Early CT and FDG-metabolic tumour volume changes show a significant correlation with survival in stage I-III small cell lung cancer: A hypothesis generating study

BACKGROUND: Many patients with stage I–III small cell lung cancer (SCLC) experience disease progression short after the completion of concurrent chemoradiotherapy (CRT). The purpose of the current study was to evaluate whether CT or FDG metabolic response early after the start of chemotherapy, but before the beginning of chest RT, is predictive for survival in SCLC. METHODS: Fifteen stage I–III SCLC patients treated with concurrent CRT with an FDG-PET and CT scan available before the start of chemotherapy and after or during the first cycle of chemotherapy, but before the start of radiotherapy, were selected. The metabolic volume (MV) was defined both within the primary tumour and in the involved nodal stations using the 40% (MV40) and 50% (MV50) threshold of the maximum SUV. Metabolic and CT response was assessed by the relative change in MV and CT volume, respectively, between both time points. The association between response and overall survival (OS) was analysed by univariate cox regression analysis. The minimum follow-up was 18 months. RESULTS: Reductions in MV40 and MV50 were −36 ± 38% (126.4 to 68.7 cm(3)) and −44 ± 38% (90.2 to 27.8 cm(3)), respectively. The median CT volume reduction was −40 ± 64% (190.6 to 113.8 cm(3)). MV40 and MV50 changes showed a significant association with survival (HR = 1.02, 95% CI: 1.00–1.04 (p = 0.042); HR = 1.02, 95% CI: 1.00–1.04 (p = 0.048), respectively), indicating a 2% increase in survival probability for 1% reduction in metabolic volume. The CT volume change was also significantly correlated with survival (HR = 1.01, 95% CI: 1.00–1.03, p = 0.007). CONCLUSIONS: This hypothesis generating study shows that both the early CT and the MV changes show a significant correlation with survival in SCLC. A prospective study is planned in a larger patient cohort to allow multivariate analysis, with the final aim to select patients early during treatment that could benefit from dose intensification or alternative treatment

Abschätzung des Schadpotentials von Hochwasser- und Extremwetterereignissen für landwirtschaft-liche Kulturen Claudia

Kurzfassung Der folgende Bericht untersucht die ökonomischen Auswirkungen von Hochwasser auf die Landwirtschaft in Deutschland anhand von Hochwasserrisikogebieten sowie die Auswirkungen von extremen Dürre und Frostereignissen auf landwirtschaftliche Erträge von Weizen, Roggen, Gerste, Raps, Kartoffeln, Mais und Zuckerrüben. Damit baut der Bericht auf das Projekt „Agrarrelevante Extremwetterlagen und Möglichkeiten von Risikomanagementsystemen“ auf, welches vom Bundesministerium für Ernährung und Landwirtschaft (BMEL) beauftragt und gefördert wurde und 2015 abgeschlossen wurde (Gömann et al. 2015). Der Literaturüberblick über die zukünftige Entwicklung von Hochwasserereignissen zeigt überwiegend eine steigende Tendenz von Hochwasserereignissen in der Zukunft, wobei das Ausmaß des Anstiegs regional und zwischen den Studien unterschiedlich ist. Insgesamt konnte in den Analysen ein maximaler Erlösverlust von 394 Mio. € beim Ackerland (davon 189 Mio. € auf Getreideflächen) ermittelt werden, wenn im Jahr 2010 100 Prozent der HQ100-Fläche in Deutschland betroffen gewesen wären. Für die Abschätzung der monetären Schäden von weiteren Extremwetterereignissen wurde der in Gömann et al. (2015) verwendete Schätzansatz geringfügig weiterentwickelt. Bei Winterweizen stellen die Verluste aufgrund von Kahlfrostextremereignissen mit ca. 30 Mio. €/Jahr den wichtigsten der untersuchten Schäden dar. Auch Trockenheit/Dürre zu unterschiedlichen Zeiten des Vegetationsverlaufes sowie extreme Hitze in der Blütezeit führen zu deutlichen Schäden auf sektoraler Ebene. In der Summe lagen die berechneten Schäden aufgrund von Trockenheit/Dürre/Hitze bei ca. 40 Mio. €/Jahr. Alle untersuchten Extremereignisse zusammen summieren sich auf 78 Mio. €/Jahr auf. Die Situation bei Wintergerste stellt sich insgesamt recht ähnlich dar und die Kosten summieren sich zusammen auf 36 Mio. €/Jahr auf. Für Winterraps summieren sich alle untersuchten Extremereignisse auf 47 Mio. €/Jahr, für Körnermais auf ca. 12 Mio. €/Jahr auf. Bei Kartoffeln haben Schäden aufgrund von extremer Sommertrockenheit die größte Bedeutung für Betriebe ohne Bewässerung, gefolgt von Ertragsverlusten aufgrund von Spätfrösten und Staunässe. Für Zuckerrüben konnten Schäden nur das Ereignis ‚Extreme Sommertrockenheit‘ bestimmt werden. Diese belaufen sich auf ca. 7 Mio. €/Jahr

Difficult medical encounters in oncology: What physicians need. An exploratory study

Objective: The objective of this study was to assess how often-medical oncology professionals encounter difficult consultations and if they desire support in the form of training. Methods: In February 2022, a survey on difficult medical encounters in oncology, training and demographics was set up. The survey was sent to 390 medical oncology professionals part of the OncoZON network of the Southeast region of the Netherlands. Results: Medical oncology professionals perceive a medical encounter as difficult when there is a dominant family member (n = 27), insufficient time (n = 24), or no agreement between medical professional and patient (n = 22). Patients involved in these encounters are most often characterized with low health literacy (n = 12) or aggressive behavior (n = 10). The inability to comprehend difficult medical information or perceived difficult behavior complicates encounters. Of the medical oncology professionals, 27–44% preferred a training as a physical group meeting (24%) or an individual virtual meeting (19%). Conclusion: Medical oncology professionals consider dominant or aggressive behavior and the inability to comprehend medical information by patients during consultations as difficult encounters for which they would appreciate support. Innovation: Our results highlight concrete medical encounters in need of specific education programs within daily oncology practice

Site-specific assessment of mechanical loads on photovoltaic modules from meteorological reanalysis data

This work demonstrates the capability of meteorological reanalysis data for estimating mechanical stresses due to wind gusts on photovoltaic modules. Besides the immediate power loss caused by the inactive solar cell areas within the module, the influence of cracks induced by such mechanical loads on the ageing and degradation behavior of PV modules is in the focus of current PV reliability research. To choose and/or design the optimum module for a given deployment site at the most economical cost, the mechanical loads the module will be exposed to during its service life need to be estimated. Hence, this paper introduces a new methodology for assessing and deducing site-specific mechanical load scenarios which are expected to be imposed on photovoltaic modules by wind gusts for a given location. The approach presented here is based on the linear calibration of meteorological reanalysis data with publicly available and standardized high-quality surface weather station data of local weather services. In this fashion, site-specific mechanical load scenarios can be deduced for virtually any site covered by the respective reanalysis data set. These scenarios can be used for developing site-specific module qualification tests, thereby providing a methodology enabling climate-specific module designs or specifications. This methodology can also be transferred to virtually any location and other climate and weather parameters such as snow loads, UV dose, etc. Hence a complete assessment of all weather-related degradation scenarios could be deduced eventually

Folgenabschätzung für Maßnahmenoptionen im Bereich Landwirtschaft und landwirtschaftliche Landnutzung, Forstwirtschaft und Holznutzung zur Umsetzung des Klimaschutzplans 2050

This working paper analyses instruments and measures to meet the targets set in the Germanys climate action plan 2050 for agriculture to reduce greenhouse gas emissions and for LULUCF to reduce greenhouse gas emissions or enhance sinks until 2030. In the focus are measures on the federal state level. For the different areas of actions and measures we discuss instruments and options for implementation, greenhouse gas mitigation potential, economic impacts, as well as impacts on employment, environment and health. The measures and implementation options analysed shall help to provide a better information basis for the planned portfolio within the pro-gram of measures to implement the German climate action plan. The working paper reflects the status of analysis from summer 2019. An update of the impact analysis of the current specification in the frame of the climate mitigation program 2030 of the federal government for the implementation of the climate action plan 2050 (Bundestagsdruck-sache 19/ 13900; 11.10.2019) is not part of this paper and needs to be part of future research

Folgenabschätzung für Maßnahmenoptionen im Bereich Landwirtschaft und landwirtschaftliche Landnutzung, Forstwirtschaft und Holznutzung zur Umsetzung des Klimaschutzplans 2050

This working paper analyses instruments and measures to meet the targets set in the Germanys climate action plan 2050 for agriculture to reduce greenhouse gas emissions and for LULUCF to reduce greenhouse gas emissions or enhance sinks until 2030. In the focus are measures on the federal state level. For the different areas of actions and measures we discuss instruments and options for implementation, greenhouse gas mitigation potential, economic impacts, as well as impacts on employment, environment and health. The measures and implementation options analysed shall help to provide a better information basis for the planned portfolio within the pro-gram of measures to implement the German climate action plan. The working paper reflects the status of analysis from summer 2019. An update of the impact analysis of the current specification in the frame of the climate mitigation program 2030 of the federal government for the implementation of the climate action plan 2050 (Bundestagsdruck-sache 19/ 13900; 11.10.2019) is not part of this paper and needs to be part of future research

Key differences in TLR3/poly I:C signaling and cytokine induction by human primary cells: a phenomenon absent from murine cell systems

TLR3 recognizes double-stranded RNA, a product associated with viral infections. Many details of TLR3-induced mechanisms have emerged from gene-targeted mice or inhibition studies in transformed cell lines. However, the pathways activated in human immune cells or cells from disease tissue are less well understood. We have investigated TLR3-induced mechanisms of human primary cells of the innate immune system, including dendritic cells (DCs), macrophages (MØs), endothelial cells (ECs), and synovial fibroblasts isolated from rheumatoid arthritis joint tissue (RA-SFs). Here, we report that while these cells all express TLR3, they differ substantially in their response to TLR3 stimulation. The key antiviral response chemokine IP-10 was produced by all cell types, while DCs and MØs failed to produce the proinflammatory cytokines TNFalpha and IL-6. Unexpectedly, TNFalpha was found secreted by TLR3-stimulated RA-SF. Furthermore, TLR3 stimulation did not activate NFkappaB, MAPKs, or IRF-3 in DCs and MØs, but was able to do so in ECs and RA-SF. These findings were specific for human cells, thereby revealing a complexity not previously expected. This is the first report of such cell type- and species-specific response for any TLR stimulation and helps to explain important difficulties in correlating murine models of inflammatory diseases and human inflammation