A Multi-Center Phase II Study (SAKK 36/06) of Single Agent Everolimus (RAD001) In Patients with Relapsed or Refractory Mantle Cell Lymphoma

Introduction: Mantle cell lymphoma (MCL) accounts for 6% of all B-cell lymphomas and remains incurable for most patients. Those who relapse after first line therapy or hematopoietic stem cell transplantation have a dismal prognosis with short response duration after salvage therapy. On a molecular level, MCL is characterised by the translocation t[11;14] leading to Cyclin D1 overexpression. Cyclin D1 is downstream of the mammalian target of rapamycin (mTOR) kinase and can be effectively blocked by mTOR inhibitors such as temsirolimus. We set out to define the single agent activity of the orally available mTOR inhibitor everolimus (RAD001) in a prospective, multi-centre trial in patients with relapsed or refractory MCL (NCT00516412). The study was performed in collaboration with the EU-MCL network. Methods: Eligible patients with histologically/cytologically confirmed relapsed (not more than 3 prior lines of systemic treatment) or refractory MCL received everolimus 10 mg orally daily on day 1 - 28 of each cycle (4 weeks) for 6 cycles or until disease progression. The primary endpoint was the best objective response with adverse reactions, time to progression (TTP), time to treatment failure, response duration and molecular response as secondary endpoints. A response rate of ≤ 10% was considered uninteresting and, conversely, promising if ≥ 30%. The required sample size was 35 pts using the Simon's optimal two-stage design with 90% power and 5% significance. Results: A total of 36 patients with 35 evaluable patients from 19 centers were enrolled between August 2007 and January 2010. The median age was 69.4 years (range 40.1 to 84.9 years), with 22 males and 13 females. Thirty patients presented with relapsed and 5 with refractory MCL with a median of two prior therapies. Treatment was generally well tolerated with anemia (11%), thrombocytopenia (11%), neutropenia (8%), diarrhea (3%) and fatigue (3%) being the most frequent complications of CTC grade III or higher. Eighteen patients received 6 or more cycles of everolimus treatment. The objective response rate was 20% (95% CI: 8-37%) with 2 CR, 5 PR, 17 SD, and 11 PD. At a median follow-up of 6 months, TTP was 5.45 months (95% CI: 2.8-8.2 months) for the entire population and 10.6 months for the 18 patients receiving 6 or more cycles of treatment. Conclusion: This study demonstrates that single agent everolimus 10 mg once daily orally is well tolerated. The null hypothesis of inactivity could be rejected indicating a moderate anti-lymphoma activity in relapsed/refractory MCL. Further studies of either everolimus in combination with chemotherapy or as single agent for maintenance treatment are warranted in MCL.

Report on theorerical results of power generation and conversion

Experimental results of a new controller able to support bidirectional power flow in a full-bridge rectifier with boost-like topology are obtained. The controller is computed using port Hamiltonian passivity techniques for a suitable generalized state space averaging truncation system, which transforms the control objectives, namely constant output voltage dc-bus and unity input power factor, into a regulation problem. Simulation results for the full system show the essential correctness of the simplifications introduced to obtain the controller, although some small experimental discrepancies point to several aspects that need further improvement.

Clinical utility of a molecular test in adjuvant treatment decision making in women with endocrine-sensitive early stage breast cancer: a retrospective, single center one year experience

Background. Molecular tests for breast cancer (BC) risk assessment are reimbursed by health insurances in Switzerland since the beginning of year 2015. The main current role of these tests is to help oncologists to decide about the usefulness of adjuvant chemotherapy in patients with early stage endocrine-sensitive and human epidermal growth factor receptor 2 (HER2)-negative BC. These gene expression signatures aim at predicting the risk of recurrence in this subgroup. One of them (OncotypeDx/OT) also predicts distant metastases rate with or without the addition of cytotoxic chemotherapy to endocrine therapy. The clinical utility of these tests -in addition to existing so-called "clinico-pathological" prognostic and predictive criteria (e.g. stage, grade, biomarkers status)-is still debated. We report a single center one year experience of the use of one molecular test (OT) in clinical decision making. Methods. We extracted from the CHUV Breast Cancer Center data base the total number of BC cases with estrogen-receptor positive (ER+), HER2-negative early breast cancer (node negative (pN0) disease or micrometastases in up to 3 lymph nodes) operated between September 2014 and August 2015. For the cases from this group in which a molecular test had been decided by the tumor board, we collected the clinicopathologic parameters, the initial tumor board decision, and the final adjuvant systemic therapy decision. Results. A molecular test (OT) was done in 12.2% of patients with ER + HER2 negative early BC. The median age was 57.4 years and the median invasive tumor size was 1.7 cm. These patients were classified by ODX testing (Recurrence Score) into low-, intermediate-, and high risk groups, respectively in 27.2%, 63.6% and 9% of cases. Treatment recommendations changed in 18.2%, predominantly from chemotherapyendocrine therapy to endocrine treatment alone. Of 8 patients originally recommended chemotherapy, 25% were recommended endocrine treatment alone after receiving the Recurrence Score result. Conclusions. Though reimbursed by health insurances since January 2015, molecular tests are used moderately in our institution as per the decision of the multidisciplinary tumor board. It's mainly used to obtain a complementary confirmation supporting the decision of no chemotherapy. The OncotypeDx Recurrence Score results were in the intermediate group in 66% of the 9 tested cases but contributed to avoid chemotherapy in 2 patients during the last 12 months.

An adaptive group sequential design for phase II/III clinical trials that select a single treatment from several

There is increasing interest in combining Phases II and III of clinical development into a single trial in which one of a small number of competing experimental treatments is ultimately selected and where a valid comparison is made between this treatment and the control treatment. Such a trial usually proceeds in stages, with the least promising experimental treatments dropped as soon as possible. In this paper we present a highly flexible design that uses adaptive group sequential methodology to monitor an order statistic. By using this approach, it is possible to design a trial which can have any number of stages, begins with any number of experimental treatments, and permits any number of these to continue at any stage. The test statistic used is based upon efficient scores, so the method can be easily applied to binary, ordinal, failure time, or normally distributed outcomes. The method is illustrated with an example, and simulations are conducted to investigate its type I error rate and power under a range of scenarios.

Effect of power densities and irradiation times on the degree of conversion and temperature increase of a microhybrid dental composite resin

The different parameters used for the photoactivation process provide changes in the degree of conversion (DC%) and temperature rise (TR) of the composite resins. Thus, the purpose of this study was to evaluate the DC (%) and TR of the microhybrid composite resin photoactivated by a new generation LED. For the KBr pellet technique, the composite resin was placed into a metallic mould (1-mm thickness and 4-mm diameter) and photoactivated as follows: continuous LED LCU with different power density values (50-1000 mW/cm(2)). The measurements for the DC (%) were made in a FTIR Spectrometer Bomen (model MB-102, Quebec-Canada). The spectroscopy (FTIR) spectra for both uncured and cured samples were analyzed using an accessory for the diffuse reflectance. The measurements were recorded in the absorbance operating under the following conditions: 32 scans, 4-cm(-1) resolution, and a 300 to 4000-cm(-1) wavelength. The percentage of unreacted carbon-carbon double bonds (% C=C) was determined from the ratio of the absorbance intensities of aliphatic C=C (peak at 1638 cm(-1)) against an internal standard before and after the curing of the specimen: aromatic C-C (peak at 1608 cm-1). For the TR, the samples were made in a metallic mould (2-mm thickness and 4-mm diameter) and photoactivated during 5, 10, and 20 s. The thermocouple was attached to the multimeter to allow the temperature readings. The DC (%) and TR were calculated by the standard technique and submitted to ANOVA and Tukey`s test (p < 0.05). The degree of conversion values varied from 35.0 (+/- 1.3) to 45.0 (+/- 2.4) for 5 s, 45.0 (+/- 1.3) to 55.0 (+/- 2.4) for 10 s, and 47.0 (+/- 1.3) to 52.0 (+/- 2.4) for 20 s. For the TR, the values ranged from 0.3 (+/- 0.01) to 5.4 (+/- 0.11)degrees C for 5 s, from 0.5 (+/- 0.02) to 9.3 (+/- 0.28)degrees C for 10 s, and from 1.0 (+/- 0.06) to 15.0 (+/- 0.95)degrees C for 20 s. The power densities and irradiation times showed a significant effect on the degree of conversion and temperature rise.

Single-phase high power-factor boost ZCS pre-regulator operating in critical conduction mode

This paper presents a new single-phase interleaved high power factor boost pre-regulator operating in critical conduction mode, where the switches and boost diode performing zero-current commutations during its turn-off, eliminating the disadvantages related to the reverse recovery losses and electromagnetic interference problems of the boost diode, when operating in the continuous conduction mode. The interleaving technique is applied in the power cell, providing a significant input current ripple reduction in comparison to discontinuous mode of operation, due to its input current continuous conduction operation. This paper presents a complete modeling for the converter operating in critical conduction mode, resulting in an improved design procedure for interleaved techniques with high input power factor, a complete design procedure, and main simulation results from a design example with two interleaved cells rated at 1kW, 400V output voltage and 220V rms input voltage.

A novel single-phase ZCS-PWM high-power-factor boost rectifier

This paper presents a novel single-phase high-power-factor (HPF) pulsewidth-modulated (PWM) boost rectifier featuring soft commutation of the active switches at zero current (ZC), It incorporates the most desirable properties of conventional PWM and soft-switching resonant techniques.The input current shaping is achieved with average current mode control and continuous inductor current mode.This new PWM converter provides ZC turn on and turn off of the active switches, and it is suitable for high-power applications employing insulated gate bipolar transistors (IGBT's),The principle of operation, the theoretical analysis, a design example, and experimental results from a laboratory prototype rated at 1600 W with 400-Vdc output voltage are presented. The measured efficiency and the power factor were 96.2% and 0.99%, respectively, with an input current total harmonic distortion (THD) equal to 3.94%, for an input voltage with THD equal to 3.8%, at rated load.

Automatic dimming multi-lamp fluorescent management system with active input power factor corrector stage

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Time-series-based maximization of distributed wind power generation integration

Energy policies and technological progress in the development of wind turbines have made wind power the fastest growing renewable power source worldwide. The inherent variability of this resource requires special attention when analyzing the impacts of high penetration on the distribution network. A time-series steady-state analysis is proposed that assesses technical issues such as energy export, losses, and short-circuit levels. A multiobjective programming approach based on the nondominated sorting genetic algorithm (NSGA) is applied in order to find configurations that maximize the integration of distributed wind power generation (DWPG) while satisfying voltage and thermal limits. The approach has been applied to a medium voltage distribution network considering hourly demand and wind profiles for part of the U.K. The Pareto optimal solutions obtained highlight the drawbacks of using a single demand and generation scenario, and indicate the importance of appropriate substation voltage settings for maximizing the connection of MPG.

Single-phase high power factor hybrid rectifier suitable for high-power applications

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Variable speed refrigeration system with HPF input rectifier stage

This paper is based on the analysis and implementation of a new drive system applied to refrigeration systems, complying with the restrictions imposed by the IEC standards (Harmonic/Flicker/EMI-Electromagnetic Interference restrictions), in order to obtain high efficiency, high power factor, reduced harmonic distortion in the input current and reduced electromagnetic interference, with excellent performance in temperature control of a refrigeration prototype system (automatic control, precision and high dynamic response). The proposal is replace the single-phase motor by a three-phase motor, in the conventional refrigeration system. In this way, a proper control technique can be applied, using a closed-loop (feedback control), that will allow an accurate adjustment of the desirable temperature. The proposed refrigeration prototype uses a 0.5Hp three-phase motor and an open (Belt-Drive) Bitzer IY type compressor. The input rectifier stage's features include the reduction in the input current ripple, the reduction in the output voltage ripple, the use of low stress devices, low volume for the EMI input filter, high input power factor (PF), and low total harmonic distortion (THD) in the input current, in compliance with the IEC61000-3-2 standards. The digital controller for the output three-phase inverter stage has been developed using a conventional voltage-frequency control (scalar V/f control), and a simplified stator oriented Vector control, in order to verify the feasibility and performance of the proposed digital controls for continuous temperature control applied at the refrigerator prototype. ©2008 IEEE.

Trolleybus power system for operation with AC or DC distribution networks

This paper presents the development and experimental analysis of a special input stage converter for a Trolleybus type vehicle allowing its operation in AC (two wires, single-phase) or DC distribution networks. The architecture of proposed input stage converter is composed by five interleaved boost rectifiers operating in discontinuous conduction mode. Furthermore, due to the power lines characteristics, the proposed input power structure can act as AC to DC or as DC to DC converter providing a proper DC output voltage range required to the DC bus. When operation is AC to DC, the converter is capable to provide high power factor with reduced harmonic distortion for the input current, complying with the restrictions imposed by IEC 61000-3-4 standard. Finally, the main experimental results are presented in order to verify the feasibility of the proposed converter, demonstrating the benefits and the possibility for AC feeding system for trolleybus type vehicle. © 2010 IEEE.

Evaluation of integrated inverter topologies for low power PV systems

This work presents the stage integration in power electronics converters as a suitable solution for solar photovoltaic inverters. The rated voltages available in Photovoltaic (PV) modules have usually low values for applications such as regulated output voltages in stand-alone or grid-connected configurations. In these cases, a boost stage or a transformer will be necessary. Transformers have low efficiencies, heavy weights and have been used only when galvanic isolation is mandatory. Furthermore, high-frequency transformers increase the converter complexity. Therefore, the most usual topologies use a boost stage and one inverter stage cascaded. However, the complexity, size, weight, cost and lifetime might be improved considering the integration of both stages. These are the expected features to turn attractive this kind of integrated structures. Therefore, some integrated converters are analyzed and compared in this paper in order to support future evaluations and trends for low power single-phase inverters for PV systems. © 2011 IEEE.