Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial

BACKGROUND: Acute promyelocytic leukaemia is a chemotherapy-sensitive subgroup of acute myeloid leukaemia characterised by the presence of the PML-RARA fusion transcript. The present standard of care, chemotherapy and all-trans retinoic acid (ATRA), results in a high proportion of patients being cured. In this study, we compare a chemotherapy-free ATRA and arsenic trioxide treatment regimen with the standard chemotherapy-based regimen (ATRA and idarubicin) in both high-risk and low-risk patients with acute promyelocytic leukaemia.

METHODS: In the randomised, controlled, multicentre, AML17 trial, eligible patients (aged ≥16 years) with acute promyelocytic leukaemia, confirmed by the presence of the PML-RARA transcript and without significant cardiac or pulmonary comorbidities or active malignancy, and who were not pregnant or breastfeeding, were enrolled from 81 UK hospitals and randomised 1:1 to receive treatment with ATRA and arsenic trioxide or ATRA and idarubicin. ATRA was given to participants in both groups in a daily divided oral dose of 45 mg/m(2) until remission, or until day 60, and then in a 2 weeks on-2 weeks off schedule. In the ATRA and idarubicin group, idarubicin was given intravenously at 12 mg/m(2) on days 2, 4, 6, and 8 of course 1, and then at 5 mg/m(2) on days 1-4 of course 2; mitoxantrone at 10 mg/m(2) on days 1-4 of course 3, and idarubicin at 12 mg/m(2) on day 1 of the final (fourth) course. In the ATRA and arsenic trioxide group, arsenic trioxide was given intravenously at 0·3 mg/kg on days 1-5 of each course, and at 0·25 mg/kg twice weekly in weeks 2-8 of course 1 and weeks 2-4 of courses 2-5. High-risk patients (those presenting with a white blood cell count >10 × 10(9) cells per L) could receive an initial dose of the immunoconjugate gemtuzumab ozogamicin (6 mg/m(2) intravenously). Neither maintenance treatment nor CNS prophylaxis was given to patients in either group. All patients were monitored by real-time quantitative PCR. Allocation was by central computer minimisation, stratified by age, performance status, and de-novo versus secondary disease. The primary endpoint was quality of life on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status. All analyses are by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN55675535.

FINDINGS: Between May 8, 2009, and Oct 3, 2013, 235 patients were enrolled and randomly assigned to ATRA and idarubicin (n=119) or ATRA and arsenic trioxide (n=116). Participants had a median age of 47 years (range 16-77; IQR 33-58) and included 57 high-risk patients. Quality of life did not differ significantly between the treatment groups (EORTC QLQ-C30 global functioning effect size 2·17 [95% CI -2·79 to 7·12; p=0·39]). Overall, 57 patients in the ATRA and idarubicin group and 40 patients in the ATRA and arsenic trioxide group reported grade 3-4 toxicities. After course 1 of treatment, grade 3-4 alopecia was reported in 23 (23%) of 98 patients in the ATRA and idarubicin group versus 5 (5%) of 95 in the ATRA and arsenic trioxide group, raised liver alanine transaminase in 11 (10%) of 108 versus 27 (25%) of 109, oral toxicity in 22 (19%) of 115 versus one (1%) of 109. After course 2 of treatment, grade 3-4 alopecia was reported in 25 (28%) of 89 patients in the ATRA and idarubicin group versus 2 (3%) of 77 in the ATRA and arsenic trioxide group; no other toxicities reached the 10% level. Patients in the ATRA and arsenic trioxide group had significantly less requirement for most aspects of supportive care than did those in the ATRA and idarubicin group.

INTERPRETATION: ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen.

A Novel Approach for Axle Detection in Bridge Weigh-In-Motion Systems

Bridge weigh-in-motion (B-WIM), a system that uses strain sensors to calculate the weights of trucks passing on bridges overhead, requires accurate axle location and speed information for effective performance. The success of a B-WIM system is dependent upon the accuracy of the axle detection method. It is widely recognised that any form of axle detector on the road surface is not ideal for B-WIM applications as it can cause disruption to the traffic (Ojio & Yamada 2002; Zhao et al. 2005; Chatterjee et al. 2006). Sensors under the bridge, that is Nothing-on-Road (NOR) B-WIM, can perform axle detection via data acquisition systems which can detect a peak in strain as the axle passes. The method is often successful, although not all bridges are suitable for NOR B-WIM due to limitations of the system. Significant research has been carried out to further develop the method and the NOR algorithms, but beam-and-slab bridges with deep beams still present a challenge. With these bridges, the slabs are used for axle detection, but peaks in the slab strains are sensitive to the transverse position of wheels on the beam. This next generation B-WIM research project extends the current B-WIM algorithm to the problem of axle detection and safety, thus overcoming the existing limitations in current state-of–the-art technology. Finite Element Analysis was used to determine the critical locations for axle detecting sensors and the findings were then tested in the field. In this paper, alternative strategies for axle detection were determined using Finite Element analysis and the findings were then tested in the field. The site selected for testing was in Loughbrickland, Northern Ireland, along the A1 corridor connecting the two cities of Belfast and Dublin. The structure is on a central route through the island of Ireland and has a high traffic volume which made it an optimum location for the study. Another huge benefit of the chosen location was its close proximity to a nearby self-operated weigh station. To determine the accuracy of the proposed B-WIM system and develop a knowledge base of the traffic load on the structure, a pavement WIM system was also installed on the northbound lane on the approach to the structure. The bridge structure selected for this B-WIM research comprised of 27 pre-cast prestressed concrete Y4-beams, and a cast in-situ concrete deck. The structure, a newly constructed integral bridge, spans 19 m and has an angle of skew of 22.7°.

Visual symptoms and retinal straylight after laser peripheral iridotomy: the Zhongshan Angle-Closure Prevention Trial.

OBJECTIVE: To assess the impact of laser peripheral iridotomy (LPI) on forward-scatter of light and subjective visual symptoms and to identify LPI parameters influencing these phenomena. DESIGN: Cohort study derived from a randomized trial, using an external control group. PARTICIPANTS: Chinese subjects initially aged 50 or older and 70 years or younger with bilateral narrow angles undergoing LPI in 1 eye selected at random, and age- and gender-matched controls. METHODS: Eighteen months after laser, LPI-treated subjects underwent digital iris photography and photogrammetry to characterize the size and location of the LPI, Lens Opacity Classification System III cataract grading, and measurement of retinal straylight (C-Quant; OCULUS, Wetzlar, Germany) in the treated and untreated eyes and completed a visual symptoms questionnaire. Controls answered the questionnaire and underwent straylight measurement and (in a random one-sixth sample) cataract grading. MAIN OUTCOME MEASURES: Retinal straylight levels and subjective visual symptoms. RESULTS: Among 230 LPI-treated subjects (121 [58.8%] with LPI totally covered by the lid, 43 [19.8%] with LPI partly covered by the lid, 53 [24.4%] with LPI uncovered by the lid), 217 (94.3%) completed all testing, as did 250 (93.3%) of 268 controls. Age, gender, and prevalence of visual symptoms did not differ between treated subjects and controls, although nuclear (P<0.01) and cortical (P = 0.03) cataract were less common among controls. Neither presenting visual acuity nor straylight score differed between the treated and untreated eyes among all treated persons, nor among those (n = 96) with LPI partially or totally uncovered. Prevalence of subjective glare did not differ significantly between participants with totally covered LPI (6.61%; 95% confidence interval [CI], 3.39%-12.5%), partially covered LPI (11.6%; 95% CI, 5.07%-24.5%), or totally uncovered LPI (9.43%; 95% CI, 4.10%-10.3%). In regression models, only worse cortical cataract grade (P = 0.01) was associated significantly with straylight score, and no predictors were associated with subjective glare. None of the LPI size or location parameters were associated with straylight or subjective symptoms. CONCLUSIONS: These results suggests that LPI is safe regarding measures of straylight and visual symptoms. This randomized design provides strong evidence that treatment programs for narrow angles would be unlikely to result in important medium-term visual disability.

Heritability of refractive error and familial aggregation of myopia in an elderly American population.

PURPOSE: To determine the heritability of refractive error and the familial aggregation of myopia in an older population. METHODS: Seven hundred fifty-nine siblings (mean age, 73.4 years) in 241 families were recruited from the Salisbury Eye Evaluation (SEE) Study in eastern Maryland. Refractive error was determined by noncycloplegic subjective refraction (if presenting distance visual acuity was < or =20/40) or lensometry (if best corrected visual acuity was >20/40 with spectacles). Participants were considered plano (refractive error of zero) if uncorrected visual acuity was >20/40. Preoperative refraction from medical records was used for pseudophakic subjects. Heritability of refractive error was calculated with multivariate linear regression and was estimated as twice the residual between-sibling correlation after adjusting for age, gender, and race. Logistic regression models were used to estimate the odds ratio (OR) of myopia, given a myopic sibling relative to having a nonmyopic sibling. RESULTS: The estimated heritability of refractive error was 61% (95% confidence interval [CI]: 34%-88%) in this population. The age-, race-, and sex-adjusted ORs of myopia were 2.65 (95% CI: 1.67-4.19), 2.25 (95% CI: 1.31-3.87), 3.00 (95% CI: 1.56-5.79), and 2.98 (95% CI: 1.51-5.87) for myopia thresholds of -0.50, -1.00, -1.50, and -2.00 D, respectively. Neither race nor gender was significantly associated with an increased risk of myopia. CONCLUSIONS: Refractive error and myopia are highly heritable in this elderly population.

Assessing the Potential for Saving Energy by Impersonating Idle Networked Devices

The idea of proxying network connectivity has been proposed as an efficient mechanism to maintain network presence on behalf of idle devices, so that they can “sleep”. The concept has been around for many years; alternative architectural solutions have been proposed to implement it, which lead to different considerations about capability, effectiveness and energy efficiency. However, there is neither a clear understanding of the potential for energy saving nor a detailed performance comparison among the different proxy architectures. In this paper, we estimate the potential energy saving achievable by different architectural solutions for proxying network connectivity. Our work considers the trade-off between the saving achievable by putting idle devices to sleep and the additional power consumption to run the proxy. Our analysis encompasses a broad range of alternatives, taking into consideration both implementations already available in the market and prototypes built for research purposes. We remark that the main value of our work is the estimation under realistic conditions, taking into consideration power measurements, usage profiles and proxying capabilities.

Auditory cueing in Parkinson's patients with freezing of gait. What matters most: action-relevance or cue-continuity?

Gait disturbances are a common feature of Parkinson’s disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson’s. Recent work has shown that, compared to walking to a metronome, Parkinson’s patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson’s patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson’s patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor ‘priming’ (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).

Matérias-primas da plataforma do Mondego para cerâmica

O presente trabalho divulga os resultados dos estudos levados a efeito nas matérias-primas argilosas que se integram tipologicamente na argila comum, ocorrentes na designada Plataforma do Mondego, Centro de Portugal, na região entre Miranda do Corvo, a SW, e Tábua, a NE. Para tal realizou-se a cartografia superficial dos sedimentos continentais do Cretácico e do Terciário, aí preservados, estabeleceram-se as colunas sedimentares, a nível regional e a nível local, nas áreas de maior potencial reconhecido e, caracterizaram-se as matérias-primas argilosas amostradas, em termos de composição, textura e aptidão cerâmica, objectivando a definição das zonas das jazidas com maior interesse industrial. A informação obtida e compilada, relativa ao caulino e ao feldspato é também apresentada, com vista a uma percepção da potencialidade destas matériasprimas cerâmicas ocorrentes na área. O estudo de caracterização dos materiais argilosos investigados teve como base 53 amostras obtidas em seis regiões da Plataforma do Mondego aqui definidas por motivo de organização do trabalho, segundo os critérios geográfico e geotectónico. As formações de Côja e de Campelo, do Terciário, constituem as unidades onde ocorrem litótipos produtivos, em termos de matéria-prima para a Cerâmica de Barro Vermelho ou Cerâmica de Construção. Relativamente às características texturais e composicionais, em síntese, apresentam-se os factos relevantes seguintes: A matéria-prima argilosa existente na área estudada materializa, granulometricamente, na maioria das amostras, silte, caindo os níveis amostrados com maior percentagem de argila, no domínio do silte argiloso. O défice em fracção argila implica limitações quanto à possibilidade de diversificação de produtos cerâmicos fabricados com estas matérias-primas tal-qual. Os diferentes métodos analíticos utilizados na caracterização mineralógica dos materiais amostrados confirmaram uma composição em termos dos minerais argilosos, consistindo de ilite/mica (em geral, o mais abundante), caulinite e esmectite, interestratificados e clorite. Os minerais não argilosos são quartzo (predominante), feldspato (sobretudo potássico) e hematite, com uma representação baixa. A mineralogia da fracção inferior a 2μm das amostras, não difere das amostras totais, salvo no teor mais elevado dos minerais argilosos e acentuada redução dos minerais não argilosos. Os resultados da análise química por fluorescência de raios X das amostras integrais correlacionam-se com as características mineralógicas observadas através das técnicas analíticas utilizadas. No respeitante às propriedades e comportamento cerâmico verifica-se: Os parâmetros relacionados com a plasticidade indicam que parte das pastas elaboradas com estes materiais argilosos têm uma trabalhabilidade aceitável, mas existem problemas de conformação e acentuada retracção num número significativo de amostras, devido à elevada plasticidade da maioria das amostras. A extrusão é satisfatória a óptima. A RMF e a retracção em seco assumem valores, respectivamente, moderados a baixos e moderados, embora seja necessário ter em conta o procedimento de extrusão dos provetes, sem dispositivo de vácuo. Todas as amostras foram sujeitas a cozedura a 900ºC, e um conjunto seleccionado foi cozido a 1000ºC e a 1100ºC. As fases mineralógicas ocorrentes após cozeduras a 900ºC e 1100ºC foram identificadas num conjunto de amostras, tendo-se evidenciado a coerência dessas fases, com a mineralogia das amostras em seco. Após cozedura a 900ºC, os valores de RMF das amostras satisfazem geralmente os valores mínimos, exigidos para o fabrico de tijolo, abobadilha e, com alguma frequência, de telha, como já se verificava com os valores daquela propriedade em seco. Os valores de retracção seco-cozido são em geral, modestos. A capacidade de absorção de água é maioritariamente elevada. A formação de vidro, sobretudo, condiciona o comportamento destas propriedades por cozedura dos provetes a 1000ºC e a 1100ºC. A coloração predominante em cru das matérias-primas argilosas amostradas é amarelo acastanhado a castanho avermelhado. Após cozedura a 900ºC, há um acentuado escurecimento e incremento no grau de vermelho. As cozeduras a 1000ºC e 1100ºC promovem escurecimento gradual, com ligeira influência na cor. O comportamento dos provetes após as cozeduras cerâmicas revelou-se homogéneo a cada uma das respectivas temperaturas, não se registando também defeitos significativos, nem eflorescências. A análise das amostras em termos composicionais e tecnológicos permitiu destacar as principais características e aspectos distintivos das matériasprimas, nas diferentes regiões definidas objectivando as diferentes potencialidades cerâmicas. Nesta abordagem comparativa foram consideradas só as amostras dos campos silte e silte arenoso, por serem aquelas com maior interesse para a Cerâmica de Construção. Nas colunas sedimentares das regiões de Tábua e Santa Quitéria constata-se a ocorrência de dois ritmos de sedimentação, que embora assumam características específicas em cada região, têm aspectos composicionais e tecnológicos em comum, traduzindo melhor aptidão cerâmica os ritmos inferiores. A conjugação da cartografia realizada com os estudos laboratoriais permite concluir que as regiões de Tábua e de Santa Quitéria serão as que têm maior potencial por explorar, em matéria-prima para Cerâmica de Construção, apesar da primeira já ser intensamente explorada. Na região de Tábua, as amostras têm como fases mineralógicas principais ilite e quartzo na mesma proporção média (35%) e caulinite (média=19%) que regista enriquecimento significativo na fracção argila (média=38%). As argilas desta região registam a cor em cru mais vermelha e pH mais ácido observados. O ritmo de sedimentação inferior, com esmectite e interestratificados e ligeiramente menos quartzoso, apresenta melhores propriedades cerâmicas. A composição mineralógica média das amostras da região de Santa Quitéria é próxima daquela da região de Tábua, mas menos caulinítica, em especial na sequência inferior, na qual o teor médio de caulinite na fracção argila (7%) é o mais baixo observado. Na região de Côja – Arganil, a actividade extractiva é significativa na bacia de Côja. Aqui, a exploração de novas áreas potenciais é condicionada pela cobertura conglomerática e por estruturas tectónicas e não tectónicas relacionadas com comportamento plástico. Na restante área desta região, os recursos argilosos são penalizados por material areno-conglomerático. As amostras desta região distinguem-se das restantes a nível textural pela maior fracção areia e mineralogicamente pela presença de clorite, teor reduzido de caulinite e elevado de feldspato. As potencialidades em barro vermelho na região de Sanguinheda não serão significativas, pois a Formação de Côja é predominantemente arcósica e a Formação de Campelo pouco espessa e conglomerática. As argilas com melhor aptidão cerâmica foram amostradas na região de Miranda do Corvo – Lousã. Na composição, estas amostras são as que contêm maior fracção de argila, maior teor de ilite e caulinite e menor de argilas expansivas. Registam os melhores valores nas características tecnológicas, nomeadamente a RMF e absorção de água. A consistência dos grupos amostrais e ritmos definidos em termos composicionais e tecnológicos é corroborada pelas técnicas de análise estatística multivariada aplicadas, que os identificam. As condições de amostragem na região de Tábua, permitiram a elaboração de uma coluna tipológica, na qual, a partir de uma caracterização expedita de amostras é possível identificar a sua afinidade com os ritmos argilosos definidos e, consequentemente, a sua situação na coluna sedimentar regional e aptidão cerâmica. A cartografia dos recursos argilosos potenciais, elaborada à escala 1:25.000, constitui um dos objectivos principais deste trabalho e nela constam unidades litológicas, nas quais são diferenciadas unidades argilosas tendo também em consideração a tipologia e guias mineralógicos resultantes da caracterização das amostras. As características composicionais destas unidades denotam diferente aptidão cerâmica e, portanto, permitem salientar as zonas com maior interesse económico.

Repply to: Brito, A.C., Brotas, V., Caetano, M., Coutinho, T.P., Bordalo, A.A., Icely, J., Neto, J.M., Serôdio, J., Moita, T. (2012) "Defining phytoplankton class boundaries in Portuguese transitional waters: an evaluation of the ecological quality status according to the Water Framework Directive" [Ecological Indicators 19, 5-14]

We write to comment on the recently published paper “Defining phytoplankton class boundaries in Portuguese transitional waters: an evaluation of the ecological quality status according to the Water Framework Directive” (Brito et al., 2012). This paper presents an integrated methodology to analyse the ecological quality status of several Portuguese transitional waters, using phytoplanktonrelated metrics. One of the systems analysed, the Guadiana estuary in southern Portugal, is considered the most problematic estuary, with its upstream water bodies classified as Poor in terms of ecological status. We strongly disagree with this conclusion and we would like to raise awareness to some methodological constraints that, in our opinion, are the basis of such deceptive conclusions and should therefore not be neglected when using phytoplankton to assess the ecological status of natural waters.

Arbeitszeit und Sonntagsruhe : Stellungnahmen zur Sonntagsarbeit als Beitrag kirchlicher Sozialkritik im 19. Jahrhundert

Mit der Forderung nach einem arbeitsfreien Sonntag haben die Kirchen im 19. Jahrhundert in die Diskussion um die Wochenarbeitszeit eingegriffen. Auch wenn das Thema der menschlichen Arbeit in der evangelischen Theologie des vergangenen Jahrhunderts nicht in dem Maße bedacht worden ist, wie es die neuzeitliche Veränderung im Verständnis der Arbeit und die Industrialisierung erfordert hätten, so lässt sie die bekannte Formel vom "Versagen der Kirche gegenüber der sozialen Frage" nicht aufrechterhalten. Die vorliegende Untersuchung fragt nach der Begründung der Sonntagsruhe für die Arbeit: Kann Sonntagsruhe im Gegensatz zu Freizeit als ein Begriff bestimmt werden, der in keinem komplementären Verhältnis zur Arbeit steht, nicht im Sinn eines Primats der Ruhe, sondern in dem Sinn, daß der Sonntag Kontrapost ist gegen den Primat der Arbeit in der Gegenwart?

Der Kampf um den freien Sonntag im 19. Jahrhundert

Im Aufsatz geht es um das kirchliche und politische Engagement im Kampf gegen die Sonntagsarbeit im 19. Jahrhundert.

TAG & RELEASE Volume 19, No. 1 March 2014

Tag & Release is the newsletter for the South Carolina Governor's Cup Billfishing Series, an official program of the South Carolina Department of Natural Resources in cooperation with the South Carolina Department of Parks, Recreation and Tourism and the Harry R.E. Hampton Memorial Wildlife Fund.