A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with 'good-risk' metastatic non-seminomatous germ cell tumors

BACKGROUND: Cisplatin-based combination chemotherapy will cure 70% to 80% of patients with metastatic non-seminomatous germ cell tumors but is associated with the possibility of severe neuro-, oto- and nephro-toxicities. Carboplatin, a cisplatin analogue, is an active drug in testicular cancer with a more favourable spectrum of side effects. In a randomized trial, the German Testicular Cancer Study Group compared a combination regimen of carboplatin, etoposide and bleomycin (CEB) to standard cisplatin, etoposide and bleomycin (PEB) chemotherapy for patients with 'minimal-' and moderate-disease' non-seminomatous germ cell tumors, according to the Indiana University classification. PATIENTS AND METHODS: PEB was given for three cycles at standard doses (given days 1-5), and the CEB regimen consisted of carboplatin (target AUC of 5 mg/ml x min) on day 1, etoposide 120 mg/m2 on days 1 to 3 and bleomycin 30 mg on days 1, 8 and 15. Four cycles of CEB were given, with the omission of bleomycin in the fourth cycle. Thus, the cumulative doses of etoposide and bleomycin applied in the two treatment arms were comparable. Fifty-four patients were entered on the trial, 29 were treated with PEB and 25 with CEB chemotherapy. Patients were stratified according to disease extent (minimal versus moderate) and the degree of tumor marker elevation. Thirty-two patients (59%) belonged to the group with minimal disease and low markers. RESULTS: No significant difference in response to chemotherapy was seen between the two arms, with CR rates of 81% for the PEB arm and 76% for CEB treatment. However, more patients treated with CEB (32% versus 13%) have relapsed after therapy, and 4 patients (16%) have died of disease progression after CEP in contrast to 1 (3%) after PEB therapy. The first interim analysis of negative events (relapse, vital tumor at secondary resection, death from disease and therapy-associated death) showed a significantly higher rate after CEB than after PEB therapy, and the trial was terminated early. After a median follow-up of 33 months for all patients, the calculation of negative events is still significantly in favour of PEB-treated patient, particularly since three late relapses > 2 years have been observed in the CEB arm (P = 0.03). CONCLUSION: This randomized trial demonstrates that even with the use of adequate doses of etoposide and full-dose bleomycin, carboplatin cannot altogether replace cisplatin in patients with testicular cancer. Treatment with the PEB regimen remains the standard approach in patients with 'good-risk' non-seminomatous germ cell tumors.     

Photonic access concentrator for ATM gigabit switching fabrics

In future broadband communication networks the interest for purely photonic switches is due to the bandwidth mismatch between optical transmission networks and electronic switching nodes. Photonic ATM switching fabrics mainly based on wavelength-switching stages are therefore being studied, to implement high capacity switches with also concentration, multiplexing and demultiplexing functions, using state-of-the-art photonic technology. The architecture of an ATM photonic access concentrator is described in this paper, illustrating the design and implementation of its basic subsystems, the traffic concentrator and the cell multiplexer. The design guidelines are outlined in detail referring to an example, where 128 user lines at 622 Mb/s are given access to 4 outlets at 2.488 Gb/s. The corresponding implementation, based on the systematic use of cell wavelength encoding, makes use either of well-known photonic components, such as Fabry-Perot filters, fiber delay lines, splitters and combiners, either of recently developed devices, like high-speed optical gates and tunable filters and lasers. Finally, the system feasibility is demonstrated presenting the results obtained on a reduced size and speed experimental setup of the cell multiplexer     

Interfacial Dipoles and Radiated Energy

Electric dipoles radiate an electromagnetic field into their surroundings. The electric and magnetic fields from a point source or from linear dipoles have components parallel to a spherical surface but also a radial component. In most investigations on radiated fields, only the part of the electric field that is parallel to a spherical surface is taken into account. The argument is that only that component contributes to the radiated energy. Here we show that the phase front in the lower half space is not a spherical surface and hence, the radial components contribute to radiated energy. We show differences in radiation patterns for point electric dipoles and linear dipoles, either modeled as perfectly conducting wires or as resistively loaded wires. Our primary interest lies with improving image resolution through processing of Ground-Penetrating Radar data. Here the emphasis lies with understanding the radiation characteristics of linear dipoles that can be incorporated with image processing algorithms. The model uses a thin-wire approximation for the transmitter antenna. The solution to the discrete system of equations is solved, incorporating interaction between the interface, using a CGFFT scheme including symmetrization and a newly developed preconditioning operator. We look at the electric and magnetic fields as well as the time-averaged Poynting vector radiation patterns in the E-plane and H-plane of the transmitting antenna. The results show that the radial component of the radiated electric and magnetic field is not negligible, even at distances more than seven wavelengths away from the antennas.     

Influence of inulin modification and flour type on the sensory quality of prebiotic wafer crackers

An inulin syrup made from Jerusalem artichoke tubers, either in its commercial form or after ultrafiltration, was freeze-dried and used as a prebiotic ingredient in the small-scale manufacture of wafer crackers. The flours used for the preparation of wafer batters were from wheat, rye or spelt wheat, or 1:1 combinations of wheat flour and rye flour or wheat flour and spelt wheat flour. Batter viscosity was strongly influenced by the selection of the flour type, but remained within technologically acceptable limits. The ultrafiltration of the inulin syrup, using a 1 kDa membrane, resulted in a significant reduction of the content of free sugars and minerals which, in turn, had a significant impact on the CIE-Lab color values of the wafer crackers. Using spelt wheat flour instead of wheat flour significantly increased wafer cracker firmness measured by penetration, as did the incorporation of ultrafiltered freeze-dried instead of native freeze-dried Jerusalem artichoke syrup. Sensory analysis revealed a significant influence of product formulation on appearance, flavor and texture of the wafer crackers. It can be concluded from quality scores, which were calculated by using weighting factors assigned to the sensory attributes, that wheat flour may be partially replaced by rye flour or spelt wheat flour without negatively affecting the sensory properties of the wafer crackers.