The Treatment Effect of an ACE-Inhibitor Based Regimen with Perindopril in Relation to Beta-Blocker use in 29,463 Patients with Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA and PROGRESS Trials

INTRODUCTION

In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking.

METHODS

In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke.

RESULTS

The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use.

CONCLUSIONS

These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use.

[Involuntary psychiatric care for inmates in France: Only for "dangerous" patients?]

The unités hospitalières spécialement aménagées (UHSA) are full-time inpatient psychiatric units for inmates in France. Their creation has been associated with several advances in access to psychiatric care for inmates in recent years. However, there is still only one means of involuntary hospitalization for prisoners in France: care by decision of a representative of the state (les soins sur décision d'un représentant de l'état [SDRE]). Interestingly, for SDRE to be recognized as legal by the French judge, the patient must be "a danger to himself or to the others". Thus, there is a major difference with involuntary hospitalization outside the prison, and there are specific criteria for involuntary psychiatric hospitalization for inmates in France. This situation questions the general framework of involuntary psychiatric care and is very inconsistent with French law. Indeed, the goal of the loi n^o 94-43 du 18 janvier 1994 relating to public health and social protection is to ensure equivalent care for all patients, incarcerated or not.

Students' memorization of anatomy, influence of drawing

INTRODUCTION

Anatomy is the cornerstone of medical education. Different teaching methods can be combined. This study was designed to evaluate the influence of students' drawing of the anatomical region before and after the dissection session on their memorization of the studied anatomical region.

METHOD

Four hundred and sixteen second-year medical students in the faculty of medicine of Damascus were included in this study during the 2013-2014 academic year. Students were randomly divided into three blinded groups. Two groups had to draw the anatomical region respectively before and after the dissection session, while the third group did not have to draw. The memorization of the region was evaluated twice, one and seven weeks after the course. Means were compared using a t-test.

RESULTS

Scores were significantly higher at 1 and 7 weeks tests in groups who were asked to draw either before or after the dissection compared to those who were not asked to draw. No statistical difference was found between the two groups who drew.

CONCLUSION

The authors recommend the use of drawing in teaching anatomy.

Effects of halving pesticide use on wheat production

Pesticides pose serious threats to both human health and the environment. In Europe, farmers are encouraged to reduce their use, and in France a recent environmental policy fixed a target of halving the pesticide use by 2018. Organic and integrated cropping systems have been proposed as possible solutions for reducing pesticide use, but the effect of reducing pesticide use on crop yield remains unclear. Here we use a set of cropping system experiments to quantify the yield losses resulting from a reduction of pesticide use for winter wheat in France. Our estimated yield losses resulting from a 50% reduction in pesticide use ranged from 5 to 13% of the yield obtained with the current pesticide use. At the scale of the whole country, these losses would decrease the French wheat production by about 2 to 3 millions of tons, which represent about 15% of the French wheat export.

Abstract P3-09-15: Permanent chemotherapy induced alopecia in early breast cancer patients after (neo)adjuvant chemotherapy: Long term follow up

Background:

Chemotherapy-induced alopecia (CIA) persisting for more than six months after the end of chemotherapy is defined as permanent alopecia. Scalp cooling is proposed to reduce this distressing side-effect.We evaluated the prevalence and the risk factors of permanent CIA in breast cancer patients receiving (neo)adjuvant chemotherapy.

Patients and methods:

79 patients (pts) treated with (neo)adjuvant chemotherapy (fluorouracil, epirubicin, cyclophosphamide (FEC-100) and docetaxel) for early breast cancer at the Oscar Lambret Center between July 2005 and December 2007 were included in our study. Scalp cooling was used to all pts during chemotherapy. All patients underwent a clinical examination and photographs of the scalp five years after the end of chemotherapy. These images were analysed by two different physicians and patients were divided into two groups: alopecia (regardless of severity) and control. They were asked for the impact on their quality of life. Potential risk factors were collected.

Results:

26 pts (32.9%) had alopecia: minimal (21 pts), moderate (2 pts) or severe (3 pts). In alopecia group, pts were significantly older and more often postmenopausal than in the control group (p 0.0073 and 0.005, respectively). In multivariate analysis (age and menopause), menopause was identified as a significant risk factor for developing alopecia (OR = 4.136, 95% CI (1.482-11.54)). The presence of impaired quality of life was significantly higher in the group alopecia than in the control group (p = 0.00006). There was no significant difference on personal history, potentially alopeciant drug intake (include hormonotherapy) and depilation of the eyebrows between the two groups. Main hypotheses are irreversible toxicity on stem cells follicles hairs, endocrine disorders and earlier onset of androgenetic alopecia in genetically predisposed subjects.

Conclusion:

The risk of permanent alopecia induced by anthracyclins and taxans based chemotherapy should not be underestimated. Early breast cancer pts, especially if they are postmenopausal, have to be aware of this toxicity with major aesthetic and psychosocial consequences.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-15.

The PROCESS experiment: exposure of amino acids in the EXPOSE-E experiment on the international space station and in laboratory simulations

To understand the chemical behavior of organic molecules in the space environment, amino acids and a dipeptide in pure form and embedded in meteorite powder were exposed in the PROCESS experiment in the EXPOSE-E facility mounted on the European Technology Exposure Facility (EuTEF) platform on board the International Space Station (ISS). After exposure to space conditions for 18 months, the samples were returned to Earth and analyzed in the laboratory for reactions caused by solar UV and cosmic radiation. Chemical degradation and possible racemization and oligomerization, the main reactions caused by photochemistry in the vacuum ultraviolet domain (VUV, wavelength range 100-200 nm for photon energy from 6.2 to 12.4 eV) were examined in particular. The molecules were extracted and derivatized by silylation and analyzed by gas chromatograph coupled to a mass spectrometer (GC-MS) to quantify the rate of the degradation of the compounds. Laboratory exposure in several wavelength ranges from UV to VUV was carried out in parallel in the Cologne Deutsches Zentrum für Luft- und Raumfahrt (DLR) Center and Centre de biophysique moléculaire (CBM) laboratories. The results show that resistance to irradiation is a function of the chemical nature of the exposed molecules and the wavelengths of the UV light. The most altered compounds were the dipeptide, aspartic acid, and aminobutyric acid. The most resistant were alanine, valine, glycine, and aminoisobutyric acid. Our results also demonstrate the protective effect of meteorite powder, which reemphasizes the importance of exogenic contribution to the inventory of prebiotic organics on early Earth.