Local and systemic therapy of recurrent medulloblastomas in children and adolescents: results of the P-HIT-REZ 2005 study

SIMPLE SUMMARY: A medulloblastoma recurrence is usually associated with an unfavorable prognosis. The German P-HIT-REZ 2005 Study gathered data from patients with relapsed medulloblastomas treated in different, non-randomized therapy arms dependent on preconditions of the patients (previous treatment, comorbidities, relapse pattern), the decision of treating physicians, and the patients’/parents’ choice. A total of 93 evaluable patients with refractory or relapsed medulloblastoma were enrolled. The main aim of this study was to analyze the impact of patient and disease characteristics as well as local and systemic therapies on post-relapse progression-free (PFS) and overall survival (OS). In multivariate analysis, a short time until the first recurrence (<18 months) was the strongest predictor for a worse PFS and OS, which was mainly associated with molecular subgroup 3. Metastatic disease, at relapse, only had a significant impact on OS. Re-biopsy, at relapse, is highly recommended to investigate the histopathological and molecular genetic tumor characteristics and to exclude a secondary malignancy. ABSTRACT: Recurrent medulloblastomas are associated with survival rates <10%. Adequate multimodal therapy is being discussed as having a major impact on survival. In this study, 93 patients with recurrent medulloblastoma treated in the German P-HIT-REZ 2005 Study were analyzed for survival (PFS, OS) dependent on patient, disease, and treatment characteristics. The median age at the first recurrence was 10.1 years (IQR: 6.9–16.1). Median PFS and OS, at first recurrence, were 7.9 months (CI: 5.7–10.0) and 18.5 months (CI: 13.6–23.5), respectively. Early relapses/progressions (<18 months, n = 30/93) found mainly in molecular subgroup 3 were associated with markedly worse median PFS (HR: 2.34) and OS (HR: 3.26) in regression analyses. A significant survival advantage was found for the use of volume-reducing surgery as well as radiotherapy. Intravenous chemotherapy with carboplatin and etoposide (ivCHT, n = 28/93) showed improved PFS and OS data and the best objective response rate (ORR) was 66.7% compared to oral temozolomide (oCHT, n = 47/93) which was 34.8%. Intraventricular (n = 43) as well as high-dose chemotherapy (n = 17) at first relapse was not related to a significant survival benefit. Although the results are limited due to a non-randomized study design, they may serve as a basis for future treatment decisions in order to improve the patients’ survival

Battery State Estimation for Lead-Acid Batteries under Float Charge Conditions by Impedance: Benchmark of Common Detection Methods

Impedance or admittance measurements are a common indicator for the condition of lead-acid batteries in field applications such as uninterruptible power supply (UPS) systems. However, several commercially available measurement units use different techniques to measure and interpret the battery impedance. This paper describes common measurement methods and compares their indication for the state of health (SoH) to those of electrochemical impedance spectroscopy (EIS). For this analysis, two strings consisting each of 24 valve-regulated lead-acid (VRLA) batteries with a rated voltage of 12 V and about 7 Ah capacity were kept under standard UPS conditions in float charge for over 560 days. They were monitored continuously with a LEM Sentinel 2 and went into regular check-ups with impedance measurements by a Hioki BT3554 as well as electrochemical impedance spectroscopy (EIS) measurements with an impedance meter (&mu;EIS). Today it is widely expected that solely the relative increase of the impedance reading is sufficient for the estimation of the available capacity. However, it can be shown that the measured relative increase deviates for different frequencies and therefore the choice of the excitation signal and measurement frequency does make a difference for the calculation of the available capacity. Finally, a method for a more decisive monitoring in field applications is suggested

Correct processing of impedance spectra for lead-acid batteries to parameterize the charge-transfer process

Electro-chemical impedance spectroscopy is widely used to analyze electro-chemical systems. Most attention is paid to the double-layer capacitance and the charge-transfer resistance as they describe the electro-chemical process on the surface of the electrode. Both values can provide specific information about aging mechanisms, which diminish the surface area. This is of interest when capacity tests are restricted to determine the aging. For lead-acid batteries, for example, this is the case in applications like micro-hybrid vehicles or uninterruptible power supply systems. However, the interpretation of impedance spectra of lead-acid batteries necessitates proper measurements, elaborated verification of measurement validity, and a sufficient model of electro-chemical processes. In this work, impedance spectra, recorded on lead-acid test cells, are processed to identify the ohmic resistance, the double-layer capacitance, and the parameters of the charge-transfer reaction of the negative electrode. This electrode suffers from sulfation, a common aging mechanism in current applications. The aim of the paper is to define a correct processing of impedance spectra for lead-acid batteries, and to depict challenges. Furthermore, possible equivalent electrical circuit models for the negative electrode are evaluated regarding their dependencies on state of charge and current rate. Many of these aspects can be transferred to other electro-chemical systems