High-dose daunorubicin in older patients with acute myeloid leukemia

BACKGROUND: A complete remission is essential for prolonging survival in patients with acute myeloid leukemia (AML). Daunorubicin is a cornerstone of the induction regimen, but the optimal dose is unknown. In older patients, it is usual to give daunorubicin at a dose of 45 to 50 mg per square meter of body-surface area. METHODS: Patients in whom AML or high-risk refractory anemia had been newly diagnosed and who were 60 to 83 years of age (median, 67) were randomly assigned to receive cytarabine, at a dose of 200 mg per square meter by continuous infusion for 7 days, plus daunorubicin for 3 days, either at the conventional dose of 45 mg per square meter (411 patients) or at an escalated dose of 90 mg per square meter (402 patients); this treatment was followed by a second cycle of cytarabine at a dose of 1000 mg per square meter every 12 hours [DOSAGE ERROR CORRECTED] for 6 days. The primary end point was event-free survival. RESULTS: The complete remission rates were 64% in the group that received the escalated dose of daunorubicin and 54% in the group that received the conventional dose (P=0.002); the rates of remission after the first cycle of induction treatment were 52% and 35%, respectively (P<0.001). There was no significant difference between the two groups in the incidence of hematologic toxic effects, 30-day mortality (11% and 12% in the two groups, respectively), or the incidence of moderate, severe, or life-threatening adverse events (P=0.08). Survival end points in the two groups did not differ significantly overall, but patients in the escalated-treatment group who were 60 to 65 years of age, as compared with the patients in the same age group who received the conventional dose, had higher rates of complete remission (73% vs. 51%), event-free survival (29% vs. 14%), and overall survival (38% vs. 23%). CONCLUSIONS: In patients with AML who are older than 60 years of age, escalation of the dose of daunorubicin to twice the conventional dose, with the entire dose administered in the first induction cycle, effects a more rapid response and a higher response rate than does the conventional dose, without additional toxic effects. (Current Controlled Trials number, ISRCTN77039377; and Netherlands National Trial Register number, NTR212.)

Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality

OBJECTIVE: Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs. METHODS: This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003). RESULTS: Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time. CONCLUSIONS: Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.

Multimodal treatment for high-risk prostate cancer with high-dose intensity-modulated radiation therapy preceded or not by radical prostatectomy, concurrent intensified-dose docetaxel and long-term androgen deprivation therapy: results of a prospective phase II trial.

BACKGROUND The optimal management of high-risk prostate cancer remains uncertain. In this study we assessed the safety and efficacy of a novel multimodal treatment paradigm for high-risk prostate cancer. METHODS This was a prospective phase II trial including 35 patients with newly diagnosed high-risk localized or locally advanced prostate cancer treated with high-dose intensity-modulated radiation therapy preceded or not by radical prostatectomy, concurrent intensified-dose docetaxel-based chemotherapy and long-term androgen deprivation therapy. Primary endpoint was acute and late toxicity evaluated with the Common Terminology Criteria for Adverse Events version 3.0. Secondary endpoint was biochemical and clinical recurrence-free survival explored with the Kaplan-Meier method. RESULTS Acute gastro-intestinal and genito-urinary toxicity was grade 2 in 23% and 20% of patients, and grade 3 in 9% and 3% of patients, respectively. Acute blood/bone marrow toxicity was grade 2 in 20% of patients. No acute grade ≥ 4 toxicity was observed. Late gastro-intestinal and genito-urinary toxicity was grade 2 in 9% of patients each. No late grade ≥ 3 toxicity was observed. Median follow-up was 63 months (interquartile range 31-79). Actuarial 5-year biochemical and clinical recurrence-free survival rate was 55% (95% confidence interval, 35-75%) and 70% (95% confidence interval, 52-88%), respectively. CONCLUSIONS In our phase II trial testing a novel multimodal treatment paradigm for high-risk prostate cancer, toxicity was acceptably low and mid-term oncological outcome was good. This treatment paradigm, thus, may warrant further evaluation in phase III randomized trials.

High-Dose Oral Ibuprofen in Treatment of Patent Ductus Arteriosus in Full-Term Neonates

Background: Patent ductus arteriosus (PDA) is an important risk for heart failure due to left to right shunt in term neonates. Objectives: In this study, we evaluated the effect of high dose ibuprofen in closure of PDA in term neonates. Patients and Methods: We used double dose ibuprofen (20 mg/kg, 10 mg/kg, and 10 mg/kg) for 3 - 30 day old term neonates with PDA who were admitted in the neonatal wards of Shiraz University of Medical Sciences. The results of this study were compared to the data of the previous study in our center which used the low dose of ibuprofen (10 mg/kg, 5 mg/kg, and 5 mg/kg). Results: 29 full term neonates received high-dose ibuprofen, in 18 neonates, PDA was closed after 4 days (62.1% versus 43.3% for the standard dose and 4.7% for the control group in the previous study) (P = 0.001). The results showed no significant correlation between the closure rate and gestational age, postnatal age, sex, and weight. In the 4th day of treatment, size of the pulmonic end of ductus arteriosus decreased from 2.09 mm to 0.77 mm compared to 1.68 mm to 0.81 mm in the standard dose of oral ibuprofen and 2.1 mm to 1.4 mm in the control group (P = 0.046). Conclusions: This study indicated that high-dose oral ibuprofen was more effective in closing or decreasing the size of PDA.

Using accelerometer, high sample rate GPS and magnetometer data to develop a cattle movement and behaviour model

The study described in this paper developed a model of animal movement, which explicitly recognised each individual as the central unit of measure. The model was developed by learning from a real dataset that measured and calculated, for individual cows in a herd, their linear and angular positions and directional and angular speeds. Two learning algorithms were implemented: a Hidden Markov model (HMM) and a long-term prediction algorithm. It is shown that a HMM can be used to describe the animal's movement and state transition behaviour within several “stay” areas where cows remained for long periods. Model parameters were estimated for hidden behaviour states such as relocating, foraging and bedding. For cows’ movement between the “stay” areas a long-term prediction algorithm was implemented. By combining these two algorithms it was possible to develop a successful model, which achieved similar results to the animal behaviour data collected. This modelling methodology could easily be applied to interactions of other animal species.

Extraordinary high strain rate superplasticity in electrodeposited nano-nickel and alloys

Superplastic materials exhibit very large elongations to failure,typically >500%, and this enables commercial forming of complex shaped components at slow strain rates of similar to 10(-4) s(-1). We report extraordinary record superplastic elongations to failure of up to 5300% at both high strain rates and low temperature in electrodeposited nanocrystalline Ni and some Ni alloys. Superplasticity is not related to the presence of sulfur or a low melting phase at grain boundaries. (C) 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Microstructural features of flow instability in α-titanium cylinders under high strain rate compression at 25°C to 400°C

Cylindrical specimens of commercial pure titanium have been compressed at strain rates in the range of 0.1 to 100 s-1 and temperatures in the range of 25-degrees-C to 400-degrees-C. At strain rates of 10 and 100 s-1, the specimens exhibited adiabatic shear bands. At lower strain rates, the material deformed in an inhomogeneous fashion. These material-related instabilities are examined in the light of the ''phenomenological model'' and the ''dynamic materials mode.'' It is found that the regime of adiabatic shear band formation is predicted by the phenomenological model, while the dynamic materials model is able to predict the inhomogeneous deformation zone. The criterion based on power partitioning is competent to predict the variations within the inhomogeneous deformation zone.

Constitutive modeling of ice in the high strain rate regime

The objective of the present work is to propose a constitutive model for ice by considering the influence of important parameters such as strain rate dependence and pressure sensitivity on the response of the material. In this regard, the constitutive model proposed by Carney et al. (2006) is considered as a starting basis and subsequently modified to incorporate the effect of brittle cracking within a continuum damage mechanics framework. The damage is taken to occur in the form of distributed cracking within the material during impact which is consistent with experimental observations. At the point of failure, the material is assumed to be fluid-like with deviatoric stress almost dropping down to zero. The constitutive model is implemented in a general purpose finite element code using an explicit formulation. Several single element tests under uniaxial tension and compression, as well as biaxial loading are conducted in order to understand the performance of the model. Few large size simulations are also performed to understand the capability of the model to predict brittle damage evolution in un-notched and notched three point bend specimens. The proposed model predicts lower strength under tensile loading as compared to compressive loading which is in tune with experimental observations. Further the model also asserts the strain rate dependency of the strength behavior under both compressive as well as tensile loading, which also corroborates well with experimental results. (C) 2010 Elsevier Ltd. All rights reserved.

Creep in TiO2 doped Zirconia: Implications for high strain rate superplasticity

In ceramics, dopants offer the possibility of higher creep rates by enhancing diffusion. The present study examines the potential for high strain rate superplasticity in a TiO2 doped zirconia, by conducting creep experiments together with microstructural characterization. It is shown that both pure and doped zirconia exhibit transitions in creep behaviour from Coble diffusion creep with n similar to 1 to an interface controlled process with n similar to 2. Doping with TiO2 enhances the creep rate by over an order of magnitude. There is evidence of substantial grain boundary sliding, consistent with diffusion creep.

Multicode MIMO for High Data Rate Mobile Ad-hoc Networks

In a mobile ad-hoc network scenario, where communication nodes are mounted on moving platforms (like jeeps, trucks, tanks, etc.), use of V-BLAST requires that the number of receive antennas in a given node must be greater than or equal to the sum of the number of transmit antennas of all its neighbor nodes. This limits the achievable spatial multiplexing gain (data rate) for a given node. In such a scenario, we propose to achieve high data rates per node through multicode direct sequence spread spectrum techniques in conjunction with V-BLAST. In the considered multicode V-BLAST system, the receiver experiences code domain interference (CDI) in frequency selective fading, in addition to space domain interference (SDI) experienced in conventional V-BLAST systems. We propose two interference cancelling receivers that employ a linear parallel interference cancellation approach to handle the CDI, followed by conventional V-BLAST detector to handle the SDI, and then evaluate their bit error rates.

The effect of grain size on the high-strain, high-strain-rate behavior of copper

Copper with four widely differing grain sizes was subjected to high-strain-rate plastic deformation in a special experimental arrangement in which high shear strains of approximately 2 to 7 were generated. The adiabatic plastic deformation produced temperature rises in excess of 300 K, creating conditions favorable for dynamic recrystallization, with an attendant change in the mechanical response. Preshocking of the specimens to an amplitude of 50 GPa generated a high dislocation density; twinning was highly dependent on grain size, being profuse for the 117- and 315-mu m grain-size specimens and virtually absent for the 9.5-mu m grain-size specimens. This has a profound effect on the subsequent mechanical response of the specimens, with the smaller grain-size material undergoing considerably more hardening than the larger grain-size material. A rationale is proposed which leads to a prediction of the shock threshold stress for twinning as a function of grain size. The strain required for localization of plastic deformation was dependent on the combined grain size/shock-induced microstructure, with the large grain-size specimens localizing more readily. The experimental results obtained are rationalized in terms of dynamic recrystallization, and a constitutive equation is applied to the experimental results; it correctly predicts the earlier onset of localization for the large grain-size specimens. It is suggested that the grain-size dependence of shock response can significantly affect the performance of shaped charges.

Design of a constrained high data rate CDMA system

This paper deals with the design of a high data rate code-division multiple-access (CDMA) system under a speci¯ed jamming mar- gin speci¯cation as well as hardware and band-width limitations. Several choices had to be made in coming up with the design such as specify-ing the number of subcarriers, choice of spread-ing codes and the nature of the modulation.The rationale behind each of the choices made is given. Descriptions of transmitter and receiver are also included. Relevant simulations of cross-correlation are also provided.