Node Surgery Research Articles

Repeat Sentinel Lymph Node Surgery in Recurrent Breast Cancer: Peritumoral vs. Periareolar Injections

BackgroundIn the setting of recurrent cancer, there is no standard methodology regarding the technical aspects of repeat sentinel lymph node (rSLN) surgery. We analyzed our institutional experience with attempted rSLN surgery to determine the optimal injection technique. Materials and MethodsSingle site, retrospective review of patients with prior lumpectomy for breast cancer who presented with recurrent or new ipsilateral breast cancer and underwent attempt at rSLN surgery from 2008 to 2017. Patients with prior mastectomy or no prior ipsilateral axillary operation were excluded. ResultsA total of 141 patients were included; 103 (73%) underwent successful rSLN biopsy procedure. Lymphoscintigraphy showed aberrant drainage in 32 (26%). Periareolar (PA) injection resulted in failed mapping in 23/99 (23%) and aberrant drainage in 25/85 (29%). By comparison, peritumoral (PT) injection had a 14/38 (37%) incidence of failed mapping and 7/37 (19%) aberrant drainage (P = .11 and .23, respectively). Of the patients with successful sentinel lymph node (SLN) biopsy procedure via PA injection, 11/76 (14%) were positive for metastatic disease as compared with 2/24 (8%) in PT injection. Sixteen patients had lymph node metastases; 13 (81%) were SLNs, including 3 positive aberrant SLNs. Five-year regional recurrence rates were 11.4% (95% confidence interval, 0%-21.5%) and 0% for PA and PT injection techniques, respectively. ConclusionPA and PT injections had a similar incidence of SLN identification and aberrant drainage. Preoperative lymphoscintigraphy is beneficial in patients with recurrent breast cancer given the higher incidence of aberrant drainage in this population. Patients who underwent PA injections had a higher incidence of regional recurrences but this difference was not statistically significant.

Abstract PS9-45: Factors causing delayed resolution of breast lymphoedema

Abstract IntroductionBreast lymphoedema impacts the quality of life and cosmesis in women undergoing breast conserving surgery for cancer. The assessment of breast lymphoedema is complex and challenging. The varied reported incidence (0-94%) is due to lack of awareness, poor reporting, subjective characterisation, absence of standardised definitions and tools for diagnosis and monitoring. Extensive research has been done on secondary limb and trunk lymphoedema following lymph node surgery and/or radiotherapy. However, there is a lack of data on breast lymphoedema. Disruption of lymphatics due to advanced oncoplastic procedures, axillary surgery, modified incisions and adjuvant radiotherapy may contribute to this problem. The objective of this study is to identify the causes of delayed resolution of breast lymphoedema. Methods A retrospective audit was carried out in women who underwent breast conserving surgery between 2011-2017.Only patients with breast oedema, seen in the lymphoedema clinic were included in the study. Data on body mass index (BMI), types of incisions, breast procedures, axillary surgery, histopathology, adjuvant treatment including the extent of adjuvant radiotherapy was collated from the hospital database. Breast lymphoedema was diagnosed by clinical examination and/or by a Delfin lymph scanner (DLS). DLS is a mobile non-invasive device which uses tissue dielectric constant (TDC) for measuring subcutaneous tissue water. A reading of 45% or higher was accepted as indicative of breast lymphoedema in our unit. Percentage water content (PWC) value was recorded only in 55 patients using DLS. ResultsDuring the study period, 1905 patients underwent breast conserving surgery, out of which 120 (6.3%) were documented as having breast lymphoedema. The median time from surgery to assessment in the lymphedema clinic was 11 months. On univariate analysis, a high BMI (>30) and radiotherapy with boost lead to non-resolution of breast oedema. The median time taken for resolution of symptoms was 18 months. Other factors such as lateral skin crease incisions, single incisions to perform both breast and axillary surgery, oncoplastic procedures and re-excisions were not statistically significant. Using a DLS, the median PWC value was 56% in this cohort. Conclusions Our study shows that high BMI and radiotherapy with boost leads to delayed resolution of breast lymphoedema. The Delfin lymph scanner may be a potential tool for monitoring breast oedema but further prospective studies are required for validation of this tool. Citation Format: Pragnya Chigurupati, Manoj Gowda, Rebecca Elwell, Arie Hawazie, Kirti Katherine Kabeer, Sekhar Marla, Sadaf Jafferbhoy, Soni Soumian, Sankaran Narayanan. Factors causing delayed resolution of breast lymphoedema [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-45.

Abstract PS1-40: Can sentinel lymph node biopsy be avoided in patients of breast cancer with normal preoperative ultrasound of axilla

Abstract Introduction: Need for any form of surgery for axillary lymph nodes in breast cancer with clinical and radiologically negative axilla is being increasingly questioned. Randomized controlled trials are underway to answer this question. This study was undertaken to evaluate the results of sentinel node lymph biopsy (SLNB) in patients with normal preoperative axillary ultrasound (AUS) after obtaining institution ethics committee approval. Materials and Methods: All patients of operable breast cancer seen in the Breast Cancer Clinic at Sultan Qaboos University Hospital, underwent routine preoperative AUS as part of staging work up. In patients with suspicious lymph nodes, fine needle aspiration cytology (FNAC) was performed. Patients with clinical and radiologically normal axilla underwent BCS/ mastectomy with SLNB (Group 1), while patients with positive lymph nodes underwent neoadjuvant chemotherapy (NACT) and repeat AUS after completion of chemotherapy. Patients who were reported to have normal AUS post NACT underwent SLNB (Group 2). Negative Predictive Value (NPV) and probability of positive SLN when AUS was normal were calculated for the entire cohort, group 1 and group 2. A comparison of NPV between two groups was performed at a 5% level of significance (MedCalc 12.7, 2013). Results: Between 2016-2018, 165 patients with normal AUS underwent SLNB. One hundred and thirteen of these patients underwent ‘upfront’ SLNB, while 52 patients had received NACT and then underwent SLNB. Mean age of patients was 49.33 years (range: 32-74 years ) and was similar in both groups. Mean number of lymph nodes obtained was 4.7 (range 2-8) in group 1 and 4.69 (range 2-6) in group 2. Mean number of positive lymph nodes was 1.69 in group 1 and 2.4 in group 2. Out of 165 patients with normal AUS, 51 patients had metastasis in SLNs. Twenty nine of 113 patients in group 1 showed metastasis in SLNs while 22 out 52 patients in group 2 showed metastasis. NPV for AUS for the whole group was 69.1% (95% CI=62.0%-76.2%), and for group 1 & 2 were 74.3% (95%CI=66.2%-82.4%) and 57.6% (95% CI=44.2%-71.0%), respectively. A significant higher NPV was found in group 1 than in group 2 (χ2=3.873, p=0.049). Thus, the probability of positive SLN even when AUS was normal was 0.31 for whole group, 0.25 for group 1 and 0.42 for group 2. Conclusion: Probability of metastasis in SLN when AUS with or without FNAC is normal is more than 20%. Thus there is need for better preoperative imaging of axilla in patients of breast cancer with clinically and radiologically negative axilla before abandoning SLNB altogether. Citation Format: AlJarrah Adil, Seenu V, Badriya Al Qassabi, Hajar Nasser Alsaadi, Safa Abdullah Al-abadi, Srineil Vuthaluru, Moon-Fai Chan, Radiya Al Ajmi. Can sentinel lymph node biopsy be avoided in patients of breast cancer with normal preoperative ultrasound of axilla [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-40.

Abstract PS6-28: Development and external validation of a clinical nomogram for individually predicting survival of metaplastic breast carcinoma

Abstract Background: Metaplastic breast cancer (MBC) is a rare subtype with distinct clinicopathological features, but few studies have concerned the prognosis of this rare and morphologically diverse malignancy. A prognostic index estimating the clinical outcomes for MBC would be attractive in current clinical practice. The aim of the present study was to develop and validate an effective nomogram for predicting survival of MBC. Methods: In current study, we retrospectively analyzed 1017 MBC patients between January 2005 and December 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified based on Cox regression analyses, and the final clinical nomogram was developed to predict the 1-, 3-, or 5-year overall survival (OS). The model was validated using bootstrap resampling of SEER validation set and a Chinese cohort for external validation. Calibration curves were provided to internally validate the performance of the nomogram and discriminative ability was appraised by concordance index (C-index). Results: A total of 1017 MBC patients were included for our analysis,whose clinical and tumor characteristics were shown in Table 1. Patients diagnosed between 2005 and 2015 were assigned into 3:1 as training set (n=763) and SEER validation set (n=254). An external validation was performed by an individual set of 94 MBC patients from National Cancer Center in China from 2005 to 2018. The nomogram finally consisted of seven independent prognostic factors including age, tumor grade, tumor size, AJCC Node stage, surgery, chemotherapy and radiotherapy. The nomogram presented a good accuracy for predicting the OS with the C-index of 0.77. Interestingly, the nomogram based on the western (including 92.5 %non-Asian) SEER validation population(C-index of nomogram: 0.76)also had an optimal discrimination in Asian population (C-index of nomogram: 0.70).The calibration plots of the nomogram predictions was also accurate and corresponded closely with the actual survival rates. Conclusions: In conclusion, this novel nomogram was accurate enough to predict the OS by using readily available clinicopathologic factors in MBC general population. This prognostic index proposed here could provide individualized recommendations for patients and clinical decisions for physicians. Table 1. Characteristic of primary metaplastic breast carcinoma cohort from SEER databaseCharacteristicsPatient with MBC (N=1017)%Univariable Analysis PAge, years59.9±13.20.001<6049448.6≥6052351.4Race0.331White71970.7Black22221.8Others767.5Laterality0.374Left51850.9Right49949.1Tumor grade0.001Grade I, II15014.7Grade III, IV86785.3Primary tumor size0.001<5cm80278.9≥5cm21521.1Pathological type0.753Metaplastic carcinoma91590.0Squamous cell carcinoma484.7Spindle cell carcinoma252.5Malignant myoepithelioma70.7Adenocarcinoma mixed222.1Molecular Subtype0.696Non-TNBC31130.6TNBC70669.4AJCC N stage0.001N075774.4N117417.1N2,N3868.5Primary tumor resection0.001No525.1Yes96594.9Radiotherapy0.001No53252.3Yes48547.7Chemotherapy0.003No28628.1Yes73171.9 Citation Format: Jiani Wang, Qing Li, Yang Luo, Fei Ma, Ruigang Cai, Qiao Li, Ying Fang, Jiayu Wang, Peng Yuan, Pin Zhang, Binghe Xu. Development and external validation of a clinical nomogram for individually predicting survival of metaplastic breast carcinoma [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-28.

Abstract PS1-31: Nomogram for predicting axillary lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy

Abstract Background: Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC). ALN status is an important prognostic factor for choosing the type of axillary lymph node surgery. Many patients with axillary pCR could replace axillary lymph node dissection (ALND) with sentinel lymph node biopsy (SLNB). Our goal is to develop a new predictive clinical model to detect axillary pCR after NAC and provide clinical clues for avoiding ALND. Methods: A retrospective series of 547 patients who had biopsy-proven positive ALNs at diagnosis from 2007 to 2014 in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences were involved. We analyzed the clinicopathologic features and developed a nomogram to predict the probability of ALN pCR. Univariate assessment was performed using chi-square test. A multivariate logistic regression stepwise model was used to generate a nomogram to predict ALN pCR in node positive patients. The receiver operating characteristic (ROC) curve was established and the area under the curve (AUC) was calculated to evaluate the accuracy of the model. Internal validation was estimated using 50-50 hold out validation method. Nomogram was validated externally with the prospective cohorts of 167 patients from 2016 to 2018 of Cancer Hospital of Chinese Academy of Medical Sciences and 75 patients from 2018 to 2019 of Beijing Tiantan hospital.Results: In the retrospective study, 172 (31.4%) patients achieved axillary pCR after NAC. Multivariate analysis indicated that clinical nodal (N) stage, hormone receptor (HR) status and clinical response of primary tumor after NAC were significant independent predictors for axillary pCR (P<0.05). The AUCs of the internal validation for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.862 and 0.766, respectively.Conclusion: We developed a nomogram to predict axillary pCR in node positive breast cancer patients after NAC. The predictive model performed well in prospective external validation. This practical tool could provide information to surgeons about whether to avoid ALND after NAC. Citation Format: Xin Wang, Wenyan Wang, Jiaxiang Liu, Xiangzhi Meng, Jiaqi Liu, Changyuan Guo, Ying Song, Ningyi Cui, Qiao Li, Zeyu Xing, Jie Wang, Menglu Zhang, Kexin Feng, Pilin Wang, Xiang Wang. Nomogram for predicting axillary lymph node pathological response in node-positive breast cancer patients after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-31.

Abstract PS10-42: Clinical outcomes with neoadjuvant chemotherapy plus dual anti-HER2 therapy in patients with operable/locally advanced breast cancer: Single institution experience

Abstract Background: Pertuzumab, a monoclonal antibody targeting subdomain II of HER2 and blocking dimerization, was approved by the FDA in 2013 as neoadjuvant therapy in combination with trastuzumab + chemotherapy for HER2+ locally advanced or early-stage breast cancer patients (pts). TCHP (Docetaxel/Carboplatin/Trastuzumab/Pertuzumab) is a popular, non-anthracycline neoadjuvant therapy. In the TRYPHAENA trial, pathologic complete response (pCR) rate was 63.6% with 6 cycles of neoadjuvant TCHP (47.5% in ER+/PR+ and 81.1% in ER-/PR- tumors). We previously reported (SABCS 2015) our institutional experience with neoadjuvant TCHP in 75 pts with operable/locally advanced HER2+ breast cancer (10/2013 - 12/2015). Now we report our updated experience of 230 pts (10/2013 - 12/2019) with neoadjuvant chemotherapy + dual anti-HER2 therapy. Patients & Methods: Medical record search identified HER2+ pts (T1c-T3/N0-3 or Tany/N1-3) treated with neoadjuvant chemotherapy + dual anti-HER2 therapy from 10/2013 to 12/2019. Collected information included pt and tumor characteristics at diagnosis, details of neoadjuvant therapy, clinical, radiologic, & pathologic assessment of tumor response, type of breast and axillary nodal surgery, and long-term disease outcomes. Results: 230 pts (229 female, 1 male) met the inclusion criteria; median age: 52 yrs (range 25-79); Clinical stage: I (2%), II (78%) , III (20%); ER+ and/or PR+ 70% ; ER-/PR- 30%. 228 pts received TCHP and 2 pts AC then THP. 170 pts (74%) received 6 cycles of TCHP without dose reduction; 49 pts (21%) received 6 cycles, but with dose reduction (most commonly due to diarrhea, nausea, neutropenia, and anemia); 11 pts (5%) received < 6 cycles (7 of those also needed dose reduction). Mean left ventricular ejection fraction was 62.0% pre-treatment, and 60.9% post-treatment. Of the 230 pts who underwent breast surgery (1 had no breast primary at presentation), 86 pts (38%) had breast conserving surgery, 19 (8%) unilateral mastectomy, and 124 (54%) bilateral mastectomy. Axillary assessment was by SLNB in 75% and ALND in 25% (with/without SLNB). Among 138 pts with cN0 and axillary assessment, 124 had SLNB (4 had + nodes), 14 had ALND (11 had + nodes). Among 91 pts with cN1-3, 47 had SLNB (1 had + nodes) and 44 had ALND (27 had + nodes). Overall pCR rate (ypT0/Tis, ypN0) was 59%. pCR rate was 50% for ER+ and/or PR+, and 79% for ER-/PR-. pCR by Stage: I (50%), II (60%), III (55%). At median follow-up of 2.9 years, 221 pts (96%) were alive with no evidence of disease; 8 pts (3.5%) have experienced recurrence (6 distant, 1 locoregional, 1 unknown site), and 1 pt died after developing AML as the only event. The table below presents details on the 8 pts who suffered recurrence: 4 had clinical stage II disease, and 4 clinical stage III. All pts had hormone receptor + tumors at diagnosis. 7 of 8 pts (88%) with recurrence did not have pCR at surgery. Most common sites of distant metastases as first event were liver and bone. Of the 8 pts with recurrence, 6 are alive with disease (median follow-up 2.8 years). There was 1 death due to disease progression, and 1 pt was lost to follow-up. Conclusions: Our updated results continue to demonstrate the clinical safety and efficacy of neoadjuvant therapy with TCHP for operable/locally advanced HER2+ breast cancer. Our pCR rates are similar to those observed in the TRYPHAENA trial. Longer follow-up is required to evaluate the long-term clinical outcomes with this regimen. Recurrence DataPatient NumberAge at DiagnosisDate of DiagnosisHormone Receptor at DiagnosisClinical Stage at DiagnosisType of Breast SurgerypCRPathologic Stage at SurgeryDate of RecurrenceTime to Metastases (Years)Site of Recurrence16511/19/14PositivecT2N1 (IIB)Left MastectomyYesypT0N0 (0)4/6/172.4Liver, Bone2366/15/15PositivecT2N0 (IIA)Bilateral MastectomyNoypT3N0 (IIB)3/19/182.8Liver3546/29/15PositivecT2N3 (IIIC)Left MastectomyNoypT1bN1a (IIA)10/2/194.3Bone4577/1/15PositivecT2N3 (IIIC)Left LumpectomyNoypT1cN1a (IIA)2/4/193.6Bone, Soft Tissue5568/20/15PositivecT2N0 (IIA)Left LumpectomyNoypT1aN0 (IA)6/28/182.8Lymph Node6264/29/16PositivecT4N0 (IIIB)Bilateral MastectomyNoypT2N1 (IIB)12/13/171.6Liver7539/27/16PositivecT3N3 (IIIC)Bilateral MastectomyNoypT3N3 (IIIC)Not KnownNot KnownNot Known8319/3/17PositivecT2N1 (IIB)Bilateral MastectomyNo (clinical progression)ypT3N2a (IIIC)6/25/180.8Lungs Citation Format: Nirja Shah, Nikita Shah, Said Baidas, Ana Cuesta-Fernandez, Marc Demers, Maria Demori, Tomas Dvorak, Rachel Eisenberg, Terrence Gross, Danielle Henry, Michael Kahky, Patrick Kelly, Swathy Kolli, Regan Rostorfer, Jeffrey Smith, Cameron Swanick, Eleftherios Mamounas. Clinical outcomes with neoadjuvant chemotherapy plus dual anti-HER2 therapy in patients with operable/locally advanced breast cancer: Single institution experience [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-42.

A prediction model of death probability for guiding wireless recharging in sensor networks

Wireless power transmission (WPT) technology is usually used to maintain the continuous operation of sensor nodes. However, when large amounts of data need to be processed, the node may enter an ab...

МОДЕЛЬ АДАПТИВНОГО ВЗАИМОДЕЙСТВИЯ СТАНЦИЙ В ТРАНСПОРТНОМ УЗЛЕ

The paper is devoted to organization of adaptive operation in a transport node. As an example, the authors consider the Ust-Luga transport node that includes a marshalling station and six port stations. The adaptive interaction includes the following. The marshalling station is able to prepare transfer trains to port stations in two variants - with a detailed selection of car sets by berths and without it. In the first case, the marshalling station executes additional operations, but the delivery time reduces. In dependence to the situation car sets are prepared in one way or another. The paper suggests a model of adaptive interaction that selects an optimal variant for all conditions. The model can become a basis for creation of adaptive operation of the transport node.

Energy‐Efficient Enhancement for the Prediction‐Based Scheduling Algorithm for the Improvement of Network Lifetime in WSNs

In wireless sensor networks, due to the restricted battery capabilities of sensor nodes, the energy issue plays a critical role in network efficiency and lifespan. In our work, an upgraded long short‐term memory is executed by the base station to frequently predict the forecast positions of the node with the help of load‐adaptive beaconing scheduling algorithm. In recent years, new technologies for wireless charging have offered a feasible technique in overcoming the WSN energy dilemma. Researchers are deploying rechargeable wireless sensor networks that introduce high‐capacity smartphone chargers for sensor nodes for charging. Nearly all R‐WSN research has focused on charging static nodes with relativistic routes or mobile nodes. In this work, it is analysed how to charge nondeterministic mobility nodes in this work. In this scenario, a new mechanism is recommended, called predicting‐based scheduling algorithm, to implement charging activities. In the suggested technique, it directs them to pursue the mobile charger and recharge the sensor, which is unique for the present work. The mobile charger will then choose a suitable node, utilizing a scheduling algorithm, as the charging object. A tracking algorithm based on the Kalman filter is preferred during energy transfer to determine the distance needed for charging between the destination node & mobile charger. Here, the collecting & processing of data are performed through the big data collection in WSNs. The R‐WSN charging operations of nondeterministic mobility nodes will be accomplished using the proposed charging strategy.

Contract-Less Mobile Data Access Beyond 5G: Fully-Decentralized, High-Throughput and Anonymous Asset Trading Over the Blockchain

The new “status quo” created by the emerging integration of Multi-Access Edge Computing (MEC) and Radio Access Network (RAN) infrastructures, combined with the openness of the 5G service market, have set new standards on how the multitude of 5G service domains should be incentivized and coordinated to comply with the performance requirements set on a per session basis. In this paper, we revisit the predominant offline contract-driven mobile data access model enabling users to gain access to the infrastructure of only a few network operators and propose a new blockchain-backed mobile data access model where the key 5G stakeholders can trade, share and consume mobile edge network assets (access to the internet, spectrum, processing, storage, local content etc.) in a fully decentralized, anonymous and highly-robust fashion. Blockchain-backed mobile data access should address critical practical challenges of blockchain decentralization, scalability and security in the context of 5G and Beyond networks. Accordingly, we provide a meticulous survey of existing solutions in the aforementioned three areas and present a comprehensive holistic framework of protocols to address the key challenges identified, including a delegated Proof-of-Stake (DPoS) for distributed blockchain consensus over 5G and Beyond mobile data networks, a future-proof smart-contract enabled payment relay service enabling instant off-chain payments in a highly robust fashion as well as a hybrid mixing protocol that enables payment relays to act as anonymous payment hubs while addressing the unique challenges opposed by the joint blockchain and network level interaction of the 5G and Beyond service components. A wide range of practical implications and mitigation measures for dishonest operation of the blockchain nodes are investigated and sophisticated yet highly-robust incentive engineering mechanisms are derived. Detailed numerical results also accompany the paper, bringing to light the unique performance trade-offs and valuable design guidelines towards blockchain-backed mobile data access for 5G and Beyond mobile data networks.

Киберфизикалық жүйенің желілік инфрақұрылым объектілерінің жұмыс істеу сенімділігін қамтамасыз етуді модельдеу

Within the framework of this research, there has been developed a structural model of an industrial cyberphysical system architecture using cloud computing as a base platform has been developed. The proposed cyber-physical system integrates all elements in four levels of abstraction, based on a multi-agency approach. The proposed approach based on the Intelligent Data Analysis System of the Monitoring System allows searching and identifying vulnerable elements of the cyber-physical network infrastructure based on the cloud platform. The research has developed a model for securing the operation of network infrastructure facilities presented in the form of a measured multigraph, which forms a plan for collecting, analyzing and verifying data from the monitoring system to provide a consolidated assessment of the current state of the network elements. At the same time, the arameters for securing the infrastructure of the cyber-physical system and the cloud platform were selected as the top of the column. As arcs are given the relationships between the fixed dimensions of reliability, which reflect the relationship between the operation and the parameters of the connected nodes of the cyber-physical system, taking into account the current parameters of the column data streams. This allows us to identify system segments that will reduce the overhead needed to make changes. At the same time, the neural network approach is used to predict the continuous infrastructure of the cyber-physical system. The use of the proposed hybrid approach allowed us to predict the behavior of the infrastructure over time and to warn of possible failures in the operation of individual components and critical nodes.

Clinical and prognostic significance of Krüppel-like transcription factor 6 expression in 67 patients with cutaneous malignant melanoma in China.

Krüppel-like transcription factor 6 (KLF6) is a ubiquitous tumor suppressor gene involved in regulating cell growth, proliferation, differentiation and angiogenesis. The objective of the study was to investigate the clinical and prognostic significance of KLF6 expression in cutaneous malignant melanoma (CMM) patients. A total of CMM 67 patients were enrolled in this study. The specimens were evaluated by immunohistochemistry to detect KLF6. The positive KLF6 expression in CMM tissues was significantly lower than in normal skin tissues (p < 0.01).The presence of KLF6 in CMM was correlated with ulceration (p < 0.01), lymph node metastasis (p < 0.01) and clinical stage (p < 0.01). The overall 5-year survival rate of the 67 patients was 13.4%. The 5-year survival rate of patients with negative KLF6 expression was correlated with KLF6 expression (p < 0.01), ulceration (p < 0.01), lymph node metastasis (p < 0.01), clinical stage (p < 0.01) and operation type (p < 0.01). Ulceration and clinical staging were independent relevant factors. In conclusion, the presence of KLF6 in CMM was correlated with ulceration, lymph node metastasis, clinical stage and poor prognosis.

Graph-Based Detection and LDPC Decoding over 2D Intersymbol Interference Channels

In this paper, we propose a fully graph-based iterative detection and decoding scheme for Low-Density Parity-Check (LDPC) coded generalized two-dimensional (2D) intersymbol interference (ISI) channels. The 2D detector consists of a downtrack detector based on the symbol-level sum-product algorithm (SPA) and a bit-level SPA-based crosstrack detector. A LDPC decoder based on simplified check node operations is also proposed to provide soft information for the 2D channel detector. Numerical results show that the proposed receiver achieves better performance as compared with the trellis-based BCJR detector over 2×2 2D channels while at a significantly lower computational complexity.

Omission of lateral lymph node dissection in medullary thyroid cancer without a desmoplastic stromal reaction.

Medullary thyroid cancer can be subdivided during surgery into tumours with or without a desmoplastic stromal reaction (DSR). DSR positivity is regarded as a sign of disposition to metastasize. The aim of this study was to analyse whether lateral lymph node dissection can be omitted in patients with DSR-negative tumours. This was a retrospective cohort study of a prospectively maintained database of patients with medullary thyroid cancer treated using a standardized protocol, and subdivided into DSR-negative and -positive groups based on the results of intraoperative frozen-section analysis. Patients in the DSR-negative group did not undergo lateral lymph node dissection. Long-term clinical and biochemical follow-up data were collected, and baseline parameters and histopathological characteristics were compared between groups. The study included 360 patients. In the DSR-negative group (17.8 per cent of all tumours) no patient had lateral lymph node or distant metastases at diagnosis or during follow-up, and all patients were biochemically cured. In the DSR-positive group (82.2 per cent of all tumours), lymph node and distant metastases were present in 31.4 and 6.4 per cent of patients respectively. DSR-negative tumours were more often stage pT1a and were significantly smaller. The median levels of basal calcitonin and carcinoembryonic antigen were significantly lower in the DSR-negative group, although when adjusted for T category both showed widely overlapping ranges. Lymph node surgery may be individualized in medullary thyroid cancer based on intraoperative analysis of the DSR. Patients with DSR-negative tumours do not require lateral lymph node dissection.

A population-based study of treatment patterns, 10-year recurrence and breast cancer-specific mortality in a cohort of elderly patients with breast cancer

BackgroundWe compared disease characteristics, therapies offered and received, and outcomes between older (>75 years) and younger (60–75 years) women with breast cancer (BC) from a regional database in Ontario, Canada. MethodsBC surgical cases from 12 hospitals were included. Younger (60–75 years) and older (>75 years) groups were compared. Cox proportional hazards regression with competing risk analyses assessed the relationship between predictor variables, 10-year recurrence and BC-specific mortality. ResultsOur sample comprised 774 women; 33.5% were older. Older women had larger tumours, were more likely to have positive nodes, had more comorbidities, were more likely to undergo mastectomy, had less nodal surgery, were less likely to receive adjuvant therapies, and experienced more recurrences and BC-specific deaths (p < 0.05). Significant predictors of recurrence were older age, higher grade and disease stage, and omission of nodal surgery. Older age, higher grade, and stage were predictors of BC-specific mortality. ConclusionOlder BC patients (>75 years) received less treatment and experienced increased recurrence and BC-specific mortality.

Optimizing concurrency under Scheduling by Edge Reversal

AbstractScheduling by Edge Reversal provides an order of operation for nodes in a graph, but maximizing or minimizing the resulting concurrency is hard. In this paper, we discuss a series of real‐world applications for this technique and propose algorithms for both problems. For maximum concurrency, we prove its general inapproximability and introduce approximation algorithms for classes of graphs. For minimum concurrency, we use hardness and inapproximability results to establish its relation to longest cycles, while also introducing a novel application for assembling musical phrases.

Intelligent Digital Currency and Dynamic Coding Service System Based on Internet of Things Technology

The amazing rise of digital currency is not only favored by investors but also attractive to lawbreakers for its anonymity and decentralization. This paper mainly discusses the intelligent digital currency and dynamic coding service system based on Internet of Things technology. In this paper, the RDCAR algorithm is used to realize the routing discovery process of the wireless network. When the intermediate node receives the RREQ message, first of all, to avoid the loop, it checks whether the same RREQ message has been introduced. If it has received it, it will discard it. Otherwise, it will cache the message and attach its own neighbor node list to the signal-to-noise ratio of the channel link, update the RREQ message, and broadcast it. The payment cipher is managed by the bank. When the user opens an account, the bank registers and sends it to the user. The key is generated by the algorithm chip, and the public key is kept in the bank background server. When the bill is delivered to the bank, the bank inputs all the elements on the bill on the counter terminal and transmits it to the verification machine for verification through the bank network. If the verification is correct, it indicates that the bill is indeed issued by the customer, and all bill elements are correct, and payment can be made. The node operation protocol of public chain and alliance chain maintains the operation of the Internet of Things system. The nodes of alliance chain generate new blocks according to the interval of 30 s. When the node fails to complete the block generation within 30 s, it will rotate to the next node. The mkfile command is used to generate 16b, 1 KB, 1 MB, and 1 GB files as input. The peak speed of the encoding service system is about 370 mb/s. The results show that the system designed in this study is robust and suitable for complex trading environment.

Secure Service Offloading for Internet of Vehicles in SDN-Enabled Mobile Edge Computing

Currently, Edge computing (EC) paradigm is adopted to provision the low-latency resources for the massive real-time services in Internet of vehicles (IoV). To alleviate the QoE (Quality of Experience) degradation of the vehicular users due to the uncertainties (e.g., resource conflicts and communicating interruption), software-defined network (SDN) is involved in the EC-enabled IoV to manage the cooperative operation of distributed edge nodes (ENs). However, the increasing privacy leakage for the IoV service offloading causes the disclosure of the sensitive information, including driving location, personal information of the driver, etc. Moreover, the regulation of SDN is practically insufficient, as the general control is incompetent to maintain balanced operation with the premise of efficient service utility. In view of these challenges, a secure service offloading method, named SOME, is designed to promote IoV service utility and edge utility, meanwhile ensuring privacy security, in SDN-enabled EC. Specifically, an SDN-based framework for IoV service management is developed to address the inherent uncertainty of edge network by SDN controllers. Besides, the locality-sensitive-hash (LSH) is leveraged to realize utility- and privacy-aware service selection. Eventually, comparative experiments are implemented to verify the effectiveness of SOME.

Pedestrian and Multi-Class Vehicle Classification in Radar Systems Using Rulex Software on the Raspberry Pi

Nowadays, cities can be perceived as increasingly dangerous places. Usually, CCTV is one of the main technologies used in a modern security system. However, poor light situations or bad weather conditions (rain, fog, etc.) limit the detection capabilities of image-based systems. Microwave radar detection systems can be an answer to this limitation and take advantage of the results obtained by low-cost technologies for the automotive market. Transportation by car may be dangerous, and every year car accidents lead to the fatalities of many individuals. Humans require automated assistance when driving through detecting and correctly classifying approaching vehicles and, more importantly, pedestrians. In this paper, we present the application of machine learning to data collected by a 24 GHz short-range radar for urban classification. The training and testing take place on a Raspberry Pi as an edge computing node operating in a client/server arrangement. The software of choice is Rulex, a high-performance machine learning package controlled through a remote interface. Forecasts with a varying number of classes were performed with one, two, or three classes for vehicles and one for humans. Furthermore, we applied a single forecast for all four classes, as well as cascading forecasts in a tree-like structure while varying algorithms, cascading the block order, setting class weights, and varying the data splitting ratio for each forecast to improve prediction accuracy. In the experiments carried out for the validation of the presented approach, an accuracy of up to 100% for human classification and 96.67% for vehicles, in general, was obtained. Vehicle sub-classes were predicted with 90.63% accuracy for motorcycles and 77.34% accuracy for both cars and trucks.

Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer.

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient’s lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.