A multicenter, multinational analysis of mitomycin C in refractory metastatic colorectal cancer

Background: A considerable number of metastatic colorectal cancer (mCRC) patients who progress on standard treatment with 5-fluorouracil (5FU), oxaliplatin, irinotecan and monoclonal antibodies, still have adequate performance status and desire further treatment. Mitomycin C (MMC) has been widely used in this context, and despite good tolerability, there are doubts regarding its true benefit. Methods: In order to assess the activity of MMC in the refractory mCRC setting, we retrospectively evaluated 109 heavily pre-treated patients who received MMC as single agent or in combination for mCRC at three different institutions in two countries. Results: Median patient's age was 54 years old, 57% were male and 94% had performance status ECOG 0 or 1. MMC was used in second line in 11%, third line in 38% and fourth line or beyond in 51% of patients. 58% received MMC combinations, mainly with capecitabine. Grade 3 or 4 toxicity was observed in 5% of patients and 6% required dose reductions. Median time to treatment failure (TTF) was 1.7 months with MMC and 3.6 months on the regimen prior to MMC, with a ratio between these TTF below 1 in 82% of patients. Median survival was only 4.5 months (95% confidence interval (CI) of 3.48-5.56). Conclusions: This retrospective data represent the largest reported series of unselected refractory mCRC patients treated with MMC. The median survival of 4.5 months is similar to the survival expected for best supportive care. This lack of activity strongly suggests that MMC should not be routinely used in refractory mCRC. (C) 2012 Elsevier Ltd. All rights reserved.

Petrology and Sr-Nd characteristics of the Nova Lacerda dike swarm, SW Amazonian Craton: new insights regarding its subcontinental mantle source and Mesoproterozoic geodynamics

The NNW-trending Nova Lacerda tholeiitic dike swarm in Mato Grosso State, Central Brazil, intrudes the Nova Lacerda granite (1.46 Ga) and the Jauru granite-greenstone terrain (ca. 1.79-1.77 Ga). The swarm comprises diabases I and II and amphibolites emplaced at ca. 1.38 Ga. Geochemical data indicate that these are evolved tholeiites characterized by high LILE/HSFE and LREE/HSFE ratios. Isotopic modelling yields positive epsilon(Nd)(T) values (+0.86 to +2.65), whereas values for epsilon(Sr)(T) range from positive to negative (+1.96 to -5.56). Crustal contamination did not play a significant petrogenetic role, as indicated by a comparison of isotopic data (Sr-Nd) from both dikes and country rocks, and by the relationship between isotopic and geochemical parameters (SiO2, K2O, Rb/Sr, and La/Yb) of the dikes. We attribute the origin of these tholeiites to fractional crystallization of evolved melts derived from a heterogeneous mantle source. Comparison of the geochemical and isotopic data of the studied swarm and other tholeiitic Mesoproterozoic mafic intrusions of the SWAmazonian Craton the Serra da Providencia, Colorado, and Nova Brasilandia bimodal suites - indicates that parental melts of the Nova Lacerda swarm were derived from the most enriched mantle source. This enrichment was probably caused by the stronger influence of the EMI component on the DMM end-member. These data, coupled with trace element bulk-rock geochemistry of the country rocks, and comparisons with the Colorado Complex of similar age, suggest a continental-margin arc setting for the emplacement of the Nova Lacerda dikes.

Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome

Objective: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization. Methods: We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in Sao Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1. Results: Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6). Conclusions: BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population. (C) 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Mixed-valence state of symmetric diruthenium complexes: synthesis, characterization, and electron transfer investigation

Complexes of the type {[(pyS)Ru(NH3)(4)](2)-mu-L}(n), where pyS = 4-mercaptopyridine, L = 4,4'-dithiodipyridine (pySSpy), pyrazine (pz) and 1,4-dicyanobenzene (DCB), and n = +4 and +5 for fully reduced and mixed-valence complexes, respectively, were synthesized and characterized. Electrochemical data showed that there is electron communication between the metal centers with comproportionation constants of 33.2, 1.30 x 10(8) and 5.56 x 10(5) for L = pySSpy, pz and DCB, respectively. It was also observed that the electronic coupling between the metal centers is affected by the p-back-bonding interaction toward the pyS ligand. Raman spectroscopy showed a dependence of the intensity of the vibrational modes on the exciting radiations giving support to the assignments of the electronic transitions. The degree of electron communication between the metal centers through the bridging ligands suggests that these systems can be molecular wire materials.

Posttreatment and physiologic occlusal changes comparison

Objective: To compare posttreatment and postretention occlusal changes with the physiologic occlusal changes caused by natural development of untreated subjects. Materials and Methods: The sample was divided into three groups. Group 1 comprised 97 subjects treated with four premolar extractions at a mean pretreatment (T0) age of 13.03 years, a mean posttreatment (T1, first observation) age of 15.12 years, and a mean postretention (T2, second observation) age of 20.52 years. The mean observation period (T2-T1) was 5.39 years. Group 2 comprised 58 subjects treated nonextraction at a mean pretreatment age of 12.83 years, a mean posttreatment age of 14.99 years, a mean postretention age of 20.22 years, and a mean observation period of 5.22 years. Group 3 comprised 114 untreated subjects at a mean age at T1 of 14.91 years and at T2 of 20.48 years. The mean observation period was 5.56 years. Dental casts were evaluated using the Peer Assessment Rating (PAR) index and the Little irregularity index in maxillary and mandibular arches. Changes in PAR and Little indexes were compared among the three groups by analysis of variance and Tukey tests. Results: Intergroup comparison showed that at T1 and T2 the treated groups presented smaller PAR and Little indexes than the untreated group. In the observation period, the treated groups showed greater increase in PAR and Little maxillary indexes than the untreated group. The extraction group showed a greater increase of the Little mandibular index than the untreated group. Conclusions: The treated groups showed more changes according to PAR and Little maxillary indexes than the untreated group. The posttreatment change of the mandibular anterior crowding of the treated extraction group was greater than the mandibular crowding caused by physiologic changes in the untreated group