MacDonald versus MAGIC treatment protocols for gastric cancer: age as a decision factor

Background: A multimodality approach is the standard of care in the treatment of locally advanced non-metastatic gastric cancer. However, it lacks studies that compares the adjuvant chemoradiotherapy strategy of the landmark MacDonald clinical trial with the perioperative chemotherapy strategy of the landmark MAGIC clinical trial.Methods: Retrospective study of patients with gastric cancer stage IB-III treated at a single cancer center between 2010 and 2013 with MacDonald or MAGIC treatment protocols.Results: Sixty-two patients were identified (38 patients in the MacDonald protocol and 24 in the MAGIC protocol), with a mean age of 68 years (range: 39-84). At a median follow-up of 37 months, the DFS survival at 12 and 36 months of the patients in the MacDonald protocol was 83.5% and 61.1% versus 79.2% and 49.7% in the MAGIC protocol, respectively (p=0.319). The overall survival at 12 and 36 months of the patients in the MacDonald protocol was 89.5% and 65.8% versus 83.3% and 54.2% in the MAGIC protocol, respectively (p=0.168). At multivariate analysis, the risk of death was significantly superior in older patients undergoing the MAGIC protocol (p=0.02), but not the MacDonald protocol (p=0.627). The differences in toxicity between the two protocols were not statistically different.Conclusions: This result suggest that patient age is a factor to consider when choosing between the MacDonald or MAGIC protocols. However, the limitations inherent to a retrospective study of small sample size must be accounted for.

Infrastructure-building for Public Health: The World Health Organization and Tuberculosis Control in South Korea, 1945–1963 / 의사학

This paper examines WHO's involvement in South Korea within the context of the changing organization of public health infrastructure in Korea during the years spanning from the end of the Japanese occupation, through the periods of American military occupation and the Korean War, and to the early years of the Park Chung Hee regime in the early 1960s, in order to demonstrate how tuberculosis came to be addressed as a public health problem. WHO launched several survey missions and relief efforts before and during the Korean War and subsequently became deeply involved in shaping government policy for public health through a number of technical assistance programs, including a program for tuberculosis control in the early 1960s. This paper argues that the principal concern for WHO was to start rebuilding the public health infrastructure beyond simply abolishing the remnants of colonial practices or showcasing the superiority of American practices vis-à-vis those practiced under a Communist rule. WHO consistently sought to address infrastructural problems by strengthening the government's role by linking the central and regional health units, and this was especially visible in its tuberculosis program, where it attempted to take back the responsibilities and functions previously assumed by voluntary organizations like the Korea National Tuberculosis Administration (KNTA). This interest in public health infrastructure was fueled by WHO's discovery of a cost-effective, drug-based, and community-oriented horizontal approach to tuberculosis control, with a hope that these practices would replace the traditional, costly, disease-specific, and seclusion-oriented vertical approach that relied on sanatoria. These policy imperatives were met with the unanticipated regime change from a civilian to a military government in 1961, which created an environment favorable for the expansion of the public health network. Technology and politics were intricately intertwined in the emergence of a new infrastructure for public health in Korea, as this case of tuberculosis control illustrates.

Introducción a la historia de la esclerosis múltiple / Introduction to the history of multiple sclerosis

La esclerosis múltiple (EM) fue descrita inicialmente en un documento escandinavo y dos siglos más tarde en el diario de una santa holandesa. Mucho después, comenzando el siglo XVIII, se reportó un caso aislado y no es sino hasta el siglo XIX cuando la enfermedad se presenta con mayor frecuencia. En la primera mitad de este siglo se referenció un paciente en la literatura médica y se divulgaron dos atlas de patología. A partir de entonces, a lo largo de la segunda mitad del siglo XIX, se desarrolló la concepción moderna de la EM, partiendo de los relatos de Frerichs, en Alemania, y más tarde de Charcot, a la cabeza de la Pitié-Salpêtrière. Pero es durante el siglo pasado que la EM alcanzó su madurez con el surgimiento de los criterios diagnósticos, el concepto de la remielinización, la neuroimagen y el tratamiento farmacológico. En el siglo XXI, a partir del avance tecnológico ydel mejor conocimiento de la enfermedad, se proponen nuevos criterios diagnósticos y se utilizan alternativas terapéuticas orales y anticuerpos monoclonales. En este siglo representan un gran desafío los adelantos en genética, biomarcadores y medicamentos de mayor eficacia.

Multiple Sclerosis (MS) was initially described in a Scandinavian document and two centuries later in the diary of a Dutch Saint. Long after, at the beginning of the eighteenth century, an isolated case was reported and it was not until the nineteenth century that cases were most frequently reported. During the first half of this century a patient was referenced, for the first time, in the medical literature and two atlas of pathology reported the disease. Thereafter, during the second half of the nineteenth century, the modern conception of MS is developed, based on the stories of Frerichs, in Germany, and later Charcot's, head of the Pitié-Salpêtrière. However, it was during the past century that MS reached maturity with the emergence of the diagnostic criteria, the concept of remyelination, neuroimage and pharmacological treatment. In the XXI century, based on technological advancement and a better understanding of the disease, new diagnostic criteria are proposed as well as alternative therapies and oral monoclonal antibodies. In this century, advances in genetics represent a great challenge, as well as biomarkers and more medications of a wider effectiveness.

MacDonald Critchley / MacDonald Critchley

The authors presented a historical review on Professor MacDonald Critchley, 15 years after his death.

Os autores apresentaram uma revisão histórica sobre o professor MacDonald Critchley, no seu 15º ano de falecimento.