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Background: Selenium or alpha‐tocopherol deficiency can cause neuromuscular disease. Beta‐carotene has limited documentation in horses. Objective: To evaluate the effect of owner practices on plasma beta‐carotene concentration and risk of selenium and alpha‐tocopherol deficiencies. Animals Three‐hundred and forty‐nine adult (≥1 year), university and privately owned horses and mules. Methods: Cross‐sectional study. Whole blood selenium, plasma alpha‐tocopherol, and plasma beta‐carotene concentrations were measured once. Estimates of daily selenium and vitamin E intake, pasture access, and exercise load were determined by owner questionnaire. Data were analyzed using t tests, Mann‐Whitney tests, parametric or nonparametric analysis of variance (ANOVA), Kruskal‐Wallis test, Spearman's correlation and contingency tables (P <.05). Results: Nearly 88% of the horses received supplemental selenium; 71.3% received ≥1 mg/d. Low blood selenium concentration (<80 ng/mL) was identified in 3.3% of horses, and 13.6% had marginal concentrations (80‐159 ng/mL). Non‐supplemented horses were much more likely to have low blood selenium (odds ratio [OR], 20.2; 95% confidence interval [CI], 9.26‐42.7; P <.001). Supplemental vitamin E was provided to 87.3% of horses; 57.7% received ≥500 IU/d. Deficient (<1.5 μg/mL) and marginal (1.5‐2.0 μg/mL) plasma (alpha‐tocopherol) occurred in 15.4% and 19.9% of horses, respectively. Pasture access (>6 h/d) and daily provision of ≥500 IU of vitamin E was associated (P <.001) with higher plasma alpha‐tocopherol concentrations. Plasma beta‐carotene concentration was higher in horses with pasture access (0.26 ± 0.43 versus 0.12 ± 0.13 μg/mL, P =.003). Conclusions and Clinical Importance: Suboptimal blood selenium and plasma alpha‐tocopherol concentrations occurred in 16.7% and 35.5% of horses, respectively, despite most owners providing supplementation. Inadequate pasture access was associated with alpha‐tocopherol deficiency, and reliance on selenium‐containing salt blocks was associated with selenium deficiency. [ABSTRACT FROM AUTHOR]

Patients with multiple myeloma (MM) inevitably relapse on initial treatment regimens, and novel combination therapies are needed. Ibrutinib is a first-in-class, once-daily inhibitor of Bruton's tyrosine kinase, an enzyme implicated in growth and survival of MM cells. Preclinical data suggest supra-additivity or synergy between ibrutinib and proteasome inhibitors (PIs) against MM. This phase 1/2b study evaluated the efficacy and safety of ibrutinib plus the PI carfilzomib and dexamethasone in patients with relapsed/refractory MM (RRMM). In this final analysis, we report results in patients who received the recommended phase 2 dose (RP2D; ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone), which was determined in phase 1. The primary efficacy endpoint was overall response rate (ORR). Fifty-nine patients with RRMM received the RP2D (18 in phase 1 and 41 in phase 2b). These patients had received a median of three prior lines of therapy; 69% were refractory to bortezomib, and 90% were refractory to their last treatment. ORR in the RP2D population was 71% (stringent complete response and complete response: 3% each). Median duration of clinical benefit and median duration of response were both 6.5 months. Median progression-free survival (PFS) was 7.4 months, and median overall survival (OS) was 35.9 months. High-risk patients had comparable ORR and median PFS (67% and 7.7 months, respectively) to non-high-risk patients, whose ORR was 73% and median PFS was 6.9 months, whereas median OS in high-risk patients was 13.9 months and not reached in non-high-risk patients. The most common grade ≥3 hematologic treatment-emergent adverse events (TEAEs) were anemia and thrombocytopenia (17% each); the most common grade ≥3 non-hematologic TEAE was hypertension (19%). In patients with RRMM treated with multiple previous lines of therapy, ibrutinib plus carfilzomib demonstrated anticancer activity within the expected efficacy range. No new safety signals were identified and the combination was well-tolerated. [ABSTRACT FROM AUTHOR]

This phase 2 study ( N = 116) evaluated single-agent vosaroxin, a first-in-class anticancer quinolone derivative, in patients ≥60 years of age with previously untreated unfavourable prognosis acute myeloid leukaemia. Dose regimen optimization was explored in sequential cohorts ( A: 72 mg/m2 d 1, 8, 15; B: 72 mg/m2 d 1, 8; C: 72 mg/m2 or 90 mg/m2 d 1, 4). The primary endpoint was combined complete remission rate (complete remission [ CR] plus CR with incomplete platelet recovery [ CRp]). Common (>20%) grade ≥3 adverse events were thrombocytopenia, febrile neutropenia, anaemia, neutropenia, sepsis, pneumonia, stomatitis and hypokalaemia. Overall CR and CR/ CRp rates were 29% and 32%; median overall survival ( OS) was 7·0 months; 1-year OS was 34%. Schedule C (72 mg/m2) had the most favourable safety and efficacy profile, with faster haematological recovery (median 27 d) and lowest incidence of aggregate sepsis (24%) and 30-d (7%) and 60-d (17%) all-cause mortality; at this dose and schedule, CR and CR/ CRp rates were 31% and 35%, median OS was 7·7 months and 1-year OS was 38%. Overall, vosaroxin resulted in low early mortality and an encouraging response rate; vosaroxin 72 mg/m2 d 1, 4 is recommended for further study in this population. Registered at : # NCT00607997. [ABSTRACT FROM AUTHOR]

Background More than 20% of patients develop chronic instability following appropriate management of an 'ankle sprain'. There is little research comparing surgical techniques. 'Anatomical' procedures, such as the modified Brostrom- Gould ( MBG), are generally preferred. However, not all patients are suitable for this procedure. Augmentation of a primary repair using a synthetic ligament, such as the ligament augmentation reconstruction system ( LARS), is another 'anatomic' option. Our objective was to compare the clinical outcome following the MBG with that following the LARS technique using a prospective randomized clinical trial. Methods Patients who satisfied the study criteria were randomly allocated to undergo the LARS procedure or the MBG procedure. All patients followed a similar rehabilitation programme. Patients completed the foot and ankle outcome score ( FAOS) before surgery, and then at 1 year and 2 years following surgery. Statistical analysis was used to compare the groups ( P < 0.05). Results Forty-one patients took part in the study, 21 were randomized to the LARS group and 20 to the MBG group. The LARS group had a significantly better improvement in the total FAOS at both 1 year (25.5 standard error ( SE) 3.8 versus 16.0 SE 3.3) and 2 years (27.1 SE 4.5 versus 15.8 SE 4.9) post-surgery. Conclusion Primary repair combined with LARS results in better patient-scored clinical outcome, at 2 years post-surgery, than the MBG procedure. Although longer follow-up is required, the LARS procedure may be considered as an alternative, especially in those patients for whom the MBG is relatively contra-indicated. [ABSTRACT FROM AUTHOR]

Background Compared with growth factor ( G) alone, the combination of G with plerixafor ( G + P) increases peripheral blood CD34+ count ( PB- CD34+) and improves CD34+ collection yield ( yCD34+) in multiple myeloma and lymphoma patients undergoing autologous hematopoietic progenitor cell ( AHPC) mobilization. It is unknown whether the improved yCD34+ with G + P results entirely from expansion of PB- CD34+ or also from increased intraapheresis CD34+ recruitment and collection efficiency. Study Design and Methods We retrospectively studied 192 patients who underwent AHPC mobilization and collection with G (n = 73) or G + P (n = 119) to compare the adjusted relative efficiency ( aRE), the proportion of the circulating CD34+ pool that is captured for each blood volume processed. Additionally, in a prospective cohort of nine patients mobilizing with G and 11 with G + P, PB- CD34+ after leukapheresis allowed calculation of the recruitment coefficient ( RC), proportion of the initial CD34+ pool recruited from the marrow into peripheral blood for each blood volume processed. Results There was no difference in aRE between G and G + P (0.50 vs. 0.46; p = 0.37) and no substantial decline in aRE with higher blood volumes processed in either group. RC was also not different between G and G + P (median, 0.39 and 0.38, respectively; p = 0.7). Prediction of yCD34+ was determined essentially by PB- CD34+ and not affected independently by plerixafor. Conclusion Kinetics of intraapheresis CD34+ recruitment and collection is proportional to PB-CD34+ but not influenced further by plerixafor. [ABSTRACT FROM AUTHOR]

BACKGROUND: Plerixafor enhances the ability of filgrastim (FIL) to mobilize CD34+ cells but adds cost to the mobilization. We hypothesized that replacing weight-based FIL with flat-dose pegfilgrastim (PEG) in a validated cost-based mobilization algorithm for patient-adapted use of plerixafor would add convenience without increased cost. STUDY DESIGN AND METHODS: A single-center retrospective analysis compared two consecutive cohorts undergoing FIL or PEG mobilization before autologous hematopoietic stem cell transplantation for multiple myeloma or lymphoma. FIL dose was 10 µg/kg/day continuing until completion of collection and a 12-mg flat dose of PEG. Peripheral blood CD34+ cells (PB-CD34+) enumeration was performed on the fourth day after initiation of growth factor. Subjects surpassing a certain target-specific threshold of PB-CD34+ started apheresis immediately while subjects with lower PB-CD34+ received plerixafor with apheresis starting on the fifth day. RESULTS: Overall 68 of 74 in the FIL group and 52 of 57 patients in the PEG group met the mobilization target. Only one patient in each cohort required remobilization. Median PB-CD34+ on Day 4 was significantly higher in patients in the PEG group (18.1 × 106 vs. 28.7 × 106 cells/L, p = 0.01). Consequently, patients in the PEG group were less likely to require administration of plerixafor (67.5% vs. 45.6%, p = 0.01). Cohorts had near identical mean number of apheresis sessions and comparable CD34+ yield. The estimated cost associated with growth factor was higher in patients in the PEG group, but it was counterbalanced by lower cost associated with use of plerixafor. CONCLUSION: Single administration of 12 mg of PEG is associated with better CD34+ mobilization than FIL allowing for effective, convenient mobilization with less frequent use of plerixafor. [ABSTRACT FROM AUTHOR]

BACKGROUND: The dose of CD34+ cells/kg in the mobilized peripheral blood product is the main determinant of neutrophil and platelet (PLT) engraftment after autologous hematopoietic stem cell transplantation (AHSCT). Whether the method of mobilization, namely, granulocyte-colony-stimulating factor (G-CSF) alone (G), G-CSF plus plerixafor (G+P), or cyclophosphamide + G/granulocyte-macrophage (GM)-CSF (Cy+G/GM), independently affects number of colony-forming unit (CFU)-GM, engraftment, and hematopoietic graft function is unknown. STUDY DESIGN AND METHODS: We used a database of AHSCT patients with multiple myeloma or lymphoma to identify three groups with different mobilization strategies receiving transplantation with similar CD34+ cell doses. Groups were compared in terms of CFU-GM, ratio of CFU-GM/CD34+, engraftment of neutrophils and PLTs, and hematopoietic graft function on Day +100. RESULTS: Ninety-six patients were included in the analysis, 26 G, 32 G+P, and 38 Cy+G/GM, with median cell doses of 4.21 × 106, 4.11 × 106, and 4.67 × 106 CD34+/kg, respectively (p = 0.433). There was no significant difference in number of CFU-GM between the three groups; however, the ratio of CFU-GM/CD34+ was significantly lower for G+P (p = 0.008). Median time for neutrophil engraftment was 13 days in G+P and 12 days in G and Cy+G/GM (p = 0.028), while PLT engraftment happened at a median of 14.5 days in G+P versus 12 days in G and 11 days in Cy+G/GM (p = 0.012). There was no difference in hematopoietic graft function at Day +100. CONCLUSION: Plerixafor-based mobilization is associated with slightly reduced number of CFU-GM and minimal delay in engraftment that is independent of CD34+ cell dose. Hematopoietic graft function on Day 100 is not affected by mobilization strategy. [ABSTRACT FROM AUTHOR]

Clofarabine and cytarabine target different steps in DNA synthesis and replication, are synergistic in vivo, and have non-overlapping toxicities, making this combination a potentially promising treatment for acute lymphocytic leukaemia. Thirty-seven patients were treated. The median age was 41 years, 44% of patients were either in ≥2nd relapse or had refractory disease and 59% of patients had poor risk cytogenetics. Six out of 36 patients (17%) achieved a complete remission with or without complete count recovery; median overall survival was 3 months. Nucleoside transporter expression did not predict outcome. This regimen lacked sufficient activity to warrant further testing. [ABSTRACT FROM AUTHOR]

Background: Studies have indicated that hypoalbuminemia is associated with decreased survival of patients with gastric cancer. However, the prognostic value of albumin may be secondary to an ongoing systemic inflammatory response. The aim of the study was to assess the relation between hypoalbuminemia, the systemic inflammatory response, and survival in patients with gastric cancer. Methods: Patients diagnosed with gastric carcinoma attending the upper gastrointestinal surgical unit in the Royal Infirmary, Glasgow between April 1997 and December 2005 and who had a pretreatment measurement of albumin and C-reactive protein (CRP) were studied. Results: Most of the patients had stage III/IV disease and received palliative treatment. The minimum follow-up was 15 months. During follow-up, 157 (72%) patients died of their cancer. On univariate analysis, stage ( p < 0.001), treatment ( p < 0.001), albumin level ( p < 0.001), and CRP level ( p < 0.001) were significant predictors of survival. On multivariate analysis, stage ( p < 0.001), treatment ( p < 0.001), and CRP level ( p < 0.001) remained significant predictors of survival. Albumin was no longer an independent predictor of survival. Conclusions: Low albumin concentrations are associated with poorer survival in patients with gastric cancer. However, the strength of this relation with survival is dependent on the presence of a systemic inflammatory response, as evidenced by an elevated CRP level. Therefore, it appears that the relation between hypoalbuminemia and poor survival is secondary to that of the systemic inflammatory response. [ABSTRACT FROM AUTHOR]

Background. Reirradiation of locoregionally recurrent, previously irradiated head/neck cancer may be considered in situations of unresectability, medical inoperability, or adverse pathologic features found at salvage resection. Methods. Retrospective cohort analysis of toxicity and survival outcomes in locoregionally recurrent, previously irradiated patients with head/neck cancer treated with hyperfractionated split-course radiotherapy and concurrent chemotherapy. Results. Between March 1998 and September 2006, 39 patients initiated reirradiation at median of 2.3 years (range, 0.5–19) following prior radiotherapy. At median survivor follow-up of 24.5 months (range, 3–63.9), 10 patients are alive without evidence of disease. Median survival is 19.0 months, with estimated 1-, 2-, and 3-year overall survivals of 60.1%, 45.1%, and 22.7%, respectively. Locoregional failure was the predominant site of postreirradiation recurrence. Male sex, total radiotherapy dose, cycles of chemotherapy completed, and clinical response were associated with improved overall survival. Conclusions. Reirradiation can offer long-term survival for patients with recurrent, previously irradiated head/neck cancers. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to compare an inflammation-based prognostic score (Glasgow Prognostic Score, GPS) with performance status (ECOG-ps) in patients receiving platinum-based chemotherapy for palliation of gastroesophageal cancer. Methods: Sixty-five patients presenting with gastroesophageal carcinoma to the Royal Infirmary, Glasgow between January 1999 and December 2005 and who received palliative chemotherapy or chemo-radiotherapy were studied. ECOG-ps, C-reactive protein, and albumin were recorded at diagnosis. Patients with both an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L) were allocated a GPS of 2. Patients in whom only one of these biochemical abnormalities was present were allocated a GPS of 1 and patients with a normal C-reactive protein and albumin were allocated a score of 0. Toxicity was recorded using the Common Toxicity Criteria. Results: The minimum follow up was 14 months. During the follow-up period, 59 (91%) of the patients died. On univariate and multivariate survival analysis, only the GPS (hazard ratios 1.65, 95% CI 1.10–2.47, P < 0.05) was a significant independent predictor of cancer survival. In addition, in comparison with patients with GPS of 0, those patients with a GPS of 1 or 2 required more frequent chemotherapy dose reduction ( P < 0.05), were less likely to exhibit a clinical response to treatment ( P < 0.05), and had shorter survival ( P < 0.05). Conclusion: The presence of a systemic inflammatory response, as evidenced by the GPS, appears to be superior to the subjective assessment of performance status (ECOG-ps) in predicting the response to platinum-based chemotherapy in patients with advanced gastroesophageal cancer. [ABSTRACT FROM AUTHOR]

Background: Incidence of the gastro-oesophageal junction adenocarcinoma is increasing. Siewert’s classification subdivides junctional adenocarcinomas anatomically. Cytokeratin (CK) 7 and 20 immunophenotypes differentiate Barrett’s intestinal metaplasia (IM) from gastric IM. Comparing CK immunostaining with Siewert’s classification may establish tumour origin and influence surgical choice. Methods: In this experimental study, 57 patients with gastro-oesophageal junction adenocarcinoma were subdivided endoscopically into 15 type 1, 26 type 2 and 16 type 3 adenocarcinomas. Representative biopsies were immunostained for CK7 and CK20. Results: Intestinal metaplasia was associated with type 1 adenocarcinoma in 12 of 15 patients, 80%; with type 2 in 13 of 26 patients, 50% and type 3 in 6 of 16 patients, 37.5%. All type 1 patients showed Barrett’s CK7/CK20 phenotype within IM; type 2 a mixture: 69% ( n = 9) Barrett’s CK7/CK20 and 31% ( n = 4) gastric CK7/CK20 whereas type 3 patients had a gastric CK7/CK20 pattern in 83% ( n = 5). Immunostaining within the adenocarcinoma was variable. Conclusion: Siewert’s type 1 adenocarcinomas express Barrett’s CK7/CK20 pattern, type 3 a gastric CK7/CK20 pattern and type 2 tumours a mixture of Barrett’s and gastric CK7/CK20 patterns within associated IM. CK immunostaining may refine Siewert’s classification into oesophageal type 1 or gastric type 2 adenocarcinoma with IM. [ABSTRACT FROM AUTHOR]

This article analyses the relationship between French anticlericalism - one of the strongest forces within that nation's political culture - and the Parti Ouvrier Français - the embodiment of nascent Marxism in France. It reveals the ambiguities of the POF's engagement with religion, which ranged from a violent hostility towards the anticlericals, seen as diverting workers from their struggle against capital, to the development of a ferocious socialist critique of the church, seen as an instrument of capitalist oppression. The Marxists' critique of anticlericalism is awarded particular attention, given the usual association between the French Left and hostility towards a supposedly reactionary church, and it is suggested that the POF developed an "agnostic" strategy that might well have guided its politics safely through the storms of French religious politics. Instead, the Parti Ouvrier all too frequently echoed the standard leftist rhetoric of priest-baiting, and even developed its own socialist variant of anticlericalism. The analysis concludes that the resultant aporias in the Parti Ouvrier's political discourse determined the relative failure of French Marxism's intervention in the long war between clericals and anti-clericals. [ABSTRACT FROM AUTHOR]

Examines trends in revenues and budgetary expenditures for the period 1950 through 1975 in the Soviet Union. Influence of state ownership and resource control and utilization on the structure of the urban budget process; Impact of indirect taxes on the tax burdens of citizens and the financial and economic system.

The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24-hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty-six patients with globus pharyngis underwent 24-hour ambulatory pH monitoring, esophageal manometry, and esophagogas-troduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non-ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24-hour esophageal pH monitoring ( P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis. [ABSTRACT FROM AUTHOR]

Describes various cases of skin diseases brought about by causative organisms reported in the July 1934 issue of "The British Journal of Dermatology and Syphilis. Signs and symptoms of the diseases; Mode of transmission of skin diseases; Etiology and factors contributing to the development of the diseases.

A letter to the editor is presented regarding the outcomes of patients suffering from multiple myeloma and renal impairment who were treated with bortezomib, cyclophosphamide, and dexamethasone.

Purpose The objective of this study was to assess a novel, new, nitinol clip for performing arteriovenous anastomoses. Methods This was a pilot, randomized, blinded trial. The trial was register with Clinicaltrials.gov identifier - NCT00829153. Thirty-one patients undergoing autologous arteriovenous fistulas for renal access, where the inflow artery had a lumen diameter of 2 mm or more and the outflow vein had a diameter of 3 mm or more, were included in this study. At the time of operative preparation and exposure of the vessels, the patients were randomized to a conventional anastomosis with 6/0 Prolene or to U Clip anastomosis. The primary outcome measure was three successful dialysis treatments using the fistula. Results The primary outcome was achieved in 8/19 (42%) of the Prolene group and 7/12 (58%) in the U Clip group ( P = 0.379 chi-squared test Pearson uncorrected). Conclusion This pilot study has shown no advantage to the U Clip anastomotic technique when compared with the traditional continuous Prolene technique. [ABSTRACT FROM AUTHOR]

The article presents a case study of 63-year-old man with relapsed lymphoplasmacytic lymphoma (LPL) and bone marrow failure which is referred to undergo haematopoietic stem cell transplantation (HSCT). It says that the patient did not have HLA histocompatibility antigens which cause to receive unmodified bone marrow donor with a mismatch on its antigen during transplantation. It adds that a second transplant was performed with Immunosuppressive and low toxicity and low rate of graft failure.

Presents the findings of a survey of the experience and practice of purchasing at a number of companies in the United States. Problems of dealing with foreign suppliers; Organizational aspects of purchasing; System of procurement management courses employed by two companies; Role of the headquarters staff in the development of competent personnel in the field.

Objectives: Concurrent chemoradiotherapy (CCRT) is the standard nonsurgical treatment in the management of locally advanced cancers of the head and neck. Recent reports support the efficacy of paclitaxel either alone or in combination with other chemotherapeutic agents. Following is a retrospective review of AHNC patients treated with CCRT.Methods: Sixty-four AHNC patients were treated at Medical University of South Carolina between September 2001 and September 2003. Forty-three received CCRT. Median age was 59 years, Stage IV 72%, Stage III 26% and Stage II 2%. Forty-six percent had T4 lesions and 2 patients developed lung metastasis on treatment. All except 3 patients (7%) received RT doses between 66–70 Gy; 36 patients received cisplatin and paclitaxel in weekly doses during RT (cisplatin 20 mg/m2 and paclitaxel 30 mg/m2). One patient received only paclitaxel weekly, 4 received cisplatin alone, and 2 received cisplatin and 5-FU.Results: At a median follow-up of 9 months, 9 patients had died. The median follow-up for surviving patients was 11 months. Seventy percent were alive without disease. Only 16% of 30 locally controlled patients have PEG tube 3–9 months after completing therapy. All but 2 patients completed RT within 8 weeks. Cisplatin and paclitaxel was well tolerated and 89% patients received >85% of prescribed chemotherapy.Conclusions: Weekly paclitaxel and cisplatin was well tolerated; 95% completed RT within 8 weeks. Although follow-up is short, loco-regional control rates are impressive considering 72% stage IV patients and 46% T4 lesions. More mature data with longer follow-up will be presented in the near future. [Copyright &y& Elsevier]