PURPOSE:The Common Terminology Criteria for Adverse Events (CTCAE) is the established toxicity scoring system that assigns severity grades (G1 = mild to G5 = death) to Adverse Events (AEs). Compared to CTCAE v3.0 (2006), updated versions introduced changes in severity grade definitions. This study evaluated changes between v3.0 and v5.0 (2017) for AEs in gynaecological radiotherapy. MATERIAL AND METHODS:After selecting AEs relevant for gynaecological radiotherapy in v3.0, changes in severity grades were identified using CTCAE v3.0-to-v5.0 mapping tables. Six radiation oncologists (ROs) evaluated severity grade definitions for changes in: clinical interpretation, subjective (patient-reported symptoms) and objective (details on medication/intervention) information, and expected severe (≥G3) events. Agreement was based on at least five (≥5)ROs. RESULTS:Gastrointestinal, urinary, reproductive, general and injury/musculoskeletal AEs were selected (n = 118). G4 definitions in v5.0 were removed in 22 % of AEs. ≥5ROs agreed on changes affecting clinical interpretation especially for G2 (31 %) and G3 (30 %). For subjective information, 18 % of G2 and 15 % of G3 were judged relying more on patient-reported symptoms. Less objective information was found in 51 % of G3 definitions. Variability in agreement was observed especially for subjective information in G3 and expected ≥G3 events. CONCLUSION:This analysis revealed that severity grade definitions in v3.0 and v5.0 for AEs in gynaecological radiotherapy present changes with potential impact on scoring in clinical studies. Notably, 22 % of AEs in v5.0 no longer have G4 defined, and G3 definitions often include fewer details on medication/intervention. Variability in ROs' interpretations is frequently observed, highlighting the need for education to standardise toxicity scoring.
BACKGROUND:Dissociation between the micro- and macrocirculation as well as the lack of specificity of current markers to signal impaired tissue oxygenation complicate the timely diagnosis and treatment of tissue hypoperfusion to prevent acute kidney injury (AKI) after cardiac surgery. The newly developed non-invasive technique to measure the mitochondrial oxygenation (mitoPO2) is currently the most downstream bedside marker of tissue oxygenation. The aim was to investigate mitoPO2 as an early marker of postoperative development of AKI. METHODS:In a prospective observational study, postoperative mitochondrial oxygen tension was measured to detect AKI (defined by KDIGO) in patients undergoing cardiac surgery. RESULTS:Of 50 included patients, 44 patients had analyzable mitoPO2 signal. 5 patients developed AKI. MitoPO2 at ICU admission was 16(13.8-24.6)mmHg in patients who developed AKI vs 63.4(37.5-77.9) mmHg in patients without AKI (p < 0.001). MitoPO2 predicted AKI (ROC 0.95 (0.89-1.0) with an optimal cut-off value of 30 mmHg (OR 4.4, CI 2.8-6.0, p < 0.001). Also, longer period of time under the mitoPO2 threshold predicted AKI with an AUROC of 0.91(0.80-1.00). In all patients, a decreased mitoPO2 occurred 4 h earlier than an clinically relevant increase in serum lactate. Other markers of tissue hypoperfusion, did not differ between patients with and without AKI. CONCLUSIONS:A mitoPO2 value below 30 mmHg at ICU admission as well as the duration below this threshold indicate the development of AKI in cardiac surgery patients, occurring earlier than an increase in lactate above the normal range.
OBJECTIVE:Population-based screening programs for breast, cervical, and colorectal cancer have been proven effective in detecting cancer at an early or precancerous stage, thereby enabling better patient outcomes. For screening programs to remain effective at a population level, high participation rates are essential. METHODS:Data on participation in the three nationwide screening programs in the Netherlands from 2018 to 2022 were obtained from the national screening information system (ScreenIT). Participation rates were calculated to assess trends over time, stratified by invitation round (first vs. subsequent) and sex (for colorectal cancer only). RESULTS:Participation was consistently lower for the first invitation rounds and men compared to subsequent rounds and women. Decreasing participation rates were observed for all programs and subgroups. In five years' time, overall participation decreased from 76.9 % to 70.7 % for breast cancer (-8.0 %), 55.5 % to 48.6 % for cervical cancer (-12.4 %), and 73.0 % to 68.4 % for colorectal cancer (-6.2 %). CONCLUSION:While some logistical factors may have contributed to decreasing participation rates, the consistent decline observed across all three nationwide screening programs remains unclarified. Our results emphasize that continuous monitoring of screening programs is crucial, and accessibility of cancer screening should be prioritized.
Predicting the impacts of a transition to a decarbonized freight transport system is challenging due to the inherent uncertainty surrounding the development and deployment of electric and automated truck technologies. This paper presents an exploratory analysis of techno-economic uncertainties for the deployment of electric trucks and automated driving technology and their impacts on the Swedish freight transport system by 2045. A modified version of the Swedish national freight model, Samgods, extended to represent manual electric trucks (METs) and automated driverless electric trucks (AETs), is used to analyze over 300 scenarios. In these scenarios, assumptions about the development and performance of METs and AETs are varied relative to the Swedish reference forecast for freight transport. System-level impacts including mode splits, logistics costs, and energy demand are analyzed. Higher levels of electric truck technology maturity correlate with reduced transport costs, increased road freight demand, and decreased reliance on biofuels. AETs further amplify these effects although with significant variation by operating model and technology maturity. Even without full SAE Level 5 automation, AETs operating exclusively on highways could, in some scenarios, perform over 75 % of domestic road transport tonne-kilometers, provided their unit economics are favorable. In addition to contributing by exploring a plausible outcome space of electrification and automated driving technology, this paper demonstrates a tractable approach for exploring system-level impacts of MET and AET deployment on logistics, mode shifts, and energy consumption with national-level freight models under uncertainty.
INTRODUCTION:Hyperbaric oxygen therapy (HBOT) is a well-established treatment for late radiation tissue injury (LRTI) of the pelvis, such as radiation-cystitis and -proctitis, but not for LRTI of the vagina. This study aims to describe the outcomes of patients with vaginal symptoms after HBOT. METHODS:The records of all patients with LRTI of the vagina, referred for HBOT from a tertiary hospital, between 2010 and 2020 were retrospectively analyzed. Patients with a non-vaginal primary complaint, fistulas, or incomplete HBOT treatment (<20 sessions) were excluded. Outcomes included patient- and physician-reported symptoms (such as dyspareunia, dryness, bleeding, and anatomical changes) and quality-of-life questionnaires. Outcomes were assessed at baseline, after HBOT, 3 months after HBOT, and during yearly follow-up. Responders were defined as patients with ≥1 vaginal symptoms improving after treatment. RESULTS:19 Patients (median age 42) received an average of 40 sessions of HBOT (80 min of 100 % oxygen at 2.5 ATA). 15/19 patients (79 %) were responders at the end of treatment (median of 3 symptoms improving). The symptoms most responsive to HBOT were ulceration (89 %), dyspareunia (82 %), pain (71 %), and changes in anatomy like stenosis or fibrosis (80 %). Response was maintained during 3 month follow-up in 14/15 patients. No major adverse events of HBOT were reported. CONCLUSION:A majority of patients had a lasting improvement of vaginal complaints after HBOT in this study. Based on this study and the generic effects of HBOT in LRTI, HBOT should be considered as a treatment option for patients with ongoing complaints of the vagina due to LRTI.
