Long-Term Follow-Up of the Intergroup Exemestane Study

Purpose The Intergroup Exemestane Study, an investigator-led study of 4,724 postmenopausal patients with early breast cancer (clinical trial information: ISRCTN11883920), has previously demonstrated that a switch from adjuvant endocrine therapy after 2 to 3 years of tamoxifen to exemestane was associated with clinically relevant improvements in efficacy. Here, we report the final efficacy analyses of this cohort. Patients and Methods Patients who remained disease free after 2 to 3 years of adjuvant tamoxifen were randomly assigned to continue tamoxifen or switch to exemestane to complete a total of 5 years of adjuvant endocrine therapy. Given the large number of non-breast cancer-related deaths now reported, breast cancer-free survival (BCFS), with censorship of intercurrent deaths, was the primary survival end point of interest. Analyses focus on patients with estrogen receptor-positive or unknown tumors (n = 4,599). Results At the time of the data snapshot, median follow-up was 120 months. In the population that was estrogen receptor positive or had unknown estrogen receptor status, 1,111 BCFS events were observed with 508 (22.1%) of 2,294 patients in the exemestane group and 603 (26.2%) of 2,305 patients in the tamoxifen group. The data corresponded to an absolute difference (between exemestane and tamoxifen) at 10 years of 4.0% (95% CI, 1.2% to 6.7%), and the hazard ratio (HR) of 0.81 (95% CI, 0.72 to 0.92) favored exemestane. This difference remained in multivariable analysis that was adjusted for nodal status, prior use of hormone replacement therapy, and prior chemotherapy (HR, 0.80; 95% CI, 0.71 to 0.90; P < .001). A modest improvement in overall survival was seen with exemestane; the absolute difference (between exemestane and tamoxifen) at 10 years in the population that was estrogen receptor positive or had unknown estrogen receptor status was 2.1% (95% CI, -0.5% to 4.6%), and the HR was 0.89 (95% CI, 0.78 to 1.01; P = .08). For the intention-to-treat population, the absolute difference was 1.6% (95% CI, -0.9% to 4.1%); the HR was 0.91 (95% CI, 0.80 to 1.03, P = .15). No statistically significant difference was observed in the proportion of patients who reported a fracture event in the post-treatment period. Conclusion The Intergroup Exemestane Study and contemporaneous studies have established that a strategy of switching to an aromatase inhibitor after 2 to 3 years of tamoxifen can lead to sustained benefits in terms of reduction of disease recurrence and breast cancer mortality.

Mathematical modeling of an urban pigeon population subject to local management strategies

This paper addresses the issue of managing urban pigeon population using some possible actions that make it reach a density target with respect to socio-ecological constraints. A mathematical model describing the dynamic of this population is introduced. This model incorporates the effect of some regulatory actions on the dynamic of this population. We use mathematical viability theory, which provides a framework to study compatibility between dynamics and state constraints. The viability study shows when and how it is possible to regulate the pigeon population with respect to the constraints.

Addition of exogenous enzymes to diets containing grape pomace: Effects on intestinal utilization of catechins and antioxidant status of chickens

Grape pomace (GP) is a rich source of polyphenols with antioxidant capacity. An experiment was conducted to study the effect of GP phenolic compounds included at 5 and 10%, and the addition (individually or combined) of hydrolyzing enzymes (carbohydrase enzyme complex and tannase at 500ppm) on intestinal utilization of catechins and antioxidant status in broiler chickens. A diet supplemented with 200ppm of α-tocopheryl acetate was also used. Our findings demonstrate the capacity of chickens to digest the monomeric (catechin, epicatechin, gallic acid, and epicatechin-O-gallate) and dimeric (procyanidin B1 and procyanidin B2) catechins present in grape pomace. The addition of enzymes (mainly tannase) hydrolyzed the polymeric structures into smaller catechins, but also promoted a lower digestibility of the monomeric and dimeric catechins suggesting that polymeric structures might favour the intestinal utilization of these catechins. The intestinal accumulation of phenolic compounds generated with tannase and with 10% GP reversed the antimicrobial effect against Clostridium perfringens observed with 5% of GP. Grape pomace improved the antioxidant status of the bird, increasing the α-tocopherol and reducing the iron content on plasma, not affecting the plasma gluthatione. Enzymes modified the intestinal utilization of catechins but not additional protective effect was detected on any of the parameters analyzed to evaluate the antioxidant status.

A Multicenter Phase II Study of Twice-Weekly Bortezomib plus Rituximab in Patients with Relapsed Follicular Lymphoma: Long-Term Follow-Up

Single-agent bortezomib (B) has shown activity in heavily pretreated patients with relapsed/refractory indolent lymphoma. On the basis of these findings, we performed a phase II study of B combined with rituximab (R) in patients with relapsed follicular lymphoma (FL). Forty-five patients with fairly good prognostic profiles were enrolled from 2007 to 2011 and received a total of 6 cycles of the B+R combination. The endpoints were the overall response rate (ORR), progression-free survival (PFS), duration of remission (DoR), overall survival (OS), and toxicity evaluation. When considering all the enrolled patients the ORR was 64%. At 5 years, the estimated PFS, DoR, and OS were 34, 49, and 70%, respectively. After excluding the 7 R-naïve patients, the ORR was 58%, with a PFS of 19 months. The most common grade >2 toxicities were thrombocytopenia (18%), peripheral neuropathy (13%), and neutropenia (2%). Our study shows the feasibility, long-term efficacy, and excellent tolerability of the B+R combination. We are aware that our study has specific limitations, such as the small sample size consisting of patients with a relatively good prognostic profile. However, because FL patients will be treated with subsequent chemotherapy regimens, a well-tolerated and effective chemotherapy-free therapy could be considered an additional tool for long-term disease control.

Nota. Diferenciación de vinos tintos varietales de la Comunidad Valenciana a partir del contenido de alcoholes y polioles / Note. Differentiation of varietal red wines from Communidad Valenciana (Spain) based on their composition in terms of alcohols and polyols

The composition in terms of alcohols and polyols of 44 and 49 red wines (harvested in 1994 and 1995, respectively) produced in Comunidad Valenciana (Spain) from the grape varieties Cabernet Sauvignon, Tempranillo, Monastrell and Bobal was,analyzed. Discriminant analysis revealed differences among wines, and a clear separation of the samples (90 and 98%) was obtained. The most important compo nents in the differentation of the varieties studied were isoamyl alcohol for Cabernet Sauvignon, cis- 3-hexenol and isobutyl alcohol for Tempranillo, methanol and cis-3-hexenol for Monastrell, and 2,3- butanediol for Bobal. The classification obtained by elimination of the five less significant variables was similar to the one obtained using statistical treatment of all variables (with 84% and 90% in their respective harvests).

Greater eccentric exercise-induced muscle damage by large versus small range of motion with the same end-point

Several factors can affect the magnitude of eccentric exercise (ECC)-induced muscle damage, but little is known regarding the effect of the range of motion (ROM) in ECC-induced muscle damage. The purpose of this study was to investigate whether elbow flexor ECC with 120° of ROM (from 60° of elbow flexion until elbow full extension - 180° [120ROM]) induces a greater magnitude of muscle damage compared with a protocol with 60° of ROM (120-180° of elbow flexion [60ROM]). Twelve healthy young men (age: 22 ± 3.1 years; height: 1.75 ± 0.05 m; body mass: 75.6 ± 13.6 kg) performed the ECC with 120ROM and 60ROM using different arms in a random order separated by 2 weeks and were tested before and 24, 48, 72 and 96 h after ECC for maximal voluntary isometric contraction torque (MVC-ISO), ROM and muscle soreness. The 120ROM protocol showed greater changes and effect sizes (ES) for MVC-ISO (-35%, ES: 1.97), ROM (-11.5°, ES: 1.27) and muscle soreness (19 mm, ES: 1.18) compared with the 60ROM protocol (-23%, ES: 0.93; -12%, ES: 0.56; 17°, ES: 0.63; 8 mm, ES: 1.07, respectively). In conclusion, ECC of the elbow flexors with 120° of ROM promotes a greater magnitude of muscle damage compared with a protocol with 60° of ROM, even when both protocols are performed at long muscle lengths.

SEOM clinical guidelines in metastatic breast cancer 2015

Metastatic breast cancer is essentially an incurable disease. However, recent advances have resulted in a significant improvement of overall survival. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with metastatic breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.

Development of the National Kidney Transplantation Program in Uruguay

The first kidney transplantation (KT) in Uruguay was performed in 1969. We report the rates of KT and survival of patients and grafts up to December 2014. The country has a surface of 176,215 km(2) and a population of 3,286,314 inhabitants (18.6 inhabitants per km(2)). Till December 31, 2014, 1,940 KT have been performed in Uruguay (41.8 pmp that year); 90.4% of them were from cadaveric donors (CD). Median age of recipients (R) was 44 ± 14 years; R older than 55 years increased from 0 to 27% during the period. Our pre-emptive KT program started in 2007. Optimal donors (D) decreased from 65.2% to 35.5%, and D older than 45 years old increased from 9% to 37%. Trauma as cause of death decreased from 49% to 32% and stroke as cause of death increased from 25% to 39%. Patient survival rates at 1, 5, and 8 years were 93%, 87%, and 78%, respectively for KT performed between 1980 and 1989; they were 98%, 93%, and 89%, respectively, for KT performed between 1990 and1999; they were 97%, 91%, and 90%, respectively, for KT performed between 2000 and 2010. In December 2013, there were 1098 patients pmp in renal replacement therapy, 758 pmp in dialysis, and 340 pmp (30.9%) with a functioning graft. Our national KT program is mainly based (90.6%) on cadaveric donation. Epidemiological changes in the characteristics of R and D followed the changes in aging that occurred in the general population and the dialysis population. The survival rates from patients and kidneys are similar to those reported by the European and the American registries.

Carcass and meat quality of light lambs using principal component analysis

Eighty-six male light lambs of Manchego breed were used in this study. Principal component (PC) analysis was performed to study the relationship between carcass quality variables (n=22) and between meat quality measures (n=21). The carcass quality was assessed using objective and subjective measurements of conformation and fatness besides the joints proportion and tissues proportion of the leg. The measurements used to evaluate meat quality were pH in longissimus dorsi and semitendinosus muscles, the colour, moisture, water holding capacity, cooking losses, texture and sensorial analysis on longissimus dorsi. The five first PCs explained about 77% of the total variability for carcass measures whereas for meat quality the 74% of the total variability was explained for the eight first PCs. All the carcass measurements showed similar weight to define the first PC, whereas the muscle and bone proportion as well as muscle:bone ratio of the leg were useful to define the second PC. The meat quality measures that were more effective to define the first PC were the meat colour measurements, whereas the sensorial variables defined the second PC. The projection of the carcass quality data in the first two PCs allowed to distinguish clearly between heavier carcasses (higher than 6.5 kg) and lighter carcasses (lower than 5.5 kg). The carcasses with a weight higher than 6.5 kg were on the left side of the figure, where the variables of conformation and fatness lie. The group of medium carcass weight were placed between the two previous groups. The projection of the meat quality data in the first two PCs did not differ between hot carcass weights, although there was a trend, the lighter carcasses lay on the left side of the graph, which implies small differences between meat quality in this range of carcass weight.