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Background: In 2017, the European Commission launched 24 European Reference Networks (ERNs). ERN eUROGEN is the network for urorectogenital diseases and complex conditions, and started with 29 full member healthcare providers (HCPs) in 11 countries. It then covered 19 different disease areas distributed over three work -streams (WSs). Objective: To provide an overview and identify challenges in data collection at European level of the ERN eUROGEN patient population treated by HCPs in the network. Design, setting, and participants: A retrospective cohort study was conducted of the 29 HCPs who were full members between 2013 and 2019. Outcome measurements and statistical analysis: Data were extracted from the original HCP applications and the ERN continuous monitoring system. Patient volumes, new patient numbers, and procedures were compared between different WSs, countries, and HCPs. Discrepancies between monitoring and application data were identified. Results and limitations: Between 2013 and 2019, 122 040 patients required long-term care within the 29 HCPs. The volume of patients treated and procedures undertaken per year increased over time. Large discrepancies were found between patient numbers contained in the application forms and those reported in the continuous monitoring system (0-1357% deviation). Conclusions: Patient numbers and procedures increased across ERN eUROGEN HCPs. Reliable data extraction appeared challenging, illustrated by the patient volume dis-crepancies between application forms and the continuous monitoring data. Improved disease definitions, re-evaluation of affiliated HCPs, and valid data extraction are needed for future improvements. Patient summary: We analysed the patient population with rare urorectogenital dis-eases or complex conditions within the ERN eUROGEN network between 2013 and 2019. Clinical activity was found to increase, but differences in patient numbers were evident between healthcare providers. In order to acquire valid patient numbers, both improved definitions of diagnostic codes and greater insight into the data-gathering process are required. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

PURPOSE: Burnout is defined as a three-dimensional syndrome—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)—caused by chronic occupational stress. The aim of the current study was to investigate the prevalence of burnout among oncologists in Eastern Europe and to identify the contributing factors. METHODS: The study was conducted as an online survey between October 2017 and March 2018. Oncologists (including medical, radiation, clinical, and surgical oncologists) from 19 countries were invited to participate. The survey consisted of 30 questions, including the standardized burnout instrument, Maslach Burnout Inventory, and eight demographic questions. Burnout risk was scored according to the scoring manual for health care workers. RESULTS: The study included 637 oncologists. Overall, 28% were at low or intermediate risk and 72% were at high risk for burnout. Forty-four percent of participants were at high risk for EE, 28.7% for DP, and 47.3% for PA. EE risk was associated with female sex. DP risk was highest among clinical and radiation oncologists, whereas PA risk was positively correlated with years of service, percentage of cancer deaths, and availability of the number of oncologists. In multivariate logistic regression analysis, burnout was significantly associated with standardized cancer mortality and fewer years of practice. CONCLUSION: Burnout among oncologists in Eastern Europe is high, and younger oncologists are the most vulnerable group. Preventive measures should be taken to address this issue, which negatively affects optimal care delivery and poses a threat to oncologists’ health and well-being.

Prva vakcina za rak koja je odobrena za rutinsko liječenje bio je sipuleucel-T za liječenje bolesnika s metastatskim kastracijski rezistentnim rakom prostate. Međutim, drugi imunoterapijski lijekovi koji su bili istraživani u bolesnika s rakom prostate, posebno inhibitori imunološke kontrolne točke, nisu pokazali terapijski učinak. Nekoliko je mogućih objašnjenja za nedostatak terapijskog odgovora na ove lijekove kod raka prostate. Ta objašnjenja koja su vezana uz specifična genetička (npr. nisko mutacijsko opterećenje) i imunološka (npr. imunosupresivni tumorski imunološki mikrookoliš) obilježja raka prostate opisana su u ovom preglednom radu. Također, prikazane su nove terapijske strategije s ciljem prevladavanja otpornosti raka prostate na imunoterapiju i za odabir podskupina bolesnika u kojih se može očekivati korist od imunoterapije.

Cervical cancer patients with locally advanced disease are treated with combined external beam radiotherapy EBRT and high dose rate brachytherapy HDRBT. In treatment reports, doses to HRCTV (high risk clinical target volume) and doses for organs at risk, bladder and rectum, are usually reported. Dose constraints for vagina as organ at risk and methods for reporting vaginal dose points are not yet introduced in clinical practice. This study aims to analyze and report vaginal dose points in the lower and upper part of vagina.

Intraluminal high dose rate brachytherapy (ILHDR BT) is one of several effective modalities for palliation of advanced esophageal cancer. Thirty patients with endoscopic-proven, mostly locally advanced, squamous cell carcinoma of the esophagus, not involving the gastroesophageal junction and without distant metastases, were included in this analysis. Twenty- nine patients received two ILHDR BT sessions of 8 Gy within a week and one patient received only one session. All patients were followed monthly. Outcomes included quality of life (QOL), symptoms control: dysphagia, regurgitation, odynophagia, and chest or back pain, as well as, overall survival. Through 4 months of follow-up, QOL was statistically improved (having lowered scores) in regards to feelings (P= 0.013), sleeping (P= 0.032), eating (P= 0.020), and social life (P= 0.002). The most significantly improved symptom was dysphagia (P < 0.006), with a reduction of 0.52 units or one-half grade. Regurgitation, odynophagia, and pain were lower during follow-up but were not statistically significant. The median overall survival from death of any cause was 165 days (with a 95% confidence interval of 128–195 days). In conclusion, ILHDR BT of advanced squamous esophageal cancer consisting of two out- patient procedures is very successful in achieving the primary objectives of the patients to reduce dysphagia and improve QOL.

Scores of avalanche injuries and fatalities occur annually. This research presents an avalanche search and rescue (SAR) proof-of-concept option that utilizes a small unmanned aerial vehicle (UAV) helicopter with a payload capable of detecting and locating a buried victim's cell phone. Cell phones involved in this research were modern-day fourth generation (4G) Long Term Evolution (LTE) devices with an application specifically designed for potential SAR detection. This study focused primarily on radio frequency (RF) propagation modeling through snow and air. The analysis and associated field trials demonstrate that it is feasible to detect these cell phone devices through avalanche debris up to 7 feet deep. Alpine UAS inclement flight demonstrations were also conducted. Although many studies have been published on detecting the position of mobile cellular devices, this is the first of its kind to quantify the detection of a cell phone that is buried under the snow.

Short-course radiotherapy for locallly advanced rectal cancer: an IAEA randomized trial

o optimize palliation in incurable locally advanced non-small cell lung cancer (NSCLC), the International Atomic Energy Agency conducted a prospective randomized study (NCT00864331) comparing protracted palliative radiotherapy (RT) course with chemotherapy (CHT) followed by short-course palliative RT. Treatment-naive patients with histologically confirmed NSCLC, stage IIIA/IIIB, received either 39 Gy in 13 fractions as RT alone (arm A, n = 31) or 2–3 platinum-based CHT cycles followed by 10 Gy in a single fraction or 16 Gy in 2 fractions separated by one week (arm B, n = 34). Primary outcome was overall survival. Treatment groups were balanced with respect to various variables. Median survival for all 65 patients was 8 months, while median survival was 7.1 and 8.1 months for the two arms, respectively (log-rank p = 0.4 by study arm, and p = 0.6 by Cox regression and stratified by country and sub-stage). One and three year survival rates for the two arms were 29%, and 9% and 41%, and 6%, respectively. There were no differences in any of the following endpoints: any failure, local failure, regional failure, contralateral thoracic failure, and distant failure between the two arms. High-grade (⩾3) toxicity was similar between the two arms. Symptoms, adverse events of any kind, KPS and body-mass index, were not different during treatment and during follow-up. There was no grade 5 toxicity. This incomplete and underpowered trial only hinted similar outcome between the treatment arms. Therefore, combined CHT-RT can perhaps be considered, in limited resource setting, where access to RT remains inadequate.

Differences in surgical resection rates , RO pathological margins and overall survival were not statistically significant, while relative safety was demonstrated for short-course RT. With a mean follow-up of 1, 5 years , the preliminary results of this trial do not show a significant difference between randomization arms. An operability rate of 60% is important fo a group of patients deemed inoperable / borderline at diagnosis in this group of developing countries.

a lecture about cancer control in croatia

Dr. Fröbe participated in the creation of the concept of research as well as writing of the article.

Vaginal brachytherapy VB and pelcic external beam radiotherapy EBRT in endometrial cancer hihg risk patients: a single institution experience.

Professor Forbe was participatiting in the analysis of the results for High dose rate Ri- 192 source calibration

U ovom radu opisana je kalibracija optički stimuliranih luminiscentnih (OSL) dozimetara za mjerenje ulazne doze. Ispitan je komercijalni dozimetrijski sistem koji uključuje čitač i točkaste OSL dozimetre malih dimenzija načinjene od ugljikom dopiranog Al2O3. Mjerene su pojedinačne osjetljivosti više od 200 OSL dozimetara dok je kalibracija izvedena na setu od 20 dozimetara. Uočen je supralinearni odziv OSLa u području terapijskih doza od 2 do 10 Gy te je predložena kalibracija prilagodbom na kvadratičnu krivulju ovisnosti odziva dozimetra o dozi. Uspoređeni su rezultati mjerenja ulaznih doza na fantomu dobivenih ovom kalibracijom i kalibracijom prema IAEA protokolu gdje se svaki pojedini OSL dozimetar kalibrira fiksnom dozom od 50 cGy uz upotrebu korekcijskih faktora za nelinearnost.

A comparison of two in-vivo dose measuring systems, diodes and optically stimulated luminescence dosimeters (OSLDs), for entrance dose estimation in external beam radiotherapy is described in this work. The results were obtained following the common methodology developed by the IAEA [1]. The study covered the dosimeter characterisation, calibration, non-reference correction factor determination, phantom evaluation and comparative analysis of their performance in a clinical setting.

Dr. Fröbe participated in the creation of the concept of research as well as writing this article.

Dr. Fröbe participated in the creation of the concept of research as well as writing paper.

Measurements were done to characterize the dosimetric properties of commercially available optically stimulated luminescence dosimeters (OSLD)for in-vivo dosimetry and phantom measurements.

Profesora Frobe je opisivala ulogi brahiterapije u liječnju melanoma oka.

Dr. Fröbe participated in the creation of the concept of research as well as writing this article.

In-vivo dosimetry for radiotherapy patients became a part of routine quality assurance procedures at the UH “ Sestre milosrdnice” Department of Oncology and Nuclear Medicine. This is generally known as a very good tool for tracking and preventing possible errors in the radiotherapy chain. Semiconductor p-type silicon diodes are employed in the measurement of the dose delivered at the depth of maximum dose. Diodes are calibrated for the entrance dose measurements in a Co-60 beam and a set of correction factors is determined to account for non-reference clinical conditions. Protocol for the characterization of detectors and the implementation of in-vivo dosimetry was proposed within the research project coordinated by the International Atomic Energy Agency (IAEA). Before starting with patient measurements a series of verification setups and measurements were taken on the anthropomorphic Alderson phantom. Until now, there are about one thousand fields examined, mainly within first three fractions of the treatment. In this work we present patient data analysis in a view of different treatment parameters such as: localization, field type, gantry and surface angle, and the use of blocks and wedges. Statistical tests are used for objective investigation of the delivered dose accuracy in relation to the above mentioned treatment parameters.

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The postsynaptic serotonin-2A (5HT-2A), receptors mediate a number of central and peripheral 5HT functions and have a role in several psychiatric disorders. 5HT-2A receptor is directly coupled to the phosphoinositide signalling system and its activation finally give rise to the intracellular calcium [Ca2+], resulting in phosphorylation/dephosphorylation of protein substrates. 5HT-2A receptors are disitributed with higest densities in brain cortex but also on blood platelets, which are studied as a potential model of membrane-related neuronal functions as well signal transduction mechanisms. The aim of the present study was to measure reactivity of 5HT-2A signal transduction system, by measuring intracellular  Ca2+ following its 5HT-induced mobilization, in rat sublines with constitutionally altered serotonin homeostasis (Wistar-Zagreb 5HT rats ; obtained by directed selective breeding for extremes in the activity of platelet 5HT transporter). Previous studies on 5HT-2A receptor kinetics and 5HT-2A mRNA expression did not show significant differences between the sublines. Fura– 2 fluorescent indicator was used for measuring intarcellular [Ca2+] in platelet-rich-plasma and frontal cortex membranes, simultaneously on animals from both sublines of Wistar-Zagreb 5HT rats. Ca2+ concentration was measured basally and after 5HT-induced Ca2+ mobilization. Sublines of Wistar-Zagreb 5HT rats showed differences in basal intracellular [Ca2+] in both, brains and platelets. Differences between sublines in [Ca 2+] after stimulation of 5HT-2A receptors by serotonin were observed only in platelets, and not in cortical membranes. Constitutionally altered serotonin homeostasis in Wistar-Zagreb 5HT rats resulted in differences in basal intracellular Ca2+ level between sublines, indicating alterations in intracellular signaling of 5HT-2A receptor. Different calcium signalization after stimulation of receptors by 5HT indicates altered functional response of 5HT-2A receptor, at least in platelets.

Dr. Fröbe participated in the creation of the concept of research as well as writing of this article.