Clinical impact of neutropenia and febrile neutropenia in metastatic colorectal cancer patients treated with FOLFOXIRI/bevacizumab: a pooled analysis of TRIBE and TRIBE2 studies by GONO

BACKGROUND

TRIBE and TRIBE-2 studies demonstrated higher benefit from FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan)/bevacizumab compared with FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX/bevacizumab as an upfront option for metastatic colorectal cancer patients, with more toxicities. We focused on the incidence and longitudinal dynamics of neutropenia and febrile neutropenia (FN) in the two studies, to evaluate their clinical relevance, the magnitude of impact of FOLFOXIRI/bevacizumab, and the role of risk factors in predicting their occurrence.

METHODS

The overall incidence of grade 3-4 (G3-4) neutropenia and FN, the time to their onset, the use of granulocyte colony-stimulating factor, and the association with risk factors were evaluated in the overall population and according to treatment arm. FN episodes were assessed by Multinational Association for Supportive Care in Cancer (MASCC) score.

RESULTS

Among 1155 patients, 568 (49%) received FOLFOXIRI/bevacizumab. Overall, 410 (35%) experienced G3-4 neutropenia and 70 (6%) FN, 21 (2%) at high risk. FOLFOXIRI/bevacizumab was associated with higher incidence of neutropenia (51% versus 21%, P < 0.001), FN (8% versus 4%, P = 0.02), and high-risk FN [18 (3%) versus 3 (1%), P = 0.015]. No related deaths were observed. The first episode of G3-4 neutropenia and FN occurred mainly in the first 2 months in both arms. Longitudinal analysis showed different patterns of evolution over cycles between the arms (P < 0.001) G3-4 neutropenia being more frequent in the first cycles with FOLFOXIRI/bevacizumab. Older patients (P = 0.01) and females (P < 0.001) had a significantly higher risk of G3-4 neutropenia. No significant interaction effect between arm and analysed risk factors in terms of risk of G3-4 neutropenia or FN was observed. The incidence of FN among older females receiving FOLFOXIRI/bevacizumab was 12%. Neither G3-4 neutropenia nor FN impaired efficacy in terms of overall response rate, progression-free survival, and overall survival.

CONCLUSIONS

FOLFOXIRI/bevacizumab has a higher risk of G3-4 neutropenia and FN than doublets/bevacizumab. FN occurred in <10% of patients, mostly as low-risk episodes. A closer monitoring during the first 2 months is recommended; prophylactic use of granulocyte colony-stimulating factor may be considered for older females.

Cardiac fibroblast activation protein density indicative of cardiovascular disease and remodeling

Background

Fibroblast activation protein (FAP) plays an important role in cardiac wound healing and remodelling. Although initially developed as a theranostic ligand for metastasized cancer, FAPI tracers have recently been used to study cardiac remodelling following myocardial infarction in small animal models. Aim of our analysis was to evaluate the activity of fibroblast activation protein via (FAPI) PET-CT scans in human hearts.

Methods

FAPI-PET-CT scans of 229 patients of two consecutive cohorts (initial cohort: n=185; confirmatory cohort: n=44) suffering from metastasized cancer were analysed using a 17-segment model of the left ventricle. Patient characteristics included age, sex, cancer entity, body mass index, renal function, thyroid stimulating hormone, cardiovascular risk factors, previous radiation to the chest, chemotherapies received, and current cardiac medication. Multivariate regression models were created using data from the initial cohort by selecting variables according to Akaike's information criterion in a step-down approach. Linear regression models were used for signal prediction to find potential outliers with unexpectedly high signal intensities. The created models were subsequently evaluated in the confirmatory cohort for reproducibility.

Results

Signal intensity were significantly higher in patients with overweight, diabetes and following radiation to the chest. Our prediction model performed well in both cohorts. A focal enrichment pattern was more frequently observed in patients with known cardiovascular risk factors.

Conclusions

FAPI-PET-CT scans represent a new imaging modality to potentially investigate active cardiac remodelling. High signal intensities are associated with cardiovascular risk factors and metabolic disease. Furthermore, high cardiac FAPI signal intensities are suggestive of an underlying cardiac disease.

Funding Acknowledgement

Type of funding source: None

Heavy Metals in Fish Muscle from an Ethiopian Rift-Valley Lake (Hawassa) and a Neighboring Stream (Boicha): Assessment of Human Health Risks

Concentrations of heavy metals (Cr, Co, Fe, Ni, Cu, Zn, As, Se, Pb and Hg) in muscle tissues of two fish species (Clarias gariepinus and Oreochromis niloticus) in an Ethiopian rift-valley lake (Hawassa) and a neighboring stream (Boicha) were determined. Target hazard quotients (THQ), hazard index (HI) and target cancer risk (TCR) were used as indices to evaluate potential human health risks from fish consumption. Average concentrations of metals decreased in the order Zn>Fe>Se>Cu>Hg>As>Ni>Cr>Co>Pb and Zn>Fe>Se>Cu>As>Hg>Cr>Ni>Pb>Co in muscle tissues of C. gariepinus and O. niloticus, respectively. Mean concentrations of Hg (0.34+0.04 mg kg-1) in muscle tissues of C. gariepinus from Lake Hawassa, and As (0.18+0.05 mg kg-1) as well as Hg (0.46+0.03 mg kg-1) in muscle tissues of C. gariepinus from Boicha stream were above the safety limits set by WHO/FAO. Likewise, mean concentrations of As (0.31+0.03 mg kg-1) and Hg (0.19+0.05 mg kg-1) in muscle tissues of O. niloticus from Lake Hawassa and Cr (0.19+0.03 mg kg-1), As (0.33 +0.04 mg kg-1), and Hg (0.34+0.09 mg kg-1) in O. niloticus from Boicha stream were also above safety limits. From the results of human health risk assessments it was concluded that Cr, Cu, Hg and As pose potential health risks due to consumption of the two fish species from both water bodies. Moreover, effects of all heavy metals put together may affect human health as indicated by the high HI. Effluents from industries are assumed to be the main sources of the heavy metals. Therefore, regular monitoring of the water bodies and policy interventions with respect to waste disposal are recommended to protect the health of the ecosystem and the public. Keywords: Fish consumption, health risk, heavy metals, Lake Hawassa

Resilient Coping and Social Networks in Old Age

Introduction

Both resilient coping strategies and the structural/functional characteristics of personal social networks are considered important factors when facing adversity and the challenges inherent to the aging process.

Objectives

To analyze the association between the configurations of ego-centred networks and different levels of resilient coping in a sample of elderly people.

Methods

Quantitative, cross-sectional study comparing groups, with 512 participants, mostly women (n = 325; 63.5%), married (n = 264; 51.5%), with 76 years old in average (SD ± 7.6), and with basic education (n = 261; 51%). We used a socio-demographic questionnaire, the IARSP-Elderly (personal social network assessment tool) and the Brief Resilient Coping Scale for data collection.

Results

We found different levels of resilient coping in our sample: low (50.4%); medium (38,7%); strong (10.9%). These three levels of coping were associated with the composition of ego-centred networks, namely the proportion of friends and colleagues (P < 0.05), different perceived emotional support, reciprocity and satisfaction with the network (P < 0.05), frequency of contacts and relationships’ durability (P < 0.05).

Conclusions

Higher levels of coping are associated with a larger proportion of friends in the network, whereas the familistic networks are associated with low coping. Although participants in our study revealed mainly kin comprised networks, these results reflect the relevance of resilient coping in the activation of non-kin relationships in old age.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Time spent in retirement, health and well-being

Introduction

From a life-span developmental perspective, retirement can be considered a life event that entails a complex psychological challenge, including leaving one's professional life and organizing/enjoying the newly available free time. The literature about retirement identifies different stages and patterns of transition/adaption associated with time spent in retirement.

Objectives

To analyze the association between time spent in retirement and subjective measures of mental health, depressive symptomatology, loneliness and satisfaction with life.

Methods

Quantitative cross-sectional study with 641 participants (M = 74,86). The instruments included: sociodemographic questionnaire; mental health inventory (MHI-5); geriatric depression scale (GDS); UCLA loneliness scale; satisfaction with life scale (SWLS).

Results

Statistically significant differences in all the health and well-being variables addressed were found between subgroups of time spent in retirement (MHI-5: P = 0.001; GDS: P < 0.001; UCLA: P = 0.038; SWLS: P = 0.022). Mental health and satisfaction with life increases in the first year after retirement, but during the second year, they decrease to the levels found in pre-retirement. Loneliness and depressive symptomatology follow an inverted pattern. With the passing of years, loneliness and depression tend to increase; mental health and satisfaction with life tend to decrease.

Conclusions

The results provide support to the hypotheses of honeymoon and disenchantment phases in the recently retired and to the existence of different patterns of transition/adaptation associated with time spent in retirement. They also highlight the relevance of devising intervention strategies that enable individuals to maintain the satisfaction levels with life and mental health achieved during the first phase of retirement.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Qualitative Assessment of Vaccination Hesitancy Among Members of the Apostolic Church of Zimbabwe: A Case Study

Vaccine hesitancy or lack of confidence in vaccines is considered a threat to the success of vaccination programs. The rise and spread of measles outbreaks in southern Africa in 2009-2010 were linked to objections among Apostolic Church members, estimated at about 3.5 million in Zimbabwe as of 2014. To inform planning of interventions for a measles-rubella vaccination campaign, we conducted an assessment of the factors contributing to vaccine hesitancy using data from various stakeholders. Among nine districts in three regions of Zimbabwe, we collected data on religious attitudes toward, and perceptions of, vaccines through focus group discussions with health workers serving Apostolic communities and members of the National Expanded Programme on Immunization; semi-structured interviews with religious leaders; and open-ended questions in structured interviews with Apostolic parents/caregivers. Poor knowledge of vaccines, lack of understanding and appreciation of the effectiveness of vaccinations, religious teachings that emphasize prayers over the use of medicine, lack of privacy in a religiously controlled community, and low levels of education were found to be the main factors contributing to vaccine hesitancy among key community members and leaders. Accepting vaccination in public is a risk of sanctions. Poor knowledge of vaccines is a major factor of hesitancy which is reinforced by religious teachings on the power of prayers as alternatives. Because parents/caregivers perceive vaccines as dangerous for their children and believe they can cause death or disease, members of the Apostolic Church have more confidence in alternative methods such as use of holy water and prayers to treat diseases. Under these circumstances, it is important to debunk the myths about the power of holy water on the one hand and disseminate positive information of the efficacy of vaccines on the other hand in order to reduce hesitancy. Education about vaccines and vaccination in conjunction with government intervention, for example, through the use of social distancing policies can provide a framework for reducing hesitancy and increasing demand for vaccination.

Quality of life related to the health and socio-economic resources of the elderly

Introduction

Aging is a very heterogeneous and dissimilar process, full of asymmetries. There is evidence that socio-economic differences determine disadvantages and inequalities in old ages. Older people face particular inequalities in healthiness especially with more complex and vulnerable long-term conditions, being more likely to need support from social care services.

Aim

To evaluate the quality of life (well-being) related to the health of the elderly according to socio-economic indicators.

Method

Cross-sectional quantitative study was performed. A total of 316 elderly people (M = 74.78; SD = 9.78 years of age) was interviewed with the Portuguese version of the EQ-5D-3L scale for health-related quality of life.

Results

The interaction between income and the type of residential follow-up (alone vs. accompanied) was not statistically significant [F (2.310) = .910, P < .407; Ƞp2 = .006]. Differences in health status index were statistically significant for income [F (2.310) = 5.518, P < .004; Ƞp2 = .034]. Post-hoc comparisons indicated that the mean score for those with insufficient income for their expenses (M = .39, SD = .27) was significantly different from those with income reaching their expenses (M = .50, SD = .25) as well as those with income covering their expenses sufficiently (M = .60, SD = .21). The main effect for the type of follow-up (alone vs. accompanied) did not reach statistical significance [F (2.310) = .224, P < .636, Ƞp2 = .672].

Conclusions

Income has an impact on health-related quality of life. Health in aging as a social phenomenon is not neutral to economic differences and is exposed to these structural disadvantages.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The temporal evolution of life satisfaction in institutionalized elderly: A longitudinal study

Introduction

Research shows that variables, such as depression, less functionality and health, less contact with family and others, may have a negative impact on life satisfaction.

Objectives

To verify which variables correlate with satisfaction with life (SWL) and analyse which of them predict the evolution of SWL.

Aims

To examine correlates and predictors of SWL in institutionalized elderly.

Methods

This study involved a subsidiary longitudinal analysis of cross-sectional data gathered at Phase I (2010–2012; n = 493 elderly) and after 36 months at Phase II (2013–2014; n = 85) of Aging Trajectories Project from Miguel Torga University College.

Results

At Phase I, higher scores in SWL scale correlated with having visits (r = 0.17; P < 0.01), specially from family (r = 0.20; P < 0.01), less depressive (r = –0.42; P < 0.001) and anxiety symptoms (r = –0.25; P < 0.001), less loneliness feelings (r = –0.37; P < 0.001), less functionality (r = 0.15; P < 0.01), and better general physical health (r = 0.25; P < 0.001). Age, sex, civil status, cognitive, and executive status did not correlate with SWL. SWL, depressive and anxiety symptoms, and loneliness feelings were stable through time, between assessment stages (P < 0.01). The worsening of depression and loneliness through time predicted the negative evolution of SWL (respectively, β = 1.16; P < 0.01; β = –0.69; P < 0.05).

Conclusions

These findings highlight the relevance of early detecting depressed mood and loneliness feelings in institutionalized elderly, and the importance of the treatment and the development of preventive interventions for this vulnerable population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Discovery of Time Variation of the Intensity of Molecular Lines in IRC+10216 in The Submillimeter and Far Infrared Domains

We report on the discovery of strong intensity variations in the high rotational lines of abundant molecular species towards the archetypical circumstellar envelope of IRC+10216. The observations have been carried out with the HIFI instrument on board Herschel and with the IRAM 30-m telescope. They cover several observing periods spreading over 3 years. The line intensity variations for molecules produced in the external layers of the envelope most probably result from time variations in the infrared pumping rates. We analyze the main implications this discovery has on the interpretation of molecular line emission in the envelopes of Mira-type stars. Radiative transfer calculations have to take into account both the time variability of infrared pumping and the possible variation of the dust and gas temperatures with stellar phase in order to reproduce the observation of molecular lines at different epochs. The effect of gas temperature variations with stellar phase could be particularly important for lines produced in the innermost regions of the envelope. Each layer of the circumstellar envelope sees the stellar light radiation with a different lag time (phase). Our results show that this effect must be included in the models. The sub-mm and FIR lines of AGB stars cannot anymore be considered as safe intensity calibrators.

A randomised study evaluating the use of pyridoxine to avoid capecitabine dose modifications

BACKGROUND

Pyridoxine is frequently used to treat capecitabine-induced hand-foot syndrome (HFS), although the evidence of benefit is lacking. We performed a randomised placebo-controlled trial to determine whether pyridoxine could avoid the need for capecitabine dose modifications and improve outcomes.

METHODS

A total of 106 patients planned for palliative single-agent capecitabine (53 in each arm, 65%/35% colorectal/breast cancer) were randomised to receive either concomitant pyridoxine (50 mg po) or matching placebo three times daily.

RESULTS

Compared with placebo, pyridoxine use was associated with an increased rate of avoiding capecitabine dose modifications (37% vs 23%, relative risk 0.59, 95% CI 0.29, 1.20, P=0.15) and fewer grade 3/4 HFS-related adverse events (9% vs 17%, odds ratio 0.51, 95% CI 0.15-1.6, P=0.26). Use of pyridoxine did not improve response rate or progression-free survival.

CONCLUSION

Pyridoxine may reduce the need for capecitabine dose modifications and the incidence of severe HFS, but does not impact on antitumour effect.

[Cognitive rehabilitation in multiple sclerosis: a review of the literature]

INTRODUCTION

Cognitive impairment is now well-known in multiple sclerosis (MS). However, few rehabilitation interventions are proposed or really efficient.

OBJECTIVES

To present a review of cognitive rehabilitation intervention research conducted in people with multiple sclerosis (MS), regarding different findings about episodic memory, working memory, attention and executive function disorders in MS.

DATA SOURCES

A search of Medline (yield 20 papers) and of PsychInfo (yield 1 article), using combinations of the following terms: cognitive rehabilitation, multiple sclerosis, cognitive therapy, neuropsychological rehabilitation, in the title or in the abstract, from 1960 to March 2010, excluding animal studies.

RESULTS

Episodic memory rehabilitation studies appear to be promising. Programs on working memory, attention and executive functions are in the very early phases.

CONCLUSIONS

Results are encouraging and allow specific recommendations for future research about: (1) inclusion criteria, often not defined, (2) a specific baseline adapted to the program of rehabilitation, (3) a control measure regarding program efficiency and (4) a role for the psychologist (presence and advice during the program).

Warm water vapour in the sooty outflow from a luminous carbon star

The detection of circumstellar water vapour around the ageing carbon star IRC +10216 challenged the current understanding of chemistry in old stars, because water was predicted to be almost absent in carbon-rich stars. Several explanations for the water were postulated, including the vaporization of icy bodies (comets or dwarf planets) in orbit around the star, grain surface reactions, and photochemistry in the outer circumstellar envelope. With a single water line detected so far from this one carbon-rich evolved star, it is difficult to discriminate between the different mechanisms proposed. Here we report the detection of dozens of water vapour lines in the far-infrared and sub-millimetre spectrum of IRC +10216 using the Herschel satellite. This includes some high-excitation lines with energies corresponding to approximately 1,000 K, which can be explained only if water is present in the warm inner sooty region of the envelope. A plausible explanation for the warm water appears to be the penetration of ultraviolet photons deep into a clumpy circumstellar envelope. This mechanism also triggers the formation of other molecules, such as ammonia, whose observed abundances are much higher than hitherto predicted.

Beclin 1 mRNA strongly correlates with Bcl-XLmRNA expression in human hepatocellular carcinoma

Beclin 1 physically associates with Bcl-x(L) and is considered as a haploinsufficient tumor suppressor. As the role of Beclin 1 in hepatocellular carcinoma (HCC) is unknown, we determined Beclin 1 mRNA expression in 27 pairs of tumoral/nontumoral (T/NT) liver samples. The Beclin 1 mRNA T/NT ratio was less than 0.5 in 2 tumors and more than 2 in 1 tumor, and was positively correlated with the Bcl-X(L) mRNA T/NT ratio (P < 0.001), but not with the proliferating cell nuclear antigen mRNA T/NT ratio. Coregulation of Beclin 1 and Bcl-X(L) expression in HCC may suggest cooperation in the regulation of apoptosis.

Prise en charge thérapeutique des troubles cognitifs dans la sclérose en plaques : données et perspectives

Taking in charge cognitive disorders is a new concept in the global care of MS patients. Cognitive disorders are observed in the all forms of the disease, sometimes early on in the evolution. These disorders can be evaluated in details even detected despite any complain in the patient. Because of the lack of clear demonstration that disease-modifying treatments could act on cognition, new specific therapeutic issues have emerged during last years. This article first discusses relationships between disease-modifying treatments and cognition for the different forms of the disease, then analyse the effects of symptomatic drug therapy especially the use of anticholinesterasics. In the last part of the article new issues about antagonists of excitatory amino-acids and individual or group cognitive training are discussed. Recent functional imaging data concerning cerebral adaptation and their modifications by drug or non-drug procedures in MS patients suggest interesting therapeutic development in a next future.