Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Compliance procedures for sound insulation between dwellings in new housing – Rules according to Danish regulations &amp; Experiences from practice

During the design process for housing, the sound insulation performance is determined considering material properties and flanking sounds according to international standards, guidelines and material specifications. Typically, simulation software is also included in this process. Building elements and junctions are carefully designed and analysed. While the design stage is vital, the construction process and application of acoustic details are equally important. Some unforeseen circumstances at construction stage can include changes in materials, incorrect application that causes flanking sound transmission, disruption of materials and sound leaks through unfilled mortar etc. Therefore, verification studies are necessary through acoustic measurements. Countries differ in requirements for the verification. Some countries may require measurements after construction, while others require only inspection at site, or in some cases calculation reports are sufficient. Therefore, cross studies are important to ensure that acoustic calculations will actually comply with the measurement results. The intention of the study aims to contribute to comparison of acoustic calculation results with site measurements. Six existing buildings were measured and acoustic performance was calculated using dedicated software packages. Some issues are highlighted that cause variance between the results.National building regulations have existed in Denmark since 1961 and have included acoustic regulations for housing. The housing stock in Denmark consists currently (2023) of almost 2.8 mio dwellings, of these are ~40% dwellings in multi-storey (MS) housing, ~40% one-family houses and ~15% terraced houses (row houses). This paper focuses on compliance with limits for airborne and impact sound insulation between dwellings in new-build and apply to both MS housing and terraced houses (row houses). Issuing of building permits and permits allowing use of buildings after completion are administered by local building authorities in the municipalities, and for decades they were involved in technical details related to the building permits. However, administration of building regulations and proof of compliance changed over time – with some of the changes unfortunately implying reduced options for check of compliance. In practice, compliance with acoustic regulations suffers from various shortcomings in the building process, some related to the builders’ lack of understanding of acoustic regulations or lack of inspection of the construction work, others due to lack of compliance test or building authorities’ lack of expertise with how to check the validity/invalidity of field test reports. The consideration behind the building regulations' requirement for documentation is partly to ensure that buildings comply with the requirements, and partly to ensure that later users of the building have a valid documentation basis. The paper describes details of the shortcomings and provides examples of severe construction defects being noticed mainly due to field tests following user complaints. Furthermore, indications of options for improvement of documentation procedures will be described