Introduction: Advanced progression the field of diagnosis and treatment of cancer patients causes increased survival of patients. Increasing life expectancy can lead to new health problems, including Multiple primary malignancies (MPM). Although the incidence of MPM is increasing, the diagnosis of MPM remains very rare. Based on the interval between tumor diagnosis, MPM can be divided into synchronous MPM and metachronous. Studies of MPM may provide useful information not only for clinical purposes but also can provide clues about etiology and management of this type of cancer. This case report was a woman with metachronous MPM (endometrium-breast).
When in a patient more than one tumour in the same or a different organ is diagnosed, multiple primary tumours may be present. For epidemiological studies, different definitions of multiple primaries are used with the two main definitions coming from the project Surveillance Epidemiology and End Results and the International Association of Cancer Registries and International Agency for Research on Cancer. The differences in the two definitions have to be taken into consideration when reports on multiple primaries are analysed. In this review, the literature on multiple primaries is reviewed and summarised. Overall, the frequency of multiple primaries is reported in the range of 2–17%.
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Nowadays, lung cancer is a leading cause of death in both men and women worldwide. There is no clear explanation for its mortality rate. However, it is already known that genetic and environmental factors as well as oncological treatment are involved. As the incidence of lung cancer soars, the number of patients diagnosed with multiple primary lung cancers (MPLC) is also rising. While differentiating between MPLC and intrapulmonary metastasis of lung cancer is important for treatment strategy and prognosis, it is also quite complicated, particularly in the cases with similar histologies. It is also important not to delay the diagnosis. The aim of this paper was to discuss MPLC in general, and the differentiation between MPLC and intrapul- monary lung cancer metastasis in particular. Based on a review of statistical data and the current literature, we discuss the diagnostic criteria and the molecular, genetic and radiographic methods used to distinguish between MPLC and intrapulmonary metastases.
Spectrum sensing is a critical functionality of cognitive radio . It enables unlicensed users, referred to as cognitive radio (CR) users hereafter, to find the “spectrum holes”. Many works have been conducted on spectrum sensing  - . Among them, energy detector is the most widely used method. All these previous works assume that the primary user is either absent or present during the whole sensing period. However, in practice, the primary user may arrive or leave during the sensing period. The effect of the primary user traffic on the sensing performance has been analyzed in  for the case when only one primary user occupies the licensed spectrum at a time. In , the energy detection was improved to reduce the effect from the primary user traffic when only one primary user is present. However, in many widely used code division multiple access (CDMA) systems, such as 3G and WiMAX, the systems are designed to have several users operating in the same frequency band simultaneously. The “spectrum holes” also include vacant unlicensed bands. In this case, several unlicensed systems, such as Wi-Fi, Bluetooth and DECT, will share the same band without coordination, giving the scenario where multiple primary users may occupy the same band. All these realistic applications motivate a general investigation of the effect of primary user traffic on the sensing performance with multiple primary users.
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We first carried out a simulation study for validating the proposed model. Our aim was to compare the estimated number of second tumours using the AJ estimator with that obtained with the person-year approach in a simula- tion. This comparison can be better performed simulating the process of second tumour occurrence taking under control biasing factors such as censoring. We then simu- lated different dynamics of second tumour occurrence. We considered a simulated cohort of 10000 patients with a first primary and with same age and period of incidence, followed up for 10 years. We imposed a survival exponen- tial law with a constant mortality rate of 0.2. Firstly, occur- rence of a second primary was kept constant for the whole follow-up period. We compared the simulated number of second tumours to the number estimated both by the per- son-year, and by the AJ approach. We let the second tumour incidence rate vary from 0.00025 to 0.004, corre- sponding to a rate ratio of 0.25, 0.5, 1, 2 and 4. Then, the effect of standardisation by age was investigated repeating the simulation for the five age classes (each with the same number of subjects), varying the occurrence rates, but always keeping them constant for the whole period. Sec- ondly, the simulation was extended to situations where also occurrence rates varied in time: at a constant decreas- ing or increasing trend, or in a bimodal way. Age stand- ardisation was then applied on bimodal rates simulation. The simulation engine was based on random chains of multinomial probabilities M (P α , P β , P γ ) at each time-click
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Typically multiple statistical tests are performed to investigate the effectiveness of the intervention on each outcome. If two outcomes are analysed inde- pendently of each other at the nominal significance level of 0.05, then the probability of finding at least one false positive significant results increases to 0.098. This probability is known as the familywise error rate, ‘FWER’. One approach to control the FWER to its desired level is to adjust the p-values corresponding to each statistical test used to investi- gate the intervention effects. Many adjustments have been proposed including the Bonferroni , Holm , Hochberg , Hommel  and Dubey/Armitage- Parmar  methods. Once the p-values have been adjusted, they can be compared to the nominal significance level. For example in the trial on sub- stance abuse , two unadjusted p-values: 0.010,0.002 were reported. If the Bonferroni method was used, the p-values could have been adjusted to 0.020, 0.004 and compared to the significance level α of 0.05. Alternatively, the significance level could be adjusted (to 0.05/2 = 0.025 in this example) and compared to the unadjusted p-values.
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The primary user channel is divided into time slots. Each time slot consist n bits. By using k bits(sensing bits) in each time slot he can check the status of the channel. If the channel is free transfer the sensing bits i.e. k bits as zeros and n-k bits are data. If the channel is busy transfer the sensing bits i.e. k bits as ones and n-k bits are zeros.
Abstract: Adenocarcinoma of gastric and colon are common malignancies, while multiple primary cancers in both gastric and colon are rare and easily misdiagnosed. Multiple primary cancers (MPC) are two or more malignan- cies in an individual without any relationship between the lesions at the same time or successively. The present study reports the rare case of a patient with synchronous triple primary cancers of gastric and transverse colon that received a systematic treatment, including surgical intervention and chemotherapy. The histological examina- tion proved one moderate differentiated gastric adenocarcinoma (pT1 b N0M0), one mucinous adenocarcinoma of the transverse colon (pT3N0M0), and another moderate differentiated adenocarcinoma of the transverse colon (pT3N0M0). Finally, we discussed the diagnostic criteria, the risk factors, the treatment criteria and the prognosis of these rare MPC. Although increasing cases of MPC have been reported today, but the exact mechanism is still unclear. Therefore, further research should focus on the pathogenesis and molecular mechanism of MPC.
Multifocal angiosarcoma in other organs has also been reported. Multifocal intestinal angiosarcoma has been described by Navarro-Chagoya et al. and multifocal hep- atic angiosarcoma has been reported by Horiguchi et al. These reports describe the specific conditions of the pa- tients, namely, postradiation for pelvic tumor and under- lying disease with dyskeratosis congenita, respectively [12, 13]. As for cutaneous angiosarcoma, a multifocal spread within the dermis is characteristic . Aside from these specific underlying conditions or cutaneous angiosarcoma, primary multifocal angiosarcoma in any organs appears to be very rare. In a previous report on multiple primary pulmonary angiosarcoma, Tanaka et al. pointed out two possible multifocal growth patterns, namely multicentric tumorigenesis and spreading from one primary site with preferred proliferation in a periar- terial microenvironment . In the present case, as all five small angiosarcoma lesions were located near the main tumor, it can be hypothesized that the latter growth pattern proposed by Tanaka et al. may be the de- velopment pattern in our case.
In this approach, we consider a 5G heterogeneous network that incorporates multiple primary networks. At any given instant, each primary network has a different number of channels available for the SUs, and each channel has a different capacity. Each network has some constraints in terms of interference, subscription fees, and capacity. SUs specify their requirements in terms of the minimum data rate and the maximum subscription fee that they are willing to pay. Based on SU requirements and primary network constraints, we employ the PSO and the modified GA algorithms to find a near-optimal solution. The goal of this paper is to find a solution such that the overall cost for all SUs is minimized and the overall interference incurred to the PUs of different primary networks is also reduced.
Additional annotation levels and layers (see Witt (2004) for a discussion about the distinction of levels and layers) can be added any time. Since XStandoff supports not only multiple annotation layers but multiple primary data files as well, there are two alternative XSF representations possible, if we extract the written text from the XHTML file and use it as primary data file: (1) The TXT file is used as additional primary data file (and serves as input for other linguistic annotation tools, see Listing 3); (2) the TXT file serves as the single pri- mary data file and both the XHTML and the POS annotation are stored as annotation levels and lay- ers. For the second option it is again necessary to pre-process the XHTML file with the already mentioned tools.
As can been seen from Fig. 3.1, while assuming the primary user only changes its occupancy status once during each frame, there are six possible scenarios with their probability of occurring given by (3.9). The spectrum sensing is therefore given by the hypothesis test in (3.10) when energy detection is applied. The unconditional probability of false alarm and the unconditional probability of detection are given by (3.20) and (3.21), respectively. Once the spectrum sensing is complete, the secondary transmission starts if the licensed channel is considered to be idle. The average BER and the average link SE for the adaptive modulation in cognitive radio are derived for both the ACR and ADR schemes in the following sections. Note that in the derivations, different symbols are used to denote BERs and link SEs in different conditions, where < · > indicates averaged values in a Nakagami-m fading channel, · indicates unconditional values that have been averaged over the probability of occurring, and < · > indicates averaged unconditional values for a Nakagami-m fading channel.
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Hoagwood, & Horwitz, 2013; Schouten et al., 2008). This has been attributed to the multi-faceted nature and diversity of QIC programs, the need to tailor programs to different settings and contexts, and to the highly context-dependent nature of QI where multiple, interacting contextual factors may influence the success of changes in practice (Dixon-Woods & Martin, 2016; Hulscher et al., 2012; Nadeem et al., 2013; Ovretveit, 2011; Schouten et al., 2008). The majority of research studies on QI programs have focused on evaluating their impact on anticipated outcomes (e.g., care processes or clinical outcomes) and have used controlled or before-after study designs that do not capture the dynamic nature of QI, how outcomes were achieved, and the contexts that lead to success or failure (Hulscher et al., 2012; Portela, Pronovost, Woodcock, Carter, & Dixon-Woods, 2015; Schouten et al., 2008; van Leijen-Zeelenberg et al., 2016). There are increasing calls for research on contextual factors that influence QI, including the use of theory and conceptual models to guide QI research (Dixon-Woods, 2014; Kaplan et al., 2010; Ovretveit, 2011; Robert & Fulop, 2014). Studies have started to develop conceptual models identifying potential factors across all levels of the health care system that influence the success of QI and QIC programs, including various team,
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Abstract: Colorectal follicular lymphoma (FL) occurs less frequently than duodenal-type FL, which is an established entity, and primary multiple FL only involving the colon is rare. Further- more, the coexistence of lymphoma and multiple myeloma (MM) within the same patient is rare and the current study reports such a case. The patient was an asymptomatic 62-year-old man. He underwent colonoscopy screening, which revealed at least five polypoid tumors from the cecum to the rectum. Biopsy samples stained positive for CD20 and B-cell lymphoma 2 (BCL2) but stained negative for CD10, and fluorescence in situ hybridization analysis identified IGH/BCL2 in 95.2% of the tumor cells. Based on these findings, the patient was diagnosed with FL. On the bone marrow aspirate, the plasma cell count was 30% of all nucleated cells. Bence-Jones κ-type protein was detected by protein electrophoresis in serum and urine. The serum-free light chain κ/λ level was significantly elevated (484.3). Thus, the patient was also diagnosed with MM. Both FL and MM were targeted therapeutically; rituximab and bendamustine were effective for FL, and lenalidomide and low-dose dexamethasone were effective for MM. The patient was treated for 3 years and 7 months and, until now, was off-treatment for 4 years without rapid progression of the two malignancies. Although both diseases are still present, the patient has maintained stable disease. Our findings suggest that lymphoma and MM should be targeted separately as independent hematological malignancies when they occur concurrently.
The same questionnaire was also completed by the primary caregivers of these patients. By primary caregivers it means the people who live with people involved with MS who has the most physical and emotional relationship with the patient and provides s/he with the most amount of help. In our study, the majority of caregivers are the patients' parents and spouse. In a small number of subjects, the primary caregivers were the patients' siblings or children. It should be noted that the interviewer was present at the time of completing the questionnaire to answer the possible questions of the subjects.
Epigenetic modifications are heritable, reversible alter- ations in gene expression, which do not affect gene sequence. They depend on environmental and biological conditions, resulting in different cell responses . The main epigenetic mechanisms consist of DNA methylation, histone alteration, and micro-RNAs. DNA methylation aims to prevent transcription factors from binding to gene promoter, thus silencing gene expression. This procedure is achieved by DNA methyl transferases (DNMTs), which convert cytosine of CpG islands in gene promoters into 5-methylcytosine. Histone alterations include several pro- cedures that regulate transcription, such as acetylation and phosphorylation. Acetylation of the N-terminal tail of a histone leads to decompression of chromatin and upregu- lates transcription . Micro-RNAs are single stranded, small in nucleotide amount RNAs, which do not encode any proteins. They can affect gene expression, acting after gene transcription and their expression depends on the interaction with the other two mechanisms . Micro- RNAs silence gene expression by improper binding to a specific or to multiple mRNA sequences into a ribonucle- oprotein called RISC (RNA-associated silencing complex). Even the same mRNA sequence can be regulated by sev- eral micro-RNAs bound up to it . Epigenetic mecha- nisms seem to influence the development of numerous M. Sokratous and E. Dardiotis contributed equally to this work.
This study investigated the levels and correlates of SD in Iranian Azeri women with MS. Among the MS patients, 88.6% of women reported primary (83.3%), secondary (56.6%), and tertiary (36.6%) SD. The high rate of SD shows that SD is a common problem among women with MS, which is in line with the results of previous studies (9,23-25). In addition, multivariate regression analyses revealed that predictive variables for the sexual disorders of women with MS included education, depression and spouse’s cooperation in home affairs so that the SD was lower in women with high education levels. This finding is in conformity with the results obtained by some previous studies (23,24). However, Ashtari et al found no meaningful relationship between SD and education (9).
To provide another approach that serves those who prefer in-person education, we will also employ educa- tional sessions in small group settings to reinforce key content and guidelines . Self-learning materials will also be used that contain the same content. Pre and post tests will be used to determine a change in knowledge [38,39]. The true test will be to see if these educational methods change diagnostic accuracy, practice patterns with patients and referral patterns to our pediatric neph- rology clinic [40-44]. If our primary care pediatricians become more comfortable recognizing, diagnosing and treating pediatric essential HTN, then referral rates of incorrectly identified patients with HTN should decline. More thoroughly evaluated and/or treated patients with HTN should increase among patient referrals to our pediatric nephrology clinic [45-47].
Three deaths occurred in the FREEDOMS study: two in the placebo group (pulmonary embolism, traffic accident) and one in the high-dose fingolimod group (suicide). However, in the TRANSFORMS study, the two deaths observed both occurred in the high-dose fingolimod group: one due to disseminated primary varicella zoster infection (with corticosteroids as concomitant medication) and the other due to herpes simplex encephalitis. Two additional patients of this study arm died after the study (aspiration pneumo- nia, metastatic breast cancer). Infections were reported equally throughout the groups (69%–72% for FREEDOMS, 51%–53% for TRANSFORMS), with serious infections in 1.6%–2.6% and 0.2%–1.7% of patients, respectively. Bronchitis and pneumonia were more common in patients treated with fingolimod. 28,29
Multiple sclerosis (MS) is a chronic inflammatory auto- immune central nervous system (CNS) disorder dis- playing a variable disease course. At clinical onset, more than 85% of MS patients are classified as having relapsing-remitting MS (RRMS) . These patients are predominately female and typically 20–30 years old at presentation of initial symptoms . The remaining 10–15% of MS patients exhibit primary progressive MS (PPMS), characterised by a continuous worsening of symptoms from the onset, when patients are typically between 30 and 50 years old [1, 2]. PPMS affects men and women with similar frequency . Both types of disease course exhibit inflammatory changes in the cerebrospinal fluid (CSF), e.g. the presence of oligoclonal bands (OCB),