Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review

Primary colorectal squamous cell carcinoma (SCC) is one of the very rare malignancies of the gastrointestinal tract. The diagnosis cannot be made before ruling out other common primary sites. Using the endoscopic ultrasound (EUS) technique to get a tissue biopsy for submucosal tumors has not been demonstrated as the best diagnostic approach in the literature. Surgery is the gold standard treatment with arising evidence of good efficacy following conventional chemoradiation therapy. A 49-year-old male presented with rectal discomfort. Sigmoidoscopy revealed multiple submucosal masses in the rectosigmoid colon. Mucosal biopsies showed nonspecific inflammation. Subsequently, an EUS with fine needle biopsy was done and established the diagnosis of rectal SCC. There were no other primary sites noticed in the extensive evaluation. The patient chose to be treated only with chemoradiation without surgery. At the time of writing this report he had no evidence of recurrence achieving 2.5 years of survival. EUS is an emerging excellent approach to diagnose submucosal colorectal SCC. This case will add supportive evidence of having a complete response following combining treatment with squamous cell directed chemotherapy and external beam radiotherapy without preceded surgery

A phase I study of CPI-613 (devimistat) in combination with chemoradiation in patients with pancreatic adenocarcinoma

Background: Local tumor progression is a cause of significant mortality and morbidity in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). Effective approaches to achieve durable local control are urgently needed. Metabolic reprogramming and enhanced mitochondrial function, both hallmarks of PDAC, are known contributors to chemo- and radio-resistance. CPI-613, a lipoic acid analog that selectively inhibits components of the Krebs cycle in tumors, showed promising preclinical synergy in combination with gemcitabine and radiation therapy (gem-RT). Methods: We describe a single-arm, single-center, open-label, phase I study designed to determine the maximumtolerated dose of CPI-613 when used concomitantly with gemcitabine and intensity modulated radiation therapy (IMRT) for local control of PDAC. CPI-613 will be administered once weekly by intravenous infusion over approximately 2 hours at a starting dose of 500 mg/m2 and dose-escalated/de-escalated using a Bayesian optimal interval design. Gemcitabine will be given once weekly at 400 mg/m2 dosage and IMRT as 54 Gray (Gy) in 30 fractions (1.8 Gy per fraction) with five fractions given per week. Up to 24 patients will be enrolled for the study after meeting the following main eligibility criteria, which include: pathologically confirmed PDAC; inoperable disease that by institutional pancreatic multidisciplinary tumor board or multidisciplinary review are considered to benefit from definitive local control of the primary tumor; ECOG of 0-2; and adequate organ and marrow function after completion of intended systemic chemotherapy. The secondary objectives are to determine the recommended phase II dose of CPI-613 when used with gem-RT, safety and tolerability of CPI-613-gem-RT, overall survival, local progression-free survival (PFS), overall PFS, patient-reported quality of life after treatment, and late gastrointestinal toxicities following treatment with CPI-613-gem-RT

"Feed from the Service": Corruption and Coercion in the State-University Relations in Central Eurasia

Education in Central Eurasia has become one of the industries, most affected by corruption. Corruption in academia, including bribery, extortions, embezzlement, nepotism, fraud, cheating, and plagiarism, is reflected in the region’s media and addressed in few scholarly works. This paper considers corruption in higher education as a product of interrelations between the government and academia. A substantial block of literature considers excessive corruption as an indicator of a weak state. In contrast to standard interpretations, this paper argues that in non-democratic societies corruption is used on a systematic basis as a mechanism of direct and indirect administrative control over higher education institutions. Informal approval of corrupt activities in exchange for loyalty and compliance with the regime may be used in the countries of Central Eurasia for the purposes of political indoctrination. This paper presents the concept of corruption and coercion in the state-university relations in Central Eurasia and outlines the model which incorporates this concept and the “feed from the service” approach. It presents implications of this model for the state-university relations and the national educational systems in Central Eurasia in general and offers some suggestions on curbing corruption

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Impedance analysis of narrowband power line communication channels

Power line communication (PLC) stands for a type of communication technology that aims to exploit the power delivery network for data transmission. Since the power grid was not originally conceived for data communication purposes, the transmission line is hostile and exhibits high attenuation, various types of noise, and frequency selectivity, which are caused by the presence of branches and unmatched impedance. For the efficient design of the next generation of smart metering and PLC applications, perfect knowledge of the PLC channel is fundamental. To enhance this knowledge, the influence of the low access impedance of the power line channel on PLC systems from a telecommunications point of view is studied in this work. Due to the increasing use of switched-mode power supplies with EMI filters inside electrical devices on the power grid, the situation of PLC transmitters has worsened and known concepts have lost their efficiency. In particular, the low access impedance at narrowband frequencies has changed the characteristics of the power line channel dramatically. As a result, the signal level permitted in the European standard EN 50065-1 cannot always be reached and the reliability of the transmission systems has deteriorated significantly. In this thesis, we present a comprehensive overview of PLC channel access impedance. First, we investigate the effects of low access impedance on narrowband-PLC applications with limited power consumption in terms of the achievable data rate. We show that the performance of the transmission system has been reduced for different access impedance scenarios. Then we develop an accurate access impedance measurement system in the frequency range of 30- 500 kHz to analyze the impedance behavior with respect to time and frequency. In this context, we carried out experimental impedance measurement campaigns on different power outlets at the university laboratory. Furthermore, this access impedance measurement system was extended to measure equipment load impedances during their operation mode on the power grid. The measured access and load impedances were also evaluated and verified according to their time and frequency characteristics. This evolution task represents the core objective of this thesis. Finally, we introduce an optimization method to improve the transmission performance of narrowband-PLC systems in the case of low access impedances. In this regard, we present a method for modeling the voltage transmitted by PLC applications corresponding to timevariant access impedances. We show that we were able to increase the achievable data rate and the packet error rate over the signal to noise ratio compared to the state of the art transmission for measured low access impedances.Die Power-Line-Communication (PLC) steht für die Kommunikationstechnologie, die darauf abzielt, das Stromnetz für die Datenübertragung zu nutzen. Da das Stromnetz nicht für Datenkommunikationszwecke konzipiert wurde, ist die Übertragungsleitung feindselig und weist eine hohe Dämpfung, verschiedene Rauscharten und eine Frequenzselektivität auf, die durch das Vorhandensein von Verzweigungen und unerreichten Impedanz verursacht wird. Für ein effizientes Design der nächsten Generation von Smart Metering und PLC-Anwendungen ist, die perfekte Kenntnis des PLC-Kanals von grundlegender Bedeutung. Insofern wird in dieser Arbeit der Einfluss der niedrigen Anschlussimpedanz des Stromleitungskanals auf PLC Systeme aus Telekommunikations- Sicht untersucht. Durch den zunehmenden Einsatz von geschalteten Netzteilen mit EMV Filtern in elektrischen Geräten im Stromnetz verschlechtert sich die Situation für die PLC Sendern und bekannte Konzepte verlieren dramatisch an Effizienz. Insbesondere niedrige Anschlussimpedanzen in bestimmten Frequenzbereichen führen dazu, dass die erlaubten Grenzwerte der EN 50065-1 immer öfter nicht mehr erreicht werden können und als Folge sich die Zuverlässigkeit der Übertragung deutlich verschlechtert, dies kann zum totalen Systemausfall führen. In dieser Arbeit geben wir einen umfassenden Überblick über die Anschlussimpedanz des PLC-Kanals. Zunächst untersuchen wir die Auswirkungen der niedrigen Anschlussimpedanz auf schmalband PLC-Anwendungen mit begrenztem Stromverbrauch in Bezug auf die erreichbare Datenrate. Es wurde gezeigt, dass die Leistungsfähigkeit des Übertragungssystems für verschiedene Anschlussimpedanzszenarien reduziert wurde. Anschließend entwickeln wir ein präzises Anschlussimpedanzmesssystem im Frequenzbereich von 30-500 kHz, um das Impedanzverhalten in Bezug auf Zeit und Frequenz zu analysieren. In diesem Kontext haben wir experimentelle Impedanzmessungen an verschiedenen Steckdosen des Universitätslabors durchgeführt. Außerdem wurde das Anschlussimpedanzmesssystem erweitert, um die Lastimpedanzen während des Betriebs am Stromnetz zu messen. Die gemessenen Anschluss und Lastimpedanzen werden ebenfalls nach ihrem Zeit- und Frequenzverhalten bewertet und verifiziert. Diese Entwicklungsaufgabe stellt das Kernziel dieser Arbeit dar. Schließlich führen wir eine Optimierungsmethode ein, um die Übertragungsleistung von schmalband PLC-Systemen bei niedrigen Anschlussimpedanzen zu verbessern. Insoweit stellen wir ein Verfahren vor, um die übertragene Spannung durch PLC-Anwendungen nach zeitvarianten Anschlussimpedanzen zu modellieren. Es wird gezeigt, dass die erreichbare Datenrate und die Paketfehlerrate gegenüber dem Signal-Rausch-Verhältnis erhöht wurde, im Vergleich zu der Übertragung nach dem Stand der Technik für die gemessenen niedrigen Anschlussimpedanzen

Coexistence analysis of impedance modulating transmitters

Recently, standardization bodies such as IEEE and ITU addressed, independently, standards for the medium access control (MAC) and physical layer specification of PLCs. MAC designers develop coexistence mechanisms irrespectively of the physical layer. Power line channel behavior changes every time a modem sends/receives on the channel. Changing the channel behavior influences the communication between nodes. As a consequence, the MAC coexistence mechanisms are affected. Power line impedance is a very important parameter on the design of PLC architecture. The changed channel behavior is a result of changing the impedance values between sending and receiving states. Transmitter and receiver nodes behave simultaneously on the power line. Transmitter nodes transmit although other nodes receive at the same time. Changing states from the MAC layer simultaneously between send and receive for the different nodes influence the channel behavior, as a consequence, influence the physical layer and the coexistence between the different nodes even when the systems are separated in frequency. In this paper, we discuss the coexistence of the NB-PLC applications considering the communication requirements. We then investigate the impedance problem of the power line by providing a typical transmission scenario and simulation results on the CENELEC frequency bands. Finally, we introduce a transmission model which overcomes the impedance problem and optimizes the communications between the non-interoperable nodes

Methods for Actors in the Electric Power System to Prevent, Detect and React to ICT Attacks and Failures

6 pages, 4 figures, to be published in Proceedings of the 2020 6th IEEE International Energy Conference (ENERGYCon)The fundamental changes in power supply and increasing decentralization require more active grid operation and an increased integration of ICT at all power system actors. This trend raises complexity and increasingly leads to interactions between primary grid operation and ICT as well as different power system actors. For example, virtual power plants control various assets in the distribution grid via ICT to jointly market existing flexibilities. Failures of ICT or targeted attacks can thus have serious effects on security of supply and system stability. This paper presents a holistic approach to providing methods specifically for actors in the power system for prevention, detection, and reaction to ICT attacks and failures. The focus of our measures are solutions for ICT monitoring, systems for the detection of ICT attacks and intrusions in the process network, and the provision of actionable guidelines as well as a practice environment for the response to potential ICT security incidents