Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial

BACKGROUND Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone. METHODS Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544). FINDINGS 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. INTERPRETATION Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy. FUNDING Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.

Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.

William Harvey revisited

William Harvey's discovery of the circulation of the blood is often described as a product of the Scientific Revolution of the Seventeenth Century. Modern research has, however, shown thatHarvey followed the Aristotelian research tradition and thus tried to reveal the purpose of the organs through examination of various animals. His publication of 1628 has to be read as an argument of natural philosophy, or, more precisely, as a series of linked observations, experiments and philosophical reasonings from which the existence of circulation has to be deduced as a logical consequence. Harvey did not consider experiments as superior to philosophical reasoning nor intended he to create a new system of medicine. He believed in the vitality of the heart and the blood and rejected Francis Bacon's empirism and the mechanistic rationalism of Descartes. Harvey's contribution and originality lied less in his single observations and experiments but in the manner how he linked them with critical reasoning and how he accepted, presented and defended the ensuing radical findings.

Origin and history of ureilitic material in the solar system: The view from asteroid 2008 TC3 and the Almahata Sitta meteorite

Asteroid 2008 TC3 (approximately 4m diameter) was tracked and studied in space for approximately 19h before it impacted Earth's atmosphere, shattering at 44-36km altitude. The recovered samples (>680 individual rocks) comprise the meteorite Almahata Sitta (AhS). Approximately 50-70% of these are ureilites (ultramafic achondrites). The rest are chondrites, mainly enstatite, ordinary, and Rumuruti types. The goal of this work is to understand how fragments of so many different types of parent bodies became mixed in the same asteroid. Almahata Sitta has been classified as a polymict ureilite with an anomalously high component of foreign clasts. However, we calculate that the mass of fallen material was 0.1% of the pre-atmospheric mass of the asteroid. Based on published data for the reflectance spectrum of the asteroid and laboratory spectra of the samples, we infer that the lost material was mostly ureilitic. Therefore, 2008 TC3 probably contained only a few percent nonureilitic materials, similar to other polymict ureilites except less well consolidated. From available data for the AhS meteorite fragments, we conclude that 2008 TC3 samples essentially the same range of types of ureilitic and nonureilitic materials as other polymict ureilites. We therefore suggest that the immediate parent of 2008 TC3 was the immediate parent of all ureilitic material sampled on Earth. We trace critical stages in the evolution of that material through solar system history. Based on various types of new modeling and re-evaluation of published data, we propose the following scenario. (1) The ureilite parent body (UPB) accreted 0.5-0.6Ma after formation of calcium-aluminum-rich inclusions (CAI), beyond the ice line (outer asteroid belt). Differentiation began approximately 1Ma after CAI. (2) The UPB was catastrophically disrupted by a major impact approximately 5Ma after CAI, with selective subsets of the fragments reassembling into daughter bodies. (3) Either the UPB (before breakup), or one of its daughters (after breakup), migrated to the inner belt due to scattering by massive embryos. (4) One daughter (after forming in or migrating to the inner belt) became the parent of 2008 TC3. It developed a regolith, mostly 3.8Ga ago. Clasts of enstatite, ordinary, and Rumuruti-type chondrites were implanted by low-velocity collisions. (5) Recently, the daughter was disrupted. Fragments were injected or drifted into Earth-crossing orbits. 2008 TC3 comes from outer layers of regolith, other polymict ureilites from deeper regolith, and main group ureilites from the interior of this body. In contrast to other models that have been proposed, this model invokes a stochastic history to explain the unique diversity of foreign materials in 2008 TC3 and other polymict ureilites.

MS 073 Guide to the William C. Moloney MD papers; 1952-1954

William C. Moloney MD kept a personal journal, with photographs, for much of his two years in Japan with the Atomic Bomb Casualty Commission. In January of 1986, Dr.Moloney donated his journal, correspondence and diary pages to the Harris County Medical Archive. He died in 1998 at the age of 91. His first contribution was a set of ten reprints representing his work with the ABCC from 1952 to 1954. Dr.Moloney's journal is a fine document, one which will be of great use to historians. It is an important record of personal impressions, thoughts and details of events. The journal gives new insights into the work of the ABCC and into the people who participated in that work. Dr. Moloney wrote in his journal from April 1952 to February 1954. The Korean War was on and there was a great deal of military activity in southern Japan. The collection is open for research. The collection consists of a handwritten journal, loose calendar or notebook pages and some reprints. The journal is in generally fair condition. The paper is slightly acidic and the binding is loose. There are numerous photos glued onto the pages. The collection encompasses the years 1952-1954 and is 0.25 cubic feet (1 box).

William Osler: Original Papers 1881-1897

Part 1: 1881-1888 On Some Points in the Etiology and Pathology of Ulcerative Endocarditis, 1881 On Certain Parasites in the Blood of the Frog, 1883 The Third Corpuscle of the Blood, 1883 On the Use of Arsenic in Certain Forms of Anaemia, 1886 Antifebrin, 1887 Case of Arterio-Venous Aneurism of the Axillary Artery and Vein of Fourteen Year's Duration, 1887 Typhilitis and Appendicitis, 1888 Part 2: 1889-1892 Annual Address - License to Practice 1889 Case of Syphiloma of the Cord of the Cauda Equina-Death From Diffuse Central Myelitis, 1889 On a Case of Simple Idiopathic Muscular Atrophy, Involving the Face and the Scapulo-Humeral Muscles, 1889 Note on Intra-Thoracic Growths Developing from the Thyroid Gland, 1889 On the Value of Laveran's Organisms in the Diagnosis of Malaria, 1889 On the Form of Convulsive Tic Associated with Corprolalia, Etc., 1890 A Case of Sensory Aphasia Word-blindness with Hemianopsia, 1891 Rudolf Virchow: The Man and the Student, 1891 The Healing of Tuberculosis, 1892 The Cold-Bath Treatment of Typhoid Fever, 1892 Part 3: 1893 Remarks on the Varieties of Chronic Chorea, and a Report Upon Two Families of the Hereditary Form, With One Autopsy, 1893 Note on Arsenical Neuritis Following the use of Fowler's Solution, 1893 Note on a Remarkable House Epidemic of Typhoid Fever, 1893 Cases of Sub-Phrenic Abscess, 1893 On Sporadic Cretinism in America, 1893 Notes on Tuberculosis in Children, 1893 Part 4: 1849-1895 Parotitis in Pneumonia, Case of Pericarditis Treated by Incision and Drainage, 1894 The Army Surgeon, 1894 Introductory Remarks to Course of Clinical Demonstrations on Typhoid Fever, 1894 Cancer of the Stomach with Very Rapid Course, 1895 Case of Sporadic Cretinism (Infantile Myxcedema) Treated Successfully with Thyroid Extract, 1895 Visible Contractile Tumour of the Pylorus Following Ulcer of the Stomach, 1895 On the Association of Enormous Heart Hypertrophy, Chronic Proliferative Peritonitis, and Recurring Ascites, with Adherent Pericardium, 1895 Teaching and Thinking the Two Functions of a Medical School, 1895 The Practical Value of Laveran's Discoveries, 1895 Part 5 1896 Addison's Disease, 1896 On Six Cases of Addison's Disease, 1896 Hemiplegia in Typhoid Fever Thomas Dover (of Dover's Powder) Physician and Buccaneer, 1896 John Keats The Apothecary Poet, 1896 On The Classification of the Tics or Habit Movements, 1896 The Cerebral Complication of Raynaud's Disease, 1896 Part 6: 1897 On Certain Features in the Prognosis of Pneumonia, 1897 Clinical Lecture on Mitral Stenosis - Sudden Death - Ball Thrombus in the Left Auricle, 1897 The Diagnosis of Malarial Fever, 1897 The Functions of a State Faculty (President's Address), 1897 A Clinical Lecture on The Ball-Valve Gall-Stone in the Common Duct, 1897 Pneumonia (Review of Cases studied), 1897 Internal Medicine as a Vocation, 1897 Back Notes

Immunologic characteristics of immunogenic variants generated by {\it in vitro\/} treatment of a methylcholanthrene-induced murine fibrosarcoma MCA-F with 1 methyl-3-nitro-1-nitrosoguanidine, 5 -aza-2$\sp\prime$-deoxycytidine, or ultraviolet radiation

This study addresses the questions of whether the frequency of generation and in vivo cross-reactivity of highly immunogenic tumor clones induced in a single parental murine fibrosarcoma cell line MCA-F is more closely related to the agent used to induce the Imm$\sp{+}$ clone or whether these characteristics are independent of the agents used. These questions were addressed by treating the parental tumor cell line MCA-F with UV-B radiation (UV-B), 1-methyl-3-nitro-1-nitrosoguanidine (MNNG), or 5-aza-2$\sp\prime$-deoxycytidine (5-azaCdR). The frequency of Imm$\sp{+}$ variant generation was similarly high for the three different agents, suggesting that the frequency of Imm$\sp{+}$ generation was related more closely to the cell line than to the inducing agent used. Cross-reactivity was tested with two Imm$\sp{+}$ clones from each treatment group in a modified immunoprotection assay that selectively engendered antivariant, but not antiparental immunity. Under these conditions each clone, except one, immunized against itself. The MNNG-induced clones engendered stronger antivariant immunity but a weaker variant cross-reactive immunity could also be detected.^ This study also characterized the lymphocyte populations responsible for antivariant and antiparental immunity in vivo. Using the local adoptive transfer assay (LATA) and antibody plus complement depletion of T-cell subsets, we showed that immunity induced by the Imm$\sp{+}$ variants against the parent MCA-F was transferred by the Thy1.2$\sp{+}$, L3T4a$\sp{+}$, Lyt2.1$\sp{-}$ (CD4$\sp{+}$) population, without an apparent contribution by Thy1.2$\sp{+}$, L3T4a$\sp{-}$, Lyt2.1$\sp{+}$ (CD8$\sp{+}$) cells. A role for Lyt2.1$\sp{+}$T lymphocytes in antivariant, but not antiparent immunity was supported by the results of LATA and CTL assays. Immunization with low numbers of viable Imm$\sp{+}$ cells, or with high numbers of non viable Imm$\sp{+}$ cells engendered only antivariant immunity without parental cross-protection. The associative recognition of parental antigens and variant neoantigens resulting in strong antiparent immunity was investigated using somatic cells hybrids of Imm$\sp{+}$ variants of MCA-F and an antigenically distinct tumor MCA-D. An unexpected result of these latter experiments was the expression of a unique tumor-specific antigen by the hybrid cells. These studies demonstrate that the parental tumor-specific antigen and the variant neoantigen must be coexpressed on the cell surface to engender parental cross-protective immunity. (Abstract shortened with permission of author.) ^

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Wetland maps including open water extent dynamics based on ENVISAT ASAR WS for Siberia, 2007 and 2008, links to GeoTIFFs

Wetlands store large amounts of carbon, and depending on their status and type, they release specific amounts of methane gas to the atmosphere. The connection between wetland type and methane emission has been investigated in various studies and utilized in climate change monitoring and modelling. For improved estimation of methane emissions, land surface models require information such as the wetland fraction and its dynamics over large areas. Existing datasets of wetland dynamics present the total amount of wetland (fraction) for each model grid cell, but do not discriminate the different wetland types like permanent lakes, periodically inundated areas or peatlands. Wetland types differently influence methane fluxes and thus their contribution to the total wetland fraction should be quantified. Especially wetlands of permafrost regions are expected to have a strong impact on future climate due to soil thawing. In this study ENIVSAT ASAR Wide Swath data was tested for operational monitoring of the distribution of areas with a long-term SW near 1 (hSW) in northern Russia (SW = degree of saturation with water, 1 = saturated), which is a specific characteristic of peatlands. For the whole northern Russia, areas with hSW were delineated and discriminated from dynamic and open water bodies for the years 2007 and 2008. The area identified with this method amounts to approximately 300,000 km**2 in northern Siberia in 2007. It overlaps with zones of high carbon storage. Comparison with a range of related datasets (static and dynamic) showed that hSW represents not only peatlands but also temporary wetlands associated with post-forest fire conditions in permafrost regions. Annual long-term monitoring of change in boreal and tundra environments is possible with the presented approach. Sentinel-1, the successor of ENVISAT ASAR, will provide data that may allow continuous monitoring of these wetland dynamics in the future complementing global observations of wetland fraction.

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Edouard Glissant e o legado de William Faulkner

Este trabajo se propone analizar el intertexto que une al escritor Edouard Glissant con William Faulkner a través de dos obras: el ensayo Faulkner, Mississipi (1996) y la novela Sartorius (1999). En el primer texto, el autor enfatiza cuestiones presentes en su propia obra novelesca: la genealogía, la relación con el espacio de la plantación, el mestizaje, la (i)legitimidad de derechos con respecto a la posesión de la tierra, la opacidad. En el segundo, traza una línea genealógica de un personaje perteneciente a una etnia africana imaginaria, haciéndolo llegar hasta las plantaciones del sur de los Estados Unidos; paralelamente, presenta la línea genealógica de los Sartoris. En esta dirección, busco mostrar cómo el proyecto literario de Glissant dialoga con la obra de Faulkner, indagando e inventariando las mismas problemáticas con respecto al transplante de poblaciones y su inserción en el espacio de las plantaciones, tanto en el sur de los Estados Unidos como en las islas del Caribe. En las obras de ambos escritores puede percibirse el mismo vértigo trágico que persigue a los personajes, conduciéndolos a la locura, el sufrimiento y la muerte

Datum events and their estimated magnetochronology at DSDP Site 72-516

Calcareous plankton biostratigraphy (foraminifers and nannoplankton) and magnetostratigraphy of the upper Oligocene to Pleistocene have been studied in hydraulic piston Cores 516-1 to 516-44, 516A-5 to 516A-11, and 516F-1 to 516F-11, Rio Grande Rise (water depth 1313 m). Some 80 biostratigraphic datum events have been correlated to the magnetic polarity stratigraphy over an interval representing the Matuyama to Chron 5, and Chrons 16 to 23. Coring disturbance and biostratigraphic evidence of a condensed section preclude unambiguous identification of polarity or biostratigraphic events over an approximately 30-m interval in the middle and upper Miocene. Sedimentation rates varied considerably during the Neogene, but an abnormally thick upper Oligocene and lower Miocene section allows a high degree of magnetobiochronologic resolution. A new planktonic foraminiferal zonation for the Miocene completes the midlatitude Neogene zonation of the South Atlantic. Important magnetobiostratigraphic correlations at Site 516 and their estimated magnetochronology include: (1) Oligocene/ Miocene boundary = first appearance datum (FAD) Globorotalia kugleri = last appearance datum (LAD) Reticulofenestra bisecta = mid-Anomaly 6C (Chron 23) = 23.7 Ma; (2) Aquitanian/Burdigalian boundary = LAD G. kugleri = between base Anomaly 6A and top of unnumbered anomaly between 6A and 6B (Chron 21) = 21.8 Ma; (3) Zone N6/N7 boundary = LAD Catapsydrax dissimilis (= FAD G. pseudomiozea and G. zealandica) = Chron 16/17 boundary = 17.6 Ma; (4) early/middle Miocene (= Burdigalian/Langhian) boundary = FAD Praeorbulina sicana = midpart of Anomaly 5C (Chron 16) = 16.6 Ma or FAD P. glomerosa = just above Anomaly 5C (inferred) = 16.3 Ma; (5) Zone N8/N9 boundary = FAD Orbulina suturalis above Anomaly 5C (later part Chron 16, inferred); (6) Miocene/ Pliocene boundary = LAD Globoquadrina dehiscens LAD Globorotalia lenguaensis = basal Gilbert Chron = 5.3 Ma.