Levinneen eturauhassyövän lääkehoito

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The most difficult at-fault fatal crashes to avoid with current active safety technology

Objective We studied which current fatal at-fault crashes would occur despite the most advanced current active safety devices (up to SAE level 2 of driving automation) and how frequent these crashes would be. Methods We carried out a cross-sectional study of passenger cars that were first registered during the period 1st January 2010 to 31st December 2017 in Finland. To gain the true exposure for these cars, we accessed the national Vehicular and Driver Data Register to obtain the mileage information and the registration count for the study period of 2010-17. Similarly, we accessed the registry of Finnish road accident investigation teams and included all fatal at-fault crashes among the cars in our study for the same period. We used a real world reference technology for each active safety system in our analysis and chose one car brand as an example. This gave us exact system specifications and enabled testing the operation of the systems on the road. We performed field tests to gain further information on the precise operation of the safety systems in different operating conditions. Finally, we gathered all information on the studied active safety systems and analyzed the investigated at-fault fatal crashes case-by-case using our four level method. Results Cars in our study were the primary party in 113 investigated fatal accidents during the years 2010-17. In 87 of the accidents, the leading cause of death was the injuries due to the crash, and these cases were classified as “unavoidable” (n = 58, 67 %), “avoidable” (n = 26, 30 %) or unsolved (n = 3, 3 %). Of the 58 “unavoidable” crashes 21 (36 %) were suicides, 21 (36%) involved active driver input which would have prevented the safety system operation, 15 (17 %) featured circumstances beyond the safety system performance and in one loss-of-control crash the driver had disabled the relevant safety system (electronic stability control). The registration years of the cars in our study (2010-17) totaled 3,772,864 and during this period, the cars travelled 75.9 billion kilometers. The crash incidence of the “unavoidable” at-fault fatal crashes was 0.76-0.80 fatal crashes per billion kilometers and 15-16 fatal crashes per million registration years. Conclusions We calculated a crash incidence for the “unavoidable” crashes which was 20–27% smaller than the observed crash rate of ESC-fitted passenger cars in our previous study. We concluded that suicides, active driver input until the crash, and challenging weather and road conditions are the most difficult factors for current active safety systems. Our analysis did not account for issues such as system usability or driver acceptance and therefore our results should be regarded as something that is currently theoretically achievable. However, the observed incidence is a good reference for automated driving development and the crash rate of automated cars.Peer reviewe

Which not-at-fault crashes are unavoidable by using current active safety technology?

Previous research has focused on analysing crash reduction potential of active safety technology in at-fault passenger cars, but only a few studies have examined counterparties' possibilities to avoid collisions by using advanced driver assistance systems (ADAS). This study quantified the incidence of fatal not-at-fault passenger car crashes that current ADAS (up to SAE level 2) would be unable to avoid. We used data taken from in-depth investigated fatal crashes in which a passenger car was involved, that car having been first registered during the period 1 January 2010 to 31 December 2017 in Finland. The evaluation of unavoidable crashes consisted of two evaluation rounds. The preliminary evaluation round identified potential active safety systems that could have operated in the studied cases. In the following round, we made a five-level case-by-case analysis including a time headway analysis in order to evaluate the possibilities for crash avoidance. The crash data included 63 fatal crashes, of which five were excluded because the death was due to a sudden illness attack. The remaining 58 crashes were classified as follows: probably unavoidable (n = 51), avoidable (n = 3), and unclear (n = 4). The crash incidence of the unavoidable not-at-fault party crashes was 0.67–0.73 fatal crashes per billion kilometers and 14–15 fatal crashes per million registration years. The results indicate that current active safety systems may be able to prevent not-at-fault party fatal crashes only in a few cases and that the driver's role in road safety remains important despite the deployment of the active safety systems.publishedVersionPeer reviewe

Eturauhassyöpää sairastavan potilaan luusto

Vertaisarvioitu.Eturauhassyöpä ja sen androgeenideprivaatiohoito (ADT) altistavat potilaan osteoporoosille ja luunmurtumille. Eturauhassyövän toteamisvaiheessa tulisi arvioida murtumariski ja aloittaa ainakin elintapahoitoon perustuva murtumien ehkäisy. Luustolääkkeiden käyttö ADT:hen liittyvän osteoporoosin hoidossa ei ole riittävästi vakiintunut. Luuhun levinnyt eturauhassyöpä voi aiheuttaa kipua, palliatiivisen sädehoidon tarvetta, murtumia tai selkäydinkompressiota. Näiden luustokomplikaatioiden estossa ja hoidossa käytetään bisfosfonaatteja ja denosumabia, mutta niiden hyöty on osoitettu vasta eturauhassyövän edettyä kastraatioresistenttiin vaiheeseen. Eturauhassyövän systeemihoitokin voi vähentää luuston haittatapahtumia. Luustoetäpesäkkeiden aiheuttamaa kipua lievitetään kipulääkkeiden lisäksi ulkoisella sädehoidolla.Peer reviewe

Radium-223 dichloride treatment in metastatic castration-resistant prostate cancer in Finland : A real-world evidence multicenter study

Background Radium-233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer. Results of a previously reported phase III randomized trial showed survival benefit for radium-223 compared to best supportive care in castration-resistant prostate cancer (CRPC) with bone metastases. However, real-world data are also needed with wider inclusion criteria. Methods We report results of a retrospective multicenter study including all patients with metastatic CRPC treated with radium-223 in all five university hospitals in Finland since the introduction of the treatment. We identified 160 patients who had received radium-223 in Finland in 2014-2019. Results The median overall survival (OS) was 13.8 months (range 0.5-57 months), and the median real-world progression-free survival (rwPFS) was 4.9 months (range 0.5-29.8 months). Alkaline phosphatase (ALP) values within the normal range before and during the radium-223 treatment or the reduction of elevated ALP to normal range during treatment were associated with better OS when compared to elevated ALP values before and during treatment (p = 100 mu g/L) before radium-223 treatment was associated with poor OS compared to low PSA level (Peer reviewe

Targeted Inhibition of CYP11A1 in Castration-Resistant Prostate Cancer

Targeted Inhibition of CYP11A1 in Prostate CancerIn this single-arm, multicenter, combined phase 1 and phase 2 study, patients with metastatic prostate adenocarcinoma with progression on prior androgen receptor pathway inhibitors and taxane-based chemotherapy were treated with ODM-208. A decrease in prostate-specific antigen levels of 50% or more occurred in 16/42 (38.1%) and 24/45 (53.3%) in phase 1 and 2 respectively. Responses mainly occurred in patients with androgen receptor mutations. Adrenal insufficiency was the dose-limiting toxicity.</p

The most difficult at-fault fatal crashes to avoid with current active safety technology

Objective: We studied which current fatal at-fault crashes would occur despite the most advanced current active safety devices (up to SAE level 2 of driving automation) and how frequent these crashes would be. Methods: We carried out a cross-sectional study of passenger cars that were first registered during the period 1st January 2010 to 31st December 2017 in Finland. To gain the true exposure for these cars, we accessed the national Vehicular and Driver Data Register to obtain the mileage information and the registration count for the study period of 2010-17. Similarly, we accessed the registry of Finnish road accident investigation teams and included all fatal at-fault crashes among the cars in our study for the same period. We used a real world reference technology for each active safety system in our analysis and chose one car brand as an example. This gave us exact system specifications and enabled testing the operation of the systems on the road. We performed field tests to gain further information on the precise operation of the safety systems in different operating conditions. Finally, we gathered all information on the studied active safety systems and analyzed the investigated at-fault fatal crashes case-by-case using our four level method. Results: Cars in our study were the primary party in 113 investigated fatal accidents during the years 2010-17. In 87 of the accidents, the leading cause of death was the injuries due to the crash, and these cases were classified as “unavoidable” (n = 58, 67 %), “avoidable” (n = 26, 30 %) or unsolved (n = 3, 3 %). Of the 58 “unavoidable” crashes 21 (36 %) were suicides, 21 (36%) involved active driver input which would have prevented the safety system operation, 15 (17 %) featured circumstances beyond the safety system performance and in one loss-of-control crash the driver had disabled the relevant safety system (electronic stability control). The registration years of the cars in our study (2010-17) totaled 3,772,864 and during this period, the cars travelled 75.9billion kilometers. The crash incidence of the “unavoidable” at-fault fatal crashes was 0.76-0.80 fatal crashes per billion kilometers and 15-16 fatal crashes per million registration years. Conclusions: We calculated a crash incidence for the “unavoidable” crashes which was 20–27% smaller than the observed crash rate of ESC-fitted passenger cars in our previous study. We concluded that suicides, active driver input until the crash, and challenging weather and road conditions are the most difficult factors for current active safety systems. Our analysis did not account for issues such as system usability or driver acceptance and therefore our results should be regarded as something that is currently theoretically achievable. However, the observed incidence is a good reference for automated driving development and the crash rate of automated cars.Peer reviewe