Radiotherapy after chemotherapy for metastatic seminoma--a diminishing role. MRC Testicular Tumour Working Party

In a retrospective study, data from 302 patients with metastatic testicular seminoma treated with chemotherapy between 1978 and 1990 in 10 European centres were analysed to evaluate the role, if any, of postchemotherapy treatment with irradiation. The primary endpoint of this study was the progression-free survival rate after chemotherapy with or without additional radiotherapy. This was related to the type of primary chemotherapy, sites and sizes of pre- and postchemotherapy masses, the extent of surgical resection after chemotherapy and the use of radiotherapy. 174 patients had residual disease at the end of chemotherapy. The most important prognostic factors for progression were the presence of any visceral metastases or raised LDH prechemotherapy, and the presence of residual disease at visceral sites after chemotherapy. Approximately half the patients with residual masses underwent postchemotherapy radiotherapy, with selection based predominantly on institutional practice. In patients receiving platinum-based chemotherapy, no significant difference was detected in progression-free survival whether or not radiotherapy was employed. Patients receiving BEP (bleomycin, etoposide and cisplatin) had a progression-free survival rate of 88% (95% CI, 80-96%) uninfluenced by postchemotherapy radiotherapy. In patients with residual masses confined to the abdomen after platinum-based chemotherapy, the absolute benefit to radiotherapy was estimated to be 2.3%. The potential benefit of postchemotherapy radiotherapy is minimal, and so it is concluded that the use of adjuvant radiotherapy to residual masses after platinum-based chemotherapy for metastatic seminoma is unnecessary.     

Co-amplification of nuclear pseudogenes and assessment of heteroplasmy of mitochondrial DNA mutations

As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.     

Enhancing the fire resistance of composite floor assemblies through the use of steel fiber reinforced concrete

This paper presents a strategy for achieving the required fire resistance in composite floor systems through the use of steel fiber reinforced concrete (SFRC). Both experimental and numerical studies were carried out to evaluate the fire performance of floor systems comprising unprotected steel beams and concrete/SFRC deck slabs. The results from these studies show that SFRC composite deck slabs develop significant tensile forces (through tensile membrane action) that transfer load from fire-weakened steel beams to other cooler parts of the structure. Preliminary results indicate that the combined effect of composite construction, tensile membrane action, and the improved properties of SFRC under realistic fire, loading, and restraint conditions can provide sufficient fire resistance in steel beam-concrete deck slabs without the need for external fire protection on the floor assembly.     

Modeling the Behavior of Fiber Reinforced Polymer-Confined Concrete Columns Exposed to Fire

Very little information is available on the behavior of fiber reinforced polymer (FRP) materials and FRP-strengthened concrete members in fire, and this is a primary factor hindering the widespread implementation of FRP strengthening technologies in the construction industry. This paper presents a numerical model for evaluating the fire behavior of conventionally reinforced circular concrete columns, FRP-wrapped reinforced concrete columns, and insulated FRP-wrapped reinforced concrete columns. The model is validated against data available in the literature from full-scale fire endurance tests on conventionally reinforced concrete columns, and preliminary predictions of the model are presented and discussed. It is demonstrated that the model agrees reasonably well with experimental data obtained from tests on circular reinforced concrete columns, that it is unlikely that the structural effectiveness of FRP materials can be maintained during fire, and that the fire behavior of FRP-wrapped columns can be dramatically improved by providing supplemental insulation for the FRP.     

Residual Behavior of Fire-Exposed Reinforced Concrete Beams Prestrengthened in Flexure with Fiber-Reinforced Polymer Sheets

Numerous research studies have shown externally bonded fiber-reinforced polymer (FRP) materials can be used efficiently and economically to repair and retrofit deteriorated or understrength concrete structures. FRP materials are being widely applied in the rehabilitation of deteriorated bridges, however, their use in buildings has been limited, partly because of insufficient knowledge about the performance of FRP materials in fire. To enable further applications of FRPs in buildings, this paper presents a study on the residual performance after fire of four reinforced-concrete (RC) T-beams that were prestrengthened with externally bonded FRP sheets and provided with a supplemental fire protection system. Results from this study suggest that the RC beams strengthened with FRPs prior to fire exposure retained most of their initial unstrengthened flexural capacity after fire. This is attributed to the fact that the temperature of the internal concrete and reinforcing steel was kept to below 200 and 593°C, respectively.     

Light-Weight Frame Wall Assemblies: Parameters for Consideration in Fire Resistance Performance-Based Design

With the advent of performance-based codes and fire safety design options, it is essential to determine parameters that affect the fire-resistance performance of assemblies. This paper presents the results of 17 full-scale fire-resistance tests conducted as part of a major industry-government research program investigating parameters that affect the fire-resistance performance of light-weight frame wall assemblies. These include the effects of insulation type, insulation width between studs, resilient channel location, gypsum board thickness, number of gypsum board layers, glass fiber in the gypsum board core, gypsum board mass per unit area, and stud type for light-weight frame wall assemblies finished with gypsum board. The effects of these parameters on the fire resistance are discussed.     

High-dose therapy including carboplatin adjusted for renal function in patients with relapsed or refractory germ cell tumour: outcome and prognostic factors

Thirty-one consecutive patients with relapsed or refractory GCT received an HDT schedule including carboplatin, the dose of which was adjusted to measured glomerular filtration rate. There was one HDT-associated death (3%), due to acute renal failure. The 3-year probability of overall and disease-free survival for 21 patients with primary refractory disease or responsive relapse was 60% and 42%, respectively, while none of ten patients with refractory relapse have survived disease free.     

FPR-混凝土粘结界面的规律

根据试验数据,研究了FRP与混凝土粘结的非线性模型Ⅱ界面规律。所提出的界面规律基于差分方程,并考虑了高剪应力下粘性剂和混凝土保护层的非线性作用。模型中的参数均在拉—拉剥离试验下校准,同时采用了不同荷载水平、不同粘结长度、沿FRP板方向的最大传递荷载与应变。通过有限粘结长度决定的最大传递荷载的估计值来确定界面规律中的断裂能,同时根据应变确定剪切－滑移关系。并通过一系列文献的试验结果验证参数优化程序。在粘结－滑移模型中采用所提出的界面定律进行数值模拟计算,得出粘结区域中FRP的应变、剪应力和滑移与试验结果很吻合。     

Behavior of high strength fly ash concrete columns under fire conditions

Fly ash concrete is finding increasing applications in construction; however there is lack of data on fire performance of fly ash concrete structural members. This paper presents results from fire resistance tests on fly ash concrete columns. Data generated from tests on high strength fly ash concrete columns is compared with those of conventional high strength concrete (HSC) columns. The effect of concrete type, fire exposure scenario, fly ash, and fibers in concrete mix on fire performance of fly ash concrete columns is discussed. Results from fire resistance tests show that fly ash concrete columns exhibit almost similar fire resistance to that of conventional HSC columns. Further, the addition of polypropylene fibers mitigates fire induced spalling in high strength fly ash concrete columns.