Neurotoxicity of stem cell mobilization chemotherapy with vinorelbine in myeloma patients after bortezomib treatment.

Vinorelbine chemotherapy with G-CSF stimulation is the standard mobilization regimen in Switzerland for multiple myeloma patients. However, with the increasing use of bortezomib during induction treatment, adding the neurotoxic compound vinorelbine for mobilization may aggravate bortezomib-induced polyneuropathy. In this retrospective single-center study, we aimed to explore vinorelbine mediated neuropathy in 106 consecutive bortezomib pretreated myeloma patients. We confirmed that vinorelbine with G-CSF represents a reliable and effective regimen for mobilization of autologous stem cells. However, the single administration of 35 mg/m(2) vinorelbine added significant neurotoxicity. We found that 24 patients (24%) reported vinorelbine mediated neurotoxicity: Aggravation of bortezomib-induced neuropathy was observed in 17 patients (17%), and vinorelbine mobilization induced first occurrence of polyneuropathy in additional 7 patients (7%). We observed that development of polyneuropathy was not associated with differing survival rates. Finally, affected patients reported polyneuropathy associated disease burden as "very high" in 13% and "high" in 50%. Our data indicate that a single administration of vinorelbine to mobilize autologous stem cells is associated with significant additional polyneuropathy in bortezomib pretreated myeloma patients. The efficacy of vinorelbine mobilization should be balanced against its neurotoxic potential.

CD34+ selected versus unselected autologous stem cell transplantation in patients with advanced-stage mantle cell and diffuse large B-cell lymphoma

Novel strategies aiming to increase survival rates in patients with advanced-stage mantle cell lymphoma (MCL) and relapsing diffuse large B-cell lymphoma (DLBCL) are a clinical need. High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) has improved progression-free (PFS) and overall survival (OS) in MCL and relapsed DLBCL. However, the role of CD34+ cell selection before ASCT in MCL and DLBCL is unclear. We retrospectively analyzed the outcome of 62 consecutive patients with advanced-stage MCL or relapsed DLBCL undergoing ASCT with (n=31) or without (n=31) prior CD34+ selection. All patients had stage III or IV disease, with 47% having DLBCL and 53% MCL. The median duration for neutrophil and platelet recovery was 12 and 16 days in CD34+ selected patients, and 11 (P<.001) and 14 days (P=.012) in the group without selection, respectively. No differences in toxicities were observed. The 5-year PFS for CD34+ selected versus not selected patients was 67% and 39% (P=.016), and the 5-year OS was 86% and 54% (P=.007). Our data suggest that using CD34+ selected autografts for ASCT in advanced stage MCL and DLBCL is associated with longer PFS and OS without increased toxicity.

Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

OBJECTIVE The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d. RESULTS Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups. CONCLUSION Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients.

First-Trimester Placental Growth Factor in Screening for Gestational Diabetes.

OBJECTIVE The aim of this study was first to assess whether first-trimester serum concentrations of placental growth factor (PlGF) differ between patients with and without gestational diabetes (GDM) and second to test whether there is a correlation between glycosylated hemoglobin (HbA1c), a factor recently shown to be useful in predicting GDM, and PlGF. METHODS PlGF was measured at 8-14 weeks with the Kryptor Immunoassay Analyzer (Brahms, Berlin, Germany). Absolute values were converted to multiples of the median using the software provided by the Fetal Medicine Foundation London. GDM was diagnosed using internationally accepted criteria. HbA1c levels were quantified using the TOSOH G7 automated hemoglobin analyzer. RESULTS From January to December 2014, 328 women were included in the study, 51 (15.5%) of whom developed GDM. First-trimester PlGF quantification does not discriminate between women at risk to develop GDM and controls, while HbA1c is able to do so. No correlation was found between PlGF and HbA1c. CONCLUSION Our findings do not lend support to the hypothesis that early PlGF values are different in women who later develop GDM.

First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes.

INTRODUCTION Our aim was to investigate the prognostic value of first-trimester glycosylated hemoglobin (HbA1c) in pregnant women with risk factors for developing gestational diabetes mellitus (GDM). MATERIAL AND METHODS This is an observational retrospective cohort study conducted at the Department of Obstetrics and Gynecology, University Hospital Bern, Switzerland. We included pregnant women at high risk for GDM (n = 208), who had an HbA1c measurement in the first trimester. We compared HbA1c values of women who later developed GDM with those who did not develop GDM. Diagnosis of GDM was made on the basis of a 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation. We further examined the prevalence of GDM in relation to the first-trimester HbA1c value. RESULTS The prevalence of GDM in our high-risk group was 14.7%. Women who developed GDM had significantly higher first-trimester HbA1c values [5.43 ± 0.31% (36 ± 3 mmol/mol) vs. 5.23 ± 0.28% (34 ± 3 mmol/mol); p = 0.0026]. Moreover, all pregnant women with HbA1c ≥6.0% (42 mmol/mol) developed GDM, whereas those with <4.5% (26 mmol/mol) did not. CONCLUSIONS Women at risk for GDM have higher first-trimester HbA1c levels and values ≥6.0% (42 mmol/mol) are predictive of GDM. This information may be useful for counseling these women and providing appropriate advice on diet and lifestyle modification early in pregnancy.

How parties justified the 2014 EP election debate. A comparative analysis in six EU countries

On the role of parties as important channels for people to voice their preferences there is a sound consensus in the literature. Traditional socio-economic concerns have been more and more displaced by culturally fought issues such as immigration and European integration. Scholarly works, however, have paid less attention how, if at all, parties combine different cultural issues. The primary aim of the analysis is to investigate if and under which conditions parties link immigration and European integration issues to address the growing discontent in the population with these issues. Our expectation is that parties endorse different strategies depending on the party competition, in particular the presence of a populist challenger. The analysis is based on a quantitative content analysis of press releases and newspapers articles published in the 12 weeks preceding the 2014 EP election in five European countries (Austria, Germany, Greece, the Netherlands and the United Kingdom).

ENaC activity in collecting ducts modulates NCC in cirrhotic mice.

Cirrhosis is a frequent and severe disease, complicated by renal sodium retention leading to ascites and oedema. A better understanding of the complex mechanisms responsible for renal sodium handling could improve clinical management of sodium retention. Our aim was to determine the importance of the amiloride-sensitive epithelial sodium channel (ENaC) in collecting ducts in compensate and decompensate cirrhosis. Bile duct ligation was performed in control mice (CTL) and collecting duct-specific αENaC knockout (KO) mice, and ascites development, aldosterone plasma concentration, urinary sodium/potassium ratio and sodium transporter expression were compared. Disruption of ENaC in collecting ducts (CDs) did not alter ascites development, urinary sodium/potassium ratio, plasma aldosterone concentrations or Na,K-ATPase abundance in CCDs. Total αENaC abundance in whole kidney increased in cirrhotic mice of both genotypes and cleaved forms of α and γ ENaC increased only in ascitic mice of both genotypes. The sodium chloride cotransporter (NCC) abundance was lower in non-ascitic KO, compared to non-ascitic CTL, and increased when ascites appeared. In ascitic mice, the lack of αENaC in CDs induced an upregulation of total ENaC and NCC and correlated with the cleavage of ENaC subunits. This revealed compensatory mechanisms which could also take place when treating the patients with diuretics. These compensatory mechanisms should be considered for future development of therapeutic strategies.

Job-shadowing: Swiss health librarians observing experienced search specialists and information skills trainers in London

Abstract As librarians of the Social & Preventive Medicine Library in Bern, we help researchers perform systematic literature searches and teach students to use medical databases. We developed our skills mainly “on the job”, and we wondered how other health librarians in Europe were trained to become experts in searching. We had a great opportunity to “job shadow” specialists in this area of library service during a 5-day-internship at the Royal Free Hospital Medical Library in London, Great Britain.

Arnold Zweig [Illustration] : Radierung

Beatrice Zweig

Algunas direcciones de la literatura comparada en los comienzos del nuevo milenio

En las últimas décadas del Siglo XX, el impacto de los nuevos paradigmas epistemológicos y el surgimiento de nuevos campos disciplinares y teorías literarias produjeron la desestructuración de los sistemas jerárquicos que en la teoría y práctica de la literatura comparada habían privilegiado la producción literaria de las culturas centrales. El nuevo comparatismo fue entendido entonces como diálogo de culturas y factor de conocimiento y convivialidad. Entrado el Siglo XXI, quiero detenerme en tres direcciones del comparatismo. Una que apunta a la profundización del enfoque interdisciplinario, una segunda que muestra un renovado retorno a la crítica temática para explorar comparativamente la construcción dialógica de conceptos centrales en el marco de una globalización hegemónica y también contrahegemónica, y, por último, una aproximación a los relatos de sujetos migrantes/cosmopolitas que desafían los criterios geopolíticos, culturales y hasta lingüísticos para definir las identidades literarias. Como ejemplo de la primera tendencia, haré referencia a estudios en literatura comparada sobre la conexión de la literatura con las ciencias duras. Ejemplificaré la segunda dirección -instancia también del énfasis actual en lo multidisciplinario- con un estudio de casos a propósito de la construcción dialógica del concepto de justicia en el discurso social y en las artes contemporáneas. Finalmente, con respecto a los relatos de sujetos migrantes, me detendré en la obra Incendies (2003) de Wajdi Mouawad y en beatrice y virgil (2010) de Yann Martel, ambos residentes actualmente en Canadá

Persistencia y cambio del campesinado. Un abordaje crítico a "La morada de la vida" desde el marxismo contemporáneo

Este trabajo se propone identificar y contrastar las estrategias teórico-metodológicas utilizadas por Beatriz M. Alásia de Heredia y Bronislaw Galeski, en el estudio de la unidad económica de producción campesina. Tomamos como referencia dos obras de los autores que consideramos sumamente relevantes para los estudios de campesinado: "La morada de la vida. Trabajo familiar de pequeños productores del nordeste de Brasil" (2003) y "Sociología del campesinado" (1977) respectivamente. Si bien, ambas obras pertenecen a tradiciones disciplinares diferentes, al analizar la unidad económica de producción campesina, consideran su persistencia en el sistema económico capitalista.

Persistencia y cambio del campesinado. Un abordaje crítico a "La morada de la vida" desde el marxismo contemporáneo

Este trabajo se propone identificar y contrastar las estrategias teórico-metodológicas utilizadas por Beatriz M. Alásia de Heredia y Bronislaw Galeski, en el estudio de la unidad económica de producción campesina. Tomamos como referencia dos obras de los autores que consideramos sumamente relevantes para los estudios de campesinado: "La morada de la vida. Trabajo familiar de pequeños productores del nordeste de Brasil" (2003) y "Sociología del campesinado" (1977) respectivamente. Si bien, ambas obras pertenecen a tradiciones disciplinares diferentes, al analizar la unidad económica de producción campesina, consideran su persistencia en el sistema económico capitalista.

Algunas direcciones de la literatura comparada en los comienzos del nuevo milenio

En las últimas décadas del Siglo XX, el impacto de los nuevos paradigmas epistemológicos y el surgimiento de nuevos campos disciplinares y teorías literarias produjeron la desestructuración de los sistemas jerárquicos que en la teoría y práctica de la literatura comparada habían privilegiado la producción literaria de las culturas centrales. El nuevo comparatismo fue entendido entonces como diálogo de culturas y factor de conocimiento y convivialidad. Entrado el Siglo XXI, quiero detenerme en tres direcciones del comparatismo. Una que apunta a la profundización del enfoque interdisciplinario, una segunda que muestra un renovado retorno a la crítica temática para explorar comparativamente la construcción dialógica de conceptos centrales en el marco de una globalización hegemónica y también contrahegemónica, y, por último, una aproximación a los relatos de sujetos migrantes/cosmopolitas que desafían los criterios geopolíticos, culturales y hasta lingüísticos para definir las identidades literarias. Como ejemplo de la primera tendencia, haré referencia a estudios en literatura comparada sobre la conexión de la literatura con las ciencias duras. Ejemplificaré la segunda dirección -instancia también del énfasis actual en lo multidisciplinario- con un estudio de casos a propósito de la construcción dialógica del concepto de justicia en el discurso social y en las artes contemporáneas. Finalmente, con respecto a los relatos de sujetos migrantes, me detendré en la obra Incendies (2003) de Wajdi Mouawad y en beatrice y virgil (2010) de Yann Martel, ambos residentes actualmente en Canadá

Algunas direcciones de la literatura comparada en los comienzos del nuevo milenio

En las últimas décadas del Siglo XX, el impacto de los nuevos paradigmas epistemológicos y el surgimiento de nuevos campos disciplinares y teorías literarias produjeron la desestructuración de los sistemas jerárquicos que en la teoría y práctica de la literatura comparada habían privilegiado la producción literaria de las culturas centrales. El nuevo comparatismo fue entendido entonces como diálogo de culturas y factor de conocimiento y convivialidad. Entrado el Siglo XXI, quiero detenerme en tres direcciones del comparatismo. Una que apunta a la profundización del enfoque interdisciplinario, una segunda que muestra un renovado retorno a la crítica temática para explorar comparativamente la construcción dialógica de conceptos centrales en el marco de una globalización hegemónica y también contrahegemónica, y, por último, una aproximación a los relatos de sujetos migrantes/cosmopolitas que desafían los criterios geopolíticos, culturales y hasta lingüísticos para definir las identidades literarias. Como ejemplo de la primera tendencia, haré referencia a estudios en literatura comparada sobre la conexión de la literatura con las ciencias duras. Ejemplificaré la segunda dirección -instancia también del énfasis actual en lo multidisciplinario- con un estudio de casos a propósito de la construcción dialógica del concepto de justicia en el discurso social y en las artes contemporáneas. Finalmente, con respecto a los relatos de sujetos migrantes, me detendré en la obra Incendies (2003) de Wajdi Mouawad y en beatrice y virgil (2010) de Yann Martel, ambos residentes actualmente en Canadá