[The effect of blood volume change on the accuracy of pulse contour cardiac output]

OBJECTIVE

To study the accuracy of pulse contour cardiac output (PCCO) during blood volume change.

METHODS

Hemorrhagic shock model was made in twenty dogs followed by volume resuscitation. Two PiCCO catheters were placed into each model to monitor the cardiac output (CO). One of catheters was used to calibrate CO by transpulmonary thermodilution technique (COTP) (calibration group), and the other one was used to calibrate PCCO (none-calibration group). In the hemorrhage phase, calibration was carried out each time when the blood volume dropped by 5 percents in the calibration group until the hemorrhage volume reached to 40 percent of the basic blood volume. Continuous monitor was done in the none-calibration group.Volume resuscitation phase started after re-calibration in the two groups. Calibration was carried out each time when the blood equivalent rose by 5 percents in calibration group until the percentage of blood equivalent volume returned back to 100. Continuous monitor was done in none-calibration group. COTP, PCCO, mean arterial pressure (MAP), systemic circulation resistance (SVR), global enddiastolic volume (GEDV) were recorded respectively in each time point.

RESULTS

(1) At the baseline, COTP in calibration group showed no statistic difference compared with PCCO in none-calibration group (P >0.05). (2) In the hemorrhage phase, COTP and GEDV in calibration group decreased gradually, and reached to the minimum value (1.06 ± 0.57) L/min, (238 ± 93) ml respectively at TH8. SVR in calibration group increased gradually, and reached to the maximum value (5 074 ± 2 342) dyn · s · cm⁻⁵ at TH6. However, PCCO and SVR in none-calibration group decreased in a fluctuating manner, and reached to the minimum value (2.42 ± 1.37) L/min, (2 285 ± 1 033) dyn · s · cm⁻⁵ respectively at TH8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TH1-8, t values were respectively -5.218, -5.495, -4.639, -6.588, -6.029, -5.510, -5.763 and -5.755, all P < 0.01). From TH1 to TH8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TH1 and TH4, t values were respectively 2.866 and 2.429, both P < 0.05, at TH2 - TH3 and TH5 - TH8, t values were respectively 3.073, 3.590, 6.847, 8.425, 6.910 and 8.799, all P < 0.01). There was no statistic difference in MAP between the two groups (P > 0.05). (3) In the volume resuscitation phase, COTP and GEDV in the calibration group increased gradually. GEDV reached to the maximum value ((394±133) ml) at TR7, and COTP reached to the maximum value (3.15 ± 1.42) L/min at TR8. SVR in the calibration group decreased gradually, and reached to the minimum value (3 284 ± 1 271) dyn · s · cm⁻⁵ at TR8. However, PCCO and SVR in the none-calibration group increased in a fluctuating manner. SVR reached to the maximum value (8 589 ± 4 771) dyn · s · cm⁻⁵ at TR7, and PCCO reached to the maximum value (1.35 ± 0.70) L/min at TR8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TR1-8, t values were respectively 8.195, 8.703, 7.903, 8.266, 9.600, 8.340, 8.938, 8.332, all P < 0.01). From TR1 to TR8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TR1, t value was -2.810, P < 0.05, at TR2-8, t values were respectively -6.026, -6.026, -5.375, -6.008, -5.406, -5.613 and -5.609, all P < 0.05). There was no statistic difference in MAP between the two groups (P > 0.05).

CONCLUSION

PCCO could not reflect the real CO in case of rapid blood volume change, which resulting in the misjudgment of patient's condition. In clinical practice, more frequent calibrations should be done to maintain the accuracy of PCCO in rapid blood volume change cases.

Prediction and retrodiction for a continuously monitored superconducting qubit

The quantum state of a superconducting transmon qubit inside a three-dimensional cavity is monitored by transmission of a microwave field through the cavity. The information inferred from the measurement record is incorporated in a density matrix ρ_{t}, which is conditioned on probe results until t, and in an auxiliary matrix E_{t}, which is conditioned on probe results obtained after t. Here, we obtain these matrices from experimental data and we illustrate their application to predict and retrodict the outcome of weak and strong qubit measurements.

Effects of platelet infusion, anticoagulant and other risk factors on the rehaemorrhagia after surgery of hypertensive cerebral hemorrhage

OBJECTIVE

Our objective is to explore the effect of platelet infusion, anticoagulant and other risk factors on the rehaemorrhagia after surgery of hypertensive cerebral hemorrhage (HCH), and to provide a reference for the prevention and treatment of rehaemorrhagia in patients with HCH.

PATIENTS AND METHODS

The patients with HCH admitted during April, 2007-June, 2012 in our hospital were selected. The general data such as age and gender, disease course, past pathogenic characters, past and present medical history such as treatment, personal history, family history and son on, were collected. The data were analyzed by t test, ANOVA, Chi-squared test and logistic regression analysis.

RESULTS

The application of aspirin and platelets has significant effect on rehaemorrhagia after surgery of HCH: 72 patients received aspirin, of which 14 cases had rehaemorrhagia while 197 patients did not receive aspirin, of which 20 cases had rehaemorrhagia. The difference between these two groups was statistically significant (p < 0.05). 186 patients received platelet infusions, of which 18 cases had rehaemorrhagia whereas among other 83 patients not receiving platelet infusions, 16 cases had rehaemorrhagia. Statistical analysis showed a significant difference between these two groups (p < 0.05). In the univariate logistic regression analysis of related data in patients with rehaemorrhagia after surgery of HCH, diastolic or systolic blood pressure at admission, the time from onset to surgery, coagulation disorder, surgical method, hematoma volume, cerebral hemia, effect of hematoma clearance and GCS at admission were the potential risk factors for rehaemorrhagia after surgery of HCH (p < 0.05). In the multivariate logistic regression analysis of related data in the same patients, diastolic blood pressure at admission (> 120 mmHg), systolic blood pressure at admission (> 200 mmHg), the time from onset to surgery and coagulation disorder were screened out (p < 0.05) to be associated with rehaemorrhagia.

CONCLUSIONS

Aspirin increased the risk of rehaemorrhagia after surgery of HCH. On the contrary, infusion of platelets decreased the risk of rehaemorrhagia and improved the prognosis of patients. High diastolic and/or high systolic blood pressure at admission, ultra-early surgery after onset of HCH and coagulation disorder were related with rehaemorrhagia after operation of HCH. Our results indicate that rehaemorrhagia rate can be decreased by controlling related risk factors.

[The value of combination of the mortality in emergency department sepsis score and blood lactate level in the risk stratification of severe sepsis in the emergency department]

OBJECTIVE

To evaluate the combination of the mortality in emergency department sepsis (MEDS) score with blood lactate level in the risk stratification of patients with severe sepsis in the emergency department (ED).

METHODS

665 adult patients with severe sepsis admitted from May 2011 to December 2012 in ED were found to be eligible for the study. MEDS score, acute physiology and chronic health evaluation II (APACHEII) score, and arterial blood lactate was determined, and the outcomes in 28 days were recorded. Logistic regression analysis was used to evaluate the relationship between each predictive factor score and prognosis. Each predictive factor was compared with the areas under the receiver operating characteristics (ROC) curve (AUC).

RESULTS

The mortality in 28 days was 34.6% in 665 patients. The mortality in group of MEDS score 12-27 was significantly higher than that group of MEDS score<12 [51.0% (156/306) vs. 20.6% (74/155), χ(2)=28.414, P=0.000]. In the meantime, APACHEII score and blood lactate level were also significantly higher in group of MEDS score 12-27 than those in group with MEDS score<12 [APACHEII score: 26.4±10.6 vs. 21.7±8.1, t=-3.555, P=0.002; lactate: 4.9 (2.3, 9.9) mmol/L vs. 3.9 (1.5, 8.9) mmol/L, Z=-2.352, P=0.023]. Kaplan-Meier survival analysis showed significant difference in the two groups (the Log Rank test 36.71, P<0.01). The levels of 3 predictive factors were predominantly higher in non-survivors than survivors [MEDS score: 14.1±6.7 vs. 8.2±4.5, t=-6.929, P=0.000; APACHEII score: 28.1±7.1 vs. 22.2±11.3, t=-6.472, P=0.000; lactate: 5.4 (2.9, 11.0) mmol/L vs. 3.8 (1.2, 9.1) mmol/L, t=-6.472, P=0.004]. The AUCs were 0.813, 0.706 and 0.727 for MEDS score, APACHEII score and blood lactate respectively. The predictive ability for 28-day mortality of MEDS score was better than blood lactate (P=0.008) and APACHEII score (P=0.005). The AUC of MEDS score combined with lactate was 0.865, and 28-day mortality prediction was better than MEDS score (AUC 0.865 vs. 0.813, P<0.001). The sensitivity (83.1%), specificity (93.2%), positive prediction value (PPV, 62.4%), and negative prediction value (NPV, 92.1%) for MEDS score combined with lactate were highest among all predictors.

CONCLUSIONS

MEDS score combined with lactate is a good risk stratification tool for emergency patients with severe sepsis, and its prognostic capability is better than either MEDS score, APACHEII score or blood lactate.

Lyn regulates cytotoxicity in respiratory epithelial cells challenged by cigarette smoke extracts

Cigarette smoking is associated with a series of lung diseases such as cancer, chronic obstructive pulmonary disease (COPD), and asthma. Despite the intense interest, the underlying molecular mechanism in smoking-related diseases is incompletely understood. Here, we show that Lyn is involved in cytotoxicity of respiratory epithelial cells induced by cigarette smoke extracts (CSE), an in vitro culture model for evaluating tobacco toxicity. In addition, exposure to CSE promotes the activation of JAK2 and STAT1, which is responsible for CSE-induced cytotoxicity. Moreover, a Lyn specific siRNA, Lyn dominant negative construct and pharmacological inhibitor all alleviated CSE-induced cytotoxicity in lung cells to different extents, respectively. Furthermore, Lyn also influences the phagocytosis of bacteria by murine alveolar macrophages, extending its impact on innate immunity. Taken together, these findings indicate that Lyn may play a role in the regulation of cigarette smoking-induced lung cell death, and may be a potential novel therapeutic target for cigarette smoking related lung diseases.

Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States

BACKGROUND

Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice.

AIMS

To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics.

METHODS

We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation.

RESULTS

We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts.

CONCLUSIONS

Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.

Re-ordering chaotic carbon: origins and application of textured carbon

Formation of nanocrystals with preferred orientation within the amorphous carbon matrix has attracted lots of theoretical and experimental attentions recently. Interesting properties of this films, easy fabrication methods and practical problems associated with the growth of other carbon nanomaterials such as carbon nanotubes (CNTs) and graphene gives this new class of carbon nanostructure a potential to be considered as a replacement for some applications such as thermal management at nanoscale and interconnects. In this short review paper, the fabrication techniques and associated formation mechanisms of these nanostructured films have been discussed. Besides, electrical and thermal properties of these nanostructured films have been compared with CNTs and graphene.

Positron emission tomography findings in patients with lymphoma-associated haemophagocytic syndrome

Lymphomas that manifest initially with haemophagocytic syndrome (HPS) often pose a diagnostic challenge, as the majority of cases have no significant lymphadenopathy for early histological diagnosis. There is paucity of data on specific features of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography with integrated computed tomography (PET/CT) in patients with lymphoma-associated HPS (LHPS). We describe three cases of LHPS and their characteristic PET imaging features. These three patients had pyrexia and pancytopenia. Their PET/CT images showed extensive and diffuse FDG uptakes in the bone marrow of the axial skeleton, with little involvement in the lymph nodes. They also faced a common initial diagnostic difficulty; the lack of nodal involvement on clinical examination or CT contributed to the delay in the diagnosis of lymphoma. The PET/CT images, however, revealed extensive and distinctive FDG uptakes in the axial skeletal marrow compartment, thus leading to a greater appreciation of the full extent of the disease.

Age of menopause and impact of climacteric symptoms by geographical region

OBJECTIVE

To describe differences in the age of onset of menopause and in the prevalence of climacteric symptoms in different geographical areas.

DESIGN

Systematic review of published data on onset of menopause and symptoms in Europe, North America, Latin America and Asia.

METHODS

We identified publications by searching electronic databases, including MEDLINE (1966-October 2009) and EMBASE (1975-October 2009). Primary search criteria were age of menopause and climacteric symptoms. A sensitive analysis that excluded papers without full data was performed.

RESULTS

The median age at menopause in Europe ranges from 50.1 to 52.8 years, in North America from 50.5 to 51.4 years, in Latin America from 43.8 to 53 years, and in Asia from 42.1 to 49.5 years. The frequency of vasomotor symptoms varies widely depending on the geographical region, selection of criteria, and method of symptom identification. The prevalence of such symptoms ranges from 74% of women in Europe, 36-50% in North America, 45-69% in Latin America and 22-63% in Asia, as reported in different, large, epidemiological studies.

CONCLUSION

There are wide geographical differences in the prevalence of menopausal symptomatology and some differences in the age of onset of menopause. Both in Asia and Latin America, women of poorer socioeconomic status have significantly earlier onset of menopause. Within a geographical region, there are ethnic differences in menopause symptoms. Given differences in study methodologies, firm conclusions are not possible. However, regional differences in age at menopause and in climacteric symptoms are important to acknowledge and lay the foundation for an informed approach to the management of menopause and an understanding of its impact on women's health in the different regions of the world.

Correlation of the long-term neurological outcomes with completeness of surgical evacuation in spontaneous supratentorial intracerebral haemorrhage: a retrospective study

INTRODUCTION

The treatment of primary spontaneous supratentorial intracerebral haemorrhage (ICH) by evacuation is not supported by randomised controlled trials. We investigate the effectiveness of the completeness of surgical evacuation of spontaneous supratentorial ICH with respect to the functional neurological outcome and mortality.

METHODS

A retrospective review of patients who underwent supratentorial ICH evacuations in the Neurosurgical Unit of the National University Hospital, Singapore, between January 2002 and December 2005 was conducted. Preoperative and postoperative computed tomography images were compared, and the patients or their family members completed follow-up questionnaires two years post surgery, in order to assess the neurological outcome.

RESULTS

The patients were subdivided into two groups based on the Glasgow Outcome Scale and haematoma volume. Patients with small pre-evacuation haematoma had a median percentage change in volume and a midline shift of 97.63 percent and 63 percent, respectively. Patients with a large haematoma volume had a median percentage change in volume and midline shift of 99.54 percent and 100 percent, respectively (the p-values for percentage change in volume and midline shift are 0.764 and 0.742, respectively). The median percentage change in volume for the poor outcome subgroup was 97.63 percent, compared to 100 percent for the good outcome subgroup (p-value is 0.288). The median change in midline shift in the poor and good outcome subgroups was 63 percent and 100 percent, respectively (p-value is 0.576).

CONCLUSION

Although not statistically significant with regard to the completeness of haematoma evacuation, a trend toward better outcome with more complete evacuation is observed with ICH.

Guidelines for hormone replacement therapy of Asian women during the menopausal transition and thereafter

These Guidelines summarize the position of an Expert Panel on Menopause in Asian Women regarding the use of hormone replacement therapy (HRT) during the menopausal transition and thereafter. They are intended to aid gynecologists, family physicians and other health-care professionals in providing optimal care to menopausal Asian women who desire HRT.

Effect of topical atropine on astigmatism

AIM

The aim of this study was to determine if topical atropine, used to retard axial length elongation and myopia progression, had any effect on ocular astigmatism.

METHODS

Data collected from subjects enrolled in the Atropine in the Treatment of Myopia (ATOM) study were analysed. In this study, 400 myopic children (aged 6-12 years) were randomly assigned to administer atropine 1% or a placebo daily to a randomly selected eye for 2 years. Cycloplegic autorefraction and keratomy readings were measured using a Canon RK5 autorefractor. The refractive error was then split into its power vector components: J0 and J45.

RESULTS

Astigmatism increased by 0.12-0.16 D per year in both treated and placebo groups. There was no difference between groups (p = 0.182). The increase was mirrored by an increase in corneal astigmatism of 0.10-0.13 D per year, suggesting that most of the change was corneal in nature. There was an increase in J0 vector (with-the-rule astigmatism) with no change in the J45 (oblique) vector over time. The change in the J0 vector was significantly larger in the atropine-treated versus atropine-untreated eyes during the 2-year treatment period (p = 0.011), but this difference disappeared after atropine was stopped.

CONCLUSION

The use of atropine on a daily basis over 2 years did not have any clinically significant effect on astigmatism.

Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review

Objective: To systematically review the literature investigating the effectiveness of physiotherapy in adults with cerebellar dysfunction and to document treatment strategies currently employed in the physiotherapy management of this patient population.

Data sources: Eight electronic databases were searched to source English-language studies published up to December 2007. Secondary searching of reference lists was also undertaken.

Review methods: Studies were included if they used a quantitative research design to investigate the effect of physiotherapy on adults with diagnosed cerebellar dysfunction. Three reviewers were involved in study selection. Eligible studies were assessed for methodological quality. Data pertaining to the participants, interventions received, outcomes measured, and the effectiveness of the intervention were systematically extracted and synthesised in a narrative format.

Results: Nine studies were included in the review. The majority of the studies (n = 7) were case studies or case series. The median quality score was 8/16 (range 4—10). The studies were heterogeneous in terms of patient characteristics, interventions received and outcomes measured. All studies reported positive effects of physiotherapy over a range of outcomes measured, in particular balance, gait and function.

Conclusion: There is some evidence that supports the effectiveness of physiotherapy in adults with cerebellar dysfunction. However, these results need to be interpreted with caution due to the low volume, quality and clinical applicability of this evidence. There is a need for further high-quality research in this area.

Identification and expression of the achaete-scute complex in the silkworm, Bombyx mori

Recently, the study of achaete-scute (AS-C) homologues has contributed enormously to understanding of gene duplication and function evolution, particularly in Diptera. We identified four AS-C homologue genes in the silkworm, Bombyx mori, referred to as BmASH, BmASH2, BmASH3, and Bmase. The complex displayed tandem array structure in the genome. Analysis of spatial expression profiles showed that they all were expressed in obviously higher levels in wing disc than in other tissues, suggesting that they might play important roles in the development of the wing. Furthermore, we found that their expression profiles in the wing discs were mostly correlated with the development of the scales, especially the BmASH gene. RNA interference results further indicated that BmASH was necessary for scale formation in silkworm wing.

Carbonyl-scavenging drugs & protection against carbonyl stress-associated cell injury

This mini-review highlights the chemical and cytoprotective properties of various hydralazine analogues that block the induction of cell death by acrolein, a highly toxic contributor to "carbonyl stress" during a diverse range of human diseases. Recent work on the action of hydralazine against various carbonyl-mediated pathologies is also reviewed.

Epithelial-mesenchymal transition (EMT) and activated extracellular signal-regulated kinase (p-Erk) in surgically resected pancreatic cancer

BACKGROUND

EMT or transformation to the mesenchymal phenotype plays an important role in tumor invasion and metastasis. In vitro data suggest that mesenchymal transformation may correlate with the activation of PI3 kinase and Ras/Erk pathways. We investigated the expression of EMT markers (low E-cadherin, high fibronectin, and vimentin) and their association with p-Erk in resected pancreatic cancer.

METHODS

Clinical data/surgical specimens from 34 consecutive pancreatic cancer patients (pts) who underwent pancreatectomy were included. Immunohistochemical staining was performed on formalin-fixed paraffin-embedded tissues using monoclonal antibodies against vimentin, fibronectin, E-cadherin, and p-Erk. The results were correlated with clinicopathological parameters and survival. Survival analysis (log-rank test, Cox proportional hazard model), categorical data analysis (Pearson's chi-square, Fisher's exact test) and Kendall's tau were performed at a significance level of 0.05.

RESULTS

The patient population was formed from 13 males and 21 females, with a median age of 66 years (range 38-84 years); American Joint Committee on Cancer (AJCC) stage 1 (n = 2), 2 (n = 27), 3 (n = 5); histological grade 1 (n = 4), 2 (n = 13), 3 (n = 16), 4 (n = 1). Median survival was 15 months (95% CI: 11-24 months). Fibronectin overexpression correlated with the presence of vimentin (p = 0.0048) and activated Erk (p = 0.0264). There was a borderline association of fibronectin with worsening grade (p = 0.06). A negative association between vimentin and E-cadherin was noted (p = 0.0024). Increased fibronectin or vimentin and decreased E-cadherin correlated with poor survival.

CONCLUSION

EMT is associated with poor survival in surgically resected pancreatic adenocarcinoma. A correlation between activated Erk and fibronectin was identified that may open avenues for targeted therapy for this subgroup.

Morphoproteomic depiction of constitutively activated mTOR and ERK pathways in adenocarcinoma of the large intestine: A pilot study

14580

Background: Preclinical studies have demonstrated a role for the mammalian target of rapamycin (mTOR) pathway in intestinal tumorigenesis. However, the mTOR and its related ERK pathway in human adenocarcinoma of the large intestine (ALI) have been little examined. Methods: To assess morphoproteomic alterations of ALI, tissue materials from three patients with ALI were analyzed in the present study. Antibody probes used included phosphorylated (p)-mTOR (Ser-2448) and one of its downstream effectors, p-p70S6K (Thr-389); bcl-2, which undergoes mTOR-dependent phosphorylative inactivation; and p-extracellular signal-regulated kinase (ERK)1/2 (Thr-202/Tyr-204), a co-activator of p-p70S6K. The intensity of the chromogenic signal and the cellular compartmentalization (plasmalemmal, cytoplasmic, and/or nuclear) were assessed and scored on a scale of 0–3+. Results: Moderate to strong (up to 2+ or 3+) expression of p-mTOR and its substrate, p-p70S6K, and p-ERK1/2 was present in all three cases. We also found plasmalemmal translocation of p-mTOR and nuclear translocation of p-p70S6K and p-ERK1/2, indicating constitutive activation of these protein analytes and their corresponding signal transduction pathways. We did not detect bcl-2 expression in any of these cases. Conclusions: Morphoproteomic analysis reveals constitutive activation of the mTOR and ERK pathways in ALI as evidenced by the collective commonalities of expression of p-mTOR, p-p70S6K, and p- ERK1/2 and the plasmalemmal translocation of p-mTOR and nuclear translocation of p-p70S6K and p-ERK1/2. The absence of bcl-2 expression in this context is noteworthy. These findings coincide with the preclinical data on the efficacy of rapamycin and a rapamycin analogue against colon cancer cell lines and xenograft models. Although preliminary, these observations of morphoproteomic alterations represent the first in primary human ALI specimens according to a review of the literature. The present pilot study offers a starting point for further studies (we are currently conducting a confirmatory study with larger series of cases) and the design of clinical trials using such small molecule inhibitors(e.g. rapamycin, RAD001) in a combinational strategy against ALI.

No significant financial relationships to disclose.

Low-dose dexamethasone and thalidomide with higher frequency zoledronic acid (dtZ) for newly diagnosed multiple myeloma

18506

Background: Although dexamethasone (Dex), thalidomide (Thal) and zoledronic acid (Zol) have frequently been combined for the treatment of multiple myeloma (MM), the ideal dosing schedule is unknown. We previously reported that lower doses of Dex and Thal can be effectively combined with high-frequency dosing of Zol (Haematologica 2005). Methods: This “dtZ” regimen - which comprises weekly Dex 20 mg OM for 4 days, Thal 50 mg ON, and 3-weekly Zol 4 mg - resulted in an impressive response rate (RR) of 61.6% and near complete remission (nCR)/complete remission (CR) rate of 7.7% in 26 patients with relapsed/refractory MM. Results: In this present study, we treated 22 newly diagnosed MM patients with “dtZ” and report an even more impressive RR of 100.0% and nCR/CR rate of 20–35%. The median time to response was 1.8 months and median time to maximum response was 2.2 months. The median time to progression (TTP) has not been achieved yet. As expected, low-dose Dex/Thal resulted in lower (18.1%) grade 3 or 4 toxicities. These were all infections; which lead to further dose-reduction of Dex. There were no thromboembolic events, despite the fact that aspirin was not routinely given. Of particular interest, 3- weekly Zol was not associated with any significant decrease in renal function, and none of our patients developed osteonecrosis of the jaw (ONJ). In fact, at the time of writing of this abstract, more than 1,000 doses of Zol had been administered in a 3-weekly fashion to these as well as other patients, and only 1 patient developed ONJ. This patient who had already received greater than 20 doses of Zol healed uneventfully after receiving appropriate outpatient dental treatment, and subsequently received another 8 doses of Zol with no recurrence of ONJ. Conclusion: In conclusion, the Zol-based “dtZ” regimen is potentially a highly-effective and safe frontline regimen for MM. Using Zol every 3 weeks with lower doses of Dex and Thal does not appear to increase the rate or severity of nephrotoxicity or ONJ. Although we do not know exactly why every patient responded to “dtZ”, we speculate that this could be due to a critical balance that has been achieved between the anti-MM, anti-osteoclastic and immunostimulatory effects of the individual drugs of the combination.

No significant financial relationships to disclose.