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Sustainable use of IV bags:lessons from the IV bag crisis
No full textMedication substantially contributes to global CO₂ emission of healthcare. IV bags and associated materials are an important source of pollution. During the IV bag crisis, caused by the closure of a factory in the US due to Hurricane Helena, emergency measures were implemented to reduce IV bag use. These measures addressed the acute problem and created an opportunity for more sustainable use of IV bags and medication. We discuss four measures to achieve sustainable reduction in usage of IV bags: (1) switching from intravenous to oral medication administration where possible, (2) optimizing intravenous administration through bolus injection or injection port, (3) extending the administration time of unmanipulated IV bags to a maximum of 7 days, and (4) reducing flow rates to 2 ml/h for maintenance of venous access. These measures reduce waste, CO₂ emissions, and costs without compromising patient safety. Environmental sustainability in healthcare requires ongoing awareness and multidisciplinary collaboration.</p
Increased incidence of primary metastatic prostate cancer in the era of PSMA PET/CT:a population-based analysis
No full textPurpose: To evaluate the effects of prostate-specific membrane antigen (PSMA) PET/CT use for primary staging on nationwide stage-specific prostate cancer (PCa) incidence rates and treatment patterns. Methods: For this population-based cohort study, all men diagnosed with PCa in the Netherlands from 2010 to 2023 were identified in the Netherlands Cancer Registry. Year of diagnosis was used as proxy measure for PSMA PET/CT availability and use for primary staging. Overall and stage-specific European age-standardized incidence rates (ESR) and estimated annual percentages change (EAPC) were calculated. Among patients with ≥ 1 high-risk feature, logistic regression was performed to assess the association between year of diagnosis and detection of pelvic lymph node and/or distant metastases. Exploratory analyses were conducted to assess changes in treatment. Results: From 2010 to 2023, the ESR of PCa declined slightly (EAPC=-0.2%, p = 0.64). Meanwhile, the ESR of pelvic node-positive only and distant metastatic PCa increased (EAPC = 4.6% [p < 0.001] and 4.1% [p < 0.001]). Patients with ≥ 1 high-risk feature were more often diagnosed with pelvic lymph node and/or distant metastases in the years with increasing (OR = 1.33) and widespread (OR = 1.65) access compared to the period with limited access to PSMA PET/CT for primary staging. Meanwhile, the proportion of patients that received systemic therapy increased from 38.7 to 42.0% (OR = 1.15). Conclusion:The implementation of PSMA PET/CT in clinical practice, appears to be associated with a substantial stage shift towards pelvic node-positive and distant metastatic PCa. Exploratory analyses also suggest more frequent treatment with palliative, rather than curative intent. Further research is needed to evaluate effects on clinical outcomes.</p
Photon-counting detector CT in musculoskeletal imaging:benefits and outlook
No full textPhoton-counting detector CT (PCD-CT) represents a significant advancement in medical imaging, particularly for musculoskeletal (MSK) applications. Its primary innovation lies in enhanced spatial resolution, which facilitates improved detection of small anatomical structures such as trabecular bone, osteophytes, and subchondral cysts. PCD-CT enables high-quality imaging with reduced radiation doses, making it especially beneficial for populations requiring frequent imaging, such as paediatric patients and individuals with multiple myeloma. Additionally, PCD-CT supports advanced applications like bone quality assessment, which correlates well with gold-standard tests, and can aid in diagnosing osteoporosis and assessing fracture risk. Techniques such as spectral shaping and virtual monoenergetic imaging further optimize the technology, minimizing artefacts and enhancing material decomposition. These capabilities extend to conditions like gout and haematologic malignancies, offering improved detection and assessment. The integration of artificial intelligence could enhance PCD-CT’s performance by reducing image noise and improving quantitative assessments. Ultimately, PCD-CT’s superior resolution, reduced dose protocols, and multi-energy imaging capabilities will likely have a transformative impact on MSK imaging, improving diagnostic accuracy, patient care, and clinical outcomes.</p
Reply:Bronchiolocentric interstitial pneumonia is a morphological term used for lung biopsy and chest imaging pattern and is not a substitute for hypersensitivity pneumonitis
No full textIntercultural contact through screens:The impact of digital media on intercultural attitudes
No full textAndrew Linklater
No full textAndrew Linklater (1949–2023) was a British international relations (IR) theorist and cosmopolitan thinker. He published two major book trilogies. The first addressed the relationship between the rights of individuals, their duties to the state or national political community, and the duties of both persons and states to humankind everywhere. The trilogy integrated attention to ethical, sociological, and practical-action issues, constituting a dialogue between global ethics and international relations theory, in the spirit of Kant. The second trilogy, on the problem of harm in international politics, applied the process sociology of Norbert Elias to issues raised by the English School of International Relations about the nature and impact of the emergence of a “society of states.” It examined what sorts of “harm conventions” have been espoused and practiced by different societies and, especially, different “societies of states"
EndoBridge 2024:pearls and highlights
No full textEndoBridge 2024 was held from October 18–20, 2024, in Antalya, Türkiye. The scientific program of the 12th Annual Meeting of EndoBridge, accredited by the European Council, featured advanced lectures and interactive case discussion sessions in small groups, all delivered by internationally renowned experts in the field. The event attracted a wide range of attendees and offered an extensive overview of key topics in endocrinology and metabolism. These included pituitary, thyroid, bone, and adrenal diseases, neuroendocrine tumors, diabetes, obesity, nutrition, and lipid disorders. Abstracts of clinical cases presented during oral and poster sessions were published in JCEM Case Reports. This article summarizes the major highlights and key insights from the meeting, covering a broad spectrum of topics such as management of acromegaly, treatment of subclinical thyroid disease, goal-directed treatment for osteoporosis, the role of adjunctive therapies in type 1 diabetes mellitus, phenotyping obesities, hormonal management of menopause and premature ovarian failure, and updates on male hypogonadism and infertility. These discussions present the most recent advancements in endocrinology and offer clinical perspectives on prevalent endocrine conditions. The 13th Annual EndoBridge Meeting is scheduled to be held from October 23 to 26, 2025, in Antalya, Türkiye.</p
De grensoverschrijdende fiscale eenheid vennootschapsbelasting en omzetbelasting: per element verschillend?
No full textOp 20 december 2024 wees de Hoge Raad, naast de bekende box 3-arresten, een opvallend arrest over de toepassing van de per-elementbenadering binnen de fiscale eenheid voor de omzetbelasting. In deze zaak probeerde belanghebbende een specifiek btw-voordeel te benutten, ondanks dat het vormen van een fiscale eenheid omzetbelasting niet mogelijk was vanwege grensoverschrijdende elementen. Deze uitspraak vormt de aanleiding voor dit artikel waarin wordt onderzocht of uit de jurisprudentie over de per-elementbenadering in de vennootschapsbelasting een kader kan worden afgeleid voor de fiscale eenheid omzetbelasting
TOWARD A DESIGN PHILOSOPHY THAT STUDIES THE DESIGN OF ARTIFACTS AND THE WORLD IN WHICH THEY ARE EMBEDDED:THE CASE OF DIGITAL TWINS
No full textIn this chapter, we engage in an ecological phenomenology of the redesign of the World in the digital age in order to show why the consideration of the redesign of the World in the digital age is relevant for contemporary design philosophies and philosophies of technology (section “A New Critical Perspective for Design Philosophies”), and how design philosophers can research both the design of concrete artifacts and the World in which they are embedded in an integrated manner (section “An Ecological Phenomenology of the Redesign of the World in the Digital Age”). Based on our findings, we propose to study design at the physical level of artifacts, the processual level of invention and evolution, and the metaphysical level of the redesign of the World in an integrated manner. In order to set the stage, however, we first ask why contemporary design philosophies—and we take Value Sensitive Design as a case in point—are not able to move beyond the artifact level of design and are not able to study the World in which these designs are embedded (section “The Inability of Contemporary Design Thinking (Value Sensitive Design) to Reflect on the Redesign of the World”)
Iberdomide plus low-dose cyclophosphamide and dexamethasone in patients with relapsed and refractory multiple myeloma (the ICON study):a multicentre, single-arm, phase 2 trial
No full textBACKGROUND: Iberdomide is an oral cereblon E3 ligase modulator with higher affinity to cereblon than immunomodulatory drugs, leading to improved direct anti-myeloma activity and enhanced immunostimulatory effects. We aimed to evaluate the safety and activity of iberdomide plus low-dose cyclophosphamide and dexamethasone (IberCd) in patients with relapsed and refractory multiple myeloma.METHODS: The ICON study is a prospective, single-arm, phase 2, open-label study conducted in eight hospitals in the Netherlands. We enrolled patients (aged ≥18 years) with relapsed and refractory multiple myeloma (lenalidomide-refractory) who had received two to four previous lines of therapy and had a WHO performance status of 0-2. Patients were treated with oral iberdomide (1·6 mg/day on days 1-21 of each 28-day cycle), oral low-dose cyclophosphamide (50 mg/day on days 1-28), and oral dexamethasone (40 mg [20 mg in patients age >75 years] once a week) until progression. All patients received thrombosis prophylaxis daily: 80 mg oral aspirin or 100 mg oral carbasalate calcium. Patients with a previous history of venous thromboembolism received only low molecular-weight heparin by subcutaneous injection. The primary endpoint was progression-free survival, defined as time from the start of treatment to the date of progression or death. Activity and safety were assessed in all patients who started treatment. This trial was registered at ClinicalTrials.gov (NCT04392037) and is ongoing.FINDINGS: Between Feb 17, 2021, and July 7, 2023, 61 patients were enrolled and received IberCd treatment (29 [48%] were female and 32 [52%] patients were male). The median number of previous lines of therapy was 3 (range 2-5); 52 (85%) patients were triple-class exposed and 27 (44%) had triple-class refractory disease. 50 patients discontinued study treatment, 39 of whom due to progressive disease, but all 61 patients were included in the main analysis population. After a median follow-up of 25·4 months (IQR 19·7-31·6), the median progression-free survival was 17·6 months (one-sided 95% CI 16·6-19·9). In all 61 patients, the most common grade 3-4 adverse events were neutropenia (34 [56%] patients) and infections (21 [34%] patients). Treatment-related serious adverse events were reported in 25 (41%) patients, with infections being the most common (34 [71%] of 48 serious adverse events). Treatment-related death occurred in one (2%) patient due to COVID-19.INTERPRETATION: IberCd is an all-oral and active combination for patients with relapsed and refractory multiple myeloma that showed clinically meaningful activity. This regimen offers a valuable treatment option for patients who have received two to four previous lines of therapy and compares favourably with other available treatments.FUNDING: Bristol Myers Squibb.</p