Immediate versus deferred chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder (EORTC 30994): an intergroup, open-label, randomised phase 3 trial

BACKGROUND Patients with muscle-invasive urothelial carcinoma of the bladder have poor survival after cystectomy. The EORTC 30994 trial aimed to compare immediate versus deferred cisplatin-based combination chemotherapy after radical cystectomy in patients with pT3-pT4 or N+ M0 urothelial carcinoma of the bladder. METHODS This intergroup, open-label, randomised, phase 3 trial recruited patients from hospitals across Europe and Canada. Eligible patients had histologically proven urothelial carcinoma of the bladder, pT3-pT4 disease or node positive (pN1-3) M0 disease after radical cystectomy and bilateral lymphadenectomy, with no evidence of any microscopic residual disease. Within 90 days of cystectomy, patients were centrally randomly assigned (1:1) by minimisation to either immediate adjuvant chemotherapy (four cycles of gemcitabine plus cisplatin, high-dose methotrexate, vinblastine, doxorubicin, and cisplatin [high-dose MVAC], or MVAC) or six cycles of deferred chemotherapy at relapse, with stratification for institution, pT category, and lymph node status according to the number of nodes dissected. Neither patients nor investigators were masked. Overall survival was the primary endpoint; all analyses were by intention to treat. The trial was closed after recruitment of 284 of the planned 660 patients. This trial is registered with ClinicalTrials.gov, number NCT00028756. FINDINGS From April 29, 2002, to Aug 14, 2008, 284 patients were randomly assigned (141 to immediate treatment and 143 to deferred treatment), and followed up until the data cutoff of Aug 21, 2013. After a median follow-up of 7·0 years (IQR 5·2-8·7), 66 (47%) of 141 patients in the immediate treatment group had died compared with 82 (57%) of 143 in the deferred treatment group. No significant improvement in overall survival was noted with immediate treatment when compared with deferred treatment (adjusted HR 0·78, 95% CI 0·56-1·08; p=0·13). Immediate treatment significantly prolonged progression-free survival compared with deferred treatment (HR 0·54, 95% CI 0·4-0·73, p<0·0001), with 5-year progression-free survival of 47·6% (95% CI 38·8-55·9) in the immediate treatment group and 31·8% (24·2-39·6) in the deferred treatment group. Grade 3-4 myelosuppression was reported in 33 (26%) of 128 patients who received treatment in the immediate chemotherapy group versus 24 (35%) of 68 patients who received treatment in the deferred chemotherapy group, neutropenia occurred in 49 (38%) versus 36 (53%) patients, respectively, and thrombocytopenia in 36 (28%) versus 26 (38%). Two patients died due to toxicity, one in each group. INTERPRETATION Our data did not show a significant improvement in overall survival with immediate versus deferred chemotherapy after radical cystectomy and bilateral lymphadenectomy for patients with muscle-invasive urothelial carcinoma. However, the trial is limited in power, and it is possible that some subgroups of patients might still benefit from immediate chemotherapy. An updated individual patient data meta-analysis and biomarker research are needed to further elucidate the potential for survival benefit in subgroups of patients. FUNDING Lilly, Canadian Cancer Society Research.

Victims of War must be loyal to deserve protection: International law and national legislation on enemy aliens 1907-1918

In international law the internment of civilians has only been regulated in writing in the context of the 4th Geneva Convention of 1949. Nevertheless this did not mean that civilians were not protected by at least some rules of customary international law before that date and especially in World War I. Furthermore specialists of international law expected states – at least those considered to be part of the community of civilized nations – to continue to treat all men equal before the law even in wartime. As research already conducted (Bird, Panayi, Fischer) has shown, this was not the case during World War I. Based on these findings the presentation proposed here wants to look into the development of international law and into some national preparations for treating so called “enemy aliens” in the period before 1914 (Austria-Hungary, Australia, United Kingdom), in order to see to what extent principles of international law protecting civilians from the consequences of war can be detected in the pre-war preparations. As far as can be judged so far the issue of loyalty was central in this context. Looking at the war itself, the presentation proposed here will try to look at how far the principles of international law alluded to above continued to influence the policies on “enemy aliens” in the countries mentioned and to see, how the International Committee of the Red Cross tried to use them to legitimize and expand its protective policies in regard to civilians interned in belligerent as well as neutral countries throughout the war.

MMM2- Turismo patrimonial: la Arquitectura del Movimiento Moderno en Misiones.16H374

Luego de una primera etapa de investigación concluida, que durante tres años nos llevó a investigar interdisciplinariamente turismo y arquitectura, el mismo equipo de investigación que llevara adelante el proyecto Patrimonio, turismo y educación: la arquitectura del Movimiento Moderno de Misiones 16H313 2010/12, Facultad de Humanidades y Ciencias Sociales (F.H.y C.S.) Universidad Nacional de Misiones (U.Na.M.), se propone un segundo estamento de investigación. Este equipo interdisciplinario de investigación en producción continua desde 2001 donde a partir del patrimonio jesuítico y el concepto de territorio museo abierto, luego con la inclusión de otras fundamentaciones como el aportado recientemente por ICOMOS de espíritu del lugar. Utilizado desde la antigüedad por el hombre el espíritu del lugar le ha servido para acordar con sus dioses antes del asentamiento de un poblado/castro/chester/burgo/burger/borgo/burg, entre ellos el de locus genius que los campamentos de centuriones romanos utilizaban para denominar al espíritu dueño de ese espacio, que en general tenía alguna caracterización particular y diferente del resto. En este nuevo ciclo nuestro equipo se plantea la cuestion en tres escalas de trabajo: La escala Macro/Territorial: el antiguo Territorio Nacional devenido con la presidencia de Juan Domingo Perón mediante, en provincia de Misiones en diciembre de 1953 en una escala macro; en La escala Media/Urbana: la influencia que algunas obras tuvieron en el devenir de sus poblados y las que no lo hicieron. La escala Micro/Arquitectónica: en la que se estudiará detenidamente la Escuela Normal de Alem, declarada recientemente Monumento Historico Nacional mediante decreto N°1934/12 del Poder Ejecutivo Nacional con la firma de la presidenta Cristina Fernández de Kirchner, y otros. La utilización de la información de este modo producida tendrá como resultado más tangible la formulación en la provincia de un Circuito Turístico de la Modernidad que utilice como antecedente el producido, puesto en marcha y analizado en MMM1, sin perjuicio de una profundización del análisis de dicho modelo en MMM2

Composition and origin of sediments at DSDP Site 54-424

The sediments recovered on Deep Sea Drilling Project Leg 54 appear to be mixtures of the normal pelagic sediments of the area and hydrothermally produced manganese and iron phases. The latter are mineralogically and chemically very similar to phases recovered from surficial sampling of the mounds. The hydrothermal nontronite which is approximately 15 meters thick in the three holes is essentially free of carbonate or detrital contaminants. The basal sediments are similar to the carbonate oozes presently being deposited in the region, but are enriched in Mn and Fe. This enrichment appears to be the result of hydrothermal deposition that took place at or near the spreading center and may not be associated with the mounds formation. Three different hypotheses for the formation of the nontronite layer and the mounds deposits are considered. An initial deposition of a widespread nontronite layer and subsequent diapiric-like movement of the layer into carbonates could account for the observed stratigraphy; however, if this be correct, analogous deposits should be present in other DSDP sites. The second hypothesis - replacement of the normal sediments by nontronite - may be feasible, but the high purity of the nontronite requires dissolution and removal of refractory elements. The third hypothesis, metal deposition in an advancing oxidation gradient, is compatible with submersible observations of the mounds; however, it can account only for the high purity of the nontronite by very rapid deposition of the hydrothermal phases.

Major and rare earth element contents and their speciations in ferruginous nodules and host sediments from the Barents Sea

Contents of Fe, Mn, Al, P, and rare earth elements (REE) in ferruginous nodules and host sediments of the eastern Barents Sea were studied. A direct Fe-P correlation in reactive components of the sediments and nodules was found. The nodules were shown to be formed through Fe(II) oxidation in the surface layer of sediments and cementation of terrigenous fraction of sediments by Fe(III) oxyhydroxides. The latter accumulate phosphorus due to processes of sorption - co-precipitation, by forming Fe(III) hydrophosphates. REE composition in the sediments and nodules normalized to NASC contents is characterized by increased proportion of light REE that may be caused by regional features of their sources. Due to significant share of terrigenous matter in the Fe nodules (up to 65% for Nd), REE composition of bulk samples is similar to that of host sediments. A negative cerium anomaly in composition of reactive REE may result from REE sorption from seawater. REE bulk composition of a ferruginous crust is closer to that of seawater than one of the ferruginous nodules from the sediments because of essentially lower content of diluent terrigenous matter.