Concurrent or Sequential Adjuvant Letrozole and Radiotherapy after Conservative Surgery for Early-stage Breast Cancer: Long-term Results of the Cohort Phase 2 Randomized Trial

Purpose/Objective(s): Letrozole radiosensitizes breast cancer cells in vitro. In clinical settings, no data exist for the combination of letrozole and radiotherapy. We assessed concurrent and sequential radiotherapy and letrozole in the adjuvant setting.Materials/Methods: The present study is registered with ClinicalTrials.gov, number NCT00208273. This Phase 2 randomized trial was undertaken in two centers in France and one in Switzerland between January 12, 2005, and February 21, 2007. One hundred fifty postmenopausal women with early-stage breast cancer were randomly assigned after conserving surgery to either concurrent radiotherapy and letrozole (n = 75) or sequential radiotherapy and letrozole (n = 75). Randomization was open label with a minimization technique, stratified by investigational centers, chemotherapy (yes vs. no), radiation boost (yes vs. no), and value of radiation-induced lymphocyte apoptosis (#16% vs. .16%). The whole breast was irradiated to a total dose of 50 Gy in 25 fractions over 5 weeks. In the case of supraclavicular and internal mammary node irradiation, the dose was 44 - 50 Gy. Letrozole was administered orally once daily at a dose of 2 - 5 mg for 5 years (beginning 3 weeks pre-radiotherapy in the concomitant group, and 3 weeks postradiotherapy in the sequential group). The primary endpoint was the occurrence of acute (during and within 6 weeks of radiotherapy) and late (within 2 years) radiation-induced Grade 2 or worse toxic effects of the skin and lung (functional pulmonary test and lung CT-scan). Analyses were by intention-to-treat. The long-term follow-up after 2 years was only performed in Montpellier (n = 121) and evaluated skin toxicity (clinical examination every 6 months), lung fibrosis (one CT-scan yearly), cosmetic outcome.Results: All patients were analyzed apart from 1 in the concurrent group who withdrew consent before any treatment.Within the first 2 years (n = 149), no lung toxicity was identified by CT scan and no modification from baseline was noted by the lung diffusion capacity test. Two patients in each group had Grade 2 or worse late effects (both radiation-induced subcutaneous fibrosis [RISF]). After 2 years (n = 121), and with a median follow-up of 50 months (38-62), 2 patients (1 in each arm) presented a Grade 3 RISF. No lung toxicity was identified by CT scan. Cosmetic results (photographies) and quality of life was good to excellent. All patients who had Grade 3 subcutaneous fibrosis had an RILA value of 16% or less, irrespective of the sequence with letrozole.Conclusions:With long-term follow-up, letrozole can be safely delivered shortly after surgery and concomitantly with radiotherapy.

Concurrent : Easy to use Python computing environment

Concurrent aims to be a different type of task distribution system compared to what MPI like system do. It adds a simple but powerful application abstraction layer to distribute the logic of an entire application onto a swarm of clusters holding similarities with volunteer computing systems. Traditional task distributed systems will just perform simple tasks onto the distributed system and wait for results. Concurrent goes one step further by letting the tasks and the application decide what to do. The programming paradigm is then totally async without any waits for results and based on notifications once a computation has been performed.

t(15;21) translocations leading to the concurrent downregulation of RUNX1 and its transcription factor partner genes SIN3A and TCF12 in myeloid disorders.

Through a combined approach integrating RNA-Seq, SNP-array, FISH and PCR techniques, we identified two novel t(15;21) translocations leading to the inactivation of RUNX1 and its partners SIN3A and TCF12. One is a complex t(15;21)(q24;q22), with both breakpoints mapped at the nucleotide level, joining RUNX1 to SIN3A and UBL7-AS1 in a patient with myelodysplasia. The other is a recurrent t(15;21)(q21;q22), juxtaposing RUNX1 and TCF12, with an opposite transcriptional orientation, in three myeloid leukemia cases. Since our transcriptome analysis indicated a significant number of differentially expressed genes associated with both translocations, we speculate an important pathogenetic role for these alterations involving RUNX1.

Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making.

BACKGROUND AND PURPOSE: For the STroke Imaging Research (STIR) and VISTA-Imaging Investigators The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials. METHODS: STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials. RESULTS: We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27-28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy. CONCLUSIONS: Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62-87%) across all clinical vignettes and time windows. Perfusion imaging with Computed Tomography or Magnetic Resonance Imaging was associated with increased probability of enrollment into clinical trials for 0-3 h. Following the release of the positive endovascular trials, selection of endovascular only treatment for 6 h increased across all clinical vignettes.

Postoperative Adjuvant Lapatinib and Concurrent Chemoradiotherapy Followed by Maintenance Lapatinib Monotherapy in High-Risk Patients With Resected Squamous Cell Carcinoma of the Head and Neck: A Phase III, Randomized, Double-Blind, Placebo-Controlled Study.

PURPOSE: This multicenter phase III study evaluated the efficacy and safety of lapatinib, an epidermal growth factor receptor/ErbB2 inhibitor, administered concomitantly with chemoradiotherapy and as maintenance monotherapy in patients with high-risk surgically treated squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Patients with resected stage II to IVA SCCHN, with a surgical margin ≤ 5 mm and/or extracapsular extension, were randomly assigned to chemoradiotherapy (66 Gy total radiation dose and cisplatin 100 mg/m(2) per day administered on days 1, 22, and 43) plus placebo or lapatinib (1,500 mg per day) before and during chemoradiotherapy, followed by 12 months of maintenance monotherapy. RESULTS: Six hundred eighty-eight patients were enrolled (lapatinib, n = 346; placebo, n = 342). With a median follow-up time of 35.3 months, the study ended early because of the apparent plateauing of disease-free survival (DFS) events. Median DFS assessed by an independent review committee was 53.6 months and not reached for lapatinib and placebo, respectively (hazard ratio, 1.10; 95% CI, 0.85 to 1.43). Investigator-assessed results confirmed the independent review committee assessment. No significant differences in DFS by human papillomavirus status or overall survival were observed between treatment arms. Similar numbers of patients in both treatment arms experienced adverse events (AEs), with more patients in the lapatinib arm than the placebo arm experiencing serious AEs (48% v 40%, respectively). The most commonly observed treatment-related AEs were diarrhea and rash, both predominantly in the lapatinib arm. CONCLUSION: Addition of lapatinib to chemoradiotherapy and its use as long-term maintenance therapy does not offer any efficacy benefits and had additional toxicity compared with placebo in patients with surgically treated high-risk SCCHN.

A concurrent region growing algorithm guided by circumscribed contours

Image segmentation of natural scenes constitutes a major problem in machine vision. This paper presents a new proposal for the image segmentation problem which has been based on the integration of edge and region information. This approach begins by detecting the main contours of the scene which are later used to guide a concurrent set of growing processes. A previous analysis of the seed pixels permits adjustment of the homogeneity criterion to the region's characteristics during the growing process. Since the high variability of regions representing outdoor scenes makes the classical homogeneity criteria useless, a new homogeneity criterion based on clustering analysis and convex hull construction is proposed. Experimental results have proven the reliability of the proposed approach

The acute effects of strength, endurance and concurrent exercises on the Akt/mTOR/p70S6K1 and AMPK signaling pathway responses in rat skeletal muscle

The activation of competing intracellular pathways has been proposed to explain the reduced training adaptations after concurrent strength and endurance exercises (CE). The present study investigated the acute effects of CE, strength exercises (SE), and endurance exercises (EE) on phosphorylated/total ratios of selected AMPK and Akt/mTOR/p70S6K1 pathway proteins in rats. Six animals per exercise group were killed immediately (0 h) and 2 h after each exercise mode. In addition, 6 animals in a non-exercised condition (NE) were killed on the same day and under the same conditions. The levels of AMPK, phospho-Thr172AMPK (p-AMPK), Akt, phospho-Ser473Akt (p-Akt), p70S6K1, phospho-Thr389-p70S6K1(p-p70S6K1), mTOR, phospho-Ser2448mTOR (p-mTOR), and phospho-Thr1462-TSC2 (p-TSC2) expression were evaluated by immunoblotting in total plantaris muscle extracts. The only significant difference detected was an increase (i.e., 87%) in Akt phosphorylated/total ratio in the CE group 2 h after exercise compared to the NE group (P = 0.002). There were no changes in AMPK, TSC2, mTOR, or p70S6K1 ratios when the exercise modes were compared to the NE condition (P ≥ 0.05). In conclusion, our data suggest that low-intensity and low-volume CE might not blunt the training-induced adaptations, since it did not activate competing intracellular pathways in an acute bout of strength and endurance exercises in rat skeletal muscle.

Exploring Teacher Candidates’ Perception of Practicum Placement Within Concurrent Teacher Education in Two Ontario Universities

In this study, teacher candidates’ perception of their concurrent education program at two Ontario universities were examined, with specific emphasis on how the programs utilized practicum placements, to determine the effectiveness in preparing teacher candidates to teach. This research also strived to uncover the best ways to optimize concurrent teacher education through practicum placements. A questionnaire and interviews were used to uncover teacher candidates’ perceptions at one teacher education program that used full integration of practicum and one that used minimal integration of practicum. The findings revealed that teacher candidates were generally more satisfied with the overall program when there was full integration of practicum. There were statistically significant differences found between the two concurrent programs with regard to practicum time and preparedness and context of the practicum and a highly significant difference found for theory-practice divide. There was also a statistically significant difference (p < .05) observed between the teacher candidates at each university in terms of their beliefs about the need for improvement of their program. Some of the improvements that participants believed could be made to their respective programs included having (a) exceptional mentor teachers and teacher educators, (b) longer placements with a balance of observation and practicum teaching, (c) clear expectations and evaluations of practicum placement, and (d) more distinct connections between theory and practice made within the programs.

On the Benefits of Abstraction in Concurrent Haskell

Heutzutage haben selbst durchschnittliche Computersysteme mehrere unabhängige Recheneinheiten (Kerne). Wird ein rechenintensives Problem in mehrere Teilberechnungen unterteilt, können diese parallel und damit schneller verarbeitet werden. Obwohl die Entwicklung paralleler Programme mittels Abstraktionen vereinfacht werden kann, ist es selbst für Experten anspruchsvoll, effiziente und korrekte Programme zu schreiben. Während traditionelle Programmiersprachen auf einem eher geringen Abstraktionsniveau arbeiten, bieten funktionale Programmiersprachen wie z.B. Haskell, Möglichkeiten zur fortgeschrittenen Abstrahierung. Das Ziel der vorliegenden Dissertation war es, zu untersuchen, wie gut verschiedene Arten der Abstraktion das Programmieren mit Concurrent Haskell unterstützen. Concurrent Haskell ist eine Bibliothek für Haskell, die parallele Programmierung auf Systemen mit gemeinsamem Speicher ermöglicht. Im Mittelpunkt der Dissertation standen zwei Forschungsfragen. Erstens wurden verschiedene Synchronisierungsansätze verglichen, die sich in ihrem Abstraktionsgrad unterscheiden. Zweitens wurde untersucht, wie Abstraktionen verwendet werden können, um die Komplexität der Parallelisierung vor dem Entwickler zu verbergen. Bei dem Vergleich der Synchronisierungsansätze wurden Locks, Compare-and-Swap Operationen und Software Transactional Memory berücksichtigt. Die Ansätze wurden zunächst bezüglich ihrer Eignung für die Synchronisation einer Prioritätenwarteschlange auf Basis von Skiplists untersucht. Anschließend wurden verschiedene Varianten des Taskpool Entwurfsmusters implementiert (globale Taskpools sowie private Taskpools mit und ohne Taskdiebstahl). Zusätzlich wurde für das Entwurfsmuster eine Abstraktionsschicht entwickelt, welche eine einfache Formulierung von Taskpool-basierten Algorithmen erlaubt. Für die Untersuchung der Frage, ob Haskells Abstraktionsmethoden die Komplexität paralleler Programmierung verbergen können, wurden zunächst stencil-basierte Algorithmen betrachtet. Es wurde eine Bibliothek entwickelt, die eine deklarative Beschreibung von stencil-basierten Algorithmen sowie ihre parallele Ausführung erlaubt. Mit Hilfe dieses deklarativen Interfaces wurde die parallele Implementation vollständig vor dem Anwender verborgen. Anschließend wurde eine eingebettete domänenspezifische Sprache (EDSL) für Knoten-basierte Graphalgorithmen sowie eine entsprechende Ausführungsplattform entwickelt. Die Plattform erlaubt die automatische parallele Verarbeitung dieser Algorithmen. Verschiedene Beispiele zeigten, dass die EDSL eine knappe und dennoch verständliche Formulierung von Graphalgorithmen ermöglicht.

ACTORS: A Model of Concurrent Computation in Distributed Systems

A foundational model of concurrency is developed in this thesis. We examine issues in the design of parallel systems and show why the actor model is suitable for exploiting large-scale parallelism. Concurrency in actors is constrained only by the availability of hardware resources and by the logical dependence inherent in the computation. Unlike dataflow and functional programming, however, actors are dynamically reconfigurable and can model shared resources with changing local state. Concurrency is spawned in actors using asynchronous message-passing, pipelining, and the dynamic creation of actors. This thesis deals with some central issues in distributed computing. Specifically, problems of divergence and deadlock are addressed. For example, actors permit dynamic deadlock detection and removal. The problem of divergence is contained because independent transactions can execute concurrently and potentially infinite processes are nevertheless available for interaction.

AFL-1: A Programming Language for Massively Concurrent Computers

Computational models are arising is which programs are constructed by specifying large networks of very simple computational devices. Although such models can potentially make use of a massive amount of concurrency, their usefulness as a programming model for the design of complex systems will ultimately be decided by the ease in which such networks can be programmed (constructed). This thesis outlines a language for specifying computational networks. The language (AFL-1) consists of a set of primitives, ad a mechanism to group these elements into higher level structures. An implementation of this language runs on the Thinking Machines Corporation, Connection machine. Two significant examples were programmed in the language, an expert system (CIS), and a planning system (AFPLAN). These systems are explained and analyzed in terms of how they compare with similar systems written in conventional languages.

A Concurrent Smalltalk Compiler for the Message-Driven Processor

This thesis describes Optimist, an optimizing compiler for the Concurrent Smalltalk language developed by the Concurrent VLSI Architecture Group. Optimist compiles Concurrent Smalltalk to the assembly language of the Message-Driven Processor (MDP). The compiler includes numerous optimization techniques such as dead code elimination, dataflow analysis, constant folding, move elimination, concurrency analysis, duplicate code merging, tail forwarding, use of register variables, as well as various MDP-specific optimizations in the code generator. The MDP presents some unique challenges and opportunities for compilation. Due to the MDP's small memory size, it is critical that the size of the generated code be as small as possible. The MDP is an inherently concurrent processor with efficient mechanisms for sending and receiving messages; the compiler takes advantage of these mechanisms. The MDP's tagged architecture allows very efficient support of object-oriented languages such as Concurrent Smalltalk. The initial goals for the MDP were to have the MDP execute about twenty instructions per method and contain 4096 words of memory. This compiler shows that these goals are too optimistic -- most methods are longer, both in terms of code size and running time. Thus, the memory size of the MDP should be increased.

Concurrent Aggregates (CA): An Object-Oriented Language for Fine-Grained Message-Passing Machines

Fine-grained parallel machines have the potential for very high speed computation. To program massively-concurrent MIMD machines, programmers need tools for managing complexity. These tools should not restrict program concurrency. Concurrent Aggregates (CA) provides multiple-access data abstraction tools, Aggregates, which can be used to implement abstractions with virtually unlimited potential for concurrency. Such tools allow programmers to modularize programs without reducing concurrency. I describe the design, motivation, implementation and evaluation of Concurrent Aggregates. CA has been used to construct a number of application programs. Multi-access data abstractions are found to be useful in constructing highly concurrent programs.

Concurrent Smalltalk on the Message-Driven Processor

Concurrent Smalltalk is the primary language used for programming the J- Machine, a MIMD message-passing computer containing thousands of 36-bit processors connected by a very low latency network. This thesis describes in detail Concurrent Smalltalk and its implementation on the J-Machine, including the Optimist II global optimizing compiler and Cosmos fine-grain parallel operating system. Quantitative and qualitative results are presented.