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The novel paclitaxel formulation (nanoparticle albumin-bound [nab] paclitaxel (Abraxane®) has recently been approved by the US FDA for treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months after adjuvant chemotherapy. Apart from its superior efficacy, as demonstrated in the pivotal Phase III study, less toxicity compared with the traditional solvent-containing paclitaxel (Taxol®) seems to contribute to its favorable therapeutic index. While approved as a single agent, nab-paclitaxel may prove more effective in combination with either biologic agents and/or other cytotoxic chemotherapeutic agents, as summarized in this article. [ABSTRACT FROM AUTHOR]

In the United States, the general laboratory method for diagnosing pertussis, caused by Bordetella pertussis, is real-time PCR (rt-PCR) targeting insertion sequence 481 (IS 481 ). Other Bordetella species ( parapertussis, holmesii , and bronchiseptica ) can also cause a pertussis-like syndrome, and some commercial laboratory assays include the insertion sequence 1001 (pIS 1001 ) that can detect B. parapertussis / B. bronchiseptica (BppBb ). Because IS 481 exists in B. pertussis and B. holmesii , current commercial assays cannot differentiate these two species. We used a multiplex rt-PCR assay containing species-specific targets to Bordetella to evaluate clinical specimens detected as B. pertussis / B. holmesii ( BpBh ) or BppBb by commercial laboratories. A sample of 3,984 clinical specimens positive for IS 481 or pIS 1001 from two commercial laboratories during 2012-2019 were re-tested at CDC. Agreement of Bordetella species between the CDC and commercial laboratory assays, and the proportion of commercial laboratory specimens that were non- B . pertussis by CDC's assay was assessed. Overall agreement in Bordetella species detection and identification between the CDC and commercial lab assays was 85%. Agreement for identifying B. pertussis was 87% for 3,663 BpBh specimens and 98% for identifying B. parapertussis in 310 BppBb specimens. CDC's assay detected B. holmesii in 55/3,984 (1.4%) specimens. Most discrepant results (410/490, 82%) were BpBh specimens interpreted as indeterminate B. pertussis at CDC. We found a small portion of B. holmesii in a sample of IS 481 -positive clinical specimens originally identified by commercial laboratory rt-PCR assays, suggesting that commercial PCR assays are a reliable diagnostic tool for correctly identifying Bordetella species in most patients with suspected pertussis., Importance: When testing specimens collected from patients with suspected pertussis, large-scale commercial laboratories in the United States employ an IS 481 -based assay that cannot differentiate between Bordetella pertussis and Bordetella holmseii . The level of B. holmesii causing pertussis-like illness in the United States is not well-understood given that only B. pertussis is nationally notifiable. After re-testing with a multiplex, species-specific rt-PCR assay, our data show low levels of B. holmesii identified in a sample of IS 481 -positive clinical specimens originally identified by commercial laboratory rt-PCR assays. These results reinforce the validity of large-scale commercial rt-PCR testing as a reliable diagnostic tool for pertussis in the United States., Competing Interests: Contributing author Dr. Clemente Montero is an employee of Quest Diagnostics, and contributing author Dr. Melinda B. Nye is an employee of Labcorp.

Background: European data support the use of low high-sensitivity troponin (hs-cTn) measurements or a 0/1-hour (0/1-h) algorithm for myocardial infarction to exclude major adverse cardiac events (MACEs) among patients in the emergency department with possible acute coronary syndrome. However, modest US data exist to validate these strategies. This study evaluated the diagnostic performance of an initial hs-cTnT measure below the limit of quantification (LOQ: 6 ng/L), a 0/1-h algorithm, and their combination with history, ECG, age, risk factors, and initial troponin (HEART) scores for excluding MACE in a multisite US cohort., Methods: A prospective cohort study was conducted at 8 US sites, enrolling adult patients in the emergency department with symptoms suggestive of acute coronary syndrome and without ST-elevation on ECG. Baseline and 1-hour blood samples were collected, and hs-cTnT (Roche; Basel, Switzerland) was measured. Treating providers blinded to hs-cTnT results prospectively calculated HEART scores. MACE (cardiac death, myocardial infarction, and coronary revascularization) at 30 days was adjudicated. The proportion of patients with initial hs-cTnT measures below the LOQ and risk according to a 0/1-h algorithm was determined. The negative predictive value (NPV) was calculated for both strategies when used alone or with a HEART score., Results: Among 1462 participants with initial hs-cTnT measures, 46.4% (678 of 1462) were women and 37.1% (542 of 1462) were Black with an age of 57.6±12.9 (mean±SD) years. MACEs at 30 days occurred in 14.4% (210 of 1462) of participants. Initial hs-cTnT measures below the LOQ occurred in 32.8% (479 of 1462), yielding an NPV of 98.3% (95% CI, 96.7-99.3) for 30-day MACEs. A low-risk HEART score with an initial hs-cTnT below the LOQ occurred in 20.1% (294 of 1462), yielding an NPV of 99.0% (95% CI, 97.0-99.8) for 30-day MACEs. A 0/1-h algorithm was complete in 1430 patients, ruling out 57.8% (826 of 1430) with an NPV of 97.2% (95% CI, 95.9-98.2) for 30-day MACEs. Adding a low HEART score to the 0/1-h algorithm ruled out 30.8% (441 of 1430) with an NPV of 98.4% (95% CI, 96.8-99.4) for 30-day MACEs., Conclusions: In a prospective multisite US cohort, an initial hs-cTnT below the LOQ combined with a low-risk HEART score has a 99% NPV for 30-day MACEs. The 0/1-h hs-cTnT algorithm did not achieve an NPV >99% for 30-day MACEs when used alone or with a HEART score. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02984436.

Objective: To analyse the lipid profile of the infant and young population of our province, and to compare our findings with those of other similar Spanish studies., Design: A cross-sectional descriptive study., Setting: School population from 2 to 16 years old in the province of Cáceres (N = 91083)., Participants: A representative and proportional sample of 2150 children, with the two sexes at 50%., Interventions: The total cholesterol (TC), HDL-C (enzymatic technique) and LDL-C (Friedewald formula) were determined., Results: The mean values of TC, LDL-C and HDL-C (mean +/- SD) were 182.77 +/- 28.96, 114.19 +/- 26.54 and 57.31 +/- 13.97, respectively. Comparison of our lipid figures by age and sex with those of other Spanish studies (Fuenlabrada, Niño Jesús, Navarra and RICARDIN) and with the North American LRCP showed, in general, higher means of TC and LDL-C and/or lesser HDL-C levels in our population., Conclusions: Comparison with earlier studies shows that children from Cáceres have a more atherogenic lipid profile. Social and methodological differences may have affected the results. However, we think that, given the time elapsed since previous studies, the differences found may reflect progressive changes in the Spanish diet towards higher consumption of saturated fats.