[Effects of extended aromatase inhibitors in women with hormone-dependent breast cancer who have already received five years of adjuvant hormone therapy: A systematic review and meta-analysis]

INTRODUCTION

Evaluating the benefits and risks of prolonged hormonal treatment with aromatase inhibitors (AIs) for treating hormone-dependent breast cancer.

METHODS

A systematic review and meta-analysis was conducted. Studies reporting on randomized clinical trials concerning prolongating hormonal therapy with AIs as compared to a placebo or no prolongation, after an initial five years of hormonal therapy, were eligible.

RESULTS

Seven clinical trials were included. Prolonged AI therapy was associated with a statistically significant improvement in disease-free survival (RR=0.70, 95% CI 0.60 to 0.80). A statistically significant increase was observed for osteoporosis (RR=1.17, 95% CI 1.03 to 1.33), hot flushes/flashes (RR=1.27, 95% CI 1.08 to 1.49), myalgia (RR=1.23, 95% CI 1.09 to 1.39), fractures (RR=1.26, 95% CI 1.09 to 1.45) and arthralgia (RR=1.17, 95% CI 1.10 to 1.25). However, no statistically significant association was observed between prolonged AI therapy and overall survival, cardiovascular events, and bone pain.

DISCUSSION

Prolonged AI therapy has significant benefits in terms of disease-free survival in women with hormone-dependent breast cancer. However, adverse effects and a lack of evidence for a benefit on overall survival must be considered in the decision-making process regarding adjuvant hormone therapy extension.

Effects of cold chemical (glutaraldehyde) versus autoclaving sterilization on the rate of coating loss of aesthetic archwires: A double-blind randomized clinical trial

OBJECTIVE

The effect of any sterilization methods (cold chemical, or hot) on film removal from coated archwires has not yet been investigated. Thus, we assessed it.

MATERIALS AND METHODS

This double-blind randomized clinical trial was performed on 120 observations: 40 macroscopically intact coated archwires from 4 brands were purchased (n=10 archwires/brand). Five wires from each brand underwent cold and 5 underwent hot sterilization. Wires were applied in 40 non-extractions patients at alignment phase of treatment (one month). Afterwards, 3 inter-bracket segments from each wire were examined microscopically, and the percentage of coating loss was recorded for each segment. Coating losses of the 4 brands and 2 sterilization methods were compared using a two-way ANOVA and a Welch t-test (α=0.05). Surfaces were also evaluated using scanning electron microscopy.

RESULTS

The mean surface coating loss of hot (autoclave) and cold (glutaraldehyde) sterilization methods was 25.6±28.7 and 28.1±30.8 percent respectively. The mean surface coating removal of the Ortho Organizers, American Orthodontics, SIA, and Gestenco brands were 24.1±28.4, 36.7±36.0, 23.0±24.4, and 23.6±28.0 percent, respectively. The two-way ANOVA indicated a lack of overall significant differences among wire brands (P=0.189) and between sterilization types (P=0.629). However, the interaction of sterilization and brands was significant (P=0.005).

CONCLUSIONS

Within the limitations of this 1-month clinical trial limited to 4 coated NiTi archwire brands only, the average coating removal of examined brands might not differ much, amounting to about 26% within a month. Glutaraldehyde and autoclave sterilization might not affect the average speed of coating loss in all brands, although each sterilization method might be favourable for certain brands.

[The ABLE study: A randomized controlled trial on the efficacy of fresh red cell units to improve the outcome of transfused critically ill adults]

Red blood cell units are stored up to 42 days post-collection. The standard policy of blood banks is to deliver the oldest units in order to limit blood wastage. Many caregivers believe that giving fresh rather than old units can improve the outcome of their transfused patients. The ABLE study aims to check if the transfusion of red blood cell units stored seven days or less (fresh arm) improve the outcome of transfused critically ill adults compared to patients who received units delivered according to the standard delivery policy (control arm). From March 2009 to May 2014, 1211 patients were allocated to the fresh arm, 1219 to the control arm (length of storage: 6.1 ± 4.9 and 22.0 ± 8.4 days respectively, P<0.001). The primary outcome measure was 90-day all-cause mortality post-randomisation: there were 448 deaths (37.0%) in the fresh arm and 430 (35.3%) in the control arm (absolute risk difference: 1.7%; 95% confidence interval: -2.1% to 5.5%). In a survival analysis, the risk of death was higher in the fresh arm (hazard ratio: 1.1; 95%CI: 0.9 to 1.2), but the difference was not statistically significant (P=0.38). The same trend against the fresh arm was observed with all but one secondary outcome measures. The conclusion is that the transfusion of red blood cell units stored seven days or less does not improve the outcome of critically ill adults compared to the transfusion of units stored about three weeks (22.0 ± 8.4 days).