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Open-graded friction course (OGFC) is a commonly used highway pavement material. The relatively low strength and low stiffness of OGFC create a concern on its interfacial bond and shear strength with the underlying dense-graded asphalt concrete (AC). The bond and shear strength may be particularly low if OGFC is directly placed on an existing milled AC layer during resurfacing operation. To address this concern, both the OGFC layer and the underlying AC layer are often resurfaced together in resurfacing operation, with the expectation that better bonding develops between two new layers. However, this practice may result in resource and monetary wastes if the bond and shear strength between the OGFC and milled AC layer are adequate. This paper reports research findings on the bond and shear strength issue based on in situ bond strength test, analysis of traffic-induced tractive force and interfacial shear stress, interfacial shear strength test, and site trials.

Objective. To determine if the perfusion parameters by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of regional nodal metastasis are helpful in characterizing nodal status and to understand the relationship with those of primary tumor of nasopharyngeal carcinoma (NPC). Materials and Methods. Newly diagnosed patients imaged between August 2010 and January 2014 and who were found to have enlarged retropharyngeal/cervical lymph nodes suggestive of nodal disease were recruited. DCE-MRI was performed. Three quantitative parameters, Ktrans, ve, and kep, were calculated for the largest node in each patient. Kruskal-Wallis test was used to evaluate the difference in the parameters of the selected nodes of different N stages. Spearman’s correlation was used to evaluate the relationship between the DCE-MRI parameters in nodes and in primary tumors. Results. Twenty-six patients (7 females; 25~67 years old) were enrolled. Ktrans was significantly different among the patients of N stages (N1, n=3; N2, n=17; N3, n=6), P=0.015. Median values (range) for N1, N2, and N3 were 0.24 min−1 (0.17~0.26 min−1), 0.29 min−1 (0.17~0.46 min−1), and 0.46 min−1 (0.29~0.70 min−1), respectively. There was no significant correlation between the parameters in nodes and primary tumors. Conclusion. DCE-MRI may play a distinct role in characterizing the metastatic cervical lymph nodes of NPC.

// Victor Ho-Fun Lee 1 , Dora Lai-Wan Kwong 1 , To-Wai Leung 1 , Cheuk-Wai Choi 1 , Vincent Lai 2 , Lydia Ng 3 , Ka-On Lam 1 , Sherry Chor-Yi Ng 1 , Chun-Kin Sze 1 , Chi-Chung Tong 1 , Patty Pui-Ying Ho 1 , Wing-Lok Chan 1 , Lai-San Wong 1 , Dennis Kwok-Chuen Leung 1 , Sum-Yin Chan 1 , Pek-Lan Khong 2 1 Department of Clinical Oncology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 3 Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA Correspondence to: Victor Ho-Fun Lee, email: vhflee@hku.hk Keywords: intensity-modulated radiation therapy, nasopharyngeal carcinoma, non-metastatic, plasma EBV DNA, prognostic factors Received: June 30, 2016 Accepted: November 22, 2016 Published: December 24, 2016 ABSTRACT Plasma Epstein-Barr virus (EBV) DNA titers have been used to monitor treatment response and provide prognostic information on survival for nasopharyngeal carcinoma (NPC). However, the long-term prognostic role of pretreatment and posttreatment titers after radical contemporaneous radiation therapy remains uncertain. We recruited 260 evaluable patients with non-metastatic NPC treated with radical intensity-modulated radiation therapy (IMRT) with or without adjunct chemotherapy. Plasma EBV DNA titers at baseline and then 8 weeks and 6 months after IMRT were measured. Cox regression models were employed to identify interaction between post-IMRT 8 th week and 6 th month undetectable titers and 3-year survival endpoints. Concordance indices (Ct) from time-dependent receiver-operating characteristics (TDROC) were compared between patients with post-IMRT undetectable and those with detectable titers. After a median follow-up duration of 3.4 years (range 1.4-4.6 years), patients with post-IMRT 8 th week and 6 th month undetectable plasma EBV DNA titers enjoyed longer 3-year survival endpoints than those who had detectable titers at the same time points. Post-IMRT 8 th week, and more significantly, post-IMRT 6 th month undetectable plasma EBV DNA were the only significant prognostic factors of 3-year survival endpoints. Ct values for all 3-year survival endpoints for both post-IMRT 8 th week and 6 th month undetectable plasma EBV DNA were significantly higher in those with stage IVA–IVB diseases compared to stage I-III counterparts. Early post-IMRT undetectable plasma EBV DNA titers were prognostic of 3-year survival endpoints in patients with non-metastatic NPC. Intensified treatment should be further explored for patients with persistently detectable titers after IMRT.

The eighth edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage classification (TNM) for nasopharyngeal carcinoma (NPC) was launched. It remains unknown if incorporation of nonanatomic factors into the stage classification would better predict survival. We prospectively recruited 518 patients with nonmetastatic NPC treated with radical intensity-modulated radiation therapy ± chemotherapy based on the eighth edition TNM. Recursive partitioning analysis (RPA) incorporating pretreatment plasma Epstein-Barr virus (EBV) DNA derived new stage groups. Multivariable analyses to calculate adjusted hazard ratios (AHRs) derived another set of stage groups. Five-year progression-free survival (PFS), overall survival (OS) and cancer-specific survival (CSS) were: Stage I (PFS 100%, OS 90%, CSS 100%), II (PFS 88%, OS 84%, CSS 95%), III (PFS 84%, OS 84%, CSS 90%) and IVA (PFS 71%, OS 75%, CSS 80%) (p < 0.001, p = 0.066 and p = 0.002, respectively). RPA derived four new stages: RPA-I (T1-T4 N0-N2 & EBV DNA

To determine the utility of stretched exponential diffusion model in characterisation of the water diffusion heterogeneity in different tumour stages of nasopharyngeal carcinoma (NPC). Fifty patients with newly diagnosed NPC were prospectively recruited. Diffusion-weighted MR imaging was performed using five b values (0–2,500 s/mm2). Respective stretched exponential parameters (DDC, distributed diffusion coefficient; and alpha (α), water heterogeneity) were calculated. Patients were stratified into low and high tumour stage groups based on the American Joint Committee on Cancer (AJCC) staging for determination of the predictive powers of DDC and α using t test and ROC curve analyses. The mean ± standard deviation values were DDC = 0.692 ± 0.199 (×10−3 mm2/s) for low stage group vs 0.794 ± 0.253 (×10−3 mm2/s) for high stage group; α = 0.792 ± 0.145 for low stage group vs 0.698 ± 0.155 for high stage group. α was significantly lower in the high stage group while DDC was negatively correlated. DDC and α were both reliable independent predictors (p

// Vincent Lai 1 , Victor Ho Fun Lee 2 , Ka On Lam 2 , Bingsheng Huang 3 , Queenie Chan 4 and Pek Lan Khong 1 1 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China 2 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China 3 Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, China 4 Philips Healthcare, Hong Kong, China Correspondence to: Vincent Lai, email: vincentlai166@yahoo.com.hk Keywords: nasopharyngeal carcinoma, intravoxel incoherent motion, dynamic contrast enhanced, magnetic resonance imaging, tumor staging Received: February 18, 2017 Accepted: June 27, 2017 Published: July 26, 2017 ABSTRACT Objectives: To compare accuracy and assess agreement between intravoxel incoherent motion (IVIM) magnetic resonance (MR) perfusion-related parameters and quantitative dynamic contrast-enhanced (DCE) MR parameters in nasopharyngeal carcinoma (NPC). Results: D , f , D* , K trans , K ep and V p were significantly lower in the high stage group while V e was significantly higher in the high stage group. Optimal cut-off values were: D =0.749 x 10 -3 mm 2 /s; f =0.145; D* =100.401 x 10 -3 mm 2 /s; K trans =0.571/min; K ep =0.8196/min; V e =0.6556 %; V p =0.0757 %. D* ( p =0.001), K trans ( p

Nasopharyngeal carcinoma (NPC) is common in Southeast Asia. Early detection and accurate staging are imperative for optimal treatment planning, helping to improve clinical outcome and survival rate. Both magnetic resonance (MR) and 18-fluoro-2-deoxy-glucose ((18)F-FDG) positron emission tomography with computed tomography (PET/CT) imaging are essential in the diagnosis, staging and post-treatment assessment of NPC, carrying important roles in different stages of the disease and are often complementary to each other. MR imaging, given its excellent soft tissue contrast resolution, is the best imaging modality of choice in the depiction and delineation of local tumor extent whilst whole body (18)F-FDG PET/CT imaging, with its added functional information, is superior in correct identification of the metastatic lymph node and distant metastasis. It is also valuable in the treatment response assessment during the early treatment and post-treatment periods, potentially facilitating the concept of adaptive radiation therapy during treatment so as to minimize complications. In this article, we will review the roles and limitations of MR and (18)F-FDG PET/CT imaging in the different stages of patient management in NPC. Also, the diagnostic challenge in differentiation between residual/recurrent disease and post-chemoradiation fibrosis in the post-treatment period will be addressed. Finally, the value of the quantitative parameters derived from functional MR and (18)F-FDG PET/CT imaging as prognostic markers in the prediction of treatment outcome will also be discussed.

A 32-Gb ReRAM test chip has been developed in a 24-nm process, with a diode as the selection device and metal oxide as the switching element. The memory array is constructed with cross-point architecture to allow multiple memory layers stacked above the supporting circuitry and minimize the circuit area overhead. Die efficiency is further improved by sharing wordlines and bitlines between adjacent blocks. As the number of sense amplifiers under the memory array is limited, a pipelined array control scheme is adopted to compensate the performance impact while utilizing the fast switching time of ReRAM cells. With the chip current consumption being dominated by the array leakage and sensitive to array bias and operating conditions, a charge pump stage control scheme is introduced to dynamically adapt to the operating conditions for optimal power consumption. Smart Read during sensing and leakage current compensation scheme during programming are applied to the large-block architecture and achieve a chip density that is several orders of magnitude higher than prior ReRAM developments.

Purpose To evaluate the correlation between standardized uptake value (SUV) (tissue metabolism) and apparent diffusion coefficient (ADC) (water diffusivity) in peritoneal metastases. Materials and Methods Patients with peritoneal dissemination detected on 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) were prospectively recruited for MRI examinations with informed consent and the study was approved by the local Institutional Review Board. FDG-PET/CT, diffusion-weighted imaging (DWI), MRI, and DWI/MRI images were independently reviewed by two radiologists based on visual analysis. SUVmax/SUVmean and ADCmin/ADCmean were obtained manually by drawing ROIs over the peritoneal metastases on FDG-PET/CT and DWI, respectively. Diagnostic characteristics of each technique were evaluated. Pearson's coefficient and McNemar and Kappa tests were used for statistical analysis. Results Eight patients were recruited for this prospective study and 34 peritoneal metastases were evaluated. ADCmean was significantly and negatively correlated with SUVmax (r = −0.528, P = 0.001) and SUVmean (r = −0.548, P = 0.001). ADCmin had similar correlation with SUVmax (r = −0.508, P = 0.002) and SUVmean (r = −0.513, P = 0.002). DWI/MRI had high diagnostic performance (accuracy = 98%) comparable to FDG-PET/CT, in peritoneal metastasis detection. Kappa values were excellent for all techniques. Conclusion There was a significant inverse correlation between SUV and ADC. J. Magn. Reson. Imaging 2014;40:99–105 © 2013 Wiley Periodicals, Inc.

To explore intravoxel incoherent motion (IVIM) characteristics of nasopharyngeal carcinoma (NPC) and relationships with different tumour stages. We prospectively recruited 80 patients with newly diagnosed undifferentiated NPC. Diffusion-weighted MR imaging was performed and IVIM parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were calculated. Patients were stratified into low and high tumour stage groups based on American Joint Committee on Cancer (AJCC) and TNM staging for determination of the predictive powers of IVIM parameters using t test, multiple logistic regression and ROC curve analyses. D, f and D* were all statistically significantly lower in high-stage groups in AJCC, T and N staging. D, f and D* were all independent predictors of AJCC staging, f and D* were independent predictors of T staging, and D was an independent predictor of N staging. D was most powerful for AJCC and N staging, whereas f was most powerful for T staging. Optimal cut-off values (area under the curve, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio) were as follows: AJCC stage, D = 0.782 × 10−3 mm2/s (0.915, 93.3 %, 76.2 %, 3.92, 0.09); T staging, f = 0.133 (0.905, 80.5 %, 92.5 %, 10.73, 0.21); N staging, D = 0.761 × 10−3 mm2/s (0.848, 87.5 %, 66.7 %, 2.62, 0.19). Multivariate analysis showed no diagnostic improvement. Nasopharyngeal carcinoma has distinctive intravoxel incoherent motion characteristics parameters in different tumour staging, potentially helping pretreatment staging. • Magnetic resonance imaging is increasingly used to assess nasopharyngeal carcinoma (NPC). • NPC has distinctive diffusion/perfusion characteristics at different stages. • Non-invasive MR imaging may help pretreatment staging prediction. • Diffusion properties of NPC best correlate with AJCC and N staging. • Perfusion properties of NPC best correlate with T staging.

To evaluate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for characterising nasopharyngeal carcinoma (NPC). Forty-five newly diagnosed NPC patients were recruited. The initial enhancement rate (E R ), contrast transfer rate (k ep ), elimination rate (k el ), maximal enhancement (MaxEn) and initial area under the curve (iAUC) were calculated from semiquantitative analysis. The K trans (volume transfer constant), v e (volume fraction) and k ep were calculated from quantitative analysis. Student’s t-test was used to evaluate the differences among tumour stages. Pearson’s correlation between the two sets of k ep was performed. Comparing tumours of T1/2 stage (n = 18) and T3/4 stage (n = 27), MaxEn (P = 0.030) and iAUC (P = 0.039) were both significantly different; however, the iAUC was the only independent variable with 69.6 % sensitivity and 76.5 % specificity respectively; v e was also significantly different (P = 0.010) with 69.6 % sensitivity and 70.6 % specificity respectively. No significant difference was found among N stages. The two sets of k ep s were highly correlated (r = 0.809, P

Objectives Endovascular treatment is effective in treating carotid blowout syndrome (CBS). We reviewed our experience in addressing CBS over eight years and presented an account of the treatment paradigm and management algorithm. Method All cases of CBS from 2003 to 2010 with endovascular treatment performed in our center were reviewed. 15 CBS in 14 patients were recruited. Based on our management algorithm, treatment regimen was stratified into deconstructive or constructive methods. Their clinical presentations, angiographic features, angiographic and clinical outcomes were reviewed. Results 10 patients were treated with deconstructive method by means of permanent vessel occlusion (PVO) and 4 patients were treated with constructive method by means of placement of covered stent ( n =3) or flow diverting device ( n =1). Immediate hemostasis was achieved in all cases. 7 (50%) patients, in whom 5 treated with PVO and 2 with covered stent, had favorable outcomes and survived at a median follow-up period of 4 months (range: 1–84 months). Conclusion Permanent vessel occlusion remains the gold standard of treatment and tends to show a favorable long-term outcome. Off-label use of covered stent and flow-diverting device can produce satisfactory results should balloon occlusion test fail, but long-term follow up would be required for definitive assessment.

We aimed to explore the diagnostic accuracy of various mediastinal measurements in determining acute nontraumatic thoracic aortic dissection with respect to posteroanterior (PA) and anteroposterior (AP) chest radiographs, which had received little attention so far. We retrospectively reviewed 100 patients (50 PA and 50 AP chest radiographs) with confirmed acute thoracic aortic dissection and 120 patients (60 PA and 60 AP chest radiographs) with confirmed normal aorta. Those who had prior history of trauma or aortic disease were excluded. The maximal mediastinal width (MW) and maximal left mediastinal width (LMW) were measured by two independent radiologists and the mediastinal width ratio (MWR) was calculated. Statistical analysis was then performed with independent sample t test. PA projection was significantly more accurate than AP projection, achieving higher sensitivity and specificity. LMW and MW were the most powerful parameters on PA and AP chest radiographs, respectively. The optimal cutoff levels were LMW = 4.95 cm (sensitivity, 90 %; specificity, 90 %) and MW = 7.45 cm (sensitivity, 90 %; specificity, 88.3 %) for PA projection and LMW = 5.45 cm (sensitivity, 76 %; specificity, 65 %) and MW = 8.65 cm (sensitivity, 72 %; specificity, 80 %) for AP projection. MWR was found less useful and less reliable. The use of LMW alone in PA film would allow more accurate prediction of aortic dissection. PA chest radiograph has a higher diagnostic accuracy when compared with AP chest radiograph, with negative PA chest radiograph showing less probability for aortic dissection. Lower threshold for proceeding to computed tomography aortogram is recommended however, especially in the elderly and patients with widened mediastinum on AP chest radiograph.

Objective Forward shifting of the posterior cervical dural sac is the most important sign in diagnosing Hirayama disease but can also be seen in normal subjects, causing potential diagnostic dilemma. We aim to explore the degree of forward displacement of posterior dural sac in normal subjects compared to that with Hirayama disease. Materials and methods 50 healthy male teenagers and 3 patients with Hirayama disease were recruited into the control group and patient group, respectively. MR imaging of the cervical spine was performed in both neutral and flexion positions for all subjects, with the following parameters measured: maximal distance of forward shifting of posterior dural sac, dimension of dural sac and spinal cord. Results Forward shifting of the posterior cervical dural sac was depicted in 46% of normal subjects upon flexion position but without associated cord compression due to intrinsic expansion of the spinal canal volume. This intrinsic compensatory mechanism was inadequate in diseased patients leading to cord compression with significant increment in ratio of anteroposterior diameter of forward displacement of posterior dural wall/anteroposterior diameter of spinal canal (“ x / y ”), and decrement in ratio of anteroposterior diameter of spinal cord/perpendicular transverse diameter of spinal cord (“ a / b ”). Conclusion Depicting of forward shifting of posterior dural sac alone on flexion position cannot reliably diagnose Hirayama disease, which should be established only if there is forward shifting of posterior dural sac, plus increased ratio of x / y and decreased ratio of a / b on flexion position from associated mass effect on the spinal cord.

GOALS To determine the clinical outcome of chronic hepatitis B cirrhotics on antiviral therapy. BACKGROUND The long-term outcome of hepatitis B cirrhotics on therapy remains to be characterized. METHODS A large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled in a treatment program of lamivudine ± adefovir therapy. Patients were analyzed for clinical outcomes, and predictors of these outcomes were evaluated by multivariate analysis. Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease score, and mortality were assessed. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression. RESULTS Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC, encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%, and 16.9%, respectively. The overall progression of liver-related complications was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9 were significantly associated with liver-related complications. Low albumin and low hepatitis B virus DNA were independent factors for liver-associated mortality. Lamivudine resistance did not affect mortality or liver disease progression. When stratified by Child-Pugh status, the mean survival of those with Child C cirrhosis was worse than Child A and B cirrhosis (P

Moyamoya disease is a chronic occlusive cerebrovascular disease affecting young patients. Its association with systemic lupus erythematosus (SLE) has not been well established though had been reported. Their similar acute neurological presentations can lead to diagnostic dilemma. We present a young Chinese female with known SLE initially presenting with unilateral moyamoya phenomenon, subsequently progressed to typical bilateral moyamoya disease 5 years later. We also compare various clinical parameters with other reported cases in past literatures.

Objective To review and compare initial high resolution computed tomography (HRCT) findings in patients with metapneumovirus pneumonia and severe acute respiratory syndrome (SARS-Coronovirus). Materials and methods 4 cases of metapneumovirus pneumonia (mean age of 52.3 years) in an institutional outbreak (Castle Peak Hospital) in 2008 and 38 cases of SARS-coronovirus (mean age of 39.6 years) admitted to Tuen Mun hospital during an epidemic outbreak in 2003 were included. HRCT findings of the lungs for all patients were retrospectively reviewed by two independent radiologists. Results In the metapneumovirus group, common HRCT features were ground glass opacities (100%), consolidation (100%), parenchymal band (100%), bronchiectasis (75%). Crazy paving pattern was absent. They were predominantly subpleural and basal in location and bilateral involvement was observed in 50% of patients. In the SARS group, common HRCT features were ground glass opacities (92.1%), interlobular septal thickening (86.8%), crazy paving pattern (73.7%) and consolidation (68%). Bronchiectasis was not seen. Majority of patient demonstrated segmental or lobar in distribution and bilateral involvement was observed in 44.7% of patients. Pleural effusion and lymphadenopathy were of consistent rare features in both groups. Conclusion Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS.

We report on a patient with subacute ruptured intracavernous carotid artery aneurysm presenting with nonspecific features of cavernous sinus thrombophlebitis initially, leading to delayed diagnosis. It alerts our awareness of the potential causes and consequences of cavernous sinus thrombophlebitis, in particular in the presence of complicating internal carotid artery aneurysm and hence, the importance of angiographic evaluation. The increased risk of thrombogenic event from coexisting inflammation raises difficulty in endovascular coiling of aneurysm, which would be further aggravated with presence of stent due to potential risk of stent infection from local spread, as demonstrated in our case with complicated parent artery occlusion due to in-stent thrombus formation during the procedure. Adequate antithrombotic therapy at both before and after the procedure is required and regular follow-up is mandatory.

6055Background: The AJCC/UICC 8th edition TNM staging classification for nasopharyngeal carcinoma (NPC) was launched in 2018. We previously proposed new stage groups which incorporated pretreatment...

A high integrated 10.2-inch WVGA LTPS LCDs with single-chip ASIC and manufactured by PMOS process was developed. Level shifters, DC-DC converters for gate driver with 2-phase shift registers and forward/reverse scanning function and 1:6 demultiplexer for source driver were integrated on the glass. The ASIC includes timing controller and 400-channel source driver. This architecture dramatically reduces cost with high mechanical robustness. Furthermore, the 6-Mask PMOS process also improves the throughput and reduces yield loss in manufacturing due to less photo layers than CMOS one, especially for large panel size. Therefore, this 10.2-inch panel is remarkable for high integration of PMOS LTPS design and the cost reduction

Objectives. To evaluate the differences in prognostic values of static and dynamic PET-CT in nasopharyngeal carcinoma (NPC).Material and Methods. Forty-five patients who had static scan were recruited. Sixteen had dynamic scan. The primary lesions were delineated from standardized uptake value (SUV) maps from static scan andKimaps from dynamic scan. The average follow-up lasted for 34 months. The patients who died or those with recurrence/residual disease were considered “poor outcome”; otherwise they were considered “good outcome.” Fisher’s exact test and ROC analysis were used to evaluate the prognostic value of various factors.Results. Tumor volume thresholded by 40% of maximal SUV (VOLSUV40) significantly predicted treatment outcome (p=0.024) in the whole cohort. In 16 patients with dynamic scan, all parameters by dynamic scan were insignificant in predicting the outcome. The combination of maximal SUV, maximalKi,VOLSUV40, andVOLKi37(the tumor volume thresholded by 37% maximalKi) achieved the highest predicting accuracy for treatment outcome with sensitivity, specificity, and accuracy of 100% in these 16 patients; however this improvement compared toVOLSUV40was insignificant.Conclusion. Tumor volume from static scan is useful in NPC prognosis. However, the role of dynamic scanning was not justified in this small cohort.

Arachnoid granulations are normal anatomical structure that allows cerebrospinal fluid (CSF) drainage from subarachnoid space into venous system. They are asymptomatic but rarely can become symptomatic when they are large enough to cause sinus occlusion. We report a rare occurrence of focal brain herniation into a giant arachnoid granulation in a pediatric patient after sustaining severe head trauma. We also highlight on the use of diffusion tensor tractography in helping to confirm the diagnosis.

SUMMARY: Radiation-induced peripheral nerve tumor, in particular a benign entity such as a neurofibroma, is rare, with only a few cases being reported so far. We demonstrate a case of radiation-induced neurofibromata along the left cervical nerve roots in a man with a background of localized targeted hypofractionated radiation therapy as adjuvant treatment for left cervical nodal metastasis complicating nasopharyngeal carcinoma. The toxicity of high-dose radiation in a hypofractionated regime is also stressed.

Acoustic rhinometry (AR) evaluates the geometry of the nasal cavity with acoustic reflections and provides information about nasal cross-sectional areas (CSA) and nasal volume within a given distance. The accuracy of the information obtained by AR was compared with that of magnetic resonance imaging (MRI) of the nasal cavity. Five healthy subjects were evaluated with AR and the MRI before and after the application of a long-acting nasal decongestant spray, to eliminate possible interference of the nasal cycle with both measurement techniques. The MRI images of 2 mm coronal sections of the nasal cavity were traced by three independent observers and the CSAs were calculated by computer-aided imaging digitization, to be compared with the calculated CSAs obtained with the AR at the corresponding distance from the nasal tip. Digitized data from the MRI images were also used to calculate the nasal volume within the first 6 cm from the nasal tip and compared with the AR volume measurements. The interobserver variation of digitized MRI data predecongestant and postdecongestant was not significant. The correlations of CSA and volume measurements between the AR and MRI were high (0.969) after the application of the decongestant. The correlation between the AR and MRI measurements before the decongestant was low (0.345). This may have been the result of interference of the nasal cycle during the long MRI measurements (1 hour) or other unknown factors. We conclude that AR measurements of nasal CSAs and volumes provide accurate information when compared with the MRI of the decongested nasal airway. (Otolaryngol Head Neck Surg 1997;117:349-54.)

To compare the intravoxel incoherent motion (IVIM) diffusion and perfusion characteristics of nasopharyngeal carcinoma (NPC) and post-chemoradiation fibrosis to aid in their differentiation. Fifty-three (64 %) patients with newly diagnosed NPC and 30 (36 %) patients with biopsy-proven post-chemoradiation fibrosis were recruited into tumour and fibrosis groups respectively. Diffusion-weighted magnetic resonance (MR) imaging was performed using 13 b values (0–1,000 s/mm2). Their respective IVIM parameters (D, pure diffusion; f, perfusion fraction; D*, pseudodiffusion coefficient) were obtained. D and f were significantly lower in NPC (D = 0.752 ± 0.194 × 10-3 mm2/s, P

ReRAM has been considered as one of the potential technologies for the next-generation nonvolatile memory, given its fast access speed, high reliability, and multi-level capability. Multiple-layered architectures have been used for several megabit test-chips and memory macros [1-3]. This paper presents a MeOx-based 32Gb ReRAM test chip developed in 24nm technology.

Improved technology in in vitro tests for allergen-specific immunoglobulin E has led to increased efficiency and faster turnaround times. ImmunoCAP (Pharmacia Diagnostics, Clayton, N.C.) is an in vitro-specific immunoglobulin E test that uses a three-dimensional cellulose solid allergen phase, which allows quick results in 6 hours. In comparison, modified Phadezym-RAST (Pharmacia Diagnostics) uses a two-dimensional solid phase, and results take 3 days to obtain. This study compares the sensitivity and specificity of CAP with that of modified RAST in the detection of specific immunoglobulin E, and it assesses the correlation of the individual class scores of CAP and modified RAST with end points obtained from skin-dilutional end-point titration. The reproducibility of CAP was also assessed. Patients evaluated at the University of Chicago Allergy Clinic who had a history and physical examination consistent with immunoglobulin E-mediated allergy and in whom skin testing was clinically indicated as part of their allergy management, were asked to donate some blood for simultaneous in vitro testing by PhadezymRAST and ImmunoCAP. Testing was performed in batches. Random samples from the CAP batches were chosen for duplicate runs under conditions blinded to the technician. Receiver operating curve analysis was used for comparison of the sensitivity and specificity of RAST vs. that of CAP. We used Pearson product-moment correlation coefficients to compare the correlation of RAST and CAP classes with the end points from skin testing. Our results indicate that the sensitivity and specificity of RAST and CAP are similar, that the classes of these two tests correlate well with the end points from skin testing, and that duplicate samples of CAP also correlate well.

Object Use of a flow-diverting device has shown promising short-term results in the management of vertebral artery (VA) dissecting aneurysms, but there is still uncertainty regarding its long-term efficacy and safety. The authors report their initial experience with respect to the potential utility and long-term clinical outcomes of using a flow-diverting device in the treatment of unruptured dissecting VA aneurysms. Methods The authors conducted a retrospective review of all cases of unruptured intracranial VA dissecting aneurysms treated at their institution (Tuen Mun Hospital) with a flow-diverting device. They describe the clinical presentations and angiographic features of the cases and report the clinical outcome (with modified Rankin Scale [mRS] scores) at most recent follow-up, as well as results of the latest angiographic assessment, with particular focus on in-stent patency and side-branch occlusion. Results A total of 4 aneurysms were successfully obliterated by using flow-diverting devices alone. Two devices were deployed in a telescoping fashion in each of 2 aneurysms, whereas only 1 device was inserted in each of the other 2 aneurysms. No periprocedural complication was encountered. No patient showed any angiographic evidence of recurrence, in-stent thrombosis, or side-branch occlusion in angiographic reassessment at a mean of 22 months after treatment (range 18–24 months). As of the most recent clinical follow-up (mean 30 months after treatment, range 24–37 months), all patients had favorable outcomes (mRS Score 0). Conclusions Reconstruction using a flow-diverting device is an attractive alternative in definitive treatment of dissecting VA aneurysms, demonstrating favorable long-term clinical and angiographic outcomes and the ability to maintain parent artery and side-branch patency. It is particularly useful in cases with eloquent side-branch or dominant VA involvement.

Acoustic rhinometry (AR) is a technique of measuring the cross-sectional area (CSA) of the nasal cavity by analyzing reflected sound waves. It allows a quantitative measurement of the changes of the nasal airway diameter after intranasal allergen challenge. In this study, AR is used to quantitate the degree of narrowing of the nasal cavity produced by various amounts of allergen challenge. Intranasal challenges were performed on seven subjects using radioallergosorbent test (RAST) discs of dust mite or ragweed allergens. At the same time, the (modified) mRAST class of the subjects was obtained by performing mRAST in vitro testing. Five subjects had positive mRAST scores to either dust mite or ragweed, and two subjects had negative mRAST scores. AR was performed prior to intranasal challenge to obtain a baseline. Then AR was performed 15, 30, and 45 minutes after the application of one RAST disc to the head of the inferior turbinate on both sides of the nose. The same measurements were taken after the serial application of two, three, and four RAST discs. For each AR measurement, the CSA at 10 locations in the nasal cavity was averaged for both sides. The endpoint is defined as the number of RAST discs required to produce a 50% reduction in the average CSA of the nasal cavity. We found that the endpoint correlates inversely with the mRAST class of the subject (r = –0.89). In the subjects with negative mRAST scores, no end point was found, even after challenge with four discs.

Objective To review the diagnostic power of various computed tomography (CT) signs in acute appendicitis, in particular those initially classified as inconclusive. Materials and methods Retrospective review of 100 CT abdomen and pelvis studies with assessment of maximal luminal diameter, wall thickness and cross-sectional diameter of the appendix, periappendiceal inflammatory changes, and presence of appendicolith. Results All CT signs show statistically significant occurrences in acute appendicitis. Their respective cut-off values with best sensitivity and specificity were calculated. Those from the inconclusive cases were also reviewed. Conclusion Maximal cross-sectional diameter of the appendix is the most powerful parameter. Rest of the CT signs is supportive, especially in cases with inconclusive results.

Patients with cirrhosis and sepsis had increased mortality.Determine factors associated with increased in-hospital mortality in cirrhotic patients admitted for sepsis.All cirrhotic patients admitted from 2004 to 2007 for sepsis were identified from hospital electronic database. Patients were included if they had liver cirrhosis and sepsis, defined as identified sources of infection, and at least one of fever, altered total white cell count, or raised C-reactive protein. Baseline characteristics, investigations, infections, and outcomes were collected. Main outcome measure was in-hospital mortality.A total of 205 admissions in 153 patients were included. In-hospital mortality rate was 24.4%. In predicting in-hospital death, area under the receiver-operating-characteristic curve for Child-Pugh score was 0.934, with optimum cut-off at 10 and above, while for model for end-stage liver disease (MELD) score was 0.751, with optimum cut-off at 17 and above. Four factors were significantly associated with in-hospital mortality on multivariate analysis: presence of1 site of infection, pneumonia, Child's C status, and MELD score 17 and above. In-hospital mortality rate increased with more factors: 0% with no factor, 7% with one factor, 21% with two factors, 87% with three factors, and 100% with four factors. The mortality of those with3 risk factors was significantly lower than those with three or more risk factors (7 vs. 91%, p = 0.000).Septic cirrhotic patients with pneumonia,1 site of infection, Child's C cirrhosis, and high MELD score had a high mortality risk.

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is an autosomal recessive disease characterized by early infantile macrocephaly and delayed motor and cognitive deterioration. Magnetic resonance imaging (MRI) shows diffusely abnormal and swollen cerebral white matter and subcortical cysts. On follow-up, atrophy ensues. Approximately 80% of MLC patients have mutations in MLC1. We report 16 MLC patients without MLC1 mutations. Eight retained the classical clinical and MRI phenotype. The other 8 showed major MRI improvement. They lacked motor decline. Five had normal intelligence; 3 displayed cognitive deficiency. In conclusion, 2 phenotypes can be distinguished among the non-MLC1 mutated MLC patients: a classical and a benign phenotype.

Originally published in the journal Group Decision and Negotiation: http://www.springerlink.com/content/100270/ Electronic Meeting Systems (EMS) are intended to support group collaboration in completing tasks. While there have been many case studies and laboratory experiments on how EMS can support group tasks, large scale macro investigations exploring EMS adoption and use have been practically non-existent. Furthermore, while several barriers to EMS adoption and use have been suggested, their validation across organizations remains unexplored. We undertook a global initiative to explore information technology support for task-oriented collaboration in the US, Australia, Hong Kong, and Norway. In this paper, we focus specifically on assessing the adoption and use of EMS, and barriers to their adoption and use in organizations across the four regions. Our results suggest that EMS currently have limited adoption and are used infrequently across all the four regions. A further investigation into barriers to EMS adoption and use suggests that significant numbers of respondents do agree with a list of fourteen suggested barriers. However, while there is significant agreement between two countries (US & Australia) over how these barriers are ranked, there is no significant agreement between the remaining pairs of countries. Implications of our findings are discussed for practitioners and researchers.

Chronic hepatitis C is a principal indication for liver transplantation. Recurrent viral infection is inevitable and graft disease is common. We report tolerability, safety and efficacy of pegylated interferon alpha 2b (PEG-IFN) monotherapy for patients with hepatitis C virus (HCV) recurrence and fibrosis after liver transplantation. Repeated measurements of serum HCV titer permitted assessment of the kinetics of the antiviral response for all patients. We screened 63 patients transplanted for HCV at our center for antiviral treatment, 14 were eligible and treated, but only 6 completed the proposed 52 weeks of therapy. Eight were withdrawn because of severe/life-threatening side effects/events, including liver dysfunction (4 patients). None of those 8 achieved a sustained virological response (SVR). Five of 6 who completed treatment were HCV RNA negative at the end of treatment, and 2 achieved an SVR. Viral kinetics were similar to published observations for treatment of non-transplanted HCV patients. Patients with genotype non-1 infection displayed a more rapid decline of viral titer than was observed for genotype 1 infection. Post-transplant HCV patients are frequently unsuitable for, or intolerant of PEG-IFN. Liver dysfunction was a major concern.

EDITOR—The incidence of obesity in the United Kingdom is increasing in parallel with an increase in the use of slimming aids, including traditional Chinese medicines. The safety and quality of herbal medicines have been weakly regulated because of an exemption in the Medicines Act 1968 that allowed them to be marketed without going through stringent criteria required for licensing of …