Nuclear medicine imaging of multiple myeloma, particularly in the relapsed setting

Multiple myeloma (MM) is characterized by a monoclonal plasma cell population in the bone marrow. Lytic lesions occur in up to 90 % of patients. For many years, whole-body X-ray (WBX) was the method of choice for detecting skeleton abnormalities. However, the value of WBX in relapsing disease is limited because lesions persist post-treatment, which restricts the capacity to distinguish between old, inactive skeletal lesions and new, active ones. Therefore, alternative techniques are necessary to visualize disease activity. Modern imaging techniques such as magnetic resonance imaging, positron emission tomography and computed tomography offer superior detection of myeloma bone disease and extramedullary manifestations. In particular, the properties of nuclear imaging enable the identification of disease activity by directly targeting the specific cellular properties of malignant plasma cells. In this review, an overview is provided of the effectiveness of radiopharmaceuticals that target metabolism, surface receptors and angiogenesis. The available literature data for commonly used nuclear imaging tracers, the promising first results of new tracers, and our pilot work indicate that a number of these radiopharmaceutical applications can be used effectively for staging and response monitoring of relapsing MM patients. Moreover, some tracers can potentially be used for radio immunotherapy

The Use of a Daily Quiz" TOPday" as Supportive Learning Method for Medical Students

Medical students consider anatomy, neurology, and traumatology as difficult study topics. A recent study showed that the daily quiz ‘Two Opportunities to Practice per day (TOPday)’ positively supported biomedical students in analyzing and solving biomechanical problems. The main purpose of this study was to investigate the effect of TOPday on self-confidence, enthusiasm, and test results for the topics anatomy, neurology and traumatology. Second-year medical students were enrolled in a four-week course on the human skeletal system at the Radboudumc (n = 799). They were randomized over three topic groups (anatomy, neurology, and traumatology) and received TOPday quizzes on every course day. At the end of the course students filled in a non-anonymous questionnaire. Students highly appreciated TOPday (7.5±0.9) and this did not differ between groups (anatomy: 7.4±0.8; neurology: 7.4±1.1; traumatology: 7.5±0.8; P = 0.68). Many students reported that TOPday increased their self-confidence (65% of the students) and enthusiasm (69% of the students) for their topic. However, test results of the students did not improve. A potential explanation for the latter result may relate to the different cognitive processes that are required to study anatomy, neurology, and traumatology compared to biomechanics. In conclusion, appreciation, self-confidence and enthusiasm were positively associated with TOPday, but test results were not

Investigating mechanisms of collective action initiatives’ development in the energy sector. Report on the comparative case studies, COMETS H2020 project

One of the emergent trends in the sustainable energy transition is the development of distributed power generation. In Europe, it is estimated that up half of citizens of the European Union (EU) could be energy self-sufficient, potentially supplying 45% of Europe’s final energy demand by 2050 (Kampman, et al., 2016). While there are many challenges with a move towards more distributed, citizen-led energy projects, they are nevertheless supported and promoted by the EU in the RED II (EU Renewable Energy Directive as part of the 2016 “Clean Energy of all Europeans” initiative, directive 2018/2001/EU), which secures the right for citizens and communities to produce, store, consume and sell renewable energy, and other rights such as consumer’s protection or access to all energy markets directly or through third parties. Socially, this often takes the form of community energy projects in the form of collective action initiatives (CAI). CAIs, which include energy cooperatives, prosumer networks, and other citizen-led energy projects, are examples of social innovation (Gregg, et al., 2020) in how they organize and gain power through a social movement mechanism. Social innovation is the development of activities and services to meet a social need, and social innovations are primarily social in both their ends and their means. Among other things, energy CAIs are typically characterized by a focus on the community, open and voluntary participation, democratic governance, and autonomy and independence (ICA, 2021). The social benefits of energy CAIs include: developing local economies, addressing energy poverty, raising awareness about sustainable energy, promoting energy justice, giving a voice to the community, developing local skills and promoting social cohesion. Current research on CAIs explores how they are defined and the different ownership structures (Gorroño-Albizu, 2019), and how they mobilize and attain power (Gregg et al., 2020). Other research traces the history of their development within specific contexts or geographical areas, and how they influence or are influenced by national energy policies (Wierling et al., 2018). Still other research uses the lens of organizational and institutional theory to understand the historical development of energy CAIs (Mey and Diesendorf, 2018)

The treatment of AL amyloidosis in the Netherlands in 2013

AL amyloidosis is the only form of amyloidosis caused by a small plasma cell clone in the bone marrow. The produced aberrant free light chain forms, together with serum amyloid P, deposits in several organs leading to organ dysfunction. Involvement of the heart is the most important prognostic factor. Treatment of systemic AL amyloidosis is based on treatments as used in multiple myeloma, however is much more complicated due to organ dysfunction and worse clinical condition of the patients. Aim of treatment is to achieve a complete haematological response. Organ responses can occur later on. High dose melphalan followed by stem cell transplantation is given to younger en fit patients. Older patients are treated with oral melphalan and dexamethasone. Bortezomib also seems to be well tolerated by patients and has good clinical efficacy. Several randomised phase III studies, such as the HOVON 104, have started to investigate superiority of treatment with proteasome inhibitors. Treatment of patients in clinical studies is highly recommended