Multicenter randomized phase III trial of Epirubicin plus Paclitaxel vs Epirubicin followed by Paclitaxel in metastatic breast cancer patients: focus on cardiac safety

The aim of the study was to evaluate cardiac safety of two different schedules of Epirubicin and Paclitaxel in advanced breast cancer patients enrolled into a multicenter randomized phase III trial. Patients received Epirubicin 90 mgm(-2) plus Paclitaxel 200 mgm(-2) (3-h infusion) on day 1 every 3 weeks for eight courses (arm A), or Epirubicin 120 mgm(-2) on day 1 every 3 weeks for four courses followed by four courses of Paclitaxel 250 mgm(-2) on day 1 every 3 weeks (arm B). Left ventricular ejection fraction was evaluated by bidimesional echocardiography at baseline, after four and eight courses of chemotherapy and every 4 months during follow-up. Baseline median left ventricular ejection fraction was 60% in arm A and 65% in arm B; after four courses, figures were 57 and 60%, respectively. After eight courses, the median left ventricular ejection fraction in arm A declined to 50% while no further reduction was detected in arm B by adding four courses of high-dose Paclitaxel. Seven episodes of congestive heart failure were observed during treatment in arm A. Present monitoring demonstrated that the risk of congestive heart failure or impairment in the cardiac function correlated only with the cumulative dose of Epirubicin; no impact on cardiotoxicity can be attributed to high-dose Paclitaxel

Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: Atherosclerosis risk in communities (ARIC) community surveillance

<p>Abstract</p> <p>Background</p> <p>Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting.</p> <p>Methods</p> <p>We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta [β]-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression.</p> <p>Results</p> <p>Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving β-blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates.</p> <p>Conclusions</p> <p>nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.</p

MicroMotility: State of the art, recent accomplishments and perspectives on the mathematical modeling of bio-motility at microscopic scales

Mathematical modeling and quantitative study of biological motility (in particular, of motility at microscopic scales) is producing new biophysical insight and is offering opportunities for new discoveries at the level of both fundamental science and technology. These range from the explanation of how complex behavior at the level of a single organism emerges from body architecture, to the understanding of collective phenomena in groups of organisms and tissues, and of how these forms of swarm intelligence can be controlled and harnessed in engineering applications, to the elucidation of processes of fundamental biological relevance at the cellular and sub-cellular level. In this paper, some of the most exciting new developments in the fields of locomotion of unicellular organisms, of soft adhesive locomotion across scales, of the study of pore translocation properties of knotted DNA, of the development of synthetic active solid sheets, of the mechanics of the unjamming transition in dense cell collectives, of the mechanics of cell sheet folding in volvocalean algae, and of the self-propulsion of topological defects in active matter are discussed. For each of these topics, we provide a brief state of the art, an example of recent achievements, and some directions for future research

Conhecimento da equipe de enfermagem sobre higiene oral em pacientes criticamente enfermos El conocimiento del equipo de enfermería sobre higiene oral en pacientes críticamente enfermos Nursing staff's knowledge about oral care in critically ill patients

Objetivou-se avaliar o conhecimento dos profissionais de enfermagem, que realizam ou supervisionam os cuidados de higiene oral em pacientes críticos e, secundariamente, verificar como julgam o cuidado prestado. Estudo exploratório, descritivo, com abordagem quantitativa, por meio de instrumento elaborado pelos autores, aplicado a enfermeiros e técnicos que atuam em uma Unidade de Terapia Intensiva (UTI) de médio porte de Porto Alegre. Os resultados mostram que 50% dos enfermeiros e 72,8% dos técnicos concordam que a higiene oral no paciente crítico é importante, mas não há relação com a pneumonia associada à ventilação mecânica (PAVM). Da amostra, 16,6% dos enfermeiros e 66,6% dos técnicos de enfermagem concordam que a rotina da instituição é adequada, sendo que 66,6% dos enfermeiros e 30,7% dos técnicos indicam novas práticas. Isso nos sugere que a higiene oral em pacientes internados não tem constituído uma preocupação evidente, tanto na assistência quanto nas práticas de educação em saúde.<br>El objetivo fue evaluar el conocimiento de los profesionales de enfermería que realizan o supervisan el cuidado de la higiene oral en pacientes críticos y, en segundo lugar, para ver cómo juzgar la atención proporcionada. Estudio exploratorio descriptivo con enfoque cuantitativo, usando un instrumento desarrollado por los autores, aplicado a los enfermeros y técnicos que trabajan en la Unidad de Cuidados Intensivos (UCI) de un hospital de tamaño mediano de la ciudad de Porto Alegre. Los resultados muestran que el 50% de los enfermeros y el 72,8% de los técnicos concuerdan que la higiene bucal en los pacientes críticos es importante, pero no hay ninguna relación con la neumonía asociada al ventilador (NAV). De la muestra, el 16,6% de los enfermeros y el 66,6% de los técnicos de enfermería concuerdan que la rutina de la institución es adecuada, mientras que el 66,6% de los enfermeros y el 30,7% de los técnicos indican nuevas prácticas. Esto nos sugiere que la higiene bucal en los pacientes hospitalizados no ha sido una preocupación evidente, en las prácticas de cuidado y educación para la salud.<br>The objective of this study was to assess the knowledge of nursing professionals who perform or supervise the oral hygiene care in critically ill patients and, secondarily, to verify their opinion about the care provided. This is an exploratory study with a quantitative approach, using an instrument developed by the authors applied to the nurses and technicians working in a mid-sized Intensive Care Unit (ICU) in Porto Alegre. The results show that 50% of nurses and 72.8% of technicians agree that oral hygiene is important in critically ill patients, but there is no relation to ventilator-associated pneumonia (VAP). Fromthe sample, 16.6% of nurses and 66.6% of nursing technicians agree that the routine of the institution is adequate, and 66.6% of nurses and 30.7% of technicians indicate new practices. This suggests that oral hygiene in hospitalized patients has not been an evident concern, regarding health education practices and care

Climate change trends, grape production, and potential alcohol concentration in wine from the "Romagna Sangiovese" appellation area (Italy)

The trend of climate change and its effect on grape production and wine composition was evaluated using a real case study of seven wineries located in the \u201cRomagna Sangiovese\u201d appellation area (northern Italy), one of the most important wine producing region of Italy. This preliminary study focused on three key aspects: (i) Assessment of climate change trends by calculating bioclimatic indices over the last 61 years (from 1953 to 2013) in the Romagna Sangiovese area: significant increasing trends were found for the maximum, mean, and minimum daily temperatures, while a decreasing trend was found for precipitation during the growing season period (April\u2013October). Mean growing season temperature was 18.49 \ub0C, considered as warm days in the Romagna Sangiovese area and optimal for vegetative growth of Sangiovese, while nights during the ripening months were cold (13.66 \ub0C). The rise of temperature shifted studied area from the temperate/warm temperate to the warm temperate-/warm grape-growing region (according to the Huglin classification). (ii) Relation between the potential alcohol content from seven wineries and the climate change from 2001 to 2012: dry spell index (DSI) and Huglin index (HI) suggested a large contribution to increasing level of potential alcohol in Sangiovese wines, whereas DSI showed higher correlation with potential alcohol respect to the HI. (iii) Relation between grape production and the climate change from 1982 to 2012: a significant increasing trend was found with little effect of the climate change trends estimated with used bioclimatic indices. Practical implication at viticultural and oenological levels is discussed

Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial

&lt;p&gt;&lt;b&gt;Background&lt;/b&gt; Ivabradine specifically inhibits the I-f current in the sinoatrial node to lower heart rate, without affecting other aspects of cardiac function. We aimed to test whether lowering the heart rate with ivabradine reduces cardiovascular death and morbidity in patients with coronary artery disease and left-ventricular systolic dysfunction.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods&lt;/b&gt; Between December, 2004, and December, 2006, we screened 12473 patients at 781 centres in 33 countries. We enrolled 10 917 eligible patients who had coronary artery disease and a left-ventricular ejection fraction of less than 40% in a randomised, double-blind, placebo-controlled, parallel-group trial. 5479 patients received 5 mg ivabradine, with the intention of increasing to the target dose of 7.5 mg twice a day, and 5438 received matched placebo in addition to appropriate cardiovascular medication. The primary endpoint was a composite of cardiovascular death admission to hospital for acute myocardial infarction, and admission to hospital for new onset or worsening heart failure. We analysed patients by intention to treat. The study is registered with ClinicalTrials.gov, number NCT00143507.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Findings&lt;/b&gt; Mean heart rate at baseline was 71.6 (SD 9.9) beats per minute (bpm). Median follow-tip was 19 months (IQR 16-24). Ivabradine reduced heart rate by 6 bpm (S E 0.2) at 12 months, corrected for placebo. Most (87%) patients were receiving beta blockers in addition to study drugs, and no safety concerns were identified. Ivabradine did not affect the primary composite endpoint (hazard ratio 1. 00, 95% CI 0 . 91-1. 1, p=0 . 94). 1233 (22 . 5%) patients in the ivabradine group had serious adverse events, compared with 1239 (22.8%) controls (p=0.70). In a prespecified subgroup of patients with heart rate of 70 bpm or greater, ivabradine treatment did not affect the primary composite outcome (hazard ratio 0 . 91, 95% CI 0 . 81-1.04, p=0.17), cardiovascular death, or admission to hospital for new-onset or worsening heart failure. However, it did reduce secondary endpoints: admission to hospital for fatal and non-fatal myocardial infarction (0 . 64, 95% CI 0 . 49-0 . 84, p=0 . 001) and coronary revascularisation (0. 70, 95% CI 0 . 52-0.93, p=0 .016).&lt;/p&gt; &lt;p&gt;&lt;b&gt;Interpretation&lt;/b&gt; Reduction in heart rate with ivabradine does not improve cardiac outcomes in all patients with stable coronary artery disease and left-ventricular systolic dysfunction, but could be used to reduce the incidence of coronary artery disease outcomes in a subgroup of patients who have heart rates of 70 bprn or greater.&lt;/p&gt