Endoscopic ultrasound in the staging of gastrointestinal luminal malignancies

Endoscopic ultrasound (EUS) is an important tool in the staging of gastrointestinal cancers. This review highlights the use of EUS in the staging of gastrointestinal luminal malignancies and compares the performance of EUS with other imaging modalities (CT, MRI and PET-CT) in the staging of these malignancies. Management algorithms in the staging of these malignancies are also presented.peer-reviewe

Spring migration of Ruffs Philomachus pugnax in Fryslân: estimates of staging duration using resighting data

Seasonal bird migration involves long flights, but most time is actually spent at intermediate staging areas. The duration of stay at these sites can be evaluated with mark–recapture methods that employ day-to-day local encounters of individually marked birds. Estimates of staging duration are based on two probabilities: the immigration probability, the complement of a bird’s seniority to an area, and the emigration probability, the complement of the staying probability. Estimating total staging duration from seniority and staying probabilities requires validation for resighting data and here we compare three data categories of Ruffs Philomachus pugnax passing through The Netherlands during northward migration: (1) newly colour-ringed, (2) previously colour-ringed and (3) radio-tagged Ruffs (recorded by automated receiving stations). Between 2004 and 2008, 4363 resighting histories and 95 telemetry recording histories were collected. As sample sizes for females were low, only data for males were analysed. Possible catching effects affecting estimates of staging duration were explored. Staying probability was estimated for all data. Seniority however, could not be estimated for newly marked Ruffs; the assumption of equal ‘capture’ probability for reverse-time models applied to estimate seniority is violated for seasonal resighting histories starting with a catching event. Therefore, estimates of total staging duration were based on resightings of previously colour-marked birds only. For radio-tagged birds a minimal staging duration (time between tagging and last recording) was calculated. Modelling indicated that newly colour-ringed birds had a higher staying probability than previously colour-ringed birds, but the difference translated to a prolonged staging duration in newly ringed birds of only 0.4–0.5 d, suggesting a very small catching effect. The minimal staging duration of radio-tagged birds validated estimates of staging duration for colour-ringed birds in 2007 but not in 2005. In 2005 a low resighting probability resulted in underestimates of staging duration. We conclude that (1) estimates of staying probability can be affected by catching although effects on staging duration might be small, and that (2) low resighting probabilities can lead to underestimates in staging duration. In our study previously ringed Ruffs resighted in 2006–08 yielded reliable estimates of staging duration as data had sufficiently high resighting probabilities. Average staging durations varied between 19 d in 2008 and 23 d in 2006.

The accurate staging of ovarian cancer using 3T magnetic resonance imaging - a realistic option

Objectives: The aim of the study was to determine whether staging primary ovarian cancer using 3.0 Tesla (3T) magnetic resonance imaging (MRI) is comparable to surgical staging of the disease. Design: A retrospective study consisting of a search of the pathology database to identify women with ovarian pathology from May 2004 to January 2007. Setting: All women treated for suspected ovarian cancer in our cancer centre region. Sample: All women suspected of ovarian pathology who underwent 3T MRI prior to primary surgical intervention between May 2004 and January 2007. Methods: All women found to have ovarian pathology, both benign and malignant, were then cross checked with the magnetic resonance (MR) database to identify those who had undergone 3T MRI prior to surgery. The resulting group of women underwent comparison of the MR, surgical and histopathological findings for each individual including diagnosis of benign or malignant disease and International Federation of Gynecology and Obstetrics (FIGO) staging where appropriate. Main outcome measures: Comparisons were made between the staging accuracy of 3T MRI and surgical staging compared with histopathological findings and FIGO stage using weighted kappa. Sensitivity, specificity and accuracy were calculated for diagnosing malignant ovarian disease with 3T MRI. Results: A total of 191 women identified as having ovarian pathology underwent imaging with 3T MR and primary surgical intervention. In 19 of these women, the ovarian disease was an incidental finding. The group for which staging methods were compared consisted of 77 women of primary ovarian malignancy (20 of whom had borderline tumours). 3T MRI was able to detect ovarian malignancy with a sensitivity of 92% and a specificity of 76%. The overall accuracy in detecting malignancy with 3T MRI was 84%, with a positive predictive value of 80% and negative predictive value of 90%. Statistical analysis of the two methods of staging using weighted kappa, gave a K value of 0.926 (SE ±0.121) for surgical staging and 0.866 (SE ±0.119) for MR staging. A further analysis of the staging data for ovarian cancers alone, excluding borderline tumours resulted in a K value of 0.931 (SE ±0.136) for histopathological staging versus MR staging and 0.958 (±0.140) for histopathological stage versus surgical staging. Conclusion: Our study has shown that MRI can achieve staging of ovarian cancer comparable with the accuracy seen with surgical staging. No previous studies comparing different modalities have used the higher field strength 3T MRI. In addition, all other studies comparing radiological assessment of ovarian cancer have grouped the stages into I, II, III and IV rather than the more clinically appropriate a, b and c subgroups. © 2008 The Authors

Prognosis of patients with hepatocellular carcinoma. Validation and ranking of established staging-systems in a large western HCC-cohort.

HCC is diagnosed in approximately half a million people per year, worldwide. Staging is a more complex issue than in most other cancer entities and, mainly due to unique geographic characteristics of the disease, no universally accepted staging system exists to date. Focusing on survival rates we analyzed demographic, etiological, clinical, laboratory and tumor characteristics of HCC-patients in our institution and applied the common staging systems. Furthermore we aimed at identifying the most suitable of the current staging systems for predicting survival. Overall, 405 patients with HCC were identified from an electronic medical record database. The following seven staging systems were applied and ranked according to their ability to predict survival by using the Akaike information criterion (AIC) and the concordance-index (c-index): BCLC, CLIP, GETCH, JIS, Okuda, TNM and Child-Pugh. Separately, every single variable of each staging system was tested for prognostic meaning in uni- and multivariate analysis. Alcoholic cirrhosis (44.4%) was the leading etiological factor followed by viral hepatitis C (18.8%). Median survival was 18.1 months (95%-CI: 15.2-22.2). Ascites, bilirubin, alkaline phosphatase, AFP, number of tumor nodes and the BCLC tumor extension remained independent prognostic factors in multivariate analysis. Overall, all of the tested staging systems showed a reasonable discriminatory ability. CLIP (closely followed by JIS) was the top-ranked score in terms of prognostic capability with the best values of the AIC and c-index (AIC 2286, c-index 0.71), surpassing other established staging systems like BCLC (AIC 2343, c-index 0.66). The unidimensional scores TNM (AIC 2342, c-index 0.64) and Child-Pugh (AIC 2369, c-index 0.63) performed in an inferior fashion. Compared with six other staging systems, the CLIP-score was identified as the most suitable staging system for predicting prognosis in a large German cohort of predominantly non-surgical HCC-patients

Time-Staging Enhancement of Hybrid System Falsification

Optimization-based falsification employs stochastic optimization algorithms to search for error input of hybrid systems. In this paper we introduce a simple idea to enhance falsification, namely time staging, that allows the time-causal structure of time-dependent signals to be exploited by the optimizers. Time staging consists of running a falsification solver multiple times, from one interval to another, incrementally constructing an input signal candidate. Our experiments show that time staging can dramatically increase performance in some realistic examples. We also present theoretical results that suggest the kinds of models and specifications for which time staging is likely to be effective

On Staging Boojum!

Boojum! was originally performed as a stage musical a dozen or so times by State Opera of South Australia, at t he 1986 Adelaide Festival of Arts; the opening night was attended by Queen Elizabeth II. It was generally regarded as a success, but I was most unhappy with the treatment it received from the director, who rewrote large parts of the show, contrary to an agreement that this would not occur

Analysis of the staging maneuver and booster glideback guidance for a two-stage, winged, fully reusable launch vehicle

One of the promising launch concepts that could replace the current space shuttle launch system is a two-stage, winged, vertical-takeoff, fully reusable launch vehicle. During the boost phase of ascent, the booster provides propellant for the orbiter engines through a cross-feed system. When the vehicle reaches a Mach number of 3, the booster propellants are depleted and the booster is staged and glides unpowered to a horizontal landing at a launch site runway. Two major design issues for this class of vehicle are the staging maneuver and the booster glideback. For the staging maneuver analysis, a technique was developed that provides for a successful separation of the booster from the orbiter over a wide range of staging angles of attack. A longitudinal flight control system was developed for control of the booster during the staging maneuver. For the booster glide back analysis, a guidance algorithm was developed that successfully guides the booster from the completion of the staging maneuver to a launch site runway while encountering many off-nominal atmospheric, aerodynamic, and staging conditions

Staging superstructures in high-TcT_c Sr/O co-doped La2−x_{2-x}Srx_xCuO4+y_{4+y}

We present high energy X-ray diffraction studies on the structural phases of an optimal high-$T_c$ superconductor La$_{2-x}$Sr$_x$CuO$_{4+y}$ tailored by co-hole-doping. This is specifically done by varying the content of two very different chemical species, Sr and O, respectively, in order to study the influence of each. A superstructure known as staging is observed in all samples, with the staging number $n$ increasing for higher Sr dopings $x$. We find that the staging phases emerge abruptly with temperature, and can be described as a second order phase transition with transition temperatures slightly depending on the Sr doping. The Sr appears to correlate the interstitial oxygen in a way that stabilises the reproducibility of the staging phase both in terms of staging period and volume fraction in a specific sample. The structural details as investigated in this letter appear to have no direct bearing on the electronic phase separation previously observed in the same samples. This provides new evidence that the electronic phase separation is determined by the overall hole concentration rather than specific Sr/O content and concommittant structural details.Comment: 8 pages, incl. 4 figure

Updated management of malignant biliary tract tumors: an illustrative review

The management of malignant biliary tumors (MBTs) is complex and requires a multidisciplinary approach. Guidelines and methods of staging for biliary tumors have recently been released by main international societies, altering the clinical and radiologic approach to this pathologic condition. The aim of the present review is to detail the updated role of imaging in preoperative staging and follow-up and to illustrate clinical/therapeutic pathways. In addition, future perspectives on imaging and targeted/embolization therapies are outlined

Multigrid Method versus Staging Algorithm for PIMC Simulations

We present a comparison of the performance of two non-local update algorithms for path integral Monte Carlo (PIMC) simulations, the multigrid Monte Carlo method and the staging algorithm. Looking at autocorrelation times for the internal energy we show that both refined algorithms beat the slowing down which is encountered for standard local update schemes in the continuum limit. We investigate the conditions under which the staging algorithm performs optimally and give a brief discussion of the mutual merits of the two algorithms.Comment: 11 pp. LaTeX, 4 Postscript Figure