Modular prevention of heart disease following acute coronary syndrome (ACS) [ISRCTN42984084]

BACKGROUND: Coronary heart disease (CHD) is a major cause of morbidity and mortality in Australia and it is recommended that all persons with unstable angina (UA) or myocardial infarction (MI) participate in secondary prevention as offered in cardiac rehabilitation (CR) programs. However, the majority of patients do not access standard CR and have higher baseline coronary risk and poorer knowledge of CHD than those persons due to commence CR. The objective of this study is to investigate whether a modular guided self-choice approach to secondary prevention improves coronary risk profile and knowledge in patients who do not access standard CR. METHODS/DESIGN: This randomised controlled trial with one year follow-up will be conducted at a tertiary referral hospital. Participants eligible for but not accessing standard CR will be randomly allocated to either a modular or conventional care group. Modular care will involve participation in individualised modules that involve choice, goal-setting and coaching. Conventional care will involve ongoing heart disease management as directed by the participant's doctors. Both modular and conventional groups will be compared with a contemporary reference group of patients attending CR. Outcomes include measured modifiable risk factors, relative heart disease risk and knowledge of risk factors. DISCUSSION: We present the rationale and design of a randomised controlled trial testing a modular approachfor the secondary prevention of coronary heart disease following acute coronary syndrome

XELOX (capecitabine plus oxaliplatin) as first-line treatment for elderly patients over 70 years of age with advanced colorectal cancer

The purpose of this phase II trial was to determine the efficacy and safety of the XELOX (capecitabine/oxaliplatin) regimen as first-line therapy in the elderly patients with metastatic colorectal cancer (MCRC). A total of 50 patients with MCRC aged ⩾70 years received oxaliplatin 130 mg m−2 on day 1 followed by oral capecitabine 1000 mg m−2 twice daily on days 1–14 every 3 weeks. Patients with creatinine clearance 30–50 ml min−1 received a reduced dose of capecitabine (750 mg m−2 twice daily). By intent-to-treat analysis, the overall response rate was 36% (95% CI, 28–49%), with three (6%) complete and 15 (30%) partial responses. In total, 18 patients (36%) had stable disease and 14 (28%) progressed. The median times to disease progression and overall survival were 5.8 months (95% CI, 3.9–7.8 months) and 13.2 months (95% CI, 7.6–16.9 months), respectively. Capecitabine was well tolerated: grade 3/4 adverse events were observed in 14 (28%) patients: 11 (22%) diarrhoea, eight (16%) asthenia, seven (14%) nausea/vomiting, three (6%) neutropenia, three (6%) thrombocytopenia, and two (4%) hand–foot syndrome. There was one treatment-related death from diarrhoea and sepsis. In conclusion, XELOX is well tolerated in elderly patients, with respectable efficacy and a meaningful clinical benefit response. Given its ease of administration compared with combinations of oxaliplatin with 5-FU/LV, it represents a good therapeutic option in the elderly

Speed Indicators for Circuit Optimization

International audienc

ABSTRACT Objectives

Locally advanced breast cancer (LABC) poses a difficult clinical challenge with an overall poor long-term prognosis. The strength of the association between tumour characteristics, treatment response, and outcome is not well defined. In the present study, we attempted to gain further insight into LABC by reviewing tumour characteristics of patients treated with neoadjuvant chemotherapy and by studying the association of those characteristics with outcome. We calculated the residual cancer burden (RCB) score obtained at surgery and attempted to study its correlation with event-free survival (EFS) and overall survival (OS). NAHLEH et al. MEDICAL ONCOLOGY Residual cancer burden in locally advanced breast cancer: a superior too

A study on landslides and subsurface piping, facilitated by dykes, using vertical electrical sounding and δO \u3c sup\u3e 18 \u3c/sup\u3e and δH \u3c sup\u3e 2 \u3c/sup\u3e stable isotopes

© 2017, Springer-Verlag Berlin Heidelberg. A combination of vertical electrical sounding (VES) and δO18 and δH2 stable isotope geochemistry is used in this study to trace out the extension of a dyke and for deciphering the subsurface piping phenomena in a landslide-affected hamlet, Pasukadavu, in the Western Ghats of Kerala, India. VES was successful in extracting three to four different subsurface layers characterized by differing resistivity. Two VES sections were prepared from 24 different VES locations, each one for understanding the dyke extension and for delineating subsurface conduits. The dyke was characterized by high resistivity of 800–5000 Ω.m and shows varying thickness. In the second profile, the void zone, which is characteristic of piping, is delineated through a low resistivity zone (75 to 350 Ω.m). δO18 and δH2 stable isotopes collected along the second VES profile show the same chemistry, indicating that it is the same water which flows all along the VES profile 2. A four-stage conceptual model was developed to illustrate and narrate the sequence of development of the piping phenomena and landslide activity