The impact of dose escalation and resistance modulation in older patients with acute myeloid leukaemia and high risk myelodysplastic syndrome: the results of the LRF AML14 trial.:the results of the LRF AML14 trial

The acute myeloid leukaemia (AML)14 trial addressed four therapeutic questions in patients predominantly aged over 60 years with AML and High Risk Myelodysplastic Syndrome: (i) Daunorubicin 50 mg/m(2) vs. 35 mg/m(2); (ii) Cytarabine 200 mg/m(2) vs. 400 mg/m(2) in two courses of DA induction; (iii) for part of the trial, patients allocated Daunorubicin 35 mg/m(2) were also randomized to receive, or not, the multidrug resistance modulator PSC-833 in a 1:1:1 randomization; and (iv) a total of three versus four courses of treatment. A total of 1273 patients were recruited. The response rate was 62% (complete remission 54%, complete remission without platelet/neutrophil recovery 8%); 5-year survival was 12%. No benefits were observed in either dose escalation randomization, or from a fourth course of treatment. There was a trend for inferior response in the PSC-833 arm due to deaths in induction. Multivariable analysis identified cytogenetics, presenting white blood count, age and secondary disease as the main predictors of outcome. Although patients with high Pgp expression and function had worse response and survival, this was not an independent prognostic factor, and was not modified by PSC-833. In conclusion, these four interventions have not improved outcomes in older patients. New agents need to be explored and novel trial designs are required to maximise prospects of achieving timely progress.

Personnel radiation dose considerations in the use of an integrated PET–CT scanner for radiotherapy treatment planning of an integrated PET-CT scanner for radiotherapy treatment planning

The acquisition of radiotherapy planning scans on positron emission tomography (PET)-CT scanners requires the involvement of radiotherapy radiographers. This study assessed the radiation dose received by these radiographers during this process. Radiotherapy planning F- fluorodeoxyglucose (F-FDG) PET-CT scans were acquired for 28 non-small cell lung cancer patients. In order to minimise the radiation dose received, a two-stage process was used in which the most time-consuming part of the set-up was performed before the patient received their F-FDG injection. Throughout this process, the radiographers wore electronic personal dosemeters and recorded the doses received at different stages of the process. The mean total radiation dose received by a radiotherapy radiographer was 5.1±2.6 mSv per patient. The use of the two-stage process reduced the time spent in close proximity to the patient by approximately a factor of four. The two-stage process was effective in keeping radiation dose to a minimum. The use of a pre-injection set-up session reduces the radiation dose to the radiotherapy radiographers because of their involvement in PET-CT radiotherapy treatment planning scans by approximately a factor of three.

The efficacy of lead shielding in megavoltage radiotherapy.

The dose received by anatomical structures which are apparently shielded by lead blocks during a course of megavoltage radiotherapy may not be negligible. The dose has three main components; there is that due to radiation transmitted through the shielding block, that due to radiation scattered within the patient and that due to radiation scattered prior to reaching the patient and so circumventing the shield. A calculation method which separates the three components has been investigated and the results have been compared with measurements in a wide range of test situations for both cobalt-60 and 6 MV photon beams. The method of calculation predicts the dose behind the shielding block with acceptable accuracy in all the conditions investigated.

Breit-Pauli R-matrix calculation of fine-structure effective collision strengths for the electron impact excitation of Mg V

Context. Electron-impact excitation collision strengths are required for the analysis and interpretation of stellar observations.
Aims. This calculation aims to provide effective collision strengths for the Mg V ion for a larger number of transitions and for a greater temperature range than previously available, using collision strength data that include contributions from resonances.
Methods. A 19-state Breit-Pauli R-matrix calculation was performed. The target states are represented by configuration interaction wavefunctions and consist of the 19 lowest LS states, having configurations 2s22p4, 2s2p5, 2p6, 2s22p33s, and 2s22p33p. These target states give rise to 37 fine-structure levels and 666 possible transitions. The effective collision strengths were calculated by averaging the electron collision strengths over a Maxwellian distribution of electron velocities.
Results. The non-zero effective collision strengths for transitions between the fine-structure levels are given for electron temperatures in the range = 3.0 - 7.0. Data for transitions among the 5 fine-structure levels arising from the 2s22p4 ground state configurations, seen in the UV range, are discussed in the paper, along with transitions in the EUV range – transitions from the ground state 3P levels to 2s2p5?3P levels. The 2s22p4?1D–2s2p5?1P transition is also noted. Data for the remaining transitions are available at the CDS.

Electron-impact excitation of Cr II A theoretical calculation of collision and effective collision strengths for forbidden transitions

Context. Absorption or emission lines of Cr II are observed in a wide variety of astrophysical spectra and accurate atomic data are urgently needed to interpret these lines. Many of these data are impossible to measure experimentally and a full theoretical treatment is the only means by which these data can be obtained.

Aims. In this paper, we present collision strengths and effective collision strengths for electron-impact excitation of Cr II for forbidden transitions among the lowest-lying 74 fine-structure levels. Effective collision strengths have been computed for 18 individual electron temperatures of astrophysical importance, ranging from 2000-100 000 K.

Methods. The parallel suite of R-matrix packages, RMATRX II, which has recently been extended to allow for the inclusion of relativistic effects, has been used in the present work to compute the collision strengths and effective collision strengths for electron-impact excitation of Cr II. We concentrate in this publication on low-lying forbidden lines among the lowest 74 jj fine-structure levels with configurations 3d(5) and 3d(4)4s, although atomic data has been evaluated for all 39 060 transitions among the 280 jj levels of configurations 3d(5), 3d(4)4s and 3d(4)4p. This work constitutes the largest evaluation ever performed for this ion involving 1932 coupled channels.

Results. Collision and effective collision strengths are presented for all transitions among the lowest 74 J pi states of Cr II and comparisons made with the work of Bautista et al. (2009). While the effective collision strengths agree well for some transitions, significant discrepancies exist for others. We believe that the present atomic data represents the most accurate, most sophisticated and most complete data set for electron-impact excitation of Cr II and we would recommend them to astrophysicists and plasma physicists in their application work. We would expect that the effective collision strengths presented for the important low-lying forbidden lines are accurate to within 15%.

Tackling antibiotic resistance: a dose of common antisense?

Resistance to antimicrobial agents undermines our ability to treat bacterial infections. It attracts intense media and political interest and impacts on personal health and costs to health infrastructures. Bacteria have developed resistance to all licensed antibacterial agents, and their ability to become resistant to unlicensed agents is often demonstrated during the development process. Conventional approaches to antimicrobial development, involving modification of existing agents or production of synthetic derivatives, are unlikely to deliver the range or type of drugs that will be needed to meet all future requirements. Although many companies are seeking novel targets, further radical approaches to both antimicrobial design and the reversal of resistance are now urgently required. In this article, we discuss ‘antisense’ (or ‘antigene’) strategies to inhibit resistance mechanisms at the genetic level. These offer an innovative approach to a global problem and could be used to restore the efficacy of clinically proven agents. Moreover, this strategy has the potential to overcome critical resistances, not only in the so-called ‘superbugs’ (methicillin-resistant Staphylococcus aureus, glycopeptide-resistant enterococci and multidrug-resistant strains of Acinetobacter baumannii, and Pseudomonas aeruginosa), but in resistant strains of any bacterial species.