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Bestimmung des klinischen Nutzens systemischer adjuvanter Therapien beim frühen Mammakarzinom
(2017)
Die onkologische Therapie befindet sich im Umbruch. Hohe Erwartungen sind mit einer Reihe innovativer zielgerichteter Medikamente verknüpft, die sich derzeit in der klinischen Entwicklung befinden. Vor diesem Hintergrund erfahren Diskussionen um die Begriffe klinischer Nutzen oder klinische Relevanz neue Aktualität. Dies gilt auch für die Weiterentwicklungen der adjuvanten systemischen Therapie des frühen Mammakarzinoms. In Anbetracht der kurativen Zielsetzung erfolgt die Beurteilung des klinischen Nutzens einer adjuvanten Therapie maßgeblich anhand von Wirksamkeitsendpunkten. Der Fokus liegt hierbei auf Verbesserungen des krankheitsfreien Überlebens und des Rezidivrisikos. Eine Aussage zum Gesamtüberleben ist aufgrund der heute erreichten niedrigen Mortalitätsraten erst nach sehr langen Beobachtungszeiten möglich. Folgerichtig sollte neuen Medikamenten für die adjuvante Therapie ein klinischer Nutzen zugesprochen werden, wenn sie eine weitere Reduktion des Rezidivrisikos über den heutigen hohen Standard hinaus ermöglichen. Die Evidenz für etablierte adjuvante Therapiestandards beim frühen Mammakarzinom kann als objektiver Maßstab zum Vergleich herangezogen werden. Am Beispiel der adjuvanten endokrinen Therapie, der adjuvanten Polychemotherapie und der adjuvanten Anti-HER2-Therapie werden in diesem Übersichtsartikel die Anforderungen für den klinischen Nutzen neuer adjuvanter Therapien beim frühen Mammakarzinom abgeleitet.
Oncologic therapy is currently undergoing significant changes. A number of innovative targeted medications currently in clinical development have raised high expectations. With that in mind, discussions about terms such as "clinical benefit" and "clinical relevance" are highly topical. This also applies to further developments in the field of adjuvant systemic therapies for early-stage breast cancer. As the treatment aim is curative, assessment of the clinical benefit of adjuvant therapies must be largely based on efficacy outcomes. The focus must be on improving disease-free survival rates and lowering the risk of recurrence. Because of the current low mortality rates, statements about overall survival rates are only possible after very long observation periods. Consequently, new drugs in adjuvant therapies should be considered as offering a clinical benefit, if they reduce the risk of recurrence below current low levels of risk. The evidence for established adjuvant therapy standards in early-stage breast cancer can be used as objective criteria for comparison. This review article considers the requirements for clinical benefit of new adjuvant therapies for early breast cancer, based on examples from adjuvant endocrine therapy, adjuvant polychemotherapy and adjuvant anti-HER2 therapy.
With the Open Conference "Being a Citizen in Europe" in Zagreb (Croatia, 29-30 June 2015) external scholars were invited to connect to the bEUcitizen-project and to explore theoretical foundations and political as well as practical realities of today’s European citizenship. The structuring idea was to highlight potential core barriers towards EU citizenship and to do so by way of conceptual discussions as well as empirical analyses mapping a variety of citizenship practices in the EU. This was reflected in four thematic streams gathering contributions from both external and bEUcitizen researchers. The streams reflected on different kinds of barriers, conceptual and practical ones. They revolve around the normative promise of citizenship, the diversity of practices and possible paths of future development.
While stream 1 reflected on the dynamic of (re)configuring citizenship as a bounded or unbounded concept, stream 2 applied a comparative perspective on the diversity of rights-based citizenship practices. Stream 3 addressed the political dimension of EU-Citizenship and discussed a lack of citizenship participation as a farreaching barrier as well as possible remedies. Finally, stream 4 focused on linguistic diversity and the difficulties it creates regarding the conceptual and practical dimension of EU-citizenship. Taken together the contributions lucidly reflect the variety of disciplines cooperating in the bEUcitizen-project and their different points of view on EU-citizenship.
The crucial lesson from the contributions to the Open Conference for the theoretical task of WP 2 and the bEUcitizen-project more generally is that without conceptual clarity about the meaning of EU-citizenship the task of identifying practical barriers and evaluating the latter’s effects remains ambivalent. A shared understanding of the meaning of a (future) EU citizenship is still missing. What shall EU citizenship be or become: a fully-fledged democratic citizenship or a market-citizenship, bundling certain rights implied by the internal market freedoms? This undecided question is at the core of the debate on EU citizenship. In order to prevent citizens from turning their backs on the EU a public contestation of our understanding of the EU is needed. European democracy à venir requires an ongoing public debate about what European integration is all about and where it should lead us to – even and especially when there is no consensus about it.
An updated inventory of the Bromeliaceae for Costa Rica is presented including citations of representative specimens for each species. The family comprises 18 genera and 198 species in Costa Rica, 32 species being endemic to the country. Additional 36 species are endemic to Costa Rica and Panama. Only 4 of the 8 bromeliad subfamilies occur in Costa Rica, with a strong predominance of Tillandsioideae (7 genera/150 spp.; 75.7% of all bromeliad species in Costa Rica). 124 species (62.6%) grow exclusively epiphytic, additional 59 spp. (29.8%) are facultative epiphytes. The most diverse genus is Werauhia, with 59 species (29.8% of the Costa Rican bromeliad flora), followed by Tillandsia with 40 species (20.2%) and Guzmania with 28 spp. (8.6%).
We report new localities for the lizard Anolis salvini Boulenger, 1885, along the Pacific slopes of the Cordillera Central in Chiriquí province and the Comarca Ngöbe-Buglé of western Panama. These records extend the known geographic distribution of this species about 70 km eastwards. They also extend the known vertical distribution approximately 70 m uphill. Additionally, we provide the first record for the Caribbean slopes, an updated distribution map, photos of specimens from different localities, an analysis of a distress call, and comments on the morphology of this species.
Some anaerobic archaea and bacteria live on substrates that do not allow the synthesis of one mol of ATP per mol of substrate via substrate level phosphorylation (SLP). Energy conservation in these cases is only possible by a chemiosmotic mechanism that involves the generation of an electrochemical ion gradient across the cytoplasmic membrane that then drives ATP synthesis via an ATP synthase. The minimal amount of energy required for ATP synthesis is thus dependent on the magnitude of the electrochemical ion gradient, the phosphorylation potential in the cell and the ion/ATP ratio of the ATP synthase. It was always thought that the minimum biological energy quantum is defined as the amount of energy required to translocate one ion across the cytoplasmic membrane. We will discuss the thermodynamics of the reactions involved in chemiosmosis and describe the limitations for ion transport and ATP synthesis that led to the proposal that at least −20 kJ/mol are required for ATP synthesis. We will challenge this hypothesis by arguing that the enzyme energizing the membrane may translocate net less than one ion: By using a primary pump connected to an antiporter module a stoichiometry below one can be obtained, implying that the minimum biological energy quantum that sustains life is even lower than assumed to date.
Binary nucleation of sulphuric acid-water particles is expected to be an important process in the free troposphere at low temperatures. SAWNUC (Sulphuric Acid Water Nucleation) is a model of binary nucleation that is based on laboratory measurements of the binding energies of sulphuric acid and water in charged and neutral clusters. Predictions of SAWNUC are compared for the first time comprehensively with experimental binary nucleation data from the CLOUD chamber at European Organization for Nuclear Research. The experimental measurements span a temperature range of 208–292 K, sulphuric acid concentrations from 1·106 to 1·109 cm−3, and distinguish between ion-induced and neutral nucleation. Good agreement, within a factor of 5, is found between the experimental and modeled formation rates for ion-induced nucleation at 278 K and below and for neutral nucleation at 208 and 223 K. Differences at warm temperatures are attributed to ammonia contamination which was indicated by the presence of ammonia-sulphuric acid clusters, detected by an Atmospheric Pressure Interface Time of Flight (APi-TOF) mass spectrometer. APi-TOF measurements of the sulphuric acid ion cluster distributions (math formula with i = 0, 1, ..., 10) show qualitative agreement with the SAWNUC ion cluster distributions. Remaining differences between the measured and modeled distributions are most likely due to fragmentation in the APi-TOF. The CLOUD results are in good agreement with previously measured cluster binding energies and show the SAWNUC model to be a good representation of ion-induced and neutral binary nucleation of sulphuric acid-water clusters in the middle and upper troposphere.
In its weak field limit, Scalar-tensor-vector gravity theory introduces a Yukawa-correction to the gravitational potential. Such a correction depends on the two parameters, α which accounts for the modification of the gravitational constant, and μ∗−1 wwhich represents the scale length on which the scalar field propagates. These parameters were found to be universal when the modified gravitational potential was used to fit the galaxy rotation curves and the mass profiles of galaxy clusters, both without Dark Matter. We test the universality of these parameters using the temperature anisotropies due to the thermal Sunyaev–Zeldovich effect. In our model the intra-cluster gas is in hydrostatic equilibrium within the modified gravitational potential well and it is described by a polytropic equation of state. We predict the thermal Sunyaev–Zeldovich temperature anisotropies produced by Coma cluster, and we compare them with those obtained using the Planck 2013 Nominal maps. In our analysis, we find α and the scale length, respectively, to be consistent and to depart from their universal values. Our analysis points out that the assumption of the universality of the Yukawa-correction to the gravitational potential is ruled out at more than 3.5σ at galaxy clusters scale, while demonstrating that such a theory of gravity is capable to fit the cluster profile if the scale dependence of the gravitational potential is restored.
Entre as diversas perspectivas de pesquisa em educação, a Hermenêutica Objetiva se destaca hoje, na Alemanha, como uma das mais difundidas e reconhecidas abordagens da pesquisa sociológica qualitativa. O estágio de pós-doutorado realizado na Faculdade de Ciências da Educação - Instituto de Formação de Professores de Nível Secundário - da Universidade Johann Wolfgang Goethe em Frankfurt am Main foi uma das ações decorrentes do intercâmbio acadêmico firmado entre dois grupos de pesquisa, o "Teoria Crítica e Educação" (UFSCar - Brasil) e o "Reconstrução Pedagógica do Ensinar" (Universidade de Frankfurt - Alemanha). A partir dos conceitos que fundamentam o processo pedagógico (educação, instrução e formação), e da formulação de uma teoria pedagógica com base empírica, operada com o referencial teórico epistemológico da Hermenêutica Objetiva, o artigo aborda a situação atual da formação política nas escolas públicas alemãs. Como resultados, três aspectos gerais se destacam: 1) As análises sobre a metodologia da Hermenêutica Objetiva apontam a pertinência desse tipo de investigação na Educação, se o propósito for evidenciar os aspectos imanentes do processo pedagógico; 2) As reformas recentes na política educacional alemã indicam o processo de instrumentalização do ensino e o empobrecimento da formação em termos sociopolíticos; 3) A reconstrução empírica das aulas de política no ensino público alemão evidencia a superficialidade do conhecimento, o autoritarismo pedagógico, as práticas pedagógicas pseudo-democráticas; além da instrumentalização e judicialização da política, como temática de ensino.
The focus of this contribution is on the mode of capitalism within the industrialized sectors of "emerging markets". Particularly in the context of the rise of the BRIC (Brazil, Russia, India and China) this question has gained considerable importance, also for the development of the world economy as a whole. The core question is whether the type of capitalism within these economies is similar to the capitalist variety of the triad, or diverges in more or less permanent ways. The article gives a preliminary answer to this question, by developing a rough sketch of a "BRIC" model of capitalism and illustrating this model with the case of Brazil. In terms of theory, the article extends the Comparative Capitalism (CC) perspective to the BRICs. On the one side, the focus is on the classical questions of CC, i.e. the determinants of economic development and the differences to other types of capitalism, on the other side the relationship between these varieties and social inequality. It argues that the "state-permeated market economies" of the BRICs rely on clans as a mode of social coordination. As demonstrated by the case of Brazil, this type of capitalism can be quite successful, but is based on a highly unequal distribution of economic and political resources.