Skywave Detection and Mitigation for the MF R-Mode Continuously Operating Reference Station.

There is an increasing need for an independent terrestrial navigation system, owing to the increasing reliance on global navigation satellite systems (GNSS). The medium-frequency range (MF R-Mode) system is considered a promising alternative; however, the skywave effect caused by ionospheric changes at night can degrade its positioning accuracy. To address this problem, we developed an algorithm to detect and mitigate the skywave effect on MF R-Mode signals. The proposed algorithm was tested using data collected from Continuously Operating Reference Stations (CORS) monitoring the MF R-Mode signals. The skywave detection algorithm is based on the signal-to-noise ratio (SNR) induced by the groundwave and skywave composition, whereas the skywave mitigation algorithm was derived from the I and Q components of the signals obtained through IQ modulation. The results demonstrate a significant improvement in the precision and standard deviation of the range estimation using CW1 and CW2 signals. The standard deviations decreased from 39.01 and 39.28 m to 7.94 and 9.12 m, respectively, while the precision (2-sigma) increased from 92.12 and 79.82 m to 15.62 and 17.84 m, respectively. These findings confirm that the proposed algorithms can enhance the accuracy and reliability of MF R-Mode systems.

Phase II clinical trial of paclitaxel loaded polymeric micelle in patients with advanced pancreatic cancer.

PURPOSE: To determine in patients, with locally advanced or metastatic pancreatic cancer (APC), efficacy and safety of treatment with intravenous paclitaxel loaded polymeric micelle (GPM). PATIENTS AND METHODS: This was a multicenter, open-label Phase II study. Patients with APC, ECOG performance status < or = 2, no prior chemotherapy and adequate organ function were treated with 3-hour GPM infusions every 3 weeks. Initial patients were treated with 435 mg/m(2) (n = 11). The dose was reduced for subsequent patients to 350 or 300 mg/m(2) (n = 45). Primary endpoint was time to tumor progression (TTP). RESULTS: 56 patients were enrolled. Median TTP for patients treated with 300 or 350 mg/m(2) doses was 3.2 months (95% CI, 2.6-4.2). Median progression free survival (PFS) was 2.8 months (95% CI, 1.4-4.0). Median overall survival (OS) was 6.5 months (95% CI, 5.1-7.9). Among patients treated with above doses of GPM, there was 1 complete remission (CR) and 2 partial remissions (PR) with an overall response rate (ORR) of 6.7%. Disease control rate (CR + PR + stable disease) was 60.0%. Most common grade 3 toxicities were: neutropenia (40.0%), fatigue (17.8%), infection, dehydration, neuropathy (each 13.3%), and abdominal pain (11.1%). CONCLUSIONS: Treatment of APC with GPM at a dose of 300 mg/m(2) q 3 weeks was well tolerated and common toxicities were qualitatively similar to Cremophor-based paclitaxel. GPM monotherapy resulted in OS and other efficacy parameters preferable to that seen historically with gemcitabine. Future studies of GPM in combination with other agents for treatment of APC are warranted.

Salvage Anterior Lumbar Interbody Fusion for Pseudoarthrosis After Posterior or Transforaminal Lumbar Interbody Fusion: A Review of 10 Patients.

BACKGROUND: After interbody cage implantation for posterior or transforaminal lumbar interbody fusion (PLIF or TLIF) spinal fusion surgery, pseudoarthrosis can develop. However, there are several shortcomings of the posterior approach if the interbody cage requires removal. Therefore, an anterior approach may be useful. METHODS: We reviewed salvage anterior lumbar interbody fusion (ALIF) for pseudoarthrosis after PLIF or TLIF performed from December 2006 to December 2016. A total of 10 patients met inclusion criteria for the study. All preoperative and postoperative clinical and radiologic parameters were recorded. RESULTS: Salvage ALIF resulted in improvements in clinical and radiologic outcomes in all cases. In 9 cases, the previously inserted cage was successfully removed. In 1 case, only 1 of the 2 previously inserted cages could be removed, as the previously inserted cage exhibited a high subsidence and remained in a diagonal position in the vertebral body. No serious complications occurred in all cases. Bone fusion was successful in all cases. CONCLUSIONS: ALIF is useful for salvage surgery to treat failed PLIF or TLIF. The advantages of salvage ALIF include improvements in clinical and radiologic outcomes and a low complication rate after surgery. To successfully remove a previously inserted cage, the vascular window of the anterior index level and the degree of subsidence of the cage should be well characterized through preoperative radiologic imaging.

Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment.

PURPOSE: This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. METHODS: Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). RESULTS: The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. CONCLUSION: The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

Changes in clinical and laboratory features of Kawasaki disease noted over time in Daejeon, Korea.

BACKGROUND: Kawasaki disease (KD) becomes one of the common diseases in Korea. Changes in clinical features and laboratory findings of KD were evaluated over a period of 10 years. METHODS: We reviewed the medical records of KD patients and compared the clinical and laboratory features of two KD patient groups: those admitted from 2000 to 2004 (group A, 284 cases) and those admitted from 2010 to 2014 (group B, 331 cases). RESULTS: There were a total of 615 KD patients (mean age: 29.7 months; male-to-female ratio = 1.6:1), including 228 incomplete KD patients. Incomplete KD patients had milder values in some laboratory indices. The preadmission and total fever durations were longer in group A than in group B. The proportion of incomplete KD was higher in group B, but incidence of coronary artery lesions (CALs) was lower. For laboratory indices, the C-reactive protein and follow-up platelet values were lower, and the hemoglobin and albumin values were higher in group B. The same clinical and laboratory findings were confirmed in the KD subgroups; those with the same fever duration of 5 or 6 days and same ages, those with complete KD, and those with incomplete KD in the two different time periods. CONCLUSIONS: Our findings suggest that clinical features of KD tend to be milder over time and manifest in a higher incidence of incomplete KD, lower incidence of CALs, and less severe laboratory findings in recent KD patients in Korea compared with their historic counterparts.

Investigation of the release behavior of DEHP from infusion sets by paclitaxel-loaded polymeric micelles.

The current clinical formulation of paclitaxel (Taxol) contains 1:1 blend of Cremophor EL (polyethoxylated castor oil) and dehydrated ethanol. Cremophor EL and dehydrated ethanol are well known to leach di-(2-ethylhexyl) phthalate (DEHP) from polyvinyl chloride (PVC) infusion bags and PVC administration sets. DEHP is a possible hepatotoxin, carcinogen, teratogen and mutagen. Long-term exposure to DEHP may cause health risks. As an alternative formulation for paclitaxel, paclitaxel-loaded polymeric micelles (PLPM), made of monomethoxy poly(ethylene glycol)-block-poly(d,l-lactide) (mPEG-PDLLA) diblock copolymer, has demonstrated clear advantages over Taxol in pharmacokinetics and therapeutic index. Paclitaxel in either PLPM or Taxol formulations, diluted in 0.9% sodium chloride injection, was stable in the PVC infusion bags. The PLPM formulation significantly reduced the amount of DEHP extracted from PVC infusion bags and PVC administration sets. For PLPM diluted in 0.9% sodium chloride injection, the total amount of DEHP delivered over the simulated infusion period was 0.7 mg for 3h and 2.0 mg for 24 h, which was less than 2.9% of the DEHP extracted by Taxol. These results confirmed that there is negligible risk of DEHP exposure from diluted PLPM i.v. infusion using PVC infusion bags and PVC administration sets.

Sensitive HPLC method for quantitation of paclitaxel (Genexol in biological samples with application to preclinical pharmacokinetics and biodistribution.

A sensitive, specific and reproducible HPLC method has been developed and validated for the quantitative determination of paclitaxel in plasma, tissues and tumor of mice. Tissue specimens including liver, kidneys, spleen, lungs, heart and tumor were separately homogenized in bovine serum albumin (BSA, 40 g/l) in water. Plasma or tissue homogenates (0.1 ml) containing paclitaxel and internal standard (dimethyl-4,4'-dimethoxy-5,6,5',6'-dimethylene dioxy biphenyl-2',2' dicarboxylate (DDB), I.S.) were extracted by ethyl acetate (10 ml). A 4.6 mm x 250 mm ODS column was used to separate the components in biological samples with UV detection at 227 nm and gradient system was applied to a quantitation of paclitaxel consisting of acetonitrile-deionized water. The I.S. and paclitaxel were eluted at 13.7 and 18.0 min, respectively, and no interfering peaks were observed. Linear relationships (r(2) > 0.999) were obtained between the peak height ratios and the corresponding biological sample concentrations over the range of 0.1-20 microg/ml. The average intra- and inter-day variations (% R.S.D.s and % deviations) of the assay for biological samples were less than 10%. The LOD and LOQ were 5 and 10 ng/ml, respectively, for paclitaxel using a microsample volume (100 microl) of plasma sample. This HPLC method has been successfully applied for the determination of paclitaxel in pharmacokinetic and biodistribution study in after administration of 50 mg equivalent paclitaxel/kg dose of paclitaxel-loaded polymeric micelle and 20 mg equivalent paclitaxel/kg dose of Taxol to female SPF C57BL/6 mice.