Resolution of severe hyponatraemia is associated with improved survival in patients with cancer

© Balachandran et al.Background: Hyponatraemia is a common finding in patients with cancer, and has been shown to be associated with poor prognosis in different settings. We have analysed the impact of severe hyponatraemia in patients with cancer. Methods: A retrospective review of all patients admitted to a specialist cancer hospital with a plasma sodium of less than 115 mmol/l and a diagnosis of malignancy was undertaken. Patient and tumour characteristics were analysed as well as impact of hyponatraemia management on overall survival and number of lines of cancer treatment received. Results: 57 patients were identified. 84% had advanced Stage 3 or 4 cancer and approximately 85% with data available had symptoms attributable to hyponatraemia. Mean length of hospital stay was 12 days, and overall survival (OS) was 5.1 months. Plasma sodium level corrected in 56% of patients and here OS was 13.6 months compared to 16 days in those whose sodium did not correct (p < 0.001). Those whose sodium corrected were more likely to receive further lines of anti-cancer treatment. Conclusions: Severe hyponatraemia in cancer is associated with very poor survival, but correction of the sodium level leads to additional treatment and significantly greater overall survival (although it is not possible to determine if this is due to specific therapy of the hyponatraemia or the resolving hyponatraemia reflects an improvement in the clinical condition). Aggressive treatment of hyponatraemia may allow more anti-cancer treatment and improve survival

Steep capillary waves on gravity waves.

SIGLEAvailable from British Library Document Supply Centre- DSC:DX176324 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Struggling to be Fit: Identity, Integrity, and the Law

This interdisciplinary co-authored Analysis piece introduces identity and integrity, which are argued to sit at the core of the person. It analyses approaches taken to these concepts by legal regimes, particularly in the context of individuals using artificial limbs or digital avatars. The piece concludes that law engages with identity and integrity to a limited and incomplete extent; and that law is thus inadequate in its engagement with the person, and its meaning making in this respect. This piece draws on two interdisciplinary funded projects, funded by the Wellcome Trust and the Arts and Humanities Research Council

Dendrimers: novel carriers for drug delivery

Dendrimers are highly branched, organic compounds with well-defined, symmetrical structure. From chemical point of view they are three-dimensional polymers, characterized by a globular shape. At the end of the arms are terminals, functional groups, which can be easily modified in order to change their chemical and physical properties. Dendrimers have nanoscopic particle size range from 1 to 100 nm. They are ideal drug delivery systems due to their feasible topology, functionality and dimensions, their size is very close to various important biological polymers and assemblies such as DNA and proteins. The structure of dendrimer molecules begins with a central atom or group of atoms labeled as the “core.” From this central structure, branches of other atoms called ‘dendrons.’ The continuous branching results in layers of branch structure called “generations.”Synthesis of dendrimers done by four methods. These are ‘Divergent’ Dendrimer Growth , ‘Convergent’ Dendrimer Growth ,‘Double Exponential’ and ‘Mixed’ Growth ,‘Click’ Synthesis (Hypercores and branched monomers growth). Mechanisms of drug loading onto dendrimer carriers by physical encapsulation of drug molecules and chemical conjugation of drug molecules. The conjugates show increased solubility, decreased systemic toxicity and selective accumulation in solid tumors. Various applications as pharmaceutical and non pharmaceuticals. Dendrimers may have toxicity mainly attributed to the interaction of the cationic dendrimers surface with negative biological load membranes damaging cellular membranes causing hemolytic toxicity and cytotoxicity also limitation that does not apply where the drug is solubilised with dendrimer and then released in the gut for absorption. Some Marketed products of dendrimers are available named as Starburst, Priostar, Stratus CS, Vivagel, Alert ticket, SuperFect, Taxotere

Heat sterilizable and impact resistant Ni-Cd battery development Quarterly report, 1 Jan. - 31 Mar. 1969

Research and development of heat sterilizable impact resistant nickel cadmium batterie

Improved survival following surgery and radiation therapy for olfactory neuroblastoma: analysis of the SEER database

<p>Abstract</p> <p>Background</p> <p>Olfactory Neuroblastoma is a rare malignant tumor of the olfactory tract. Reports in the literature comparing treatment modalities for this tumor are limited.</p> <p>Methods</p> <p>The SEER database (1973-2006) was queried by diagnosis code to identify patients with Olfactory Neuroblastoma. Kaplan-Meier was used to estimate survival distributions based on treatment modality. Differences in survival distributions were determined by the log-rank test. A Cox multiple regression analysis was then performed using treatment, race, SEER historic stage, sex, age at diagnosis, year at diagnosis and SEER geographic registry.</p> <p>Results</p> <p>A total of 511 Olfactory Neuroblastoma cases were reported. Five year overall survival, stratified by treatment modality was: 73% for surgery with radiotherapy, 68% for surgery only, 35% for radiotherapy only, and 26% for neither surgery nor radiotherapy. There was a significant difference in overall survival between the four treatment groups (p < 0.01). At ten years, overall survival stratified by treatment modality and stage, there was no significant improvement in survival with the addition of radiation to surgery.</p> <p>Conclusions</p> <p>Best survival results were obtained for surgery with radiotherapy.</p

A prospective observational study of on-treatment plasma homocysteine levels as a biomarker of toxicity, depression and vitamin supplementation lead-in time pre pemetrexed, in patients with non-small cell lung cancer and malignant mesothelioma

OBJECTIVES: Vitamin supplementation reduces pemetrexed toxicity. Raised plasma homocysteine reflects deficiency in vitamin B12 and folate, and is suppressed by supplementation. This observational study of 112 patients receiving pemetrexed-based chemotherapy assessed homocysteine levels after 3 weeks of vitamin supplementation, hypothesising high levels would correlate with ongoing deficiency, thus increased toxicity. MATERIAL AND METHODS: Primary endpoint was the composite of proportion of patients with treatment delay/ dose reduction/ drug change or hospitalisation during the first six weeks of chemotherapy, comparing those with normal plasma homocysteine (successfully supplemented, SS) and those with high homocysteine (unsuccessfully supplemented, USS). Secondary endpoints included toxicity and analyses for depression. Post-hoc analysis examined correlation between interval of vitamin and folate supplementation and pemetrexed on primary endpoint and grade 3-4 toxicities. RESULTS: Eighty-four patients (84%) were successfully supplemented (SS group). The proportion of patients undergoing a treatment delay/ dose reduction/ drug change or hospitalisation in SS group was 44.0% (95% confidence interval [CI] 33.2%-55.3%) and in USS group was 18.8% (95% CI 4.0%-45.6%) (p = 0.09). Twelve percent of patients gave a past history of depression however 66% of patients had an on study Hospital Anxiety and Depression (HAD) score of >7. Supplementation status was not associated with depression. The median overall survival (OS) was 11.8 months (95% CI 8.6-16.5) in the SS group and 8.8 months (95% CI 6.6-16.2) in the US group (p = 0.5). The number of days (<7 or ≥ 7 days) between vitamin B12 and folate initiation and pemetrexed administration, had no effect on the primary endpoint and grade 3-4 toxicities. CONCLUSION: On-treatment homocysteine levels were not a biomarker of toxicity or depression. Standard vitamin supplementation is adequate in the majority of patients receiving pemetrexed. High HAD score were noted in this population giving an opportunity for mental health intervention. The lead-in time for vitamin supplementation can be short