Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma

Background: The pancreas is an uncommon but recognizable site for metastases from renal cell carcinoma (RCC). Isolated pancreatic RCC metastases are still rarer and often present years after initial nephrectomy. Surgical resection has been the treatment of choice because of superior patient survival compared with traditional immunotherapy. In recent years, the advent of targeted therapy has transformed the outcomes of patients with metastatic RCC although little evidence is available on its effectiveness on this subset of patients. We report our experience of 6 patients with pancreatic RCC metastases. Patients and Methods: Between 2007 and 2012, 6 patients (2 men, 4 women; median age 78 years) were diagnosed to have pancreatic RCC metastases at our institute. The clinical features, treatment and outcomes were examined. Results: All 6 patients had a primary RCC of clear cell type. The median interval between initial curative nephrectomy and re-presentation with pancreatic metastases was 12.5 years. Four patients were asymptomatic at the time of diagnosis, one presented with obstructive jaundice and another with acute gastrointestinal bleed. Four patients had extra-pancreatic disease. All were deemed unsuitable or unfit for surgical metastasectomy. Five patients had a Memorial Sloan-Kettering Cancer Center (MSKCC) score of 1 (moderate risk) and the other patient had a score of 0 (good risk). Two patients were commenced on Sunitinib, one received Pazopanib and one received Temsirolimus. Two patients did not undergo further treatment. Of the 4 patients who underwent targeted therapy, the median follow up was 33 months with a median progression free survival of 16 months. One achieved complete response but recurred soon after treatment was stopped. Targetted therapy was recommenced and the disease remained stable. A second patient had long period of stable disease before disease progression. A third achieved partial response since started on targeted therapy and a fourth had disease progression despite treatment. Of the four patients who underwent systemic therapy, three are still alive at the time of this report. Conclusion: Pancreatic metastasis from RCC is a unique subgroup of disease which runs an indolent course, and a higher incidence in an elderly population. Our results demonstrate that targeted therapy can be efficacious in some patients where surgical resection is not suitable or possible.published_or_final_versio

Contamination nitratée des eaux souterraines d'un bassin versant agricole hétérogène: 1. Évaluation des apports à la nappe (modèle Agriflux)

Au cours des dernières décennies, la hausse de la productivité agricole s'est accompagnée d'une forte augmentation des fertilisations azotées qui a entraîné l'augmentation des concentrations en nitrates dans les eaux souterraines. Récemment, les études sur la gestion des pollutions diffuses agricoles ont intégré l'échelle du bassin versant hydrologique. Dans cet article, une approche basée sur un découpage en secteurs pédologiquement et agronomiquement homogènes a été élaborée pour permettre l'utilisation d'un modèle d'évaluation (AgriFlux), et obtenir les flux d'eau et de nitrates sortant de la zone racinaire sur l'ensemble d'un bassin. La modélisation du bassin de La Jannerie a porté sur une période de quatre ans impliquant 19 zones de simulation. L'influence du cycle végétatif des cultures et leur nature sur l'évolution des flux de nitrates a été mise en évidence par des simulations préliminaires, de même que l'influence du type de sol. L'évolution des concentrations moyennes saisonnières en nitrates sortant de la zone racinaire montre que les fertilisations minérales ne sont pas les seules sources importantes de nitrates dans les sols. Les pratiques culturales, comme le retournement des prairies, l'enfouissement des résidus de récoltes ou l'assolement, ont une forte influence sur la dynamique spatiale et temporelle des flux de nitrates percolant vers la nappe.In agricultural regions, groundwater contamination by nitrogen compounds originating from fertilizers is one of the most significant environmental problems. Along with in situ monitoring, simulation models have been developed for non point pollution (nitrates, pesticides) in order to evaluate both the level and the extent of the contamination. Simulation models, originally intended for research purposes in relation to the dynamics of agricultural systems, have been adapted and applied to environmental management in order to quantify water volumes and contaminant masses likely to reach groundwater systems. Recently, mechanistic models such as Agriflux (Banton et al., 1993) have been developed for use in the field. Agriflux is based on a mechanistic approach to the processes and incorporates a stochastic analysis that takes into account the spatial variability of the parameters. lt. calculates nitrate concentrations as well as water fluxes in the unsaturated zone. In the present study, environmental management principles integrating heterogeneity in soils and agricultural practices were applied to an agricultural watershed in Poitou (France). Preliminary simulations were carried out in order to estimate the influence of various parameters on the nitrate and water fluxes. First, a three-year wheat mono-crop was simulated using the same fertilization rate for each year. The calculated nitrate concentrations follow a trend opposite to that of the seasonal growing crop. To estimate the influence of the soil characteristics on the nitrate concentrations, the four types of soil in the watershed were simulated using the same three-year crop rotation. The results show that the soil type directly influences the amount of nitrate leaching. Under different soils types, the evolution of the concentrations over time follows the same pattern, but the concentration levels are significantly different. To quantify the impact of crops on the nitrate concentrations, the main crop rotations were simulated for the same type of soil. This set of simulations underlines the environmental differences between winter and spring crops. lt. also shows the differences induced by the presence of residues. The La Jannerie watershed was divided into homogeneous zones for soil and crop characteristics. During a four-year period, seasonal and annual nitrate concentrations were calculated for each homogeneous zone from the daily water and nitrate fluxes simulated with Agriflux. The results demonstrate the influence of the agricultural practices on the calculated concentrations. Overall, nitrate levels remain quasi-constant during the periods when the crops are active but vary considerably during the winter when the crops are absent or inactive. This winter period corresponds to a peak in nitrate leaching because of the excess rainfall and the absence of nitrogen uptake by the plants. The incorporation of crop residues in the soil in the autumn generates a high production of nitrates during winter due to the mineralization of the organic nitrogen.Two different environmental approaches can be used jointly to evaluate agricultural practices. The first consists of a comparison between the nitrate flux that can reach the saturated area and the fertilizer rate. This approach provides an estimate of the amount of nitrogen lost to the aquifer. Simulations with Agriflux show that the nitrate fluxes are highest during the autumn when plant uptake is non-existent, except in fields with winter crops. The second approach compares the calculated nitrate concentrations that may occur in the aquifer with recognized water quality criteria. lt. is interesting and important to note that, during the simulated period, the calculated concentrations in the leach were often much lower than the water quality criterion (50 mg NO3/L). This result indicates that the fertilization practices applied in the watershed during this period tended to approach the real crop requirements (minimal requirements) and were more environmentally adequate (environmental optimum) than those used previously

Organ Transplants: Ethical, Social, and Religious Issues in a Multicultural Society

Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia

Organ transplants: ethical, social, and religious issues in a multicultural society

"Recent advances in the fields of organ donation and organ transplant have introduced new hope for the treatment of serious diseases. However, this promise has been accompanied by several issues. The most common issue raised is ethical implications, but in a multicultural society like Malaysia, additional concerns arise pertaining to social and religious issues. These concerns needs to be addressed as attitudes toward and acceptability of organ donation varies according to social, culture, and religion. The diverse cultural, religious, and traditional concepts pertaining to organ donation may hamper its acceptability and cause a lack of willingness to donate organs. The purpose of this article is to briefly explore the ethical issues involved in organ transplant and the various religious opinions on organ donation. It is hoped that this knowledge and understanding may benefit both health care providers and patients in a multicultural society like Malaysia." [author's abstracts

Let us not neglect the impact of organizational culture on increasing diversity within medical schools.

Peer reviewedPublisher PD

Parades, parties and pests: contradictions of everyday life in peacekeeping economies

Based on research studies conducted in the UN peacekeeping mission in Liberia in 2006, 2012 and 2013, this article argues that peacekeepers’ everyday experiences reflect a series of contradictory identities and performances with regard to nation, work and gender. Peacekeepers straddle paradoxical worlds simultaneously and manage oppositional demands and obligations, although it is often assumed that they inhabit peacekeeping economies in homogenous ways. Importantly, the experiences provide opportunities for peacekeepers to invest in, accumulate and deploy military capital; to consolidate their military identities; and to favourably and tactically position themselves as deserving and useful subjects within the peacekeeping landscape

Retelling racialized violence, remaking white innocence: the politics of interlocking oppressions in transgender day of remembrance

Transgender Day of Remembrance has become a significant political event among those resisting violence against gender-variant persons. Commemorated in more than 250 locations worldwide, this day honors individuals who were killed due to anti-transgender hatred or prejudice. However, by focusing on transphobia as the definitive cause of violence, this ritual potentially obscures the ways in which hierarchies of race, class, and sexuality constitute such acts. Taking the Transgender Day of Remembrance/Remembering Our Dead project as a case study for considering the politics of memorialization, as well as tracing the narrative history of the Fred F. C. Martinez murder case in Colorado, the author argues that deracialized accounts of violence produce seemingly innocent White witnesses who can consume these spectacles of domination without confronting their own complicity in such acts. The author suggests that remembrance practices require critical rethinking if we are to confront violence in more effective ways. Description from publisher's site: http://caliber.ucpress.net/doi/abs/10.1525/srsp.2008.5.1.2

Diagnostic yield of fine needle aspiration biopsy in HIV-infected adults with suspected mycobacterial lymphadenitis

Background. Fine needle aspiration biopsy (FNAB) has been shown to be the diagnostic procedure of choice for superficial lymphadenitis in tuberculosis endemic regions.Methods. We conducted a retrospective laboratory-based study to determine the bacteriological yield of clinically suspected mycobacterial tuberculous lymphadenitis following FNAB in adults, and specifically HIV-positive patients, to determine the need for the introduction of automated nucleic acid amplification tests (NAATs) such as the Xpert MTB/RIF assay as the initial diagnostic modality. Results. A diagnostic yield of 80% was achieved, significantly higher in HIV-positive v. HIV-negative patients (84% v. 52%, respectively; p<0.001). Conclusion. The results justify using automated NAATs such as the Xpert MTB/RIF assay as the initial diagnostic modality to expedite management in HIV-infected patients. 

GAD65 antibody prevalence and association with c-peptide, HLA class II alleles in Beninese patients with type 1 diabetes

Background: Antibodies to glutamic acid decarboxylase and particularly their isoforms in 65 kDa are one of markers for the diagnosis of the type 1 diabetes (T1D). The aim of this study is to assess the prevalence of GAD65 antibodies (GAD65Ab) and investigate the association of GAD65Ab with C-peptide values, HLA Class II alleles genotyping. The diagnosis of T1D was set up according to American Diabetes Association criteria.Methods: Radioimmunoassay was used to determine the GAD65Ab and C-peptide values. Class II HLA genotyping was performed in 51 patients with T1D and 51 healthy unrelated as control by using the PCR-SSP method. The sensitivity and specificity of the tests were calculated by standard formula.Results: Result revealed that GAD65Ab were present in 74.5% (38/51) of the patients with T1D. There was no significant difference between the positivity or the negativity of GAD65Ab and gender, onset and duration of diabetes, frequencies of HLA-DR4, HLA-DR3-DR4, HLA-DQB1*0201. However, GAD65Ab values are linked to C-peptide concentration (χ2 =15.73, P=0.0001), the presence of HLA-DR3 (χ2 =9.75, P= 0.002), HLA-DQA1*0501 (χ2 =4.09, P= 0.043) alleles. The GAD65Ab test sensitivity and specificity were 74.5% and 94.1%, respectively. The C-peptide test showed a sensitivity around 82.4 % and 86.3 % for the specificity.Conclusions: GAD65Ab showed to be a valuable early predictive marker and is associated with the risk to develop of T1D