Blue City Mannheim Innovative Konzepte für Konversionsflächen in Mannheim

Im Rahmen der Konversion von 510 ha US-Militärflächen entsteht für die Stadt Mannheim die Chance Zukunftsthemen der Stadtentwicklung intensiv aufzugreifen. Stadterneuerung, Energieeffizienz, Infrastruktur und Mobilität sowie Innovationen und Entfaltungsmöglichkeiten heimischer Unternehmen stehen hierbei gleichermaßen im Fokus. Zur Entwicklung innovativer Ansätze wurde die AG Ingenieursmeile gebildet, in der Themen wie Neue Mobilität, Elektromobilität und Smart Grids herausgearbeitet wurden. Für die Weiterentwicklung und Integration dieser Ansätze hat der Fachbereich Wirtschafts- und Strukturförderung der Stadt Mannheim das themenübergreifende Konzept von MVV Enamic Regioplan erarbeiten lassen. Der Schwerpunkt des Konzeptes „Blue City Mannheim“ liegt auf der Ableitung konkreter Maßnahmen, die in den nächsten Jahren schrittweise umgesetzt werden sollen. Ein wesentliches Ziel ist die Reduktion der CO2-Emissionen im Verkehrssektor durch den Einsatz emissionsarmer (Elektro-) Fahrzeuge und die Umgestaltung des Modal Split. Die Maßnahmen wurden mit den strategischen Zielen der Stadt Mannheim, der wirtschaftspolitischen Strategie und den Anforderungen der Klimaschutzkonzeption 2020 abgestimmt. Als Grundlage werden zunächst vier übergeordnete Maßnahmen definiert: • Vernetzung / Öffentlichkeitsarbeit, • Masterplan Ladeinfrastruktur, • Masterplan Green Logistik sowie • Masterplan blue_village_franklin. Hierauf bauen 21 Einzelmaßnahmen in den Bereichen Fahrzeuge / Fuhrparks, Logistik, Verlagerung Modal Split, Intelligente Netze, Ladeinfrastruktur und Wissenstransfer auf. Als Einzelmaßnahmen werden beispielsweise Einsatzbereiche für emissionsarme Fahrzeuge bei der Umstellung von Fuhrparks und Flotten aufgezeigt. Im Bereich Logistik steht der innerstädtischen Liefer- und Güterverkehr im Mittelpunkt. Maßnahmen betreffen hier z.B. die Umstellung von innerstädtischen Transportverkehren auf Elektrofahrzeuge. Ziel hierbei ist neben der Einsparung von CO2-Emissionen insbesondere auch eine Verkehrslärmreduzierung im Stadtgebiet. Für eine Umgestaltung des Modal Split wird die Verknüpfung von Motorisiertem Individualverkehr (MIV) und ÖPNV an attraktiven Umsteigestationen vorgesehen. Weitere Maßnahmenschwerpunkte liegen in den Bereichen Energieerzeugung, speicherung und -verteilung, durch welche die Umweltpotenziale der Elektromobilität erst vollständig aktiviert werden können. Eine Optimierung von Verbrauch und Erzeugung erfolgt durch Einsatz von IT-Lösungen in intelligenten Netzen (Smart Grids). Maßnahmen für den Ausbau von Ladeinfrastrukturen im gesamten Stadtgebiet sowie die Einrichtung von Multi-System-Tankstellen für unterschiedliche Antriebstechniken ergänzen das Gesamtkonzept. Für den Wissenstransfer und für die öffentliche Wahrnehmung sollen Fachtagungen und Kongresse zu Themen der Neuen Mobilität und der Energieeffizienz durchgeführt werden. Der Maßnahmenkatalog ist nicht abschließend und kann bei Bedarf um weitere Maßnahmen ergänzt werden. Als Akteure für die Umsetzung dieser Maßnahmen sind sowohl Fachbereiche und Betriebe der Stadt Mannheim als auch Mannheimer Unternehmen, Einzelhandel und Handwerk angesprochen. Weiterhin werden die Mannheimer Hochschulen ebenso wie Verbände, die Kammern bis hin zu Privatpersonen in die Umsetzung einbezogen

Filariasis of the Axilla in a Patient Returning from Travel Abroad: A Case Report

Background: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites. Patients and Methods: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy. Results: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae. Conclusion: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine

Clinicians' use of breast cancer risk assessment tools according to their perceived importance of breast cancer risk factors: an international survey.

The BOADICEA breast cancer (BC) risk assessment model and its associated Web Application v3 (BWA) tool are being extended to incorporate additional genetic and non-genetic BC risk factors. From an online survey through the BOADICEA website and UK, Dutch, French and Swedish national genetic societies, we explored the relationships between the usage frequencies of the BWA and six other common BC risk assessment tools and respondents' perceived importance of BC risk factors. Respondents (N = 443) varied in age, country and clinical seniority but comprised mainly genetics health professionals (82%) and BWA users (93%). Oncology professionals perceived reproductive, hormonal (exogenous) and lifestyle BC risk factors as more important in BC risk assessment compared to genetics professionals (p values < 0.05 to 0.0001). BWA was used more frequently by respondents who gave high weight to breast tumour pathology and low weight to personal BC history as BC risk factors. BWA use was positively related to the weight given to hormonal BC risk factors. The importance attributed to lifestyle and BMI BC risk factors was not associated with the use of BWA or any of the other tools. Next version of the BWA encompassing additional BC risk factors will facilitate more comprehensive BC risk assessment in genetics and oncology practice

The Oncological Emergency Case: Paraneoplastic Hypoglycemia in Metastatic Breast Cancer - Case Report and Brief Review of the Literature

Background: Paraneoplastic hypoglycemia is a rare syndrome amoungtumorous diseases. It is often associated with a paraneoplasticsecretion of ‘big’ insulin-like growth factor-II. Methods: We describethis syndrome in a 60-year-old patient with advanced breast cancer 8years after primary diagnosis. Results and Conclusion: This non-isletcell tumor-induced hypoglycemia may be the only evidence for anotherwise clinically occult disease progression. Fast diagnosis andappropriate acute and causal treatment concepts should be part ofoncological management

The risk of contralateral breast cancer in patients from BRCA1/2 negative high risk families as compared to patients from BRCA1 or BRCA2 positive families: a retrospective cohort study

Introduction: While it has been reported that the risk of contralateral breast cancer in patients from BRCA1 or BRCA2 positive families is elevated, little is known about contralateral breast cancer risk in patients from high risk families that tested negative for BRCA1/2 mutations. Methods: A retrospective, multicenter cohort study was performed from 1996 to 2011 and comprised 6,235 women with unilateral breast cancer from 6,230 high risk families that had tested positive for BRCA1 (n = 1,154) or BRCA2 (n = 575) mutations or tested negative (n = 4,501). Cumulative contralateral breast cancer risks were calculated using the Kaplan-Meier product-limit method and were compared between groups using the log-rank test. Cox regression analysis was applied to assess the impact of the age at first breast cancer and the familial history stratified by mutation status. Results: The cumulative risk of contralateral breast cancer 25 years after first breast cancer was 44.1% (95%CI, 37.6% to 50.6%) for patients from BRCA1 positive families, 33.5% (95%CI, 22.4% to 44.7%) for patients from BRCA2 positive families and 17.2% (95%CI, 14.5% to 19.9%) for patients from families that tested negative for BRCA1/2 mutations. Younger age at first breast cancer was associated with a higher risk of contralateral breast cancer. For women who had their first breast cancer before the age of 40 years, the cumulative risk of contralateral breast cancer after 25 years was 55.1% for BRCA1, 38.4% for BRCA2, and 28.4% for patients from BRCA1/2 negative families. If the first breast cancer was diagnosed at the age of 50 or later, 25-year cumulative risks were 21.6% for BRCA1, 15.5% for BRCA2, and 12.9% for BRCA1/2 negative families. Conclusions: Contralateral breast cancer risk in patients from high risk families that tested negative for BRCA1/2 mutations is similar to the risk in patients with sporadic breast cancer. Thus, the mutation status should guide decision making for contralateral mastectomy

Strong evidence that the common variant S384F in BRCA2 has no pathogenic relevance in hereditary breast cancer

INTRODUCTION: Unclassified variants (UVs) of unknown clinical significance are frequently detected in the BRCA2 gene. In this study, we have investigated the potential pathogenic relevance of the recurrent UV S384F (BRCA2, exon 10). METHODS: For co-segregation, four women from a large kindred (BN326) suffering from breast cancer were analysed. Moreover, paraffin-embedded tumours from two patients were analysed for loss of heterozygosity. Co-occurrence of the variant with a deleterious mutation was further determined in a large data set of 43,029 index cases. Nature and position of the UV and conservation among species were evaluated. RESULTS: We identified the unclassified variant S384F in three of the four breast cancer patients (the three were diagnosed at 41, 43 and 57 years of age). One woman with bilateral breast cancer (diagnosed at ages 32 and 50) did not carry the variant. Both tumours were heterozygous for the S384F variant, so loss of the wild-type allele could be excluded. Ser384 is not located in a region of functional importance and cross-species sequence comparison revealed incomplete conservation in the human, dog, rodent and chicken BRCA2 homologues. Overall, the variant was detected in 116 patients, five of which co-occurred with different deleterious mutations. The combined likelihood ratio of co-occurrence, co-segregation and loss of heterozygosity revealed a value of 1.4 × 10(-8 )in favour of neutrality of the variant. CONCLUSION: Our data provide conclusive evidence that the S384F variant is not a disease causing mutation

Triple malignancy in a single patient including a cervical carcinoma, a basal cell carcinoma of the skin and a neuroendocrine carcinoma from an unknown primary site: A case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>The occurrence of multiple primary cancers is rare. Only a few cases and patient reviews of an association of triple malignancy have been reported.</p> <p>Case presentation</p> <p>We report here a case of a 78-year-old Moroccan woman presenting initially with a synchronous double malignancy, the first in her cervix and the second in her skin. Our patient was treated with radiation therapy for both tumors and remained in good control for 17 years, when she developed a metastatic disease from a neuroendocrine carcinoma of an unknown primary site.</p> <p>Conclusions</p> <p>Although the association of multiple primary cancers can be considered a rare occurrence, improving survival in cancer patients has made this situation more frequent.</p

Risikoadaptierte Prävention: Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken

Die vorliegende Studie empfiehlt, Leistungsansprüche für Personen mit interventionsfordernden (Brustkrebs-)Risiken anhand einer neuen Rechtskategorie, der ‚risikoadaptieren Prävention‘, abzubilden. Spätestens seit dem bioinformatischen Innovationsschub (Big Data) kann eine risikoadaptierte Anwendung von prophylaktischen Maßnahmen umfassend gewährleistet werden. Jedoch können die gegebenen Rechtskategorien (primäre Prävention, Vorsorge, Krankenbehandlung) das medizinische Anwendungsfeld nicht adäquat steuern