Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group

Background: The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. Patients and methods: In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. Results: Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). Conclusion: Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoide

Non-local kinetic and macroscopic models for self-organised animal aggregations

The last two decades have seen a surge in kinetic and macroscopic models derived to investigate the multi-scale aspects of self-organised biological aggregations. Because the individual-level details incorporated into the kinetic models (e.g., individual speeds and turning rates) make them somewhat difficult to investigate, one is interested in transforming these models into simpler macroscopic models, by using various scaling techniques that are imposed by the biological assumptions of the models. However, not many studies investigate how the dynamics of the initial models are preserved via these scalings. Here, we consider two scaling approaches (parabolic and grazing collision limits) that can be used to reduce a class of non-local 1D and 2D models for biological aggregations to simpler models existent in the literature. Then, we investigate how some of the spatio-temporal patterns exhibited by the original kinetic models are preserved via these scalings. To this end, we focus on the parabolic scaling for non-local 1D models and apply asymptotic preserving numerical methods, which allow us to analyse changes in the patterns as the scaling coefficient ϵ is varied from ϵ=1 (for 1D transport models) to ϵ=0 (for 1D parabolic models). We show that some patterns (describing stationary aggregations) are preserved in the limit ϵ→0, while other patterns (describing moving aggregations) are lost. To understand the loss of these patterns, we construct bifurcation diagrams

Upconversion-induced heat generation and thermal lensing in Nd:YLF and Nd:YAG

We investigate the influence of interionic upconversion between neighboring ions in the upper laser level of Nd:YLF and Nd:YAG on population dynamics, heat generation, and thermal lensing under lasing and non-lasing conditions. It is shown that cascaded multiphonon relaxations following each upconversion process generate significant extra heat dissipation in the crystal under non-lasing compared to lasing conditions. Owing to the unfavorable temperature dependence of thermal and thermo-optical parameters, this leads, firstly, to a significant temperature increase in the rod, secondly, to strong thermal lensing with pronounced spherical aberrations and, ultimately, to rod fracture in a high-power end-pumped system. In a three-dimensional finite-element calculation, excitation densities, upconversion rates, heat generation temperature profiles, and thermal lensing are calculated. Differences in thermal lens power between non-lasing and lasing conditions up to a factor of six in Nd:YLF and up to a factor of two in Nd:YAG are experimentally observed and explained by the calculation. This results in a strong deterioration in performance when operating these systems in a Q-switched regime, as an amplifier, or on a low-gain transition. Methods to decrease the influence of interionic upconversion are discussed. It is shown that tuning of the pump wavelength can significantly alter the rod temperature

Impaired ventilatory acclimatization to hypoxia in female mice overexpressing erythropoietin: unexpected deleterious effect of estradiol in carotid bodies

Apart from enhancing the production of red blood cells, erythropoietin (Epo) alters the ventilatory response when oxygen supply is reduced. We recently demonstrated that Epo's beneficial effect on the ventilatory response to acute hypoxia is sex-dependent, with female mice being better able to cope with reduced oxygenation. In the present work we hypothesized that ventilatory acclimatization to chronic hypoxia (VAH) in transgenic female mice (Tg6) harboring high levels of Epo in the brain and blood will also be improved compared to wilde type (WT) animals. Surprisingly, VAH was blunted in Tg6 female mice. To define whether this phenomenon had a central (brainstem respiratory centers) and/or peripheral (carotid bodies) origin, a bilateral transection of carotid sinus nerve (chemodenervation) was performed. This procedure allowed the analysis of the central response in the absence of carotid body information. Interestingly, chemodenervation restored the VAH in Tg6 mice, suggesting that carotid bodies were responsible for the blunted response. Coherently with this observation, the sensitivity to oxygen alteration in arterial blood (Dejour test) after chronic hypoxia was lower in transgenic carotid bodies compared to the WT control. As blunted VAH occurred in female but not male transgenic mice, the involvement of sex female steroids was obvious. Indeed, measurement of sexual female hormones revealed that the estradiol serum level was 4 times higher in transgenic mice Tg6 than in WT animals. While ovariectomy decreased VAH in WT females, this treatment restored VAH in Tg6 female mice. In line with this observation, injections of estradiol in ovariectomized Tg6 females dramatically reduced the VAH. We concluded that during chronic hypoxia, estradiol in carotid bodies suppresses the Epo-mediated elevation of ventilation. Considering the increased application of recombinant Epo for a variety of disorders, our data implies the need to take the patient's hormonal status into consideration

Cerebelläre Abiotrophie bei Vollblutaraber-Fohlen

Four pure-bred Arabian foals showed severe central nervous symptoms at three weeks to three months of age. The clinical diagnosis ''cerebellar abiotrophy'' was established and later confirmed histopathologically in three of the cases (one foal was not available for autopsy). The dominant clinical signs consisted in severe ataxia, distinctly more pronounced in the front legs (including rump ataxia), in dys- and extreme hypermetric gaits and - above all - in an intention tremor of the head. The menace or blink reflex was absent although the vision of the foals was probably unimpaired. The clinical signs were due to an almost total hypoplasia or atrophy of the Purkinje cell layer. The analysis of the pedigrees of the four Swiss cases, as well as of seven Belgian and one Finnish case showed that all foals were inbred to Skowronek, a stallion born in 1909 in the Ukraine and used predominantly in England. All foals trace to Skowronek through his son Naseem (England, later in Russia) and/or his grandson Nana Sahib (Spain). In addition, some of the foals also trace, through Bakszysz and nor through Skowronek, to Skowronek's grandfather Rymnik. An autosomal recessive mode of inheritance of the trait is the most likely