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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries’ income based on the World Bank Country and Lending Groups. Methods We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36‑1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63‑3,33; p = 0.3). Conclusion There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

Sanfilippo syndrome type B (MPS IIIB) is a lysosomal storage disease caused by a deficiency of N-acetyl-glucosaminidase (NAGLU) activity. Since early therapeutic intervention is likely to yield the most efficacious results, we sought to determine the possible therapeutic utility of rAAV in early gene therapy based interventions. Currently, the application of recombinant adeno-associated virus (AAV) vectors is one of the most widely used gene transfer systems, and represents a promising approach in the treatment of MPS IIIB. From a translational standpoint, a minimally invasive, yet highly efficient method of vector administration is ideal. The thalamus is thought to be the switchboard for signal relay in the central nervous system (CNS) and therefore represents an attractive target. To identify an optimal AAV vector for early therapeutic intervention, and establish whether thalamic administration represents a feasible therapeutic approach, we performed a comprehensive assessment of transduction and biodistribution profiles of four green fluorescent protein (GFP) bearing rAAV serotypes, -5, -8, -9 and -rh10, administered bilaterally into the thalamus. Of the four serotypes compared, AAV8 and -9 proved superior to AAV5 and -rh10 both in biodistribution and transduction efficiency profiles. Genotype differences in transduction efficiency and biodistribution patterns were also observed. Importantly, we conclude that AAV8 and to a lesser extent, AAV9 represent preferable candidates for early gene therapy based intervention in the treatment of MPS IIIB. We also highlight the feasibility of thalamic rAAV administration, and conclude that this method results in moderate rAAV biodistribution with limited treatment capacity, thus suggesting a need for alternate methods of vector delivery.

Background: The taxanes and platinum agents provide substantial improvement in the treatment of breast and other cancers. Neuropathy is often the dose limiting toxicity of these agents and can devastatingly affect the patient due to diminished fine motor skills and pain in the hands and feet that diminishes the ability to exercise and interact in normal life. Clinically significant neuropathy occurs in 40% of patients and >10% will persist past a year causing permanent effects on quality of life. Perhaps more devastating, patients often have to discontinue effective treatment due to the development of these symptoms. Additionally, anemia contributes to dose reductions and delays that compromise therapy and cause significant fatigue that diminishes quality of life. Interventions that could reduce these symptoms would provide a substantial improvement in the ability to care for these patients. Toward this end we have developed a non-toxic dietary approach that incorporates supplementation with several natural products. Together, this therapeutic approach, called CS.001 is able to alleviate many of the negative side effects of breast cancer chemotherapy. Methods: C57BL/6 mice were treated with Paclitaxel weekly or Oxaliplatin three times weekly. Animals were tested for neuropathic pain using a cold sensitivity test [acetone test] and sensitivity to mechanical stimulus [Von Frey Test]. A CBC and CMP were performed to assess systemic toxicity. Animals were provided with a nutritional complete diet that limited their carbohydrates to 10% of total caloric input and were additionally supplemented with the following natural products: [1] Medium chain triglycerides [30g/kg], [2] Curcumin [1200mg/kg], [3]EGCG [1200mg/kg] and [4]broccoli sprout powder [20g/kg]. Animals were placed on the CS.001 diet 1 week before beginning chemotherapy. Results: Paclitaxel & Oxaliplatin treatment resulted in a statistically significantly increase in sensitivity to cold stimulus [Acetone test, p Conclusion: Dietary intervention combined with a supplementation of 4 natural products was able to attenuate chemotherapy induced anemia and neuropathy following chemotherapy treatment in mice. This combination is a promising quality of life intervention to evaluate in cancer patients receiving taxanes or platinums. Citation Format: Coy D Heldermon, Ben G Griffith, Matt Bloom, Jennifer Owen, Regina J Martuscello, Yosef Schwartz, Brent A Reynolds, Loic P Deleyrolle. A combination natural product therapy attenuates common side effects associated with chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-10.

Treatment with lapatinib results in many toxicities. Described here is a novel toxicity, mucosal discoloration that developed after lapatinib was initiated in a breast cancer patient.