Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients

Background: Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. Patients and methods: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). Results: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75\u20130.80). After external validation the accuracy of the nomogram was confirmed. Conclusion: The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients

A Magnetically Tuned Quadrature Oscillator

Continuous frequency tuning by control of the magnetic field of a transformer—capacitor tank, in a selective oscillator, is explored in this work. A quadrature generator is built connecting two identical transformer—capacitor oscillator cells in a feedback loop. The topology itself assures the currents in the transformer windings are aligned in phase, while their relative amplitude determines, via magnetic coupling, oscillators’ tank reactance,i.e., oscillation frequency. This paper introduces the idea, analyzesoscillation amplitude, frequency tuning band, phase noise, and phase accuracy, and discusses design and experiments. Prototypes,realized in 65 nm CMOS, employing MOS varactors to further extend operation bandwidth, show the following performances:3.2 GHz and 7.3 GHz minimum and maximum oscillation orequency, respectively. Phase noise figure of merit of 176.5 dBat 3.2 GHz and 170.5 dB at 6.4 GHz is observed, with 24 mWmaximum power consumption and 1.5 maximum deviation fromquadrature

Method of adjusting the resonance frequency of an L-C resonant circuit and resonant circuit

An L-C resonant circuit with an adjustable resonance frequency, having a capacitor and a first inductor electrically coupled together and a second inductor magnetically coupled to the first inductor. Additionally, there is a control circuit to sense a signal representing a first current flowing through the first inductor and to force through the second inductor a second current that is a replica of the first current for setting the adjustable resonance frequency of the L-C resonant circuit

A 19mW 2.2GHz Fully Integrated CMOS Sigma Delta Fractional Synthesiser With 35Hz Frequency Step and Quantization Noise Compensation

A fully integrated 0.18μm CMOS ΣΔ fractional synthesizer targeting 3G wireless terminals applications is presented. This work is a practical example of a more general study on frequency fractional synthesis. A simple linear model of the system is presented and used to simulate different ΣΔ modulators topologies and to evaluate the effects of circuits non-idealities particularly on output spurious tones. Phase Frequency Detector (PFD) and Charge Pump (CP) non-linearity effects are analysed in details, the obtained results are confirmed by measurement. Solutions to overcome these limitations are given. At last, a ΣΔ quantization noise compensation technique is presented allowing to break the trade-off between Phase Locked Loop (PLL) bandwidth and high frequency noise regrowth

An UMTS ΣΔ fractional synthesizer with 200 kHz bandwidth and -128 dBc/Hz @ 1 MHz using spurs compensation and linearization techniques

This paper describes a general study on spurs generation in fractional synthesis and techniques for their reduction. This theory has been verified with the realization of two IC prototypes fabricated in 0.18 μm CMOS, targeting UMTS-WCDMA specifications, both with a frequency resolution of 35 Hz. The first one is a fully integrated (1.9×1.6 mm2) 2.1 GHz ΣΔ synthesizer burning 19 mW, with 600 kHz 3 dB closed loop bandwidth. Its spur performance is limited by non-linear effects. This limitation has been overcome by linearization techniques implemented in a second chip with external VCO and loop filter. This synthesizer achieves -128 dBc/Hz @ 1 MHz offset with a 200 kHz 3 dB closed loop bandwidth

A Multi-Standard WLAN RF Front-End Transmitter with Single-Spiral Dual-Resonant Tank Loads

This paper describes a radio frequency (RF) front end transmitter for wireless LAN (WLAN), designed for the most common standards, integrated in digital CMOS 0.18mum technology. It covers 802.11a/b/g specifications, concurrently working in the 2.5GHz and 5-6GHz frequency ranges. An innovative solution for the design of the LC tank allows to use a single-spiral inductor in dual resonant tank, with a strong reduction in die area. The dual band RF transmitter size is only 1mm, the smallest ever reported in literatur