Prevalence of monoclonal gammopathy of undetermined significance in Thailand

Individuals with monoclonal gammopathy of undetermined significance (MGUS) develop multiple myeloma and related malignancies at the rate of 1% per year. Given differences in ethnicity, data on prevalence and risk factors of MGUS in Thai population will be helpful in understanding the pathogenesis of plasma cell disorders and designing an early cancer detection strategy. Subjects of 50 years or older were included. Demographic data and suspected risk factors were collected. Monoclonal proteins were detected using serum protein electrophoresis. Serum was obtained from 3,260 participants; 1,104 males (33.9%) and 2,156 females (66.1%). The median age was 57 years (range 50–93 years). Monoclonal proteins were detectable in 2.3% (95% confidence interval [CI] 1.8–2.8). M spikes were found in gamma- and beta-globulin regions in 50 (1.5%) and 25 (0.8%) subjects, respectively. The prevalence of MGUS in subjects 50–59, 60–69, and 70 years or older was 2.0% (41/1,975), 2.6% (22/851), and 2.8% (12/434), respectively. By multivariate analysis, MGUS was associated with living outside Bangkok (odds ratio 2.25, 95% CI 1.11–4.58). The overall prevalence of MGUS in the Thai population was 2.3%, which was lower than that in Western countries, but comparable to that in Japan.     

Rituximab-CHOP-ESHAP vs CHOP-ESHAP-high-dose therapy vs conventional CHOP chemotherapy in high-intermediate and high-risk aggressive non-Hodgkin's lymphoma

With currently available combination chemotherapy regimens, the outcome of the patients newly diagnosed with aggressive non-Hodgkin's lymphoma (NHL) identified as 'high' and 'high-intermediate' risk groups according to the international prognostic index (IPI) is still unsatisfactory and a more innovative therapy is urgently required to improve the survival of the patients. The purpose of this study was to compare the efficacy of rituximab given in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and ESHAP (etoposide, methylprednisolone, high-dose Ara-C, cisplatin) vs CHOP-ESHAP and upfront high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) vs standard CHOP in patients aged < or = 65 years old newly diagnosed with 'high' and 'high-intermediate' risk aggressive lymphoma enrolled onto two consecutive treatment trials at the institute. Between May 1995 - July 2002, 84 patients, aged 15 - 65 years old, with newly diagnosed aggressive NHL and an age-adjusted IPI of 2 or 3 were enrolled. The median age of the patients was 38 years (range 15 - 65). The baseline demographic features, in particular the major prognostic variables, were similar between the treatment groups. Patients treated with rituximab-CHOP-ESHAP received eight cycles of rituximab (375 mg m(-2) on day 1 of cycles 1 - 6 and days 21 and 28 of cycle 7) plus CHOP (day 3 of cycles 1, 3 and 5) and ESHAP (day 3 of cycles 2, 4 and 6 and day 1 of cycle 7) at 21-day intervals. Patients enrolled onto the CHOP-ESHAP-HDT arm (n = 23) were treated with three courses of CHOP and then switched to two or four cycles of ESHAP followed by HDT. Patients treated with CHOP alone (n = 25) were treated with the standard eight cycles of CHOP. The rate of complete remission was significantly improved with rituximab-CHOP-ESHAP compared with either CHOP-ESHAP-HDT or CHOP alone (67% compared with 44% and 36%, respectively; p = 0.043). With a median follow-up time of 53 months, the 5-year overall survival (OS) was improved by the addition of rituximab-61% with rituximab-CHOP-ESHAP, compared with 43% for CHOP-ESHAP-HDT and 24% for CHOP alone (p = 0.088). Significant increases in failure-free survival (FFS) and disease-free survival (DFS) (61% and 96%), compared with CHOP-ESHAP-HDT (34% and 90%) and CHOP (16% and 44%; p = 0.002 and p < 0.001, respectively) were observed. Compared to CHOP, rituximab-CHOP-ESHAP yielded significantly superior OS (p = 0.014), FFS (p < 0.001) and DFS (p < 0.001). The survivals, however, were not significantly different from patients treated with CHOP-ESHAP-HDT. It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.     

Surgeon's vigilance in the operating room

Objective

Surgeons' vigilance regarding patient condition was assessed using eye-tracking techniques during a simulated laparoscopic procedure.

Methods

Surgeons were required to perform a partial cholecystectomy in a virtual reality trainer (SurgicalSim; METI Inc, Sarasota, FL) while wearing a lightweight head-mounted eye-tracker (Locarna systems Inc, Victoria, British Columbia, Canada). Half of the patients were preprogrammed to present a mildly unstable cardiac condition during the procedure. Surgical performance (evaluated by task time, instrument trajectory, and errors), mental workload (by the National Aeronautics and Space Administration Task Load Index), and eye movement were recorded and compared between 13 experienced and 10 novice surgeons.

Results

Experienced surgeons took longer to complete the task and also made more errors. The overall workload reported by surgeons was similar, but expert surgeons reported a higher level of frustration and a lower level of physical demands. Surgeon workload was greater when operating on the unstable patient than on the stable patient. Novices performed faster but focused more of their attention on the surgical task. In contrast, experts glanced more frequently at the anesthetic monitor.

Conclusions

This study shows the usefulness of using eye-tracking technology to measure a surgeon's vigilance during an operation. Eye-tracking observations can lead to inferences about a surgeon's behavior for patient safety. The unsatisfactory performance of expert surgeons on the VR simulator suggests that the fidelity of the virtual simulator needs to improve to enable surgeons to transfer their clinical skills. This, in turn, suggests using caution when having clinical experts as instructors to teach skills with virtual simulators.     

Axoplasmic transport of substances in motoneuronal axons of the spinal cord in old age

Seven to eight microliters of aqueous solution of L-[14C]Leucine (spec. act. 339 mCi/mmol) were introduced in the zone of ventral horn (L5-L6) of the spinal cord of adult (8-12 months) and old (26-28 months) rats. The radioactivity of various parts of the corresponding ventral roots was measured 1-2.5 h thereafter. Labelled substances (including protein) were found to migrate with fast flow in adult rats at the rate of 408 +/- 10.9 and 380 +/- 22 mm/24 h, respectively, as compared with 217 +/- 11.3 and 200 +/- 40 mm/24 h in old rats. The axoplasmic flow slows down in old rats with the increase of distance from the neuronal body. Uncoupling of oxidation and phosphorylation by the administration of 2,4-dinitrophenol, inhibition of glycolysis with NaF, hypoxemia produce more marked deceleration of axoplasmic flow in old rats, while small doses of NaF accelerate the flow, which correlates with the rise of cAMP in ventral roots. Sex steroids accelerate significantly the rate of axoplasmic flow. There is a marked increase in the rate due to the administration of estradiol dipropionate in old rats and due to testosterone propionate in adult animals. Changes in resting membrane potential and direct excitability thresholds of some muscles following colchicine blockade of axoplasmic transport are less marked in old rats that evidences for the weakening of neurotrophic control in old age.     

Non-bacterial infections in Asian patients treated with alemtuzumab: a retrospective study of the Asian Lymphoma Study Group

This retrospective study concerns non-bacterial infections in Asian patients receiving alemtuzumab. The clinical data of 182 patients treated with alemtuzumab alone or alemtuzumab-containing chemotherapy between the years 2003 and 2009 was collected from six Asian countries. Alemtuzumab was used in the setting of frontline (n =48) or salvage (n =90) treatment, and as a part of the conditioning regimen for allogeneic stem cell transplant (n =44). Reactivation of cytomegalovirus (66/182) and varicella zoster virus (25/182), and fungal infection (31/182) including invasive pulmonary aspergillosis, were the most common infectious complications in this retrospective analysis. Thus, we recommend routine prophylaxis with valganciclovir and itraconazole, especially when alemtuzumab is used in the conditioning regimen for allogeneic stem cell transplant. Pneumocystis jirovecii pneumonia (PJP) was found in four patients (3%, 4/122) receiving alemtuzumab as conditioning for stem cell transplant or salvage treatment. Three cases of hepatitis B virus reactivation were found in antigen-negative patients, and 16 cases of tuberculosis were observed. Infection is the major complication of alemtuzumab therapy, and these infectious complications are potentially severe and life-threatening. Based on our retrospective analysis, we have constructed a guideline for antimicrobial prophylaxis in Asian patients receiving alemtuzumab therapy.     

Forensic entomology cases in Thailand: a review of cases from 2000 to 2006

This paper presents and discusses 30 cases of cadavers that had been transferred for forensic entomology investigations to the Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University, northern Thailand, from 2000 to 2006. Variable death scenes were determined, including forested area and suburban and urban outdoor and indoor environments. The fly specimens found in the corpses obtained were the most commonly of the blow fly of family Calliphoridae, and consisted of Chrysomya megacephala (F.), Chrysomya rufifacies (Macquart) Chrysomya villeneuvi Patton, Chrysomya nigripes Aubertin, Chrysomya bezziana Villeneuve, Chrysomya chani Kurahashi, Lucilia cuprina (Wiedemann), Hemipyrellia ligurriens (Wiedemann), and two unknown species. Flies of the family Muscidae [Hydrotaea spinigera Stein, Synthesiomyia nudiseta (Wulp)], Piophilidae [Piophila casei (L.)], Phoridae [Megaselia scalaris (Loew)], Sarcophagidae [Parasarcophaga ruficornis (F.) and three unknown species], and Stratiomyiidae (Sargus sp.) were also collected from these human remains. Larvae and adults of the beetle, Dermestes maculatus DeGeer (Coleoptera: Dermestidae), were also found in some cases. Chrysomya megacephala and C. rufifacies were the most common species found in the ecologically varied death scene habitats associated with both urban and forested areas, while C. nigripes was commonly discovered in forested places. S. nudiseta was collected only from corpses found in an indoor death scene.     

Electrocatalytical of chlorophenoxycarboxylic acids at a protoporphyrin IX cobalt(III) chloride modified glassy carbon electrode

Protoporphyrin IX cobalt(III) chloride (Co(ProP)Cl) was immobilized on a glassy carbon electrode (GCE) to facilitate the electrocatalytical determination of 2,4-dichlorophenoxycarboxylic acids (2,4-D) and three of its derivatives 2-(2,4-dichlorophenoxy) propionic acid (2,4-DP), 2-(2,4,5-trichlorophenoxy) propionic acid (2,4,5-TP) and 4-(2,4-dichlorophenoxy)butyric acid (2,4-DB) in aqueous solution. Co(ProP)Cl was immobilized by a spontaneous adsorption method. The electrocatalytic reduction peak of 2,4-D and its three derivatives was found at ?1.12 V (vs. Ag/AgCl). Employing chronoamperometry, the highest limiting current was found for a modified GCE with 1 mM Co(ProP)Cl in acetonitrile∣water (1:3; v/v) containing 0.1 M KCl at ?1.15 V. Good linear response of the modified electrode was found in 10–400 μM for 2,4-D, 2,4-DP and 2,4,5-TP; and in 10–300 μM for 2,4-DB. The detection limits were estimated as 0.98, 1.14, 0.89, and 2.77 μM for 2,4-D, 2,4-DP, 2,4,5-TP and 2,4-DB, respectively. The lifetime of the Co(ProP)Cl-GCE was seven times for 2,4-D; eight times for 2,4,5-TP; and six times for 2,4-DP and 2,4-DB.     

The comparative characteristics of the age-related changes in the rate of fast axonal transport in the vagus and hypoglossal nerves and in the ventral spinal cord roots of rats]

The study was undertaken on the fast axonal transport (FAT) of 3H- or 14C-leucine labelled substances along the n. vagus, n. hypoglossus and ventral roots of the spinal cord in adult (8-10 months) and old (26-28 months) male rats after the label administration into nucleus ambiguus, nucleus hypoglossus, and the area of the ventral horn of the spinal cord, respectively. It has been found that in old rats compared to adult animals the rate of FAT along the n. vagus decreased from 552 +/- 12.7 mm to 252 +/- 13 mm per 24 hours; along the n. hypoglossus--from 492 +/- 38 mm to 216 mm per 24 hours; and along the ventral L5 and L6 roots--from 408 +/- 10.9 mm to 217 +/- 11.3 mm per 24 hours. It is suggested that age-related functional shifts in n. vagus influencing the heart are, to some degree, determined by the most significant disturbances of FAT substances in it.