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Background The cost utility of image-guided surveillance using computed tomography (CT) and positron emission tomography (PET)-CT to planned postradiation neck dissection (PRND) was compared for the management of advanced nodal human papillomavirus-positive oropharyngeal cancer following chemoradiation. Methods A universal payer perspective was adopted. A Markov model was designed to simulate four treatment approaches with 3-month cycles over a lifetime horizon: 1) CT surveillance, 2) standard PET-CT surveillance, 3) a novel PET-CT approach with repeat PET at 6 months postchemoradiation for equivocal responders, and 4) PRND. Parameters including probabilities of CT nodal progression/resolution, PET avidity, recurrence, and survival were obtained from the literature. Costs were reported in 2019 Canadian dollars and utilities were expressed in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. Results PET-CT surveillance dominated CT surveillance and PRND in the base case scenario, and the novel PET-CT approach was the most cost-effective strategy across a wide range of variables tested in one-way sensitivity analysis. On probabilistic sensitivity analysis, novel PET-CT surveillance was the most cost-effective strategy in 78.1% of model iterations at a willingness-to-pay of $50,000/QALYs. Novel PET-CT surveillance resulted in a 49% lower rate of neck dissection compared with traditional PET-CT, and yielded an incremental benefit of 0.14 QALYs with average cost savings of $1309. Conclusions Image-guided surveillance including PET-CT and CT are more cost effective than PRND. The novel PET-CT approach with repeat PET for equivocal responders was the dominant strategy and yielded both higher benefit and lower costs compared with standard PET-CT surveillance.

Background Endoscopic endonasal approaches (EEAs) have been adopted as an alternative to standard transcranial approaches for olfactory groove meningiomas (OGMs). However, the relative cost-effectiveness remains controversial. Methods Cost-utility analysis from a societal perspective comparing EEA vs transcranial approaches for OGM was used in this study. Surgical treatment was modeled using decision analysis, and a Markov model was adopted over a 20-year horizon. Parameters were obtained from literature review. Costs were expressed in 2017 Canadian dollars. Results In the base case, EEA was cost-effective compared with transcranial surgery with an incremental cost-effectiveness ratio of $33 523 ($30 475 USD)/QALY. There was a 55% likelihood that EEA was cost-effective at a willingness-to-pay of $50 000/QALY. EEA remained cost-effective at a cerebrospinal fluid leak rate below 60%, gross total resection rate above 25%, and base cost less than $66 174 ($60 158 USD). Conclusion EEA may be a cost-effective alternative to transcranial approaches for selected OGM.

ummary Background Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the United States (US) and an emerging cause in China. Aim To compare the clinical characteristics of hepatitis C patients in the US and China, and factors influencing disease stage. Methods Prospective study of 2 cohorts of HCV patients recruited at 1 site in the US and 3 sites in China. Standardised questionnaire on risk factors and medical history were used and diagnosis of cirrhosis and HCC was based on pre-defined criteria. Results One thousand nine hundred and fifty seven patients (1000 US and 957 China) were enrolled. US patients were more likely to be men (61.4% vs 48.5%), older (median age 57 vs 53 years), obese (38.4% vs 16.8%) and diabetic (21.8% vs 10.8%). A significantly higher per cent of US patients had cirrhosis (38.2% vs 16.0%) and HCC (14.1% vs 2.7%). Investigator estimated time at infection in US was 10 years earlier than in Chinese patients but US patients were more likely to have advanced disease even after stratifying for duration of infection. Study site in the US, older age, truncal obesity, diabetes and prior HCV treatment were significant predictors of advanced disease on multivariate analysis. Conclusions HCV patients in the US had more advanced liver disease than those in China. We speculate that underlying fatty liver disease may be a major contributor to this difference, and management of glycometabolic abnormalities should occur in parallel with anti-viral therapy to achieve optimal outcomes.

Background Endoscopic approaches have been adopted as an alternative to craniofacial resection in the surgical management of olfactory neuroblastoma. Methods We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, Cochrane, and CINAHL (2000–2014) to compare outcomes for open versus endoscopic approaches. Results Thirty-six studies containing 609 patients were included. Meta-analysis of (a) all patients, (b) Kadish C/D only, and (c) Hyams III/IV only, failed to show a difference in locoregional control and metastasis-free survival between approaches. However, endoscopic approaches were associated with improved overall survival (OS) for all 3 groups (p = .001, .04, and .001, respectively), and higher disease-specific survival (DSS) for all patients (p = .004) and Hyams III/IV only (p = .002). Conclusion The current study suggests that endoscopic approaches have comparable control rates to open approaches for olfactory neuroblastoma. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Objective/Hypothesis Our study evaluates the effectiveness of the OtoSim as an educational tool for teaching otoscopy and normal middle ear anatomy to first-year medical students. Study Design Cross-sectional survey design. Methods A large group otoscopy simulator teaching session was held in January 2014 for 29 first-year medical students at the University of Toronto. Following the training session, survey questions were administered to assess the student experience. Results A total of 29 students completed the survey. All respondents rated the overall quality of the event as very good or excellent. Ninety-three percent of respondents indicated that the simulator increased their confidence in otoscopy. Students also commented that they were able to learn normal middle ear anatomy without causing discomfort to patients. Conclusions The use of otoscopy simulation is a novel addition to traditional learning methods for undergraduate medical students. Students can effectively learn normal external and middle ear anatomy and improve their confidence in performing otoscopy examination. Level of Evidence NA Laryngoscope, 125:2159–2162, 2015

Predicting the human-health effects of reducing atmospheric emissions of nitrogen oxide (NOx) emissions from power plants, motor vehicles, and other sources is complex because of nonlinearity in the relevant atmospheric processes. We estimate the health impacts of changes in fine particulate matter (PM2.5) and ozone concentrations that result from control of NOx emissions alone and in conjunction with other pollutants in and outside the mega-city of Shanghai, China. The Community Multiscale Air Quality (CMAQ) Modeling System is applied to model the effects on atmospheric concentrations of emissions from different economic sectors and geographic locations. Health impacts are quantified by combining concentration-response functions from the epidemiological literature with pollutant concentration and population distributions. We find that the health benefits per ton of emission reduction are more sensitive to the location (i.e., inside vs. outside of Shanghai) than to the sectors that are controlled. For eastern China, we predict between 1 and 20 fewer premature deaths per year per 1,000 tons of NOx emission reductions, valued at $300-$6,000 per ton. Health benefits are sensitive to seasonal variation in emission controls. Policies to control NOx emissions need to consider emission location, season, and simultaneous control of other pollutants to avoid unintended consequences.

With the end of apartheid, Johannesburg and other South African cities are now part of a new global race to become 'world-class' tourist and business centers. At the center of this development is the importation of Vegas-style spectacle by local entrepreneurs, firms and other city boosters who create fantasyscapes such as the Emperor's Palace and Grand West. Financed and run by South African impresarios - whose luxurious empires transcend the continent - these resorts represent not only the globalization of gaming but the way in which South African cities see themselves within the worldwide urban hierarchy. As such, this article seeks to untangle the global and local aspects of importing fantasy into the 'new South Africa'.

This article presents a wideband, double-balanced microwave/millimeter-wave Gilbert-cell mixer, using 0.15 μm GaAs pHEMT technology. Two baluns and a matching network are used in RF- and LO-ports to convert single-ended signals to differential signals, for wideband use. This mixer demonstrates an average conversion gain is 2.22 ± 1.5 dB at PLO = 2 dBm, from 30 to 65 GHz. The LO-to-RF and LO-to-IF isolations are all better than 28 dB, between 30 and 65 GHz. The measured P1dB and IIP3 are 5 dBm at 40 GHz and 10 dBm at 60 GHz, respectively. The mixer occupies a chip area, including probing pads, of 1.68 mm2 and consumes 21 mA, with a supply voltage of 5V. © 2012 Wiley Periodicals, Inc. Microwave Opt Technol Lett 54:1196–1200, 2012

This work designs miniaturized stub-type microstrip bandpass filters and develops a novel vertical interconnection scheme in a multilayer structure to design vertically folded filters for size reduction. The current study exploits the fabrication process of low-temperature cofired ceramic (LTCC) for filter realization and fabricates two LTCC Chebyshev stub-type filters at 28 GHz and 5.8 GHz to verify effectiveness of the proposed structure with a maximum size reduction of 50%. © 2011 Wiley Periodicals, Inc. Microwave Opt Technol Lett 53:1389–1394, 2011; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.26024

A high-gain Ka-band 0.18-μm CMOS low-noise amplifier with semicircle stacked grounded coplanar waveguide (SCS-GCPW) structure transmission line is proposed. SCS-GCPW transmission line is adopted to reduce the signal loss by shaping the electric fields under the signal line especially at microwave and millimeter wave applications. The SCS-GCPW demonstrated a similar electric field distribution of coaxial cable and achieved a substrate dielectric attenuation constant of 0.075 Np/m. It is superior to 0.081 Np/m and 0.144 Np/m of traditional microstrip transmission line and CPW transmission line, respectively. By adopting the low loss SCS-GCPW transmission line, the Ka-band LNA demonstrated a 24.5 dB gain together with a noise figure (NF) of 7.5 dB at 33 GHz operation. The measured output power 1 dB compression point (P1 dB) was −2 dBm. The dc power consumption was 40 mW and chip size was 0.6 × 1 mm2 for this Ka-band LNA. © 2011 Wiley Periodicals, Inc. Microwave Opt Technol Lett 53:1131–1134, 2011; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.25910

This work presents a K-band balance single side-band subharmonically pumped image rejection diode mixer (SHIRM).It uses lumped elements and three-conductor-line quadrature couplers and is fabricated in a 0.15-μm GaAs process. The SHIRM is realized in size reduction by using two antiparallel diode pairs for frequency mixing. The three-conductor-line bending coupler is 55% reduction in size compared to the nonbending one for radio frequency port, and lumped elements realization is 62% smaller in size than the quarter-wavelength line for local oscillator port. The proposed circuit with a symmetric layout provides good matches on amplitude and phase performances. The measured results exhibit a minimum conversion loss of 13 dB, a maximum image rejection ratio of 19 dB. All ports isolations are better than 10 dB. The chip area is only 1.5 × 1 mm2. © 2011 Wiley Periodicals, Inc. Microwave Opt Technol Lett 53:485–488, 2011; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.25781

Aims This study examines the relationship between menthol cigarette smoking and the population quit ratio and whether menthol smokers differ in utilization of evidence-based smoking cessation aids among a nationally representative sample of US adult smokers. Design, setting and particiants Secondary data analysis of cross-sectional data from the 2005 National Health Interview Survey (NHIS) Cancer Control Supplement. The NHIS is a nationally representative survey of US households conducted annually. Measurements The main outcome variables of interest were (1) the population quit ratio and (2) use of smoking quit aids. All analyses were conducted using SAS version 9.2 with SUDAAN, which corrects for the complex sampling design of the study. Univariate analyses were used to determine variables that differed significantly by menthol status and utilization of types of quit aids. Multiple logistic regression analysis modeled the relationship between menthol smoking status, demographic characteristics and smoking-related characteristics on the population quit ratio and utilization of quit aids. Findings We observed significant differences in the population quit ratio for menthol versus non-menthol among African American smokers (34% versus 49%, P

This letter proposes a new divide-by-2 injection locked frequency divider (ILFD) fabricated by 0.5 μm GaAs ED-Mode PHEMTs process and describes the operation principle of the dual-transformer ILFD. The first transformer is applied to replace two inductors of the cross-couple LC-tank oscillator circuit. The injection signal of the ILFD transmits into a transistor through a second transformer, which consisted of a bandpass filter achieving a high injection signal power and wide locking range. The measurement results show that the divider's free-running frequency were from 6.47 to 9.54 GHz (32.2%) with 3 V supply voltage. With an incident power of 0 dBm, the locking range is 3.07 GHz from the incident frequency 16.41 to 19.45 GHz (15.6%). The measured phase noise of free running VCO is −92.2 dBc/Hz at 1 MHz offset frequency at 9.45 GHz and this value of the locked ILFD is −128.4 dBc/Hz, which is 36.2 dB lower than the free running VCO. The core power consumption was 42 mW. © 2010 Wiley Periodicals, Inc. Microwave Opt Technol Lett 52:2302–2306, 2010; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.25442

In this study, a fully integrated active Gilbert cell mixer with two Marchand baluns was proposed.The proposed circuit was designed at 12 GHz with bandwidth from 7.5 to 19 GHz and fabricated in a 0.5-μm pHEMT process. In addition, the “current bleeding” technique was also provided in the Gilbert cell mixer to boost the conversion gain. The greatest conversion gain of 4.5 dB can be achieved in the designed circuit under LO input power of −2 dBm. Both RF-IF and LO-IF isolations were better than 30 dB. The third order intercept point input power, IIP3, achieved as high as 2 dBm. The mixer works from 7.5 to 19 GHz. © 2010 Wiley Periodicals, Inc. Microwave Opt Technol Lett 52: 1302–1306, 2010; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.25174

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays an important role in pathogenesis of asthma. A high level of MIF has been detected in bronchoalveolar lavage fluid, serum and sputum in asthma. Polymorphisms associated with inflammatory diseases exist in the promoter region of MIF, which alter its expression. The aim of this study was to evaluate the potential relationship between functional polymorphisms of MIF and childhood asthma in a northeastern Chinese population. The study consisted of a set of 41 trios and an independent sample set of 189 childhood asthma patients and 261 healthy controls. We genotyped MIF-173G/C using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Additionally, MIF-794CATT(5-8) microsatellite polymorphism was genotyped by polyacrylamide gel electrophoresis (PAGE). A statistically significant difference in the distribution of the MIF-173C allele between patients and controls [P = 0.01, odds ratio (OR) = 1.55, 95% confidence interval (CI) = 1.13-2.18] was observed. In addition, the frequency of the MIF-173CC genotype was higher in asthmatic children (P < 0.01, OR = 3.37, 95% CI = 1.27-8.93). No difference in the distribution of CATT(5-8) was found between patients and healthy controls. Haplotype analysis showed that only the MIFCATT(7)-173C haplotype was associated with greater susceptibility to childhood asthma (P = 0.03, OR = 1.54, 95% CI 1.03-2.28). However, the transmission disequilibrium test confirmed a positive association between MIF-173G/C and childhood asthma (P = 0.005), and the absence of an association between the MIF-794CATT(5-8) and the disease. These preliminary results suggest an association between the MIF-173C allele and childhood asthma.

An ultra-wideband voltage-controlled oscillator (VCO) in a standard 0.18-μm CMOS process is presented in this article. The designed VCO adopts two active inductors to replace the passive spiral inductors; this results in an increase in tuning-range and chip area reduction. The active inductor provides a variable inductance range from 1.7 to 3.6 nH, so that the output frequencies of the novel VCO can be obtained from 2 to 6 GHz, with a tuning-range of around 100%. According to the experimental result, it indicates that the proposed design exhibits a significant wide tuning-range and compact chip size compared with a standard VCO with passive inductors. © 2008 Wiley Periodicals, Inc. Microwave Opt Technol Lett 50: 2311–2315, 2008; Published online in Wiley InterScience (www.interscience.wiley.com).DOI 10.1002/mop.23655

Background: Although depression is common among alcohol and tobacco dependent patients, its impact on treatment outcomes is not well established. The purpose of this study was to examine the impact of depressive symptoms on abstinence from tobacco and alcohol after treatment for alcohol dependence and nicotine dependence. Methods: The Timing of Alcohol and Smoking Cessation Study (TASC) randomized adults receiving intensive alcohol dependence treatment, who were also smokers, to concurrent or delayed smoking cessation treatment. The sample consisted of 462 adults who completed depression and substance use (alcohol and smoking) assessments at treatment entry and 6, 12, and 18 months posttreatment. Longitudinal regression models were used to examine the relationships between depression and subsequent abstinence from alcohol and tobacco after baseline characteristics, including alcohol and smoking histories, were considered. Results: Depressive symptoms were prospectively related to nonabstinence from alcohol. Depressive symptoms at the previous assessment increased the odds of drinking at the subsequent time point by a factor of 1.67 (95% CI 1.14, 2.43), p

A 2.60-GHz integer-N frequency synthesizer was designed and implemented in SiGe BiCMOS technology. The single chip includes fully integrated VCO (voltage control oscillator) as well as LPF (loop-filter). The synthesizer provides a wide frequency range of 300 MHz, which covers 2.59–2.66 and 2.8725–2.9025 GHz, with a single VCO. Digital technique is employed at VCO and charge-pump to cover the frequency range and cater for process variation. Using reference frequency of 2.5 MHz, the fabricated prototype demonstrates a settling time of 32 μs, and reference spur below −56 dBc. The synthesizer's phase noise is −115 dBc/Hz at 1.0-MHz offset frequency. It consumes approximately 42 mW power from a 3.0 V single supply, with a total active area of 2.34 mm2. © 2007 Wiley Periodicals, Inc. Microwave Opt Technol Lett 49: 2579–2582, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.22773

Glasses were prepared by systematic additions of P{sub 2}O{sub 5}, BaO, and PbO to glasses consisting of Al{sub 2}O{sub 3}-B{sub 2}O{sub 3}-(BaO)-CaO-Fe{sub 2}O{sub 3}-K{sub 2}O-MgO-Na{sub 2}O-(PbO)-(P{sub 2}O{sub 5})-SiO{sub 2}, and their chemical durability was examined by the EPA TCLP test. The addition of about 1 mol% P{sub 2}O{sub 5} to a glass containing 5 mol% PbO increases the normalized lead leach rate (NLLR) by about 40 relative %, but increasing P{sub 2}O{sub 5} to 2 mol% decreases the NLLR to about the NLLR obtained without P{sub 2}O{sub 5}. A similar, but more dramatic, behavior with changes in the NLLR of about 300 relative % is obtained by sequential combined additions of 1 mol% each of P{sub 2}O{sub 5} and BaO to a glass containing 1 mol% PbO.

BACKGROUND Hypoxia-inducible factor-1α (HIF-1α) regulates cellular responses to hypoxia and is rapidly degraded under normoxia through von Hippel-Lindau (VHL) mediated ubiquitination. Although HIF-1α stabilization appears to be the molecular basis for VHL-associated cancers, stabilizing mutations in HIF-1α have not been reported. METHODS A series of 15 metastatic androgen independent prostate cancers were examined for mutations in the oxygen-dependent domain (ODD) of HIF-1α by PCR amplification and DNA sequencing. RESULTS A somatic proline to serine mutation in codon 582 (P582S) was identified in one sample. Transfection studies with a HIF-1α regulated reporter gene showed increased transcriptional activity that correlated with higher mutant HIF-1α protein expression. Increased expression of the P582S mutant induced by iron chelation, which blocks proline hydroxylation of wild-type HIF-1α, was markedly attenuated. The mutant also showed increased stability under normoxic versus hypoxic conditions. CONCLUSION The P582S HIF-1α is a stable variant and HIF-1α mutation is a mechanism for enhancing HIF-1α activity in human cancer. The recent identification of the identical P582S HIF-1α as a polymorphism suggests that this variant may increase tumor susceptibility or cause more aggressive biological behavior. © 2004 Wiley-Liss, Inc.

In this paper, a compact bandpass filter using folded λ/4 coupled-line resonators is presented. An accurate model is made by using an efficient analytic design approach. Equations for extraction of the equivalent parallel-coupled-line structure representing the folded-line section are developed. A simple systematic design procedure is established for filter designers. Finally, a three-pole bandpass filter for the new resonators is designed. The new folded coupled-line filter exhibits a significant reduction in footprint as compared to the conventional design. © 2005 Wiley Periodicals, Inc. Microwave Opt Technol Lett 45: 32–35, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20714

Design and development of a photonic bandgap (PBG)-assisted shared-aperture dual-band orthogonal aperture-fed rectangular microstrip patch antenna element, which is suitable for a portable very small aperture terminal (VSAT), are presented in this paper. The dual-band dual-polarized antenna element achieves 21% input impedance bandwidth at the S- and C-bands. A comparison of the antenna with and without 2D PBG grids shows that the inclusion of PBG structures (PBGSs) improves the antenna performances. (c) 2005 Wiley Periodicals, Inc.

A novel filter structure is presented in this paper to reduce the crosstalk in cross connection and switching in all-optical networks based on dense wavelength-division multiplexing (DWDM). Following the principle of an optical film filter, the filter is constructed by a dielectric waveguide with the waveguide boundary or the waveguide itself discontinuous in the transmitting direction. As the propagation phase constant β does not change in the wave propagating direction z, the waveguide system can be considered as a homogeneous dielectric medium with effective refractive index ne in this direction. Because the effective refractive index ne changes with the thickness or parameters as ni of the waveguide at a given field mode, we arrange different ne alternately as an optical film filter. After proving this kind of waveguide's filtering properties, the design principle and an example are given, which will be very useful to reduce the crosstalk in optical cross connection and switching in all-optical networks based on DWDM. This kind of filter can be easily connected to other related components. © 2000 John Wiley & Sons, Inc. Microwave Opt Technol Lett 24: 197–202, 2000.

After the electromagnetic fields in a line are discussed, conformal mapping and the singular integral-equation technique are used to derive the expression for the characteristic impedance of a rectangular coaxial cone transmission line with an offset inner conductor (RCCTLO). Simple and very accurate formulas, based on only the spherical TEM mode propagating, for the capacitance and characteristic impedance are found in terms of complete elliptic integrals. The method enables the characteristic impedance of a GTEM cell to be evaluated accurately and easily. © 1998 John Wiley & Sons, Inc. Microwave Opt Technol Lett 19: 267–271, 1998.

Methanol, which is detoxified via a folic acid-dependent pathway, has been shown to be teratogenic in mice. Given recent observations that the level of dietary folic acid intake may be inversely related to the occurrence of select birth defects in humans, we tested the hypothesis that dietary folic acid intake would influence the developmental toxicity of methanol. Virgin female mice were fed one of three diets containing 400 (low), 600 (marginal), or 1,200 (adequate) nmol folic acid/kg diet for 5 weeks prior to and following mating. On gestation days (GD) 6-15, dams were administered by gavage either vehicle (distilled, deionized water) or methanol at 2.0 or 2.5 g/kg body weight, twice daily. On GD 18, mice were weighed and killed and the liver, kidneys, and gravid uteri removed and weighed. Implantation sites, live and dead fetuses, and resorptions were counted; fetuses were weighed individually and examined for cleft palate and exencephaly. One third of the fetuses in each litter were examined for skeletal morphology. Maternal liver folate concentrations were approximately 40-50% lower in the low dietary folic acid groups than in the marginal and adequate groups; methanol did not affect maternal liver folate concentration at term. Maternal net gestational weight gain was lowest at the lowest dietary folate level but was not affected by methanol. Gravid uterus weights were lowest in the low dietary folic acid groups exposed to the high methanol dose and the number of live fetuses per litter was lowest in the low folic acid groups. Fetal body weights were lowest in the low folic acid groups and significantly lower in the methanol groups relative to vehicle-treated animals. Fetal crown-rump lengths were shorter in the methanol-treated groups; this parameter was not affected by folic acid treatment. Both methanol and low dietary folic acid increased the incidence of cleft palate, with the highest number of affected litters in the low dietary folic acid group. These results support the concept that maternal folate status can modulate the developmental toxicity of methanol.

BACKGROUND. Angiosarcomas (AS) are rare, aggressive tumors. Optimal treatment has not been well defined. The authors undertook a retrospective review of patients seen at their institution with the intent of identifying prognostic factors and optimal treatment strategies. METHODS. Between 1955 and 1990, 67 patients with AS were seen at the University of California, at Los Angeles Medical Center. Follow-up ranged from 1 to 173 months with a median of 30 months. RESULTS. The overall prognosis was poor. The actuarial 2- and 5-year disease free survivals (DFS) were 44% and 24%, respectively. Of 52 recurrences after primary treatment, 81% (42 of 52) had a component of local failure. Twenty-eight patients had developed distant metastases at last follow-up. Of patients who received surgery (S) and radiation therapy (RT), with or without chemotherapy (CT), 5-year actuarial DFS was 43%, compared with 17% for patients who underwent S+/-CT as initial treatment (P = 0.03). Only 9% of patients (1 of 11) treated with RT+/-CT were rendered free of disease. CONCLUSIONS. Patients with AS usually present with high grade histology, and with multifocal disease. There is a propensity for both local recurrence and distant metastases. Our results and a review of the literature, suggest that S plus RT offers the best chance for long term control of this aggressive tumor. The role of CT remains undefined.

Rosai-Dorfman disease is a rare, idiopathic, benign histiocytic proliferation usually seen in younger patients. Massive lymphadenopathy most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes. Nearly half of the patients will have extranodal involvement, 75% occurring in sites in the head and neck. Three cases of extranodal Rosai-Dorfman disease of the head and neck involving the nose, paranasal sinuses, and parotid gland are presented. The clinical presentation, histologic characteristics, radiographic findings, and treatment of the disease are discussed. Because of the scarcity of cases, the clinical and histopathologic features of this disease may be overlooked. Familiarity with its relatively frequent clinical manifestations in the head and neck, as well as with the diagnostic histopathology, should preclude confusion with other disease entities.

Metastatic mucosal melanoma is extremely rare. Only 0.6% to 9.3% of patients with cutaneous malignant melanoma will have metastases to the mucosa of the upper aerodigestive tract. The records of all patients with mucosal melanoma of the head and neck at the University of California, Los Angeles Medical Center during the past 30 years were reviewed. Patients with primary tumors were separated form those with metastatic involvement from a cutaneous primary site. These two groups were compared for differences in clinical symptoms, histopathologic findings, treatment, and survival characteristics. Frequent sites of metastatic involvement included the base of tongue and nasal cavity. These arose from a variety of cutaneous sites including the trunk and extremities and, in most instances, did not arise until 2 to 7 years after the initial cutaneous lesion. Most of those with metastases to the head and neck mucosa had disseminated disease. The histopathologic distinction between the two groups is described with photomicrographs. Junctional activity in the overlying or adjacent mucosa distinguishes primary mucosal melanoma from metastatic disease, in which the overlying mucosa is usually intact. This difference is useful in determining workup and treatment options. Aggressive surgical resection is suggested in treatment of primary melanomas, whereas surgery is at best palliative in those with metastatic disease.

Background. Breast reconstruction is performed with increasing frequency and has become important in the treatment of mastectomy patients. Methods. The development of recurrent carcinoma after a mastectomy and transverse rectus abdominus myocutaneous (TRAM) flap procedure is described. Results. The lesion was nonpalpable and was detected by mammography. Conclusion. This case raises questions about the practice of not performing postreconstruction mammography for detection of local recurrence after mastectomy.

BACKGROUND: Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance. METHODS: Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions. CONCLUSION: Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.

Background. With improvement in survival after cancer treatment, it is becoming increasingly important to examine treatment-related morbidity and mortality. Sarcomas can develop in the irradiated field after radiation therapy (RT). The authors undertook a study to estimate the risk, and compared the risk of postirradiation sarcoma (PIS) with other treatment modalities used against cancer. Me(hods. Since 1987 the authors have reviewed the records of 1089 patients with head and neck, gynecologic, gastrointestinal, and extremity sarcomas. Of these 1089 patients, 37 had a prior history of RT

Background. This report describes the unusually high response rate of metastatic synovial sarcoma to high dose ifosfamide (14–18 g/m2) when that drug was used to treat 13 consecutive patients with recurrent metastatic synovial sarcoma before surgery (or thoracotomies) to provide optimal salvage therapy for these patients. Patients and Methods. Thirteen patients with recurrent or pulmonary metastatic synovial sarcoma seen at the Cedars-Sinai Comprehensive Cancer Center (Los Angeles, CA) from April, 1989 through January, 1993 were treated with high dose ifosfamide (14–18 g/m2). Ifosfamide was infused at the dose of 2 g/m2 over a 4-hour bolus infusion, followed by 2-g/m2 24-hour continuous infusions of ifosfamide, for a total of 14 or 18 g/m2 (6–8 days). Mesna (Mesnex, Bristol-Myers Oncology, Princeton, NJ) was infused with the ifosfamide at equimolar doses. Supplemental sodium bicarbonate (180 mEq) was given daily to prevent severe acidosis. Nine of the thirteen patients were treated with prior chemotherapy for their primary tumors. Prior chemotherapy consisted of doxorubicin (Adriamycin, Adria Labs, Dublin, OH) in all patients and doxorubicin combined with cisplatin in eight of them. Results. All 13 patients had objective responses to high dose ifosfamide chemotherapy. There were nine partial responses and four complete responses. Five of the patients died of disease at 20–40 months (median, 27 months) from initial therapy. Eight patients have survived from 2 to 43 months (median, 20 months) from initial therapy, and three of these patients are disease free. Those patients surviving disease free had successful surgical removal of their residual metastatic disease after chemotherapy. Conclusion. Metastatic synovial sarcoma appears to be particularly sensitive to high dose ifosfamide chemotherapy. This experience suggests that there is a role for high dose ifosfamide chemotherapy in preoperative and postoperative adjuvant chemotherapy for primary synovial sarcoma, which is usually always a high grade malignant lesion with a poor prognosis after surgery alone.

The microwave noise performances of metamorphic (MM) InP/In0.53Ga0.47As/InP double-heterojunction bipolar transistors (DHBTs) on GaAs substrate are investigated for the first time. The noise figures and associated gains of the device with an emitter size of 5 × 5 μm2 are studied in the frequency range of 2–10 GHz. The variations of minimum noise figure at different collector currents are presented. At 2 GHz, the best minimum noise figure (FMIN) of 2.1 dB with an associated gain (GASS) of 12.7 dB have been achieved at VCE= 1.5 V and IC= 0.3 mA (1.2 kA/cm2). For comparable size and current density, these results show noise performance comparable to those of reported lattice-matched InP HBT at lower frequency (∼2 GHz). © 2002 Wiley Periodicals, Inc. Microwave Opt Technol Lett 33: 306–308, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.10303

Background. With improvement in survival after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Sarcoma can develop in the irradiated field after radiation therapy. The authors performed a study to estimate the risk, and compared the risk of sarcoma after radiation therapy with that of other treatment modalities used against cancer. Methods. Between 1955 and 1988, 229 patients with sarcoma of the head and neck were seen at the University of California, Los Angeles (UCLA), Medical Center. Of these, 13 (6%) had a previous history of radiation therapy to the head and neck. Results. Radiation doses were known in 10 of 13 patients and ranged from 30 to 124.4 Gy. The latency time from radiation therapy to the development of postirradiation sarcoma (PIS) ranged from 3 months to 50 years, with a median of 12 years. More than 2000 patients have received radiation therapy to the head and neck for various conditions at the UCLA Medical Center since 1955. Conclusions. The authors conclude that most head and neck sarcomas are not radiation related and that the risk of PIS after head and neck irradiation for other diseases is low. From a review of the literature comparing mortality risks of chemotherapy, general surgery, and anesthesia, the risk of PIS appears no worse. Given the large number of patients who can be cured or receive palliation with radiation therapy, concern about PIS should not be a major factor influencing treatment decisions in patients with cancer.

Purpose: This study was to evaluate the significance of weekly imageguided patient setup and to assess the volumetric and dosimetric changes in no-small-cell-lung cancer (NSCLC) patients treated with adaptive conformal radiotherapy (CRT). Methods: 9 NSCLC patients treated with 3D CRT underwent 4D CT-on-rail every five fractions. ITV was generated from three phases of the 4DCT (the end of exhalation, 25% before and after the end of exhalation). The margin of ITV to PTV is 5mm. 6 weekly CTs were acquired for each patient. The weekly CTs were fused with the planning CT by vertebrae. The couch shift was recorded for each weekly CT to evaluate the setup error. The gross tumor volumes (GTVs) were contoured on weekly CT images by a physician. Beams from the original plans were applied to weekly CTs to calculate the delivered doses. All patients underwent replanning after 20 fractions. Results: Among the total 54 CTs, the average setup error was 2.0± 1.7, 2.6± 2.1, 2.7± 2.2 mm in X, Y, and Z direction, respectively. The average volume of the primary GTV was reduced from 42.45 cc to 22.78 cc (47.04%) after 6 weeks. The maximal volume regression occurred between 15 and 20 fractions. Adaptive radiation therapy (ART) reduced the V20 and V5 of the lung by 33.5% and 16.89%, respectively. ART also reduced Dmean and D1/3 of the heart by 31.7% and 32.32%, respectively. Dmax of the spinal cord did not vary much during the treatment course. Conclusion: 5 mm margin is sufficient for 4D weekly CTguided radiotherapy in lung cancer. Tumor regression was observed in the majority of patients. ART significantly reduced the OARs dose. Our preliminary results indicated that an off-line ART approach is appropriate in clinical practice.

A novel millimeter-wave short backfire antenna with a circular waveguide TM01 mode feed is proposed and simulated using the FDTD method. It has a radiation pattern that is similar to that of a circular microstrip patch antenna operating in the TM02 mode, but it has a much higher gain and lower sidelobe levels. The proposed antenna can be used for millimeter-wave wireless LAN applications. ©2000 John Wiley & Sons, Inc. Microwave Opt Technol Lett 24: 348–349, 2000.

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.

The prognosis of the glandular neoplasms of the uterine cervix is related to the clinical stage and, to a lesser extent, to the histologic type, growth pattern, and degree of differentiation of the neoplasms. To determine further the prognostic significance of the stem cell ploidy levels as determined by nuclear DNA quantitation, the authors separated the tumors into low ploidy (less than 3N) and high ploidy (greater than 3N) groups. Of the clinical Stage I and II neoplasms, low ploidy tumors had a better prognosis than high ploidy tumors of comparable stage. Low ploidy tumors had a better prognosis than high ploidy tumors irrespective of the degree of differentiation. Mixed carcinomas had a poorer prognosis than pure adenocarcinomas of comparable clinical stage. This might be explained by the greater proportion of high ploidy stem cells in mixed carcinomas than in pure adenocarcinomas. Although advanced clinical Stage III and IV neoplasms had a poor outlook regardless of the DNA ploidy level, there was a proportional increase of high ploidy tumors with increasing clinical stage. These findings suggest that cervical granular neoplasms having high ploidy stem cell lines are biologically more aggressive than those with low ploidy stem cell lines.

Over a 32-year period at the University of California, Los Angeles Medical Center, all cases of adenocarcinoma and adenosquamous carcinoma of the uterine cervix were reviewed to determine the incidence of ovarian metastases in stage I disease. One of 25 patients (4.0%) who underwent an exploratory laparotomy and radical hysterectomy had a microscopic ovarian metastasis. A literature review identified nine additional patients who had ovarian metastases and stage I adenocarcinoma of the cervix. Including our series, the overall reported rate of ovarian metastases is 1.8%. All ten patients had at least one of the following additional characteristics: They were postmenopausal, they had adnexal pathology, or they had positive pelvic lymph nodes. Thus, ovarian preservation is warranted in premenopausal patients who do not have ovarian pathology or evidence of other metastatic disease at surgery. Bilateral oophorectomy may be performed if frozen-section examination of enlarged or suspicious nodes documents metastases. If the ovaries are left in the pelvis at the completion of the surgical procedure and microscopic spread to other pelvic tissues is documented, pelvic irradiation can be administered.

Forty-nine cases of ovarian endometrioid carcinoma with squamous foci were reviewed. Of particular interest was the biologic behavior of the neoplasms in relation to the appearance of the epithelium. As previously noted for the analogous uterine endometrial tumors, the ovarian adenosquamous lesions occurred later in life, were more advanced, were associated with less differentiated adenocarcinomatous components, and had a poorer prognosis. The five-year survival rate for patients with adenosquamous endometrioid ovarian carcinoma was 21% in comparison with the 90% survival found in patients with ovarian endometrioid adenocanthoma.

In a previous topographic study of cervical conization specimens, condylomatous changes were commonly present in direct contact with intraepithelial neoplasia and were always located distal (ectocervical side) to the neoplasia. Viral DNA was detected by in situ hybridization using 35S-labeled nick translated DNA probes in 50 of 70 cases (71%) which had adequate lesions: HPV-16 in 30, HPV-18 in ten, HPV-31 in six, and multiple types in four cases. HPV-6/11 was detected only once, in a multiple infection. As a rule, a positive cervix contained a single virus type, and the same virus type was found in condylomatous and neoplastic areas. The results suggest that the neoplastic process is initiated in the area of condyloma toward the endocervix and, once established, extends proximally toward the cervical canal. Capsid antigen was detected in 19 cases, indicating that a proportion of the high-grade lesions is potentially infectious.

Seven benign and four malignant mixed tumors of the salivary gland, biopsied using fine-needle aspiration, were analyzed using digital image analysis. Mean nuclear form factor, perimeter, and area were significantly increased in malignant cases. Better separation between diagnostic categories, however, was achieved by utilizing the coefficient of variation (CV) within a case rather than mean value. Form factor CV alone divided cases into nonoverlapping diagnostic categories. This quantitative analog of "pleomorphism" provided a useful marker for malignancy in mixed tumors.

In this study of 101 cervical conization specimens, the location and the size of condyloma and intraepithelial neoplasia (dysplasia and carcinoma in situ) were mapped using the last endocervical gland as the marker for the original squamocolumnar junction. Condylomatous changes were identified in 85% of cervices affected by the intraepithelial neoplasia, and were in direct contact with 68% of intraepithelial neoplasms. The proximal location of intraepithelial neoplasia in relation to the condyloma can be explained by the occurrence of neoplasia just proximal to the condyloma and subsequent expansion of neoplasia towards the cervical canal. This study adds topographic evidence linking cervical condyloma to the development of intraepithelial neoplasia.

Cross-linked networks of poly(dimethylsiloxane) were swelled with styrene containing benzoyl peroxide. Polymerization of the styrene in situ, by increasing the temperature, gave novel elastomeric composites. Scanning electron micrographs suggest that low concentrations of styrene (∼ 14 wt.%) gave primarily low-molecular-weight polystyrene (PS), which acted merely as a diluent in the networks. Larger amounts gave PS which phase separated into glassy particles having diameters in the approximate range 0.05–1.5 μm. In these cases, an increase in wt.% PS gave networks showing large increases in ultimate strength, which was to be expected. Surprisingly, there were also increases in maximum extensibility, which usually decreases in response to modifications which increase the ultimate strength.