Einfluss der individuellen subjektiven Therapieerwartung auf Angst und Depressivität im Verlauf einer allogenen Stammzelltransplanation

Stammzelltransplantationen gelten heute als wirksame und oft einzig kurative Therapieoption bei hämatoonkologischen Erkrankungen. Durch das hohe Nebenwirkungsspektrum und die „aggressive“ und langwierige Therapie stellt die Stammzelltransplantation für den einzelnen Patienten jedoch ein risikoreiches und vor allem körperlich und psychisch belastendes Verfahren dar. Ziel der ID Step Studie war einerseits die Messung der psychoonkologischen Belastung für den Patienten im Verlauf einer Stammzelltransplantation sowie andererseits die Erfassung des Einflusses der subjektiven Therapieerwartung auf Angst und Depressivität im Verlauf einer allogenen Stammzelltransplantation Die statistische Analyse zeigte, dass Angst und Depressivität auf einem erhöhten Niveau erlebt wurden. Die Analyse zeigte für bis zu 29 % der Patienten klinisch relevante Angst- (Cut off > 8) und bei über 40% der Patienten klinisch relevante Depressivitätswerte (HADS). Bei der Berechnung des Einflusses der subjektiven Therapiewartungen auf Angst und Depressivität konnte ein Zusammenhang zwischen im Vorfeld geäußerter „negativer“ Erwartungen der Patienten (Ausbleiben eines Therapieerfolges; dem Erwarten von Nebenwirkungen, sowie einer eingeschränkten aktuellen oder früheren psychischen Belastbarkeit) und dem Auftreten von erhöhten Angst- und Depressivitätswerten gefunden werden

Can accurate distance-specific emissions of nitrogen oxide emissions from cars be determined using remote sensing without measuring exhaust flowrate?

Portable Emission Measurement Systems (PEMS) are commonly used to measure absolute (mass per unit distance) emissions of a range of pollutants from road vehicles under real driving conditions. Because measuring large numbers of vehicles with PEMS is impractical, this paper investigates how vehicle emission remote sensing device (RSD) can supplement the use of PEMS. We simulate whether remote sensing measurements can accurately predict a vehicle's real-world distance-specific nitrogen oxides (NOX) emissions using RSD without measuring its exhaust flow rate. The approach uses readily available type-approval carbon dioxide (CO2) emission data together with average real-world divergences from studies based on user-reported fuel economy data. We find that at least 30 RS measurements from a given vehicle's journey are needed to reach a mean absolute error of 30% compared to a large reference data set of individual PEMS measurements. With that condition met, it is concluded that estimates agree well with actual NOX emissions from cars and the applied method does not introduce a systematic bias. It is also found that the accuracy of estimates for distance-specific NOX emissions does not significantly improve when more than 300 remote-sensing samples are available, with a mean absolute error converging to 23%. We conclude that this method could be used to screen large car fleets and identify vehicles or group of vehicles that are likely grossly exceeding air pollution standards

Intravenous ibandronate reduces the incidence of skeletal complications in patients with breast cancer and bone metastases

Background: This phase III study compared the efficacy of the new potent bisphosphonate, ibandronate, with placebo as intravenous (i.v.) therapy in metastatic bone disease due to breast cancer. Patients and methods: A total of 466 patients were randomised to receive placebo (n = 158), or 2 mg (n = 154) or 6 mg (n = 154) ibandronate every 3-4 weeks for up to 2 years. The primary efficacy parameter was the number of 12-week periods with new bone complications, expressed as the skeletal morbidity period rate (SMPR). Bone pain, analgesic use and safety were evaluated monthly. Results SMPR was lower in both ibandronate groups compared with the placebo group; the difference was statistically significant for the ibandronate 6 mg group (P = 0.004 versus placebo). Consistent with the SMPR, ibandronate 6 mg significantly reduced the number of new bone events (by 38%) and increased time to first new bone event. Patients on ibandronate 6 mg also experienced decreased bone pain scores and analgesic use. Treatment with ibandronate was well tolerated. Conclusions: These results indicate that 6 mg i.v. ibandronate is effective and safe in the treatment of bone metastases from breast cance

Single-agent gemcitabine versus cisplatin-etoposide: Early results of a randomised phase II study in locally advanced or metastatic non-small-cell lung cancer

Background This randomised study was designed to determine the response rate, survival and toxicity of single-agent gemcitabine and cisplatin-etoposide in chemo-naïve patients with locally advanced or metastatic non-small-cell lung cancer. Patients and methods Gemcitabine 1,000 mg/m2 was given as a 30 min intravenous infusion on days 1, 8, 15 of a 28-day cycle, cisplatin 100 mg/m2 on day 1, and etoposide 100 mg/m2 on days 1 (following cisplatin), 2 and 3. Major eligibility criteria included histologically confirmed non-small-cell lung cancer, measurable disease, Zubrod PS 0-2; no prior chemotherapy, no prior radiation of the measured lesion, and no CNS metastases. Results 146 patients were enrolled, 71 patients on gemcitabine and 75 patients on cisplatin-etoposide. Patient characteristics were well matched across both arms. Sixty-six gemcitabine patients and 72 cisplatin-etoposide patients were evaluable. Partial responses were seen in 12 gemcitabine patients (18.2%; 95% CI: 9.8-30) and 11 cisplatin-etoposide patients (15.3%; 95% CI: 7.9-25.7). Early indications show no statistical differences between the two treatments with respect to time to disease progression or survival. Haematological and laboratory toxicity were moderate and manageable. However, hospitalisation because of neutropenic fever was required for 6 (8%) cisplatin-etoposide patients but not for any gemcitabine patients. Non-haematological toxicity was more pronounced with significant differences in nausea and vomiting (grade 3 and 4: 11% gemcitabine vs. 29% cisplatin-etoposide; despite the allowance for 5-HT3 antiemetics during the first cycle of cisplatin-etoposide), and alopecia (grade 3 and 4: 3% gemcitabine vs. 62% cisplatin-etoposide). Conclusions In this randomised study, single-agent gemcitabine was at least as active but better tolerated than the combination cisplatin-etoposid

Platinbasierte Chemotherapie versus Cetuximab simultan zur Re-Bestrahlung bei rezidivierten Plattenepithelkarzinomen im Kopf-Hals-Bereich : eine retrospektive Analyse

Purpose. Locoregional recurrence remains the main pattern of failure after primary combined modality treatment of squamous cell carcinoma of the head and neck (SCCHN). We compared the efficacy and toxicity of either cisplatin or cetuximab in combination with re-irradiation (ReRT) for recurrent irresectable SCCHN. Various clinicopathological factors were investigated to establish a prognostic score. Patients and methods. Between 2007-2014, 66 patients with recurrent SCCHN, originating in a previously irradiated area, received concomitant cetuximab (n=33) or cisplatin-based chemotherapy (n=33) and ReRT. Toxicity was evaluated weekly and at every follow-up visit. Physical examination, endoscopy, CT- or MRI-scans were used to evaluate response and disease control. Results. With a mean follow-up of 18.3 months, the 1-year-overall survival (OS) for Re-RT with cetuximab and cisplatin-based chemotherapy was 44.4% and 45.5% (p=0.352), respectively. Local control rates were 46.4% and 54.2% (p=0.625), freedom from metastases rates 73.6% and 81% (p=0.842) at one year, respectively. Haematological toxicity ≥ grade 3 occurred more often in the cisplatin-group (p< 0.001), pain ≥ grade 3 was increased in the cetuximab-group (p=0.034). A physiological haemoglobin level and a longer interval between primary RT and ReRT, proved to be significant prognostic factors for OS (multivariate: p=0.003, p=0.002 respectively). The site of the recurrence and the gross target volume did not show a significant impact on OS in multivariate analysis (p=0.160 and p=0.167). A prognostic-score based on these four variables identified significantly different subgroups: 1-year-OS for 0/1/2/3/4 prognostic points: 10%, 38%, 76%, 80% and 100% (p<0.001). Conclusion. Both cetuximab- and cisplatin-based ReRT of SCCHN-recurrences are feasible and effective treatment options with comparable results concerning tumor control and survival. Acute adverse events may differ slightly. Our prognostic score could help to identify appropriate patients for ReRT and stratify patients within future clinical trials.Ziel. Lokoregionäre Rezidive sind der Hauptgrund für ein Therapieversagen nach primärer multimodaler Behandlung von Plattenepithelkarzinomen der Kopf-Hals-Region (SCCHN). Wir verglichen die Effektivität und Toxizität von Cisplatin oder Cetuximab simultan zur Re-Bestrahlung (ReRT) bei inoperablen SCCHN-Rezidiven. Ein prognostischer Score sollte auf Grundlage verschiedener klinischer und pathologischer Faktoren etabliert werden. Patienten und Methoden. 66 Patienten mit in vorbestrahlten Regionen rezidivierten SCCHN wurden von 2007 bis 2014 simultan mit Cetuximab (n=33) oder cisplatin-basierter Chemotherapie (n=33) re-bestrahlt. Die Toxizität wurde wöchentlich sowie bei jedem Nachsorgetermin erfasst. Klinische Untersuchung, Endoskopie, CT- oder MRT-Untersuchungen wurden zur Beurteilung des Therapieansprechens und der Krankheitskontrolle eingesetzt. Ergebnisse. Nach einer mittleren Nachbeobachtungszeit von 18,3 Monaten betrug das 1-Jahres-Überleben (OS) für ReRT mit Cetuximab 44,4% und mit cisplatin-basierter Chemotherapie 45,5% (p=0.352). Die lokalen Kontollraten nach einem Jahr waren jeweils 46,4% und 54,2% (p=0.625); die Raten an Metastasenfreiheit 73,6% und 81% (p=0.842). Hämatologische Toxizität ≥ Grad 3 kam in der Cisplatin-Gruppe häufiger vor (p<0.001), dagegen trat Schmerz ≥ Grad 3 in der Cetuximab-Gruppe häufiger auf (p=0.034). Ein physiologischer Hb-Wert und ein längeres Intervall zwischen primärer RT und ReRT erwiesen sich als signifikante prognostische Faktoren für das OS (multivariat: p=0.003 und p=0.002). Die Rezidivlokalisation sowie das GTV zeigten keinen signifikanten Einfluss auf das OS in der multivariaten Analyse (p=0.160 und p=0.167). Ein auf Grundlage dieser Variablen konstruierter Prognose-Score (0 bis 4 Punkte) zeigte signifikante Überlebensunterschiede: 1-Jahres-OS für 0/1/2/3/4 Prognosepunkte: 10%, 38%, 76%, 80% und 100% (p<0.001). Schlussfolgerung. Sowohl Cetuximab- als auch Cisplatin-basierte ReRT für SCCHN-Rezidive sind gut durchführbare und effektive Behandlungsoptionen mit vergleichbaren Ergebnissen bezüglich Tumorkontrolle und Überleben. Die akuten Nebenwirkungen könnten gering variieren. Unser Prognose-Score könnte zur Identifizierung der für ReRT geeigneten Patienten sowie zur Stratifizierung in künftigen klinischen Studien dienen

Getting Green to Work in the Northwest Industrial District

Forest Park and its surrounding watershed experience measurable environmental problems such as urban heat island impacts, increased storm water runoff containing pollutants, fragmentations of habitat connectivity due to their proximities to high-impact land uses, poor air quality, absence of public space, and lack of pedestrian and bicycle infrastructure. Getting Green to Work in the Northwest Industrial District identifies strategies to address environmental issues that affect local human and environmental health in the Northwest Indusrial District, Forest Park and the Willamette River, while benefiting local businesses workers and firms. Getting Green to Work explores voluntary approaches to address local environmental problems with green infrastructure and other place-based remedies. Through engagement with industrial stakeholders and technical advisors we determined where the greatest environmental benefit could be achievable and what opportunities and obstacles exist to implementation. Building on this information, final recommendations outline priorities and strategies for Forest Park Conservancy, City of Portland Bureau of Environmental Services and their advocates to expand green infrastructure on private and public lands in the Northwest Industrial District. This project was conducted under the supervision of Sy Adler, Marisa Zapat