Global population growth is urban growth and, therefore, most of the water-related challenges and solutions reside in cities. Unless water management and water governance processes are significantly ...improved within the next decade or so, cities are likely to face serious and prolonged water insecurity, urban floods, and/or heat stress, which may result in social instability and, ultimately, massive migration. Aging water infrastructure, one of the most expensive infrastructures in cities, is a relevant challenge in order to address Sustainable Development Goal (SDG) 6: clean water and sanitation, SDG 11: sustainable cities and communities, and SDG 13: climate action. The choice of good governance arrangements has important consequences for economic performance, for the well-being of citizens, and for the quality of life in urban areas. The better governance arrangements work in coordinating policies across jurisdictions and policy fields, the better the outcomes. Rapidly-changing global conditions will make future water governance more complex than ever before in human history, and expectations are that water governance and water management will change more during the next 20 years compared to the past 100 years. In this Special Issue of Water, the focus will be on practical concepts and tools for water management and water governance, with a focus on cities.
The China Environment Yearbook (2005) van Leeuwen, Cornelis Johannes (Kees)
Environmental Science and Pollution Research - International,
06/2008, Letnik:
15, Številka:
4
Book Review, Journal Article
The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is ...unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.
To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.
CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.
Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab.
The aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.
A total of 196 patients were included in the intention-to-treat analysis (112 57% men; median IQR age, 65 59-70 years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.
Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.
ClinicalTrials.gov Identifier: NCT01606098.
