Abstract
Introduction: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment,
and follow-up on germ cell tumours (GCTs) of the testis in
adult patients. We ...present the guideline content in two
publications. Part I covers the topic’s background, methods, epidemiology, classification systems, diagnostics,
prognosis, and treatment recommendations for the localized stages. Methods: An interdisciplinary panel of 42 experts including 1 patient representative developed the
guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review
questions, which were based on systematic literature
searches (last search was in March 2018) were provided.
Thirty-one experts entitled to vote, rated the final clinical
recommendations and statements. Results: We provide
161 clinical recommendations and statements. We present
information on the quality of cancer care and epidemiology
and give recommendations for staging and classification as
well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I,
we separately present the treatment recommendations for
germ cell neoplasia in situ, and the organ-confined stages
(clinical stage I) of both seminoma and nonseminoma. Conclusion: Although GCT is a rare tumour entity with excellent
survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional
expertise and can be reassured by established online-based
second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary
approach as well as the referral of selected patients to centres with proven experience can help achieve favourable
clinical outcomes.
Objectives: We developed the first German evidence- and
consensus-based clinical guideline on diagnosis, treatment,
and follow-up of germ cell tumours (GCT) of the testes in
adult patients. We ...present the guideline content in 2 separate publications. The present second part summarizes the
recommendations for the treatment of advanced disease
stages and for the management of follow-up and late effects.
Materials and Methods: An interdisciplinary panel of 42 experts including 1 patient representative developed the
guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review
questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. Results: Here we present
the treatment recommendations separately for patients
with metastatic seminoma and non-seminomatous GCT
(stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex
cord/stromal tumours, the management of follow-up and
toxicity, quality-of-life aspects, palliative care, and supportive therapy. Conclusion: Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present
guideline. The guideline also comprises quality indicators for
measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented
in a future publication
Unmanned Vehicle Material Flammability Test Urban, David L; Ruff, Gary A; Smirnov, Nickolay ...
NASA Center for AeroSpace Information (CASI). Misc. Resources,
11/2012
Web Resource
Microgravity fire behaviour remains poorly understood and a significant risk for spaceflight An experiment is under development that will provide the first real opportunity to examine this issue ...focussing on two objectives: a) Flame Spread. b) Material Flammability. This experiment has been shown to be feasible on both ESA's ATV and Orbital Science's Cygnus vehicles with the Cygnus as the current base-line carrier. An international topical team has been formed to develop concepts for that experiment and support its implementation: a) Pressure Rise prediction. b) Sample Material Selection. This experiment would be a landmark for spacecraft fire safety with the data and subsequent analysis providing much needed verification of spacecraft fire safety protocols for the crews of future exploration vehicles and habitats.
Full scale fire testing complemented by computer modelling has provided significant know how about the risk, prevention and suppression of fire in terrestrial systems (cars, ships, planes, buildings, ...mines, and tunnels). In comparison, no such testing has been carried out for manned spacecraft due to the complexity, cost and risk associated with operating a long duration fire safety experiment of a relevant size in microgravity. Therefore, there is currently a gap in knowledge of fire behaviour in spacecraft. The entire body of low-gravity fire research has either been conducted in short duration ground-based microgravity facilities or has been limited to very small fuel samples. Still, the work conducted to date has shown that fire behaviour in low-gravity is very different from that in normal-gravity, with differences observed for flammability limits, ignition delay, flame spread behaviour, flame colour and flame structure. As a result, the prediction of the behaviour of fires in reduced gravity is at present not validated. To address this gap in knowledge, a collaborative international project, Spacecraft Fire Safety, has been established with its cornerstone being the development of an experiment (Fire Safety 1) to be conducted on an ISS resupply vehicle, such as the Automated Transfer Vehicle (ATV) or Orbital Cygnus after it leaves the ISS and before it enters the atmosphere. A computer modelling effort will complement the experimental effort. Although the experiment will need to meet rigorous safety requirements to ensure the carrier vehicle does not sustain damage, the absence of a crew removes the need for strict containment of combustion products. This will facilitate the possibility of examining fire behaviour on a scale that is relevant to spacecraft fire safety and will provide unique data for fire model validation. This unprecedented opportunity will expand the understanding of the fundamentals of fire behaviour in spacecraft. The experiment is being developed by an international topical team that is collaboratively defining the experiment requirements and performing supporting analysis, experimentation and technology development. This paper presents the objectives, status and concept of this project.
Ecdysone receptor (EcR) was expressed in vertebrate cells to study its functional properties in the absence of the heterodimerization partner Ultraspiracle (Usp) and to avoid interference with ...endogenous receptor isoforms. Comparison of different isoforms affords determination of receptor concentration, which was achieved either by determination of ligand binding sites by Scatchard analysis or by quantitative evaluation of specific Western blot signals, but not by normalization on transfection efficiency as determined by cotransfection with a constitutive reporter plasmid. Ligand- and DNA- binding, and transcriptional activity of EcR isoforms and the influence of Ultraspiracle (Usp) were described.
In the Kuwaiti town of Ahmedy, home to the Kuwait Oil Corp., a brilliant garden full of wildflowers and desert grasses blooms along a hillside. "This park is a unique kind of park, not only for the ...Gulf region, but in the whole world," says Hani Al-Zalzaleh, a horticultural scientist with the Kuwait Institute for Scientific Research (KISR). This fires-to-flowers story is one of the few bright spots in the environmental legacy of the Gulf War. Although the fires of Kuwait were extinguished in late 1991, the country still struggles with the legacy of hundreds of standing oil lakes in the desert, and the contamination of millions of cubic meters of soil and of 40 percent of the country's aquifers, as well as sea sediments drenched in heavy metals and other toxic pollutants. Such reasoning angers Shukri al-Hasham, an environmental activist in Kuwait. He says the government is in denial about the country's environmental problems. "There have not been any honest or sincere pollution studies since liberation, not from the Ministry of Health or Environment, or the government," he says. Mr. Hasham has tried to organize likeminded Kuwaitis to spur the government into action, but most nongovernmental organizations are forbidden in Kuwait. Instead, public opinion filters up to the government through informal weekly meetings - men only - with officials and locals known as dewaniyas.
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