Pathological serosa and node-based classification accurately predicts gastric cancer recurrence risk and outcome, and determines potential and limitation of a Japanese-style extensive surgery for Western patients: A prospective with quality control 10-year follow-up study

UICC classification accurately predicts overall survival but not recurrence-risk. We report here data of overall and first site-specific recurrence following curative surgery useful for the development of recurrence-oriented preventive target therapies. Patients who underwent resection for gastric cancer were stratified according to curability of surgery [curative (R0) vs non-curative resection], extent of surgery [limited (D1) vs extended (D2) node dissection] and pathological nodal/serosal status. The intent-to-treat principle, log-rank test and Cox regression analysis were used for statistical analysis of time-to-event (recurrence, death) endpoints. Curative resection only produced a chance of cure whereas survival was very poor following non-curative resection (P < 0.0001). For D2 R0 subgroup of patients, a pathological serosa and a node state-based classification into three groups, proved to be of clinical implication. Risk of recurrence after a median follow-up of 92 months was low among patients with both serosa and node-negative cancer (first group; 11%), moderate among those with either serosa or node-positive cancer (second group; 53%) and very high among those with both serosa and node-positive cancer (third group; 83%). In multivariate analysis, the relative risks of recurrence and death from gastric cancer among patients in the second and third groups, as compared to those in the first, were 7.07 (95% CI, 2.36–21.17;P  = 0.0002) and 16.19 (95% CI, 5.76–45.54;P < 0.0001) respectively. First site-specific recurrence analysis revealed: low rate of loco-regional recurrence alone (12%), serosa state determinant factor of the site-recurrence (peritoneal for serosa-positive and haematogenous for serosa-negative cancers) and dramatic increase of all types of recurrence by the presence of nodal metastases. Our findings demonstrate that a pathological serosa- and node-based classification is very simple and predicts accurately site-specific recurrence-risks. Furthermore they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers, but very high in serosa- and node-positive cancers suggesting the need for new therapeutic strategies in this subgroup of patients. © 2001 Cancer Research Campaign http://www.bjcancer.co

Improving the Price of Anarchy for Selfish Routing via Coordination Mechanisms

We reconsider the well-studied Selfish Routing game with affine latency functions. The Price of Anarchy for this class of games takes maximum value 4/3; this maximum is attained already for a simple network of two parallel links, known as Pigou's network. We improve upon the value 4/3 by means of Coordination Mechanisms. We increase the latency functions of the edges in the network, i.e., if $\ell_e(x)$ is the latency function of an edge $e$, we replace it by $\hat{\ell}_e(x)$ with $\ell_e(x) \le \hat{\ell}_e(x)$ for all $x$. Then an adversary fixes a demand rate as input. The engineered Price of Anarchy of the mechanism is defined as the worst-case ratio of the Nash social cost in the modified network over the optimal social cost in the original network. Formally, if \CM(r) denotes the cost of the worst Nash flow in the modified network for rate $r$ and \Copt(r) denotes the cost of the optimal flow in the original network for the same rate then [\ePoA = \max_{r \ge 0} \frac{\CM(r)}{\Copt(r)}.] We first exhibit a simple coordination mechanism that achieves for any network of parallel links an engineered Price of Anarchy strictly less than 4/3. For the case of two parallel links our basic mechanism gives 5/4 = 1.25. Then, for the case of two parallel links, we describe an optimal mechanism; its engineered Price of Anarchy lies between 1.191 and 1.192.Comment: 17 pages, 2 figures, preliminary version appeared at ESA 201

THGEM-based detectors for sampling elements in DHCAL: laboratory and beam evaluation

We report on the results of an extensive R&D program aimed at the evaluation of Thick-Gas Electron Multipliers (THGEM) as potential active elements for Digital Hadron Calorimetry (DHCAL). Results are presented on efficiency, pad multiplicity and discharge probability of a 10x10 cm2 prototype detector with 1 cm2 readout pads. The detector is comprised of single- or double-THGEM multipliers coupled to the pad electrode either directly or via a resistive anode. Investigations employing standard discrete electronics and the KPiX readout system have been carried out both under laboratory conditions and with muons and pions at the CERN RD51 test beam. For detectors having a charge-induction gap, it has been shown that even a ~6 mm thick single-THGEM detector reached detection efficiencies above 95%, with pad-hit multiplicity of 1.1-1.2 per event; discharge probabilities were of the order of 1e-6 - 1e-5 sparks/trigger, depending on the detector structure and gain. Preliminary beam tests with a WELL hole-structure, closed by a resistive anode, yielded discharge probabilities of <2e-6 for an efficiency of ~95%. Methods are presented to reduce charge-spread and pad multiplicity with resistive anodes. The new method showed good prospects for further evaluation of very thin THGEM-based detectors as potential active elements for DHCAL, with competitive performances, simplicity and robustness. Further developments are in course.Comment: 15 pages, 11 figures, MPGD2011 conference proceedin

Portable optical blood scattering sensor

Modern non-invasive medical sensors can continuously provide vital information such as blood oxygenation, hemoglobin and glucose, based on substance-specific spectral or electrochemical properties. Cells and other geometrical formations are difficult to observe non-invasively due to the absence of a distinctive substantial signature. Optical scattering angle measurements could provide geometrical information but multiple scattering results in diffusion profiles, limiting their direct applicability. Mie scattering correlation to blood cell size has been demonstrated in the lab and various biomedical optical techniques are under intense investigation towards decoupling direct from indirect scattering, requiring specialized equipment. In this paper, a portable sensor is introduced for in-vitro and potentially in-vivo study of light scattering from blood. A microcontroller-based prototype has been designed and fabricated, with a 650 nm laser source, a 128 × 1 photodiode array and a custom dual-core real-time data acquisition algorithm. The prototype has been evaluated using latex sphere solutions calibrated to emulated red blood cells, white blood cells and platelets. Distinct scattering signatures are demonstrated for the three blood cell sizes. Reproducibility and repeatability tests analyzing data from multiple independent experiments demonstrate the reliability of the demonstration. This device platform provides a flexible and simple means for evaluating optical processing methods towards non-invasive continuous counting of blood cells

ACTiCLOUD: Enabling the Next Generation of Cloud Applications

Despite their proliferation as a dominant computing paradigm, cloud computing systems lack effective mechanisms to manage their vast amounts of resources efficiently. Resources are stranded and fragmented, ultimately limiting cloud systems' applicability to large classes of critical applications that pose non-moderate resource demands. Eliminating current technological barriers of actual fluidity and scalability of cloud resources is essential to strengthen cloud computing's role as a critical cornerstone for the digital economy. ACTiCLOUD proposes a novel cloud architecture that breaks the existing scale-up and share-nothing barriers and enables the holistic management of physical resources both at the local cloud site and at distributed levels. Specifically, it makes advancements in the cloud resource management stacks by extending state-of-the-art hypervisor technology beyond the physical server boundary and localized cloud management system to provide a holistic resource management within a rack, within a site, and across distributed cloud sites. On top of this, ACTiCLOUD will adapt and optimize system libraries and runtimes (e.g., JVM) as well as ACTiCLOUD-native applications, which are extremely demanding, and critical classes of applications that currently face severe difficulties in matching their resource requirements to state-of-the-art cloud offerings