Severe Rhabdomyolysis during Treatment with Trabectedin in Combination with a Herbal Drug in a Patient with Metastatic Synovial Sarcoma: A Case Report

Rhabdomyolysis is defined as dissolution of striped muscle characterized by leakage of intracellular muscle components into the circulation, which can ultimately lead to renal failure with a possible fatal outcome. This is an uncommon side effect of trabectedin which is used in second-line therapy of metastatic sarcoma after anthracycline and ifosfamide failure. Here, we describe a case of reversible rhabdomyolysis in a male patient with recurrent metastatic synovial sarcoma of the hand, with marked 18F-FDG uptake into his skeletal muscles, after 4 cycles of trabectedin, and who at the same time was taking an alternative medicine (bioflavonoids) suspected of triggering this adverse event

Reducing Message Latency and CPU Utilization in the CAF Actor Framework

In this work, we consider the C++ Actor Framework (CAF), a recent proposal that revamped the interest in building concurrent and distributed applications using the actor programming model in C++. CAF has been optimized for high-throughput computing, whereas message latency between actors is greatly influenced by the message data rate: At low and moderate rates the latency is higher than at high data rates. To this end, we propose a modification of the polling strategies in the work-stealing CAF scheduler, which can reduce message latency at low and moderate data rates up to two orders of magnitude without compromising the overall throughput and message latency at maximum pressure. The technique proposed uses a lightweight event notification protocol that is general enough to be used used to optimize the runtime of other frameworks experiencing similar issues

Critical review of sham surgery clinical trials: Confounding factors analysis

Objective: Sham surgery (placebo surgery) is an intervention that omits the step thought to be therapeutically necessary. In surgical clinical trials, sham surgery serves an analogous purpose to placebo drugs, neutralizing biases such as the placebo effect. A critical review was performed to study the statistical relevance of the clinical trials about sham surgery in the light of potential confounding factors. Materials and methods: For the critical review 52 articles were included. The possible confounding factors have been studied using a structured interpretative research form designed by the authors. This form includes the following ten confounding factors: I), lack of homogeneity among inclusion/exclusion criteria. II), false double blind. III), lack of post-surgery double blind. IV), power of the study. V), sample characteristics. VI), lost patients to Follow-up. VII), gender distribution. VIII), age equilibrium. IX), lack of psychological patient evaluation. X), lack of psychiatric patient evaluation. In most of the studies, at least one confounding factor was present. Results: The analysis of the confounding factors showed that they could influence the reliability of the surgical placebo effects. Conclusions: The validity of sham surgery should be reconsidered

18F-FDG and 68Ga-somatostatin analogs PET/CT in patients with Merkel cell carcinoma: a comparison study

Abstract Background Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin tumor. Currently, 18F-fluoro-deoxy-glucose (18F-FDG) PET/CT is the functional imaging modality of choice. Few data are available on the use of 68Ga-somatostatin analogs. The aim of our study was to evaluate and compare the diagnostic performance of 18F-FDG and 68Ga-somatostatin analog PET/CT in MCC patients. Results Fifteen patients (12 males, 3 females; median age 73 years; range 41–81 years) with histologically proven MCC (4 with unknown primary lesion) who underwent both 18F-FDG and 68Ga-somatostatin analog PET/CT for staging, re-staging, or treatment response assessment were retrospectively evaluated. Results of both studies were qualitatively analyzed and compared on a patient- and lesion-based analysis, using histology or clinical/radiological follow-up as reference standard for final diagnosis. According to final diagnosis, 8/15 patients had at least one MCC lesion and 7/15 had no evidence of disease. On a patient-based analysis, 18F-FDG and 68Ga-somatostatin analogs correctly classified as positive 8/8 (100% sensitivity) patients and as negative 6/7 (85.7% specificity) and 5/7 (71.4% specificity) patients, respectively, with no significant difference. On a lesion-based analysis, 18F-FDG detected 67/75 lesions (89%) and 68Ga-somatostatin analogs 69/75 (92%), with no significant difference. In four patients with unknown primary MCC, both tracers failed to identify the primary MCC site. Conclusions Our preliminary data suggest that 18F-FDG and 68Ga-somatostatin analog PET/CT provide good and equivalent diagnostic performance, adding interesting insights into the complex MCC biology. However, these results do not suggest that 18F-FDG PET/CT should be replaced by 68Ga-somatostatin receptor imaging, which should be performed in addition, according to clinical indication, to the perspective of “personalized medicine.

Phenolic Acid Composition and Antioxidant Activity of Whole and Defatted Seeds of Italian Hemp Cultivars: A Two-Year Case Study

The study investigated the nutritional profile and nutraceutical composition of the seeds (whole and defatted) of two monoecious hemp cultivars (Carmaleonte, Codimono) and one dioecious cultivar (CS) grown during the 2018 and 2019 crop seasons. The phenolic acid profiles, both free and bound, antioxidant activity (AA), protein content (PC), total phenolic content (TPC), β-carotene, lutein content, and condensed tannins (CT) were studied, and the effects of genotype (G), year (Y), and GxY interaction were also measured. The results indicated the stronger involvement of the year in the nutritional and antioxidant properties of the whole seeds than in those of the defatted seeds, as indicated by the analysis of the variance. The PC, TPC, AA, sum of phenolics free (SPF), and sum of phenolics bound (SPB) were significantly affected by year, while the lutein and some phenolic acids, free and bound (ferulic and p-coumaric acids and N-trans-caffeoyltyramine), showed significant effects of the genotype. In this respect, the Carmaleonte revealed the highest content of ferulic and p-coumaric acids, as well as CS of N-trans-caffeoyltyramine. A prevalence of Y effect over G was measured in the free and bound fraction of the phenolics of the whole seeds, in contrast to the defatted seeds, in which significant effects of GxY were also measured. Moreover, the Pearson’s correlation coefficients indicated a strict involvement of precipitations in the variation of the phenolics accumulation, above all with bound p-hydroxybenzoic acid (r = 0.71 **), bound syringic acid (r = 0.69 *), bound N-trans-caffeoyltyramine (r = 0.64 *), and SPB (r = 0.60 *). As phenolics bound fractions have strong biological activities, (including antioxidant and anti-inflammatory activities) the high concentrations of N-trans-Caffeoyltyramine B in the CS defatted seeds suggest that it is valuable ingredient for functional foods

Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia

Purpose of review: We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia. Recent findings: Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation. Summary: Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research