Patient reported upper gastro-intestinal symptoms associated with fractionated image-guided conformal radiotherapy for metastatic spinal cord compression

Background and purpose Palliative radiotherapy is given to sustain or improve quality of life for patients with advanced cancer. Radiotherapy may however result in symptomatic side effects, which may affect the patient negatively. This prospective longitudinal study of 30 patients aimed at investigating the incidence and severity of early toxicity, particularly focusing on dysphagia, esophagitis and mucositis, following fractionated radiotherapy for cervical and thoracic metastatic spinal cord compression (MSCC), as well as determining the relationship between esophageal dose and early upper gastro-intestinal symptoms. Materials and methods Thirty patients receiving radiotherapy of 3Gyx10 for MSCC were included in the study. Patients were assessed for a total of 7 weeks from onset of radiotherapy using the Edmonton Symptom Assessment System (ESAS) questionnaire. Upper gastro-intestinal symptoms and severity were assessed from the tenth and eleventh question section of the ESAS questionnaire of “other problems” and how much this affected them. The relationships between the mean and maximum esophageal doses and incidence of dysphagia, esophagitis or mucositis were estimated and dose response curves determined. Results Eleven patients reported esophageal symptoms (average duration eleven days, range 1–18 days). Incidence of esophageal toxicity in patients treated at Th8 or above was 79 percent, while no patients treated below Th8 reported any symptoms (p < 0.001). Furthermore, 2 out of 3 patients irradiated at the cervical region reported substantial changes in taste sensation. Risk of symptoms correlated with both mean and maximum esophageal dose and may be a useful tool in planning radiotherapy for MSCC, potentially reducing early upper gastro-intestinal toxicity

Global-scale changes to extreme ocean wave events due to anthropogenic warming

Extreme surface ocean waves are often primary drivers of coastal flooding and erosion over various time scales. Hence, understanding future changes in extreme wave events owing to global warming is of socio-economic and environmental significance. However, our current knowledge of potential changes in high-frequency (defined here as having return periods of less than 1 year) extreme wave events are largely unknown, despite being strongly linked to coastal hazards across time scales relevant to coastal management. Here, we present global climate-modeling evidence, based on the most comprehensive multi-method, multi-model wave ensemble, of projected changes in a core set of extreme wave indices describing high-frequency, extra-tropical storm-driven waves. We find changes in high-frequency extreme wave events of up to ∼50%-100% under RCP8.5 high-emission scenario; which is nearly double the expected changes for RCP4.5 scenario, when globally integrated. The projected changes exhibit strong inter-hemispheric asymmetry, with strong increases in extreme wave activity across the tropics and high latitudes of the Southern Hemisphere region, and a widespread decrease across most of the Northern Hemisphere. We find that the patterns of projected increase across these extreme wave events over the Southern Hemisphere region resemble their historical response to the positive anomaly of the Southern Annular Mode. Our findings highlight that many countries with low-adaptive capacity are likely to face increasing exposure to much more frequent extreme wave events in the future

Uncertainty and Bias in Global to Regional Scale Assessments of Current and Future Coastal Flood Risk

This study provides a literature-based comparative assessment of uncertainties and biases in global to world-regional scale assessments of current and future coastal flood risks, considering mean and extreme sea-level hazards, the propagation of these into the floodplain, people and coastal assets exposed, and their vulnerability. Globally, by far the largest bias is introduced by not considering human adaptation, which can lead to an overestimation of coastal flood risk in 2100 by up to factor 1300. But even when considering adaptation, uncertainties in how coastal societies will adapt to sea-level rise dominate with a factor of up to 27 all other uncertainties. Other large uncertainties that have been quantified globally are associated with socio-economic development (factors 2.3–5.8), digital elevation data (factors 1.2–3.8), ice sheet models (factor 1.6–3.8) and greenhouse gas emissions (factors 1.6–2.1). Local uncertainties that stand out but have not been quantified globally, relate to depth-damage functions, defense failure mechanisms, surge and wave heights in areas affected by tropical cyclones (in particular for large return periods), as well as nearshore interactions between mean sea-levels, storm surges, tides and waves. Advancing the state-of-the-art requires analyzing and reporting more comprehensively on underlying uncertainties, including those in data, methods and adaptation scenarios. Epistemic uncertainties in digital elevation, coastal protection levels and depth-damage functions would be best reduced through open community-based efforts, in which many scholars work together in collecting and validating these data

Global ocean wave fields show consistent regional trends between 1980 and 2014 in a multi-product ensemble

Historical trends in the direction and magnitude of ocean surface wave height, period, or direction are debated due to diverse data, time-periods, or methodologies. Using a consistent community-driven ensemble of global wave products, we quantify and establish regions with robust trends in global multivariate wave fields between 1980 and 2014. We find that about 30-40% of the global ocean experienced robust seasonal trends in mean and extreme wave height, period, and direction. Most of the Southern Hemisphere exhibited strong upward-trending wave heights (1-2 cm per year) and periods during winter and summer. Ocean basins with robust positive trends are far larger than those with negative trends. Historical trends calculated over shorter periods generally agree with satellite records but vary from product to product, with some showing a consistently negative bias. Variability in trends across products and time-periods highlights the importance of considering multiple sources when seeking robust change analyses

Motility-related protein-1 (MRP-1/CD9) expression can predict disease-free survival in patients with squamous cell carcinoma of the head and neck

CD9 is a transmembrane protein that has been implicated in cell adhesion, motility and proliferation, and numerous studies have demonstrated the prognostic value of its expression in different solid tumours. The purpose of this study is to determine the predictive value of CD9 in squamous cell carcinoma (SCC) of the head and neck. A total of 153 cases were examined for CD9 expression using immunohistochemistry applied on formalin-fixed, paraffin-embedded tissue. Cases were stratified in two categories depending on CD9 expression, as positive (>/=50% positive cells) or reduced (<50%). In all, 108 cases were positive for CD9 (85 cases with membranous, and 23 with both membranous and cytoplasmic staining) and 45 reduced expression. Reduced CD9 expression was significantly associated with high grade (P=0.0007) and lower disease-free survival (DFS) (P=0.017). The latter retained its significance in the multivariate analysis. When the 23 cases with both membranous and cytoplasmic patterns were studied as a separate subgroup, there were significant associations between CD9 expression and tumour grade (P=0.025) (95% CI 11-68), tumour stage (P=0.08) (95% CI 3.5-86) and the occurrence of any failure (P=0.083) (95% CI -1.7-57). Immunohistochemical CD9 expression proved to be an independent prognostic factor in SCC of the head and neck, and it may detect patients at a high risk of recurrence. In addition, the cytoplasmic pattern seems to have an even more significant value. However, this finding is limited to the small number of cases with this pattern

Global ocean wave fields show consistent regional trends between 1980 and 2014 in a multi-product ensemble

Historical trends in the direction and magnitude of ocean surface wave height, period, or direction are debated due to diverse data, time-periods, or methodologies. Using a consistent community-driven ensemble of global wave products, we quantify and establish regions with robust trends in global multivariate wave fields between 1980 and 2014. We find that about 30–40% of the global ocean experienced robust seasonal trends in mean and extreme wave height, period, and direction. Most of the Southern Hemisphere exhibited strong upward-trending wave heights (1–2 cm per year) and periods during winter and summer. Ocean basins with robust positive trends are far larger than those with negative trends. Historical trends calculated over shorter periods generally agree with satellite records but vary from product to product, with some showing a consistently negative bias. Variability in trends across products and time-periods highlights the importance of considering multiple sources when seeking robust change analyses.publishedVersio

Robustness and uncertainties in global multivariate wind-wave climate projections

Understanding climate-driven impacts on the multivariate global wind-wave climate is paramount to effective offshore/coastal climate adaptation planning. However, the use of single-method ensembles and variations arising from different methodologies has resulted in unquantified uncertainty amongst existing global wave climate projections. Here, assessing the first coherent, community-driven, multi-method ensemble of global wave climate projections, we demonstrate widespread ocean regions with robust changes in annual mean significant wave height and mean wave period of 5–15% and shifts in mean wave direction of 5–15°, under a high-emission scenario. Approximately 50% of the world’s coastline is at risk from wave climate change, with ~40% revealing robust changes in at least two variables. Furthermore, we find that uncertainty in current projections is dominated by climate model-driven uncertainty, and that single-method modelling studies are unable to capture up to ~50% of the total associated uncertainty