Thérapie prolongée au mesylate d'imatinib avant la chirurgie pour les tumeurs stromales gastrointestinales avancées : résultats d'une étude prospective de phase II

Les tumeurs stromales gastrointestinales (GIST) sont les néoplasies mésenchymateuses les plus complexes du système gastrointestinal. Le traitement curatif standard de cette pathologie est la chirurgie avec l'obtention de marges microscopiques négatives. Les résultats impressionnants obtenus sur la prolongation de la survie avec l'administration d'imatinib (IM) chez les patients atteints de maladie métastatique et non-réséquable ont suggéré aux cliniciens que ce même médicament pourrait aussi collaborer à l'obtention de marges négatives plus aisément lors de cancer avancé. Jusqu'à présent, aucune étude prospective n'a caractérisée l'effet d'une thérapie néoadjuvante prolongée à l'IM sur la qualité de la résection chirurgicale subséquente. L'objectif de ce projet de maîtrise était d'évaluer l'efficacité de l'imatinib utilisé avant la chirurgie (néoadjuvant) jusqu'à l'obtention d'une réponse maximale, en vue d'augmenter le taux de résection microscopique complète (R0) dans le traitement chirurgical des GIST à haut risque de résection microscopique incomplète (R1) ou impossible (R2). Pour ce faire, une étude prospective multicentrique de phase II a été réalisée. Le traitement néoadjuvant à l'IM a été instauré chez des patients porteurs d'une GIST localement avancée ou métastatique. Au total, quatorze patients ont reçu une dose de 400-600 mg/d d'IM pour une durée de 6-12 mois avant la chirurgie. Quatorze patients ont été inclus dans l'étude. Onze ont eu une chirurgie à visée curative, un patient a démontré une maladie non-réséquable suite à une laparotomie exploratrice et deux patients ont refusé la chirurgie. Après un suivi moyen de 48 mois, tous les patients opérés étaient vivants et sept sans évidence de récidive. L'utilisation prolongée (12 mois) d'IM dans un contexte néoadjuvant est faisable, sécuritaire, efficace et comporte peu de toxicité. De plus, cette approche est associée à des hauts taux de résection complète (R0), tout en permettant une chirurgie moins extensive. Des études de phase III actuellement en cours sont nécessaires afin de confirmer nos résultats.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Resultados de la cirugía laparoscópica comparada con la cirugía abierta en el cáncer colorrectal. Revisión sistemática

Determinar el efecto de la cirugía laparoscópica versus cirugía abierta sobre la supervivencia en el manejo de pacientes del cáncer colorectal.

Choice of designs and doses for early phase trials

This paper reviews state-of-art statistical designs for dose-escalation procedures in first-into-man studies. The main focus will be on studies in oncology, as most statistical procedures for phase I trials have been proposed in this context. Extensions to situations such as the observation of bivariate outcomes and healthy volunteer studies are also discussed. The number of dose levels and cohort sizes used in early phase trials are considered. Finally, this paper raises some practical issues for dose-escalation procedures.

Analysis and compensation of I/Q imbalance in MIMO transmit-receive diversity systems

In wireless communication systems, all in-phase and quadrature-phase (I/Q) signal processing receivers face the problem of I/Q imbalance. In this paper, we investigate the effect of I/Q imbalance on the performance of multiple-input multiple-output (MIMO) maximal ratio combining (MRC) systems that perform the combining at the radio frequency (RF) level, thereby requiring only one RF chain. In order to perform the MIMO MRC, we propose a channel estimation algorithm that accounts for the I/Q imbalance. Moreover, a compensation algorithm for the I/Q imbalance in MIMO MRC systems is proposed, which first employs the least-squares (LS) rule to estimate the coefficients of the channel gain matrix, beamforming and combining weight vectors, and parameters of I/Q imbalance jointly, and then makes use of the received signal together with its conjugation to detect the transmitted signal. The performance of the MIMO MRC system under study is evaluated in terms of average symbol error probability (SEP), outage probability and ergodic capacity, which are derived considering transmission over Rayleigh fading channels. Numerical results are provided and show that the proposed compensation algorithm can efficiently mitigate the effect of I/Q imbalance.

Impact of I/Q imbalance on the performance of two-way CSI-assisted AF relaying

In this paper, we investigate half-duplex two-way dual-hop channel state information (CSI)-assisted amplify-and-forward (AF) relaying in the presence of in-phase and quadrature-phase (I/Q) imbalance. A compensation approach for the I/Q imbalance is proposed, which employs the received signals together with their conjugations to detect the desired signal. We also derive the average symbol error probability of the considered half-duplex two-way dual-hop CSI-assisted AF relaying networks with and without compensation for I/Q imbalance in Rayleigh fading channels. Numerical results are provided and show that the proposed compensation method mitigates the impact of I/Q imbalance to a certain extent.

Analysis and compensation of I/Q imbalance in amplify-and-forward cooperative systems

In this paper, dual-hop amplify-and-forward (AF) cooperative systems in the presence of in-phase and quadrature-phase (I/Q) imbalance, which refers to the mismatch between components in I and Q branches, are investigated. First, we analyze the performance of the considered AF cooperative protocol without compensation for I/Q imbalance as the benchmark. Furthermore, a compensation algorithm for I/Q imbalance is proposed, which makes use of the received signals at the destination, from the source and relay nodes, together with their conjugations to detect the transmitted signal. The performance of the AF cooperative system under study is evaluated in terms of average symbol error probability (SEP), which is derived considering transmission over Rayleigh fading channels. Numerical results are provided and show that the proposed compensation algorithm can efficiently mitigate the effect of I/Q imbalance.

Analysis and compensation for the joint effects of HPA nonlinearity, I/Q imbalance and crosstalk in MIMO beamforming systems

In this paper, we investigate the joint effects of high-power amplifier (HPA) nonlinearity, in-phase/quadrature-phase (I/Q) imbalance and crosstalk, on the performance of multiple-input multiple-output (MIMO) transmit beamforming (TB) systems, and propose a compensation method for the three impairments together. The performance of the MIMO TB system equipped with the proposed compensation scheme is evaluated in terms of average symbol error probability and capacity when transmissions are performed over uncorrelated Rayleigh fading channels. Numerical results are provided and show the effects on performance of several system parameters, namely, the HPA parameters, image-leakage ratio, crosstalk, numbers of antennas, length of pilot symbols and phase-shift keying modulation order.

Compensation for HPA nonlinearity and I/Q imbalance in MIMO beamforming systems

In this paper, we investigate the effects of high-power amplifier (HPA) nonlinearity and in-phase and quadrature-phase (I/Q) imbalance on the performance of multiple-input multiple-output (MIMO) transmit beamforming (TB) systems. Specifically, we propose a compensation method for HPA nonlinearity and I/Q imbalance together in MIMO TB systems. The performance of the MIMO TB system under study is evaluated in terms of the average symbol error probability (SEP) and system capacity, considering transmission over uncorrelated frequency-flat Rayleigh fading channels. Numerical results are provided and show the effects of several system parameters, such as the HPA parameters, image-leakage ratio, numbers of transmit and receive antennas, length of pilot symbols, and modulation order of phase-shift keying (PSK), on performance.

Radiative forcing of the direct aerosol effect from AeroCom Phase II simulations

We report on the AeroCom Phase II direct aerosol effect (DAE) experiment where 16 detailed global aerosol models have been used to simulate the changes in the aerosol distribution over the industrial era. All 16 models have estimated the radiative forcing (RF) of the anthropogenic DAE, and have taken into account anthropogenic sulphate, black carbon (BC) and organic aerosols (OA) from fossil fuel, biofuel, and biomass burning emissions. In addition several models have simulated the DAE of anthropogenic nitrate and anthropogenic influenced secondary organic aerosols (SOA). The model simulated all-sky RF of the DAE from total anthropogenic aerosols has a range from −0.58 to −0.02Wm−2, with a mean of −0.27Wm−2 for the 16 models. Several models did not include nitrate or SOA and modifying the estimate by accounting for this with information from the other AeroCom models reduces the range and slightly strengthens the mean. Modifying the model estimates for missing aerosol components and for the time period 1750 to 2010 results in a mean RF for the DAE of −0.35Wm−2. Compared to AeroCom Phase I (Schulz et al., 2006) we find very similar spreads in both total DAE and aerosol component RF. However, the RF of the total DAE is stronger negative and RF from BC from fossil fuel and biofuel emissions are stronger positive in the present study than in the previous AeroCom study.We find a tendency for models having a strong (positive) BC RF to also have strong (negative) sulphate or OA RF. This relationship leads to smaller uncertainty in the total RF of the DAE compared to the RF of the sum of the individual aerosol components. The spread in results for the individual aerosol components is substantial, and can be divided into diversities in burden, mass extinction coefficient (MEC), and normalized RF with respect to AOD. We find that these three factors give similar contributions to the spread in results.

Multi-hop amplify-and-forward relaying cooperation in the presence of I/Q imbalance

In this paper, multi-hop cooperative networks implementing channel state information (CSI)-assisted amplify-and-forward (AF) relaying in the presence of in-phase and quadrature-phase (I/Q) imbalance are investigated. We propose a compensation algorithm for the I/Q imbalance. The performance of the multi-hop CSI-assisted AF cooperative networks with and without compensation for I/Q imbalance in Nakagami-m fading environment is evaluated in terms of average symbol error probability. Numerical results are provided and show that the proposed compensation method can effectively mitigate the impact of I/Q imbalance.

Dual-hop amplify-and-forward cooperative relaying in the presence of Tx and Rx in-phase and quadrature-phase imbalance

In this study, dual-hop channel state information-assisted amplify-and-forward (AF) cooperative systems in the presence of in-phase and quadrature-phase (I/Q) imbalance, which refers to the mismatch between components in the I and Q branches, are investigated. First, the authors analyse the performance of the considered AF cooperative protocol without compensation for the I/Q imbalance as the benchmark. Then, a compensation algorithm for the I/Q imbalance is proposed, which makes use of the received signals at the destination, from the source and the relay nodes, together with their conjugations to detect the transmitted signal. Moreover, the authors study the considered AF cooperative system implemented with the opportunistic relay selection and the proposed compensation mechanism for the I/Q imbalance. The performance of the AF cooperative system under study is evaluated in terms of average symbol error probability, which is derived by considering transmission in a Rayleigh fading environment. Numerical results are provided and show that the proposed compensation algorithm can efficiently mitigate the effect of the I/Q imbalance. On the other hand, it is observed that the AF cooperative system with opportunistic relay selection acquires a performance gain beyond that without relay selection.

Estudo de fase I e farmacocinética com etoposide oral em crianças e adolescentes com tumores sólidos refratários

Introdução. Embora muitas crianças com câncer possam ser curadas, um número significativo têm resposta insatisfatória por ineficácia da terapêutica tornando necessário identificar agentes anticâncer mais efetivos contra tumores refratários ou recaídos. Estudos com Etoposide revelaram uma clara relação entre o tempo de exposição e os seus efeitos citotóxicos, mostrando resultados superiores com o uso de doses fracionadas quando comparado ao uso de uma dose única. Estudos de farmacocinética sugerem que as concentrações plasmáticas ativas de Etoposide se situa entre 1 e 5 μg/ml e que níveis acima de 5 μg/ml determinam uma mielotoxicidade importante. O Etoposide apresenta um bom espectro antitumoral mesmo em pacientes que já foram tratados por via parenteral e uma adequada biodisponibilidade pela via oral, podendo ser administrado com segurança em regime ambulatorial. Portanto, torna-se atraente a busca de esquemas de administração deste agente, os quais produzem níveis de concentração plasmática seguras pelo maior tempo possível. Objetivos. Os objetivos deste estudo de fase I é avaliar o perfil de toxicidade, a toxicidade dose-limitante, a dose máxima tolerada, a farmacocinética plasmática e a dose segura do Etoposide oral recomendada para estudos de fase II em pacientes pediátricos portadores de tumor sólido refratário. Materiais e Métodos. Todos os pacientes eram portadores de tumor sólido não responsivo aos tratamentos estabelecidos. A dose inicial do Etoposide foi de 20mg/m2/dose, a cada 8 horas durante 14 dias seguido de um intervalo de 7 dias antes de iniciar o próximo ciclo. A farmacocinética plasmática do Etoposide foi estudada durante o primeiro dia de tratamento e os níveis de Etoposide determinados pelo método de HPLC. Resultados. Dezessete pacientes foram incluídos no estudo, sendo que em 13 foram realizados o estudo de farmacocinética. O número total de cursos de quimioterapia foi de 64. Nove pacientes foram incluídos no Nível de dose I, sendo que leucopenia grau 2-3 foi observada em 5. A dose foi então escalonada para 25 mg/m2 (Nível de dose II) e fornecida a 8 pacientes subsequentes o que determinou leucopenia grau 3-4 em 4 deles. Este Nível de dose foi então considerado como DMT (Dose Máxima Tolerada). A TDL foi neutropenia. As concentrações plasmáticas máximas de Etoposide nos pacientes incluídos no Nível de dose I e II foram de 2,97 e 8,59 μg/ml, respectivamente, e os níveis da droga >1 μg/ml foi mantido durante cerca de 6,3 horas após a administração da droga em ambos os níveis de dose. Resposta parcial foi observada em 1 paciente e 4 apresentaram doença estável. Conclusões. A administração prolongada de Etoposide oral nas doses de 20 mg/m2 a cada 8 horas durante 14 dias consecutivos, seguidos de 7 dias de repouso, foi bem tolerada e determinou uma toxicidade manejável em crianças e adolescentes portadores de doenças malignas refratárias. A dose de 20 mg/m2 aparentemente preencheu os requisitos farmacocinéticos que objetivam melhorar o índice terapêutico do Etoposide, ou seja, a obtenção de níveis plasmáticos citotóxicos sustentados e abaixo do limite de toxicidade clínica da droga.

Topotatic-like phase transformation of amorphous lead titanate to cubic lead titanate

The crystallization process of lead titanate (PT) prepared using the polymeric precursor method was investigated using X-ray diffractometry, Raman spectroscopy, electron microscopy, and X-ray absorption spectroscopy techniques. The results showed that amorphous PT was formed by an O-Ti-O structure composed of fivefold and sixfold oxygen-coordinated titanium. The local structure of the amorphous PT phase was similar to that of the cubic PT phase, i.e., similar coordination number and similar bond lengths, leading to a topotactic-like transformation during the phase transformation from amorphous to cubic perovskite PT. Because of the low crystallization temperature, every transformation observed during the crystallization process was associated with a short-range rearrangement process.

A randomized and controlled trial about the use of oral isotretinoin for photoaging

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; off label indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40-55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66±0.31 vs. 0.94±0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary. © 2010 The International Society of Dermatology.