Thermal ablation of saphenous veins is feasible and safe in patients older than 75 years: A prospective study (EVTA study)

OBJECTIVES

To investigate the tolerance and safety of thermal ablation (TA), consisting of radiofrequency or endovenous laser (EVLA) of saphenous veins (SV) in elderly (group 1 ≥75 years), compared with a control group (group 2 <75 years).

METHOD

An Observational multicenter-prospective study was conducted, under the aegis of the French and Swiss Societies of Phlebology (18 centers). Ninety patients were included in group 1, 617 in group 2 (mean age 80 years and 53 years; 69% women in both groups), representing 863 SV. Mean trunk diameters were similar in both groups (small SV: 6 mm; great SV: 7 mm). In group 1, comorbidities were more frequent, particularly cardiac insufficiency, diabetes, history of thrombosis, and CEAP clinical class was significantly higher.

RESULTS

EVLA was used in 86% of cases. Settings used were similar in both groups for each technique. Only 6% of TA was performed in an operating room for group 1 (14% group 2). Tumescent local anaesthesia (TLA) alone was used in 91% of cases in group 1 (85% group 2). The mean pain score was only 1.6 for the procedure itself (VASP 0-10; 10 max.) and 1.4 for the 10 days following the procedure. Side effects were few, but rate of paraesthesia was higher when general anaesthesia was used (11.8%) compared with TLA alone (2.2%). At three months, 100% of SV was occluded in group 1 (99.5% group 2), with high satisfaction score (9.3/10).

CONCLUSION

TA is safe and effective in elderly; it should be performed strictly under TLA to minimize side effects.

Large-mode-area infrared guiding in ultrafast laser written waveguides in sulfur-based chalcogenide glasses

Current demands in astrophotonics impose advancing optical functions in infrared domains within embedded refractive index designs. We demonstrate concepts for large-mode-area guiding in ultrafast laser photowritten waveguides in bulk Sulfur-based chalcogenide glasses. If positive index contrasts are weak in As2S3, Ge doping increases the matrix rigidity and allows for high contrast (10(-3)) positive refractive index changes. Guiding with variable mode diameter and large-mode-area light transport is demonstrated up to 10 μm spectral domain using transverse slit-shaped and evanescently-coupled multicore traces.

TIMES-SS--recent refinements resulting from an industrial skin sensitisation consortium

The TImes MEtabolism Simulator platform for predicting Skin Sensitisation (TIMES-SS) is a hybrid expert system, first developed at Bourgas University using funding and data from a consortium of industry and regulators. TIMES-SS encodes structure-toxicity and structure-skin metabolism relationships through a number of transformations, some of which are underpinned by mechanistic 3D QSARs. The model estimates semi-quantitative skin sensitisation potency classes and has been developed with the aim of minimising animal testing, and also to be scientifically valid in accordance with the OECD principles for (Q)SAR validation. In 2007 an external validation exercise was undertaken to fully address these principles. In 2010, a new industry consortium was established to coordinate research efforts in three specific areas: refinement of abiotic reactions in the skin (namely autoxidation) in the skin, refinement of the manner in which chemical reactivity was captured in terms of structure-toxicity rules (inclusion of alert reliability parameters) and defining the domain based on the underlying experimental data (study of discrepancies between local lymph node assay Local Lymph Node Assay (LLNA) and Guinea Pig Maximisation Test (GPMT)). The present paper summarises the progress of these activities and explains how the insights derived have been translated into refinements, resulting in increased confidence and transparency in the robustness of the TIMES-SS predictions.

Echinococcus cysts affecting oromaxillofacial structures--a systematic review

OBJECTIVES

Cystic echinococcosis is a worldwide spread zoonosis and humans become accidental intermediate hosts. Any tissue can be affected. However, oromaxillofacial cystic echinococcosis is very uncommon and has never been studied systematically and no evidence-based treatment recommendations are available. Aim of this paper is to summarize the current knowledge and clinical experience with oromaxillofacial manifestations of cystic echinococcosis.

MATERIALS AND METHODS

PubMed database was accessed with a comprehensive, complex search strategy. Medical Subject Headings terms, wildcard search, truncated search terms and Boolean operators were used. No filters to restrict the results were set. Two evaluators jointly assessed the results in terms of defined criteria.

RESULTS

The search strategy retrieved 538 results in total. After evaluation 83 publications presenting 108 cases on oromaxillofacial cystic echinococcosis were included. Parotid gland, mandibular region and maxillary region were most commonly affected. Median patient age was 22 years (range 2.5 months to 81 years). Surgical treatment was performed in 97 cases.

CONCLUSIONS

In cases of oromaxillofacial cystic echinococcosis a thorough evaluation of the patients for further cysts is essential. Therapeutic treatment options are surgical or minimally invasive intervention and drug treatment with benzimidazoles. The diagnosis can be difficult and often require a multidisciplinary approach.

Abstract P3-14-01: Features of neoadjuvant and adjuvant chemotherapy in breast cancer – A population-based study on 39404 patients

Background: Neoadjuvant chemotherapy (NACT) is increasingly used globally in clinical trials for breast cancer patients. In Germany, NACT has been implemented as a standard option of care for almost a decade. In a population-based benchmark cohort study, the West German Breast Center (WBC) recorded approximately 50% of all breast cancer cases diagnosed in Germany between 2007 and 2010. We compare baseline and treatment pattern of patients treated either with adjuvant (ACT) or NACT.

Methods: Approx. 200 accredited breast centers treated 115169 primary breast cancer patients of whom 32609 received ACT and 6795 NACT. Pathological complete response (pCR) was stated if no invasive and no non-invasive tumor residues (ypT0 ypN0) were detected. Follow up information was available for 55% of patients.

Results: Use of NACT increased from 16.4% in 2007 to 19.1% in 2010 (p&lt;.0001). Patients treated with NACT were younger, had higher clinical nodal involvement, fewer lobular-invasive cancers, more undifferentiated, hormone-receptor-negative, and HER2-positive cancers, and more multicentric tumors compared to patients treated with ACT (all p&lt;0.002). 34% of patients in the NACT group had cT3/4 tumors compared to 7.7% of pT3/4 tumors in the ACT group. cN0 status was twice as frequent (70.6% vs 37.7%, p&lt;.0001) whereas pN0 status was reported less frequently (47.4% vs 51.4%, p&lt;0.0001) in the ACT and NACT group, respectively. Time between diagnosis and start of systemic treatment or surgery was in median 12 (range 1-902) and 22 (range 1-721) days in the ACT and NACT group, respectively (p&lt;.0001). 66.2% and 91.4% of patients received ACT and NACT with a taxane, respectively (p&lt;.0001). 9.7% and 37.5% of patients receiving treatment for &gt; = 18 weeks, respectively. 35.2% and 69.9% of patients with HER2-positive tumors received adjuvant or neoadjuvant trastuzumab, respectively (p&lt;.0001). 21.7% and 31.4% of patients were treated in ACT or NACT clinical trials, respectively (p&lt;.0001). Breast conservation was possible in 69.4% and 55.2% in the ACT and NACT group, respectively (p&lt;.0001). 30.5% and 37.5% needed two or more surgical interventions in the ACT and NACT group, respectively (p&lt;.0001).

Multivariable logistic regression analysis confirmed taxane- and trastuzumab-based treatment, study participation, age, histologic type, grading, and hormone-receptor status as independent predictors of pCR. pCR rate was not dependent on the time between diagnosis and start of treatment or the time between end of chemotherapy and surgery.

In univariate analysis patients receiving NACT showed a 4-year overall survival rate of 78%, compared to 92% in patients receiving ACT (p&lt;.0001). However, patients with a pCR after NACT showed a comparable survival to patients in the ACT group, whereas patients without a pCR showed a 4-year overall survival rate of 76%. In the hormone-receptor-positive/HER2-positive and even more in the triple-negative subgroup, survival of patients with a pCR appeared better than in patients with ACT.

Conclusion: In this population-based study, NACT was used in patients with unfavorable risk factors and was more intense than ACT. Outcome of patients with pCR after NACT was similar and in aggressive tumor subtypes even better than after ACT.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-01.

[Informations and recommendations of the German Respiratory Society and the Paul-Ehrlich-Society for chemotherapy concerning the outbreak of influenza A(H7N9) virus infections in humans]

In March 2013, the first cases of avian influenza virus infections in humans were reported by the authorities of the PR of China to the World Health Organization. This influenza A(H7N9) virus comprises genes of at least four different avian influenza viruses, some segments mimicking human-like influenza-signatures. Until 11 August, 2013 135 humans were infected, 44 (33%) died. The clinical course is characterized by fever, cough, gastrointestinal symptoms, lympho- and thrombopenia as well by the rapid onset of an acute respiratory distress syndrome in nearly 25% of the cases. Although human to human transmission may have occurred only in the context of three clusters, strict hygiene measures should be instituted and any suspect case should be reported to the local health authorities immediately. The detection of influenza A(H7N9) is based on real-time polymerase chain reaction (PCR). Antiviral treatment should be initiated as early as possible for suspect, probable or confirmed cases, even when 48 hours have passed after symptom onset. At present the future development of this epidemic cannot be predicted.

MOLECULAR CHARACTERISATION OF ECHINOCOCCUS GRANULOSUS SPECIES/STRAINS IN HUMAN INFECTIONS FROM TURKANA, KENYA

BACKGROUND

Cystic echinococcosis (CE) or hydatid disease is a neglected, economically important zoonotic disease endemic in pastoralist communities, in particular the Turkana community of Kenya. It is caused by the larval stage of the highly diverse species complex of Echinococcusgranulosus sensu lato (s.l). The situation on the genetic diversity in humans in Kenya is not well established.

OBJECTIVE

To characterise Echinococcus granulosus (s.1) species/strains isolated from humans undergoing surgery in Turkana, Kenya.

DESIGN

A Cross sectional study.

SETTING

The Kakuma Mission Hospital and Centre for Microbiology Research, Kenya Medical Research Institute.

SUBJECTS

Eighty (80) parasite samples from 26 subjects were analysed by Polymerase chain reaction--Restriction fragment length polymorphism (PCR-RFLP) targeting the nad 1 gene for molecular characterization.

RESULTS

Two different genotypes of E. granulosus were identified from the samples analysed: E. granulosus sensu stricto (G1-G3) 85% of the samples analysed and E. canadensis G6/7 (15%). Most of the hydatid cysts (35%) were isolated from the liver. Other sites where cysts were isolated from include: kidney, abdomen, omentum, retroperitonium and the submandibular. Majority of cysts presented as CE1 (50%) and CE3B (42%) images according to WHO ultrasound classification. Both males and females were infected with E. granulosus s.s but only the females showed infection with E. canadensis G6/7. Chi-square test revealed significant difference between age of individuals and cysts classification by ultrasound. In addition, there was an association between cyst presentation (single or multiple) and genotype whereby all the E. canadensis G6/7 cases presented as single cysts in the infected persons.

CONCLUSION

This study corroborates previous reports that E. canadensis G6/7 strain is present in Turkana, a place where initially only E. granulosus s.s (G1-G3) was known to be present and that E. granulosis (G1-G3) remains the most widespread genotype infecting humans in the Turkana community.

European guidelines for sclerotherapy in chronic venous disorders

Aim

Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy.

Methods

This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7–10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines.

Results

This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.

[Quality of life in patients traited for primary superficial venous insufficiency]

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p<0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

[Curriculum for "Rheumatology health professionals DGRh-BDRh" as a way of qualification for clinical nursing specialists : Concept and results of an evaluation]

Rheumatological care in Germany is influenced by limited resources and education and qualification of health professionals is a way to optimize utilization of these resources.The curriculum for rheumatology health professionals of the Academy of the German Association of Rheumatologists (DGRh) was developed to qualify clinical nursing specialists of rheumatology clinics as well as specialized rheumatology hospitals on a systematic basis.Since 2006 499 participants have each been trained over 4 weekends and certification was achieved by examinations. The topics cover the principles of anatomy and the pathology of diseases up to modern diagnostic methods and treatment, including practical skills. Additional specialized courses for nurses of rheumatology hospitals and refresher courses give the participants the opportunity to increase their depth of knowledge.After 8 of the basic courses questionnaires were sent to all participants for evaluation and 143 (51%) out of 277 participants responded. Of the responders 95% found that their knowledge of understanding rheumatic diseases improved considerably or very considerably, 90% found that their ability to determine urgent cases and 86% to correctly judge emergency situations had improved and 50% agreed with the statement that their field of work and their tasks had changed after the training courses. Increased responsibilities, documentations of patient history, involvement in clinical trials and infusions and information of the patients about their disease or the treatment were listed as new tasks of the participants. In conclusion the evaluation shows that the curriculum for rheumatology health professionals is an effective step towards qualification for clinical nursing specialists. We believe that this will support the work of medical doctors in rheumatology and will improve the quality of care for patients with rheumatic diseases.

An advanced simulation model for membrane bioreactors: development, calibration and validation

Membrane wastewater treatment plants (WWTPs) have several advantages compared with conventionally designed WWTPs with classical purification techniques. The filtration process is the key to their commercial success in Germany with respect to energy consumption and effectiveness, enabled by the optimization of filtration using a dynamic simulation model. This work is focused on the development of a robust, flexible and practically applicable membrane simulation model for submerged hollow-fibre and flat-sheet membrane modules. The model is based on standard parameters usually measured on membrane WWTPs. The performance of the model is demonstrated by successful calibration and validation for three different full-scale membrane WWTPs achieving good results. Furthermore, the model is combinable with Activated Sludge Models.

Pathologic response rate (pCR) and near-pathologic response rate (near-pCR) with docetaxel-carboplatin (TCarb) in early triple-negative breast cancer

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Background: Triple-negative breast cancer (TNBC) is associated with a poor prognosis unless a pathological complete response is achieved (Liedtke C et al. 2008: J Clin Oncol 26:1275-1281) or almost achieved (Symmans WF. 2007: J Clin Oncol 25:4414-4422). Sensitivity to platin compounds has been demonstrated in BRCA1-positive settings (Byrski T et al. 2010: J Clin Oncol 20:28:375-9; Silver DP. 2010: J Clin Oncol 28:1145-1153) with only limited numbers of patients (Byrski T et al. 2010: J Clin Oncol 20:28:375-9) or in sporadic breast cancer with heterogeneous cohorts (Sikov WM et al 2009: J Clin Oncol 27:4693-4700; Chang HR et al. 2010: Cancer 15; 116:4227-4237).

Methods: This pivotal trial was to assess the efficacy of platinum and taxane-based combination therapy without the use of anthracyclines. 27 patients with primary TNBC (majority of them cT2, two cT3 and one cT4a) had to be unsuitable for standard anthracycline-based chemotherapy. They received 6 cycles, respectively in two cases only 5 cycles, of carboplatin AUC 6 and docetaxel 75 mg/m2 q3w. The primary endpoint was the pCR-rate, secondary endpoint toxicity.

Results: 20 out of 27 (74%) patients had pathological complete response (52%) or near-complete response (22%)—ypT1mic and ypT1a—both being associated with a good prognosis. Seven remaining patients had still good partial response, leaving only low residual cancer burden, which was defined as ypT1. Treatment was well-tolerated: grade III and IV toxicities were neutropenia, thrombopenia, oedema, nausea, joint pain, nail changes, fatigue, hypertension, and alopecia.

Conclusions: These results show a high efficacy of carboplatin AUC6 and docetaxel 75 mg/m2 q3w and good feasibility as primary chemotherapy for TNBC with a pCR- and near-pCR-rate of 74% and total response rate of 100%. The incorporation of anthracyclines and parp-inhibitors into further trial designs could enhance the efficacy of these compounds. The omission of exposure to anthracyclines in patients with considerable heart disease risks seems to be feasible with a good pCR-rate, the latter being a surrogate-marker for long-term survival.

Simulation and optimization of an experimental membrane wastewater treatment plant using computational intelligence methods

The optimization of relaxation and filtration times of submerged microfiltration flat modules in membrane bioreactors used for municipal wastewater treatment is essential for efficient plant operation. However, the optimization and control of such plants and their filtration processes is a challenging problem due to the underlying highly nonlinear and complex processes. This paper presents the use of genetic algorithms for this optimization problem in conjunction with a fully calibrated simulation model, as computational intelligence methods are perfectly suited to the nonconvex multi-objective nature of the optimization problems posed by these complex systems. The simulation model is developed and calibrated using membrane modules from the wastewater simulation software GPS-X based on the Activated Sludge Model No.1 (ASM1). Simulation results have been validated at a technical reference plant. They clearly show that filtration process costs for cleaning and energy can be reduced significantly by intelligent process optimization.