Разработка модели контейнера для сбора компактных люминесцентных ламп

Предложена конструкция контейнера для сбора у населения компактных люминесцентных ламп. Разработан и создан демонстрационный макет контейнера. Проверена его работоспособность.A container design is proposed for collecting compact fluorescent lamps from the city residents. A demonstration mock-up of the container was developed and created. It is checked up its working capacity

Myasthenia Gravis in Pregnancy: A Case Report

Objective. To present a case of maternal myasthenia gravis in pregnancy and give a systematic review of the literature. Case. We report the case of a 38-year-old parturient with a life-threatening complication of immune-mediated myasthenia gravis shortly after an elective cesarean section on patient's request under spinal anesthesia at 35 + 3 weeks of gestation. The newborn was transferred to the pediatric unit for surveillance and did not show any signs of muscular weakness in the course of time. The mother developed a respiratory insufficiency on the second day postpartum. The myasthenic crisis led to a progressive dyspnoea within minutes, which exacerbated in a secondary generalized seizure with cardiac-circulatory arrest. After successful cardiopulmonary resuscitation, the patient was transferred to intensive care. The interdisciplinary therapeutic approach included ventilatory assistance via endotracheal intubation, parenteral pyridostigmine, azathioprine, and steroids. By interdisciplinary measures, a stable state was regained. Conclusion. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management

Longitudinal cosmetic outcome after planned IORT boost with low kV X-rays: monocentric results from the TARGIT BQR registry

Background: Intraoperative radiotherapy can serve as an anticipated boost (IORT boost) in combination with a subsequent external whole breast irradiation in high-risk breast cancer patients and is part of many guidelines. Nevertheless, there are only few prospective data available regarding cosmetic outcome after IORT boost using kV X-rays. The aim of this study was to evaluate the cosmetic outcome of patients treated within the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) in one center.Methods: In the context of the TARGIT BQR study standardized photos in three positions (arms down, arms up, from the side) were available for different time points. For this analysis a layperson, a radiation oncologist and a gynecologist evaluated available photos at different time points during follow-up with up to 4 years using the Harvard scale (comparison of treated and the untreated breast; rating: excellent, good, fair, poor). Longitudinal results were compared to preoperative results (baseline).Results: Seventy-three patients were available for the analysis. Baseline cosmetic assessment was excellent/good in 98.8% (mean value for all three positions). Postoperative cosmetic outcome (median) was good for all positions and remained constant for 4 years. Around 30% of the patients showed a constant or even improved cosmetic outcome compared to baseline. Only few patients showed a poor result at 4 years. The majority of patients showed an excellent or good cosmetic outcome at all time points.Conclusions: Patients from the prospective TARGIT BQR study treated with IORT boost and additional whole breast irradiation showed good or excellent cosmetic outcomes in most cases during 4 years of follow-up. These results add important information for shared decision making in breast cancer patients

Spatial Distance Between Sites of Sampling Associated With Genetic Variation Among Neospora Caninum in Aborted Bovine Foetuses From Northern Italy

Background: Neospora caninum , a coccidian protozoan, represents an important cause of bovine abortion. While only a single genotype of N. caninum exists word-wide, available N. caninum strains show considerable variation in vitro and in vivo , including different virulence in cattle. To which extent sexual recombination, possible in the intestines of domestic dogs and closely related carnivores as definitive hosts, contribute to this variation is not clear, yet. Methods: Aborted bovine foetuses were collected between 2015 and early 2019 from Italian Holstein Friesian dairy herds suffering from reproductive problems. A total of 198 samples were collected from 165 intensive farms located in Lombardy, northern Italy. N. caninum samples were subjected to multilocus-microsatellite genotyping (MLMG) using ten previously established microsatellite markers. In addition to own data, those from a recent study providing data on five markers from other northern Italian regions were included and analyzed. Results: Of the 55 samples finally subjected to MLMG, 35 were typed at all or 9 out of 10 loci. Linear regression revealed a statistically significant association between the spatial distance of the sampling sites with the genetic distance of N. caninum MLMGs (P< 0.001). Including data from a previous North Italian study (eBURST analysis) revealed that part of N. caninum MLMGs from northern Italy separate into four groups; most of the samples from Lombardy clustered in one of these groups. Principle component analysis revealed similar clusters and confirmed MLMG groups identified by eBURST. Variations observed between MLMGs were not equally distributed over all loci, but predominantly observed in MS7, MS6A, or MS10. Conclusions: Our findings confirm the concept of local N. caninum subpopulations. The geographic distance of sampling was associated with the genetic distance as determined by MLMGs. Results suggest that multi-parental recombination in N. caninum is a rare event, but does not exclude uniparental mating. More comprehensive studies on microsatellites in N. caninum and related species like Toxoplasma gondii should be undertaken, not only to improve genotyping capabilities, but also to understand possible functions of these regions in the genomes of these parasites

Oncological outcomes of breast cancer patients after planned IORT boost with low-kV x-rays — results of the TARGIT BQR prospective phase IV trial

Purpose The TARGIT BQR (boost quality registry) phase IV trial investigates clinical outcomes of breast cancer patients with standard external-beam radiotherapy (EBRT) of the whole breast and intraoperative radiotherapy (IORT) with low-kV x‑rays as an anticipated tumor bed boost in a real-world setting. Methods Intraoperative radiotherapy was performed immediately after breast-conserving surgery in one fraction. External-beam radiotherapy and systemic treatment were given according to the German S3 guideline for breast cancer and local tumor board recommendations. Outcome parameters were death, local recurrence, metastasis, local lymph node recurrence, and ipsilateral and contralateral invasive breast cancer. Kaplan–Meier estimates were used to calculate overall survival, metastasis-free survival, local recurrence-free survival, and disease-free survival. Results From 10 centers, 1133 patients were recruited. This analysis included 871 patients with 879 cancers, with a median follow-up of 36 months (up to 12 years). An IORT boost was performed in 82% and whole-breast irradiation in 84%. Overall survival was 98.4% after 3 years, 96.8% after 5 years, and 95.4% after 10 years (16 deaths; 1.8%). Metastasis and local recurrence occurred in 11 patients each (1.3%). At 5 years, the local control rate was 97.4% and local recurrence-free survival was 94.4%. Ipsilateral breast cancer occurred in 2 patients, contralateral breast cancer in 3 patients, and local lymph node recurrence in 2 patients. Disease-free survival was 92.9% after 5 years and 82.6% after 10 years. Conclusion This phase IV trial confirms previously reported outcomes on upfront IORT boost, with excellent disease-control outcomes

A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

BACKGROUND: Since the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials. METHODS: Between 01/03 – 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C “consolidation”, risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR “boost quality registry”: every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+. RESULTS: Out of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the eligible patients fulfilling the criteria for IORT boost (35%) about one third was eventually treated. CONCLUSIONS: Patient selection for IORT should be restrictive. For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements

Laparoscopic Fertility-Sparing Surgery for Early Ovarian Malignancies

The demand for fertility-sparing surgery (FSS) has increased in the last decade due to increased maternal age, increased incidence of ovarian malignancies in younger patients, and technical advances in surgery. Data on oncological safety and fertility outcomes of patients with ovarian cancer after laparoscopic FSS are sparse, but some retrospective studies have shown that open FSS may be offered to selected patients. We assessed the role of minimally invasive FSS in comparison with radical surgery (RS) in terms of oncological safety and reproductive outcomes after FSS in this multicenter study. Eighty patients with FIGO stage I/II ovarian cancer treated with laparoscopic FSS or RS between 01/2000 and 10/2018 at the participating centers (comprehensive gynecological cancer centers with minimally invasive surgical expertise) were included in this retrospective analysis of prospectively kept data. Case–control (n = 40 each) matching according to the FIGO stage was performed. Progression-free survival [150 (3–150) and 150 (5–150) months; p = 0.61] and overall survival [36 (3–150) and 50 (1–275) months; p = 0.65] did not differ between the FSS and RS groups. Eight (25.8%) women became pregnant after FSS, resulting in seven (22.5%) deliveries; three (37.5%) patients conceived after in vitro fertilization, and five (62.5%) conceived spontaneously. Laparoscopic FSS seems to be applicable and oncologically safe for patients with early-stage ovarian cancer, with adequate fertility outcomes

Does Maternal Underweight Prior to Conception Influence Pregnancy Risks and Outcome?

While obesity in pregnancy and pregnancy outcome in obese women are subjects of diverse research in recent publications, it is remarkable that the data for pregnancy outcome in pre-conceptional underweight mothers is extremely limited. Apart from an increasing prevalence of obesity, however, the prevalence for underweight in distinct sub-groups of mothers is also increasing. In contrary to obesity, less people are affected by underweight in Europe. The World Health Organization (WHO) classifies human weight into different categories (1). A body mass index (BMI) less than 18.5 kg/m 2 is defined as underweight. In Germany, the incidence of underweight in women is low with a nationwide prevalence of 3% (2). Especially in young women in certain social groups, an anorectic model-like weight is the ideal of beauty and a lot of cases of underweight in women of childbearing age are due to eating disorders (3). The lifetime incidence of eating disorders in young women of childbearing age is 5.2-6.5 % (4). While obesity is a frequently encountered problem in pregnant women with multiple complications during pregnancy and delivery (5-16), data on pregnant women with underweight or anorexia are scarce Because of hormonal disorders due to anorexia, underweight women often have menstrual irregularities leading to amenorrhea and infertility. Disorders in hypothalamic-hypophysis functions result in hypogonadotrope anovulatory cycle