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.

Effect of Mixture Composition on Washout Resistance of Highly Flowable Underwater Concrete

The underwater casting of relatively thin lifts of concrete in water requires the proportioning of highly flowable concrete that can resist water dilution and segregation and spread readily into place. An investigation was carried out to determine the effects of antiwashout admixture concentration, water-cementitious materials ratio, and binder composition on the washout resistance of highly flowable concrete. Two main types of antiwashout admixtures were used: 1) a powdered welan gum at concentrations of 0.07 and 0.15% (by mass of binder); and 2) a liquid-based cellulosic admixture with dosages up to 1.65 L/100 kg of binder. The water-cementitious materials ratios were set at 0.41 and 0.47, corresponding to high-quality underwater concrete. Four binder compositions were used: a standard Canadian Type 10 cement, the same cement with 10% silica fume replacement, the cement with 50% granulated blast-furnace slag replacement, and a ternary cement containing 6% silica fume and 20% Class F fly ash. The concentrations of anti-washout admixture have direct impact on washout resistance. For a given washout loss, greater slump flow consistency can be achieved with the increases in anti-washout admixture concentration and decreases in water-binder ratio. The washout mass loss can be reduced, for a given consistency

In situ cross-calibration of in-fibre Bragg Grating and Electrical Resistance Strain Gauges for structural monitoring using an extensometer

Special issue on Sensor Systems for Structural Health Monitoring Abstract—This study addresses the direct calibration of optical fiber strain sensors used for structural monitoring and is carried out in situ. The behavior of fiber-Bragg-grating-based sensor systems when attached to metal bars, in a manner representative of their use as reinforcement bars in structures, was examined and their response calibrated. To ensure the validity of the measurements,this was done using an extensometer with a further calibrationagainst the response of electrical resistance strain gauges, often conventionally used, for comparison. The results show a repeatable calibration generating a suitable geometric factor of extension to strain for these sensors, to enable accurate strain data to be obtained when the fiber-optic sensor system is in use in structural monitoring applications.

Low-fat versus low-carbohydrate weight reduction diets:Effects on weight loss, insulin resistance, and cardiovascular risk: a randomized control trial

OBJECTIVE Low-fat hypocaloric diets reduce insulin resistance and prevent type 2 diabetes in those at risk. Low-carbohydrate, high-fat diets are advocated as an alternative, but reciprocal increases in dietary fat may have detrimental effects on insulin resistance and offset the benefits of weight reduction.

RESEARCH DESIGN AND METHODS We investigated a low-fat (20% fat, 60% carbohydrate) versus a low-carbohydrate (60% fat, 20% carbohydrate) weight reduction diet in 24 overweight/obese subjects ([mean ± SD] BMI 33.6 ± 3.7 kg/m2, aged 39 ± 10 years) in an 8-week randomized controlled trial. All food was weighed and distributed, and intake was calculated to produce a 500 kcal/day energy deficit. Insulin action was assessed by the euglycemic clamp and insulin secretion by meal tolerance test. Body composition, adipokine levels, and vascular compliance by pulse-wave analysis were also measured.

RESULTS Significant weight loss occurred in both groups (P < 0.01), with no difference between groups (P = 0.40). Peripheral glucose uptake increased, but there was no difference between groups (P = 0.28), and suppression of endogenous glucose production was also similar between groups. Meal tolerance–related insulin secretion decreased with weight loss with no difference between groups (P = 0.71). The change in overall systemic arterial stiffness was, however, significantly different between diets (P = 0.04); this reflected a significant decrease in augmentation index following the low-fat diet, compared with a nonsignificant increase within the low-carbohydrate group.

CONCLUSIONS This study demonstrates comparable effects on insulin resistance of low-fat and low-carbohydrate diets independent of macronutrient content. The difference in augmentation index may imply a negative effect of low-carbohydrate diets on vascular risk.