated carbon as negative electrode allowed the cell voltage to be increased up to 1.9 V. In addition, the use of a cation-exchange membrane significantly enhanced the electrochemical performance of the system by minimizing secondary reactions of cerium ions on the negative electrode. The optimized device reached energy and power density values up to ∼20 W h kg-1 and 524 W kg-1 respectively. Moreover, the system showed a good long-term electrochemical performance over 20,000 cycles.

  13. Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants: A Propensity Score-matched Cohort Study.

    Science.gov (United States)

    Luo, Li-Juan; Li, Xin; Yang, Kai-Di; Lu, Jiang-Yi; Li, Lu-Quan

    2015-10-01

    Necrotizing enterocolitis (NEC) is the most common and frequently dangerous neonatal gastrointestinal disease. Studies have shown broad-spectrum antibiotics plus anaerobic antimicrobial therapy did not prevent the deterioration of NEC among very low birth preterm infants. However, few studies about this therapy which focused on full-term and near-term infant with NEC has been reported. The aim of this study was to evaluate the effect of broad-spectrum antibiotic plus metronidazole in preventing the deterioration of NEC from stage II to III in full-term and near-term infants.A retrospective cohort study based on the propensity score (PS) 1:1 matching was performed among the full-term and near-term infants with NEC (Bell stage ≥II). All infants who received broad-spectrum antibiotics were divided into 2 groups: group with metronidazole treatment (metronidazole was used ≥4 days continuously, 15 mg/kg/day) and group without metronidazole treatment. The depraved rates of stage II NEC between the 2 groups were compared. Meanwhile, the risk factors associated with the deterioration of stage II NEC were analyzed by case-control study in the PS-matched cases.A total of 229 infants met the inclusion criteria. Before PS-matching, we found the deterioration of NEC rate in the group with metronidazole treatment was higher than that in the group without metronidazole treatment (18.1% [28/155] vs 8.1% [6/74]; P = 0.048). After PS-matching, 73 pairs were matched, and the depraved rate of NEC in the group with metronidazole treatment was not lower than that in the group without metronidazole treatment (15.1% vs 8.2%; P = 0.2). Binary logistic regression analysis showed that sepsis after NEC (odds ratio [OR] 3.748, 95% confidence interval [CI] 1.171-11.998, P = 0.03), the need to use transfusion of blood products after diagnosis of NEC (OR 8.003, 95% CI 2.365-27.087, P = 0.00), and the need of longer time for nasogastric suction were risk factors for stage II NEC progressing to

  14. Prediction of treatment outcome by cisplatin-DNA adduct formation in patients with stage III/IV head and neck squamous cell carcinoma, treated by concurrent cisplatin-radiation (RADPLAT).

    NARCIS (Netherlands)

    Hoebers, F.J.; Pluim, D.; Verheij, M.; Balm, A.J.M.; Bartelink, H.; Schellens, J.H.M.; Begg, A.C.

    2006-01-01

    The purpose of our study was to test the predictive value of cisplatin-DNA adduct levels in head and neck squamous cell carcinoma (HNSCC) patients treated with cisplatin-radiation. Patients with advanced-stage HNSCC were treated within a randomized trial, investigating the optimal route of cisplatin

  15. Performance assessment and transient optimization of multi-stage solid desiccant air conditioning systems with building PV/T integration

    Science.gov (United States)

    Gadalla, Mohamed; Saghafifar, Mohammad

    2016-09-01

    One of the popular solar air conditioning technologies is desiccant air conditioning. Nonetheless, single stage desiccant air conditioning systems' coefficient of performance (COP) are relatively low. Therefore, multi-stage solid desiccant air conditioning systems are recommended. In this paper, an integrated double-stage desiccant air conditioning systems and PV/T collector is suggested for hot and humid climates such as the UAE. The results for the PV/T implementation in the double-stage desiccant cooling system are assessed against the PV/T results for a single-stage desiccant air conditioning system. In order to provide a valid comparative evaluation between the single and double stage desiccant air conditioning systems, an identical PV/T module, in terms of dimensions, is incorporated into these systems. The overall required auxiliary air heating is abated by 46.0% from 386.8 MWh to 209.0 MWh by replacing the single stage desiccant air conditioning system with the proposed double stage configuration during June to October. Moreover, the overall averaged solar share during the investigated months for the single and double stage systems are 36.5% and 43.3%.

  16. Cementless total hip arthroplasty for patients with Crowe type III or IV developmental dysplasia of the hip: two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips.

    Science.gov (United States)

    Yoon, Pil Whan; Kim, Jung Il; Kim, Dong Ok; Yu, Cheol Hwan; Yoo, Jeong Joon; Kim, Hee Joong; Yoon, Kang Sup

    2013-09-01

    Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.

  17. Expression and prognostic significance of APAF-1, caspase-8 and caspase-9 in stage II/III colon carcinoma: caspase-8 and caspase-9 is associated with poor prognosis.

    Science.gov (United States)

    Sträter, Jörn; Herter, Ines; Merkel, Gaby; Hinz, Ulf; Weitz, Jürgen; Möller, Peter

    2010-08-15

    Apoptosis protease activating factor-1 (APAF-1), caspase-8 and caspase-9 are important factors in the execution of death signals. To study their prognostic influence in colon carcinoma, expression of APAF-1, caspase-8 and caspase-9 was determined by immunohistochemistry in normal colon mucosa (n = 8) and R0-resected stage II/III colon carcinomas (n >or= 124) using a semiquantitative score. Staining results were correlated with disease-free survival by Kaplan-Meier estimates, and multivariate Cox analyses were performed. In normal colon, APAF-1 and caspase-8 are most strongly expressed in the luminal surface epithelium, whereas caspase-9 is expressed all along the crypt axis. In colon carcinomas, there is considerable variability in the expression of these proapoptotic factors, although complete loss of caspase-8 and caspase-9 is rare. APAF-1 expression did not correlate with disease-free survival. Instead, both expression of caspase-9 and high-level expression of caspase-8 in a majority of tumor cells were significantly associated with adverse prognosis (p = 0.004 and p = 0.029, respectively). The influence of caspase-8 expression was mainly seen in patients with stage III colon carcinoma (p = 0.011), whereas the prognostic influence of caspase-9 expression was significant in stage II cases (p = 0.037) and just failed to be significant in stage III tumors (p = 0.0581). After adjusting for confounding factors in a multivariate Cox analysis, the effect of caspase-9 in predicting disease-free survival was confirmed (p = 0.003). Our data suggest that, in colon carcinomas, expression of caspase-8 and caspase-9 is significantly associated with poor survival. Caspase-9 may be an independent prognosticator in colon carcinoma.

  18. Chemotherapy and Radiation Therapy With or Without Metformin Hydrochloride in Treating Patients With Stage III Non-small Cell Lung Cancer

    Science.gov (United States)

    2016-06-17

    Adenosquamous Lung Carcinoma; Bronchioloalveolar Carcinoma; Large Cell Lung Carcinoma; Lung Adenocarcinoma; Non-Small Cell Lung Carcinoma; Recurrent Non-Small Cell Lung Carcinoma; Squamous Cell Lung Carcinoma; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIB Non-Small Cell Lung Cancer

  19. Analysis of seven stages supply chain management in electronic component inventory optimization for warehouse with economic load dispatch using genetic algorithm

    Directory of Open Access Journals (Sweden)

    Ajay Singh Yadav

    2017-06-01

    Full Text Available The purpose of the proposed study is to give a new dimension on warehouse with Economic Load Dispatch using genetic algorithm processes in Seven Stages - 10 Member Supply Chain in Electronic component inventory optimization to describe the certain and uncertain market demand which is based on supply reliability and to develop more realistic and more flexible models. we hope that the proposed study has a great potential to solve various practical tribulations related to the warehouse using genetic algorithm processes in Seven Stages - 10 Member Supply Chain in Electronic component inventory optimization and also provide a general review for the application of soft computing techniques like genetic algorithms to use for improve the effectiveness and efficiency for various aspect of warehouse with Economic Load Dispatch using genetic algorithm.

  20. Parametric Dose Standardization for Optimizing Two-Agent Combinations in a Phase I-II Trial with Ordinal Outcomes.

    Science.gov (United States)

    Thall, Peter F; Nguyen, Hoang Q; Zinner, Ralph G

    2017-01-01

    A Bayesian model and design are described for a phase I-II trial to jointly optimise the doses of a targeted agent and a chemotherapy agent for solid tumors. A challenge in designing the trial was that both the efficacy and toxicity outcomes were defined as four-level ordinal variables. To reflect possibly complex joint effects of the two doses on each of the two outcomes, for each marginal distribution a generalised continuation ratio model was assumed, with each agent's dose parametrically standardised in the linear term. A copula was assumed to obtain a bivariate distribution. Elicited outcome probabilities were used to construct a prior, with variances calibrated to obtain small prior effective sample size. Elicited numerical utilities of the 16 elementary outcomes were used to compute posterior mean utilities as criteria for selecting dose pairs, with adaptive randomisation to reduce the risk of getting stuck at a suboptimal pair. A simulation study showed that parametric dose standardisation with additive dose effects provides a robust, reliable model for dose pair optimisation in this setting, and it compares favourably with designs based on alternative models that include dose-dose interaction terms. The proposed model and method are applicable generally to other clinical trial settings with similar dose and outcome structures.

  1. Acute toxicity profile and compliance to accelerated radiotherapy plus carbogen and nicotinamide for clinical stage T2-4 laryngeal cancer: results of a phase III randomized trial.

    NARCIS (Netherlands)

    Janssens, G.O.R.J.; Terhaard, C.H.J.; Doornaert, P.A.; Bijl, H.P.; Ende, P. van den; Chin, A.; Pop, L.A.M.; Kaanders, J.H.A.M.

    2012-01-01

    PURPOSE: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. METHODS AND MATERIALS: From April 2001 to February 2008, 345 patients with

  2. ACUTE TOXICITY PROFILE AND COMPLIANCE TO ACCELERATED RADIOTHERAPY PLUS CARBOGEN AND NICOTINAMIDE FOR CLINICAL STAGE T2-4 LARYNGEAL CANCER : RESULTS OF A PHASE III RANDOMIZED TRIAL

    NARCIS (Netherlands)

    Janssens, Geert O.; Terhaard, Chris H.; Doornaert, Patricia A.; Bijl, Hendrik P.; van den Ende, Piet; Chin, Alim; Pop, Lucas A.; Kaanders, Johannes H.

    2012-01-01

    Purpose: To report the acute toxicity profile and compliance from a randomized Phase III trial comparing accelerated radiotherapy (AR) with accelerated radiotherapy plus carbogen and nicotinamide (ARCON) in laryngeal cancer. Methods and Materials: From April 2001 to February 2008, 345 patients with

  3. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer

    DEFF Research Database (Denmark)

    Scagliotti, G.V.; Parikh, P.; Pawel, J. von

    2008-01-01

    Purpose Cisplatin plus gemcitabine is a standard regimen for first-line treatment of advanced non-small-cell lung cancer (NSCLC). Phase II studies of pemetrexed plus platinum compounds have also shown activity in this setting. Patients and Methods This noninferiority, phase III, randomized study ...... neutropenia (P = .002); and alopecia (P

  4. A novel Fe(III) dependent bioflocculant from Klebsiella oxytoca GS-4-08: culture conditions optimization and flocculation mechanism

    Science.gov (United States)

    Yu, Lei; Tang, Qing-wen; Zhang, Yu-jia; Chen, Rong-ping; Liu, Xin; Qiao, Wei-chuan; Li, Wen-wei; Ruan, Hong-hua; Song, Xin

    2016-01-01

    In this work, the effect of cultivation factors on the flocculation efficiency (FE) of bioflocculant P-GS408 from Klebsiella oxytoca was optimized by the response surface methodology. The most significant factor, i.e. culture time, was determined by gray relational analysis. A total of 240 mg of purified P-GS408 was prepared from 1 liter of culture solution under the optimal conditions. GC-MS analysis results indicated that the polysaccharide of P-GS408 mainly contains Rhamnose and Galactose, and the existence of abundant hydroxyl, carboxyl and amino groups was evidenced by FTIR and XPS analyses. With the aid of Fe3+, the FE of kaolin solution by P-GS408 could achieve 99.48% in ten minutes. Functional groups of polysaccharide were involved in the first adsorption step and the zeta potential of kaolin solution changed from −39.0 mV to 43.4 mV in the presence of Fe3+ and P-GS408. Three-dimensional excitation-emission (EEM) fluorescence spectra demonstrates that the trivalent Fe3+ and Al3+ can bind efficiently with P-GS408, while those univalent and divalent cations cannot. With the help of SEM images, FTIR, zeta potential and EEM spectra, we proposed the P-GS408 flocculation mechanism, which consists of coordination bond combination, charge neutrality, adsorption and bridging, and net catching. PMID:27713559

  5. QUALITY ASSURANCE OF 4D-CT SCAN TECHNIQUES IN MULTICENTER PHASE III TRIAL OF SURGERY VERSUS STEREOTACTIC RADIOTHERAPY (RADIOSURGERY OR SURGERY FOR OPERABLE EARLY STAGE (STAGE 1A) NON-SMALL-CELL LUNG CANCER [ROSEL] STUDY)

    NARCIS (Netherlands)

    Hurkmans, Coen W.; van Lieshout, Maarten; Schuring, Danny; van Heumen, Marielle J. T.; Cuijpers, Johan P.; Lagerwaard, Frank J.; Widder, Joachim; van der Heide, Uulke A.; Senan, Suresh

    2011-01-01

    Purpose: To determine the accuracy of four-dimensional computed tomography (4D-CT) scanning techniques in institutions participating in a Phase III trial of surgery vs. stereotactic radiotherapy (SBRT) for lung cancer. Methods and Materials: All 9 centers performed a 4D-CT scan of a motion phantom (

  6. Optimism

    Science.gov (United States)

    Carver, Charles S.; Scheier, Michael F.; Segerstrom, Suzanne C.

    2010-01-01

    Optimism is an individual difference variable that reflects the extent to which people hold generalized favorable expectancies for their future. Higher levels of optimism have been related prospectively to better subjective well-being in times of adversity or difficulty (i.e., controlling for previous well-being). Consistent with such findings, optimism has been linked to higher levels of engagement coping and lower levels of avoidance, or disengagement, coping. There is evidence that optimism is associated with taking proactive steps to protect one's health, whereas pessimism is associated with health-damaging behaviors. Consistent with such findings, optimism is also related to indicators of better physical health. The energetic, task-focused approach that optimists take to goals also relates to benefits in the socioeconomic world. Some evidence suggests that optimism relates to more persistence in educational efforts and to higher later income. Optimists also appear to fare better than pessimists in relationships. Although there are instances in which optimism fails to convey an advantage, and instances in which it may convey a disadvantage, those instances are relatively rare. In sum, the behavioral patterns of optimists appear to provide models of living for others to learn from. PMID:20170998

  7. SCORE2 Report 1: Techniques to Optimize Recruitment in Phase III Clinical Trials of Patients With Central Retinal Vein Occlusion.

    Science.gov (United States)

    Scott, Ingrid U; VanVeldhuisen, Paul C; Ip, Michael S; Blodi, Barbara A; Oden, Neal L; Figueroa, Maria

    2016-10-01

    To investigate recruitment rates of patients with central retinal vein occlusion (CRVO) into phase III clinical trials evaluating intravitreal pharmacotherapy for treatment of macular edema in the United States, describe recruitment techniques in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), and assess which SCORE2 recruitment techniques were most useful to principal investigators and clinical coordinators. Retrospective survey within a randomized clinical trial. Recruitment rates of the Standard Care versus COrticosteroid for REtinal Vein Occlusion (SCORE)-CRVO trial, CRUISE Study, and SCORE2 were calculated. Techniques employed to facilitate recruitment in SCORE2 are described, and a survey was sent to the principal investigator and primary clinical coordinator of each SCORE2 site to assess the usefulness of recruitment techniques. In SCORE2, the recruitment rate of 0.39 participants/month/site was higher than in SCORE-CRVO (0.10 participants/month/site) and CRUISE (0.23 participants/month/site). For study design factors in SCORE2, investigators and coordinators rated provision of standard-of-care treatments to all study participants as having a major positive impact on recruitment. A monthly e-newsletter to site staff and communication by physician members of the SCORE2 Executive Committee to sites upon each randomization were perceived as effective means to help site staff focus on recruitment. The SCORE2 recruitment rate compares favorably to previous clinical trials investigating intravitreal pharmacotherapy for treatment of CRVO-associated macular edema. Study design factors, methods of communication with sites, and recruitment techniques implemented in SCORE2 were well received by investigators and coordinators and may be helpful in future clinical trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Optimization

    CERN Document Server

    Pearce, Charles

    2009-01-01

    Focuses on mathematical structure, and on real-world applications. This book includes developments in several optimization-related topics such as decision theory, linear programming, turnpike theory, duality theory, convex analysis, and queuing theory.

  9. Diglycolamic acid anchored on polyamine matrix for the mutual separation of Eu(III) and Am(III)

    Energy Technology Data Exchange (ETDEWEB)

    Suneesh, A.S.; Syamala, K.V.; Venkatesan, K.A.; Antony, M.P.; Vasudeva Rao, P.R. [Indira Gandhi Centre for Atomic Research, Kalpakkam (India). Fuel Chemistry Div.

    2016-04-01

    Diglycolamic acid was anchored on a polyamine matrix and the product (PA-DGAH) was characterized by ion-exchange capacity measurement, TG-DTA and FT-IR spectroscopy. The extraction behavior of Am(III) and Eu(III) in PA-DGAH was studied from dilute nitric acid medium to examine the feasibility using the anchored adsorbent for their mutual separation. The effect of various parameters such as the duration of equilibration, concentration of europium, nitric acid and diethylenetriaminepentaacetic acid (DTPA) in aqueous phase on the distribution coefficient (K{sub d}) of Am(III) and Eu(III) was studied. The distribution coefficient decreased with increase in the concentration of nitric acid. Rapid extraction of metal ions in the initial stages of equilibration followed by the establishment of equilibrium occurred within 4 h. The data on the rate of uptake of Am(III) and Eu(III) were fitted into pseudo-first order and pseudo-second order rate equation. The extraction isotherm was fitted to Langmuir and Freundlich adsorption models and the apparent europium extraction capacity was determined. The mechanism of extraction was elucidated and the conditions needed for efficient separation of Am(III) from Eu(III) was optimized using DTPA. The study indicated the possibility of using PA-DGAH for the separation of Eu(III) from Am(III) with high separation factors.

  10. A comparison of volumetric modulated arc therapy and sliding-window intensity-modulated radiotherapy in the treatment of Stage I-II nasal natural killer/T-cell lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Xianfeng [Department of Radiation Oncology, Chongqing Cancer Institute, Chongqing (China); Yang, Yong [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Jin, Fu; He, Yanan; Zhong, Mingsong; Luo, Huanli; Qiu, Da; Li, Chao; Yang, Han; He, Guanglei [Department of Radiation Oncology, Chongqing Cancer Institute, Chongqing (China); Wang, Ying, E-mail: zjajf@126.com [Department of Radiation Oncology, Chongqing Cancer Institute, Chongqing (China)

    2016-04-01

    This article is aimed to compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for Stage I-II nasal natural killer/T-cell lymphoma (NNKTL). Ten patients with Stage I-II NNKTL treated with IMRT were replanned with VMAT (2 arcs). The prescribed dose of the planning target volume (PTV) was 50 Gy in 25 fractions. The VMAT plans with the Anisotropic Analytical Algorithm (Version 8.6.15) were based on an Eclipse treatment planning system; the monitor units (MUs) and treatment time (T) were scored to measure the expected treatment efficiency. All the 10 patients under the study were subject to comparisons regarding the quality of target coverage, the efficiency of delivery, and the exposure of normal adjacent organs at risk (OARs). The study shows that VMAT was associated with a better conformal index (CI) and homogeneity index (HI) (both p < 0.05) but slightly higher dose to OARs than IMRT. The MUs with VMAT (650.80 ± 24.59) were fewer than with IMRT (1300.10 ± 57.12) (relative reduction of 49.94%, p = 0.00) when using 2-Gy dose fractions. The treatment time with VMAT (3.20 ± 0.02 minutes) was shorter than with IMRT (7.38 ± 0.18 minutes) (relative reduction of 56.64%, p = 0.00). We found that VMAT and IMRT both provide satisfactory target dosimetric coverage and OARs sparing clinically. Likely to deliver a bit higher dose to OARs, VMAT in comparison with IMRT, is still a better choice for treatment of patients with Stage I-II NNKTL, thanks to better dose distribution, fewer MUs, and shorter delivery time.

  11. Radiotherapy and prognostic factors evaluation in patients with squamous cell carcinoma of the uterine cervix - stage III b; Avaliacao da radioterapia de fatores prognosticos em pacientes com carcinoma epidermoide do colo uterino estadio IIIB

    Energy Technology Data Exchange (ETDEWEB)

    Teixeira, Julio Cesar; Monti, Carlos Roberto; Derchain, Sophie Francoise Mauricette; Teixeira, Luiz Carlos [Universidade Estadual de Campinas, SP (Brazil). Centro de Atencao Integral a Saude da Mulher; Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Tocoginecologia; E-mail: julioc@bestway.com.br

    2000-03-01

    The aim of retrospective clinical study was to evaluate some characteristics of patient, disease and radiotherapy as factors associated to therapeutic response, recurrence and survival time of hundred patients with squamous cell carcinoma of the uterine cervix - stage III b, with mean age of fifty-three years, treated from 1985 to 1990 and followed up for 124 months. Complete therapeutic response, about 42%, were observed. The Regression Analysis showed that the probability of complete response is directly associated to progressive increase in radiation dose and the age of patients.

  12. Selection of the optimal completion of horizontal wells with multi-stage hydraulic fracturing of the low-permeable formation, field C

    Science.gov (United States)

    Bozoev, A. M.; Demidova, E. A.

    2016-03-01

    At the moment, many fields of Western Siberia are in the later stages of development. In this regard, the multilayer fields are actually involved in the development of hard to recover reserves by conducting well interventions. However, most of these assets may not to be economical profitable without application of horizontal drilling and multi-stage hydraulic fracturing treatment. Moreover, location of frac ports in relative to each other, number of stages, volume of proppant per one stage are the main issues due to the fact that the interference effect could lead to the loss of oil production. The optimal arrangement of horizontal wells with multi-stage hydraulic fracture was defined in this paper. Several analytical approaches have been used to predict the started oil flow rate and chose the most appropriate for field C reservoir J1. However, none of the analytical equations could not take into account the interference effect and determine the optimum number of fractures. Therefore, the simulation modelling was used. Finally, the universal equation is derived for this field C, the reservoir J1. This tool could be used to predict the flow rate of the horizontal well with hydraulic fracturing treatment on the qualitative level without simulation model.

  13. Optimization of atrazine and imidacloprid removal from water using biochars: Designing single or multi-staged batch adsorption systems.

    Science.gov (United States)

    Mandal, Abhishek; Singh, Neera

    2017-05-01

    Contamination of surface and ground water by pesticides from agricultural runoff and industrial discharge is one of the main causes of aqueous contaminations world over. Biochar, agricultural waste derived highly aromatic substance produced after pyrolysis and carbonification of biomass have exhibited good adsorption capacity for pesticides and can be used to develop on-site bio-purification systems for organic contaminant removal from polluted waters. However, high amounts of adsorbent required in single stage-batch sorption plant increases the cost of water treatment; therefore, multistage plant systems were investigated. Normal (RSBC) and phosphoric acid treated (T-RSBC) rice straw biochars were evaluated for atrazine and imidacloprid sorption and data fitted to the Freundlich isotherm. The adsorption data was modelled to develop single or multi-staged adsorber plants for pesticide removal from water. Both biochars showed significantly high adsorption capacity for imidacloprid and atrazine. Modelling studies using the Freundlich adsorption parameters suggested that the amounts (kg/1000L) of RSBC and T-RSBC for 95% of atrazine removal (10mg/L) in single-, two- and three-staged adsorber plant models were 8.84, 2.44, 1.61kg and 4.47, 1.42, 0.98kg, respectively. Corresponding amounts for 95% imidacloprid removal (10mg/L) were 3.97, 1.22, 0.84kg and 3.98, 1.38, 0.96kg, respectively. Thus, the two-staged model suggested 65-72% reduction in amount of adsorbent required over the single stage model, while the three-staged model suggested 30-34% adsorbent saving over the two-staged plant model. Single and two-staged adsorber plant model findings were validated for atrazine removal using T-RSBC. Results suggested that amounts calculated using modelling studies were fairly accurate. Biochars, as low cost adsorbents for atrazine and imidacloprid removal from contaminated water, can be used to develop low cost adsorber plants based on multiple batch sorption systems for the

  14. The Role of Postmastectomy Radiation Therapy After Neoadjuvant Chemotherapy in Clinical Stage II-III Breast Cancer Patients With pN0: A Multicenter, Retrospective Study (KROG 12-05)

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Su Jung [Department of Radiation Oncology, Eulji General Hospital, College of Medicine, Eulji University, Seoul (Korea, Republic of); Park, Won, E-mail: wonro.park@samsung.com [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae; Choi, Doo Ho [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Lee, Nam Kwon [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea Medical Center, Korea University, School of Medicine, Seoul (Korea, Republic of); Suh, Chang-Ok; Keum, Ki Chang; Kim, Yong Bae [Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Ahn, Seung Do; Kim, Su Ssan [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Ha, Sung W.; Chie, Eui Kyu; Kim, Kyubo [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Shin, Hyun Soo [Department of Radiation Oncology, Bundang CHA Hospital, School of Medicine, CHA University, Seongnam (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Lee, Hyung-Sik [Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan (Korea, Republic of)

    2014-01-01

    Purpose: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials: We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log–rank test and Cox proportional regression analysis. Results: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (≤40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (≤40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

  15. Nox2 modification of LDL is essential for optimal apolipoprotein B-mediated control of agr type III Staphylococcus aureus quorum-sensing.

    Directory of Open Access Journals (Sweden)

    Pamela R Hall

    2013-02-01

    Full Text Available Staphylococcus aureus contains an autoinducing quorum-sensing system encoded within the agr operon that coordinates expression of virulence genes required for invasive infection. Allelic variation within agr has generated four agr specific groups, agr I-IV, each of which secretes a distinct autoinducing peptide pheromone (AIP1-4 that drives agr signaling. Because agr signaling mediates a phenotypic change in this pathogen from an adherent colonizing phenotype to one associated with considerable tissue injury and invasiveness, we postulated that a significant contribution to host defense against tissue damaging and invasive infections could be provided by innate immune mechanisms that antagonize agr signaling. We determined whether two host defense factors that inhibit AIP1-induced agrI signaling, Nox2 and apolipoprotein B (apoB, also contribute to innate control of AIP3-induced agrIII signaling. We hypothesized that apoB and Nox2 would function differently against AIP3, which differs from AIP1 in amino acid sequence and length. Here we show that unlike AIP1, AIP3 is resistant to direct oxidant inactivation by Nox2 characteristic ROS. Rather, the contribution of Nox2 to defense against agrIII signaling is through oxidation of LDL. ApoB in the context of oxLDL, and not LDL, provides optimal host defense against S. aureus agrIII infection by binding the secreted signaling peptide, AIP3, and preventing expression of the agr-driven virulence factors which mediate invasive infection. ApoB within the context of oxLDL also binds AIP 1-4 and oxLDL antagonizes agr signaling by all four agr alleles. Our results suggest that Nox2-mediated oxidation of LDL facilitates a conformational change in apoB to one sufficient for binding and sequestration of all four AIPs, demonstrating the interdependence of apoB and Nox2 in host defense against agr signaling. These data reveal a novel role for oxLDL in host defense against S. aureus quorum-sensing signaling.

  16. Extended schedule, escalated dose temozolomide versus dacarbazine in stage IV melanoma: final results of a randomised phase III study (EORTC 18032)

    NARCIS (Netherlands)

    Patel, P.M.; Suciu, S.; Mortier, L.; Kruit, W.H.; Robert, C.; Schadendorf, D.; Trefzer, U.; Punt, C.J.A.; Dummer, R.; Davidson, N.; Becker, J.; Conry, R.; Thompson, J.A.; Hwu, W.J.; Engelen, K. van; Agarwala, S.S.; Keilholz, U.; Eggermont, A.M.M.; Spatz, A.

    2011-01-01

    PURPOSE: To compare the efficacy of an extended schedule escalated dose of temozolomide versus standard dose dacarbazine in a large population of patients with stage IV melanoma. PATIENTS AND METHODS: A total of 859 patients were randomised to receive oral temozolomide at 150 mg/m(2)/day for seven c

  17. Optimizing the Steel Plate Storage Yard Crane Scheduling Problem Using a Two Stage Planning/Scheduling Approach

    DEFF Research Database (Denmark)

    Hansen, Anders Dohn; Clausen, Jens

    This paper presents the Steel Plate Storage Yard Crane Scheduling Problem. The task is to generate a schedule for two gantry cranes sharing tracks. The schedule must comply with a number of constraints and at the same time be cost efficient. We propose some ideas for a two stage planning...

  18. The STAR trial protocol: a randomised multi-stage phase II/III study of Sunitinib comparing temporary cessation with allowing continuation, at the time of maximal radiological response, in the first-line treatment of locally advanced/metastatic Renal Cancer

    Directory of Open Access Journals (Sweden)

    Collinson Fiona J

    2012-12-01

    Full Text Available Abstract Background Over recent years a number of novel therapies have shown promise in advanced renal cell carcinoma (RCC. Internationally the standard of care of first-line therapy is sunitinib™, after a clear survival benefit was demonstrated over interferon-α. Convention dictates that sunitinib is continued until evidence of disease progression, assuming tolerability, although there is no evidence that this approach is superior to intermittent periods of treatment. The purpose of the STAR trial is to compare the standard treatment strategy (conventional continuation strategy, CCS with a novel drug free interval strategy (DFIS which includes planned treatment breaks. Methods/Design The STAR trial is an NIHR HTA-funded UK pragmatic randomised phase II/III clinical trial in the first-line treatment of advanced RCC. Participants will be randomised (1:1 to either a sunitinib CCS or a DFIS. The overall aim of the trial is to determine whether a DFIS is non-inferior, in terms of 2-year overall survival (OS and quality adjusted life years (QALY (averaged over treatment and follow up, compared to a CCS. The QALY primary endpoint was selected to assess whether any detriment in terms of OS could be balanced with improvements in quality of life (QoL. This is a complex trial with a number of design challenges, and to address these issue