Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.

INTRODUCTION: Acute painful diabetic neuropathy (APDN) is a distinctive diabetic polyneuropathy and consists of two subtypes: treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). The characteristics of APDN are (1.) the small-fibre involvement, (2.) occurrence paradoxically after short-term achievement of good glycaemia control, (3.) intense pain sensation and (4.) eventual recovery. In the face of current recommendations to achieve quickly glycaemic targets, it appears necessary to recognise and understand this neuropathy. METHODS AND RESULTS: Over 2009 to 2012, we reported four cases of APDN. Four patients (three males and one female) were identified and had a mean age at onset of TIN of 47.7 years (±6.99 years). Mean baseline HbA1c was 14.2% (±1.42) and 7.0% (±3.60) after treatment. Mean estimated time to correct HbA1c was 4.5 months (±3.82 months). Three patients presented with a mean time to symptom resolution of 12.7 months (±1.15 months). One patient had an initial normal electroneuromyogram (ENMG) despite the presence of neuropathic symptoms, and a second abnormal ENMG showing axonal and myelin neuropathy. One patient had a peroneal nerve biopsy showing loss of large myelinated fibres as well as unmyelinated fibres, and signs of microangiopathy. CONCLUSIONS: According to the current recommendations of promptly achieving glycaemic targets, it appears necessary to recognise and understand this neuropathy. Based on our observations and data from the literature we propose an algorithmic approach for differential diagnosis and therapeutic management of APDN patients.

Screening for ALK in non-small cell lung carcinomas: 5A4 and D5F3 antibodies perform equally well, but combined use with FISH is recommended.

OBJECTIVES: Immunohistochemistry (IHC) has become a promising method for pre-screening ALK-rearrangements in non-small cell lung carcinomas (NSCLC). Various ALK antibodies, detection systems and automated immunostainers are available. We therefore aimed to compare the performance of the monoclonal 5A4 (Novocastra, Leica) and D5F3 (Cell Signaling, Ventana) antibodies using two different immunostainers. Additionally we analyzed the accuracy of prospective ALK IHC-testing in routine diagnostics. MATERIALS AND METHODS: Seventy-two NSCLC with available ALK FISH results and enriched for FISH-positive carcinomas were retrospectively analyzed. IHC was performed on BenchMarkXT (Ventana) using 5A4 and D5F3, respectively, and additionally with 5A4 on Bond-MAX (Leica). Data from our routine diagnostics on prospective ALK-testing with parallel IHC, using 5A4, and FISH were available from 303 NSCLC. RESULTS: All three IHC protocols showed congruent results. Only 1/25 FISH-positive NSCLC (4%) was false negative by IHC. For all three IHC protocols the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) compared to FISH were 96%, 100%, 100% and 97.8%, respectively. In the prospective cohort 3/32 FISH-positive (9.4%) and 2/271 FISH-negative (0.7%) NSCLC were false negative and false positive by IHC, respectively. In routine diagnostics the sensitivity, specificity, PPV and NPV of IHC compared to FISH were 90.6%, 99.3%, 93.5% and 98.9%, respectively. CONCLUSIONS: 5A4 and D5F3 are equally well suited for detecting ALK-rearranged NSCLC. BenchMark and BOND-MAX immunostainers can be used for IHC with 5A4. True discrepancies between IHC and FISH results do exist and need to be addressed when implementing IHC in an ALK-testing algorithm.

Small Cell Carcinoma of the Urinary Bladder: A Retrospective, Multicenter Rare Cancer Network Study of 107 Patients.

PURPOSE: Small cell carcinomas of the bladder (SCCB) account for fewer than 1% of all urinary bladder tumors. There is no consensus regarding the optimal treatment for SCCB. METHODS AND MATERIALS: Fifteen academic Rare Cancer Network medical centers contributed SCCB cases. The eligibility criteria were as follows: pure or mixed SCC; local, locoregional, and metastatic stages; and age ≥18 years. The overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis according to the Kaplan-Meier method. The log-rank and Wilcoxon tests were used to analyze survival as functions of clinical and therapeutic factors. RESULTS: The study included 107 patients (mean [±standard deviation, SD] age, 69.6 [±10.6] years; mean follow-up time, 4.4 years) with primary bladder SCC, with 66% of these patients having pure SCC. Seventy-two percent and 12% of the patients presented with T2-4N0M0 and T2-4N1-3M0 stages, respectively, and 16% presented with synchronous metastases. The most frequent curative treatments were radical surgery and chemotherapy, sequential chemotherapy and radiation therapy, and radical surgery alone. The median (interquartile range, IQR) OS and DFS times were 12.9 months (IQR, 7-32 months) and 9 months (IQR, 5-23 months), respectively. The metastatic, T2-4N0M0, and T2-4N1-3M0 groups differed significantly (P=.001) in terms of median OS and DFS. In a multivariate analysis, impaired creatinine clearance (OS and DFS), clinical stage (OS and DFS), a Karnofsky performance status <80 (OS), and pure SCC histology (OS) were independent and significant adverse prognostic factors. In the patients with nonmetastatic disease, the type of treatment (ie radical surgery with or without adjuvant chemotherapy vs conservative treatment) did not significantly influence OS or DFS (P=.7). CONCLUSIONS: The prognosis for SCCB remains poor. The finding that radical cystectomy did not influence DFS or OS in the patients with nonmetastatic disease suggests that conservative treatment is appropriate in this situation.

Business Process Modeling in Software Requirements Engineering for Small and Medium Software Projects

Vaatimusmäärittelyn tavoitteena on luoda halutun järjestelmän kokonaisen, yhtenäisen vaatimusluettelon vaatimusten määrittämiseksi käsitteellisellä tasolla. Liiketoimintaprosessien mallintaminen on varsin hyödyllinen vaatimusmäärittelyn varhaisissa vaiheissa. Tämä työ tutkii liiketoimintaprosessien mallintamista tietojärjestelmien kehittämistä varten. Nykyään on olemassa erilaisia liiketoimintaprosessien mallintamiseen tarkoitettuja tekniikoita. Tämä työ tarkastaa liiketoimintaprosessien mallintamisen periaatteet ja näkökohdat sekä eri mallinnustekniikoita. Uusi menetelmä, joka on suunniteltu erityisesti pienille ja keskisuurille ohjelmistoprojekteille, on kehitetty prosessinäkökohtien ja UML-kaavioiden perusteella.

Software testing design and implementation in a small software company

Monet ohjelmistoyritykset ovat alkaneet kiinnittää yhä enemmän huomiota ohjelmistotuotteidensa laatuun. Tämä on johtanut siihen, että useimmat niistä ovat valinneet ohjelmistotestauksen välineeksi, jolla tätä laatua voidaan parantaa. Testausta ei pidä rajoittaa ainoastaan ohjelmistotuotteeseen itseensä, vaan sen tulisi kattaa koko ohjelmiston kehitysprosessi. Validaatiotestauksessa keskitytään varmistamaan, että lopputuote täyttää sille asetetut vaatimukset, kun taas verifikaatiotestausta käytetään ennaltaehkäisevänä testauksena, jolla pyritään poistamaan virheitä jo ennenkuin ne pääsevät lähdekoodiin asti. Työ, johon tämä diplomityö perustuu, tehtiin alkukevään ja kesän aikana vuonna 2003 Necsom Oy:n toimeksiannosta. Necsom on pieni suomalainen ohjelmistoyritys, jonka tutkimus- ja kehitysyksikkö toimii Lappeenrannassa.Tässä diplomityössä tutustutaan aluksi ohjelmistotestaukseen sekä eri tapoihin sen organisoimiseksi. Tämän lisäksi annetaan yleisiä ohjeita testisuunnitelmien ja testaustapausten tekoon, joita onnistunut ja tehokas testaus edellyttää. Kun tämä teoria on käyty läpi, esitetään esimerkkinä kuinka sisäinen ohjelmistotestaus toteutettiin Necsomilla. Lopuksi esitetään johtopäätökset, joihin päädyttiin käytännön testausprosessin seuraamisen jälkeen ja annetaan jatkotoimenpide-ehdotuksia.

Protein homology reveals new targets for bioactive small molecules.

MOTIVATION: The functional impact of small molecules is increasingly being assessed in different eukaryotic species through large-scale phenotypic screening initiatives. Identifying the targets of these molecules is crucial to mechanistically understand their function and uncover new therapeutically relevant modes of action. However, despite extensive work carried out in model organisms and human, it is still unclear to what extent one can use information obtained in one species to make predictions in other species. RESULTS: Here, for the first time, we explore and validate at a large scale the use of protein homology relationships to predict the targets of small molecules across different species. Our results show that exploiting target homology can significantly improve the predictions, especially for molecules experimentally tested in other species. Interestingly, when considering separately orthology and paralogy relationships, we observe that mapping small molecule interactions among orthologs improves prediction accuracy, while including paralogs does not improve and even sometimes worsens the prediction accuracy. Overall, our results provide a novel approach to integrate chemical screening results across multiple species and highlight the promises and remaining challenges of using protein homology for small molecule target identification. AVAILABILITY AND IMPLEMENTATION: Homology-based predictions can be tested on our website http://www.swisstargetprediction.ch. CONTACT: david.gfeller@unil.ch or vincent.zoete@isb-sib.ch. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Critical success factors of sales strategy in small and medium- sized ICT-companies

Tyon tavoitteena on selvittaa. mitka myyntistrategian ja siihen liittyvien muiden strategioiden kriittiset osat pienten ja keskisuurten ICT- yritysten toiminnassa. Tutkimusmenetelmana kaytettiin case- tutkimusta, jossa vertailtiin neljan pienen ja keskisuuren ohjelmisto talon toimintaa. Tutkimuksessa tunnistettiin nelja kriittista osa-aluetta, joiden hoitamiseen yritysten erityisesti tulisi kiinnittaa huomiota. Nama olivat: segmentointi ja kohdemarkkinoiden valinta, myyntikanavien valinta, myyntihenkiloston organisointi ja asiakassuuntautuneisuus, ja markkinointi tietojarjestelma. Tutkimus osoitti, etta yrityksen kasvaessa ja omistuksen eriytyessa toimivasta johdosta yrityksen strategia suunnittelusta tulee jarjestelmallisempaa.

Segmentation model for small and medium size business sector: Case Oy Compaq Computer Ab

Markkinasegmentointi nousi esiin ensi kerran jo 50-luvulla ja se on ollut siitä lähtien yksi markkinoinnin peruskäsitteistä. Suuri osa segmentointia käsittelevästä tutkimuksesta on kuitenkin keskittynyt kuluttajamarkkinoiden segmentointiin yritys- ja teollisuusmarkkinoiden segmentoinnin jäädessä vähemmälle huomiolle. Tämän tutkimuksen tavoitteena on luoda segmentointimalli teollismarkkinoille tietotekniikan tuotteiden ja palveluiden tarjoajan näkökulmasta. Tarkoituksena on selvittää mahdollistavatko case-yrityksen nykyiset asiakastietokannat tehokkaan segmentoinnin, selvittää sopivat segmentointikriteerit sekä arvioida tulisiko tietokantoja kehittää ja kuinka niitä tulisi kehittää tehokkaamman segmentoinnin mahdollistamiseksi. Tarkoitus on luoda yksi malli eri liiketoimintayksiköille yhteisesti. Näin ollen eri yksiköiden tavoitteet tulee ottaa huomioon eturistiriitojen välttämiseksi. Tutkimusmetodologia on tapaustutkimus. Lähteinä tutkimuksessa käytettiin sekundäärisiä lähteitä sekä primäärejä lähteitä kuten case-yrityksen omia tietokantoja sekä haastatteluita. Tutkimuksen lähtökohtana oli tutkimusongelma: Voiko tietokantoihin perustuvaa segmentointia käyttää kannattavaan asiakassuhdejohtamiseen PK-yritys sektorilla? Tavoitteena on luoda segmentointimalli, joka hyödyntää tietokannoissa olevia tietoja tinkimättä kuitenkaan tehokkaan ja kannattavan segmentoinnin ehdoista. Teoriaosa tutkii segmentointia yleensä painottuen kuitenkin teolliseen markkinasegmentointiin. Tarkoituksena on luoda selkeä kuva erilaisista lähestymistavoista aiheeseen ja syventää näkemystä tärkeimpien teorioiden osalta. Tietokantojen analysointi osoitti selviä puutteita asiakastiedoissa. Peruskontaktitiedot löytyvät mutta segmentointia varten tietoa on erittäin rajoitetusti. Tietojen saantia jälleenmyyjiltä ja tukkureilta tulisi parantaa loppuasiakastietojen saannin takia. Segmentointi nykyisten tietojen varassa perustuu lähinnä sekundäärisiin tietoihin kuten toimialaan ja yrityskokoon. Näitäkään tietoja ei ole saatavilla kaikkien tietokannassa olevien yritysten kohdalta.

International Growth Strategies of Small and Medium-Sized Enterprises in Infocom Sector

Tutkimuksen päätavoite on selvitää infocom-toimialan pk-yritysten kansainväliset kasvustrategiat. Aluksi on tarkasteltu kasvua edesauttaneita ja hidastaneita tekijöitä, jotka muodostavat pohjan kansainvälisen kasvun suunnittelulle. Näiden pohjalta on aikaisemmin esitettyihin teoriamalleihin ja yritysten kansainvälistymisen asteeseen yhdistettynä määritelty infocom-toimialan pk-yrityksten kansainväliset kasvustrategiavaihtoehdot. Tutkimuksen tarkasteluun on vaikuttanut born global-ilmiö, jonka pääpiirre on nopea kansainvälistyminen yrityksen aikaisessa kehitysvaiheessa. Työn empiirisessä osassa on havainnollistettu teoriassa käsiteltyjä kansainväliseen kasvuun liittyviä tekijöitä. Empiirisessä osassa on käytetty sekä kvantitatiivisia että kvalitatiivisia menetelmiä. Kvantitatiivinen survey tutkimus on pohjautunut aineistoon, joka on kerätty vuosina 1999-2000 Telecom Business Research Centerissä Lappeenrannassa. Kvalitatiivisessa case-tutkimuksessa on haastateltu infocom-toimialan pk-yrityksiä. Nopeasti kehittyvän infocom-toimialan pk-yrityksille kansainvälistyminen on haaste ja tärkein menestyksen edellytys. Pk-yritysten kasvuresurssit ovat rajalliset, mutta lisääntyvän verkostoitumisen myötä on yritysten välisestä yhteistyöstä saavutettu etuja, jotka ovat mahdollistaneet kansainvälisen kasvun. Markkinoiden muutosnopeus on suuri ja siksi strategisen suunnittelun aikaväli lyhenee. Kansainvälisiä kasvustrategioita muodostettaessa yritykset joutuvat samanaikaisesti turvautumaan useampaan eri kasvustrategiaan, joiden yhdistelmänä yritysten merkittävimmäksi kasvustrategiaksi muodostuvat hybridit kasvustrategiat.

Evaluation and realisation of a market entry method: The entry of a small high technology company into the British construction software markets

Tutkielman tavoitteena on tutkia, mikä olisi parhaiten case-yritykselle sopiva menetelmä tulla tekemään kauppaa ulkomaan markkinoille. Kaikki yleiset kansainvälisille markkinoilletulomenetelmät esitetään ja niiden edut ja haitat tuodaan esille. Selvittäessä tehtävänantajayrityksen resurssit, odotukset ja vaatimukset todetaan, että yhteistyössä tehtävä markkinoilletulo on pätevin vaihtoehto. Tämän jälkeen valitaan parhaiten tarkoitukseen sopiva yritys ennalta valitusta yritysvaihtoehtojen ryhmästä ja testataan tämän yrityksen yhteistyösopivuus case-yrityksen kanssa. Yritysten välinen yhteistyösopivuus arvioidaan analysoimalla yritykset haastattelujen avulla ja tutkielmassa esitettyjen teorioiden avulla. Sopivuus todetaan hyväksi, kattaen 71 prosenttia analysoiduista kohdista. Kaksikymmentäyhdeksän prosenttia kohdista todetaan kohdiksi, joissa yritysten välinen yhteisymmärrys ei ole toimeksiantajayrityksen minimivaatimukset täyttävää. Näitä kohtia tullaan käyttämään suunnittelun pohjana kun suunnitellaan jatkoneuvotteluja yhteistyön käynnistämiseksi.

Small business management in English

The goal was to define how growth creates problems in small companies with a staff of uner 20, and how the problems are solved. It is not about fast growing companies, but about smoothly or even slowly growing companies. The growth is started through the turnover and the main motive is to have a economic stability. Almost all the companies felt that the main reason for this strate-gic growth was to increase the competitivety. Growth was mainly from the domestic market, and new products and new markets. The biggest problem with this growth was providing capital and also a lack of reas-surance. In additinon to this it was dificult to find suitable personnel and there was a lack of time needed to plan and develop the operation. The lack of product develop-ment, was found to be a problem to some extent, particulary in smaller companies. The follow-up of the finances take place mainly through the profit and loss account, income statement and balance sheets. Apart from that they find the follow up by pro-duct was important. Another important element was to have company tailor-made consulting/sparring in order to develop the operation.

Small-size pines suitability for glueboards

The aim of the research was to evaluate the suitability of small-size pine as a raw material for glueboard. A further aim was to investigate claims that dead knots and the twisting of the heartwood cause, quality problems in the but of the small-size pine. The theoretical framework of the study details the whole manufacturing process from raw material to the finished article; the description of the qualities of raw material, the sawing and drying processes as well as the making of the glueboard. The solve the research problem the following figures were calculated: amount of small-size pines, the yield and quality of sawn timber which can be used for making glueboard as well as the variables which affect the various stages of the process. The results show that about half of the timber from the thinning process was suitable material for sawing. The most common problem with the unsuitable timber was form defects of the stem. The average usage ratio of sawing was 2,31 k-m3/m3. 87,97 % of the sawn timber could be used for the production of glueboard. The unsuitability of sawn timber for making glueboard was mainly caused by breakage and the twisting of the heartwood. Dead knots were small and did not effect the quality of the but of the small-size pine. It can therefore be concluded that small-size pine is suitable raw material for glueboard.

Bevacizumab, Pemetrexed, and Cisplatin, or Bevacizumab and Erlotinib for Patients With Advanced Non-Small-Cell Lung Cancer Stratified by Epidermal Growth Factor Receptor Mutation: Phase II Trial SAKK19/09.

OBJECTIVE: The goal was to demonstrate that tailored therapy, according to tumor histology and epidermal growth factor receptor (EGFR) mutation status, and the introduction of novel drug combinations in the treatment of advanced non-small-cell lung cancer are promising for further investigation. METHODS: We conducted a multicenter phase II trial with mandatory EGFR testing and 2 strata. Patients with EGFR wild type received 4 cycles of bevacizumab, pemetrexed, and cisplatin, followed by maintenance with bevacizumab and pemetrexed until progression. Patients with EGFR mutations received bevacizumab and erlotinib until progression. Patients had computed tomography scans every 6 weeks and repeat biopsy at progression. The primary end point was progression-free survival (PFS) ≥ 35% at 6 months in stratum EGFR wild type; 77 patients were required to reach a power of 90% with an alpha of 5%. Secondary end points were median PFS, overall survival, best overall response rate (ORR), and tolerability. Further biomarkers and biopsy at progression were also evaluated. RESULTS: A total of 77 evaluable patients with EGFR wild type received an average of 9 cycles (range, 1-25). PFS at 6 months was 45.5%, median PFS was 6.9 months, overall survival was 12.1 months, and ORR was 62%. Kirsten rat sarcoma oncogene mutations and circulating vascular endothelial growth factor negatively correlated with survival, but thymidylate synthase expression did not. A total of 20 patients with EGFR mutations received an average of 16 cycles. PFS at 6 months was 70%, median PFS was 14 months, and ORR was 70%. Biopsy at progression was safe and successful in 71% of the cases. CONCLUSIONS: Both combination therapies were promising for further studies. Biopsy at progression was feasible and will be part of future SAKK studies to investigate molecular mechanisms of resistance.

Market Orientation in Rapidly Internationalizing Small Companies — Evidence from the Software Industry

For more than a decade, researchers have been aware of the increased pace of small-firm internationalization and the greater effect of these rapidly growing small businesses on the wealth, international trade, and job-creation opportunities of countries. Due to the small size of the home market, Finnish companies have been generally considered highly interested in internationalization. One particular domain in which rapid internationalization has been considered feasible is the global software business, with its knowledge-intensive nature and high growth potential. However, over time the failure rate of small entrepreneurial firms has remained especially high in high-technology markets. One of the reasons for this seems to lie in the fact that these companies are often formed by people with a strong technological background but limited competences in other areas. Further, research on the marketing capabilities of rapidly internationalizing high-tech firms has been scarce thus far. In addition, while there is much research on the first years of operations of rapidly internationalizing companies, it is not well known what becomes of them later on. Therefore, there is a need for more investigation into the managerial mindset, competences and decision-making in these small companies, especially from the perspective of how they acquire and exploit market knowledge, and enhance their networking capabilities in order to promote international expansion. The present study focuses on market orientation in small software firms that internationalize their operations rapidly in global software markets. It builds on qualitative data to illustrate how these companies develop their market-oriented product-market strategies during the process of increasing international commitment. It also shows how they manage their network relationships in order to be able to offer better customer service and to thrive in the fierce global competition. The study was conducted in the empirical context of Finnish small software companies, and the main data consists of interviews with top managers in these businesses. The interviews were designed to cover a minimum period of five years of the company's international operations, thus offering a retrospective in-depth perspective on market orientation, internationalization and partnerships in the given context. One particular focus is on less successfully internationalized software companies, and the challenges they face when approaching international markets. This study makes a significant contribution to the literature on market orientation for several reasons. First, building on data from the software industry, it clarifies the existing theory in the context of rapid internationalization and network relationships. Secondly, it provides a good body of evidence on market orientation in both successfully and less successfully internationalized companies, and identifies the key related differences between the two company groups. Thirdly, it highlights the importance of inter-firm networks in the rapid internationalization of small software firms, providing companies with important market knowledge and, in some cases, management challenges. Fourthly, this investigation clarifies market orientation in the context of different software-product strategies, thus, combining the perspectives of market orientation in both manufacturing and services. In sum, the results of the study are significant for both small software firms and public-policy makers since they shed light on the market-oriented managerial mindset and the market-information gathering and sharing processes that are needed in successful rapid internationalization.