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This letter presents a novel rectifying metasurface with high efficiency at low power applicable to wireless power transfer and energy harvesting. The proposed rectifying metasurface is a two-sided structure consisting of modified electric-inductive-capacitive unit cells on one side and a rectifying circuitry on the other, designed to resonate and rectify at 2.45 GHz. Each unit cell is directly connected to a voltage-doubler rectifier, allowing the incident microwaves to be directly rectified upon reception. The impedance characteristics and rectification performance of the proposed rectifying metasurface are tested via numerical simulation and measurement, respectively. The measured results demonstrate an overall conversion efficiency (electromagnetic power absorption + rectification) of 76.8% at 0.4 dBm incident power.

PURPOSE: During radiotherapy (RT), patient symptoms are evaluated and managed weekly during physician on-treatment visits (OTVs). The Edmonton Symptom Assessment Scale (ESAS) is a 9-symptom validated self-assessment tool for reporting common symptoms in patients with cancer. We hypothesized that implementation and physician review of ESAS during weekly OTVs may result in betterment of symptom severity during RT for certain modifiable domains. METHODS: As an institutional quality improvement project, patients were partitioned into 2 groups: (1) 85 patients completing weekly ESAS (preintervention) but blinded to their providers who gave routine symptom management and (2) 170 completing weekly ESAS (postintervention group) reviewed by providers during weekly OTVs with possible intervention. To determine the independent association with symptom severity of the intervention, multivariate logistic regression was performed. At study conclusion, provider assessments of ESAS utility were also collected. RESULTS: Compared with the preintervention group, stable or improved symptom severity was seen in the postintervention group for pain (70.7% v 85.6%; P = .005) and anxiety (79.3% v 92.9%; P = .002). The postintervention group had decreased association (on multivariate analysis) with worsening severity of pain (OR, 0.13; P < .001), nausea (OR, 0.25; P = .023), loss of appetite (OR, 0.30; P = .024), and anxiety (OR, 0.19; P = .005). Most physicians (87.5%) and nurses (75%) found ESAS review useful in symptom management. CONCLUSION: Incorporation of ESAS for OTVs was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, anti-emetics, appetite stimulants, and anti-anxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.

ObjectivesWe aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe.MethodsThe online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries.ResultsCentres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors.ConclusionThe first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.

Metasurfaces allow the rapid development of compact and flat electromagnetic devices owing to their capability in manipulating the wavefront of electromagnetic waves. Particularly, with respect to the metasurface lenses, wide operational bandwidth and wide incident angle behavior are critically required for practical applications. Herein, a single-layer phase gradient metasurface lens is presented to achieve millimeter-wave focusing at a focal point of 13 mm regardless of the incident angle. The proposed metasurface lens is fabricated by constructing subwavelength-thick (

BACKGROUND AND OBJECTIVES: Idiopathic uric acid nephrolithiasis, which is closely associated with obesity and the metabolic syndrome, is increasing in prevalence. Unduly acidic urine pH, the quintessential pathophysiologic feature of this disease, is in part explained by inadequate excretion of the principal urinary buffer ammonium. The role of net acid excretion in the pathogenesis of uric acid nephrolithiasis is incompletely understood. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compared acid-base parameters of patients with idiopathic uric acid nephrolithiasis with matched control subjects under controlled diets in an inpatient metabolic unit. Measurements included fasting blood and 24-hour urine chemistries and 24-hour urine metabolomic analysis. Comparisons between groups included analysis of covariance models controlling for urine pH or body mass index. RESULTS: Subjects with idiopathic uric acid nephrolithiasis had lower urine pH (5.5 versus 5.9; P

The Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) project has described phenotypic differences of severe asthma using a systems biology approach. We obtained three molecular phenotypes termed transcription-associated clusters (TACs) using hierarchical clustering of differentially expressed transcripts between T2-high and T2-low [1]. TAC1 was characterised by receptors IL33R, CCR3 and TSLPR, with the highest enrichment of gene signatures for IL-13/type-2 (T2) inflammation with sputum eosinophilia; TAC2 by inflammasome-associated genes, interferon-α (IFN-α) and tumour necrosis factor-α (TNF-α)-associated genes with sputum neutrophilia; and TAC3 by metabolic and mitochondrial function genes with pauci-granulocytic inflammation. Given that sputum eosinophilia may vary with time in many asthmatic subjects [2, 3], we hypothesised that TAC status may also change with time., At 1 year, 45% of severe asthma change molecular phenotype as determined by sputum transcriptomic analysis. Together with concomitant shift in sputum granulocytic markers, this may indicate variability of driving mechanisms in this unstable group. https://bit.ly/35aj489

Expectations or predictions about upcoming content play an important role during language comprehension and processing. One important aspect of recent studies of language comprehension and processing concerns the estimation of the upcoming words in a sentence or discourse. Many studies have used eye-tracking data to explore computational and cognitive models for contextual word predictions and word processing. Eye-tracking data has previously been widely explored with a view to investigating the factors that influence word prediction. However, these studies are problematic on several levels, including the stimuli, corpora, statistical tools they applied. Although various computational models have been proposed for simulating contextual word predictions, past studies usually preferred to use a single computational model. The disadvantage of this is that it often cannot give an adequate account of cognitive processing in language comprehension. To avoid these problems, this study draws upon a massive natural and coherent discourse as stimuli in collecting the data on reading time. This study trains two state-of-art computational models (surprisal and semantic (dis)similarity from word vectors by linear discriminative learning (LDL)), measuring knowledge of both the syntagmatic and paradigmatic structure of language. We develop a `dynamic approach' to compute semantic (dis)similarity. It is the first time that these two computational models have been merged. Models are evaluated using advanced statistical methods. Meanwhile, in order to test the efficiency of our approach, one recently developed cosine method of computing semantic (dis)similarity based on word vectors data adopted is used to compare with our `dynamic' approach. The two computational and fixed-effect statistical models can be used to cross-verify the findings, thus ensuring that the result is reliable. All results support that surprisal and semantic similarity are opposed in the prediction of the reading time of words although both can make good predictions. Additionally, our `dynamic' approach performs better than the popular cosine method. The findings of this study are therefore of significance with regard to acquiring a better understanding how humans process words in a real-world context and how they make predictions in language cognition and processing.

Hyperuricemia is more prevalent among people with obesity and metabolic syndrome, and is associated with adverse clinical outcomes. We hypothesized that increased renal reabsorption of uric acid (UA) in obesity and metabolic syndrome may be an adaptive response of the kidney when faced with fatty acid-induced oxidative stress. To test this hypothesis, we examined lipid accumulation, markers of oxidative stress, and renal UA handling in Zucker diabetic fatty (ZDF) rats, and in matched lean control animals. Rats were randomized to either normal rodent chow or a diet supplemented with antioxidants (α-tocopheryl acetate, sodium selenite, zinc sulfate, and ascorbic acid), and were followed up for either 4 or 20 weeks after randomization. Dietary antioxidant supplementation had no significant effects in lean control rats but led to partial improvement in markers of elevated oxidative stress in the kidney of ZDF rats. Renal UA handling was not affected by antioxidant supplementation. We observed robust correlations between renal lipid content and oxidative stress markers in the pooled experimental groups, particularly in older animals after 20 weeks on the study diets. Dietary antioxidant supplementation did not prevent the gradual decline in renal function observed in older ZDF rats. These findings suggest that hyperuricemia in the ZDF rat model of obesity and the metabolic syndrome is not caused by renal oxidative stress, that there may be a pathophysiological link between lipid accumulation and oxidative stress in the kidney, and that antioxidant supplementation does not prevent age-related decline in renal function in ZDF rats.

We present a metasurface superstrate designed to improve reception of incident waves in far-field wireless power transfer and energy harvesting at Ka-band. The proposed metasurface consists of four metal layers filled with three thin substrates that make up a flat lens to focus incident plane waves. Numerical simulation is performed to verify the proposed metasurface design and its focusing ability.

This paper presents a Rotman lens as a retrodirective beamforming system applicable to far-field wire- less power transfer at millimeter-wave frequencies (Ka-Band). In particular, the proposed Rotman lens is designed to operate at 28-38 GHz. The designed Rotman lens consists of seven-input and eight-output ports that feed a linear Vivaldi array and its performance is validated via numerical simulation. The results demonstrate the beamforming capability of the Rotman lens over a scan range of ±30°.

In this work, the performance of a recently proposed broadband RF-to-DC rectifier is evaluated for short pulses. The rectifier is designed to cover 0.61 – 1.36 GHz based on the impedance bandwidth. However, this impedance bandwidth is based on the measurement at discrete frequencies and may not be linearly scalable to short wideband pulses due to the nonlinear characteristics of the diodes. Therefore, in order to evaluate the performance of the rectifier on short pulses, a test is performed via circuit simulation using Gaussian input pulses with various pulsewidths and pulse repetition intervals. The results demonstrate that the broadband rectifier still exhibits sufficient rectification efficiency even for very short pulses. Although the rectification efficiency decreases with shorter pulsewidths, the efficiency can be further improved by optimizing the pulse repetition interval and input power.

BackgroundEarly detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. This study evaluated a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment.Methods99 participants diagnosed with Dementia, Mild Cognitive Impairment (MCI), or Normal Cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group.ResultsBrainCheck battery performance showed significant differences between the NC, MCI, and Dementia groups, achieving ≥88% sensitivity/specificity for separating NC from Dementia, and ≥77% sensitivity/specificity in separating the MCI group from NC/Dementia groups. Three-group classification found true positive rates ≥80% for the NC and Dementia groups and ≥64% for the MCI group.ConclusionsBrainCheck was able to distinguish between diagnoses of Dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.

Objective To evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC). Materials and methods The National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 M0 OPSCC (AJCC v.7) who underwent treatment from 2010 to 2016. Demographics, tumor characteristics, treatment type, social, and geographic factors were all collected. Univariate analysis and multivariate logistic regression were then performed. Results Among 9267 identified patients, 1774 (19.1%) received transoral robotic surgery (TORS), 1191 (12.9%) received transoral endoscopic surgery, and 6302 (68%) received radiation therapy. We found that lower cancer stage, lower comorbidity burden and HPV- positive status predicted a statistically significant increased likelihood of receiving surgery. Patients who reside in suburban or small urban areas (>1 million population), were low-to- middle income, or rely on Medicaid were less likely to receive surgery. Patients that reside in Medicaid-expansion states were more likely to receive TORS (p > .0001). Patients that reside in states that expanded Medicaid January 2014 and after were more likely to receive non-robotic transoral endoscopic surgery (p > .0001). Conclusions Poorer baseline health, lower socioeconomic status and residence in small urban areas may act as barriers to accessing minimally invasive transoral surgery while residence in a Medicaid-expansion state may improve access. Barriers to accessing robotic surgery may be greater than accessing non-robotic surgery.

Mildly elevated serum uric acid levels are common in people with metabolic syndrome and type 2 diabetes mellitus (T2DM), but whether elevated uric acid has a causal role in the pathogenesis of diabetes remains uncertain. We tested whether chronic mild hyperuricemia in rodents under controlled laboratory conditions can cause glucose intolerance in otherwise healthy animals, or whether it can worsen glucometabolic control in animals that are genetically predisposed to T2DM. We used an established model of experimental hyperuricemia in rodents with potassium oxonate dietary supplementation, which led to sustained, approximately two-fold elevation of uric acid compared with control animals. We also reversed the hyperuricemic effect of oxonate in some animals by treatment with a xanthine oxidase inhibitor. Manipulation of serum uric acid levels in Sprague-Dawley rats for up to 18 weeks did not affect fasting glucose and glucose tolerance. Blood pressure was also not affected by hyperuricemia in rats fed a Western-type diet. We next sought to determine whether uric acid may aggravate or accelerate the onset of glucometabolic abnormalities in rats already predisposed to T2DM. Chronic oxonate treatment in Zucker diabetic fatty (ZDF) and lean control rats for up to 6 weeks did not affect fasting glucose, insulin, and glucose tolerance in ZDF rats. Taken together, these findings indicate that elevated uric acid does not directly contribute to the pathogenesis of glucose intolerance and T2DM in rodents.

An ultra-compact pulse compressor for generating ultrawideband short pulses is proposed and tested. The proposed pulse compressor consists of a thin copper-coated dielectric laminate to form an ‘ultra-compact’ reverberant cavity, where a time-reversal-based input pulse is compressed into an ultrawideband short pulse. The proposed pulse compressor is validated via numerical simulation and measurement, and results show that a short pulse is generated with a peak gain of >10 dB.

Background: The purpose of this study was to investigate the incidence and timing of postoperative symptomatic pulmonary embolism (PE) in patients receiving non-warfarin following primary total joint arthroplasty (TJA), to clarify the appropriate duration of postoperative VTE prophylaxis. Methods: We retrospectively reviewed the medical records of 11148 patients who underwent primary TJA, including total knee arthroplasty (TKA) and total hip arthroplasty (THA) at our institution from January 2012 to March 2019. The median postoperative day of diagnosis of symptomatic PE and interquartile range for day of diagnosis were determined. Multivariate Cox proportional hazards modeling was used to test the difference of timing for PE based on demographics and comorbidities. Results: The overall 90-day rate of symptomatic PE was 0.71%. The median day of diagnosis for symptomatic PE was 3 day postoperatively (interquartile: 2–7 day). Factors that showed statistical significance on multivariate analysis in association with earlier timing of PE occurrence in patients with atrial fibrillation, diabetes mellitus, coronary heart disease and history of stroke. Conclusion: The vast majority symptomatic PE occurs in the early postoperative period after TJA, and atrial fibrillation, diabetes mellitus, coronary heart disease and history of stroke were independent factors affecting the timing of symptomatic PE.

An encryption device based on wave-chaos for enhanced physical security of wireless wave transmission is presented. The proposed encryption device is composed of a compact 2D wave-chaotic (disordered) cavity, where a signal passes through before transmission to be distorted in a random fashion. On the receive end, the signal can only be decrypted when it passes through the same device. If a different cavity is used in the receiver, a completely different wave dynamic in that cavity prevents the signal from being decrypted and cause it to appear as noise. We numerically validate the proposed concept.

In this paper, we present a dual-polarized rectifying metasurface designed for far-field wireless power transmission and energy harvesting at 2.45 GHz band. The proposed rectifying metasurface is a double-sided structure, where the front and back sides consist of metasurface unit cells and rectifying circuits, respectively. The metasurface unit cell is a diagonally symmetric design that allows reception of vertical and horizontal polarizations. The rectifying circuitry on the back side is linked with the metasurface through a via hole. We verify the proposed rectifying metasurface with numerical simulation. The results show good rectification efficiency for both polarizations.

Background Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high-risk nonendemic patients. Methods Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group. Results On MVA, NAC-improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046). Conclusions NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.

Gastro-oesophageal reflux disease (GORD) and obesity are associated with frequent exacerbations and poor quality of life in asthmatics. Multiple mechanisms have been proposed for the effect of obesity, including modification of inflammation affecting epithelial cell proliferation and wound repair, while the role of GORD is poorly understood and proton pump inhibitor (PPI) are of variable efficacy. GORD might exert a deleterious effect by inducing vagal reflex, neuroinflammation and directly ( via microaspiration) triggering airway inflammation. Studies of reflux in animal models and human bronchial epithelial cell culture show varying impact on inflammation and airway remodelling. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr PEROTIN has nothing to disclose. Conflict of interest: Dr Schofield has nothing to disclose. Conflict of interest: Dr Wilson has nothing to disclose. Conflict of interest: Dr Ward has nothing to disclose. Conflict of interest: Dr Brandsma has nothing to disclose. Conflict of interest: Dr Strazzeri has nothing to disclose. Conflict of interest: Dr Bansal has nothing to disclose. Conflict of interest: Dr Yang has nothing to disclose. Conflict of interest: Dr Rowe reports and a full time employee and shareholder of Janssen Pharmaceutical Companies of Johnson and Johnson. Conflict of interest: Miss Corfield has nothing to disclose. Conflict of interest: Dr Lutter has nothing to disclose. Conflict of interest: Prof. Shaw reports personal fees and non-financial support from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Teva, personal fees from Circassia, and a grant from GSK, outside the submitted work. Conflict of interest: Dr Bakke reports personal fees from GSK, AZ, Novartis andTeva, outside the submitted work. Conflict of interest: MC have no conflict of interest to disclose. Conflict of interest: Dr Dahlen has nothing to disclose. Conflict of interest: Dr Fowler reports personal fees and non-financial support from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Teva, outside the submitted work. Conflict of interest: Dr Horvath reports personal fees from Astra Zeneca, Boehringer Ingelheim, Novartis, CSL, Chiesi, Roche, GSK, Berlin-Chemie and Sandoz, outside the submitted work. Conflict of interest: Dr Howarth reports personal fees from GSK, outside the submitted work. Conflict of interest: Dr Krug has nothing to disclose. Conflict of interest: Dr Montuschi has nothing to disclose. Conflict of interest: Dr Sanak has nothing to disclose. Conflict of interest: Dr Sandstrom reports other monetary support from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr Sun has nothing to disclose. Conflict of interest: Dr Pandis has nothing to disclose. Conflict of interest: Dr Auffray reports grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Dr De Meulder reports grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Ms. Lefaudeux reports grants from Innovative Medicine Initiative, grants from Innovative Medicine Initiative, during the conduct of the study. Conflict of interest: Dr Riley reports and I have shares in and I am employed by GSK. Conflict of interest: Dr Sousa has nothing to disclose. Conflict of interest: Dr Dahlen has nothing to disclose. Conflict of interest: Dr Adcock reports grants from EU-IMI, during the conduct of the study. Conflict of interest: KFC has received honoraria for participating in Advisory Board meetings of GSK, AZ, BI, Teva, Novartis and Merck regarding treatments for asthma and chronic obstructive pulmonary disease and has also been renumerated for speaking engagements. Conflict of interest: Dr Sterk reports grants from Innovative Medicines Initiative, during the conduct of the study. Conflict of interest: Dr Skipp has nothing to disclose. Conflict of interest: Dr Collins reports a patent application for use of a genetically modified Drosophila line carrying one or more mammalian genes associated with a chronic respiratory disease and uses to screen the impact of such genes. Conflict of interest: Dr Davies has nothing to disclose. Conflict of interest: Dr Djukanovic reports receiving fees for lectures at symposia organised by Novartis, AstraZeneca and TEVA, consultation for TEVA and Novartis as member of advisory boards, and participation in a scientific discussion about asthma organised by GlaxoSmithKline. He is a co-founder and current consultant, and has shares in Synairgen, a University of Southampton spin out company.

Background Multilevel data integration is becoming a major area of research in systems biology. Within this area, multi-‘omics datasets on complex diseases are becoming more readily available and there is a need to set standards and good practices for integrated analysis of biological, clinical and environmental data. We present a framework to plan and generate single and multi-‘omics signatures of disease states. Methods The framework is divided into four major steps: dataset subsetting, feature filtering, ‘omics-based clustering and biomarker identification. Results We illustrate the usefulness of this framework by identifying potential patient clusters based on integrated multi-‘omics signatures in a publicly available ovarian cystadenocarcinoma dataset. The analysis generated a higher number of stable and clinically relevant clusters than previously reported, and enabled the generation of predictive models of patient outcomes. Conclusions This framework will help health researchers plan and perform multi-‘omics big data analyses to generate hypotheses and make sense of their rich, diverse and ever growing datasets, to enable implementation of translational P4 medicine. Electronic supplementary material The online version of this article (10.1186/s12918-018-0556-z) contains supplementary material, which is available to authorized users.

Benefits of surgical resection for early-stage nonepithelioid malignant pleural mesothelioma (MPM) have not been clearly elucidated. This study investigated whether cancer-directed surgery affects overall survival compared with nonsurgical therapies for T1-T2 N0 M0 sarcomatoid or biphasic MPM patients.Adult patients with clinical stage I or II MPM were identified in the National Cancer Database from 2004 to 2103. Patients who underwent cancer-directed surgery were matched by propensity score with patients who had received chemotherapy/radiotherapy or no treatments. Overall survival was compared using a Cox proportional hazard regression model.From National Cancer Database queries, 878 patients with clinical stage I or II MPM with sarcomatoid (n = 524) or biphasic (n = 354) histology were identified. Overall median survival was 5.5 months for patients with sarcomatoid mesothelioma. The cancer-directed surgery improved overall survival compared with no operation (median survival, 7.56 months vs 4.21 months, respectively; p0.01). In the biphasic group, median overall survival was 12.2 months. Again, the cancer-directed surgery improved survival compared with no operation (15.8 months vs 9.3 months, p0.01). For both histologies, the cancer-directed surgery improved overall survival compared with those who underwent chemotherapy or radiotherapy, or both, without resection (p0.05). Perioperative mortality was 6.0% at 30 days and 21.4% at 90 days.The cancer-directed surgery is associated with improved survival in early-stage MPM patients with nonepithelioid histology compared with those who did not undergo resection or chose medical therapy. Given the high perioperative mortality, a careful patient selection and multidisciplinary evaluation is recommended.

To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in 18F-FDG-PET scan. A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, 18F-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups ( 200 mg/dl). Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p 200 mg/dl had significantly lower SUVmax. If BGL is lower than 200 mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.

This paper proposes the differential coding in visible light communication using image sensor. The transmitted frame is a result of comparing the current bitstream with previous bitstreams. The purpose of this scheme is limiting the number of white LED in one frame to mitigate the interpixel interference (IPI). The image sensor is used to take snap consecutive image frames. The simulation outcome shows that proposed scheme gains the BER performance.

Objective To calculate dose delivered to the lumbosacral plexus (LSP) with cervical brachytherapy using 3-dimensional imaging, and to compare this with the position of the tandem in the pelvis using bony landmarks. We also report long-term LSP toxicity outcomes. Methods and Materials Treatment planning images from 55 patients treated with tandem and ring brachytherapy from October 2009 through November 2012 were reviewed. The LSP was contoured on planning computed tomographic scans to calculate dose received. Lumbosacral plexus dose was studied as a function of tandem distance from the sacrum and pubic symphysis (STratio) measured on digitally reconstructed radiographs. Patient and implant characteristics were included as covariates on LSP dose. Clinical follow up on LSP toxicity was recorded. Results Patients were prescribed 550 to 700 cGy using computed tomography–based imaged-guided brachytherapy for 4 to 5 fractions. The maximum dose to 2 cc (D2cc) of LSP ranged from 44 to 287 cGy per implant. The median D2cc was 118 cGy, corresponding to 18% of prescription dose. Patients with an STratio less than 0.33 (closer to the sacrum) and at least 0.33 had median LSP doses of 138 and 98 cGy, respectively. Lumbosacral plexus dose did not change significantly with body mass index, uterus position, or tumor stage. Two patients reported symptoms of peripheral neuropathy, with a median follow-up of 14.7 months. Conclusions The mean D2cc per fraction to the LSP is roughly 20% of the prescribed high dose-rate and varies with the position of the tandem from the sacrum. The dose threshold for radiation-induced neuropathy of the LSP remains undefined.

In this paper, we demonstrate a device that is capable of generating an ultrashort (sub-nanosecond) high power microwave pulse by means of passive pulse compression in a compact reverberant cavity. The long duration input pulse into the cavity is created using time-reversal techniques, which allows the waveform to contain the inverse profile of the cavity phase distortion. When fed back into the cavity, the wave focusing at the output port results in a compressed ultrashort pulse with enhanced peak amplitude. We experimentally demonstrate a pulse compressor consisting of a 0.0074 m 3 cavity capable of generating a 130 picosecond pulse from an input waveform of 300 nanosecond duration with the peak gain of up to 19 dB.

Objective To evaluate the role of concurrent systemic therapy to postoperative radiation therapy (RT) for locally advanced cutaneous head and neck squamous cell carcinoma (LA-cHNSCC). Materials and methods A retrospective study of 32 patients with LA-cHNSCC receiving postoperative RT with and without systemic therapy was conducted. Patients with LA-cHNSCC after surgical resection with one or more high risk features were evaluated. Local regional control (LRC), distant control (DC), and acute and late toxicities were evaluated with Fisher exact tests. Progression-free survival (PFS) and overall survival (OS) were evaluated utilizing Kaplan Meier and log-rank analyses. Univariate Cox proportional hazard analyses were used to examine patient, disease, and treatment-related factors with OS and PFS. Results While comparing patients receiving RT with systemic therapy (n = 14) vs RT alone (n = 18), LRC was 92.9% vs 72.2% (p = 0.20), DC 92.9% vs 94.4% (p = 1.0), median PFS 17.7 months vs 34.4 months (p = 0.48), and median OS 20.9 months vs 34.4 months (p = 0.03), respectively. On univariate analyses, use of concurrent systemic therapy was associated with an increased risk of death with an HR of 3.5 [95% confidence interval (CI): 1.04 - 11.6] (p = 0.04), while patients treated for recurrent disease who had previously treated superficial primaries had improved OS with an HR of 0.10 [95% CI: 0.01-0.80] (p = 0.03). There were no significant differences in acute or chronic toxicities between groups. Conclusions Patients receiving postoperative RT alone for LA-cHNSCC had better OS than patients receiving concurrent systemic therapy. There were no differences in any other endpoints evaluated.

Rationale: A proportion of severe asthma patients suffers fro m persistent airflow limitation, often associated with more symptoms and exacerbations . Little is known about the underlying mechanisms. Aiming for discovery of unexplored potential mechanisms, we used Gene Set Variation Analysis (GSVA), a sensitive technique that can detect underlying pathways in heterogeneous samples. Methods: Severe asthma patients from the U -BIOPRED cohort with persistent airflow limitation (post -bronchodilator FEV 1 /FVC ratio < lower limit of normal) were compared to those without persistent airflow limitation. Gene expression was assessed on the total RNA of sputum cells, nasal brushin gs and endobronchial brushings and biopsies. GSVA was applied to identify differentially - enriched pre -defined gene signatures based on all available gene expression publications and data on airways disease. Results: Differentially -enriched gene signatures were identified in nasal brushings (1), sputum (9), bronchial brushings (1) and bronchial biopsies (4), that were associated with response to inhaled steroids, eosinophils, IL -13, IFN -alpha, specific CD4+ T -cells and airway remodeling. Conclusion: Persiste nt airflow limitation in severe asthma has distinguishable underlying gene networks that are associated with treatment, inflammatory pathways and airway remodeling. These results point towards targets for the therapy of persistent airflow limitation in sev ere asthma.

In this work, we present the DORT (decomposition of the time-reversal operator) technique in combination with pulse inversion (PI) applied to detection and selective focusing on nonlinear targets. When nonlinear targets of interest are present in a field of linear scatterers, the harmonic responses from the nonlinear targets can be used as a distinguishing feature when applying DORT. Furthermore, PI suppresses fundamental and odd order harmonics, retaining only the second harmonics originated from nonlinear targets of interest, thereby reducing clutter from unwanted linear scatterers and occasional natural nonlinear scatterers (rusty metals). Two-dimensional numerical simulations are presented for a basic demonstration of the proposed approach.

Objective Positron emission tomography/computed tomography (PET/CT) imaging for head and neck cancers (HNC) is commonly utilized for post-treatment assessment. Though PET/CT in this setting has been reported to have high negative predictive values (> 90%), positive predictive values have been reported at approximately 50%, leading to high rates of false positivity (FP) and troubling management decisions for both patient and practitioner. The objective of this study was to identify patient, disease, treatment and imaging factors that might be associated with a higher likelihood of FP on initial post-treatment PET/CT imaging for patients treated for HNC. Materials and methods A retrospective chart review was performed on 84 patients treated for HNC who received radiation therapy (RT) as part of their overall management from October 2005 to August 2013. Of the patients screened, 19 were found to have mucosally based squamous cell carcinoma (SCC) with positive initial post-treatment PET/CT studies (23%). Fisher’s exact test was used to analyze the association between categorical variables and FP, including patient's gender, disease laterality, primary tumor site and stage, nodal and overall stage, high dose RT fraction size, number of RT fractions completed, total RT dose, biologically effective dose and timing of PET/CT acquisition. Wilcoxon rank-sum test was used to analyze the association between continuous variables and FP, including patient age, total elapsed days of RT, an amount of infused fluorodeoxyglucose 18F-FDG, pre-PET/CT serum glucose levels, and maximum standardized uptake value SUVmax. Statistically significant findings were those that were deemed p 90%) in the post-treatment setting for HNC, high rates of FP remains a clinical challenge. Our study suggests that tumor stage (T-stage) may impact FP rates in positive initial post-treatment PET/CT scans. We recommend careful multidisciplinary discussion regarding positive PET/CT studies in the post-treatment setting for HNC, particularly if invasive intervention is considered.

In this letter, we present a nonlinear metamaterial capable of transitioning between a broadband reflective and broadband nonreflective state depending on the incident power level. Below the activation voltage, broadband reflectivity is created by forbidding propagation through the metamaterial as a result of the effective permittivity and permeability having different signs. Above the activation voltage, reflection is suppressed by matching the effective permittivity and permeability. Full-wave simulations are performed to analyze the electromagnetic characteristics of the structure, with experimental results presented at S-band frequencies in a WR-284 waveguide. These measurements demonstrate a 10 dB reduction in reflected amplitude over an 18% bandwidth, a 3-dB reduction over a greater than 30% bandwidth, and a maximum difference in reflection of nearly 42 dB.

In this letter, we present a new approach to beam-steering of short, ultrawideband (UWB) pulses using a single-feed radiating structure. Utilizing a radiator consisting of small apertures backed by a reverberating cavity, a time-reversal technique is applied to generate a short pulse at each aperture with the corresponding time delay for beamforming at a desired steering angle. In the process, we also employ a novel method to improve beamforming performance. This approach offers significantly simpler beamforming and steering of short pulses compared to conventional methods, which typically require a complex multifeed structure. Moreover, beam-steering of high-power short pulses is achievable using this approach with a suitable choice of feed.

Objectives/Hypothesis The clinical features and treatment outcomes of benign paroxysmal positional vertigo (BPPV) are known to be different depending on the type of and involved canal. This difference could be due to differences in the functional change of the otolith organ. Study Design Case series. Methods Forty-nine patients were diagnosed to primary BPPV; 18 were categorized as posterior canal canalolithiasis (PC canalolithiasis), and 31 were categorized as horizontal canal (HC) BPPV with canalolithiasis or cupulolithiasis (HC canalolithiasis or HC cupulolithiasis). Diagnostic interventions to measure vestibular functions were performed such as electronystagmography (ENG), videonystagmography (VNG), and static and dynamic subjective visual vertical (SVV). BPPV was confirmed with nystagmus during positioning/positional test under ENG and VNG. Static SVV was recorded with a light-emitting diode (LED) bar located in front of the patients before eccentric rotation and dynamic SVV was recorded during eccentric rotation with the LED bar. SVV angles were read by the examiner and analyzed. The measured values were compared to those of normal controls and each other. Results Dynamic SVV toward the lesion side in all subtypes of BPPV were significantly different from those of the controls; HC cupulolithiasis showed significantly lower values than those of PC canalolithiasis and HC canalolithiasis. Conclusions HC cupulolithiasis shows a lesser degree of utricular dysfunction compared with other subtypes. It could postulate the difference of pathophysiology between canalolithiasis and cupulolithiasis. Level of Evidence 4. Laryngoscope, 124:984–988, 2014

The use of tumor-specific resonances is investigated for more efficient microwave hyperthermia of breast cancer. This concept is based on the idea that an increased power coupling (or absorption) would take place at the resonance. For hyperthermia treatment, higher power absorption means faster temperature rise to a desired therapeutic level. The natural resonances would vary depending on the tumor size, shape, and breast tissue configuration. Therefore, by adaptively tuning the source frequency of an applicator corresponding to the tumor-specific natural resonance, it could improve the overall efficiency of hyperthermia treatment. In this article, we demonstrate this concept by applying the singularity-expansion method to estimate the natural resonances (poles) and using the frequency of the dominant pole as the tumor-specific frequency. The performance is evaluated via the power absorption density in the breast. Results from numerical simulations and a simple experiment shows that the optimal power absorption in the tumor takes place at the tumor-specific resonance frequency in comparison to other frequencies. Using a multielement array setup for focused microwave, we also demonstrate that the relative phase shift between the residues (of the poles) obtained at different array elements can be used for phasing the array to create a focus at the tumor. © 2013 Wiley Periodicals, Inc. Microwave Opt Technol Lett 55:2659–2665, 2013

In this paper, we demonstrate the use of a time reversal (TR) technique to effectively focus an arbitrary RF pulse at a remote location from a single-feed aperture for directed energy applications. The TR focusing is achieved by backing the aperture with a reverberating cavity, whose multipath environment enables the reconstruction of the aperture field distribution needed for directing the energy to the target location. Here, we use the impulse response between the target location and the time-reversal mirror (TRM) located inside the cavity to enable the effective transmission of arbitrary RF pulses, which are convolved with the time-reversed impulse response before transmission. The demonstration is carried out both numerically and experimentally for various RF pulses. The results show good temporal and spatial focusing at the target location. This approach could be an efficient selective “beamforming” method for directed energy, where it only requires a single feed and the impulse response between the ...

Objective Cross-talk between inflammation and angiogenesis pathways has been recently reported. The objectives of this study were to: (i) examine whether amniotic fluid (AF) concentrations of soluble endoglin (sEng), a protein with anti-angiogenic properties, change during pregnancy, parturition, or intra-amniotic infection and/or inflammation (IAI); (ii) determine whether an increase in sEng in the AF of patients with preterm labor (PTL) and preterm prelabor rupture of membranes (PROM) is associated with adverse neonatal outcomes; and (iii) investigate potential sources of sEng in AF. Study design A cross-sectional study was conducted to include patients in the following groups: (i) mid-trimester (n = 20); (ii) PTL with term delivery (n = 95); (iii) PTL leading to preterm delivery with (n = 40) and without IAI (n = 46); (iv) preterm PROM with (n = 37) and without IAI (n = 37); (v) term in labor (n = 48) and not in labor (n = 44). AF concentrations of sEng were determined by enzyme-linked immunosorbent assay. Chorioamniotic membranes, umbilical cord blood, and AF macrophages were examined for the expression of endoglin. Results (i) Patients with IAI had a higher median AF concentration of sEng than those without IAI (P = 0.02 for PTL and 0.06 for preterm PROM); (ii) AF concentrations of sEng in the 3rd and 4th quartiles were associated with IAI (OR 2.5 and 7.9, respectively); (iii) an AF sEng concentration ≥779.5 pg/mL was associated with bronchopulmonary dysplasia (BPD) (OR 7.9); (iv) endoglin was co-localized with CD14+ macrophages in AF pellets of patients with IAI by immunofluorescence and flow cytometry; and (v) the concentration of sEng in the supernatant was significantly increased after the treatment of macrophages with endotoxin or TNF-α. Conclusions Soluble endoglin participates in the host response against IAI. Activated macrophages may be a source of sEng concentrations in the AF of patients with IAI. An increase of sEng in the AF is associated with BPD and adverse neonatal outcomes.

In this work, we investigate how the sensitivity of a nanowire or nanoribbon sensor is influenced by the subthreshold slope of the sensing transistor. Polysilicon nanoribbon sensors are fabricated with a wide range of subthreshold slopes and the sensitivity is characterized using pH measurements. It is shown that there is a strong relationship between the sensitivity and the device subthreshold slope. The sensitivity is characterized using the current sensitivity per pH, which is shown to increase from 1.2% ph-1 to 33.6% ph-1 as the subthreshold slope improves from 6.2 V dec-1 to 0.23 V dec-1 respectively. We propose a model that relates current sensitivity per pH to the subthreshold slope of the sensing transistor. The model shows that sensitivity is determined only on the subthreshold slope of the sensing transistor and the choice of gate insulator. The model fully explains the values of current sensitivity per pH for the broad range of subthreshold slopes obtained in our fabricated nanoribbon devices. It is also able to explain values of sensitivity reported in the literature, which range from 2.5%pH-1 to 650%/pH-1 for a variety of nanoribbon and nanowire sensors. Furthermore, it shows that aggressive device scaling is not the key to high sensitivity. For the first time, a figure-of-merit is proposed to compare the performance of nanoscale field effect transistor sensors fabricated using different materials and technologies.

Purpose To generate a reproducible step-wise guideline for the delineation of the lumbosacral plexus (LSP) on axial computed tomography (CT) planning images and to provide a preliminary dosimetric analysis on 15 representative patients with rectal or anal cancers treated with an intensity-modulated radiotherapy (IMRT) technique. Methods and materials A standardized method for contouring the LSP on axial CT images was devised. The LSP was referenced to identifiable anatomic structures from the L4-5 interspace to the level of the sciatic nerve. It was then contoured retrospectively on 15 patients treated with IMRT for rectal or anal cancer. No dose limitations were placed on this organ at risk during initial treatment planning. Dosimetric parameters were evaluated. The incidence of radiation-induced lumbosacral plexopathy (RILSP) was calculated. Results Total prescribed dose to 95% of the planned target volume ranged from 50.4 to 59.4 Gy (median 54 Gy). The mean (± standard deviation [SD]) LSP volume for the 15 patients was 100 ± 22 cm(3) (range, 71-138 cm(3)). The mean maximal dose to the LSP was 52.6 ± 3.9 Gy (range, 44.5-58.6 Gy). The mean irradiated volumes of the LSP were V40Gy = 58% ± 19%, V50Gy = 22% ± 23%, and V55Gy = 0.5% ± 0.9%. One patient (7%) was found to have developed RILSP at 13 months after treatment. Conclusions The true incidence of RILSP in the literature is likely underreported and is not a toxicity commonly assessed by radiation oncologists. In our analysis the LSP commonly received doses approaching the prescribed target dose, and 1 patient developed RILSP. Identification of the LSP during IMRT planning may reduce RILSP. We have provided a reproducible method for delineation of the LSP on CT images and a preliminary dosimetric analysis for potential future dose constraints.

The purpose of this study was to analyze inter- and intra-fractional changes in tumor volume with respect to both spatial and volumetric parameters among patients treated by SBRT for lung cancer. Twelve patients (13 tumors) were treated by SBRT with abdominal compression in 3–5 fractions over a 2 week period to a median dose of 60 Gy (range, 48 to 60 Gy). Kilovoltage cone-beam CT (CBCT) was obtained prior to the delivery of each fraction as well as intra-fractionally yielding a total of 55 CBCT scans. All CBCT scans were registered with the planning CT for target alignment and shifts were recorded and analyzed. Retrospectively, gross tumor volume (GTV) was contoured on all CBCT images and compared to initial planning volumes; positional differences were evaluated utilizing directional and vector analysis. Shifts greater than 5 mm were applied inter-fractionally in 6.8% (lateral), 29.5% (longitudinal), and 6.8% (vertical) of all delivered treatments. Using a 10 mm threshold, the corresponding percentages were 2.3%, 13.6%, and 2.3%, respectively. Across all fractions, the calculated inter-fractional shift vectors ranged from 0 to 31.2 mm, with 40.9%, 15.9%, and 11.4% of all fractions having shift vectors ≥5 mm, ≥10 mm, and ≥20 mm, respectively. Intra-fractional shifts were also evaluated and found negligible in a small portion of patients evaluated. The mean overall reduction in GTV was 21.1% during SBRT. Significant changes in both position and volume occur during SBRT for lung cancer. Shifts (particularly in the superior-inferior axis) may exceed applied margins and compromise target coverage. Due to the extreme hypofractionation associated with SBRT, inter-fractional image guidance is necessary.