Antiviral therapy improves overall survival in hepatitis C virus‐infected patients who develop diffuse large B‐cell lymphoma

Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non‐Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV‐infected patients with diffuse large B‐cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT's impact on oncologic outcomes of HCV‐infected patients (cases) who developed DLBCL. Cases seen at our institution (June 2004–May 2014) were matched with uninfected counterparts (controls) and then divided according to prior AVT consisting of interferon‐based regimens. We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% vs. 72%; p = 0.07) and upper gastrointestinal (GI; 42% vs. 24%; p = 0.004) involvement. Cases never given AVT had DLBCL more refractory to first‐line chemotherapy than that in the controls (33% vs. 17%; p = 0.05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% vs. 32%; p = 0.09) or cases given AVT (50% vs. 27%; p = 0.06). Cases never given AVT had worse 5‐year overall survival (OS) rates than did the controls (HR, 2.3 [95% CI, 1.01–5.3]; p = 0.04). Furthermore, AVT improved 5‐year OS rates among cases in both univariate (median [Interquartile range]: 39 [26–56] vs. 16 [6–41] months, p = 0.02) and multivariate analyses (HR = 0.21 [95% CI, 0.06–0.69]; p = 0.01). This study highlights the negative impact of chronic HCV on survival of DLBCL patients and shows that treatment of HCV infection is associated with a better cancer response to chemotherapy and improves 5‐year OS.     

Phase II results of an intraocular steroid delivery system for cataract surgery.

OBJECTIVE: To evaluate the safety and efficacy of an intraocular biodegradable polymer dexamethasone drug delivery system (DEX DDS) in treating postoperative inflammation after cataract surgery. STUDY DESIGN: Multicenter, randomized, double-masked, parallel group study comparing two dose levels of the DEX DDS to concurrent placebo and no treatment control subjects. PARTICIPANTS: Ninety patients scheduled to undergo extracapsular cataract extraction with phacoemulsification and intraocular lens implantation participated in the study. INTERVENTION: One or two DEX DDSs, each containing 60 microg of dexamethasone, were placed in the posterior chamber after cataract surgery. Patients receiving the placebo received a DDS composed of the same matrix with no active drug. In vivo rabbit studies have determined that the DEX DDS releases dexamethasone into the anterior chamber (AC) for approximately 7 to 10 days. MAIN OUTCOME MEASURES: The AC cells and the AC flare were assessed over a 60-day postoperative period using slit-lamp examination by masked observers. The number and percent of patients in each treatment group requiring additional postoperative topical anti-inflammatory medication were compared. RESULTS: Ninety patients were randomized into 4 treatment groups (30 to the 2 DEX DDS group, 30 to the 1 DEX DDS group, 15 to the placebo DDS group, and 15 to the no treatment group). The control patients required the addition of topical steroids as rescue medication more frequently and sooner than patients receiving DEX DDS (80% vs. 7% at week 2) (P < 0.001). Patients receiving DEX DDS showed a significant reduction in postoperative inflammation as assessed by the combined AC cell and flare scores when compared to the control group from day 3 (P = 0.002) through week 3. The DEX DDS was well tolerated. No clinically significant difference in any safety evaluations, including intraocular pressure, was seen between the DEX DDS-treated and control groups. CONCLUSION: The DEX DDS was safe and effective in suppressing postoperative inflammation after uncomplicated cataract surgery. Additional topical anti-inflammatory drops were not needed for most patients.     

Preparation and characterization of technetium and rhenium tricarbonyl complexes bearing the 4-nitrobenzyl moiety as potential bioreductive diagnostic radiopharmaceuticals. In vitro and in vivo studies

The synthesis of a ligand containing a nitrobenzyl group as bioreductive pharmacophore and the preparation of the corresponding technetium and rhenium complexes are presented. (99m)Tc labelling was performed in high yield (>90%) by ligand substitution using fac-[(99m)Tc(CO)(3)(H(2)O)(3)](+) as precursor. The structure of the technetium complex was established by chromatographic comparison with the analogous rhenium compound which was fully characterized by elemental analysis, spectroscopic methods and X-ray crystallography. Reduction potential of the rhenium complex was in the characteristic range for bioreductive compounds. Biodistribution in normal mice was characterized by fast blood and soft tissue depuration and combined excretion via the hepatobiliary and urinary systems. Tumour uptake was low, probably due to low lipophilicity but tumour/muscle ratios were favourable as a consequence of high excretion.     

Prevalence of chronic diseases and morbidity in primary health care in central Greece: An epidemiological study

Background  

In Greece there is lack of large epidemiological studies regarding morbidity and mortality in primary health care. The aim of the present study was to estimate the prevalence and morbidity of the most common diseases in a large population sample from primary health care.     

Acculturation and dental health among Vietnamese living in Melbourne, Australia

OBJECTIVES: To describe the relationship between acculturation and oral health status, oral health knowledge and frequency of dental visits in subjects of Vietnamese background, 18 years or older, living in Melbourne, Australia. METHODS: Oral health status was measured using the DMFS index. Oral health knowledge was estimated by responses to six specific oral preventive measures: brushing, flossing, use of fluorides, diet, and dental visits. Dental visits was measured by the number of visits in the 12 months prior to the survey. Acculturation was measured along two dimensions, psychological and behavioural, using the Psychological-Behavioural Acculturation Scale. Data were analysed using multivariate analysis to identify the combined effect of eight predictors (age, gender, occupational status, education, reason for migration, proportion of life in the host country, behavioural acculturation and psychological acculturation) against the dependent variables. RESULTS: The analysis was conducted on a sample of 147 subjects and showed significant interactions between the acculturation variables and three outcome measures: dental caries, knowledge of preventive measures and dental visits. Results indicated that acculturation was an important intervening variable. Psychological acculturation was strongly related to the three oral health outcomes, although the effect of behavioural acculturation was also apparent regarding dental status. CONCLUSIONS: This study offers several insights for understanding the mechanisms by which acculturation impacts oral health status. Interventions that simplify the cultural influence of immigrant groups by focusing on socio-demographic differences and even immigration variables to define risk groups might not produce predicted changes in oral health status.     

Magnetic resonance imaging of autologous chondrocyte implantation

There is now over 10 years experience with autologous chondrocyte implantation (ACI) for the management of full-thickness chondral injuries in the knee. This article briefly reviews the surgical procedure, the time lines of graft maturation, and patient rehabilitation in the context of postoperative magnetic resonance imaging (MRI) assessment. The normal and abnormal appearances of ACI repair cartilage on MR images are described, with an emphasis on the MR appearances of the complications that may occur after this procedure, and the usefulness of MR imaging for the surgeon.