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

Thermal comfort in urban spaces: a cross-cultural study in the hot arid climate

This cross-cultural research is an inaugural attempt to investigate the outdoor thermal comfort and the effect of cultural and social differences in hot arid climates. Case studies were carefully selected in two different parts of the world (Marrakech in North Africa and Phoenix, Arizona, in North America) to represent two different cultures in similar climatic context. Field surveys, carried out during winter and summer, included structured interviews with a standard questionnaire, observations and microclimatic monitoring. The results demonstrate a wide thermal comfort zone and prevalence of air-conditioning influencing thermal comfort requirements. The work also provides evidence of substantial cross-cultural differences in thermal comfort requirements between residents in Marrakech and Phoenix. It shows that adaptive measures, such as level of clothing, changing place, cold drinks consumption and thermal experience, varies between cultures and this influences the thermal evaluation of visitors in outdoor spaces in the hot arid climate. Evidence between the time spent in outdoor spaces and thermal expectations has been found. Moreover, environmental variables such as air temperature and solar radiation have a great impact on the use of the outdoor spaces in the hot arid climate and may determine the number of people in urban spaces. The study also identified significant differences in thermal comfort requirements between different socio-economic groups, highlighting the need for comfortable open spaces