Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad

Background  

There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad.     

Somatic expansion behaviour of the (CTG)n repeat in myotonic dystrophy knock-in mice is differentially affected by Msh3 and Msh6 mismatch-repair proteins

The mechanism of expansion of the (CTG)_n repeat in myotonicdystrophy (DM1) patients and the cause of its pathobiologicaleffects are still largely unknown. Most likely, long repeatsexert toxicity at the level of nuclear RNA transport or splicing.Here, we analyse cis- and trans-acting parameters that determinerepeat behaviour in novel mouse models for DM1. Our mice carry‘humanized’ myotonic dystrophy protein kinase (Dmpk)allele(s) with either a (CTG)₈₄ or a (CTG)₁₁ repeat, insertedat the correct position into the endogenous DM locus. Unlikein the human situation, the (CTG)₈₄ repeat in the syntenic mouseenvironment was relatively stable during intergenerational segregation.However, somatic tissues showed substantial repeat expansionswhich were progressive upon aging and prominent in kidney, andin stomach and small intestine, where it was cell-type restricted.Other tissues examined showed only marginal size changes. The(CTG)₁₁ allele was completely stable, as anticipated. Introducingthe (CTG)₈₄ allele into an Msh3-deficient background completelyblocked the somatic repeat instability. In contrast, Msh6 deficiencyresulted in a significant increase in the frequency of somaticexpansions. Competition of Msh3 and Msh6 for binding to Msh2in functional complexes with different DNA mismatch-recognitionspecificity may explain why the somatic (CTG)_n expansion rateis differentially affected by ablation of Msh3 and Msh6. ⁺ To whom correspondence should be addressed. Tel: +31 24 3614329;Fax: +31 24 3615317; Email: b.wieringa@ncmls.kun.nlPresent address:PatriciaJ. T. A. Groenen, Department of Pathology, UMC Nijmegen, Nijmegen,The Netherlands     

Factors influencing overall survival rates for patients with pineocytoma

Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of patients, prognostic factors following treatment of pineocytoma remain unclear. We therefore compiled a systematic review of the literature concerning post-treatment outcomes for pineocytoma to better determine factors associated with overall survival among patients with pineocytoma. We performed a comprehensive search of the published English language literature to identify studies containing outcome data for patients undergoing treatment for pineocytoma. Kaplan–Meier analysis was utilized to determine overall survival rates. Our systematic review identified 168 total patients reported in 64 articles. Among these patients, 21% underwent biopsy, 38% underwent subtotal resection, 42% underwent gross total resection, and 29% underwent radiation therapy, either as mono- or adjuvant therapy. The 1 and 5 year overall survival rates for patients receiving gross total resection versus subtotal resection plus radiotherapy were 91 versus 88%, and 84 versus 17%, respectively. When compared to subtotal resection alone, subtotal resection plus radiation therapy did not offer a significant improvement in overall survival. Gross total resection is the most appropriate treatment for pineocytoma. The potential benefit of conventional radiotherapy for the treatment of these lesions is unproven, and little evidence supports its use at present.     

Southwestern Oncology Group Phase II Trial (S0526) of Pemetrexed in Bronchioloalveolar Carcinoma Subtypes of Advanced Adenocarcinoma

BackgroundPemetrexed, a multitargeted antifolate drug, is an active agent in non–small-cell lung cancer (NSCLC), especially adenocarcinomas. Based on preclinical data supporting the relevance of alpha-folate receptors in adenocarcinoma of the bronchioloalveolar carcinoma (BAC) subtype, this trial was designed to assess pemetrexed in patients with this pathologic subtype of lung adenocarcinoma.Patients and MethodsPatients with histologically confirmed stage IIIB (with malignant pleural effusion) or stage IV adenocarcinoma with BAC features or pure BAC were eligible. Treatment consisted of pemetrexed, 500 mg/m², administered intravenously every 21 days.ResultsOf 27 patients enrolled, 24 were eligible and assessable for adverse events: Toxicity was primarily hematologic, consisting of leukopenia/neutropenia, thrombocytopenia, and anemia. The median follow-up among patients still alive (n = 8) was 35 months (range, 26-47 months). Among 17 patients with measurable disease, the response rate was 23% (all partial responses; 95% confidence interval [CI], 10%-56%). The median progression-free survival (PFS) and overall survival (OS) were 6 and 25 months, respectively.ConclusionPemetrexed is active and well tolerated and, in patients with adenocarcinoma BAC subtypes, likely related to its underlying mechanism of action as a multitargeted antifolate drug.     

Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer

Objectives

Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer.

Design

Retrospective review.

Setting

Tertiary care center.

Participants

Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66–72 Gy at 2–2.12 Gy/fraction to > 95% of the gross tumor volume in the definitive setting or for positive margins and 60–66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0–94.4 months).

Main outcomes measures

Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0.

Results

Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan–Meier estimate of overall survival was 55%.

Conclusion

Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.