Prognostic value of the diagnostic criteria distinguishing endometrial stromal sarcoma, low grade from undifferentiated endometrial sarcoma, 2 entities within the invasive endometrial stromal neoplasia family

The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms: noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important to note that the WHO 2003 does not define moderate atypia (an important differentiating diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance. Moreover, studies on reproducibility and additional prognostic value of other diagnostic features in large are lacking. Using strict definitions, we analyzed the agreement between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year recurrence-free survival rates for necrosis absent/inconspicuous versus prominent were 89% and 45% (P<0.001) and those for review-confirmed none/mild, moderate, severe atypia were 90%, 30%, and <20% (P<0.00001). Therefore, cases with moderate/severe atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic values (Cox regression). Once these features were taken into account, no other feature had an independent additional prognostic value, including mitotic count. Using "none/mild atypia, necrosis absent/inconspicuous" as ESS, low grade versus "moderate/severe atypia present or necrosis present" as UES resulted in 68 ESS, low grade and 23 UES cases with disease-specific overall mortality-free survival of 99% versus 48% (P<0.00001, hazard ratio=45.4). When strictly defined microscopic criteria are used, the WHO 2003 diagnoses of ESS, low grade and UES are well reproducible and prognostically strong. © 2012 International Society of Gynecological Pathologists.

US-Based Food and Agricultural Value Chains and Their Relevance to Healthy Diets.

This article examines the structure and health implications of two industries, chicken and tomatoes, that play prominent roles in US food and agricultural competitiveness. Both industries have become more concentrated over time, with powerful "lead firms" driving geographical, technological, and marketing changes. Overall, a processed food revolution has taken place in agricultural products that transforms the types of food and dietary options available to consumers. The nature of contemporary food and agricultural value chains affects the strategies and policies that can be effectively employed to address major health goals such as improved nutrition, food safety, and food security.

The Philippines in the Aerospace Global Value Chain

This report uses the Duke CGGC Global Value Chain (GVC) framework to examine the role of the Philippines in the global aerospace industry and identify opportunities for the country to upgrade. The Philippines is a newcomer to the growing global aerospace manufacturing industry. Although the country has been host to a major flight controls manufacturer since 1985, the industry really only began to expand within the past five to ten years. During this recent period (2007-2014), the country has rapidly ramped up its aerospace manufacturing exports, reaching US$604 million in 2014 and more than tripling employment. The industry now employs 3,000 full time and 3,000 part time workers. Although still a very small player, accounting for less than 0.15% of the global industry, this incipient growth is promising. Both foreign firms and local suppliers that have established operations in the industry have already achieved some degree of upgrading within a short timeframe. These include expanding the product lines served, obtaining essential process certifications and upgrading beyond basic assembly operations to undertake additional manufacturing processes such as machining as well as initiating procurement and engineering functions in country.

The Philippines in the Automotive Global Value Chain

This report uses the Duke CGGC Global Value Chain (GVC) framework to examine the role of the Philippines in the global automotive industry and identify opportunities for upgrading. The country’s strength in the sector is in electrical and electronic automotive components, with approximately two-thirds of its US$3.98 billion exports in 2014 falling in one of these categories. The Philippines has a particularly strong foothold in wire harnesses, exports of which increased by 129% from 2007 to 2014 to allow it to become the world’s fourth largest global exporter. The prominence of the cluster affords the country a number of upgrading opportunities moving forward. Otherwise, the relatively small size of the domestic market has constrained the development of the industry, with local companies unable to generate the economies of scale necessary to compete in an increasingly consolidated global environment.

The Philippines in the Chemical Global Value Chain

This report uses the Duke CGGC global value chain (GVC) framework to examine the role of the Philippines in the global chemical industry and identify opportunities for the country to upgrade. The Philippine chemicals sector is growing rapidly alongside economic expansion and a revival in manufacturing. By 2013, the chemicals sector as a whole accounted for 6.7% of GDP. Chemicals exports reached US$2.2 billion in 2014, approximately 3.5% of the country’s export basket. The sector’s expansion has outpaced both global and regional trade; with a compound annual growth rate of 13% since 2007, three times as fast as global exports, and twice as fast as Asian regional exports. Participation in the export market is based primarily on commodity products in the oleochemicals and petrochemicals sub-sectors. Within these segments, exports are driven by a small number of products, with the top 10 accounting for approximately threequarters of all exports. While the country is a small player in the global chemicals trade, accounting for just 0.2% of exports in 2014, it has generally been successful in carving out a presence in these niche products, and is one of the global leaders in most of its top product categories.