Phase IB study of the FLT3 kinase inhibitor midostaurin with chemotherapy in younger newly diagnosed adult patients with acute myeloid leukemia

This phase 1b trial investigated several doses and schedules of midostaurin in combination with daunorubicin and cytarabine induction and high-dose cytarabine post-remission therapy in newly diagnosed patients with acute myeloid leukemia (AML). The discontinuation rate on the 50-mg twice-daily dose schedule was lower than 100 mg twice daily, and no grade 3/4 nausea or vomiting was seen. The complete remission rate for the midostaurin 50-mg twice-daily dose schedule was 80% (FMS-like tyrosine kinase 3 receptor (FLT3)-wild-type: 20 of 27 (74%), FLT3-mutant: 12 of 13 (92%)). Overall survival (OS) probabilities of patients with FLT3-mutant AML at 1 and 2 years (0.85 and 0.62, respectively) were similar to the FLT3-wild-type population (0.78 and 0.52, respectively). Midostaurin in combination with standard chemotherapy demonstrated high complete response and OS rates in newly diagnosed younger adults with AML, and was generally well tolerated at 50 mg twice daily for 14 days. A phase III prospective trial is ongoing (CALGB 10603, NCT00651261).

[Authorization procedure of clinical trials with medical devices. First practical analysis of the BfArM]

The 4th amendment of the Medical Device Law introduced the authorization procedure for clinical trials with medical devices. The Federal Institute for Drugs and Medical Devices ("Bundesinstitut für Arzneimittel und Medizinprodukte", BfArM) has now drawn the first substantial interim balance on the basis of daily practice in order to describe results achieved by applications of clinical trials with medical devices. Overall, realization of the new authorization procedure of clinical trials is well underway. This empirical practical analysis of the first 405 applications points out further possibilities for improvements for future applicants. Furthermore, initial figures demonstrate the cooperative relationship with national and international applicants. Because the by far largest percentage of the premarket clinical trials with medical devices in the European Community are conducted in Germany (28%), the analysis also provides a comparison with other European countries in order to detect differences in specific areas as the result of the implementation of Directive 2007/47/EC.

Fluids with quenched disorder: scaling of the free energy barrier near critical points

In the context of Monte Carlo simulations, the analysis of the probability distribution P(L)(m) of the order parameter m, as obtained in simulation boxes of finite linear extension L, allows for an easy estimation of the location of the critical point and the critical exponents. For Ising-like systems without quenched disorder, P(L)(m) becomes scale-invariant at the critical point, where it assumes a characteristic bimodal shape featuring two overlapping peaks. In particular, the ratio between the value of P(L)(m) at the peaks (P(L, max)) and the value at the minimum in between (P(L, min)) becomes L-independent at criticality. However, for Ising-like systems with quenched random fields, we argue that instead ΔF(L) := ln(P(L, max)/P(L, min)) proportional to L(θ) should be observed, where θ > 0 is the 'violation of hyperscaling' exponent. Since θ is substantially non-zero, the scaling of ΔF(L) with system size should be easily detectable in simulations. For two fluid models with quenched disorder, ΔF(L) versus L was measured and the expected scaling was confirmed. This provides further evidence that fluids with quenched disorder belong to the universality class of the random field Ising model.

New computerized fetal heart rate analysis for surveillance of intrauterine growth restriction

OBJECTIVE

Decreased fetal heart rate variability is associated with higher perinatal morbidity and mortality in intrauterine growth restriction (IUGR). This study used a new method [phase-rectified signal averaging (PRSA)] to calculate acceleration- and deceleration-related fluctuations of the fetal heart rate.

METHOD

Cardiotocograms from 74 growth-restricted and 161 normal fetuses were included. Both groups were matched for gestational age. The transformed PRSA signal was quantified by the acceleration-related parameter-averaged acceleration capacity (AAC) and compared to the standard short-term variation (STV). Mann-Whitney test and receiver operator characteristic (ROC) curves were used for statistical analysis.

RESULTS

For AAC, the median values of the IUGR group and control group were 1.97 bpm [interquartile range (IQR): 1.66-2.23] and 2.49 bpm (IQR: 2.24-2.72), respectively. For STV, these values were 5.44 ms (IQR: 4.49-7.38) and 7.79 ms (IQR: 6.35-9.66), respectively. The area under the ROC curve was 81.4% for AAC and 70.5% for STV.

CONCLUSION

The results of AAC are in both groups comparable to STV. Longitudinal studies are needed to investigate the association of AAC with the clinical outcome of the newborn.

Improvement of the Luminescing Behaviour of Simmplanted SiO2 Films

In previous work we reported on the observation of continuously tunable photoluminescence in Si+-implanted SiO2-films with moderate intensities. In this paper we demonstrate improved performance of such samples. The photoluminescence intensity increases abruptly up to two orders of magnitude when the anneal temperature is elevated to values higher than 1000…1100°C. This strong photoluminescence degrades less than that of porous silicon. Very fine tunability in the spectral range from 2.1 eV to 1.3 eV is achieved in samples implanted with a graded dose. In the analysis of the results we try to distinguish between the contributions of the Si-nanocrystals and of the oxide related defects.

Finite-size scaling in Ising-like systems with quenched random fields: evidence of hyperscaling violation

In systems belonging to the universality class of the random field Ising model, the standard hyperscaling relation between critical exponents does not hold, but is replaced with a modified hyperscaling relation. As a result, standard formulations of finite-size scaling near critical points break down. In this work, the consequences of modified hyperscaling are analyzed in detail. The most striking outcome is that the free-energy cost ΔF of interface formation at the critical point is no longer a universal constant, but instead increases as a power law with system size, ΔF∝L(θ), with θ as the violation of hyperscaling critical exponent and L as the linear extension of the system. This modified behavior facilitates a number of numerical approaches that can be used to locate critical points in random field systems from finite-size simulation data. We test and confirm the approaches on two random field systems in three dimensions, namely, the random field Ising model and the demixing transition in the Widom-Rowlinson fluid with quenched obstacles.

Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS®-US classification system with sonoelastography

PURPOSE

Hitachi real-time tissue elastography (HI-RTE) is an ultrasound technique that facilitates the estimation of tissue elasticity. Our study evaluates whether sonoelastography improves the differentiation of benign and malignant breast lesions.

MATERIALS AND METHODS

In a multicenter approach sonoelastography of focal breast lesions was carried out in 779 patients with subsequent histological confirmation. We present data from 3 study centers (Berlin, Bielefeld, Homburg/Saar) focusing on the sensitivity (SE), specificity (SP) and the positive (PPV) and negative predictive value (NPV) of sonoelastography. In addition we performed an analysis of the diagnostic performance, expressed by the pretest and posttest probability of disease (POD), in BI-RADS®-US 3 or 4 lesions as these categories can imply both malignant and benign lesions and a more precise prediction would be a preferable aim.

RESULTS

Sonoelastography demonstrated an improved SP (89.5 %) and an excellent PPV (86.8 %) compared to B-mode ultrasound (76.1 % and 77.2 %). Especially in dense breasts ACR III-IV, the SP was even higher (92.8 %). In BI-RADS-US 3 lesions, a suspicious elastogram significantly modified the POD from 8.3 % to a posttest POD of 45.5 %. In BI-RADS-US 4 lesions, we found a pretest POD of 56.6 %. The posttest POD changed significantly to 24.2 % with a normal elastogram and to 81.5 % with a suspicious elastogram.

CONCLUSION

Our data demonstrates that the complementary use of sonoelastography definitely improves the performance in breast diagnostics. Finally we present a protocol of how sonoelastography can be integrated into our daily practice.

The Widom-Rowlinson mixture on a sphere: elimination of exponential slowing down at first-order phase transitions

Computer simulations of first-order phase transitions using 'standard' toroidal boundary conditions are generally hampered by exponential slowing down. This is partly due to interface formation, and partly due to shape transitions. The latter occur when droplets become large such that they self-interact through the periodic boundaries. On a spherical simulation topology, however, shape transitions are absent. We expect that by using an appropriate bias function, exponential slowing down can be largely eliminated. In this work, these ideas are applied to the two-dimensional Widom-Rowlinson mixture confined to the surface of a sphere. Indeed, on the sphere, we find that the number of Monte Carlo steps needed to sample a first-order phase transition does not increase exponentially with system size, but rather as a power law τ α V(α), with α≈2.5, and V the system area. This is remarkably close to a random walk for which α(RW) = 2. The benefit of this improved scaling behavior for biased sampling methods, such as the Wang-Landau algorithm, is investigated in detail.

Phase-sensitive terahertz spectroscopy with backward-wave oscillators in reflection mode

In this article we describe a method which allows accurate measurements of the complex reflection coefficient r = absolute value(r) x exp(i phi(R)) of a solid at frequencies of 1-50 cm(-1) (30 GHz-1.5 THz). Backward-wave oscillators are used as sources for monochromatic coherent radiation tunable in frequency. The amplitude of the complex reflection (the reflectivity) is measured in a standard way, while the phase shift, introduced by the reflection from the sample surface, is measured using a Michelson interferometer. This method is particular useful for nontransparent samples, where phase-sensitive transmission measurements are not possible. The method requires no Kramers-Kronig transformation in order to extract the sample's electrodynamic properties (such as the complex dielectric function or complex conductivity). Another area of application of this method is the study of magnetic materials with complex dynamic permeabilities different from unity at the measurement frequencies (for example, colossal-magnetoresistance materials and metamaterials). Measuring both the phase-sensitive transmission and the phase-sensitive reflection allows for a straightforward model-independent determination of the dielectric permittivity and magnetic permeability of such materials.

Novel pathway in Bcr-Abl signal transduction involves Akt-independent, PLC-gamma1-driven activation of mTOR/p70S6-kinase pathway

In chronic myeloid leukemia, activation of the phosphoinositide 3-kinase (PI3K)/Akt pathway is crucial for survival and proliferation of leukemic cells. Essential downstream molecules involve mammalian target of rapamycin (mTOR) and S6-kinase. Here, we present a comprehensive analysis of the molecular events involved in activation of these key signaling pathways. We provide evidence for a previously unrecognized phospholipase C-gamma1 (PLC-gamma1)-controlled mechanism of mTOR/p70S6-kinase activation, which operates in parallel to the classical Akt-dependent machinery. Short-term imatinib treatment of Bcr-Abl-positive cells caused dephosphorylation of p70S6-K and S6-protein without inactivation of Akt. Suppression of Akt activity alone did not affect phosphorylation of p70-S6K and S6. These results suggested the existence of an alternative mechanism for mTOR/p70S6-K activation. In Bcr-Abl-expressing cells, we detected strong PLC-gamma1 activation, which was suppressed by imatinib. Pharmacological inhibition and siRNA knockdown of PLC-gamma1 blocked p70S6-K and S6 phosphorylation. By inhibiting the Ca-signaling, CaMK and PKCs we demonstrated participation of these molecules in the pathway. Suppression of PLC-gamma1 led to inhibition of cell proliferation and enhanced apoptosis. The novel pathway proved to be essential for survival and proliferation of leukemic cells and almost complete cell death was observed upon combined PLC-gamma1 and Bcr-Abl inhibition. The pivotal role of PLC-gamma1 was further confirmed in a mouse leukemogenesis model.

[Diagnosis and treatment of preeclampsia: overview of international recommendations]

The new german guidelines for the treatment of hypertensive disorders in pregnancy have some important differentiations. The aim of the new guidelines is to avoid the early premature birth and to reduce the fetal and maternal morbidity and mortality. For the first time there ist the possibility and the recommendation for the prolongation of pregnancy. This means that the treatment of hypertensive disorders should start not before a blood pressure of >or=170/110 mmHg; thus the nutrition of the fetus will not be worsened and the worse perfusion of the placenta will be avoided. Further more the selection of antihypertensive treatment has changed: the first choice is not longer Dihydralazin (Nepresol) but Nifedipin (Adalat). In the treatment of HELLP-Syndrom there ist only one difference to the treatment of preeclampsia: the use of glucocorticosteroids. In the treatment of both hypertensive disorders in pregnancy there is the aim to finish the fetal lung mature induction before the delivery is planned or necessary. A new point of view in the german guidelines is the possibility of prediction and prevention of hypertensive disorders in pregnancy: patients who had already a hypertensive disorder in the pregnancy before or patients who have a pathologic flow in the Art. uterinae have a significant higher risk for a preeclampsia in this pregnancy. They should receive a preventive therapy with ASS. Because of these changes in the german guidelines the prolongation of pregnancy and the reduced rate of premature birth becomes more importance and helps to avoid a high rate of neonatal mortality and morbidity.