Economic evaluation of hormonal therapies for postmenopausal women with estrogen receptor–positive early breast cancer in Canada

Background

Aromatase inhibitor (ai) therapy has been subjected to numerous cost-effectiveness analyses. However, with most ais having reached the end of patent protection and with maturation of the clinical trials data, a re-analysis of ai cost-effectiveness and a consideration of ai use as part of sequential therapy is desirable. Our objective was to assess the cost-effectiveness of the 5-year upfront and sequential tamoxifen (tam) and ai hormonal strategies currently used for treating patients with estrogen receptor (er)–positive early breast cancer.

Methods

The cost-effectiveness analysis used a Markov model that took a Canadian health system perspective with a lifetime time horizon. The base case involved 65-year-old women with er-positive early breast cancer. Probabilistic sensitivity analyses were used to incorporate parameter uncertainties. An expected-value-of-perfect-information test was performed to identify future research directions. Outcomes were quality-adjusted life-years (qalys) and costs.

Results

The sequential tam–ai strategy was less costly than the other strategies, but less effective than upfront ai and more effective than upfront tam. Upfront ai was more effective and less costly than upfront tam because of less breast cancer recurrence and differences in adverse events. In an exploratory analysis that included a sequential ai–tam strategy, ai–tam dominated based on small numerical differences unlikely to be clinically significant; that strategy was thus not used in the base-case analysis.

Conclusions

In postmenopausal women with er-positive early breast cancer, strategies using ais appear to provide more benefit than strategies using tam alone. Among the ai-containing strategies, sequential strategies using tam and an ai appear to provide benefits similar to those provided by upfront ai, but at a lower cost.     

Multiple Myeloma and Atopic Eczema in an Adult

Multiple myeloma is the fourteenth cause of cancer-related death. The symptoms of myeloma are mostly nonspecific, and there is significant delay between the first symptoms and diagnosis of myeloma. Atopic eczema is a common chronic inflammatory skin disease associated with dysregulation of the immune system. It generally develops in early childhood but can also occur in adults. Eczema is associated with a variety of hematological and solid malignancies, and possibly multiple myeloma. We report a patient with eczema that developed 5 years before the diagnosis of multiple myeloma but was mistaken for psoriasis.Key Words: Multiple myeloma, Atopic eczema, Early symptoms, Diagnostic criteria     

Collagenous matrix supported by a 3D-printed scaffold for osteogenic differentiation of dental pulp cells

Objective

A systematic characterization of hybrid scaffolds, fabricated based on combinatorial additive manufacturing technique and freeze-drying method, is presented as a new platform for osteoblastic differentiation of dental pulp cells (DPCs).

Paving the way towards green catalytic materials for green fuels: impact of chemical species on Mo-based catalysts for hydrodeoxygenation

A series of Mo-based catalysts were synthesized by tuning the sulfidation temperature to produce mixtures of MoO₃ and MoS₂ as active phases for the hydrodeoxygenation (HDO) of palmitic acid. Differences in the oxidation states of Mo, and the chemical species present in the catalytic materials were determined by spectroscopic techniques. Palmitic acid was used as a fatty-acid model compound to test the performance of these catalysts. The catalytic performance was related to different chemical species formed within the materials. Sulfidation of these otherwise inactive catalysts significantly increased their performance. The catalytic activity remains optimal between the sulfidation temperatures of 100 °C and 200 °C, whereas the most active catalyst was obtained at 200 °C. The catalytic performance decreased significantly at 400 °C due to a higher proportion of sulfides formed in the materials. Furthermore, the relative proportion of MoO₃ to MoS₂ is essential to form highly active materials to produce O-free hydrocarbons from biomass feedstock. The transition from MoS₂ to MoO₃ reveals the importance of Mo–S and Mo–O catalytically active species needed for the HDO process and hence for biomass transformation. We conclude that transitioning from MoS₂ to MoO₃ catalysts is a step in the right direction to produce green fuels.

A series of Mo-based catalysts were synthesized by tuning the sulfidation temperature to produce mixtures of MoO₃ and MoS₂ as active phases for the hydrodeoxygenation (HDO) of palmitic acid.     

The effect of a gadolinium-based contrast agent on diffusion tensor imaging

Objective

The aim of this study was to investigate in detail the effect of gadolinium contrast on diffusion tensor imaging scans. As the present literature offers conflicting results, we have included a large selection of indices in the analysis.

Materials and methods

Sixteen patients harboring an intra-axial contrast enhancing brain tumor were included in this study. Two diffusion tensor imaging scans were performed—one natively, and the second following a gadolinium contrast agent application. Maps of the invariant indices fractional anisotropy (FA), linear, planar, and spherical indices, trace, eigenvalues λ₁, λ₂, λ₃ as well as of the components of the diffusion tensor matrix Dxx, Dyy, Dzz, Dxy, Dxz and Dyz were co-registered and compared statistically with matching ROI pairs in the contrast enhancing areas, peritumoral edema and the normal appearing white matter.

Results

We have observed a significant increase in the FA and disproportional decrease of the eigenvalues in the post-contrast scans. In accordance with these findings, the spherical index was decreased and the linear and planar indices were increased. There was a significant decrease of all diagonal components of the diffusion tensor matrix. These changes have been strongest in the contrast enhancing areas, but there were also significant changes in the peritumoral edema and the normal appearing white matter.

Conclusion

Diffusion tensor imaging scans performed after gadolinium contrast agent administration may display artificially increased FA values due to disproportional changes of the measured eigenvalues. The distortion of the diffusion measurement is strongest in, but not limited to the contrasting areas.     

A framework for analysis of brain cine MR sequences

In this paper, we propose a framework to automate the assessment of the movements of a third cerebral ventricle in a cine MR sequence. Indeed, the goal of this assessment is to build an atlas of the movements of the healthy ventricles in the context of the hydrocephalus pathology. This approach is composed of two phases: a contour extraction, using fractional integration and a registration method, based on dynamic evolutionary optimization. The first phase of the framework is based on the fractional integration thresholding, that allows delineating the contours of the area of interest. In order to track over time each point of the primitive and achieve the assessment of the deformation, a matching method, based on a new dynamic optimization algorithm, called Dynamic Covariance Matrix Adaptation Evolution Strategy (D-CMAES), is used. The obtained results for quantification have been clinically validated by an expert and compared to those presented in the literature.     

Intestinal Injury Secondary to an Umbilical Piercing

Background:

Body piercing has become increasingly popular throughout the world and may cause unanticipated complications during surgery.

Methods:

We describe the case of a 35-y-old woman with hepatocellular carcinoma who underwent a diagnostic laparoscopy for metastatic disease evaluation.

Results:

An early intestinal injury occurred upon abdominal entry and introduction of pneumoperitoneum. The injury was secondary to a single adhesion between the abdominal wall and small bowel caused by a previous umbilical piercing.

Conclusions:

Umbilical piercing can lead to unanticipated intraoperative complications even if it is removed prior to surgery. Surgeons performing laparoscopy should be aware of potential pitfalls associated with these art forms.