Phase II study of eribulin mesylate (E7389) in patients with metastatic castration-resistant prostate cancer stratified by prior taxane therapy

BackgroundTreatment options remain limited for patients with castration-resistant prostate cancer (CRPC). We evaluated eribulin mesylate (E7389), a nontaxane halichondrin B analog microtubule inhibitor, in patients with metastatic CRPC with or without previous taxane exposure.Patients and methodsMen with histologically proven CRPC, with or without prior taxane exposure, were enrolled in an open-label, single-arm phase II trial. Patients received eribulin mesylate 1.4 mg/m² as a 2- to 5-min i.v. bolus infusion on days 1 and 8 of a 21-day cycle. The primary efficacy end point was prostate-specific antigen (PSA) response rate.ResultsIn total, 108 patients were assessable for safety (50 were taxane-pretreated) and 105 for efficacy in the per-protocol population. The median age of patients was 71 years and median number of cycles was 4. PSA decreases of ≥50% were achieved in 22.4% and 8.5% of taxane-naive and taxane-pretreated patients, respectively. The most common grade 3/4 adverse event was neutropenia, seen in 22.4% of chemo-naive and 40% of taxane-pretreated men. Grade 3 peripheral neuropathy occurred in none of the taxane-naive patients and 6.0% of taxane-pretreated patients.ConclusionEribulin mesylate demonstrated activity and a relatively favorable toxicity profile in metastatic CRPC.     

Selectivity of photothermolysis in the treatment of port wine stains using multiple pulses with a pulsed dye laser

BackgroundIn 25 % to 50 % of patients with port wine stains treated with pulsed dye laser (even in multiple sessions), only a partial improvement is obtained that is often unsatisfactory for the patient. Various factors have been proposed to explain the resistance to treatment, such as the presence of deep, small-caliber, or very thick vessels that cannot be coagulated with a single laser pulse. Certain mathematical models suggest that multiple pulses would be effective in coagulating those vessels without losing the selectivity of photothermolysis, since more energy could be delivered to the target structures without damaging the surrounding tissue. The aim of this study was to assess the efficacy and selectivity of photothermolysis with multiple laser pulses.MethodsTwelve patients with port wine stains were included in the study. Various areas of each lesion were treated with pulsed dye laser (Candela V-beam, 595 nm) using different parameters. Immediately afterwards, the treated areas were biopsied.ResultsThe risk of exceeding an appropriate dose was greater with small spot size, long pulse duration, short intervals between pulses, and high fluences. Heat damage was less with spots of 10 mm, short pulses, intervals of 1 minute between pulses, and low fluences. In selected cases, multiple pulses were effective and selective where single pulses did not successfully coagulate the vessels.ConclusionsOur results indicate the enormous possibilities of multiple laser pulses for the treatment of refractory vascular lesions. In addition, we have addressed the variables defining the complex thermodynamic interaction between the laser and the cutaneous tissue and indicated the safest parameters. We discuss the possible usefulness of this approach with other lasers and skin diseases.     

Evaluation of productive efficiency in the Unified National Health System hospitals in the State of Santa Catarina, Brazil

This study evaluated the productive efficiency of 112 hospitals under the Unified National Health System (SUS) in the State of Santa Catarina, Brazil. The objective was to verify which hospitals apply the available resources efficiently. The research was based on data from 2003 collected from the SUS Hospital Data System (SIH-SUS). Data Envelopment Analysis (DEA) was applied under the assumption of variable returns to scale. The study focused exclusively on general hospitals with similar characteristics in terms of size and specialization. The results identified 23 efficient hospitals and efficiency targets for each hospital. According to the empirical model, the number of hospitalizations with discharges could be increased by 15%. Application of an input reduction model would result in savings of 25% on human resources (physicians and nurse technicians), 17% on hospital beds, and 13% on admissions costs for the overall hospital system.     

Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome

Purpose

To compare clinical and computed tomography (CT) measures in extension, 20° and 30° of flexion of symptomatic knees of patient with idiopathic patellofemoral pain syndrome with the contra lateral asymptomatic knee.

Materials and methods

Knees of 52 consecutive patients with idiopathic patellofemoral pain were studied with CT. In 28 patients this condition was unilateral and asymptomatic knee was used as control; 76 knees were symptomatic.

Results

In patients with idiopathic patellofemoral pain we found a greater Q angle and internal condylar facet width in symptomatic knees with regard to asymptomatic knees.

Conclusion

Greater Q angle and medial condylar facet can lead to overpressure on the medial knee compartment during maneuvers that increase contact between patella and medial condylar facet, such as knee flexion and squatting, contributing to development of idiopathic patellofemoral pain.