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Rationale and Objectives Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification. Materials and Methods We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA). Segmental stenosis on CTA was measured using three window settings: width of 1000 Hounsfield units (HU) and level of 200 HU (“default”), 1500/200 HU (“widened”), and width and level based on the mean HU of the calcified plaque and pericoronary fat (“calcium-specific”). Segmental stenosis on ICA was quantified by a blinded experienced reader. Results ICA found ≥50% stenosis in 30 segments. Displaying segments with widened and calcium-specific settings improved overall accuracy of detecting ≥50% stenosis ( P 's P 's P 's Conclusions We showed for the first time that in calcified segments, widening display window width significantly improved CTA quantification of stenosis compared to ICA.

A general approach to the surface control of the localization, guiding, and redirecting of volume-mode light in photonic waveguides via tailoring their interfaces (surfaces) is proposed. The approach is demonstrated for dielectric rod-type photonic crystal slabs, whose regular and defect parts are distinguished by whether the nanocylinders are covered by metal caps. Thus, the rod-array part of the structure is not changed, while the local modifications are only applied to the interfaces. The basic functionalities, i.e., localized volume wave guiding, bending, and splitting are achievable. Selective dual-mode operation is possible due to the co-existence of a defect mode and a chainlike mode in one structure.

Conflicting data exists on the role of exercise interventions in patients with prostate cancer (PCa) regarding quality of life (QOL) endpoints.To evaluate the effects of exercise interventions on fatigue, QOL, depression, and anxiety in PCa patients.We searched seven major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and Scopus) for randomized control trials (RCTs) of supervised exercise interventions for men with PCa from database inception to October 2015. For meta-analyses, studies required standardized fatigue, QOL, or mood-related scales with standard-care control groups. The effect size was measured in terms of mean difference (MD) with 95% confidence interval (CI) for continuous outcomes using a random-effects model. Statistical heterogeneity between studies was assessed using the Cochrane Q test and IWe selected 13 RCTs enrolling 1057 PCa patients (mean age 69.4±2.1 yr) undergoing exercise interventions, of which eight studies involving 675 patients qualified for meta-analyses. The study duration varied from 4 wk to 6 mo. A 12-16-wk exercise intervention significantly improved fatigue symptoms (MD 4.83, 95% CI 3.24-6.43; p0.00001) as assessed according to the Functional Assessment of Cancer Therapy (FACT)-Fatigue scale. Fatigue remained improved at 6 mo (MD 3.60, 95% CI 2.80-5.12; p0.00001). Furthermore, exercise interventions improved QOL measured using the FACT-General (MD 3.93, 95% CI 1.37-5.92; p = 0.003) and FACT-Prostate (MD 3.85, 95% CI 1.25-6.46; p=0.04) scales. The pooled data did not reveal a significant improvement in depression or anxiety.Combined evidence from RCTs shows improvement in QOL and fatigue according to FACT scales. No significant differences in depression or anxiety were observed.Exercise improves fatigue and quality-of-life outcomes in patients with prostate cancer. Further studies are necessary to identify patient-specific exercise regimens to optimize these benefits.

Historically, androgen-deprivation therapy has been the cornerstone for treatment of metastatic prostate cancer. Unfortunately, nearly majority patients with prostate cancer transition to the refractory state of castration-resistant prostate cancer (CRPC). Newer therapeutic agents are needed for treating these CRPC patients that are unresponsive to androgen deprivation and/or chemotherapy. The histone deacetylase (HDAC) family of enzymes limits the expression of genomic regions by improving binding between histones and the DNA backbone. Modulating the role of HDAC enzymes can alter the cell’s regulation of proto-oncogenes and tumor suppressor genes, thereby regulating potential neoplastic proliferation. As a result, histone deacetylase inhibitors (HDAC i) are now being evaluated for CRPC or chemotherapy-resistant prostate cancer due to their effects on the expression of the androgen receptor gene. In this paper, we review the molecular mechanism and functional target molecules of different HDAC i as applicable to CRPC as well as describe recent and current clinical trials involving HDAC i in prostate cancer. To date, four HDAC classes comprising 18 isoenzymes have been identified. Recent clinical trials of vorinostat, romidepsin, and panobinostat have provided cautious optimism towards improved outcomes using these novel therapeutic agents for CPRC patients. Nevertheless, no phase III trial has been conducted to cement one of these drugs as an adjunct to androgen-deprivation therapy. Consequently, further investigation is necessary to delineate the benefits and drawbacks of these medications.

A very high efficiency Ultra wide band(UWB) hemispherical dielectric resonator antenna is simulated. The antenna is excited by commonly used feeding technique known as microstrip feeding. The dielectric resonator (DR) is inserted in the vertical edge of the substrate, which covers almost entire UWB bands(3.1 GHz to 10.6 GHz). A high impedance bandwidth of 3.74 GHz to 10.49 GHz is achieved in simulation. Compared to normal hemispherical dielectric resonator antenna, this design shows large volume reduction. A significant result analysis is also given in the paper.

e21094Background: The delays toward the diagnosis and management of lung cancer likely contribute to considerable morbidity and mortality among lesser income patients in the developing world. We so...

Dignity Therapy is a brief psychotherapy performed with patients at the end of life. Previous research has examined the effects of Dignity Therapy with patients and family, but none has examined hospice staff perceptions of the treatment.The study objective was to investigate hospice staff perspectives regarding the impact and value of Dignity Therapy when provided as a clinical service.Eighteen hospice staff members who referred patients for Dignity Therapy were asked to rate the value of the treatment. The staff also completed qualitative interviews to gather more detailed information about their most common reasons for referral; their perspectives regarding the therapy's impact on patients; and their beliefs about the costs, benefits, and barriers to treatment. The staff interview responses were qualitatively analyzed to measure the most common emergent themes.Hospice staff members rated Dignity Therapy as worthwhile, and somewhat able to reduce patients' pain and suffering. The vast majority (92%) of hospice staff members believed the treatment would help patients' families in the future, and 100% reported a desire to recommend the treatment to others. Qualitative analyses revealed that staff commonly viewed Dignity Therapy as a positive, affirming experience for patients and felt the emotional or time requirements of the treatment were justified. As a result of offering the service, the staff noted an increased connection with patients and related increases in job satisfaction.Hospice staff believe Dignity Therapy is a worthwhile service that offers a positive, quality-enhancing experience for patients at the end of life. The addition of this clinical service may further enhance staff members' job satisfaction and connection with patients. These findings provide useful information for clinicians or organizational leaders who consider offering Dignity Therapy in their setting.

A very simple low profile rectangular dielectric resonator antenna (DRA) is proposed in this paper. A partially printed metallic ground with two stepped section removed has been used. A stepped microstrip feed line is used to excite the DRA. The structure gives a very high bandwidth from 3.71GHz to 13.01 GHz with a band notch at 5.725 GHz. A T shape slot is used in the ground plane to create the notch at 5.725 GHz. This notch reduces the interference between UWB band and local Wi-MAX communication system.

Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification.We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA). Segmental stenosis on CTA was measured using three window settings: width of 1000 Hounsfield units (HU) and level of 200 HU ("default"), 1500/200 HU ("widened"), and width and level based on the mean HU of the calcified plaque and pericoronary fat ("calcium-specific"). Segmental stenosis on ICA was quantified by a blinded experienced reader.ICA found ≥50% stenosis in 30 segments. Displaying segments with widened and calcium-specific settings improved overall accuracy of detecting ≥50% stenosis (P's0.001) by increasing the rate of accurately quantifying50% stenosis (P's0.001), and improved correlation of stenosis quantification to ICA (P's0.05). There was no difference in stenosis quantification accuracy between widened and calcium-specific window settings. Limits of agreement between CTA stenosis quantification and ICA narrowed with widened and calcium-specific settings.We showed for the first time that in calcified segments, widening display window width significantly improved CTA quantification of stenosis compared to ICA.

Context.—Ureteroscopic biopsy is the gold standard for the histopathologic diagnosis of urothelial carcinoma of the upper urinary tract. Objective.—To assess the accuracy of endoscopically obtained biopsy samples in diagnosing, grading, and staging urothelial carcinoma and correlate diagnostic findings to biopsy sample size. Design.—We retrospectively reviewed endoscopic biopsies of the ureter, renal pelvis, and ureteropelvic junction from 2008 to 2011. Biopsy diagnoses that were discordant with follow-up pathology and/or ureteroscopic impression were rereviewed and samples were immunohistochemically analyzed. Results.—Endoscopic biopsies (n = 118) yielded a sensitivity of 85.4% for the ureter (n = 79), 77.8% for the renal pelvis (n = 37), and 100% for the ureteropelvic junction (n = 2). A specificity of 100% for all locations and a diagnostic accuracy of 98.3% were identified. The median sample size was 0.3 cm for true positives, 0.3 cm for true negatives, and 0.2 cm for false negatives with no statistical significance. We found that 87.1% of tumors diagnosed on biopsy had concordant grade and 60.0% had concordant pT stage with follow-up surgical resections (n = 43) and biopsies (n = 24). Biopsy samples with concordant tumor grades (mean = 0.6 cm) compared with follow-up resection were larger than biopsy samples with discordant grades (mean = 0.3 cm) (P = .04). Conclusions.—Though highly specific, endoscopic biopsy does provide a significant false-negative rate owing to both sampling and diagnostic errors when assessing the upper urinary tract for urothelial carcinoma. Tumor grading is accurate, particularly with larger tissue samples, but tumor staging is unreliable.

e15136Background: The role of granulocyte-colony stimulating factor (G-CSF) agents for patients undergoing oxaliplatin-based adjuvant therapy for stage III colon cancer has not been assessed. We so...

Background Although Muscle Invasive Bladder Cancer (MIBC) is increasing in incidence, treatment has largely remained limited to radical cystectomy with or without cisplatin-based neoadjuvant and/or adjuvant chemotherapy. We reviewed the current and recent clinical trials evaluating perioperative chemotherapy, targeted therapy, and novel therapeutic regimens for MIBC patients undergoing radical cystectomy. Methods An overview of perioperative MIBC management was conducted initially using MEDLINE. The Clinical Trials Registry and MEDLINE were further searched specifically for perioperative MIBC chemotherapy, targeted therapy, and other novel therapeutic approaches. Trials involving non-perioperative management, operative management other than radical cystectomy, multiple tumors, or purely superficial or metastatic disease were excluded from selection. These criteria were not specifically fulfilled for mTOR inhibitor and immune therapy trials. Only phase III chemotherapy and phase II targeted therapy trials found in the Clinical Trials Registry were selected. MEDLINE searches of specific treatments were limited to January 2009 to January 2014 whereas the Clinical Trials Registry search had no timeline. Systematic MEDLINE searches had no phase restrictions. Trials known by the authors to fulfill search criteria but were not found via searches were also selected. Results Twenty-five trials were selected from the Clinical Trials Registry including 7 phase III chemotherapy trials, 11 Phase II targeted therapy trials, 3 immune therapy trials, 1 mammalian target of rapamycin (mTOR) inhibitor trial, and 3 gene and vaccine therapy trials. Nine trials have been completed and 5 have been terminated early or withdrawn. Nine trials have data available when individually searched using MEDLINE and/or Google. Systematic searches of MEDLINE separately found 12 trials in the past 5 years. Two phase III chemotherapy trials were selected based on knowledge by the authors. No phase III trials of targeted therapy have been registered or published. Conclusions New trials are currently being conducted that may revolutionize MIBC treatment preceding or following cystectomy. Head-to-head phase III trials of perioperative chemotherapy and further phase II and phase III trials of targeted therapy and other therapeutic approaches are necessary before the current cisplatin-based perioperative chemotherapy paradigm is altered.