Rumen Fluid from Slaughtered Animals: A Standardized Procedure for Sampling, Storage and Use in Digestibility Trials

Digestibility trials need a viable rumen fluid as inoculum to degrade feeds. The variability of rumen fluid depends on the animal’s diet, while its viability is greatly influenced by the sampling and handling procedures. In this article, we present a replicable protocol for sampling the rumen fluid from slaughtered animals for in vitro digestibility trials. A detailed list of the tools and a step-by-step standardized procedure for the collection, storage and the transportation of the rumen fluid from the slaughterhouse to the laboratory is presented. We also describe a digestibility trial for establishing the maximum storage time of rumen fluid from sampling to its use. The results show that the rumen fluid, collected and maintained according to the proposed protocol, can be stored and used from 30 to 300 min from sampling without significantly compromising the fermentative activity of the microbial population.

Comparison of In Vivo and In Vitro Digestibility in Rabbits

The apparent dry matter digestibility of diets for rabbits was measured in vivo (ADMDvv) and in vitro with the Ankom DaisyII Incubator. Four diets were tested: low fiber (LF), LF + 5% of pregerminated fenugreek seeds (PGFS) (LF5), LF + 10% PGFS (LF10), and high fiber (HF). For the ADMDvv, feces samples were collected from 56 White New-Zealand × Californian rabbits fed the 4 diets; animals were randomly allocated into 4 groups and housed in individual cages. For the in vitro trial, 3 methods were tested: fecal inoculum (FA) with Kansans State buffer; fecal inoculum with artificial saliva (FB); and multienzyme (ENZ). Fecal inocula were collected at slaughtering from the distal colon of rabbits fed ad libitum the LF diet. For FA and FB methods, the digestibility was measured at 36 and 48 h. The in vitro methods ranked the apparent dry matter digestibility of diets in the same order as in vivo, but ENZ values were always higher than FA and FB at 36 and 48 h. The prediction equations of in vivo digestibility with the ENZ method showed higher coefficient of determination (R2 = 0.69) and lower SE (0.190) than FA and FB; also, reproducibility was higher with ENZ (CV = 3.1%). In conclusion, different methods can be applied to the Ankom DaisyII Incubator to study the digestibility in rabbits. In our trial, the better reproducibility was observed with the multienzyme method than FA and FB were probably related to the variability of inocula.

Characterization and Growth under Different Storage Temperatures of Ropy Slime-Producing Leuconostoc mesenteroides Isolated from Cooked Meat Products

ABSTRACT

The presence of lactic acid bacteria can be detrimental when the abundant growth of slime-producing strains (Lactobacillus spp. and Leuconostoc spp.) causes spoilage of meat products. Two strains of lactic acid bacteria were isolated from vacuum-packed cooked hams that had been withdrawn from the market for the so-called ropy slime defect and identified as Leuconostoc mesenteroides. In an attempt to define the behavior of ropy slime-producing bacteria, two strains of L. mesenteroides were incubated in de Man Rogosa Sharpe broth at different storage temperatures and conditions of thermal abuse (4, 12, 20, 30, 37, and 44°C). Both strains showed a lack of growth at 44°C, a good level of development at 30 and 37°C, and evident growth ability at low temperatures, with a long stationary phase. In particular, the bacterial concentration at 4°C was >105 CFU mL-1 after more than 120 days of incubation. This study demonstrates that the refrigeration temperature for cooked meat products does not constitute a hurdle for ropy slime producers and their subsequent ability to spoil.

HIGHLIGHTS

Internet Narratives Focused on Health Travelers' Experiences in India: Qualitative Analysis

Background

The medical tourism industry is currently popular in India, but there is no confirmation of the common perspectives among the country’s medical travelers.

Objective

This qualitative research study analyzed web-based narratives from health travelers visiting India and described the themes of their experiences. This study aimed to answer the following primary question: What can we learn about health travelers’ experiences in India from an analysis of their web-based narratives? The secondary questions were as follows: (1) What are the primary health care reasons for which patients in the examined narratives traveled to India? (2) What can be derived from the narratives regarding medical tourists’ satisfaction with the outcome and result of the treatment they received in India? (3) What are some positive and negative factors influencing medical tourists’ perceptions and overall experiences about their health travel to India? (4) What are the characteristics of medical tourists who write web-based narratives regarding their health experiences in India?

Methods

Publicly available narratives written by medical tourists who visited India were obtained from a Google search. The narratives included blog posts and discussion board posts by medical tourists. The analysis process consisted of initial open coding being conducted on the narratives to create initial codes and identify common themes with a focus on the primary research question and subquestions.

Results

Although Mumbai, Chennai, and New Delhi were not the only destination cities mentioned, these were the most popular cities patients visited for care. The medical tourists, who stated their origin country, came from one of the following continents: Africa, Europe, North America, and Oceania. Dental care, Ayurveda treatment, and eye care were the most popular types of care that medical tourists sought. The results showed that most of the medical tourists were happy with the overall experience of receiving care in India. The most popular themes with regard to the patients’ satisfaction were low costs, good customer service, and services being offered that were unavailable in their home country. When negative feedback was provided, it was mainly concentrated on the overall environment of India being unorganized and unsanitary.

Conclusions

Primarily, the study’s findings can benefit health care providers and patients. Providers hosting medical tourists in India can use negative feedback to improve their services; similarly, providers who are losing patients to medical tourism can identify opportunities for improvement (ie, why are we losing patients). Indian providers hosting medical tourists should keep their prices competitive and continue to provide exceptional service; however, they should do their best to lessen the crowdedness of their facilities while making sure they are esthetically pleasing. Providers losing patients to medical tourism need to identify ways to ensure their services match the benefits that their international counterparts are providing, such as competitive pricing and expansion on the services provided.

In Vitro Digestibility Measurement of Feedstuffs in Donkeys Using the DaisyII Incubator

Successful studies on in vitro digestibility measurement of feedstuffs with fecal inoculum have been reported for horses, whereas data on donkeys are currently lacking. In this study, we evaluated the use of the Daisy^II Incubator for in vitro digestibility measurement of feedstuffs using donkey feces as source of microbial inoculum. The method was tested using seven feedstuffs commonly used in donkey diets (alfalfa, bromegrass, ryegrass, and timothy hays; wheat bran and wheat straw; barley grains). Feces were obtained from four female donkeys, and incubations were carried out at 1-week intervals for four consecutive weeks. Two bags of each feedstuff were incubated in digestion vessels containing a buffer/feces solution (90:10). In vitro apparent dry matter digestibility (DMD), true dry matter digestibility (IVTD), and neutral detergent fiber digestibility (NDFD) were evaluated at four incubation times: 30, 48, 60, and 72 hours. All digestibility parameters significantly increased from 30 to 72 hours of incubation. At 72 hours of incubation, the within-laboratory repeatability and reproducibility of the method were 2.7% and 5.0% for DMD and 1.6% and 3.9% for IVTD, respectively. The method was less repeatable and reproducible for NDFD (4.5% and 10.4%, respectively).

Noise assessment in slaughterhouses by means of a smartphone app

Regulation (EC) No. 1099/2009 on the protection of animals at the time of killing establishes an obligation to spare animals any avoidable suffering or stress prior to their slaughter. Although it has been pointed out that stressors also include noise, which can cause suffering and affect the quality of the meat, current legislation does not set a limit for environmental noise in slaughterhouses. This study was conducted in three slaughterhouses in central Italy to assess the environmental acoustic level using a smartphone app. The selected, medium-sized slaughterhouses for pigs and cattle were subjected to measurements using a sound-level meter (Noise Meter for iOS) during working hours at the unloading area and lairage, along the chute to the restraining pen, at the time of stunning and at the slaughter hall. For the bovine lines the average values expressed in dB ranged from 76.33 (SD 2.08) to 93.00 (SD 2.14) for abattoir 1, from 75.00 (SD 1.87) to 92.33 (SD 4.89) for abattoir 2 and from 75.67 (SD 7.09) to 88.83 (SD 4.79) for abattoir 3. For the pig lines the average values expressed in dB ranged from 77.50 (SD 3.11) to 100.33 (SD 1.53) for abattoir 1, from 83.00 (SD 2.00) to 99.75 (SD 2.63) for abattoir 2 and from 71.20 (SD 6.49) to 99.50 (SD 1.31) for abattoir 3. Data show that the pig slaughter line was always noisier than the cattle line and the slaughter hall always showed the highest values (i.e. 100 dB), when compared to the unloading area (i.e. 79 dB).

Canonical discriminant analysis and meat quality analysis as complementary tools to detect the illicit use of dexamethasone as a growth promoter in Friesian bulls

A screening method based on meat quality parameters and production traits for detecting the effects of illegal administration of dexamethasone in Friesian bulls was assessed. Twenty finishing bulls were divided into an untreated control group (n=8) and two treatment groups receiving dexamethasone orally at dosages of 1.4 (n=6) or 0.7 (n=6)mg per head per day for 60 days. The animals were slaughtered 26days after cessation of treatment. Thirty-six parameters were measured on live animals, carcasses and samples of the longissimus thoracis muscle. The production traits were similar between groups, but there were significant differences in meat quality between treatment groups. The higher dosage of dexamethasone improved meat tenderness, while the lower dosage resulted in more saturated red meat, with increased meat cooking shrinkage and cooking loss. The use of a portable 'electronic nose' as a screening tool was not successful in discriminating between treated and untreated meat. These results indicate that a multivariable approach using canonical discriminant analysis may be a complementary tool to identify meat from animals illegally treated with dexamethasone, based on several parameters (meat flavour, cooking and thawing loss, tenderness, colour and live weight gain), which are part of the normal analysis of meat quality.

Healthcare Utilizing Deliberate Discussion Linking Events (HUDDLE): A Systematic Review

The phenomenon, "huddle moments," can be described as a preparatory briefing among healthcare providers for the purpose of collaborating, exchanging information, and bringing awareness to patient safety concerns. A historical background of huddle communication is described and a systematic literature review was conducted on preoperative briefing and huddle communication. The article also describes a need for increased interprofessional collaboration education in anesthesia and a need for leadership to support initiatives that improve patient safety. The purpose of this article is to provide a systematic review of huddle communication and give future evidence-based recommendations on how the huddle can be used in healthcare as well as how to roll out use of the HUDDLE acronym: Healthcare, Utilizing, Deliberate, Discussion, Linking, Events.

Zoledronic acid in patients with stage IIIA/B NSCLC: results of a randomized, phase III study

BACKGROUND

Bone metastases are common in patients with advanced non-small-cell lung cancer (NSCLC) and can have devastating consequences. Preventing or delaying bone metastases may improve outcomes.

PATIENTS AND METHODS

This study evaluated whether zoledronic acid (ZOL) delayed disease progression or recurrence in patients with controlled stage IIIA/B NSCLC after first-line therapy. Patients received vitamin D and calcium supplementation and were randomized to i.v. ZOL (every 3-4 weeks) or no treatment (control). The primary end point was progression-free survival (PFS).

RESULTS

No significant intergroup differences were observed in PFS or overall survival (OS). Median PFS was 9.0 months with ZOL versus 11.3 months for control. Fifteen ZOL-treated (6.6%) and 19 control patients (9.0%) developed bone metastases. Estimated 1-year OS was 81.8% for each group. ZOL safety profile was consistent with previous clinical data, but with higher discontinuations versus control. Fifteen ZOL-treated (6.6%) and five control patients (2.3%) had renal adverse events. Two cases of osteonecrosis of the jaw were reported.

CONCLUSIONS

ZOL did not significantly affect PFS or OS in stage IIIA/B NSCLC patients with controlled disease, with a trend toward worsening PFS in the longer-term follow-up. Few patients experienced bone metastases, possibly limiting the potential ZOL impact on disease course.

Intracerebroventricular administration of human umbilical cord blood cells delays disease progression in two murine models of motor neuron degeneration

The lack of effective drug therapies for motor neuron diseases (MND), and in general for all the neurodegenerative disorders, has increased the interest toward the potential use of stem cells. Among the cell therapy approaches so far tested in MND animal models, systemic injection of human cord blood mononuclear cells (HuCB-MNCs) has proven to reproducibly increase, although modestly, the life span of SOD1G93A mice, a model of familial amyotrophic lateral sclerosis (ALS), even if only few transplanted cells were found in the damaged areas. In attempt to improve the potential efficacy of these cells in the central nervous system, we examined the effect and distribution of Hoechst 33258-labeled HuCB-MNCs after a single bilateral intracerberoventricular injection in two models of motor neuron degeneration, the transgenic SOD1G93A and wobbler mice. HuCB-MNCs significantly ameliorated symptoms progression in both mouse models and prolonged survival in SOD1G93A mice. They were localized in the lateral ventricles, even 4 months after administration. However, HuCB-MNCs were not found in the spinal cord ventral horns. This evidence strengthens the hypothesis that the beneficial role of transplanted cells is not due to cell replacement but is rather associated with the production and release of circulating protective factors that may act both at the central and/or peripheral levels. In particular, we show that HuCB-MNCs release a series of cytokines and chemokines with antiinflammatory properties that could be responsible of the functional improvement of mouse models of motor neuron degenerative disorders.

Phase III study in stage IV non-small-cell lung cancer patients treated with two courses of cisplatin/gemcitabine followed by a randomization to three additional courses of the same combination or gemcitabine alone

BACKGROUND

This randomised phase III study investigated if in responsive and stable disease (SD) stage IV patients after two courses of cisplatin and gemcitabine, single-agent gemcitabine (experimental arm) was not inferior in terms of overall survival (OS) to cisplatin-gemcitabine (standard arm).

PATIENTS AND METHODS

Noninferiority was defined as an increase in the hazard of death (HR) < or = 1.33 in the experimental arm. From January 2001 to February 2004, 340 patients were registered and 250 were randomised. Cisplatin was administered on day 1 at 75 mg/m2 and Gemcitabine on days 1 and 8 at 1250 mg/m2 every 3 weeks.

RESULTS

Response rate after two courses was 29%. The 1-year progression-free survival was 13% in both arms. One-year survival was 52% in the standard and 42% in the experimental arm for an HR of 1.21 [90% confidence interval (CI) 0.97-1.51]. Postprogression survival was in favour of the standard arm (HR 1.30, 95% CI 0.99-1.70, P = 0.051). Grades 3-4 toxicity favoured in the experimental arm.

CONCLUSION

In responsive and SD patients with stage IV non-small-cell lung cancer it was not possible to demonstrate that three courses of gemcitabine alone are not inferior, in terms of OS, to the standard approach of three courses of cisplatin-gemcitabine.

Two-drug gemcitabine-based first-line treatment of elderly patients (pts) with small cell lung cancer (SCLC): The G-STEP program

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Background: Trials testing chemotherapy for elderly pts with SCLC are scanty. Gemcitabine (Gem) is active and well tolerated. The G-STEP program looked for optimal 2-drug combination of G with either vinorelbine (Vin), etoposide (Eto), cisplatin (Cis), or carboplatin (Car). Methods: Extended stage SCLC pts, aged >70 years, PS 0–2, were eligible. Dose of G was 1,000 mg/m2, dd 1&8, every 3 weeks in all the four combinations. As safety data in the elderly were already available for Gem+Vin (Vin dose 25 mg/m2, dd 1&8), a two-stage minimax flexible design was applied with response as end-point: ≥13 responses/30 pts required at 1st stage, with p0=0.40, p1=0.60, α and β=0.10. For Gem+Car, Gem+Cis, Gem+Eto a phase 1–2 Bayesian design to select optimal dose was applied (Thall & Russell, Biometrics, 1998), with 3 possible outcomes for each patient: “active” (response and no unacceptable toxicity [UT]), “inactive” (no response, no UT), or “toxic” (UT independently of response). A response rate [RR] ≥60% and a rate of UT ≤25% were acceptable. Dose levels to explore were: Car: AUC 3.5 / 4 / 4.5, d1; Cis: 50 / 60 / 70 mg/m2, d1; Eto: 60 / 70 / 80 mg/m2, dd 1,2,3. Results: From May 2000 to September 2005, 78 eligible pts were enrolled; median age was 74 years (42% of pts older than 75yrs). In the whole group, median progression-free survival and overall survival were 20.3 weeks (95% CI 17.6 - 24.1) and 33.7 weeks (95% CI 23.7 - 41.6), respectively. Study of Gem+Vin was closed for inactivity after 1st stage with 11 responses / 30 pts (RR 36.7%, 95% exact CI: 19.9–56.1). Gem+Eto arm was closed after 10 pts (5 inactive and 5 toxic) because too high probability (0.994) of inactivity. Gem+Cis arm was closed after 12 pts (2 active, 5 inactive, 5 toxic) because too high probability (0.988) of inactivity. With Gem+Car (December 2005: 2 pts ongoing, 24 analysed: 12 active, 6, inactive and 6 toxic), RR in the 20 pts receiving Car at AUC 3.5 was 60% (95% exact CI: 36.1–80.9). Conclusions: The combination of gemcitabine and carboplatin seems promising for future trials in elderly patients with extended SCLC. The G-STEP program was supported by GIOGER.

No significant financial relationships to disclose.

A prospective phase II study of single-agent gemcitabine at prolonged constant infusion at 10mg/m2/min rate (PCI-G) in first-line treatment of elderly patients (pts) with advanced non-small cell lung cancer (NSCLC): The MILES-2G study

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Background: Single-agent chemotherapy is the standard treatment for elderly pts with advanced NSCLC, following the results of the ELVIS and MILES-1 trials. Some hints that infusing gemcitabine at a fixed dose rate of 10 mg/m2/minute can optimize its pharmacokinetics have been reported. A prospective phase 2 study was conducted to describe activity and toxicity of PCI-G. Methods: Advanced (stage IV or IIIb with supraclavear nodes or pleural effusion) NSCLC pts, aged >70, PS 0–1, were eligible. 51 patients were required according to a single-stage phase 2 design to have 90% confidence in estimating a 25% ±10% response rate. Response was assessed with RECIST; toxicity was coded with NCI-CTC. Results: From October 2002 to June 2003, 51 pts were enrolled. 26 pts (51%) were older than 75 years. Two complete and seven partial responses were observed, for an overall response rate of 17.6% (95% exact CI: 8–31). The median progression-free survival was 16 wks (95% CI: 11–21) and the median overall survival was 41 wks (95% CI: 28–51). Two toxic deaths were recorded (1 bronchial bleeding and 1 hepatic toxicity). Other relevant toxicities were (% of pts): grade 3–4 neutropenia (11.8%), grade 3 thrombocytopenia (5.9%), grade 3 pulmonary toxicity (3.9%) and grade 3 liver toxicity (3.9%); platelet transfusion, grade 3 anemia, RBC transfusion, non-neutropenic infection, and grade 4 neurotoxicity were all reported in one pt each. Conclusions: In this phase 2 prospective study dedicated to elderly pts with advanced NSCLC, PCI-G was not sufficiently active to warrant further investigation.

No significant financial relationships to disclose.

Performances and meat quality of two Italian pig breeds fed diets for commercial hybrids

The effects of specific diets for commercial hybrids were investigated on 6 Casertana and 11 Mora Romagnola, two endangered Italian pig breeds. Average daily gain (ADG), feed conversion index (FCI), dressing percentage and meat and fat quality of animals bred under similar environmental and nutritional conditions were compared to define their optimal slaughtering weight. Animals were fed the same diets assuming that requirements of Mora Romagnola and Casertana did not differ, and changed every 30kg of weight gain. ADG and FCI were calculated every 15 days. Weight gains, divided into 5 groups based on live weight (LW) of animals (⩽60kg, 60<kg⩽90, 90<kg⩽120, 120<kg⩽160, >160kg), showed higher values for Casertana than Mora Romagnola, particularly from 121 to 160kg LW (687g/d). Average FCI from 50 to 160kg LW was similar in both breeds (4.2). After 403 days of trial, animals were slaughtered at about 195kg LW. Carcass measurements showed that Casertana had higher dressing percentage and lean cuts than Mora Romagnola. Both breeds showed extraordinary high ultimate pH values of M. longissimus thoracis (5.96 and 6.15 for Casertana and Mora Romagnola, respectively) M. semimembranosus (6.37 and 6.30), showing an incomplete post mortem glycolysis. Colour of M. longissimus thoracis did not differ between breeds and was particularly dark. Chemical analysis of Casertana meat showed lower percentage of water and fat; the total amount of fatty acids (SFA, MUFA and PUFA) and the SFA/UFA ratio did not show significant differences between breeds. Results showed that from a growth point of view the optimal slaughtering weight of Casertana and Mora Romagnola should not exceed 160kg LW. Both breeds had an uncommon reactivity to stress probably due to interactions of genetic, nutritional and management factors.

A randomised clinical trial of two docetaxel regimens (weekly vs 3 week) in the second-line treatment of non-small-cell lung cancer. The DISTAL 01 study

Docetaxel (75 mg m(-2) 3-weekly) is standard second-line treatment in advanced non-small-cell lung cancer (NSCLC) with significant toxicity. To verify whether a weekly schedule (33.3 mg m(-2) for 6 weeks) improved quality of life (QoL), a phase III study was performed with 220 advanced NSCLC patients, < or =75 years, ECOG PS < or =2. QoL was assessed by EORTC questionnaires and the Daily Diary Card (DDC). No difference was found in global QoL scores at 3 weeks. Pain, cough and hair loss significantly favoured the weekly schedule, while diarrhoea was worse. DDC analysis showed that loss of appetite and overall condition were significantly worse in the 3-week arm in the first week, while nausea and loss of appetite were more severe in the weekly arm in the third week. Response rate and survival were similar, hazard ratio of death in the weekly arm being 1.04 (95% CI 0.77-1.39). A 3-weekly docetaxel was more toxic for leukopenia, neutropenia, febrile neutropenia and hair loss; any grade 3-4 haematologic toxicity was significantly more frequent in the standard arm (25 vs 6%). The weekly schedule could be preferred for patients candidate to receive docetaxel as second-line treatment for advanced NSCLC, because of some QoL advantages, lower toxicity and no evidence of strikingly different effect on survival.

Retrospective analysis of adverse drug reactions induced by gemcitabine treatment in patients with non-small cell lung cancer

Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the world. Traditional chemotherapy for advanced NSCLC is often considered excessively toxic. Recent clinical trials documented that gemcitabine may represent a good therapeutical option in patients with NSCLC. Aim of our research was to retrospectively evaluate the adverse effects induced by gemcitabine in patients with NSCLC from 1 January 1997 to 31 December 2002, in clinical records of Oncology Divisions of "S. Giovanni di Dio" Hospital of Crotone, "Ospedali Riuniti" Hospital of Reggio Calabria, Hospital of Paola, and in Pneumological Oncology Division of "Mariano Santo" Hospital of Cosenza, Italy. Clinical records of patients treated with gemcitabine (1000mgm(-2) on days 1 and 8) were reviewed and following data were obtained: sex and age of the patients, histologic diagnosis and disease stage, World Health Organisation (WHO) performance status and toxic effects induced by gemcitabine. We reported that 71.6% of NSCLC patients (age range 48-77 years; 135 males, 27 females; performance status 0=53, 1=109) were eligible for our study. Side effect of gemcitabine involved gastrointestinal system (nausea, vomiting and diarrhoea) and only in the last cycles (VIII-XI) emopoiethic system (leukopenia, neutropenia, thrombocytopenia and anemia). Grade IV vomiting occurred in three patients, thrombocytopenia in two. Grade III leukopenia was observed in three patients. Other toxicities were mild. None of the patients died during chemotherapy. In conclusion, these data showed that gemcitabine present a very good tolerability in patients with NSCLC. Therefore, it could be considered as a new therapeutic agents to use as first line therapy for this disease.

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Pain is a highly distressing symptom for patients with advanced cancer. WHO analgesic ladder is widely accepted as a guideline for its treatment. Our aim was to describe pain prevalence among patients diagnosed with advanced non-small-cell lung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of pain management. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded. Adequacy of pain management was evaluated by the Pain Management Index (PMI). Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe); 50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3% very much). Bone metastases strongly affected presence of pain. Mean global QoL linearly decreased from 64.9 to 36.4 from patients without pain to those with severe pain (P<0.001). According to PMI, 616 out of 752 patients reporting pain (82%) received inadequate analgesic treatment. Bone metastases were associated with improved adequacy and worst pain with reduced adequacy at multivariate analysis. In conclusion, pain is common in patients with advanced NSCLC, significantly affects QoL, and is frequently undertreated. We recommend that: (i) pain self-assessment should be part of oncological clinical practice; (ii) pain control should be a primary goal in clinical practice and in clinical trials; (iii) physicians should receive more training in pain management; (iv) analgesic treatment deserves greater attention in protocols of anticancer treatment.

Determination of disodium clodronate in human plasma and urine using gas-chromatography–nitrogen-phosphorous detections: validation and application in pharmacokinetic study

We present a specific method for the determination of disodium clodronate in human plasma and urine using a gas-chromatographic system with nitrogen phosphorus detector (NPD). The compound was extracted from plasma and urine samples by an anion-exchange resin and derivatizated with bistrimethylsilyltrifluoroacetamide (BSTFA). Sodium bromobisphosphonate was used as internal standard. The calibration curves were linear in both plasma and urine, with a regression coefficient r > 0.9975 in plasma and r > 0.9977 in urine. The limit of quantitation was 0.3 microg/ml in plasma and 0.5 microg/ml in urine. The method was validated by intra-day assays at three concentration levels. During the study we carried out inter-day assays to confirm the feasibility of the method. The precision in plasma at 0.5, 15, and 45 microg/ml was 12.4, 0.2, and 6.5% (n = 40), respectively; in urine at 0.8, 8, and 40 microg/ml it was 8.6, 6.4, and 9.3% (n = 40), respectively. The method was accurate and reproducible, and was successfully applied to determine the pharmacokinetic parameters of clodronate in healthy volunteers after intravenous infusion and intramuscular injection of 200 mg of the compound. The Cmax after intravenous infusion and intramuscular injection was 16.1 and 12.8 microg/ml, respectively. AUC(0-48 h) after infusion administration and intramuscular injection was 44.2 +/- 18.0 and 47.5 +/- 12.4 h microg/ml, respectively. The elimination half-life in both administrations was 6.31 +/- 2.7 h.

Supportive care in patients with advanced non-small-cell lung cancer

The present study describes supportive care (SC) in patients with advanced non-small-cell lung cancer (NSCLC), evaluating whether it is affected by concomitant chemotherapy, patient's performance status (PS) and age. Data of patients enrolled in three randomised trials of first-line chemotherapy, conducted between 1996 and 2001, were pooled. The analysis was limited to the first three cycles of treatment. Supportive care data were available for 1185 out of 1312 (90%) enrolled patients. Gastrointestinal drugs (45.7%), corticosteroids (33.4%) and analgesics (23.8%) were the most frequently observed categories. The mean number of drugs per patient was 2.43; 538 patients (45.4%) assumed three or more supportive drugs. Vinorelbine does not produce substantial variations in the SC pattern, while cisplatin-based treatment requires an overall higher number of supportive drugs, with higher use of antiemetics (41 vs 27%) and antianaemics (10 vs 4%). Patients with worse PS are more exposed to corticosteroids (42 vs 30%). Elderly patients require drugs against concomitant diseases significantly more than adults (20 vs 7%) and are less frequently exposed to antiemetics (12 vs 27%). In conclusion, polypharmacotherapy is a relevant issue in patients with advanced NSCLC. Chemotherapy does not remarkably affect the pattern of SC, except for some drugs against side effects. Elderly patients assume more drugs for concomitant diseases and receive less antiemetics than adults.

[Evaluation of malnutrition risk in adult hospital patients]

BACKGROUND

The aim of the study was to evaluate the validity and reliability of a risk of malnutrition screening tool (MST) proposed by Ferguson et al. for adult hospital patients.

METHODS

The study included 207 consecutive patients admitted to a Hospital (118 males, 89 females, aged 61+/-16 years) including internal medicine (89), lung (60) and surgical (58) patients. The MST, consisting of three questions regarding appetite and recent unintentional weight loss, was applied to each patients. Peripheral lymphocytes and serum albumin considered as predictor of nutritional status were also evaluated.

RESULTS

Forty-two patients (20% of overall population) resulted malnourished at admission and nutrition support was rapidly established. Of the remaining, 141 (85%), according to the score of MST were not at risk of malnutrition, while 24 (15%) were classified at risk. Peripheral lymphocytes and serum albumin were unable to discriminate the risk in well-nourished patients.

CONCLUSIONS

The proposed MST is confirmed as strongly predictor of nutritional status. It is a simple, quick, reliable, valid tool and can be carried out nursing staff. Its routine application will consistently identify patients at risk of malnutrition so that nutrition care can be promptly started.

[Use of monofilament prosthesis in inguinal hernia treatment: cost-benefit ratio]

BACKGROUND

The authors aimed to demonstrate the real advantages in terms of cost and patient comfort of inguinal hernia surgery using monofilament prostheses.

METHODS

A retrospective survey was carried out on two groups of patients: the first group, consisting of 1032 patients who underwent inguinal hernia surgery under general anesthetic between 1985 and 1995 at the Institute of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery that did not use monofilament prosthesis. The second group, consisting of 348 patients operated under local anesthesia between 1996 and 1999 at the IV Division of General Surgery at the University Polyclinic of Messina, included cases of both emergency and elective surgery using tension-free techniques and polypropylene mesh. The numbers of recidivations and complications were compared, together with the relative costs of the methods used in both groups.

CONCLUSIONS

In the light of these experimental results, it is clear that the use of biocompatible alloplastic materials in monofilament considerably reduces the risks of recidivation, without no significant increase in the number of dehiscences, infections or postoperative complications. Moreover, there was a striking reduction in costs linked not only to the shorter hospitalisation of patients and the reduced use of painkillers, but also a fall in the number of future hospital admissions owing to recidivation.

[Carcinoma of the gastric stump]

After having emphasized that carcinoma of the gastric stump represents a "major" risk in patients undergoing gastric resection, the authors describe the physiopathology of the new anatomical and functional status of the gastroenteric apparatus and underline the probable etiopathogenetic stages attributable to carcinogenesis. They then describe the treatment of this neoplasia with a marked aggressive character and conclude with the affirmation that the surgeon's efforts must be focused on the correct execution of gastroresection and the follow-up of gastro-resected patients in order to allow the early identification of precancerous conditions and therefore the commencement rational oncological prophylaxis.

Cisplatin-vindesine-mitomycin (MVP) vs cisplatin-ifosfamide-vinorelbine (PIN) vs carboplatin-vinorelbine (CaN) in patients with advanced non-small-cell lung cancer (NSCLC): a FONICAP randomized phase II study. Italian Lung Cancer Task Force (FONICAP)

In the present multicentre randomized phase II trial, the activity and toxicity of three platinum-based combination regimens for the treatment of advanced non-small-cell lung cancer (NSCLC) were evaluated. The three regimens were: MVP (mitomycin-C 6 mg m(-2) on day 1, vindesine 3 mg m(-2) on days 1 and 15, and cisplatin 80 mg m(-2) on day 1 every 28 days), PIN (cisplatin 80 mg m(-2) day 1, ifosfamide 3 g m(-2) day 1 and vinorelbine 25 mg m(-2) day 1 and 8 every 21 days) and CaN (carboplatin 350 mg m(-2) day 1 and vinorelbine 25 mg m(-2) days 1 and 8 every 28 days). A total of 140 chemotherapy-naive patients entered the study; 49 patients were treated with MVP, 48 with PIN and 43 with CaN. Sixty-seven per cent of the patients had stage IV disease. Response rates, calculated on an 'intention to treat' basis, were as follows: MVP, 14.3% (95% CI 5.94-27.2%); PIN, 16.7% (95% CI 7.4-30.2%); and CaN, 14% (95% CI 5.3-27.9%). The overall median survivals were 256, 269 and 243 days for patients treated with MVP, PIN and CaN respectively. Myelosuppression was the most frequent toxicity: grade 3-4 leucopenia was observed in 14.3%, 25% and 18.6% of patients treated with MVP, PIN and CaN respectively. This multicentre phase II randomized trial shows that MVP, PIN and CaN can be administered on an outpatient basis with acceptable toxicities. Unfortunately, the three regimens showed an activity significantly lower than that reported in previous single-institution phase II trials.

[Breast cancer today]

Authors, after a short dissertation about evolution, trough out the years, of the diagnosis and the therapy of the mammary carcinoma, specify the leading role of primary prevention. Self palpation and the mammography reduce of about 30% the mortality. Modern pharmacology and radiotherapy allow a surgical preservative approach, produce better esthetic and functional results. Preservative therapy (QUART) also warrants a good quality of life, and allows the excellent control of primary disease.

[Development of a teleradiology system]

PURPOSE

the development of a cost-effective diagnostic system for transmitting high-resolution images on normal phone lines.

MATERIALS AND METHODS

A 486 PC with super VGA screen, 16,800-band external modem and graphic software.

RESULTS

the graphic software allows the PC to be connected to the video output of MRI, CT or US units, or to a video camera as in the case of X-ray units. Image spatial resolution is as high as 1,024 x 768 lines. Transmission times are lower than 45 seconds, corresponding to files of 50-80 kbytes. In 6 months, more than 130 Megabytes (500 images) were transmitted between our diagnostic center and our consultants in northern Italy, France and California.

CONCLUSIONS

this cost-effective teleradiology system allows real-time image transmissions between diagnostic centers all over the world for scientific updating and quick reference purposes. Portable units can be developed.

Neonatal rhabdomyolysis as a presentation of muscular dystrophy

We report a unique presentation of X-linked recessive dystrophy as neonatal rhabdomyolysis. There was induration of the proximal musculature in an otherwise well neonate and striking CK elevation, without myoglobinuria. Muscle biopsy at age 1 year showed dystrophic alterations, and X chromosome analysis showed a deletion within or adjacent to the Duchenne/Becker locus.