The melanoma-specific graded prognostic assessment does not adequately discriminate prognosis in a modern population with brain metastases from malignant melanoma

The melanoma-specific graded prognostic assessment (msGPA) assigns patients with brain metastases from malignant melanoma to 1 of 4 prognostic groups. It was largely derived using clinical data from patients treated in the era that preceded the development of newer therapies such as BRAF, MEK and immune checkpoint inhibitors. Therefore, its current relevance to patients diagnosed with brain metastases from malignant melanoma is unclear. This study is an external validation of the msGPA in two temporally distinct British populations.Performance of the msGPA was assessed in Cohort I (1997-2008, n=231) and Cohort II (2008-2013, n=162) using Kaplan-Meier methods and Harrell's c-index of concordance. Cox regression was used to explore additional factors that may have prognostic relevance.The msGPA does not perform well as a prognostic score outside of the derivation cohort, with suboptimal statistical calibration and discrimination, particularly in those patients with an intermediate prognosis. Extra-cerebral metastases, leptomeningeal disease, age and potential use of novel targeted agents after brain metastases are diagnosed, should be incorporated into future prognostic models.An improved prognostic score is required to underpin high-quality randomised controlled trials in an area with a wide disparity in clinical care

Schweizerisches Handbuch fuer die Konzeption des Strassenoberbaus. (Manuel suisse de conception des chaussées).

Le présent manuel de conception des chaussées s'adresse aux ingénieurs et aux techniciens oeuvrant dans le domaine de la construction et de l'entretien des chaussées en Suisse. L'ouvrage fournit les outils et conseils nécessaires au dimensionnement d'une chaussée, à la sélection de la structure offrant la solution économique optimale et à la sélection des techniques d'entretien et des matériaux adéquats, compte tenu du trafic, des conditions géométriques, topographiques et environnementales de l'ouvrage concerné. Il contient le savoir-faire d'experts de la construction et de l'entretien des chaussées en Suisse et fournit les informations utiles à la conception et à l'entretien des superstructures routières, qu'elles soient souples, semi- rigides ou en béton, mais ne comprend pas les ouvrages d'art. Il traite également des techniques et des matériaux innovants. Le manuel se veut complémentaire aux normes suisses et aux publications helvétiques en matière de conception et d'entretien des chaussées. Les normes reprises dans ce recueil sont complétées par les considérations pratiques en matière de construction et de maintenance des chaussées, en particulier pour le choix des structures, des techniques d'entretien et des matériaux. Le manuel doit fournir au praticien la solution technique et économique la mieux adaptée compte tenu des conditions locales de l'ouvrage considéré

Mechanical properties of porous asphalt, recommendations for standardization

Porous Asphalt (PA) is used worldwide for its favorable splash and spray properties and its reduction of aquaplaning under rainy conditions as well as its noise reduction properties. Switzerland started using PA in 1979 with mixed results. According to a survey taken in 2004, nine of the 26 cantons use PA. In particular, canton Vaud in western Switzerland is known as one of the leaders in promoting and using PA. Currently, 1/3 of the Vaud motorways are covered with porous asphalt and the use of PA is planned to be extended to most of the motorway surfaces in the canton Vaud up to an altitude of 600m. In addition, there are several bridge trial sections with PA. After the initial survey of the literature appropriate mechanical tests for porous asphalt were chosen (Table 8. 1). At the same time a survey of current experience with porous asphalt in Switzerland was conducted (Appendix 2). Tests were performed on laboratory prepared specimens (AG1, AG4, AG5, VD7, VD8, VD9) and cores (VD2, VD3, VD4, VD5, VS6, AG2, AG3, VD10) taken from selected pavements chosen based on the feedback from various cantons. The behavior of the selected materials was also assessed using an analytical model. Laboratory tests allowed the comparison of core performance with that of laboratory prepared specimen as well as comparison with field performance. Based on the results two mixes were optimized (VD9, AG5) and recommendations for mechanical tests appropriate for porous asphalt were made

Patterns of Disease Progression and Outcome of Patients With Testicular Seminoma Who Relapse After Adjuvant or Curative Radiation Therapy

\ua9 2022 The Authors. Purpose: Radiation therapy is a possible treatment strategy for patients with testicular seminoma after orchiectomy in clinical stage I or II disease. Little is known about the outcome of patients who experience a relapse after radiation therapy. Methods and Materials: Data from 61 patients who relapsed after adjuvant or curative radiation therapy from 17 centers in 11 countries were collected and retrospectively analyzed. Primary outcomes were disease-free and overall survival. Secondary outcomes were time to relapse, stage at relapse, treatment for relapse, and rate of febrile neutropenia during chemotherapy for relapse. Results: With a median follow-up of 9.9 years (95% confidence interval [CI], 7.5-10.9), we found a 5-year disease-free survival of 90% (95% CI, 79-95) and a 5-year overall survival of 98% (95% CI, 89-100). Sixty-six percent of patients had stage III disease at time of relapse and 93% of patients fell into the good prognosis group per the International Germ Cell Cancer Collaborative Group classification. The median time to relapse after radiation therapy was 15.6 months (95% CI, 12-23). Twenty-two (36%) patients relapsed more than 2 years after radiation therapy and 7 (11.5%) patients relapsed more than 5 years after radiation therapy. One-third of relapses was detected owing to patients’ symptoms, whereas two-thirds of relapses were detected during routine follow-up. The majority (93%) of cases were treated with cisplatin-based chemotherapy. The rate of febrile neutropenia during chemotherapy was 35%. Five patients experienced a second relapse. At last follow-up, 55 patients (90%) were alive without disease. Only 1 patient died owing to disease progression. Conclusions: Cisplatin-based chemotherapy for patients with seminoma who have relapsed after treatment with radiation therapy alone leads to excellent outcomes. Patients and physicians should be aware of possible late relapses after radiation therapy

Habitat use at fine spatial scale: how does patch clustering criteria explain the use of meadows by red deer ?

Large mammalian herbivores are keystone species in different ecosystems. To mediate the effects of large mammalian herbivores on ecosystems, it is crucial to understand their habitat selection pattern. At finer scales, herbivore patch selection depends strongly on plant community traits and therefore its understanding is constrained by patch definition criteria. Our aim was to assess which criteria for patch definition best explained use of meadows by wild, free-ranging, red deer (Cervus elaphus) in a study area in Northeast Portugal. We used two clustering criteria types based on floristic composition and gross forage classes, respectively. For the floristic criteria, phytosociological approach was used to classify plant communities, and its objectivity evaluated with a mathematical clustering of the floristic relevés. Cover of dominant plant species was tested as a proxy for the phytosociological method. For the gross forage classes, the graminoids/forbs ratio and the percentage cover of legumes were used. For assessing deer relative use of meadows we used faecal accumulation rates. Patches clustered according to floristic classification better explained selection of patches by deer. Plant community classifications based on phytosociology, or proxies of this, used for characterizing meadow patches resulted useful to understand herbivore selection pattern at fine scales and thus potentially suitable to assist wildlife management decisions

Rheological Properties of Polymer Modified Bitumen from Long-term Field Tests

The possibility to monitor aging of pavements and bituminous binders directly on the operative field, under their typical environmental conditions, can contribute to better understand the factors influencing the aging process, can be used for material optimization and to improve the performance behavior of bituminous binders. The high frequency torsional rheometer (HFTR) described in this paper is a useful device to study the time evolution of the theological properties of bituminous binders during field tests. In comparison with prevailing rheometers, the HFTR is inexpensive and, due to its portability and operative frequency (5 kHz) that allows measurements to be unaffected by traffic induced low frequencies, is a useful tool for continuous monitoring of field tests. The HFTR device and the measurement technique are described in this paper. The extraction of the theological parameters from the experiments is made through analytical and finite element models that reproduce the particular conditions of the field tests. In this study, the long-term aging of an asphaltic plug joint of a highway bridge is investigated with an HFTR over three consecutive years of exposure to environmental conditions. The evolution of the theological properties of the plug joint material, containing styrene-butadiene-styrene polymer modified bitumen, is quantified in terms of the complex shear modulus G*, showing a progressive material hardening and an increase in the temperature susceptibility of the binder</p