Efficacy of immune checkpoint inhibitors in alveolar soft-part sarcoma: results from a retrospective worldwide registry

BACKGROUND

Conventional cytotoxic drugs are not effective in alveolar soft-part sarcoma (ASPS). Immune checkpoint (programmed cell death protein 1/programmed death-ligand 1) inhibitors (ICIs) are promising drugs in ASPS. A worldwide registry explored the efficacy of ICI in ASPS.

MATERIALS AND METHODS

Data from adult patients diagnosed with ASPS and treated with ICI for advanced disease in expert sarcoma centers from Europe, Australia and North America were retrospectively collected, including demographics and data related to treatments and outcome.

RESULTS

Seventy-six ASPS patients, with a median age at diagnosis of 25 years (range 3-61 years), were registered. All patients received ICI for metastatic disease. Immunotherapy regimens consisted of monotherapy in 38 patients (50%) and combination in 38 (50%) (23 with a tyrosine kinase inhibitor). Among the 68 assessable patients, there were 3 complete responses and 34 partial responses, translating into an overall response rate of 54.4%. After a median follow-up of 36 months [95% confidence interval (CI) 32-40 months] since the start of immunotherapy, 45 (59%) patients have progressed on ICI, with a median progression-free survival (PFS) of 16.3 months (95% CI 8-25 months). Receiving ICI in first line (P = 0.042) and achieving an objective response (P = 0.043) correlated with a better PFS. Median estimated overall survival (OS) from ICI initiation has not been reached. The 12-month and 24-month OS rates were 94% and 81%, respectively.

CONCLUSIONS

This registry constitutes the largest available series of ASPS treated with ICI. Our results suggest that the ICI treatment provides long-lasting disease control and prolonged OS in patients with advanced ASPS, an ultra-rare entity with limited active therapeutic options.

Preliminary dengue vector surveillance in the Sunda Islands, Indonesia: Interchange of breeding habitat preferences of Aedes aegypti and Aedes albopictus

Ovitrap surveillance was conducted to determine the infestation patterns of dengue vectors in fourteen study sites across eight provinces located in the Sunda Islands, Indonesia. High ovitrap indices up to 70% and 90% were obtained from indoor and outdoor areas, respectively. Mean numbers of Ae. aegypti and Ae. albopictus larvae ranged from 0.13 to 14.50 and 0.10 to 18.60, respectively. Mixed infestation (<10%) and interchange of breeding habitat preferences of Ae. albopictus and Ae. aegypti were also observed in the present study.

Monitoring Insecticide Resistance Profiles of Aedes aegypti (Diptera: Culicidae) in the Sunda Islands of Indonesia Based on Diagnostic Doses of Larvicides

This study was conducted to monitor the susceptibility status of Aedes aegypti (Linnaeus) larvae in the Sunda Islands of Indonesia against various organophosphates and organochlorines. Larval bioassay was performed in accordance with the World Health Organization standard protocol. Field-collected and reference strains of Ae. aegypti larvae were tested against diagnostic doses of eight larvicides belonging to organophosphates and organochlorines, namely bromophos (0.050 mg/liter), chlopyrifos (0.002 mg/liter), fenitrothion (0.020 mg/liter), fenthion (0.025 mg/liter), malathion (0.125 mg/liter), temephos (0.012 mg/liter), DDT (0.012 mg/liter), and dieldrin (0.025 mg/liter). Mortality rates of larvae were recorded at 24-h posttreatment. This study showed that Ae. aegypti larvae from Padang, Samarinda, Manggarai Barat, and South Central Timor were susceptible to both fenitrothion and dieldrin (mortality rates ≥ 98%). About 6 out of 10 field strains of Ae. aegypti larvae were resistant (<80% mortality rates) against fenthion, whereas Ae. aegypti larvae from Kuningan, Samarinda, Sumba, and South Central Timor exhibited some degrees of resistance (mortality rates 80-98%). All field-collected Ae. aegypti larvae were resistant against diagnostic doses of chlorpyrifos, malathion, temephos, and DDT with mortality rates ranging from 0 to 74.67%. Continued insecticide susceptibility studies are essential to identify the efficacy of insecticides for an improved dengue vector control and to delay the development of insecticide resistance.

Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis

OBJECTIVE

Pregnancy-induced hypertension (PIH) is associated with preterm delivery but its independent impact on neonatal outcomes remains unclear. We sought to systematically review and meta-analyze clinical outcomes of preterm infants <37 weeks' gestation born to mothers with and without PIH.

STUDY DESIGN

Medline, Embase, PsychINFO and CINAHL were searched from January 2000 to October 2016. Studies with low-moderate risk of bias reporting neonatal outcomes based on PIH as primary exposure variable were included. Data were extracted independently by two co-authors.

RESULTS

PIH was associated with lower mortality (3 studies; adjusted odds ratio (aOR) 0.65; 95% confidence interval (CI) 0.54 to 0.79), lower severe retinopathy of prematurity (ROP) (2 studies; aOR 0.83; 0.72 to 0.96) and lower severe brain injury (2 studies; unadjusted OR (uOR) 0.57; 0.49 to 0.66). No association between PIH and short-term respiratory outcomes, bronchopulmonary dysplasia (BPD) or necrotizing enterocolitis (NEC) was identified. In subgroup analysis among infants <29 weeks' gestation, BPD odds were higher (3 studies; aOR 1.15; 1.06 to 1.26), whereas mortality lower (2 studies; aOR 0.73; 0.69 to 0.77). In subgroup analysis limited to severe PIH, odds of mortality (3 studies; uOR 2.36; 1.07 to 5.22) and invasive ventilation (3 studies; uOR 3.26; 1.11 to 9.61) were higher. In subgroup analysis limited to preeclampsia, odds of BPD (3 studies; uOR 1.21; 95% CI:1.03 to 1.43) and NEC were higher (3 studies; uOR 2.79; 95% CI:1.57 to 4.96).

CONCLUSION

PIH was associated with reduced odds of mortality and ROP (all infants), but higher odds for BPD (<29 weeks' gestation). The paradoxical reduction in mortality may be due to survival bias and deserves further exploration in future studies.

The effect of Dermo and Seal-In X5 prosthetic liners on pressure distributions and reported satisfaction during ramp ambulation in persons with transtibial limb loss

BACKGROUND

Lower limb amputee's are greatly affected in dealing with the environmental barriers such as ramps and stairs and reported high interface pressure between the residual limb and socket/liner. Interface pressure between the residual limb and socket/liner can affect the satisfaction and use of the prosthesis. Until now, little attention has been paid to interface pressure between socket and stump during ramp negotiation and its effect on amputee's satisfaction.

AIM

The aim of this study was to evaluate the interface pressure produced by two different liners (Seal-In X5 and Dermo) between the residual limb and socket, and their effects on amputee's satisfaction during ramp negotiation.

DESIGN

Observational study.

SETTING

The study was performed in rehabilitation and biomedical departments of University Malaya Medical Centre.

POPULATION

Total ten (7 male, 3 female) transtibial amputees with unilateral amputation were included.

METHODS

Two prostheses were fabricated for each amputee. After four weeks of acclimation period, interface pressure between socket and residual limb was measured during walking on ramp and Prosthetic Evaluation Questionnaire (PEQ) was filled for each liner.

RESULTS

Mean peak pressure was significantly (P<0.05) lower with the Dermo liner compared with the Seal-In X5 liner in ramp walking. In addition, the participants were more satisfied with the Dermo liner (83.50 vs. 71.50) and mentioned fewer problems (87.00 vs. 69.00) compared with the Seal-In X5 liner during ramp negotiation.

CONCLUSION

It might be concluded that Dermo liner could be a good choice for the transtibial level of amputation due to relative decrease in interface pressure, satisfaction and fewer problems.

CLINICAL REHABILITATION IMPACT

The advantages of the Dermo liner may improve clinical rehabilitation of transtibial amputee's, as it provides more satisfaction and experienced fewer problems during ramp negotiation. This provides an improved walking and better quality of life in long term.

Metallosis, psoas abscess and infected hip prosthesis in a patient with bilateral metal on metal total hip replacement

Metal on metal hip (MoM) resurfacing / replacement has recently been one of the most discussed topics in orthopaedics. Significant revision rates and complications are associated with MoM. We report a patient presenting with infection of a total hip prosthesis in conjunction with a psoas abscess in which the presentation is complicated by radiological evidence of suspected metallic debris in the lower limb tissues and elevated chromium and cobalt levels, suggestive of metallosis secondary to MoM.

Loose body following cross-pin fixation for anterior cruciate ligament reconstruction

We report a case of loosening of a bioabsorbable cross-pin fixation device for anterior cruciate ligament reconstruction. Forty-two months following a bone tendon bone reconstruction of the anterior cruciate ligament, the patient presented with a subcutaneous collection in the medial side of the knee. At subsequent surgery, a RIGIDFIX cross-pin fixator (Mitek, Westwood, MA, USA) was retrieved, intact, from the sterile fluctuant mass around the superomedial aspect of the knee. The graft was stable both radiologically and clinically, and the patient remains symptom free. This case raises concern about the use of this smooth cross-pin fixator and the consequences of backing out and the resultant intraarticular loose body. We suggest consideration of a loose body if the patient becomes symptomatic postoperatively, and early intervention to prevent chondral damage is recommended.

Domiciliary cockroaches found in restaurants in five zones of Kuala Lumpur Federal Territory, peninsular Malaysia

The following domiciliary cockroaches were collected from restaurants in five zones of Kuala Lumpur Federal Territory, Malaysia using 1L glass beaker traps baited with ground mouse-pellets: Periplaneta americana (Linnaeus) (n = 820), Periplaneta brunnea Burmeister (n = 46), Blattella germanica (Linnaeus) (n = 12504), Supella longipalpa (Fabricius) (n = 321), Symploce pallens Stephens (n = 29) and Neostylopyga rhombifolia (Stoll) (n = 5). The following bacteria were isolated from 10 cockroach specimens: Enterobacter cloacae, Klebsiella pneumoniae ssp. pneumoniae, Klebsiella pneumoniae ssp. rhinoscleromatis and Serratia liquefaciens from 5 B. germanica; Acinetobacter calcoaceticus var. anitratus, Citrobacter diversus/amalonaticus, Escherichia vulneris and K.p. pneumoniae from 3 P. brunnea; and Citrobacter freundii, Enterobacter agglomerans 4, Escherichia adecarboxylate, E. vulneris, K. p. pneumonia, K. p. rhinoscleromatis and Proteus vulgeris from 2 P. americana.

[Surgical treatment of primary hyperparathyroidism in pregnancy]

Primary hyperparathyroidism during pregnancy is a pathological entity with an unknown incidence that presents certain physiological, therapeutic and prognostic characteristics leading to greater difficulty in diagnosis and a high risk of complications. We present the case of a 16-week pregnant woman who presented with asymptomatic hypercalcemia secondary to a solitary parathyroid adenoma. Since conservative measures produced no improvement, surgery was performed in the second trimester of pregnancy, with satisfactory pre- and postnatal results. Surgery in the second trimester constitutes a safe alternative to conservative treatment.

Aerodigestive amyloidosis presenting as acute asthma

Aerodigestive amyloidosis is a rare disorder characterized by fibrillar protein deposition in the aerodigestive tree. We present a case of a 19-year-old Chinese gentleman whose diagnosis was initially missed as he presented with features suggestive of severe bronchial asthma and was intubated and ventilated. He subsequently presented 2 years later with severe stridor and required emergency tracheostomy. Current literature is reviewed for the histopathology, common clinical features, radiological findings and treatment options for aerodigestive amyloidosis.

Peptide design using omega-amino acids: unusual turn structures nucleated by an N-terminal single gamma-aminobutyric acid residue in short model peptides

Incorporation of omega-amino acids into peptide sequences plays an important role in designing peptides with modified backbone conformation and enhanced stability against proteolysis. The present study establishes the presence of unusual turns involving 12-membered hydrogen bonded rings in terminally blocked tri- and tetrapeptides. X-ray diffraction analysis of single crystals and NMR studies have been used to probe the three-dimensional structures of two terminally protected short peptides, Boc-gamma-Abu(1)-Aib(2)-Ala(3)-OMe 1 and Boc-gamma-Abu(1)-Aib(2)-Ala(3)-Aib(4)-OMe 2 (gamma-Abu = gamma-aminobutyric acid), in which conformationally flexible omega-amino acids (gamma-Abu) and conformationally restricted alpha-aminoisobutyric acid (Aib) residues are positioned contiguously. The crystal structures of both peptides 1 and 2 exhibit unusual turns composed of 12-membered hydrogen bonded rings involving C [double bond] O from the Boc-group and Ala(3) NH. A type I' beta-turn was observed in the structure of peptide 2 adjacent to the unusual turn with a hydrogen bond between gamma-Abu(1) C [double bond] O and Aib(4) NH. The crystals of peptide 1 are in the space group P2(1), a = 9.3020(10) A, b = 23.785(2) A, c = 10.022(3) A, beta = 101.35 degrees(4), Z = 4, R = 5.7%, and R(w) = 14.5%. Similarly, the crystals of peptide 2 are in the space group C2, a = 19.0772(6) A, b = 8.7883(2) A, c = 16.7758(3) A, beta = 110.7910 degrees(10), Z = 4, R = 6.71%, and R(w) = 15.11%. The unusual turn in both peptides 1 and 2 are retained in solution as is evident from NMR studies in CDCl(3). The role of the adjacently located Aib residue to nucleate the 12-membered hydrogen bonded ring is also addressed.

A five year review of scar dehiscence in the Rotunda Hospital, Dublin

The aims of this study were to identify risk factors for scar dehiscence in labour, to illustrate the clinical presentations of patients with scar dehiscence and to quantify the risk posed by the use of oxytocin in labour. This was a case controlled, 5 year retrospective study. Patients with scar dehiscence were identified from labour ward records with matched controls and chart review of case and control patients were performed. Our results showed that the vaginal delivery rate for trial of scar was 76.9%. The incidence of scar dehiscence was 0.043%. Oxytocic labour augmentation was a risk factor (OR 4.5, 95% CI 0.9313-42.8, p=0.065) but induction of labour using oxytocin was not (p=0.222). The commonest symptom of scar dehiscence was fetal distress (OR 12.3, 95% CI 1.9-81). There was no maternal or fetal mortality. We concluded that trial of labour after one caesarean section is acceptable practice with a good success rate and a low incidence of serious morbidity. The use of oxytocin to augment labour is associated with scar dehiscence.

Fine needle aspiration cytology of the thyroid--a review of experience in 1853 cases

1853 thyroid lesions subjected to cytological sampling (either by the fine needle aspiration or fine needle capillary sampling technique) from January 1992 to December 1997 at the University Hospital, Kuala Lumpur, were reviewed. Nodular goitre was the most common thyroid lesion needled (67.35%). Among the neoplastic lesions, follicular neoplasms predominated (64%), followed by papillary carcinoma (29.4%). In 325 cases, partial or total thyroidectomy had been done, providing material for histological review and cyto-histological correlation. Cytological diagnosis was found to have high sensitivity and specificity rates of over 75%. Besides, most non-neoplastic thyroid lesions could be diagnosed on cytology. The scope of cytology in the diagnosis of lymphomas, anaplastic and metastatic tumours rendered diagnostic biopsies (or thyroidectomy) unnecessary in these cases. Being a cost-effective technique and having the capacity to provide exact morphological diagnosis in a large variety of thyroid lesions, cytology is obviously the method of choice in the assessment of thyroid nodules.