Randomized Trial of Basiliximab Induction versus Steroid Therapy in Pediatric Liver Allograft Recipients Under Tacrolimus Immunosuppression

Avoidance of corticosteroids could be beneficial after pediatric liver transplantation (LTx). To test this hypothesis, we performed a randomized prospective study to compare immunosuppression with tacrolimus (TAC) and steroids versus TAC and basiliximab (BAS) after pediatric LTx. Seventy-two patients were recruited, 36 receiving TAC and steroids and 36 TAC and BAS. The primary endpoint was the occurrence of the first rejection episode. Secondary endpoints were the cumulative incidence and severity of rejection, patient and graft survival, and incidence of adverse events. Overall 1-year patient and graft survival rates were 91.4% and 85.5% in the steroid group, and 88.6% and 80% in the BAS group (p = NS). Patients free from rejection were 87.7% in the BAS group and 67.7% in the steroid group (p = 0.036). The use of BAS was associated with a 63.6% reduction in incidence of acute rejection episodes. Overall incidence of infection was 72.3% in the steroid group and 50% in the BAS group (p = 0.035). We conclude that the combination of TAC with BAS is an alternative to TAC and steroid immunosuppression in pediatric LTx, which allows for a significant reduction in the incidence of acute rejection and infectious complications.     

Neoadjuvant and Adjuvant Systemic Therapy for Newly Diagnosed Stage II–IV Epithelial Ovary,Fallopian Tube,or Primary Peritoneal Carcinoma: A Practice Guideline

Background: This study aims to provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II–IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma. Methods: EMBASE, MEDLINE, and Cochrane Library were investigated for relevant systematic reviews and phase III trials. Articles focusing on consolidation and maintenance therapies were excluded. Results: For women with potentially resectable disease, primary cytoreductive surgery, followed by six to eight cycles of intravenous three-weekly paclitaxel and carboplatin is recommended. For those with a high-risk profile for primary cytoreductive surgery, neoadjuvant chemotherapy can be an option. Adjuvant chemotherapy with six cycles of dose-dense weekly paclitaxel plus three-weekly carboplatin can be considered for women of Japanese descent. In women with stage III or IV disease, the incorporation of bevacizumab concurrent with paclitaxel and carboplatin is not recommended for use as adjuvant therapy unless bevacizumab is continued as maintenance therapy. Intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel can be considered for stage III optimally debulked women who did not receive neoadjuvant chemotherapy. However, intraperitoneal administration of chemotherapy with bevacizumab should not be considered as an option for stage II–IV optimally debulked women. Discussion: The recommendations represent a current standard of care that is feasible to implement and valued by both clinicians and patients.     

Experimentelle Schocktherapie mit den durch Glutathion verstärkten Blutplasmaersatzlösungen

Zusammenfassung An pathologischen Standardmodellen, die die Dynamik des Blutungsprozesses simulieren, wurde die therapeutische Wirkung von Blutersatzmitteln untersucht, die mit Glutathion verstärkt waren. Es zeigte sich, daß die Zugabe einer geeigneten Glutathionmenge-40 mg je 100 ml transfundierten Blutes oder infundierter Plasmaersatzlösungen-das Überleben der einem posthämorrhagischen Schock unterzogenen Versuchstiere erheblich beeinflußt. Im Vergleich zu Kontrolltieren überleben durchschnittlich 50% mehr Tiere. Glutathion im Blut oder in dem Blutersatzmittel ist außerdem imstande, die übliche Dauer der Pentothalnarkose bei den Versuchstieren bedeutend abzukürzen.

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Summary The therapeutical action of blood substitutes intensified by glutathione was studied in pathological standard models simulating the dynamics of the hemorrhagic process. It was found that the addition of an adequate amount of glutathione-40 mg. per 100 ml. of transfused blood or infused solution of plasma substitute-considerably influences the survival of an experimental animal with an experimentally induced posthemorrhagic shock. In comparison with control animals, the rate of the surviving animals was 50% higher. In addition, glutathione in the blood or blood substitute provides for a considerable reduction of the duration of pentothal anaestesia in experimental animals.