Oligometastatic Disease Management: Finding the Sweet Spot.

Hematogenous dissemination represents a common manifestation of squamous cell carcinoma of the head and neck, and the recommended therapeutic options usually consist of systemically administered drugs with palliative intent. However, mounting evidence suggests that patients with few and slowly progressive distant lesions of small size may benefit from various local ablation techniques, which have already been established as standard-of-care modalities for example in colorectal and renal cell carcinomas and in sarcomas. In principle, serving as radical approaches to eradicate cancer, these interventions can be curative. Their impact on local control and overall survival has been shown in numerous retrospective and prospective studies. The term oligometastatic refers to the number of distant lesions which should generally not surpass five in total, ideally in one organ. Currently, surgical resection remains the method of choice supported by the majority of published data. More recently, stereotactic (ablative) body radiotherapy (SABR/SBRT) has emerged as a viable alternative. In cases technically amenable to such local interventions, several other clinical variables need to be taken into account also, including patient-related factors (general health status, patient preferences, socioeconomic background) and disease-related factors (primary tumor site, growth kinetics, synchronous or metachronous metastases). In head and neck cancer, patients presenting with late development of slowly progressive oligometastatic lesions in the lungs secondary to human papillomavirus (HPV)-positive oropharyngeal cancer are the ideal candidates for metastasectomy or other local therapies. However, literature data are still limited to say whether there are other subgroups benefiting from this approach. One of the plausible explanations is that radiological follow-up after primary curative therapy is usually not recommended because its impact on survival has not been unequivocal, which is also due to the rarity of oligometastatic manifestations in this disease. At the same time, aggressive treatment of synchronous metastases early in the disease course should be weighed against the risk of futile interventions in a disease with already multimetastatic microscopic dissemination. Therefore, attentive treatment sequencing, meticulous appraisal of cancer extension, refinement of post-treatment surveillance, and understanding of tumor biology and kinetics are crucial in the management of oligometastases

Energy Use and Energy Use Efficiency of Specialised Dairy Farms in Flanders

Our highly mechanised agriculture largely depends on ever declining stocks of fossil energy and hence contributes to global warming through the emission of greenhouse gases. Therefore, energy use (efficiency) is an important aspect of eco-efficient and sustainable agricultural production systems. In this study, we estimated direct and indirect energy use on a representative set of specialised dairy farms in Flanders (334 farm datasets in 1989-1990 and 147 farm datasets in 2000-2001) and we calculated their energy use efficiency. We studied the observed evolution between 1989-1990 and 2000-2001

Nitrogen Use Efficiency of Specialized Dairy Farms in Flanders: Evolution and Future Goals

Efficient use of nutrients is one of the major aims of eco-efficient and sustainable agricultural production systems. We determined the nitrogen use efficiency of a representative set of specialised dairy farms in Flanders, between 1989-1990 and 2000-2001 and set achievable eco-efficiency targets for sustainability

Reinforced reasoning in medicine

Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. A more reliable type of reasoning may be distinguished by appealing to recent work on evidential pluralism in the epistemology of medicine. A case study from virology provides an example of this so‐called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine

Derivative corrections to the Born-Infeld action through beta-function calculations in N=2 boundary superspace

We calculate the beta-functions for an open string sigma-model in the presence of a U(1) background. Passing to N=2 boundary superspace, in which the background is fully characterized by a scalar potential, significantly facilitates the calculation. Performing the calculation through three loops yields the equations of motion up to five derivatives on the fieldstrengths, which upon integration gives the bosonic sector of the effective action for a single D-brane in trivial bulk background fields through four derivatives and to all orders in alpha'. Finally, the present calculation shows that demanding ultra-violet finiteness of the non-linear sigma-model can be reformulated as the requirement that the background is a deformed stable holomorphic U(1) bundle.Comment: 25 pages, numerous figure

Investigation of Performance and Cavitation Treatment in a Kaplan Hydro Turbine

Cavitation is a phenomenon that occurs in various turbomachinery applications causing drawbacks on the. Some of these downsides are damaging the components of the system, generating noise and vibration, and loss of the turbine efficiency over time. Thus, it is imperative to address issue of cavitation to increase the life span of the equipment in addition to improve the system performance. This thesis introduces a method used to mitigate the cavitation phenomenon in a 3-inch Kaplan hydro turbine via injecting air at the leading edge of the rotor blades. The study is based on modeling the turbine using Computational Fluid Dynamics (CFD) software as well as carrying out experimental tests. The simulations were conducted at different air injection pressures over a spectrum of rotational speeds using Large Eddy Simulation (LES) for turbulence and volume of fluid for multiphase interactions: water, vapor water and air. The cavitation behavior was observed first without aeration, then followed by air injection simulations to investigate the effect of aeration. Each case was simulated for 12 cycles at rotational speeds of 1000, 2000, 3000, 4000, and 5000 rpm. The Vapor Volume Fraction (VVF) and the output mechanical power were monitored throughout the simulations. The data acquired from the simulations were compared to the experimental results for verifications. It was observed that the cavitation was mitigated in both the computer simulations and the experiment testing reaching up to 49.7% as an average reduction, while the output power was reduced by 6.6%

Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study

Abstract In a 24-month prospective, randomized, multicenter, open-label study, de novo liver transplant patients were randomized at 30 days to everolimus (EVR) + Reduced tacrolimus (TAC; n = 245), TAC Control (n = 243) or TAC Elimination (n = 231). Randomization to TAC Elimination was stopped prematurely due to a significantly higher rate of treated biopsy-proven acute rejection (tBPAR). The incidence of the primary efficacy endpoint, composite efficacy failure rate of tBPAR, graft loss or death postrandomization was similar with EVR + Reduced TAC (10.3%) or TAC Control (12.5%) at month 24 (difference -2.2%, 97.5% confidence interval [CI] -8.8%, 4.4%). BPAR was less frequent in the EVR + Reduced TAC group (6.1% vs. 13.3% in TAC Control, p = 0.010). Adjusted change in estimated glomerular filtration rate (eGFR) from randomization to month 24 was superior with EVR + Reduced TAC versus TAC Control: difference 6.7 mL/min/1.73 m(2) (97.5% CI 1.9, 11.4 mL/min/1.73 m(2), p = 0.002). Among patients who remained on treatment, mean (SD) eGFR at month 24 was 77.6 (26.5) mL/min/1.73 m(2) in the EVR + Reduced TAC group and 66.1 (19.3) mL/min/1.73 m(2) in the TAC Control group (p < 0.001). Study medication was discontinued due to adverse events in 28.6% of EVR + Reduced TAC and 18.2% of TAC Control patients. Early introduction of everolimus with reduced-exposure tacrolimus at 1 month after liver transplantation provided a significant and clinically relevant benefit for renal function at 2 years posttransplant