Actual Stage Research Articles

Emerging molecular markers for the prognosis of differentiated thyroid cancer patients

Epithelial thyroid cancers are represented by the differentiated papillary and follicular thyroid carcinomas which, following dedifferentiation, are thought to give rise to the highly aggressive and incurable anaplastic thyroid carcinomas. Although derived from the same cell type, the different thyroid tumors show specific histological features, biological behavior and degree of differentiation as a consequence of different genetic alterations. Over the last few years, our knowledge regarding the molecular alterations underlying thyroid cell malignant transformation and cancer progression has considerably increased; however, the prognosis of differentiated thyroid cancer patients still relies on high-risk clinic-pathological variables. In particular, the actual staging systems provides only a rough prediction for cancer mortality and risk of recurrences, including in each risk group patients with highly different tumor-specific progression, disease-free interval and survival time. In order to improve DTC patient's risk stratification, both the European and the American Thyroid Associations proposed practical guidelines to integrate the actual staging systems with additional clinical features such as the tumor histological variant, the results of post-ablative whole body scan and the serum thyroglobulin levels. Despite that, patients within the same risk group still show a very heterogeneous behavior in terms of disease-free interval. As a consequence, the identification of new prognostic molecular biomarkers able to testify tumor aggressiveness is highly required. Here we'll review recently characterized new molecular markers potentially able to ameliorate the prognosis in DTC patients.

Discordance between perceived and actual cancer stage among cancer patients in Korea: a nationwide survey.

PurposeWe assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea.MethodsInformation was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis.ResultsThe stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30–0.87), recurrence (OR = 0.64, 95% CI = 0.50–0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39–0.72).ConclusionThere are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.

Multiplex Protein Analysis to Determine Fibrosis Stage and Progression in Patients With Chronic Hepatitis C

Noninvasive tests cannot differentiate between adjacent stages of fibrosis, which limits assessment of disease progression and regression during therapy. We investigated whether levels of cytokines and extracellular matrix proteins in serum and biopsy samples can be used to determine actual stage of liver fibrosis in patients with chronic hepatitis C (CHC) and in prognosis. We collected data from 383 treatment-naive patients with CHC from the Duke Hepatology Clinical Research Database and Biorepository, from 2006 through 2009, for use in the training set. Serum samples were obtained from 100 individuals without CHC (controls). We selected 37 serum biomarkers for customized array analysis by using the SearchLight multiplex sandwich enzyme-linked immunosorbent assay. Data from 434 treatment-naive patients with CHC, which were obtained from the Trent HCV cohort, were used in the validation analysis. Multivariable modeling, marker selection, and validation included randomForest and Obuchowski measures, with independent comparison with FibroSURE. Four serum markers (levels of hyaluronic acid, vascular cell adhesion molecule 1, alpha-2 macroglobulin, and retinol-binding protein 4) and age associated with fibrosis stage (F0-1, F2-3, or F4); these had Obuchowski measures of 0.85-0.89, with misclassification rates of 38% and 29% in training and validation sets, compared with 50% for the FibroSURE test. In the training set, area under the curve values for the multiplex markers were similar to those from the FibroSURE test: stages F0 vs F1 (0.51 vs 0.53), F1 vs F2 (0.60 vs 0.59), F2 vs F3 (0.69 vs 0.72), and F3 vs F4 (0.51 vs 0.52). Area under the curve values were similar in the validation cohort. In longitudinal analyses of 133 paired biopsies, 9 markers (level of alanine aminotransferase, γ-glutamyltransferase, hyaluronic acid, intracellular adhesion molecule 1, interleukin 4, CXCL10, CXCL9, and vascular cell adhesion molecule 1) were associated with change in the histologic activity index (P values ranging from .000 to .049), and 4 (granulocyte-macrophage colony-stimulating factor, interleukin 12, interleukin 2, and matrix metalloproteinase 13) were associated with a change in fibrosis stage (P values ranging from .001 to .042). We identified serum biomarkers that can be measured by multiplex enzyme-linked immunosorbent assay to determine levels of fibrosis in patients with CHC, although misclassification is frequent and results are comparable with those from the FibroSURE test. Changes in protein levels in biopsy samples were associated with progression of fibrosis in patients.

Advanced Remote Sensing Technology for Sustainable Land Development in Arid Lands

Researchers have recognized the potential use of multi-sensor remote sensing as one of the main datasources for monitoring and assessing the impact of rapid land use changes especially in fragileecosystems such as drylands. Most mapping methods have been developed for multi spectral images sincethis type of imagery currently provides the longest Earth Observing (EO) records that can be used toconstruct time series for monitoring the status of arid and semi-arid ecosystems. The spatial resolution ofolder generation EO sensors imposes, however, a problem in relation to the spatial variability ofecosystem components and status, especially in urban areas. Several techniques have been developed toimprove the detection and mapping of surface features that occur at sub-pixel resolution so that theirspectral information can be used for feature identification and extrapolated in space and time. However,ground observation is often needed to characterize and verify the land surface components making up apixel as well as to relate their spectral response to their actual physical stage (e.g., vegetation health, soilsalinity and moisture content etc.). When ground information is not available or feasible, high resolutionimagery can provide the required spatial information. This paper discusses current techniques in multisensordata analysis by illustrating their applications in urban and agricultural settings of arid lands. Keywords: multispectral, hyper spectral data, object-based classification, spectral angle mapper, aridland applications

Determination of sentinel lymph node by Tc(99m) in small-cell lung cancer

In the prospective study was aimed to be the actual node staging identified sentinel and mediastinel lymph nodes and mapping in patient with operable non-small cell lung carcinomas. Twelve patients underwent pulmonary resections due to non-small cell bronchial carcinoma in the study were included . Intraoperatively, by injecting Tc99m to peritumoral tissues, average 96 minutes later, radioactivity levels of the tumoral tissue and lymph nodes were measured. All patients were evaluated by bronchoscopy for endobronchial lesions. The patients were scanned for the metastasis of solid organs in order to pre-operative staging. The interlobar lymph node stations as a sentinel lymph nodes were detected in 45% of the patient. Lobes of specific, lymph node stations and skip metastasis detected lymph nodes were identified. Sentinel lymph node was in 77% of patients at the level N1 and in 66%of patients at the level N2. It were at two different stations in 66% of patients and at single-station in 33% of patient . In 1 (11%) of 9 patients identified sentinel lymph node, the metastasis has been reported by the routine histopathological examination. To detection sentinel lymph node, micrometastasis also allows for a more detailed pathological examination. It provides making true node staging in patients and postoperative therapy helps to organize appropriate support with non-small cell lung cancer.

Estimating clinical stage of amyotrophic lateral sclerosis from the ALS Functional Rating Scale

ALS is a progressive neurodegenerative disease. The stage of disease reached can be described using a simple system based on the number of central nervous system regions involved. Historically, datasets have not attempted to record clinical stage, but being able to re-analyse the data by stage would have several advantages. We therefore explored the possibility of using an algorithm based on the revised ALS Functional Rating Scale (ALSFRS-R), which is commonly used in clinical practice, to estimate clinical stage. We devised an algorithm to convert ALSFRS-R score into clinical stage. ALSFRS-R domains were mapped to equivalent CNS regions. Stage 4 is reached when gastrostomy or non- invasive ventilation is needed, but as a proxy we used provision. We collected ALSFRS-R from clinic visits, and compared the estimation of clinical stage from the ALSFRS-R with the actual stage. Results showed that the agreement between staging by the two methods was excellent with an intraclass correlation coefficient of 0.92 (95% confidence interval 0.88–0.94). There was no systematic bias towards over-staging or under-staging using the algorithm. In conclusion, we have shown that clinical stage in ALS can be reliably estimated using the ALSFRS-R in historical data and in current data where stage has not been recorded

Manifold population modeling as a neuro-imaging biomarker: Application to ADNI and ADNI-GO

We propose a framework for feature extraction from learned low-dimensional subspaces that represent inter-subject variability. The manifold subspace is built from data-driven regions of interest (ROI). The regions are learned via sparse regression using the mini-mental state examination (MMSE) score as an independent variable which correlates better with the actual disease stage than a discrete class label. The sparse regression is used to perform variable selection along with a re-sampling scheme to reduce sampling bias. We then use the learned manifold coordinates to perform visualization and classification of the subjects. Results of the proposed approach are shown using the ADNI and ADNI-GO datasets. Three types of classification techniques, including a new MRI Disease-State-Score (MRI-DSS) classifier, are tested in conjunction with two learning strategies. In the first case Alzheimer's Disease (AD) and progressive mild cognitive impairment (pMCI) subjects were grouped together, while cognitive normal (CN) and stable mild cognitive impaired (sMCI) subjects were also grouped together. In the second approach, the classifiers are learned using the original class labels (with no grouping). We show results that are comparable to other state-of-the-art methods. A classification rate of 71%, of arguably the most clinically relevant subjects, sMCI and pMCI, is shown. Additionally, we present classification accuracies between CN and early MCI (eMCI) subjects, from the ADNI-GO dataset, of 65%. To our knowledge this is the first time classification accuracies for eMCI patients have been reported.

A suggested modification to FIGO stage I endometrial cancer

ObjectiveFIGO stage I endometrial cancers are divided into two substages, regardless of the presence or absence of lymphovascular space invasion (LVSI). The aim of this study was to investigate whether stratification based on the LVSI status would better predict mortality. MethodsUsing a multicentric database, we identified patients who underwent endometrial cancer operations between 2000 and 2010. The staging performance was quantified with respect to discrimination. ResultsThe study cohort included 508 patients (198 with LVSI-positive tumors and 310 with LVSI-negative tumors). The survival difference between the stage I patients with LVSI-positive and LVSI-negative tumors was highly significant (81% and 97%, respectively P=.009), whereas the difference between the stage I patients with tumors invading greater or less than half of the myometrium was not (87% and 96%, respectively P=0.09). The 5-year OS rates for the patients with LVSI-negative tumors invading less than half of the myometrium, with LVSI-negative tumors invading more than half of the myometrium and with LVSI-positive invading more than or less than half of the myometrium were 98%, 95%, and 81%, respectively (P=.03). Separating the LVSI-negative and LVSI-positive tumors would improve discrimination (concordance index, 77% vs. 75%, respectively, using the actual staging system). ConclusionA LVSI-positive status has a significantly worse prognosis. In this study, the distinction by LVSI status appears to be more relevant than the distinction between stages IA and IB for predicting survival in stage I endometrial cancer. This difference in prognosis would favor restaging these two entities.

Clowns do ethnography: an experiment in long-distance comic failure

This paper examines the role of clowning in practice-as-research, and explores tensions between aspiration and execution in interdisciplinary projects. It draws on documentary assets (video screen grabs, photographs, texts) from a version of Euripides’ Iphigenia at Aulis devised online and presented at The Light in Leeds as Ugly Scenes (Performance Studies international, Psi#18). It is also an experiment in writing ‘for’ and ‘as’ idiots, bringing together four interlocuting voices: those of two academics ‘in conversation with’ their antagonists and clown-esque alter egos, Kurt Zarniko and Teddy Love. The performance involved collaboration between academics and artists in the UK, USA, and Greece in the form of online auditioning, online devising, and collaborative writing. Formed into an international company, the group used open-source software (Google Docs, Skype, and Snagit) as platforms that offer productive arenas for live performance and improvisation. These platforms have an inherent potential for technological calamity (which is understood as fruitful in clown and comic modes). The actual staging of this work by this international but amateur outfit presented numerous obstacles, comical ‘failures’ and shortcomings, and there remains a wealth of material that offers a rich resource for a visually striking critical reflection.

Design and Control of an Optical Alignment System Using a XXY Stage Integrated with dual CCDs

The aim of this study is to investigate assembly and positioning tasks of a micro-component using a co-plane XXY stage integrated with an automatic optical inspection (AOI) system instead of manual alignment. An artificial neural algorithm is added for alignment to enhance the alignment accuracy of the system. Therefore, a servo alignment system is proposed to use the AOI system to guide the XXY stage using vision technology. The image identification system is used to make the specimen align the target specimen using dual CCDs. Since the XXY stage has no positioning feedback of the optical scale or encoder, the artificial neural network (ANN) system is used to map the relative relationship between the image position and the actual XXY stage's position.

Image Clustering Technique in Oil Palm Fresh Fruit Bunch (FFB) Growth Modeling

Digital images of FFB from anthesis to harvesting stage were acquired and grouped into 25 maturity stages. K-means clustering technique was used to separate the images into three colours clusters that represent three FFB features, Fruitlet, Brown spine and Green spine. The relationship of Hue colour component and FFB maturity stages was established. The FFB was found to grow in three major stages, from week 0 to 5, week 6 to 14 and week 15 to 24. From the relationship a Growth Model was developed and was validated with actual maturity stage. The coefficient of determination, R2 was 0.95.

A Proposed Tool for Managing Intellectual Capital in Small and Medium Size Enterprises

Abstract In the actual stage of Knowledge Era, enterprises need to gain and maintain their competitive advantage and one of the feasible ways is through their intellectual capital management. This approach supposes a great effort from the middle and low level managers in providing timely information and knowledge about the company's processes and results (a big amount of data, information and knowledge have to be stored and combined in order to calculate related indicators for organizational performance). Another challenging problem of the intellectual capital management is related to the control and better valorised of organization intangible assets that generate added value for the company. This is the context and motivation of the present article though which we aim to debate the problem of intellectual capital management by the concepts state-of-the-art that will underline and present the intellectual capital evaluation tools. Based on the literature review, there will be proposed a new tool and an associated methodology for the intellectual capital evaluation. A case study will provide arguments for the validity of the proposed methodology. Finally, some conclusions and remarks will be made in order to underline the originality of the research done and the future work that should be developed.

RELATIONSHIP MARKETING IN THE INNOVATION PROCESSES

Inspired from the context of business-to-business markets, relationship marketing in the context of innovation have been expanded more and more to the consumer markets as well. The paper starts with a review of several most relevant studies on relationship marketing-innovation topic, from the first references to the current complex approaches. The effective stakeholder involvement in the value creation provides a more fertile ground for further successful innovations. All of the variables generating the success of a relationship marketing approach – trust, commitment, communication, seller’s customer orientation and empathy, experience and satisfaction a.s.o. – are also involved, with specific particularities, in the management of the innovation and new product development processes. The paper also outline the different perspectives to understand the relationship marketing-innovation approaches, coming from the product type, its business-to-business or business-to-consumer settings, the specific industry, the actual stage of the market evolution – emerging or mature –, the level of technological novelty as dimension of technological uncertainty, the position/ status and role of stakeholders as part in the relationships, the state of the new product development process in which the interactions occurs or special issues like sustainable innovation, for profit and not-for-profit areas etc.

Late Bronze Age and Early Iron Age habitat in the Someşul Mic Basin

The emergence of large fortifications at the beginning of Early Iron Age reflects a change in settlements system. The current paper studies settlement sites along with metal finds, graves and graveyards from Late Bronze Age cultures to Early Iron Age/Hallstatt period in the Transylvanian Plateau.Our aim is to investigate the transformations and the dynamics of the settlements through cartographic documents and data relating to the landscape around the sites (using satellite images, aerial photographs and geophysical measurements) stored in a geographic information system.Modeling the territories of central Transylvanian prehistoric communities provides information about the division of space and possible land use strategies. The research is also based on the existing macro-regional palaeo-environmental data of Central North-Western Romania.We can state that the Late Bronze Age and Early Iron Age chiefdoms form peer polities controlling small territories along single or more valleys. Our approach represents the actual stage of research of the subject; the future field researches will bring new concluding evidence in this matter.

Method for Approximate Calculation of Multistage Liquid Extraction

An engineering method is proposed for calculation of the number of theoretical and actual extraction stages. The extraction of phenol from waste water, and acetic acid from an aqueous solution is calculated on the basis of this method, and the data obtained are compared with results of other authors.

Online SOC Estimation of Battery for Wireless Tramcar

SUMMARYWireless tramcars (battery‐driven tramcars) are developing to the actual application stage. The most important information to be considered while operating a wireless tramcar is the state of charge (SOC) of the battery. The purpose of this study is to develop an online method for SOC estimation. This method employs a new equivalent circuit of a lithium‐ion battery. SOC estimation using a conventional equivalent circuit results in a large error during fast current transients. In order to improve the accuracy of the estimation, we propose a new equivalent circuit of a lithium‐ion battery. Because the parameters of the proposed equivalent circuit depend on temperature, we propose a new method for SOC estimation in which the temperature estimation is taken into account. This method requires only instantaneous values of the voltage and current, and therefore no temperature measurement is required.Experimental results show that the accuracy of the proposed method is significantly improved when the temperature is taken into account. © 2013 Wiley Periodicals, Inc. Electr Eng Jpn, 186(2): 83–89, 2014; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/eej.21174

Automatic Control of the Driving of Loading-Unloading Machines Used for Servicing a Rotary Hearth Furnace

In this paper, a solution for the automatic control of the driving mechanisms that load/unload billets in/from a rotary hearth furnace is proposed. This problem is approached because in the actual stage the control of the loading/unloading machines is made manually. The treated solution is based on using, for each machine, a direct-current motor (d.c. motor) supplied through a direct-current converter (d.c. converter) for the forward-backward moving of the two machines to/from the furnace. In this context, the tuning of the controller implemented in the converter is made in order to assure the imposed speed of the motors and implicitly of the machines, respectively an appropriate speed evolution of the motors in the period of their acceleration and deceleration to assure the machines correct positioning.

Feasibility Analysis of Laboratory Emulation Study on In-Run Phase of Freestyle Skiing Aerial Athletes

In order to summarize the kinematic law of in-run stage of free skiing aerials and identify the feasibility and scientificity of the method of laboratory emulation study, this study employed video analysis method etc. to compare the kinematic indices of laboratory in-run emulation and actual in-run stage on snow. Results show that the actions of our national ski steam are highly identical and there is no significant difference between laboratory and actual parameters. So we can safely come to the conclusion that laboratory emulation is feasible in the analysis of the in-run phase of free skiing aerials.

Somatic Maintenance Resources in the Honeybee Worker Fat Body Are Distributed to Withstand the Most Life-Threatening Challenges at Each Life Stage

In a global transcriptome analysis of three natural and three manipulated honeybee worker phenotypes at different ages, we have investigated the distribution of investment in somatic maintenance of the fat body. Gene expression is modulated so that the bees are able to resist the most life-threatening challenges at the actual life stage. Different modes of maintenance and repair are regulated, apparently to meet the environmental challenges most detrimental to survival and reproductive potential for the hive. We observed a broad down-regulation of genomic and cellular maintenance in the short-lived foragers and nurse bees compared to the long-lived winter bees. Our results show that survival and reproduction of the entire hive is given priority over the individual bees, hence supporting the idea of the honeybee society as a superorganism. Our results also fit the disposable soma theory of aging.

Kriterien für die Priorisierung medizinischer Leistungen im Licht eines regionalen Surveys – Ergebnisse und methodologische Fragen

In Germany, in contrast to many foreign countries, scientists and medical professionals have been discussing prioritisation in medicine almost without consulting German citizens. We address the question of what questionnaire surveys can contribute to the understanding of citizens' attitudes towards prioritisation - with a focus on some difficulties and challenges of the method. We conducted a postal survey with a random sample of 3 000 residents of the City of Lübeck (age ≥18). Respondents were asked to appraise different substantial and procedural criteria for prioritisation in medicine. In addition to descriptive statistical analyses, logistical regression models were performed to identify potential explanatory variables for the appraisal of prioritisation criteria. The response rate was 45.6% (N=1 363). Some prioritisation criteria are accepted by the majority: severity of disease, effectiveness of an intervention and a firm evidence base. Other criteria were appraised controversially: personal life-style, responsibility for family members and general prioritisation of children. A patient's responsibility in society and age as well as an intervention's cost-benefit ratio were generally rejected. The results of logistic regression analyses showed some significant but minor effects of demographic and health-related variables. The citizens in our study want decision-making procedures in health care to be transparent and equally applied to all patients. According to the survey respondents decisions about the catalogue of services of Germany's statutory health insurance should mainly be made by doctors. The statutory health insurance as well as patients and scientists also should take part in the decision-making procedure. Comparing our results to those of a national interview survey reveals some relevant differences: The respondents' assessment of some substantial criteria seems to vary according to the contextualisation and wording of the items. We found less difference - but still some inconsistent results - in the participants' appraisal of potential decision-makers in health care. To our surprise, the logistic regression models including standard demographic and health-related variables account for only a small proportion of the variance of all dependent variables. Our discussion emphasises some difficulties and challenges of questionnaire surveys on prioritisation criteria - reflecting on the state of the German debate on prioritisation. There has been hardly any public discussion on this issue prior to our survey in autumn 2009. It is thus unlikely that people have been able to state well-informed preferences. Instead they seem to have followed some kind of "social reflexes" depending on the context and wording of each item. Subsequent studies on preferences and priorities should (i) more closely assess the understanding of each item in advance and (ii) adapt the aims of their study and its methodology to the actual stage of the public discourse on the topic in question.