Etoposide, methylprednisolone, cytarabine and cisplatin successfully cytoreduces resistant myeloma patients and mobilizes them for transplant without adverse effects

Myeloma remains incurable with a median survival of 4 years, but outcome can be improved by the use of high-dose therapy. We used the etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) regimen as second-line therapy in 42 newly diagnosed myeloma patients who had failed vincristine, adriamycin and dexamethasone (VAD)- type therapy (n = 36), responded to first-line treatment but persisted in having significant residual marrow plasmacytosis (n = 5) or failed prior stem cell harvesting (n = 1), with the dual aim of improving disease response and mobilizing peripheral blood stem cells. Fourteen of 21 (67%) patients with no change or progressive disease after VAD responded to ESHAP; seven of 12 (58%) patients with minor response converted to partial response. Marrow plasmacytosis fell from a median of 52% at diagnosis to 23.5% after primary therapy and to15% after ESHAP. ESHAP chemotherapy was well-tolerated. There were 11 admissions due to febrile neutropenia (n = 7), nausea and vomiting (n = 2), pneumonia (n = 1) and perforated bowel (n = 1). Renal function deteriorated in 13 of 42 patients after ESHAP, but none required renal support. ESHAP mobilization was performed in 32 patients of whom 87% achieved a CD34(+) yield >2 x 10(6)/kg. In all, 38 patients proceeded to high-dose therapy. The overall survival for all patients was 62% at 4 years following ESHAP. We conclude that ESHAP has acceptable toxicity and efficient stem cell mobilizing capability, effectively cytoreduced this chemoresistant group of patients, and did not appear to adversely affect transplant outcome.     

Patent hemostasis of radial artery: Comparison of two methods

BACKGROUND Radial artery obstruction is the most common complication of coronary angiography performed via transradial access. Patent hemostasis can significantly reduce the risk of radial artery occlusion. Previous studies utilized sophisticated methods to evaluate radial artery patency. Simplified and easily applicable methods for successful patent hemostasis are currently lacking.AIM To determine which method(pulse oximeter vs the traditional radial artery palpation) is better to achieve patent hemostasis.METHODS This prospective, single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019. Patients less than 18 years old, with a history of radial artery disease, or no palpable artery pulse were excluded from the study. Patients were randomly assigned to two groups. In the first group, radial artery flow was assessed by palpation of the artery during hemostasis(traditional method). In the second group, radial artery patency was estimated with the use of a pulse oximeter. Two different compression devices were used for hemostasis(air chamber and pressure valve). The primary study endpoint was the achievement of successful patent hemostasis.RESULTS The two groups(pulse oximeter vs artery palpation) had no significant differences in age, sex, body mass index, risk factors, or comorbidities except for supraventricular arrhythmias. The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group(82.2% vs 68.1%, P = 0.005). A lower percentage of patients with spasm was recorded in the pulse oximeter group(9.9% vs 19.0%, P = 0.024). The incidence of local complications, edema, bleeding, hematoma, vagotonia, or pain did not differ between the two groups. In the multivariate analysis, the use of a pulse oximeter(OR: 2.35, 95%CI: 1.34-4.13, P = 0.003) and advanced age(OR: 1.04, 95%CI: 1.01-1.07, P = 0.006), were independently associated with an increased probability of successful patent hemostasis. The type of hemostatic device did not affect patent hemostasis(P = 0.450).CONCLUSION Patent hemostasis with the use of pulse oximeter is a simple, efficient, and safe method that is worthy of further investigation. Larger randomized studies are required to consider its clinical implications.     

Gambling involvement and problem gambling correlates among European adolescents: results from the European Network for Addictive Behavior study

Social Psychiatry and Psychiatric Epidemiology - Worldwide, concern has grown over the expansion of gambling among adolescents, who have an increased likelihood of developing risk-taking behaviors....     

Rotating shift-related changes in hormone levels in intensive care unit nurses

Title.  Rotating shift-related changes in hormone levels in intensive care unit nurses.
Aim.  This paper is a report of a study to investigate if an irregular rotating shift system, including night shifts, can cause changes to the secretion of hormones in nurses.
Method.  In 2006, 32 healthy intensive care unit nurses completed the Standard Shiftwork Index (SSI) and blood samples were collected from each participant at the beginning and end of each shift. Change in hormone levels between the beginning and end of morning shifts were examined and compared between nurses on morning only and rotating shifts. Correlations between change in hormone concentrations and scores from the SSI are presented.
Results.  The mean reduction of cortisol level between the two measurements was statistically significantly greater for the 'rotating' than 'morning' shift group ( P  = 0·032). There were no statistically significant differences between the two groups in overall mean change from the first to the second measurement of prolactin, triiodothyronine and thyroid-stimulating hormone. Levels of thyroxine increased statistically significantly in the 'rotating' group ( P  = 0·049) but not in the 'morning' group. The morningness scale score was greater for the 'rotating' group, while greater job satisfaction levels were found in the 'morning' group. Statistically significant correlations were found between thyroid-stimulating hormone, triiodothyronine, thyroxine and prolactin changes and specific scales of the SSI questionnaire.
Conclusion.  Ergonomic shift schedules sympathetic to the body clock and nurses' preferences should be adopted to mitigate the adverse effects on health.     

Overview of the Greek legislation regarding assisted reproduction and comparison with the EU legal framework

The aim of this research was to ascertain how the opportunities now open by the Greek legislation regarding assisted reproduction fits with Greek society and how it compares with the wider EU legal framework. A revision of the Greek legislation took place a few years ago, with two new Acts. The different issues that arise from the two Acts and the relevant statements are examined. Issues such as the legal state of the newborn, involvement of a third party in the reproduction process, surrogacy, post-mortem fertilization and cryopreserved embryos are analytically presented. A pragmatic orientation seems to unfold, which is characterized by the prevalence of the benefits that can be obtained from the resources of reproductive technologies. The reality is that Greek society is still quite traditional, therefore specific parts of this new legislation do not fit with the current picture. A comparison with the other national legislative systems in existence within the EU has revealed specific differences. The creation of a common legislative framework covering most of the points raised through the implementation of assisted reproduction could provide guidance for any future legislative reforms or updates within a EU state, including Greece.     

Intensive hog farming operations,health risks,and quality of life of nearby residents in east Mediterranean

As part of the Mediterranean region, Greece has a high mean temperature. Consequently, the amount of toxic gas emissions from intensive hog farming operations (IHFOs) is greater than that from equivalents in northern Europe and USA. This study evaluated the health-related quality of life (HRQoL) of people who live near IHFOs in central and southern Greece. The collected data from 72-item self-report questionnaires, obtained from 377 residents in vicinity with three IHFOs, have been analyzed. The experimental group consisted of 209 people living within 3 km from IHFOs (near IHFOs), while the control group consisted of 168 people living more than 3 km but less than 5 km away from IHFOs (far IHFOs). There was a statistically significant difference between experimental and control groups in the following: wheezing (26.9 vs. 7.8 %), night-time awakenings due to dyspnea (24.5 vs. 7.2 %), night-time awakenings due to coughing (41.6 vs. 16.8 %), and night or day coughing for at least 3 months per year (42.5 vs. 17.3 %). Subjects living near IHFOs had increased odds for suffering from wheezing, night-time awakenings due to dyspnea, night-time awakenings due to coughing, and night or day coughing for at least 3 months per year. Our research verified that IHFOs adversely affect respiratory and mental health as well as the quality of life of nearby residents.     

Doping and musculoskeletal system: short-term and long-lasting effects of doping agents

Doping is a problem that has plagued the world of competition and sports for ages. Even before the dawn of Olympic history in ancient Greece, competitors have looked for artificial means to improve athletic performance. Since ancient times, athletes have attempted to gain an unfair competitive advantage through the use of doping substances. A Prohibited List of doping substances and methods banned in sports is published yearly by the World Anti‐Doping Agency. Among the substances included are steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, β₂‐agonists, diuretics and masking agents, narcotics, and cannabinoids. Blood doping, tampering, infusions, and gene doping are examples of prohibited methods indicated on the List. Apart from the unethical aspect of doping, as it abrogates fair‐play’s principle, it is extremely important to consider the hazards it presents to the health and well‐being of athletes. The referred negative effects for the athlete’s health have to do, on the one hand, by the high doses of the performance‐enhancing agents and on the other hand, by the relentless, superhuman strict training that the elite or amateur athletes put their muscles, bones, and joints. The purpose of this article is to highlight the early and the long‐lasting consequences of the doping abuse on bone and muscle metabolism.