Academic literature on the topic 'HD 6961.5 2012'

Abstract Introduction There has been dramatic evolution in multiple myeloma (MM) therapy in the last decade. The novel agents (Thal, Bor, and Len) have been reported to improve natural history of the cases with MM. In order to use optimal drugs for each patient, we should investigate the actual conditions of the clinical practice. However, we could not have the information regarding epidemiology, clinical features, treatment results, prognosis, and so on because there is no large-scale database demonstrating the clinical features of MM-related diseases in Japan. Therefore, we have founded the study group, named as Kansai Myeloma Forum (KMF), for the purpose of registering the cases with MM-related diseases in Kansai area of Japan on November, 2012. In this study, we analyzed the clinical characteristics and outcomes of MM-related diseases registered in KMF and evaluated the treatment strategies in the novel agent era. Patients & Results Among a total of 923 cases initially diagnosed since 2006 and registered to KMF database until March 31, 2013, we analyzed 434 symptomatic MM cases (213 females/221 males), who were treated since 2006. The median age was 69 (range: 32-96), and the OS rates at 3 and 5 years were 68.7% and 45.3%, respectively. The prognosis of the cases treated after 2010 became significantly better than that of the cases treated between 2006 and 2009 (log-rank test: P=0.019). The prognosis of the cases treated with the novel agents was significantly better than without them (p=0.005). Among the non-transplanted 339 cases, the effects of the novel drugs were shown more clearly (p=0.002). The best response during the course differentiated the prognosis; the hazard ratios of CR, VGPR, PR, SD and PD compared to sCR were 2.23, 3.19, 9.54, 16.84 and 432.01, respectively (P<0.001). Ninety-five cases received the high-dose melphalan therapy (HD-MEL) with stem cell support. The OS rate of these 95 cases was significantly better than that of non-transplanted 339 cases (90.1% at 3-year/61.4% at 5-year vs. 61.6%/40.2%, p<0.001). CR/sCR rate after HD-MEL was 50%. Also, 83 out of 95 cases received at least one of the novel agents during their clinical courses, and 51 cases achieved CR/sCR as best response, showing significant better survival than the cases with best response of VGPR or <PR (p=0.008). The superiority of OS in HD-MEL group was also observed even when less than 65 years old patients (74 out of 95 patients) were compared to 55 patients (≤ 65 years) without HD-MEL but receiving novel agents (90.6% at 3-year/71.4% at 5-year vs. 73.6%/47.3%, p=0.036). Next, we analyzed 123 cases with MGUS and 54 with smoldering MM (SMM), who had diagnosed in 2006 or later. The median age at diagnosis was 66.0 (range: 34-88) in 123 MGUS cases (53 females/70 males). The type of paraprotein detected was IgA in 15.4% of the cases and IgG in 69.1 %. With a median follow-up period of 27.2 months, 8 cases (6.5%) received chemotherapies due to the disease evolution. The evolution rates at 1, 3 and 5 years after the diagnosis were 2.1%, 9.0% and 12.0%, respectively (2.4% per year). The 3-year OS after the start of treatments was 75.0%. In 54 SMM cases (29 females/25 males), the median age was 68.2 (range: 40-87), and IgG and IgA types comprised 72.2% and 14.8%, respectively. With a median follow-up period of 22.4 months, 15 cases (27.8%) received chemotherapy due to progression to symptomatic MM. The evolution rates at 1, 3 and 5 years after diagnosis were 15.4%, 36.7% and 62.5%, respectively (12.5% per year). The 3-year OS after the start of treatments was 76.9%. Discussion & Conclusion The current study revealed the significant effects of novel agents on symptomatic MM cases in the practical use. It has been still unknown and controversial whether HD-MEL with auto-PBSCT is necessary or not in the novel agent era. In this analysis, it was shown that HD-MEL could provide significant survival benefit to symptomatic MM cases even in the novel-agent era. However, it is necessary to determine when and how we should perform HD-MEL for MM during therapeutic sequences including novel agents. This study also suggested that it might be unnecessary to generally consider an early chemotherapy to MGUS or SMM cases before the evolution, since the prognosis after the evolution seemed not to be inferior to that of the de-novo symptomatic MM. Thus, KMF database would provide abundant and beneficial information to consider the treatment strategies of the cases with MM-related diseases. Disclosures: Tanaka: celgene: Research Funding. Kosugi:Janssen: Honoraria; celgene: Research Funding. Kida:celgene: Research Funding. Ohta:celgene: Research Funding. Yamamura:celgene: Research Funding. Shibayama:Janssen: Honoraria; celgene: Honoraria, Research Funding. Kohara:celgene: Research Funding. Kaneko:celgene: Research Funding. Fuchida:celgene: Research Funding. Kobayashi:celgene: Research Funding. Miyamoto:celgene: Research Funding. Shindo:celgene: Research Funding. Kuroda:celgene: Research Funding. Uoshima:celgene: Research Funding. Matsumura:celgene: Research Funding. Yoshii:celgene: Research Funding. Kamitsuji:celgene: Research Funding. Boku:celgene: Research Funding. Ishii:celgene: Research Funding. Matsuda:celgene: Research Funding. Takahashi:celgene: Research Funding. Hamada:celgene: Research Funding. Adachi:celgene: Research Funding. Nakatani:celgene: Research Funding. Nomura:celgene: Research Funding. Taniwaki:celgene: Research Funding. Takaori:celgene: Research Funding. Shimazaki:celgene: Research Funding. Tsudo:celgene: Research Funding. Hino:celgene: Research Funding. Matsumura:Janssen: Honoraria, Research Funding; celgene: Research Funding. Kanakura:celgene: Research Funding.

To examine the relationship between dialysis modality and prognosis in Japanese patients, we conducted a prospective multicenter observational study. We recruited 83 background-matched peritoneal dialysis (PD) and 83 hemodialysis (HD) patients (average age, 64.9 years; men, 53.6%; diabetic patients, 22.9%; median duration of dialysis, 48 months in all patients) and followed them for 5 years. During the follow-up period, 27 PD patients (16 cardiovascular and 11 non-cardiovascular deaths) and 27 HD patients died (14 cardiovascular and 13 non-cardiovascular deaths). There were 8 PD patients switched to HD, and 6 PD patients received renal transplantation. Kaplan-Meier analysis revealed that the crude survival rate was not significantly different at the end of 5 years (PD 67.5% versus 67.5%, log-rankP=0.719). The difference in cardiovascular and non-cardiovascular mortalities between PD and HD was not statistically significant. Multivariate Cox analysis showed that the independent predictors for death were age and serum albumin levels, but not the dialysis modality. This study showed that the overall mortality was not significantly different between PD and HD patients, which suggests that dialysis modality might not be an independent factor for survival in Japanese patients.

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD).Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure.Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR.Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

Background. In previous reports with a majority of Caucasian patients, peritoneal dialysis (PD) before kidney transplantation has been associated with poor outcomes and higher rates of graft thrombosis and infectious complications than hemodialysis (HD). We report our experience on the outcomes of prerenal transplant peritoneal dialysis in predominantly (73%) African American patient population.Methods. A retrospective data analysis of 401 kidney transplants performed at our center from 2000 to 2006 was performed. Adult recipients with at least three months of pretransplant HD or PD were included.Results. There were 339 patients on HD and 62 patients on PD. There was no difference in graft (P=0.51) and patient survival (P=0.52) at 1, 3, and 5-years. Patients on HD were more likely to experience delayed graft function than PD (38.8% versus 17.7%,P<0.005). There was no difference in the incidence of vascular thrombosis or posttransplant infectious complications. When only the African American patients in the two groups were compared, there were no differences in graft or patient survival.Conclusions. Pretransplant peritoneal dialysis is associated with excellent patient and renal allograft outcomes in African Americans and does not predispose them to an increased risk of infectious or thrombotic complications.

The study was conducted with the aim at: 1) describing situation of scientific research in Hue university of medicine and pharmacy (HUMP) and health facilities in Thua Thien Hue (TTH) province during 5 years from 2012 to 2016; and 2) evaluating effectiveness of activities of scientific research (SR) in study settings. This is a quantitative and cross sectional study. 220 researchers and 4 managers of scientific research department were directly interviewed based on structured questionnaire to learn about scientific research activities of individuals and organizations during 5 years from 2012 to 2016. Secondary data including documents, agreements related to quality management of scientific research in study settings were also reviewed. Findings showed that during 5 years from 2012 to 2016, number of scientific research project in Hue Central Hospital (HCH), HUMP and Health department of the province (HD) are 990, 596 and 582, respectively. Most of them are project with basis level. Number of scientific paper published is 1776 in HUMP, 1115 in HCH and 440 in HD. Almost of them were published in the dosmetic journals. Scientific research project were applied in health care pratice accounting for 88.1% in HD, 45.3% in HUMP and 4.7% in HCH. HUMP is only unit that gets enough contents of procedure of quality management in scientific research projects. Activities of scientific research of health section of the province achieve effectiveness according to criteria suggested. In order to enhance quality of scientific research works, procedure of their management should be improved in quality aspect of the studies and the resource support to researchers should be paid attention.

Regulatory Foxp3-expressing T cells (Tregs), IL-10-producing B cells (Bregs), and IDO-expressing dendritic cells (DCregs) downregulate inflammatory processes and induces peripheral tolerance. These subpopulations also might participate in maintaining allograft immunological quiescence in kidney transplant recipients (KTRs) with an excellent long-term graft function under immunosuppression (ELTGF). The aim of the study was to characterize and to enumerate peripheral Tregs, Bregs, and DCregs in KTR with an ELTGF for more than 5 years after transplant. Fourteen KTR with an ELTGF, 9 KTR with chronic graft dysfunction (CGD), and 12 healthy donors (HDs) were included in the study. CD19+-expressing peripheral B lymphocytes were purified by positive selection. IL-10-producing B cells, CD4+/CD25hi, and CD8+/CD28−Tregs, as well as CCR6+/CD123+/IDO+DCs, were quantitated by flow cytometry. IL-10-producing Bregs (immature/transitional, but not CD19+/CD38hi/CD24hi/CD27+B10 cells), CCR6+/CD123+/IDO+DCs, and Tregs from ELTGF patients had similar or higher percentages versus HD (P<0.05). By contrast, number of Tregs, DCregs, and Bregs except for CD27+B10 cells from CGD patients had lower levels versus HD and ELTGF patients (P<0.05). The findings of this exploratory study might suggest that in ELTGF patients, peripheral tolerance mechanisms could be directly involved in the maintenance of a quiescent immunologic state and graft function stability.

Background:Approximately 10% of women engage in resistance training during pregnancy; however there is limited research on this activity. The purpose of this study was to examine associations between resistance training and adverse outcomes.Methods:Women completed an online survey and recalled their exercise habits during each trimester of their most recent pregnancy within the previous 5 years. Women also reported pregnancy and birth outcomes. Participants were then categorized into 3 groups based on leisure-time exercise: 1) Resistance + aerobic training (RTAE), 2) Aerobic exercise only (AE), and 3) no exercise (NE).Results:284 women completed the survey. Women in the RTAE group resistance trained on average 2.9 days/week for 27.3 minutes/session. The prevalences of hypertensive disorders (HD) and gestational diabetes mellitus (GDM) were significantly lower in the RTAE group when compared with the grouping of AE + NE women. Prepregnancy body mass index (BMI) was the strongest factor related to both GDM and HD. There was no difference in the risk of preterm labor, mode of delivery, or gestational age at delivery by exercise status.Conclusions:Our results suggest that women can safely engage in aerobic exercise and resistance training for muscular endurance 3 days/week for 30 minutes throughout gestation.

Background: We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones.Methods: Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5- to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET.Results: Patients were divided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1,the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively).Interpretation: We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted.

2034 Background: The current institutional standard for treatment of patients with newly-diagnosed primary CNS lymphomas (PCNSL) at Johns Hopkins Hospital (JHH) consists of treatment with high-dose methotrexate plus rituximab (hd-MTX/R) every 2 weeks until complete response (CR), progression or unacceptable toxicities. Once CR is achieved, this is followed by monthly treatments for a total of up to one year for consolidation. Prior to 2008, the institutional standard had been treatment with hd-MTX alone. The benefit of adding rituximab to hd-MTX has not been formally evaluated. Methods: This is a retrospective study of HIV-negative adult patients with newly-diagnosed PCNSL treated at JHH with either hd-MTX or hd-MTX/R as initial therapy. Patients were identified using the cancer center registry (1995-2012) and were included if they had received at least one cycle of therapy (intention-to-treat). Primary objectives were CR rate (patients with sufficient imaging data; centrally reviewed) and overall survival (OS, all patients included). Results: A total of 81 patients were analyzed (median age of 65 yrs; 52% male). 54 patients received hd-MTX alone (median age, 65 yrs) and 27 patients received hd-MTX/R (median age, 66 yrs). 37 and 24 patients in the two groups were evaluable for response, respectively. Among these, the CR rate was 51% in patients treated with hd-MTX alone (overall response rate, ORR, 76%) and 79% in patients treated with hd-MTX/R (ORR 96%). The median number of cycles to CR was 5 and 4.5, respectively. Median OS among all patients (both groups combined) was 26 months (95% CI: 11-44). Conclusions: These data show potential clinical benefit from the addition of rituximab to hd-MTX for newly diagnosed patients with PCNSL based on a higher CR rate. Analysis of OS benefit between patients treated with hd-MTX and hd-MTX/R is pending maturation of further survival data.

Introduction Iron overload is one of the most controversial topics in the management of anemic dialysis patients. Parenteral iron supplementation is commonly prescribed to hemodialysis (HD) patients but less frequently to peritoneal dialysis (PD) patients. Moreover, ferritin targets are far lower and more physiological in PD than in HD. Methods We compared the liver iron concentration (LIC) measured by means of Signal-Intensity ratio (SIR) magnetic resonance imaging (MRI) according to Rennes University method in a cohort of 32 PD patients living in the Paris region published in 2017, with two cohorts of French HD patients studied in the same way (119 patients reported in 2012 and 80 further patients reported in 2014). Results Normal hepatic iron load (LIC ≤ 50 µmol/g of dry weight) was observed in 81.3% of the 32 PD patients (CI: 64.3-91.5%), as compared to only 16% (CI: 10.4-23.7%) in the first HD cohort and 35% (CI: 25.4-45.9%) in the second HD cohort (p<0.0001 for both comparisons; X2 test). Mild iron overload (50 < LIC ≤ 100 µmol/g) was found in 5 PD patients and severe overload (LIC > 200 µmol/g) in only one PD patient (who had received IV iron) (3.1%; CI: 0-17.1%). Conversely, severe iron overload was found in 30.3% of patients in the first HD cohort (CI: 22.7-39%) and 11.3% of those in the second HD cohort (CI: 5.8-20.2%) (p= 0.0033 versus the first HD cohort, X2 test). Conclusion Contrary to hemodialysis patients, iron overload is rare and mostly mild in peritoneal dialysis patients.