Discordance of retroperitoneal and thoracic histologic findings in patients with metastatic germ cell tumors at postchemotherapy residual tumor resection.

INTRODUCTION AND OBJECTIVES: Postchemotherapy residual tumor resection (PC-RTR) is an important part of the multimodal treatment for patients with metastatic germ cell tumors. Simultaneous retroperitoneal and thoracic metastases often require consecutive surgical procedures. This study analyzes the histologic findings after abdominal and thoracic surgery in order to tailor the sequence and intensity of surgery. PATIENTS AND METHODS: From a total of 671 PC-RTRs from 2008 to 2021 we analyzed 50 patients with stage III non-seminomatous germ cell tumor (NSGCT) who had undergone both retroperitoneal and thoracic postchemotherapy residual tumor resection after first-line and salvage chemotherapy. RESULTS: All patients included had stage III NSGCT. 39 and 11 patients received first-line and salvage chemotherapy, respectively. 45 (90%) patients received retroperitoneal resection first, followed by thoracic surgery. Three patients (6%) underwent thoracic surgery before retroperitoneal surgery and two patients (4%) underwent simultaneous surgery. Overall, the histology of retroperitoneal and thoracic specimens was discordant in 23% of cases. After first-line chemotherapy, of fourteen patients with necrosis in retroperitoneal histology, four patients had vital carcinoma in lung histology. In patients with teratoma in the retroperitoneum, the thoracic findings were concordant in most cases (78%). When teratomatous elements were also present in the orchiectomy specimen, concordance was 100%. After salvage chemotherapy, the discordance rate was 55%. CONCLUSION: The data presented in this study underline that retroperitoneal residual masses with necrosis cannot reliably predict histologic findings of thoracic specimens. Patients with teratoma in the retroperitoneum have a high likelihood of teratoma in the thoracic specimen.

Characterizing the mutational burden, DNA methylation landscape, and proteome of germ cell tumor-related somatic-type malignancies to identify the tissue-of-origin, mechanisms of therapy resistance, and druggable targets.

BACKGROUND: Germ cell tumors (GCT) might undergo transformation into a somatic-type malignancy (STM), resulting in a cell fate switch to tumors usually found in somatic tissues, such as rhabdomyosarcomas or adenocarcinomas. STM is associated with a poor prognosis, but the molecular and epigenetic mechanisms triggering STM are still enigmatic, the tissue-of-origin is under debate and biomarkers are lacking. METHODS: To address these questions, we characterized a unique cohort of STM tissues on mutational, epigenetic and protein level using modern and high-throughput methods like TSO assays, 850k DNA methylation arrays and mass spectrometry. RESULTS AND CONCLUSIONS: For the first time, we show that based on DNA methylation and proteome data carcinoma-related STM more closely resemble yolk-sac tumors, while sarcoma-related STM resemble teratoma. STM harbor mutations in FGF signaling factors (FGF6/23, FGFR1/4) highlighting the corresponding pathway as a therapeutic target. Furthermore, STM utilize signaling pathways, like AKT, FGF, MAPK, and WNT to mediate molecular functions coping with oxidative stress, toxin transport, DNA helicase activity, apoptosis and the cell cycle. Collectively, these data might explain the high therapy resistance of STM. Finally, we identified putative novel biomarkers secreted by STM, like EFEMP1, MIF, and DNA methylation at specific CpG dinucleotides.

Improved N2 Selectivity of MnOx Catalysts for NOx Reduction by Engineering Bridged Mn3+ Sites.

Mn-based catalysts are promising for selective catalytic reduction (SCR) of NOx with NH3 at low temperatures due to their excellent redox capacity. However, the N2 selectivity of Mn-based catalysts is an urgent problem for practical application owing to excessive oxidizability. To solve this issue, we report a Mn-based catalyst using amorphous ZrTiOx as the support (Mn/ZrTi-A) with both excellent low-temperature NOx conversion and N2 selectivity. It is found that the amorphous structure of ZrTiOx modulates the metal-support interaction for anchoring the highly dispersed active MnOx species and constructs a uniquely bridged Mn3+ bonded with the support through oxygen linked to Ti4+ and Zr4+, respectively, which regulates the optimal oxidizability of the MnOx species. As a result, Mn/ZrTi-A is not conducive to the formation of ammonium nitrate that readily decomposes to N2O, thus further increasing N2 selectivity. This work investigates the role of an amorphous support in promoting the N2 selectivity of a manganese-based catalyst and sheds light on the design of efficient low-temperature deNOx catalysts.

Trends and influencing factors of HIV health education receive rate among 0.57 million migrants in China from 2009 to 2017: a national population-based study.

INTRODUCTION: China has implemented Basic Public Health Service (BPHS) in 2009, aiming to improve the health status of the people, and the content of service includes implying health education for residents. As an important group of people, the migrants can easily become main reason for major infectious diseases such as HIV between different provinces, but the effect of receiving health education is still unknown for migrants. Therefore, the health education of China's migrant population has received widespread attention. METHODS: This study used the data of the China Migrants Dynamic Survey (CMDS) from 2009 to 2017, and evaluated the trend of HIV health education acceptance rate of different migrant groups across the country (n = 570,614). Logistic regression model was used to test the influencing factors of HIV health education rate. RESULTS: The study found that the overall HIV health education rate of Chinese migrants decreased from 2009 to 2017, and different types of migrants showed different trends. The proportion of migrants aged 20-35 who receive education fluctuates, and ethnic minorities, western regions, and migrants with high education were more likely to receive HIV health education. CONCLUSION: These findings identify when implementing health education for migrants, we can carry out more education for specific groups to promote the health equity of the migrant population.

Isoamericanin A improves lipopolysaccharide-induced memory impairment in mice through suppression of the nicotinamide adenine dinucleotide phosphateoxidase-dependent nuclear factor kappa B signaling pathway.

Alzheimer's disease (AD) is the most frequent cause of dementia in the elderly. Isoamericanin A (ISOA) is a natural lignan possessing great potential for AD treatment. This study investigated the efficacy of ISOA on memory impairments in the mice intrahippocampal injected with lipopolysaccharide (LPS) and the underlying mechanism. Y-maze and Morris Water Maze data suggested that ISOA (5 and 10 mg/kg) ameliorated short- and long-term memory impairments, and attenuated neuronal loss and lactate dehydrogenase activity. ISOA exerted anti-inflammatory effect demonstrating by the reduction of ionized calcium-binding adapter molecule 1 positive cells and suppression of marker protein and pro-inflammation cytokines expressions induced by LPS. ISOA suppressed the nuclear factor kappa B (NF-κB) signaling pathway by inhibiting IκBα phosphorylation and NF-κB p65 phosphorylation and nuclear translocation. ISOA inhibited superoxide and intracellular reactive oxygen species accumulation by reducing nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation, demonstrating by suppressing NADP+ and NADPH contents, gp91phox expression, and p47phox expression and membrane translocation. These effects were enhanced in combination with NADPH oxidase inhibitor apocynin. The neuroprotective effect of ISOA was further proved in the in vitro models. Overall, our data revealed a novel pharmacological activity of ISOA: ameliorating memory impairment in AD via inhibiting neuroinflammation.

High-carbon expansion or low-carbon intensive and mixed land-use? Recent observations from megacities in developing countries: A case study of Shanghai, China.

Cities have become significant sources of greenhouse gas emissions. Effective land management may be the solution to carbon neutrality targets for megacities with limited land resources. This paper takes Shanghai as a case study to investigate the regional land use dynamics and its impact on carbon emissions following the implementation of land conservation and intensive use policy. During 2010-2020, the land use pattern in Shanghai changed from the previous urban land expansion to a combination of industrial land reduction and woodland expansion. Meanwhile, the area proportion of land-use mixture grids increased from 90.50% to 92.28% with the spatial pattern of mixed types also changing. Furthermore, the notable land-use mixture does not necessarily lead to carbon emission reduction, but it can reduce carbon emission hotspots in industrial agglomerations by promoting the mixed use of industrial land and other land use types. However, megacities cannot achieve carbon balance through land use management alone. Due to the increasing carbon emission density of hybrid industrial land, the joint implementation of a land conservation and intensive use strategy with industrial and energy structure adjustments may be an effective way forward.

Evaluation of the household solid waste mandatory sorting policy in Shanghai: A 1-year public opinion survey.

Sustainable management of household solid waste (HSW) is an essential step in realizing the development of a circular economy (CE). However, for many developing countries, HSW sorting is evolving incrementally, and focusing on the intervention role of policy and the sorting behaviour of residents can help achieve sustainable waste management. This study aims to investigate the main determinants of residents' HSW sorting behaviour and how policy particularly contributes to it. Drawing upon the theory of planned behaviour (TPB) and incorporating experiences, a conceptual framework is tested on a sample of Chinese residents in Shanghai (n = 560, from November to December 2020) using structural equation modelling analysis. The empirical results show that experience and behavioural intention greatly influence HSW sorting behaviour. Moreover, the positive attitude of residents promotes the success of HSW sorting. Subjective norms and perceived behaviour control indirectly affect behavioural intention and behaviour via attitude. The findings of this study provide policymakers with critical factors for the successful implementation of HSW sorting. We also propose policy implications to maintain and improve sorting efficiency from the perspective of residents (education, communication and publicity), neighbourhood committees (degree and efficiency of supervision) and property management companies (good infrastructure, services and processes).

Postchemotherapy Residual Tumor Resection in Patients with Elevated Tumor Markers.

PURPOSE: The oncologic benefit of postchemotherapy (PC) residual tumor resection (RTR) in patients with germ cell tumors and elevated serum tumor markers (STMs) remains unclear. This analysis was performed to better define patients who benefit from surgery in this setting. MATERIALS AND METHODS: Of 575 PC-RTR procedures (July 2008-July 2019) 153 were performed in patients with elevated STMs (human chorionic gonadotropin [HCG] >2.0 mIU/ml, alpha-fetoprotein [AFP] >7.0 µg/l), including 55 after first line and 98 after second or later line chemotherapy. RESULTS: Viable cancer in the resected specimen was significantly more common in the salvage group than in the first line group (48.98% vs 16.36%, p=0.0001988) and was a predictor of survival in both groups. A preoperative serum level of AFP ≥30 µg/l was a significant predictor of viable cancer in the first line and salvage groups (55.56% [p=0.0157] and 66.67% [p=0.0017], respectively). The overall relapse-free survival rate (22.7% and 50%, p=0.00032) and overall survival rate (37.8% and 65%, p=0.0059) were significantly worse in the salvage group than in the first line group. A preoperative serum level of AFP ≥30 µg/l and viable cancer/teratoma found in the histological examination of the RTR specimens were significant predictors of relapse after first line chemotherapy. Serum AFP ≥30 µg/l and HCG ≥20 mIU/ml were significant factors affecting survival in the first line group. CONCLUSIONS: Patients with AFP serum levels >30 µg/l and HCG ≥20 mIU/ml after first line chemotherapy should receive salvage chemotherapy instead of surgery. After second or later line therapy, the prognosis of patients with elevated markers and surgery is poor regardless of the tumor marker levels. However, 38% of these patients are long-term survivors, which justifies PC-RTR in this setting.

Late relapsing germ cell tumors with elevated tumor markers.

PURPOSE: Late relapsing germ cell tumors (LR-GCT) are considered a rare distinct biologic entity as their clinical presentation and response to treatment is different to early recurrences. While serum tumor markers (AFP and ß-HCG) play an important role at the time of first diagnosis to correctly classify prognosis and treatment of germ cell tumors, they may not have the same significance in a late relapse situation. PATIENTS AND METHODS: Thirty-seven patients with LR-GCT with elevated serum tumor markers were identified in our database. Twenty-six patients underwent primary surgical resection of the late relapsing tumor. Eleven patients received salvage chemotherapy and a post-chemotherapy residual tumor resection. Serum tumor markers, histological findings and oncological outcome were analyzed. RESULTS: In the histopathological specimen, viable cancer was found in 20 cases (54%) and teratoma was found in 16 cases (43%). In nine cases (24%), a somatic-type malignant transformation was present. In 19 of 37 patients (51.4%), the late relapse specimen presented a histological type of GCT, which was not present in the primary histology. Twenty-two patients (59.5%) were included in follow-up analysis. Mean and median follow-up time was 62.2 and 53 months, respectively. Seventeen patients (77.3%) suffered a relapse or had progressive disease after LR therapy. Five patients (22.7%) have been relapse-free after LR therapy (mean FU 61.6 months). Ten patients died of disease during follow-up (45.5%) and had a mean time from LR to death of 66.4 months. Eleven patients were alive at last follow-up (mean FU 62.2 months). Relapse and survival rate were similar between patients who received primary resection of LR tumor and patients who received salvage chemotherapy followed by surgery. CONCLUSION: Patients with a late relapsing germ cell tumor and elevated markers have a poor prognosis and a high risk for another relapse independent on primary treatment. The histological type and aggressiveness of a late relapsing tumor cannot be predicted with serum tumor marker levels at the time of diagnosis of LR. In up to 54% of cases, primary histology did not coincide with LR histology. Therefore, we propose primary surgical resection of a late relapsing tumor if a complete resection is feasible in order to gain exact histology and tailor further treatment.

Challenge of rainwater harvesting in Shanghai, China: A public psychological perspective.

Rainwater harvesting systems (RWHs) are vital to alleviate water shortages, especially in arid regions. However, research on the application of RWHs in humid regions is necessary because they may also face the challenges of water supply shortages, urban flooding, runoff pollution, and heat island phenomena. Public acceptance plays a key role in the reuse of water resources. This study takes Shanghai, China, as an example and explores the public intention and motivation to use RWHs in humid regions by adding six psychological factors to the technology acceptance model (TAM). The results indicate that social influence, subjective knowledge, and the technological environment are direct drivers. Other psychological factors influence the intention to use through the moderation of perceived usefulness and attitude. The total effect of social influence, subjective knowledge, and social trust are essential for RWHs implementation. However, the technical environment and perceived risk may be psychological barriers to accepting RWHs. In addition, there is no significant effect of the perceived cost. The findings provide critical insights for policymakers to understand the public's attitudes and intrinsic motivations to address the challenges of rainwater harvesting in a humid region.

Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study.

BACKGROUND: Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China. METHODS: This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records. RESULTS: The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records. CONCLUSION: There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy.

Linking hydraulic geometry, land use, and stream water quality in the Taihu Basin, China.

Understanding the complexity of catchment-scale human activities, natural factors, and stream water quality is particularly important for basin water resources management. Thorough investigations on how multiple environmental factors quantitatively and simultaneously affect water quality are limited. This study employed Spearman's correlation and ridge regression analysis (RRA) to disentangle the hydraulic geometry and land use contributions to water quality variables (WQVs). Nine and six indicators were used to describe the hydraulic geometry and land use characteristics, respectively, in the Taihu Basin. The results revealed significant correlations between the land use, hydraulic geometry, and stream water quality. Built-up land and cropland negatively impacted the stream water quality, while woodland had the opposite trend. The structure and morphological connectivity of the river network were associated with most WQVs. The hydrologic connectivity characteristics strongly influenced ammonia-nitrogen (NH3-N), permanganate index (CODMn), and dissolved oxygen (DO). Six equations that estimated the stream water quality were established through RRA. Human factors impose a greater impact on the stream water quality than natural factors in the Taihu Basin. Our findings provide quantitative insights to mitigate water pollution via reasonable management and control of the river structure and connectivity and land-use patterns.

Novel variants in AP4B1 cause spastic tetraplegia, moderate psychomotor development delay and febrile seizures in a Chinese patient: a case report.

INTRODUCTION: The AP4B1 gene encodes a subunit of adaptor protein complex-4 (AP4), a component of intracellular transportation of proteins which plays important roles in neurons. Bi-allelic mutations in AP4B1 cause autosomal recessive spastic paraplegia-47(SPG47). CASE PRESENTATION: Here we present a Chinese patient with spastic tetraplegia, moderate psychomotor development delay and febrile seizures plus. Brain MRIs showed dilated supratentorial ventricle, thin posterior and splenium part of corpus callosum. The patient had little progress through medical treatments and rehabilitating regimens. Whole exome sequencing identified novel compound heterozygous truncating variants c.1207C > T (p.Gln403*) and c.52_53delAC (p.Cys18Glnfs*7) in AP4B1 gene. Causal mutations in AP4B1 have been reported in 29 individuals from 22 families so far, most of which are homozygous mutations. CONCLUSIONS: Our study enriched the genetic and phenotypic spectrum of SPG47. Early discovery, diagnosis and proper treatment on the conditions generally increase chances of improvement on the quality of life for patients.

Coping with waste: A government-NGO collaborative governance approach in Shanghai.

Complex environmental issues are leading local governments to collaborate with non-governmental organizations (NGOs) in the urban environmental governance sphere. While previous studies have emphasized how the Chinese government engages NGOs in service contracting to meet rising service demands, they have not provided empirical evidence of the outcomes of these collaborations at a local level. Based on a mixed methods research design developed from May 2016 to February 2017 in Shanghai, the impact of Aifen, an environmental NGO, is assessed in the context of municipal solid waste management. A total of 400 questionnaires were completed. 200 questionnaires in 10 communities where Aifen developed its activities and 200 questionnaires in 10 communities where no environmental NGO activities were accomplished. The results show that a local government-NGO collaborative governance approach enhances public participation and respond to state decentralization and rising environmental issues in urban areas.

Mapping Water Vulnerability of the Yangtze River Basin: 1994-2013.

A holistic understanding of the magnitude and long-term trend of water vulnerability is essential for making management decisions in a given river basin. Existing procedures to assess the spatiotemporal dynamic of water vulnerability in complex mega-scale river basins are inadequate; a new method named ensemble hydrologic assessment was proposed in this study, which allows collection of data and knowledge about many aspects of water resources to be synthesized in a useful way for vulnerability assessment. The objective of this study is to illustrate the practical utility of such an integrated approach in examining water vulnerability in the Yangtze River Basin. Overall, the results demonstrated that the ensemble hydrologic assessment model could largely explain the spatiotemporal evolution of water vulnerability. This paper improves understanding of the status and trends of water resources in the Yangtze River Basin.

A Coupled SD and CLUE-S Model for Exploring the Impact of Land Use Change on Ecosystem Service Value: A Case Study in Baoshan District, Shanghai, China.

Most of the cities in developing countries are experiencing rapid urbanization. Land use change driven by urban sprawl, population growth, and intensified socio-economic activities have led to a steep decline of ecosystem service value (ESV) in rapid urbanization areas, and decision-makers often ignore some valuable ecosystem service functions and values in land use planning. In this paper, we attempt to build a modeling framework which integrated System Dynamics model with Conversion of Land Use and its Effects at Small Extent model to simulate the dynamics of ESV of landscape and explore the potential impacts of land use change on ESV. We take Baoshan district of Shanghai as an example which is a fast urbanization area of metropolitan in China. The results of the study indicate that: (1) The integrated methodology can improve the characterization and presentation of the dynamics of ESV, which may give insight into understanding the possible impacts of land use change on ESV and provide information for land use planning. (2) Land use polices can affect the magnitude and location of ESV both directly and indirectly. Land use changes tend to weaken and simplify ecosystem service functions and values of landscape at urban rural fringe where land use change is more intensive. (3) The application of the methodology has proved that the integration of currently existing models within a single modeling framework could be a beneficial exploration, and should be encouraged and enhanced in the future research on the changing dynamics of ESV due to the complexity of ecosystem services and land use system.

Multilevel analysis of a riverscape under rapid urbanization in the Yangtze delta plain, China: 1965-2006.

River networks are the typical hydrological characteristic of the Yangtze delta plain. They have important ecological service functions and a unique landscape, which has been significantly degraded during the past 50 years. Qingpu District in Shanghai has been used as study area to develop an integrated method for riverscape assessment in floodplain areas with a dense river network. This integrated method bridges geomorgraphy, landscape, and regional planning. Indicators of sinuosity, connectivity, and circuitry have been integrated into a three-level framework, including river, intersection, and river network level. Furthermore, this method was integrated by the geographic information system method and stepwise regression to identify the riverscape response to the changes in the use of the land. The spatial and temporal changes of the riverscape and land use were calculated for each grid (3000 m×3000 m) from 1965 to 2006. The results indicated that the riverscape had been significantly degraded during the study period in terms of sinuosity, connectivity, and circuitry reducing. The land use changed significantly with more building areas and less water regions and agricultural land. Additionally, the regression results indicated that several specific land use conversion types had had strong effects on the change in the riverscape structure. Finally, according to the assessing method, we have proposed specific planning and management recommendations based on the pressure-state-response model to protect the riverscape from the impact of rapid urbanization.

A quantitative analysis of municipal solid waste disposal charges in China.

Rapid industrialization and economic development have caused a tremendous increase in municipal solid waste (MSW) generation in China. China began implementing a policy of MSW disposal fees for household waste management at the end of last century. Three charging methods were implemented throughout the country: a fixed disposal fee, a potable water-based disposal fee, and a plastic bag-based disposal fee. To date, there has been little qualitative or quantitative analysis on the effectiveness of this relatively new policy. This paper provides a general overview of MSW fee policy in China, attempts to verify whether the policy is successful in reducing general waste collected, and proposes an improved charging system to address current problems. The paper presents an empirical statistical analysis of policy effectiveness derived from an environmental Kuznets curve (EKC) test on panel data of China. EKC tests on different kinds of MSW charge systems were then examined for individual provinces or cities. A comparison of existing charging systems was conducted using environmental and economic criteria. The results indicate the following: (1) the MSW policies implemented over the study period were effective in the reduction of waste generation, (2) the household waste discharge fee policy did not act as a strong driver in terms of waste prevention and reduction, and (3) the plastic bag-based disposal fee appeared to be performing well according to qualitative and quantitative analysis. Based on current situation of waste discharging management in China, a three-stage transitional charging scheme is proposed and both advantages and drawbacks discussed. Evidence suggests that a transition from a fixed disposal fee to a plastic bag-based disposal fee involving various stakeholders should be the next objective of waste reduction efforts.

Residential preferences for river network improvement: an exploration of choice experiments in Zhujiajiao, Shanghai, China.

River networks have both ecological and social benefits for urban development. However, river networks have suffered extensive destruction as a result of urbanization and industrialization, especially in China. River restoration is a growth business but suffers poor efficiency due to a lack of social understanding. Assessing the benefits of river system restoration and recognizing public preferences are critical for effective river ecosystem restoration and sustainable river management. This study used a choice experiment with a multinomial logit model and a random parameter logit model to assess respondents' cognitive preferences regarding attributes of river networks, and their possible sources of heterogeneity. Results showed that riverfront condition was the attribute most preferred by respondents, while stream morphology was the least preferred. Results also illustrated that the current status of each of three river network attributes was not desirable, and respondents would prefer a river network with a "branch pattern," that is "limpid with no odor," and "accessible with vegetation." Estimated willingness to pay was mainly affected by household monthly income, residential location, and whether respondents had household members engaged in a water protection career. The assessment results can provide guidance and a reference for managers, sponsors, and researchers.

[Neutropenia - when is GCSF support indicated?] / Neutropenie ­ wann ist eine GCSF Unterstützung notwendig?

Many systemic treatments used in genitourinary oncology negatively affect haematopoiesis, thus leading to neutropenia. Neutropenic patients are vulnerable to bacterial, and other infections. Often fever is the only symptom in these patients. Neutropenic fever is a major threat for these patients, as it may lead to life-threatening therapy complications that significantly impair the patient's quality of life, Moreover, it may also worsen the prognosis due to therapy delays or necessary dose modifications. Granulocyte colony stimulating factors (GCSF), which can improve neutrophil granulocyte formation, are used both for supportive treatment in febrile neutropenia and for its prophylaxis. The correct indication for such GCSF support depends on the general risk of febrile neutropenia of the therapy used, as well as on individual patient factors and the treatment intent (palliative vs. curative). Based on the current recommendations both of the German and international guidelines, this article aims to provide an up-to-date and practice-oriented overview of the use of GCSF in uro-oncology.