One of the main reasons is the older age of the expectant mother. When their first child is born, women today are on average only a few years older than their mothers and grandmothers were. Overall, however, the reproductive phase is extending further and further back, so that the majority of children are now born to women over 30. However, with age, the risk of developing cancer also increases. Consequently, cancer is increasingly being diagnosed in pregnant women as well. Tendency increasing.

Even if it sounds unlikely, chemotherapy for pregnant women is possible – and not necessarily harmful to the unborn child. At least that is what the experience of doctors around the world proves over the past decades. One of the pioneers was the mexican doctor agustin aviles, who in 1973 treated a pregnant patient with acute leukemia for the first time. She was the first of 84 women aviles treated with chemotherapy over the next three decades, 58 of them in the first trimester of pregnancy, the critical period when all organs are formed in the fetus. All of the children survived, only 5.8 percent had malformations, the fewest of which were severe (the rate is within the usual range). The first patient also survived and gave birth to a healthy daughter, who today has six children of her own.

In the past, women were forced to terminate their pregnancies

Other studies have found a malformation rate of 14 to 19 percent, although there is only limited comparability between the studies. The number of cases is generally small, monitoring is patchy and the parameters vary widely. Many drugs are no longer used, and it is unclear whether chemotherapy or the original cancer or both are responsible for the malformation. In addition, extreme stress of the mother can also lead to severe malformations in the child. In any case, aviles has done further research and, after analyzing more than a thousand case histories, sees no reason to forego chemotherapy in the first trimester of pregnancy.

Around 1940, pregnant women with breast cancer were considered untreatable. As a rule, they were advised to terminate the pregnancy prematurely. They had to choose between themselves and their baby. However, a norwegian study from 2007 shows that the survival rate of women with cancer is independent of whether they are pregnant or not (the treatment success of more than 45 women was compared).0000 female cancer patients treated between 1967 and 2004). And two small studies suggest that a pregnancy carried to term increases the chances of survival.

Cancer in pregnancy has not been a focus of research to date

Obstetric medicine has adapted to the older age of the mother. For example, the older the mother, the higher the probability that her child will have a malformation. Every mother over 35 is aware of this, because she is automatically considered to be at risk and is therefore referred to a pranatal specialist as a precautionary measure, so that he or she can record the nuchal translucency and other parameters of the unborn child at the end of the first trimester of pregnancy. In addition, numerous other preventive examinations are available and customary in germany in order to assess the health of the unborn child in every respect.

While pranatal diagnostics is currently experiencing an upswing, cancer in pregnancy has not been a focus of research to date. Many doctors who diagnose cancer in a pregnant woman are correspondingly perplexed. If they discover it at all. Breast cancer, for example, is detected two to 15 months later in pregnant women than in non-pregnant women. A major reason is pregnancy-related changes in the breast.

Why breast cancer is often discovered late in pregnant women

Many women first suspect that they are pregnant when their breasts suddenly become unusually hard, firm and sensitive to pain. Even before the belly increases in size, they need to buy a new bust holder with coarser baskets. Although the baby will not be born until months later, the female breast is already converted to milk production in the first month of pregnancy. However, the flood of hormones, which sometimes results in sensational bust sizes, can have fatal consequences: if a woman develops breast cancer at this time of all times, the tumor will grow rapidly. At the same time, the mother’s immune system is more tolerant, otherwise it would reject the fetus, which is actually a genetic foreign body – comparable to a transplant.

However, the swelling milk glands make palpation difficult, and imaging techniques such as mammography provide only unreliable images during pregnancy: both cancerous tumors and the abundant milk glands appear as female spots. Deshalb werden viele der bosartigen geschwure erst spat entdeckt. The findings are correspondingly worse: the risk of breast cancer already being in an advanced stage is two and a half times higher in pregnant women than in non-pregnant women.

Women are particularly at risk in the first two years after pregnancy

Once the diagnosis has been made, a race against time begins, because with many types of cancer, every day counts. Depending on the severity of the cancer, pregnant breast cancer patients may need to have their breasts removed. But even if the breast can be preserved, breastfeeding is strictly prohibited if chemotherapy is continued. For some women, treatment with cytostatic drugs is only the beginning of an extensive cancer therapy. For example, radiation treatments are common only after childbirth.

Even after pregnancy, the danger is not over: studies show that pregnancy in principle minimizes the risk of developing breast cancer in the future. However, this does not apply to the first two to ten years after birth, because the risk is increased during this period. Women are most at risk in the two years after pregnancy: if they get breast cancer at this time, the mortality rate is doubled.

Doctors estimate an average of one cancer case per 1000 pregnancies. Detection is difficult because there is no national or international cancer registry. More precise figures can only be expected in the future. In germany there are currently about 700.000 pregnancies per year, that is, about 700 pregnant women who develop cancer. The most common forms include breast cancer, cervical cancer, hodgkin’s lymphoma, ovarian cancer, melanoma, colorectal cancer and leukemia.

Folic acid for all

For comparison: in an average of 1.5 out of 1000 pregnancies, the child suffers from a neural tube defect or so-called "open hernia". To minimize the risk of this often fatal malformation in the child, it is recommended that all pregnant women and women who wish to have children take folic acid regularly, especially in the first weeks of pregnancy. In fact, the neural tube closes already in the first four weeks of pregnancy, at a time when most women do not even know that they are pregnant (especially since the first two weeks of pregnancy exist only purely mathematically: officially, a pregnancy begins on the first day of the last bleeding, but ovulation and conception usually occur only in the second week of pregnancy). In the usa and canada, flour has been fortified with folic acid for ten years. In germany, too, there are plans to fortify flour with folic acid as standard in order to reach all pregnant women. Compared to this, efforts to detect cancer in pregnant women are close to zero. Although the risk is as high as 1 in 1000.

Centers of excellence and new long-term studies

A decisive step towards better care for pregnant women diagnosed with cancer was the establishment of a competence center in berlin at the end of 2007. The german center for neoplasia and pregnancy (nuss) is located in the obstetrics department of the charite, but works across disciplines. The staff coordinates the therapy and monitors mother and child during pregnancy, but the cancer therapy itself takes place in the individual disciplines. If there are acute problems and, for example, the birth has to be induced prematurely, the obstetrics department takes over. Contact with the mothers is maintained even after delivery. Since the nuss was founded, there have been numerous inquiries from patients, relatives and doctors from all over germany.

Overall, however, the treatment of pregnant women with cancer is still in its infancy. In the usa and canada, new, large-scale, long-term studies are expected to provide insights into the effects of chemotherapy during pregnancy on the child. There are also tentative attempts to further develop chemotherapy in pregnant women. At prestigious cancer hospitals such as memorial sloan-kettering cancer center and dana-farber cancer institute, for example, some pregnant women are now treated with cytostatic drugs every two weeks, as are non-pregnant patients, rather than only every three weeks. Pregnant cancer patients have one tiny advantage: they do not suffer from severe nausea, as is common and feared with chemotherapy.

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The apache software foundation (asf) releases apache hudi from the incubator calls the tool for managing data lakes to the top-level project.

Developers who manage analytical records quickly on the hadoop distributed file system (hdfs) – or in cloud stores, with apache hudi, get a tool to help with the managing data lakes in the gross range of petabytes. Hudi supports companies while writing and reading rough quantities of raw data for stream processing. Dafur sets the storage management on distributed file systems (dfs) such as hdfs (hadoop distributed file system) or compatible cloud stores.

A backlack on the beginning

The short hudi, spoken hoodie, stands for hadoop upserts deletes and incrementals. Uber has developed the project in 2016 and laid the code opened in 2017. The open source project started in january 2019 in the preservation phase in the apache incubator of the asf. Meanwhile, there are also companies such as the alibaba group, emis health, linknovate, tathastu.Ai, and tencent on apache hudi. A list of other companies can be found on the website for apache hudi. As part of amazon elastic mapreduce (emr) it is also supported by the amazon web services.

Further information about apache hudi can be found on the official website of the project. The apache software foundation also has a contribution to the commands of the project on top level level – interested can be informed about the apache blog.

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A car that is ten years on the market? In times of increasing development cycles is already worth a comment. However, we speak of the maserati gt from the emilia-romagna, where the watches go different anyway. After the maserati levante for the mass taste it is now called: back to the roots. "That’s a classic gt," says maserati. The italians look so confident that contradiction seems unthawl.

But that’s exactly considered that is a trimming of the facts. Because maserati granturismo was presented in 2007, is conceptually at least 14 years old. If you look closely, it falls up. The 4.92 meter long granturismo weighs 1873 kilograms. Intelligent lightweight construction? Material mix? There was something?

What is the neumodic stuff, the many visual carbon in the interior makes already a wonderful bella figura, says anywhere maserati fan, still a double espresso and looks full of affection on the long bonnet of the gt. The design is slightly refreshed, with the narrow led bi-xenon slots modern, adapted to the current maserati design language without negating the classic lines.

With new infotainment

Assistance systems? Totwinkelwarner? Spacer? Does not need a human, the lover replies in a tone as if he wanted to say, "are a german pedant". The gt has now a jerk camera (which is really helpful!) and a new infotainment system, which is now also apple carplay and android car. Instead of a mouse coinus, there is now an 8.4-inch tabletal touchscreen, with which the operation goes without gross complication by the hand, at least with the car standing.

In the cockpit are the numerous carbonized plastic parts in contrast to bright red-colored leather. That’s just a statement like the whole car. Who drives this maserati, a little around automobile conventions, and around the entire spab refusers in their health raffles anyway. If stort please, that the two steering wheel levers are hidden behind huge switch paddle?

Summit of anachronism

The engine is the summit of anachronism. Under the bonnet with the two coarse nurses a archaic 4.7 liter v8 sucker with 338 kw / 460 hp. Downsizing? Turbo? Hybrid? Now our imaginar conversation partner does not taste the heating potion anymore.

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Colonel court in warsaw. Image: darwinek / cc by-sa-3.0

Can the ruling party "law and justice" grant the choice obviously? The polish opposition will escape this with respect to the seats of the senate

"The protest, which the pis raises, and the demand to repay the voices again, can lead to an attempt to change the election result", said grzegorz schetyna, boss of the conservative-liberal party bond "state burger coalition" (ko), on wednesday in strabburg in front of the council of europe.

The national conservatives, the on 13.10 had won the parliamentary elections for the second time (right and left-hand prere), lost their majority in the second chamber, in the senate. There they only place 48 out of 100 deputies. The pis has requested this week, in six constituencies in which their candidates had lost the voices again. There were striking many non-trusted votes. Schetyna calls on the osce, the council of europe and the venice commission on a possible monitoring of voting. The oppositions of the opposition had also set on the other, in three election circles for the senate to repeat the choice for allegedly formal errors.

Michal laskowski, the speaker of the supreme court in warsaw, criticized the codes of pis on wednesday as "too little concrete". On the other hand, an international observation is not provided.

The onset of the superest court of first trainers will decide on the application – an institution that was founded by the pis and whose government-related lawyers have been nominated by the government council, which also consists of government-related lawyers. After schetyna was not really "fair" procedure possible. An urge of the election result by means of a governmental chamber is considered a terror scenario, before the government opponent had warned in poland.

Since autumn 2015, the pis is under the tactically savvy jaroslav kaczynski through its controversial justice reform in international criticism; the eu commission has begun several legality procedures against poland. Kaczynski plans another amendment for the coming government period, by means of which he wants to reform several dishes, including the court of appeal, again party-proof judges were losing their office.

The second chamber in poland, the senate, has no gross power of power formally. However, the senate can be proposed by the sejm proposed laws and to further discuss the sejm for further discussion. Thus, the majority of members of the chamber can stimulate a public debate and slow down the progress of judicial reform.

After polish law, there are two possibilities of voice payment – the supreme court commissions a regional court in the corresponding constituency or the ballots are transported to warsaw and disbursed under supervision of three judges of the supreme court. In the latter case it would be interesting who these are three judges. The supreme court is not completely controlled by the pis, according to a judgment of the european court of justice, forced persons had to be made in autumn 2018, including the chairman of the court, malgorzota gersdorf. The opposition hopes here on the influence of the judge, which occurred as a critic of judicial reform, but it can not act formally in this process.

The pis first tried to draw some senators of the opposition to their side, one even got the ministry of health offered. The government-critical media speak of bribery offers. Michal dworcyk, the chief of the law firm of prime minister mateusz morawieci, has assisted on television that "currently some talking."

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