Frontline treatment of elderly non transplant-eligible multiple myeloma patients using CyBorD with or without thalidomide-based consolidation: a retrospective multi-centre analysis of real-world data

Bortezomib in combination with cyclophosphamide and dexamethasone (CyBorD, is a well-established frontline chemotherapy regimen for patients with multiple myeloma, but prospective data on elderly non-transplant eligible patients is limited. A total of 155 patients aged 70 years or older with newly diagnosed multiple myeloma who received at least one cycle of CyBorD chemotherapy in three centres across New Zealand were evaluated. Partial response or better was achieved in 79·4%, of whom 52·9% achieved at least a very good partial response. After a median follow-up of 31·9 months, the median event-free survival (EFS) was 17·0 months (age 70–80 years, 17·7 months; age above 80 years, 8·6 months; P = 0·002). The median overall survival was 45·1 months (age 70–80, 49·8 months; above 80, 33·3 months; P = 0·003). Amongst those who had seven or more cycles of treatment, those who had a pre-planned switch to bortezomib-thalidomide-dexamethasone (VTD) consolidation had a superior median EFS of 25·4 months, compared with 20·3 months in the CyBorD only group (P = 0·028). This is the largest real-world dataset on the efficacy of CyBorD in the elderly population, and pre-planned switch to VTD was associated with better outcomes.     

The inflammatory modulation effect of glutamine-enriched total parenteral nutrition in postoperative gastrointestinal cancer patients

The objective of this study is to explore the inflammatory modulation effect of glutamine-enriched total parenteral nutrition (TPN) by investigating the alterations of inflammation-related cytokines in gastrointestinal (GI) cancer patients postoperatively. Fifty GI cancer patients received postoperative 7 days of isocaloric and isonitrogenous TPN after operation. They were randomly divided to receive either glutamine-enriched TPN or standard TPN. The inflammation-related cytokines including interleukin-6, interleukin-10, and tumor necrosis factor-α were also determined. Records of nutritional assessments, inflammatory status, and postoperative complications were compared between the two groups. Of 50 enrolled patients, 25 patients were classified as the intervention group, and the control group also comprised 25 patients. The differences of gender, age, primary GI malignancies, and hematological and biochemical data between the two compared groups were not statistically significant (all P > 0.05). Compared with standard TPN, a higher serum prealbumin level and better nitrogen balance were observed in glutamine-enriched TPN (P = 0.039 and 0.048 respectively). A significantly lower serum interleukin-6 level was found in comparing glutamine-enriched with standard TPN (P = 0.01), but not in interleukin-10 (P = 0.374) and tumor necrosis factor-α levels (P = 0.653). Moreover, a significant lower serum C-reactive protein level was detected in glutamine-enriched TPN compared with standard TPN (P = 0.013). Indeed, four cases of postoperative infectious complications were noted in the control group, but no postoperative infectious complications were observed in the interventional group (P = 0.037). Our present study shows that glutamine-enriched TPN may be beneficial in improving the inflammatory status and decreasing the infectious morbidity in postoperative GI cancer patients.     

Use of mobile telemedicine for cervical cancer screening

Visual inspection of the cervix with application of 4% acetic acid (VIA) is an inexpensive alternative to cytology-based screening in areas where resources are limited, such as in many developing countries. We have examined the diagnostic agreement between off-site (remote) expert diagnosis using photographs of the cervix (photographic inspection with acetic acid, PIA) and in-person VIA. The images for remote evaluation were taken with a mobile phone and transmitted by MMS. The study population consisted of 95 HIV-positive women in Gaborone, Botswana. An expert gynaecologist made a definitive positive or negative reading on the PIA results of 64 out of the 95 women whose PIA images were also read by the nurse midwives. The remaining 31 PIA images were deemed insufficient in quality for a reading by the expert gynaecologist. The positive nurse PIA readings were concordant with the positive expert PIA readings in 82% of cases, and the negative PIA readings between the two groups were fully concordant in 89% of cases. These results suggest that mobile telemedicine may be useful to improve access of women in remote areas to cervical cancer screening utilizing the VIA 'see-and-treat' method.     

Racial and ethnic disparities in contraceptive method choice in California

CONTEXT: Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied. METHODS: Racial and ethnic disparities in contraceptive use among 3,277 women aged 18–44 and at risk for unintended pregnancy were assessed using 2006–2008 data from of the California Women’s Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice. RESULTS: Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign‐born Asians were less likely than whites to use high‐efficacy reversible methods—that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.‐born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign‐born Asians had reduced odds of such use (0.4). Finally, blacks and foreign‐born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively). CONCLUSIONS: Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high‐risk groups.     

Factors associated with social contacts in four communities during the 2007-2008 influenza season

Mathematical models of influenza pandemics are sensitive to changes in contact rates between individuals. We conducted population-based telephone surveys in four North Carolina counties to determine the number of social interactions between individuals during the 2007-2008 influenza season. Influenza activity was monitored through sentinel medical practices. Among 3845 adults, the number of social contacts varied with age, was lower on weekends than on weekdays, and further decreased during school holiday periods. Adults with influenza-like illnesses had fewer social contacts. Adults' contacts in the community setting increased during periods of peak influenza activity. Among 290 children, potential contacts (i.e. other people in the same location) were lowest among preschool-age children and decreased on weekends and during school holidays. In adjusted analyses, children's potential social contacts did not change during periods of peak influenza activity. These results should be useful for modelling influenza epidemics and pandemics and in planning mitigation and response strategies.     

Thigh muscle volume predicted by anthropometric measurements and correlated with physical function in the older adults

Objectives  

1) to correlate thigh muscle volume measured by magnetic resonance image (MRI) with anthropometric measurements and physical function in elderly subjects; 2) to predict MRI-measured thigh muscle volume using anthropometric measurements and physical functional status in elderly subjects.