Sensitivity of broiler performance, organ weights and plasma constituents to amino acid supplementation and reused litter exposure using ideal protein-formulated rations

Effects of amino acid supplementation to ideal protein (IP) formulated rations were investigated on growth performance, plasma metabolites and organ weights of broilers placed on 100% recycled (reused) litter. Day-old Ross308 male broilers were raised on either clean or reused litter and fed for three weeks on one of five isoenergetic diets, where an IP-based control diet (C) was compared with diets containing threonine (T) or arginine (A) at 25% above requirements, or with 1% supplemented glutamine (G), or with each amino acid added (TAG). Litter and diet treatments did not strongly interact on outcomes. Reused litter placement resulted in greater weight gain, smaller feed conversion ratio and heavier bursal weights (P < 0.05) compared to clean litter placement. Relative to C and T birds, TAG birds reduced weight gain and feed intake (P < 0.05). Plasma uric acid levels in G birds were greater than in C, T and A birds (P < 0.001). Collectively, since the outcomes of placement on reused litter increased performance and the control diet was IP formulated, the absence of increased growth performance in response to amino acid supplementation would be consistent with amino acids tested being excess to requirements.

Ti-30Nb-3Ag alloy with improved corrosion resistance and antibacterial properties for orthopedic and dental applications produced by mechanical alloying

Titanium alloys have gained popularity as a bioimplant material due to their biocompatibility, low modulus of elasticity, and increased strength. However, other issues, such as corrosion resistance, and infections can reduce the implant's lifespan. This paper aims to fabricate a new Ti-30Nb-3Ag at% alloy with enhanced in vitro corrosion and antibacterial properties by mechanical alloying (MA) followed by powder consolidation. XRD, SEM/EDX, and Vickers microhardness analyses were used to examine the phases compositions, microstructure, and microhardness, respectively. The in vitro corrosion performance of Ti-30Nb-3Ag alloy was inspected in a simulated body medium and artificial saliva. The alloy's antibacterial properties were evaluated in the gram-positive and negative bacterial medium. The results showed that after MA for 60 h, nanocrystalline β-Ti (BCC) and α-Ti (HCP) solid solutions were formed with crystallite sizes of 7.44 and 3.47 nm, respectively. The sintered sample exhibited densifications of 97%, with a microstructure composed of β-Ti, α-Ti, and a minor quantity of ultrafine Ti₂Ag phase. The microhardness result showed that Ti-30Nb-3Ag alloy possesses HV 491.5. Ti-30Nb-3Ag alloy has a potent antibacterial capability of 85.75% and 88.81% relative to Ti-6Al-4V alloy and CP-Ti, respectively. In vitro corrosion results revealed that the Ti-30Nb-3Ag alloy exhibited the widespread passive area in the investigated anodic regions and presented the highest impedance values in comparison with the commercial alloys, confirming its improved corrosion resistance performance in both studied mediums. Ti-30Nb-3Ag alloy possibly be a competitive bioimplant material for orthopedic and dental uses owing to its enhanced biocorrosion and antibacterial properties compared to commercial Ti-6Al-4V alloy and CP-Ti.

Myelopreservation with the CDK4/6 inhibitor trilaciclib in patients with small-cell lung cancer receiving first-line chemotherapy: a phase Ib/randomized phase II trial

BACKGROUND

Chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPC) causes multi-lineage myelosuppression. Trilaciclib is an intravenous CDK4/6 inhibitor in development to proactively preserve HSPC and immune system function during chemotherapy (myelopreservation). Preclinically, trilaciclib transiently maintains HSPC in G1 arrest and protects them from chemotherapy damage, leading to faster hematopoietic recovery and enhanced antitumor immunity.

PATIENTS AND METHODS

This was a phase Ib (open-label, dose-finding) and phase II (randomized, double-blind placebo-controlled) study of the safety, efficacy and PK of trilaciclib in combination with etoposide/carboplatin (E/P) therapy for treatment-naive extensive-stage small-cell lung cancer patients. Patients received trilaciclib or placebo before E/P on days 1-3 of each cycle. Select end points were prespecified to assess the effect of trilaciclib on myelosuppression and antitumor efficacy.

RESULTS

A total of 122 patients were enrolled, with 19 patients in part 1 and 75 patients in part 2 receiving study drug. Improvements were seen with trilaciclib in neutrophil, RBC (red blood cell) and lymphocyte measures. Safety on trilaciclib+E/P was improved with fewer ≥G3 adverse events (AEs) in trilaciclib (50%) versus placebo (83.8%), primarily due to less hematological toxicity. No trilaciclib-related ≥G3 AEs occurred. Antitumor efficacy assessment for trilaciclib versus placebo, respectively, showed: ORR (66.7% versus 56.8%, P = 0.3831); median PFS [6.2 versus 5.0 m; hazard ratio (HR) 0.71; P = 0.1695]; and OS (10.9 versus 10.6 m; HR 0.87; P = 0.6107).

CONCLUSION

Trilaciclib demonstrated an improvement in the patient's tolerability of chemotherapy as shown by myelopreservation across multiple hematopoietic lineages resulting in fewer supportive care interventions and dose reductions, improved safety profile, and no detriment to antitumor efficacy. These data demonstrate strong proof-of-concept for trilaciclib's myelopreservation benefits.

CLINICAL TRAIL NUMBER

NCT02499770.

PEDOT/FHA nanocomposite coatings on newly developed Ti-Nb-Zr implants: Biocompatibility and surface protection against corrosion and bacterial infections

The fabrication of bioactive polymer nanocomposite coatings with enhanced biocompatibility and surface protection has been a topic of abundant concern in orthopaedic implant applications. Herein, we electrochemically prepared a novel poly (3,4-ethylenedioxythiophene) (PEDOT) based nanocomposite coatings with different contents of fluoro hydroxyapatite (FHA) nanoparticles on a newly developed Ti-Nb-Zr (TNZ) alloy; an appropriate approach to advance the surface features of TNZ implants. FTIR, XRD, and Raman analyses of the coating confirm the successful preparation of PEDOT/FHA nanocomposite, and XPS validate the chemical interaction between FHA and PEDOT matrix. SEM and TEM examination show the uniform distribution of spherical FHA nanoparticles inside the PEDOT matrix. Hardness and contact angle measurement results showed improving in the hardness and surface wettability of the coated samples respectively. Electrochemical corrosion tests specified that the PEDOT/FHA coatings exhibit higher corrosion protection than the pure PEDOT coatings. The fabricated nanocomposite coating supports the cell adsorption and proliferation of MG-63 cells. Moreover, antibacterial studies against Gram positive and negative bacteria reveal the enhanced antibacterial performance of the coated TNZ substrates. Our results show the potential applications of PEDOT/FHA nanocomposite as a most viable coating for the orthopaedic implants.

Influence of surface treatment on PEDOT coatings: surface and electrochemical corrosion aspects of newly developed Ti alloy

Surface treatment of metallic materials prior to the application of polymer coatings plays an important role in providing improved surface features and enhanced corrosion protection. In the current investigation, we aimed to evaluate the effect of surface treatment of newly developed TiNbZr (TNZ) alloys on the surface characteristics, including the surface topography, morphology, hydrophobicity and adhesion strength of subsequent poly(3,4-ethylenedioxythiophene) (PEDOT) coatings. The surface morphology, chemical composition, and surface roughness of both treated and coated alloys were characterized by scanning electron microscopy, energy dispersive spectroscopy, and optical profilometry, respectively. The adhesion strength of the coating was measured using a micro scratch machine. Furthermore, we also evaluated the performance of electrochemically synthesized PEDOT coatings on surface-treated TNZ alloys in terms of the surface protective performance in simulated body fluid (SBF) and in vitro bioactivity in osteoblast MG63 cells. Surface analysis findings indicated that the nature of the PEDOT coating (surface morphology, topography, wettability and adhesion strength) was intensely altered, while the surface treatment performed before electrodeposition facilitated the overall performance of PEDOT coatings as implant coating materials. The obtained corrosion studies confirmed the enhanced corrosion protection performance of PEDOT coatings on treated TNZ substrates. In vitro cell culture studies validated the improved cell adhesion and proliferation rate, further highlighting the important role of surface treatment before electrodeposition.

An efficient method for retro-Claisen-type C–C bond cleavage of diketones with tropylium catalyst

We report a new convenient and efficient method utilizing the tropylium ion as a mild and environmentally friendly organocatalyst to mediate retro-Claisen-type reactions.

Universal Linear Fit Identification: A Method Independent of Data, Outliers and Noise Distribution Model and Free of Missing or Removed Data Imputation

Data processing requires a robust linear fit identification method. In this paper, we introduce a non-parametric robust linear fit identification method for time series. The method uses an indicator 2/n to identify linear fit, where n is number of terms in a series. The ratio R_max of a_max− a_min and S_n− a_min*n and that of R_min of a_max− a_min and a_max*n − S_n are always equal to 2/n, where a_max is the maximum element, a_min is the minimum element and S_n is the sum of all elements. If any series expected to follow y = c consists of data that do not agree with y = c form, R_max> 2/n and R_min> 2/n imply that the maximum and minimum elements, respectively, do not agree with linear fit. We define threshold values for outliers and noise detection as 2/n * (1 + k₁) and 2/n * (1 + k₂), respectively, where k₁ > k₂ and 0 ≤ k₁≤ n/2 − 1. Given this relation and transformation technique, which transforms data into the form y = c, we show that removing all data that do not agree with linear fit is possible. Furthermore, the method is independent of the number of data points, missing data, removed data points and nature of distribution (Gaussian or non-Gaussian) of outliers, noise and clean data. These are major advantages over the existing linear fit methods. Since having a perfect linear relation between two variables in the real world is impossible, we used artificial data sets with extreme conditions to verify the method. The method detects the correct linear fit when the percentage of data agreeing with linear fit is less than 50%, and the deviation of data that do not agree with linear fit is very small, of the order of ±10⁻⁴%. The method results in incorrect detections only when numerical accuracy is insufficient in the calculation process.

Density, ultrasound velocity, acoustic impedance, reflection and absorption coefficient determination of liquids via multiple reflection method

The accuracy of density, reflection coefficient, and acoustic impedance determination via multiple reflection method was validated experimentally. The ternary system water-maltose-ethanol was used to execute a systematic, temperature dependent study over a wide range of densities and viscosities aiming an application as inline sensor in beverage industries. The validation results of the presented method and setup show root mean square errors of: 1.201E-3 g cm(-3) (±0.12%) density, 0.515E-3 (0.15%) reflection coefficient and 1.851E+3 kg s(-1) m(-2) (0.12%) specific acoustic impedance. The results of the diffraction corrected absorption showed an average standard deviation of only 0.12%. It was found that the absorption change shows a good correlation to concentration variations and may be useful for laboratory analysis of sufficiently pure liquids. The main part of the observed errors can be explained by the observed noise, temperature variation and the low signal resolution of 50 MHz. In particular, the poor signal-to-noise ratio of the second reflector echo was found to be a main accuracy limitation. Concerning the investigation of liquids the unstable properties of the reference material PMMA, due to hygroscopicity, were identified to be an additional, unpredictable source of uncertainty. While dimensional changes can be considered by adequate methodology, the impact of the time and temperature dependent water absorption on relevant reference properties like the buffer's sound velocity and density could not be considered and may explain part of the observed deviations.

Ultrasonic sensor for predicting sugar concentration using multivariate calibration

This paper presents a multivariate regression method for the prediction of maltose concentration in aqueous solutions. For this purpose, time and frequency domain of ultrasonic signals are analyzed. It is shown, that the prediction of concentration at different temperatures is possible by using several multivariate regression models for individual temperature points. Combining these models by a linear approximation of each coefficient over temperature results in a unified solution, which takes temperature effects into account. The benefit of the proposed method is the low processing time required for analyzing online signals as well as the non-invasive sensor setup which can be used in pipelines. Also the ultrasonic signal sections used in the presented investigation were extracted out of buffer reflections which remain primarily unaffected by bubble and particle interferences. Model calibration was performed in order to investigate the feasibility of online monitoring in fermentation processes. The temperature range investigated was from 10 °C to 21 °C. This range fits to fermentation processes used in the brewing industry. This paper describes the processing of ultrasonic signals for regression, the model evaluation as well as the input variable selection. The statistical approach used for creating the final prediction solution was partial least squares (PLS) regression validated by cross validation. The overall minimum root mean squared error achieved was 0.64 g/100 g.

Outlier detection method in linear regression based on sum of arithmetic progression

We introduce a new nonparametric outlier detection method for linear series, which requires no missing or removed data imputation. For an arithmetic progression (a series without outliers) with n elements, the ratio (R) of the sum of the minimum and the maximum elements and the sum of all elements is always 2/n : (0,1]. R ≠ 2/n always implies the existence of outliers. Usually, R < 2/n implies that the minimum is an outlier, and R > 2/n implies that the maximum is an outlier. Based upon this, we derived a new method for identifying significant and nonsignificant outliers, separately. Two different techniques were used to manage missing data and removed outliers: (1) recalculate the terms after (or before) the removed or missing element while maintaining the initial angle in relation to a certain point or (2) transform data into a constant value, which is not affected by missing or removed elements. With a reference element, which was not an outlier, the method detected all outliers from data sets with 6 to 1000 elements containing 50% outliers which deviated by a factor of ±1.0e - 2 to ±1.0e + 2 from the correct value.

Psychosocial paediatric training in Iraq: perspectives of trainers and students

There is an absence of education regarding psychosocial issues in Iraqi paediatric training programmes. The aim of this study is to examine current knowledge and perspectives around these topics and to explore potential development in these programmes. 56 paediatric trainers and students at the Child Central Teaching Hospital, a hospital affiliated to the Al-Mustansyria medical college in Baghdad, responded to a questionnaire to evaluate knowledge and perspectives regarding psychosocial approaches to child and adolescent health as delivered presently via academic training and used in professional practice. The majority of the respondents reported having no training in psychosocial interventions. Using a scale from 0 ('not relevant') to 10 ('very important'), psychosocial issues were rated 7.1 in their relevance to everyday paediatric practice. On a scale of 0 ('very poor') to 10 ('totally adequate'), respondents rated formal current psychosocial training at 2.5. It is concluded that incorporating psychosocial approaches in paediatric training will lead to a broader base of knowledge in children's health and contribute to the promotion of multidisciplinary practice in Iraq.

Investigating and understanding fouling in a planar setup using ultrasonic methods

Fouling is an unwanted deposit on heat transfer surfaces and occurs regularly in foodstuff heat exchangers. Fouling causes high costs because cleaning of heat exchangers has to be carried out and cleaning success cannot easily be monitored. Thus, used cleaning cycles in foodstuff industry are usually too long leading to high costs. In this paper, a setup is described with which it is possible, first, to produce dairy protein fouling similar to the one found in industrial heat exchangers and, second, to detect the presence and absence of such fouling using an ultrasonic based measuring method. The developed setup resembles a planar heat exchanger in which fouling can be made and cleaned reproducible. Fouling presence, absence, and cleaning progress can be monitored by using an ultrasonic detection unit. The setup is described theoretically based on electrical and mechanical lumped circuits to derive the wave equation and the transfer function to perform a sensitivity analysis. Sensitivity analysis was done to determine influencing quantities and showed that fouling is measurable. Also, first experimental results are compared with results from sensitivity analysis.

Controlling the sugar beet fly Pegomyia mixta Vill. with entomopathogenic nematodes

Sugar beet, Beta vulgaris L. is a strategic crop of sugar industry in Egypt. It is threatened by several insect pests among most important of them is the beet fly Pegomyia mixta. This work deals with the biological control of this insect using four entomopathogenic nematodes (EPNs). The nematodes included Steinernema carpocapsae S2, Steinernema feltiae, Heterorhabditis bacteriophora (HB1-3) and Heterorhabditis bacteriophora S1. Daily mortality of larvae and pupae of P. mixta were recorded after treatment with serial concentrations (500, 1000, 2000 and 4000 infective juveniles (IJs)/ml) of each of four studied EPNs. In the laboratory all tested nematodes killed the larvae inside their mines in the sugar beet leaves and developed in their bodies in different extends. They also killed the insect pupae in the soil and developed in their bodies. Young larvae were more susceptible than old ones. New pupae were more susceptible than old ones. In the field a single spray of S. feltiae or H. bacteriophora caused 81.3 or 75.9% reduction in the larval population of the in sugar beet leaves.

Phase II study of pegylated liposomal doxorubicin (PLD), low-dose dexamethasone (DEX), and lenalidomide (LEN) in patients with newly diagnosed (ND) multiple myeloma (MM)

8518

Background: We previously reported the results of a phase I/II trial of PLD, low dose DEX and LEN in patients with relapsed and refractory MM in which the MTD of LEN was 10 mg (for 21 of 28 days) and the overall response rate was 75% with 29% of patients achieving nCR or better (Ann Oncol 2006). Accordingly we evaluated this regimen in ND MM. Methods: We hypothesized that patients with ND MM would tolerate this combination better. Accordingly, patients received PLD (40 mg/m2 on day 1), DEX (40 mg on days 1–4) and LEN (25 mg Days 1–21) every 28 days (for 2 cycles beyond best response: 4–8 cycles). Prophylactic low dose aspirin, acyclovir and fluoroquinolone were recommended. Patients not eligible or not wishing to proceed with high dose therapy continued on the tolerated dose of LEN and DEX until disease progression or unacceptable toxicity. Results: Between 2/2008 and 8/2008, 31 of a planned 60 patients were enrolled. 2 patients were screen failures and are not included in subsequent analysis. The mean age was 64 years (41–82) and 58% were males. The median β2microglobulin was 2.8 mg/dL (34% had β2m>3.5). Using the modified SWOG criteria and after a median of 4 cycles of therapy, the overall response rate was 80% with 40% VGPR and better. Two patients had stable disease and 3 patients had progressive disease. Grade 3/4 hematologic toxicity was as follows: neutropenia (48%), anemia (10%), thrombocytopenia (7%). Grade 3/4 non-hematologic toxicity included: Fatigue (21%), infections and febrile neutropenia (20%, only 1 patient with febrile neutropenia), venous thromboembolic events (10%). 14 patients went off study including 8 patients to proceed with high dose therapy. Conclusions: The combination of PLD, LEN and DEX is an active regimen in patients with ND MM. Due to the unexpected higher rates of neutropenia and fatigue, the dose of PLD will be decreased to 30 mg/m2 every 28 days. Updated results will be presented at the time of the meeting.

[Table: see text]

An analysis of erythropoietin (EPO) and venous thromboembolic events (VTE) in multiple myeloma (MM) patients (pts) treated with anthracycline-based chemotherapy and the immunomodulator agent thalidomide

8107

Background: The use of EPO has recently been reported to be associated with higher rates of VTE in MM pts receiving lenalidomide or thalidomide and dexamethasone (Knight et al. NEJM 2006). Uncontrolled erythrocytosis, a recognized risk factor for VTE, may complicate therapy with EPO when the hemoglobin is not carefully monitored. Other risk factors such as renal failure in this pt population might contribute to hypercoagulability. We sought to evaluate the contribution of EPO use to the development of VTEs in pts with MM treated with the immunomodulator agent thalidomide in combination with chemotherapy. Methods: We retrospectively reviewed records of 105 pts enrolled on a clinical trial for newly diagnosed or relapsed MM pts with pegylated liposomal doxorubicin, vincristine, dexamethasone and thalidomide (DVd-T). In this study pts pts were aggressively monitored for VTE as previously described (Hussein et al Mayo Clin.Proc. 81 (7):889–895, 2006). Demographic variables, aspirin therapy (on intent to treat basis), EPO therapy, as well as the occurrence of VTEs were extracted. Results: The median age was 63 years and 62 (59%) received EPO in conjunction with their MM therapy. VTE prophylaxis with aspirin (81mg daily) was administered to all but 21 pts. Of the 62 pts receiving EPO, 15 (24%) had a VTE compared to 11 (26%) who did not receive EPO (OR 0.928, 95% CI 0.38 - 2.3). Among the 21 pts who did not receive aspirin as VTE prophylaxis, 11 (52%) experienced a VTE compared to 18% (15/84) in those who did receive aspirin as VTE prophylaxis (OR 5.1, 95% CI 1.8 - 14). In the subgroup of 62 pts that received EPO, 54% (7/13) of pts who did not receive aspirin developed a VTE compared to 16% (8/49) who received aspirin and developed a VTE (OR 6, 95% CI 1.6 - 22.6), which is comparable to the overall study population. Conclusions: These results do not indicate an association between EPO use and VTE in MM pts receiving anthracycline-based chemotherapy with the immunomodulator thalidomide and on intent to treat basis low dose aspirin is effective in reducing the incidence of VTE with this complex regimen.

[Table: see text]

Prediction of response and progression in multiple myeloma (MM) with serum-free light chains (sFLC): Corroboration of the International Myeloma Working Group (IMWG) criteria

8047

Background: The sFLC assay was proposed as a tool for the assessment of response in patients with non-secretory or oligosecretory MM and patients with primary amyloidosis. Response and progression criteria have been proposed by the IMWG, but have not been thoroughly validated. Methods: Electronic records of patients (pts) with MM enrolled in various clinical trials at the Cleveland Clinic between 4/2004 and 12/2006 were reviewed. Response to treatment and progression were assessed using the European Blood and Bone Marrow Transplantation (EBMT) criteria for all pts. sFLC responses were defined per IMWG criteria: response (R, decrease in the difference between the involved and uninvolved light chain by greater than 50%), progression (P, increase in the difference between the involved and uninvolved light chain by greater than 25%), and stable disease (SD, not meeting the criteria for either R or P). sFLC responses were assessed in pts with involved FLC =10 mg/dL (=100mg/L) per the IMWG criteria. Results: 89 pts were identified. The median age was 61 years (range 41–87) and 58 pts were males. The involved light chain was kappa in 67 pts (75%), and lambda in the remainder. By EBMT criteria, 4 pts had a complete response, 22 a partial response, 34 stable disease, 26 progressive disease and 3 were inevaluable. Only 43/89 pts (48%) had an involved sFLC=10mg/dL; of which 14 had R, 8 had SD, 18 had P, and 3 were inevaluable. Table 1 reviews the test characteristics for sFLC assay for the prediction of response or progression. Conclusions: sFLC reliably predicts response and progression in MM pts. However, half the pts had an involved sFLC that would not be considered evaluable by IMWG, which limits its potential use.

No significant financial relationships to disclose.

[Table: see text]

Recombinant human erythropoietin is associated with increased overall survival in patients with multiple myeloma

BACKGROUND

Recombinant human erythropoietin (rhEPO) is effective for the treatment of anemia associated with multiple myeloma. Data from animal studies and case reports suggest that rhEPO has antineoplastic properties.

METHODS

Two hundred and ninety-two patients enrolled on different chemotherapy clinical trials at the Cleveland Clinic Myeloma Program between 1997 and 2003 were the subjects of this study. Information on erythropoietin use as well as baseline prognostic variables were collected retrospectively.

RESULTS

The population consisted of 257 patients with multiple myeloma treated at the Cleveland Clinic Foundation from 1997 to 2003 and followed for at least 1 month. Thirty-five patients were excluded from this analysis because information on erythropoietin use was not available. One hundred and twenty-seven patients received rhEPO for at least 1 month and the rest did not received rhEPO. On average, patients who received rhEPO were older, had a higher Southwest Oncology Group (SWOG) stage, higher serum creatinine, lower serum hemoglobin, higher beta2-microglobulin, lower platelet counts, and a longer time from diagnosis to enrollment at the myeloma program (p < 0.001 for all). After adjusting for age, months from diagnosis to enrollment, serum creatinine, hemoglobin, platelet count, and beta2-microglobulin, the use of rhEPO was associated with improved overall survival (hazard ratio = 0.6; 95% CI = 0.38-0.94) in patients with SWOG stages II, III and IV but not in patients with SWOG stage I.

CONCLUSION

rhEPO was associated with improved overall survival in this population of anemic multiple myeloma patients with SWOG stages of II, III and IV. A prospective randomized trial is warranted to corroborate this finding.

Lenalidomide and pegylated liposomal doxorubicin-based chemotherapy for relapsed or refractory multiple myeloma: safety and efficacy

BACKGROUND

Lenalidomide is active and well tolerated in relapsed and refractory multiple myeloma. We conducted a phase I/II trial of the combination of lenalidomide and chemotherapy to evaluate the safety and efficacy of the combination.

METHODS

The 62 patients enrolled received liposomal doxorubicin 40 mg/m(2) i.v. and vincristine 2 mg i.v. on day 1, dexamethasone 40 mg p.o. on days 1-4 (DVd), and lenalidomide on days 1-21 in 28-day cycles. Primary end points were maximum tolerated dose (MTD) of lenalidomide with DVd chemotherapy and overall response rate (ORR) by Southwest Oncology Group criteria of the combination.

FINDINGS

The median age was 62 years, 70% of patients were males and 65% had refractory multiple myeloma. The MTD of lenalidomide with DVd chemotherapy was 10 mg and the dose-limiting toxicity was non-neutropenic sepsis. After 7.5 months of median follow-up, the ORR of the combination was 75%, with 29% of patients achieving a complete or near complete remission. The median progression-free survival was 12 months, while the median overall survival has not yet been reached.

INTERPRETATION

The combination of lenalidomide and DVd chemotherapy was well tolerated and resulted in high response rates in this mostly refractory patient population. Evaluation of this combination in newly diagnosed patients is warranted.

Phase II study of dexamethasone, ascorbic acid, thalidomide and arsenic trioxide (DATA) in high risk previously untreated (PU) and relapsed/refractory (RR) multiple myeloma (MM)

17535

Background: The combination of Thalidomide (T) and Dexamethasone (D) is often used first line in patients with MM. Arsenic trioxide (ATO) is active and well tolerated in patients with RR MM. ATO, D and T have non-overlapping toxicity. We therefore initiated a phase II study to assess the efficacy and toxicity of this combination in patients with high risk PU MM (serum B2 microglobulin>5.5, chromosome 13 or 14 abnormalities by FISH or the presence of peripheral plasma cells) and RR MM. Methods: On week 1, ATO was given at a dose of 0.25mg/kg IV on days 1–5. On weeks 2–12, ATO was given at the same dose twice weekly. On weeks 13–16, the patients did not receive treatment. Ascorbic acid 1000mg IV was given after each ATO infusion. D was given at a dose of 20mg orally on days 1–4 of a 28 days cycle, and T was started at a dose of 50mg daily and increased as tolerated to a dose of 100mg daily. A similar 16 weeks consolidation course was given. Maintenance included ATO 0.25mg/kg on days 1,8,15 and 22 every 12 weeks in addition to the above schedule for D, T and Ascorbic acid. Results: Sixteen patients were enrolled (3 with PU and 13 RR), 13 are evaluable for response. The median age was 57 years and 62% were males. The median number of prior chemotherapy regimen is 2 (range 0–6), 7 patients had received a prior T containing regimen, and 2 patients had received an ATO-containing regimen. Seven, seven and two patients had SWOG stages 2, 3 and 4 respectively. The mean serum B2 microglobulin was 7.1-mg/dL (s.d. 4.4). After a median follow up of 9.5 months (range 1–12), 9 patients progressed and 5 died. The median progression free survival was 9.4 months. The median progression free survival for responder has not been reached. Four patients had a PR (31%), 8 had stable disease (62%), and 1 had progressive disease. No patient had a QT>500 or a cardiac arrhythmia. Grade 3 leukopenia, anemia, neuropathy and renal failure occurred in 3, 2, 1 and 1 patients respectively. Three patients had a venous thromboembolic event (2 DVT and 1 PE). Conclusions: The addition of T to the combination of ATO, Ascorbic acid and D is safe, well tolerated and results in 30% PR and 61% stable disease in patients with poor risk MM.

[Table: see text]

Jaw Complications Associated with Bisphosphonate Use in Patients with Plasma Cell Dyscrasias

Osteonecrosis of the jaw has been linked with bisphosphonate use in breast cancer and multiple myeloma patients. We report 17 cases of patients with plasma cell dyscrasia being treated with bisphosphonate who developed osteonecrosis/osteomyelitis of the jaw. Seventeen patients evaluated at our institution between 1998 and 2005 are reported. All were being treated with bisphosphonates for a median of 5 mo prior to the onset of jaw symptoms. Sixteen of the 17 patients are 51 yr or older. None of the patients had been irradiated in the jaw nor had obvious osseous manifestation of multiple myeloma in the jaw. Thirteen patients were receiving zoledronic acid and four patients were receiving pamidronate at the onset of jaw symptoms. Six of the 17 did receive both agents at some time and all of these individuals were receiving zoledronic acid at diagnosis. Microorganisms were isolated in 7/17 patients with the most common organism being actinomycosis. We have initiated the following guidelines in an effort to ameliorate the incidence of this complication. Patients should have a full dental examination at the time of diagnosis of the plasma cell dyscrasia especially if bisphosphonates are to be considered as part of the therapy. In addition, bisphosphonates are held for a period of 3 mo prior to invasive dental procedures to allow for the osteoclastic recovery, therefore enhanced debris removal and lessening the chance of creating a fertile bacterial medium. Following the dental procedure we would re-introduce bisphosphonates only after the healing process is complete. Finally, multiple myeloma patients diagnosed with jaw osteonecrosis probably have a concurrent infection and should be aggressively treated with antibiotics.

Seasonal variation in heavy metal accumulation in subtropical population of the terrestrial isopod, Porcellio laevis

The aim of the present study is to evaluate the seasonal fluctuation of heavy metals in the isopod Porcellio laevis at four uncontaminated subtropical locations. This study was carried out at four different field sites in Assiut, Egypt. The concentrations of cadmium, lead, copper, and zinc in animal, soil, and litter (mug/g dry weight) were monthly recorded during the period from June 2002 till May 2003. There was little difference in metal accumulation trends between the sites. In general, the isopod showed significant increased Pb and Zn concentration during summer and spring months, whereas this was not the case for Cd and Cu. The bioaccumulation (BAF) and bioconcentration factors (BCF) of the metals revealed marked seasonal changes throughout the year. Generally, BAF of metals were higher during summer and spring, and BCF were higher during summer and autumn. Comparing the metal accumulation with climatic fluctuations (measured) it was speculated that temperature was the main factor causing seasonal fluctuations of the internal metal concentration in the isopod.

Cyclophosphamide followed by fludarabine for untreated chronic lymphocytic leukemia: a phase II SWOG TRIAL 9706

B-cell chronic lymphocytic leukemia (CLL) accounts for 95% of chronic leukemia cases and 25% of all leukemia. Despite the prevalence of CLL, progress in its treatment has been only modest over the past three decades. Based upon the ability of fludarabine to produce high-grade remissions especially among patients with low initial tumor mass, and the ability of alkylators to reduce tumor mass, we hypothesized that sequential administration of a limited number of cycles of intermediate-dose cyclophosphamide followed by fludarabine could result in a larger percentage of patients with complete remissions (CRs). In all, 27 of the 49 eligible patients achieved overall responses of CR, unconfirmed complete remission (UCR), or PR, for a total response rate of 55% (95% confidence interval (CI) 40-69%). Considering the confounding medical issues of this patient population with advanced aggressive disease, the regimen was generally well tolerated. This study demonstrates that high-dose cyclophosphamide followed by fludarabine was relatively well tolerated in this group of advanced CLL patients. The study's criterion for testing whether the regimen is sufficiently effective to warrant further investigation was met: 14 (32%) of the first 44 eligible patients achieved CR or UCR.

Occupational exposure of phosphate mine workers: airborne radioactivity measurements and dose assessment

Under the Egyptian program for radiation safety and control, airborne radioactivity measurements and radiological dose assessment were conducted in some phosphate and uranium mines. Abu-Tartor mine is one of the biggest underground phosphate mines in Egypt. Airborne radioactivity, radon ((222)Rn) and its short-lived decay products (progenies) and thoron ((220)Rn), were measured in selected locations along the mine. The environmental gamma and workers dose equivalent rate (mSv/y) were measured inside and outside the mine using thermo-luminescence dosimeters (TLD). The results were presented and discussed. The calculated annual effective dose due to airborne radioactivity is the main source of occupational exposure and exceeding the maximum recommended level by ICRP-60 inside the mine tunnels. A number of recommendations are suggested to control the occupational exposures.

Stratification of Khartoum urban area by the risk of malaria transmission

A cross-sectional community-based study was carried out in Khartoum urban area aimed at stratifying the area by risk of malaria transmission. Two thousand households [8092 individuals] were surveyed during the cold, dry and rainy seasons of 2002. Households with screened windows, using bednets or both were 5.0% [95% CI: 4.1-6.0], 10.9% [95% CI: 9.5-12.3] and 1.8% [95% CI: 1.2-2.5] respectively. Access to health services was high. Only 3.8% [95% CI: 2.9-4.7] of households kept antimalarial drugs at home. The parasite rate, spleen rate and fever rate were very low [0.21%, 0.17% and 0.97% respectively]. Overall, people in Greater Bahry suffer a greater burden of malaria than those in Greater Khartoum or Greater Omdurman, with a seasonal pattern of transmission.

Stratification of Khartoum urban area by the risk of malaria transmission

A cross-sectional community-based study was carried out in Khartoum urban area aimed at stratifying the area by risk of malaria transmission. Two thousand households (8092 individuals) were surveyed during the cold, dry and rainy seasons of 2002. Households with screened windows, using bednets or both were 5.0% (95% CI: 4.1-6.0), 10.9% (95% CI: 9.5-12.3) and 1.8% (95% CI: 1.2-2.5) respectively. Access to health services was high. Only 3.8% (95% CI: 2.9-4.7) of households kept antimalarial drugs at home. The parasite rate, spleen rate and fever rate were very low (0.21%, 0.17% and 0.97% respectively). Overall, people in Greater Bahry suffer a greater burden of malaria than those in Greater Khartoum or Greater Omdurman, with a seasonal pattern of transmission.

Etanercept Therapy in Patients with Advanced Primary Amyloidosis

No effective treatment exists for primary amyloidosis, a plasma cell dyscrasia characterized by deposition of amyloid fibrils consisting of monoclonal light chains in various organs. TNF-alpha has been implicated in other amyloid disorders; therefore, we used etanercept to treat patients with advanced amyloidosis who had failed other therapies or were ineligible for other treatment regimens. Sixteen patients with amyloidosis that included patients with severe cardiac or multiple organ involvement were treated with etanercept and evaluated every 4-6 wk for evidence of toxicity and clinical response. Patients were treated with etanercept for a median of 42 wk. Eight of 16 patients (50%) experienced objective improvements and 14 patients (88%) experienced subjective improvements in symptoms. Only one patient experienced an adverse effect attributable to etanercept. For the entire group, improvement in performance status was statistically significant (p = 0.001), estimated median survival is 24.2 mo, 8 of whom are still alive with a median survival is 26.6 mo. The 12 patients with any cardiac involvement had an estimated median survival of 24.2 mo. Six of those 12 patients are still alive, with a median survival is 26.6 mo. The group of eight patients with severe cardiac involvement showed an estimated median survival of 13.2 mo, three of whom are still alive with a median survival is 25.9 mo. The clinical observations in this group of advanced and relapsed/refractory patients are highly encouraging. For the group as a whole, median survival was 24.2 mo and improvement in performance status was highly significant. Median survival for the patients with severe cardiac involvement was 13.2 mo with 3/8 patients are alive with a median survival of 25+ mo. Moreover, there was a statistically significant improvement in patients' performance status. These results, even though in a small group of patients, suggest that etanercept may provide a new therapeutic option for the management of amyloidosis that should be studied further.