Crystallization and visible-near-infrared luminescence of Bi-doped gehlenite glass.

Gehlenite glass microspheres, doped with a different concentration of Bi3+ ions (0.5, 1, 3 mol%), were prepared by a combination of solid-state reaction followed by flame synthesis. The prepared glass microspheres were characterized from the point of view of surface morphology, phase composition, thermal and photoluminescence (PL) properties by optical and scanning electron microscopy (SEM), X-ray diffraction (XRD), differential scanning calorimetry (DSC) and PL spectroscopy. The closer inspection of glass microsphere surface by SEM confirmed a smooth surface. This was further verified by XRD. The basic thermal characteristics of prepared glasses, i.e. T g (glass transition temperature), T x (onset of crystallization peak temperature), T f (temperature of the inflection point of the crystallization peak) and T p (maximum of crystallization peak temperature), were estimated from the DSC records. High-temperature XRD experiments in the temperature interval range 600-1100°C were also performed. The PL emission properties of prepared glasses and their polycrystalline analogues (glass crystallized at 1000°C for 10 h) were studied in the visible and near-infrared (NIR) spectral range. When excited at 300 nm, the glasses, as well as their polycrystalline analogues, exhibit broad emission in the visible spectral range from 350 to 650 nm centred at about 410-450 nm, corresponding to Bi3+ luminescence centres. The emission intensity of polycrystalline samples was found to be at least 30 times higher than the emission of their glass analogues. In addition, a weak emission band was observed around 775 nm under 300 nm excitation. This band was attributed to the presence of a minor amount of Bi2+ species in prepared samples. In the NIR spectral range, the broad band emission was observed in the spectral range of 1200-1600 nm with the maxima at 1350 nm. The chemistry of Bi and its oxidation state equilibrium in glasses and polycrystalline matrices is discussed in detail.

Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients.

BACKGROUND: Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. PATIENTS AND METHODS: Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10-20%), or high (>20%) risk for inducing neutropenia. RESULTS: The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). CONCLUSION: An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens.

Statistical controversies in clinical research: should schedules of tumor size assessments be changed?

BACKGROUND: Time to progression (TTP) is often used as a primary end point in phase II clinical trials. Since the actual date of nadir and progression is never known, most calculated TTP are overestimated. This study evaluates the imprecision on the estimate of TTP under two hypothetical tumor kinetic settings and various assessment schedules. DESIGN: A two-component tumor growth model was used to account for treatment effect assuming exponential decay for tumor shrinkage and linear growth for progression. Evolution of tumor burden (TB) was modelized according to two scenarios using either a cytotoxic or a cytostatic agent and several assessment schedules. TB, nadir, progression and TTP were simulated for each visit schedule. RESULTS: For cytotoxic agents, our model predicted response at 1.5 weeks, a TB at nadir of 40.2 mm (starting from 100 mm) occurring at 6.7 weeks and true progression at 11.2 weeks with a TB of 48.2 mm. For cytostatic agents, our model predicted no response, a TB at nadir of 77 mm occurring at 9.2 weeks and true progression at 19.4 weeks with a TB of 92 mm. Depending on the assessment schedule, estimated TTP was increased from 0.8 to 36.8 weeks and from 0.6 to 28.6 weeks when compared with the true TTP and varied from 5.2% to 298% and from 1.66 to 109.58% when compared with the true TB at progression for cytotoxic and cytostatic agents, respectively. Our model further shows that for cytotoxic agents, evaluation of TB every 6 weeks is optimal to capture the true nadir, the time to nadir, the true progression and the true TTP, whereas for cytostatic agents, this evaluation is optimal every 10 weeks. CONCLUSIONS: Our results emphasize the importance to estimate the effects of tested drugs on tumor shrinkage before design any phase II clinical trials to choose optimal TB evaluation's timing.

How to report toxicity associated with targeted therapies?

BACKGROUND: In the era of personalized medicine, molecularly targeted therapies (MTT) have modified the outcome of some cancer types. The price of tumor control needs to be balanced with toxicity since these new therapies are administered continuously for several months or sometimes for several years. For cytotoxic drugs, the incidence of adverse event (AE) was traditionally reported as frequency and intensity. This simple measure is not sufficient to capture the recurrent nature and duration of AE. This paper presents two methods to better describe the toxicity burden across the time: prevalence and Q-TWiST. PATIENTS AND METHODS: Limitation of worst-grade method and advantages of prevalence and Q-TWiST in the analysis of toxicity were illustrated using data from a phase II trial and a hypothetically simulated clinical trial. RESULTS: Prevalence integrates the recurrent nature of AE. Using prevalence, it is possible to obtain a time profile of AE. Q-TWiST method evaluates the weighted time spent in each health state and also considers the recurrent nature of side-effects in order to assess the 'risk-benefit' ratio of a treatment. When interpreting Q-TWiST results, it is necessary to take into account overall survival and progression-free survival and to define a clinically relevant difference according to the setting. CONCLUSION: The two methods presented here capture different effects. They are helpful for physicians in their treatment choice (balance benefit risk), to counsel patients and to optimize supportive care. In order to ensure consistency and provide critical information required for medical decision-making, it is important to encourage the use of alternative statistical methods in the analysis of toxicities associated with MTT. CLINICAL TRIAL: NCT00541008.

Sorafenib in patients with locally advanced and metastatic chordomas: a phase II trial of the French Sarcoma Group (GSF/GETO).

BACKGROUND: There is no consensual treatment of locally advanced or metastatic chordomas. PATIENTS AND METHODS: We conducted a multicenter, open-label, uncontrolled phase II trial of sorafenib (800 mg/day). The primary end point was the 9-month progression-free rate according to RECIST 1.1. All patients had documented progressive disease at the time of study entry. RESULTS: Twenty-seven patients were enrolled between May 2011 and January 2014. The median age was 64 (range, 30-86) years. There were 17 men and 10 women. Twelve patients had been previously treated with chemotherapy and molecularly targeted agents. The maximum toxicity grade per patient was grade 3 in 21 cases (77.8%) and grade 4 in 4 cases (14.8%). Sorafenib provided an intent-to-treat best objective response of 1/27 [3.7%; 95% confidence interval (CI) 0.1% to 19.0%], a 9-month progression-free rate of 73.0% (95% CI 46.1-88.0) and a 12-month overall survival rate of 86.5% (95% CI 55.8-96.5). Survival curves were similar in pretreated and not pretreated patients. DISCUSSION: Additional clinical trials further exploring sorafenib as a treatment of locally advanced or metastatic chordomas are warranted.

Identification of peripartum near-miss for perinatal audit.

INTRODUCTION: Today, perinatal audit focuses basically on cases of perinatal mortality. In most centres in Western Europe, perinatal mortality is low. Identification of metabolic acidosis at birth may increase index cases eligible for evaluation of perinatal care, and this might improve quality of perinatal audit. The aim of this study is to assess the incidence of metabolic acidosis at birth in order to estimate its impact on perinatal audit. PATIENTS AND METHODS: Cord blood was analysed for every neonate born between January 1, 2010 and December 31, 2012 in Ziekenhuis Oost-Limburg, Genk. Acidosis was defined as an umbilical arterial pH ≤ 7.05 with or without a venous pH ≤ 7.17. Respiratory acidosis (RA) was defined as acidosis with normal base excess, and metabolic acidosis (MA) was defined as acidosis with an arterial or venous base excess ≤ -10 mmol/L. In case of failed cord blood sampling, 5 minute Apgar score ≤ 6 was considered as the clinical equivalent of MA. Retrospective chart review of obstetric and paediatric files was performed for all cases of MA, together with review of paediatric follow-up charts from at least 6 months after birth. Perinatal asphyxia was defined as biochemical evidence for MA at birth, associated with early onset neonatal encephalopathy and long-term symptoms of cerebral palsy. RESULTS: In a total of 6614 babies, perinatal death up to 7 days of life occurred in 40 babies (6.0‰). Acidosis was present in 183 neonates (2.8%), of which 130 (2.0%) had RA and 53 (0.8%) had MA. Of the 173 neonates with unknown pH values, 6 had Apgar scores ≤ 6. Of 59 babies born with MA or its clinical equivalent, 52 (88.1%) showed no neurologic symptoms at birth. Two (3.4%) died in the early neonatal period, one after abruptio placentae and one due to chorioamnionitis and severe prematurity. Five (8.5%) MA babies had symptoms of early onset neonatal encephalopathy, which recovered in three (5.1%), and persisted long-term in two others (3.4%). The two babies with cerebral palsy (prevalence 1/3300) were both born after instrumental vaginal delivery for foetal distress. CONCLUSION: In our study cohort, the incidence of perinatal mortality is 6‰. The incidence of metabolic acidosis is 9‰. Addition of cases of metabolic acidosis to those of mortality doubles index cases eligible for perinatal audit. The incidence of babies surviving with cerebral palsy after metabolic acidosis at birth is very low (0.3‰). Our results suggest that instrumental delivery for foetal distress might be a risk factor for metabolic acidosis with persisting neurologic dysfunction. Our study illustrates that identification of peripartum near-miss is useful for perinatal audit.

Prenatal detection of an enteric duplication cyst.

Enteric duplication cysts are rare congenital malformations of unknown aetiology. Because of improvements in prenatal ultrasound, more and more duplication cysts are found prenatally and treatment is started early. We describe a case of enteric duplication cyst diagnosed prenatally and resected soon after birth. Early diagnosis and prompt surgical treatment are the best way to prevent associated morbidity.

A dose-escalating phase I of imatinib mesylate with fixed dose of metronomic cyclophosphamide in targeted solid tumours.

BACKGROUND: Preclinical findings suggest that imatinib mesylate (IM) and metronomic cyclophosphamide (MC) combination provides synergistic antiangiogenic activity on both pericytes and endothelial cells. METHODS: We have designed a 3+3 dose-escalating phase I trial with a fixed dose of MC (50 mg two times daily) plus IM (400 mg per day; 300 and 400 mg two times daily). Enrolled patients had IM- and sutininib-refractory advanced gastrointestinal stromal tumours (GIST) (n=17), chordoma (n=7) and mucosal melanoma (n=2). Dose-limiting toxicities were monitored for the first 6 weeks. Progression-free survival (PFS) and response assessment are based on RECIST 1.0 guidelines. Pharmacokinetics of IM were measured before and after exposure to MC. RESULTS: No dose-limiting toxicity was observed. Fourteen patients of the expanded cohort received 400 mg two times daily of IM with MC. Apart from a case of possibly related acute leukaemia occurring after 4 years of treatment, we did not see unexpected toxicity. No drug-drug pharmacokinetic interaction was observed. There was no objective response. We have observed long-lasting stable disease in chordoma patients (median PFS=10.2 months; range, 4.2-18+) and short-term stable disease in heavily GIST pretreated patients (median PFS=2.3 months; range, 2.1-6.6). CONCLUSION: This combination is feasible and may warrant further exploration in refractory GIST or chordoma patients.

Omeprazole in infants with cimetidine-resistant peptic esophagitis.

Twelve neurologically normal infants (age 2.9+/-0.9 months) with peptic esophagitis (grade 2) who did not respond to cimetidine (in addition to positioning, cisapride, and Gaviscon) were treated with omeprazole, 0.5 mg/kg once a day, for 6 weeks. The effectiveness of omeprazole was evaluated in all infants by clinical assessment and endoscopy before and after treatment and by 24-hour gastric pH monitoring during treatment in seven infants. Omeprazole therapy led to a marked decrease in symptoms, endoscopic and histologic signs of esophagitis, and intragastric acidity.