Thalidomide, dexamethasone, and pegylated liposomal doxorubicin (ThaDD) for patients older than 65 years with newly diagnosed multiple myeloma

We present the results of a phase 2 study using thalidomide, dexamethasone, and pegylated liposomal doxorubicin (ThaDD) in the treatment of 50 patients older than 65 years with newly diagnosed multiple myeloma. Thalidomide 100 mg was administered orally at bedtime continuously, dexamethasone 40 mg was administered orally on days 1 to 4 and 9 to 12, and pegylated liposomal doxorubicin 40 mg/m2 was administered intravenously on day 1 over the 28-day cycle. Response was assessed according to the EBMT criteria. Seventeen (34%) patients achieved CR, 7 (14%) nCR, 5 (10%) VGPR, 15 (30%) PR, and 5 (10%) MR, resulting in an ORR of 98%. Only 1 patient (2%) presented progressive disease. Time to progression (TTP), event-free survival (EFS), and overall survival (OS) projected at 3 years were 60%, 57%, and 74%, respectively, and these parameters were significantly higher in those patients achieving a response of at least VGPR versus those who did not. Grade 3 and 4 nonhematologic adverse events were constipation (10%), fatigue (6%), tremors (4%), mucositis (4%), and palmar-plantar erythrodysesthesia (2%). Grade 3 and 4 neutropenia occurred in 12% of patients. Grade 3 and 4 infections and thromboembolic accidents were observed in 22% and 14% of patients, respectively. In the treatment of elderly patients with newly diagnosed multiple myeloma, ThaDD is a very effective regimen with manageable toxicity.     

Stapled Endorectal Mucosectomy for High Extrasphincteric Fistula-in-Ano: Preliminary Report

Purpose There is no optimum surgical method of repair for high extrasphincteric fistula-in-ano. We describe a relatively simple procedure for surgery of extrasphincteric fistula, which entirely preserves the anal sphincter, does not interfere with anal function, and does not preclude the possibility of further surgery, if necessary. Methods Five patients have been treated for high extrasphincteric fistula with a stapled endorectal flap by using a circular hemorrhoidal stapler gun. The procedure involved two 180° pursestrings placed above the dentate line and 3 cm apart, proximal and distal to the internal opening. On firing, the result was the excision of a 180° rectal flap, containing the internal ostium, and including rectal mucosa and submucosa. Results No perioperative complications were encountered. There was some temporary difficulty in controlling flatus and/or defecatory urgency in two patients, which spontaneously reversed with no treatment within the first two postoperative months. The mean Cleveland Clinic Score of Incontinence did not vary significantly after surgery. Overall anal manometry did not register any significant differences between preoperative and postoperative values. With up to 26 months of follow-up, none of the fistulas recurred. Conclusions These preliminary promising results suggest that the stapled endorectal flap could have a role in the management of high extrasphincteric fistula-in-ano. An erratum to this article is available at .     

Relative and disease-free survival for breast cancer in relation to subtype: a population-based study

Purpose

No population-based study has investigated breast cancer (BC) subtypes defined by including Ki67. The aim of this study was to evaluate the relative proportions of immunohistochemical subtypes and differences in relative and disease-free survival between subtypes, in relation to patient and other cancer characteristics in Italian BC patient.

Methods

Information on estrogen, progesterone, human epidermal growth factor (HER2), Ki67, and relapses was obtained for 3,381 cases, sampled randomly and anonymously from cases diagnosed in 2003–2005 in nine Italian cancer registries. Relative excess risks (RERs) of death and risks of relapse 5 years after diagnosis were estimated.

Results

Luminal A cancers were 42 % of the total, luminal B 27 %, luminal-HER2 14 %, triple-negative 11 %, and HER2-enriched 7 %. For non-metastatic (3,302) cases, 4 and 7 % developed locoregional and distant metastases, respectively. RERs of death and risks of relapse were significantly greater for all cancer subtypes than luminal A, particularly for triple-negative and HER2-enriched cancers, which were more frequent in women <40 years.

Conclusions

Our population-based findings confirm that subtype is an independent prognostic factor for BC. Triple-negative and HER2-enriched subtypes would benefit from the development and wide application, respectively, of targeted treatments, which would also improve survival for younger patients.     

Responsabilidad social corporativa en los centros de la red hospitalaria de utilización pública de Cataluña

The adoption of a management approach that integrates corporate social responsibility in organizations is an increasing trend that responds to the demands of society related to sustainability, ethics and transparency. Health organizations are adopting corporate social responsibility asymmetrically, which raises the analysis of the implementation models and the developed initiatives. Through qualitative research, with four in-depth case studies of the Catalan health sector, this article analyzes the need to address this new approach and to identify good practices and the challenges for its implementation.     

The relationship between stress and relaxation in calf pericardium used in the construction of cardiac bioprostheses

Assessment of relaxation (loss of load within a given time) without apparent deformation is a necessary step before durability assay of biomaterials. From results obtained using calf pericardium, the following conclusions were drawn: (a) there is no limit to relaxation for this biomaterials; (b) the lesser the load applied, the greater the relaxation; and (c) the relaxation curve follows the logarithmic function y = K1 - K2 - Int. These findings demonstrate the poor behaviour of the biomaterial at supposedly low loads and suggest that rupture-point load is not a reliable reference to determine the safety coefficient of calf pericardium used in cardiac bioprostheses.     

Recommendations for the use of sensor‐augmented pumps with predictive low‐glucose suspend features in children: The importance of education

Abstract: Sensor‐augmented pumps, which consist of a pump and a continuous glucose monitoring system, offer considerable therapeutic opportunities, despite requiring close attention in the early phase of their use. The aim of this paper is to provide recommendations on the use of a predictive low glucose management (PLGM) system (Minimed 640G?, Medtronic, Northridge, CA, USA) in adolescents with type 1 diabetes either at the start of therapy or during follow‐up. Sound clinical recommendations on PLGM are of increasing importance since several recent papers have reported significant clinical improvements in patients with PLGM, especially in adults. These recommendations are based on the experience of a group of pediatric endocrinologists who collaborated to closely and intensively study the on‐boarding of adolescent patients with type 1 diabetes on automated systems to gain first‐hand experience and peer‐to‐peer insights in a unique free‐living environment. The suggestions provided here are indicative, so can be adapted to the individual realities and experiences of different diabetes centers. However, we believe that close adherence to the proposed scheme is likely to increase the chances of improving the clinical and metabolic outcomes of patients treated with this therapy.     

Utility of omentoplasty for poststernotomy mediastinitis secondary to myocardial revascularization surgery

Acute poststernotomy mediastinitis is a serious complication of cardiac surgery and is associated with high mortality. Conservative treatment with local debridement, irrigating-suction systems, and specific antibiotic therapy is sometimes inadequate. Omentoplasty is occasionally used for reconstruction and the treatment of various chest diseases. This useful procedure is most often indicated for suppurative processes and radionecrosis, to complement myoplasty, or to cover a chest wall prosthesis. When used to treat poststernotomy mediastinitis secondary to cardiac surgery, omentoplasty improves control of infection and prognosis. We describe 2 cases of poststernotomy mediastinitis secondary to cardiac revascularization surgery in which omentoplasty was an effective treatment. Excellent control of infection was achieved.     

Upper molar morphology,homologies and evolutionary patterns of chinchilloid rodents (Mammalia,Caviomorpha)

Chinchilloidea are a clade of caviomorph rodents that includes seven living species, the Dinomyidae Dinomys branickii, the Chinchillidae Lagostomus maximus, two species of Chinchilla and three species of Lagidium. In addition, two extinct families are traditionally considered chinchilloids – Neoepiblemidae and Cephalomyidae. The phylogeny of the Chinchilloidea has so far not been well established and is based on partial analyses. Studying the anatomy and ontogeny of extinct and extant taxa, we propose homologies for the upper molars of Chinchilloidea for which these homologies have not been previously proposed: that is the Chinchillidae Prolagostomus, Lagostomus, Lagidium and Chinchilla, and the Neoepiblemidae Neoepiblema and Phoberomys. We identify patterns of occlusal simplification within Chinchilloidea and evaluate its importance in an evolutionary context. A phylogenetic analysis recovered Dinomyidae, Chinchillidae and Neoepiblemidae as clades. ‘Cephalomyidae’ have not been not recovered as a monophyletic group and ‘cephalomyids’ are closely related to Neoepiblemidae. Branisamys is not included within the Dinomyidae and appears to be a basal chinchilloid.