Journal articles: 'Eighteen eighty-five' – Grafiati (2024)

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The role of age and education in adult moral reasoning was examined utilizing Kohlberg's cognitive-developmental stage theory of moral development and the most recent Standard Scoring System for assessing moral judgments. Individual interviews utilizing standard Kohlberg moral dilemmas were conducted with 195 adults ranging in age from nineteen to eighty-two years and in years of education from three to twenty-five years. Results indicated no overall significant effect for age of reasoner, no significant effect for sex, and a significant effect for education ( p < .01). However, the effect of age was significant in the group with eighteen or more years of education, but not in the group with less than eighteen years of education.

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Studies examining patient populations have found that information-seeking decreases with age. However, researchers usually define information-seeking as involving only the medical establishment, while they neglect other sources of information. The present study examined the use of two types of information sources, non-medical establishment (newspaper, television, and friends) and medical establishment (doctors and nurses), among seventy-five cancer patients aged eighteen to eighty-one years. Patients responded to questionnaires asking about information-seeking, desire for more cancer information, self-perception of their knowledge about cancer, and actual knowledge of facts about cancer. For the medical establishment source, information-seeking decreased with age; however, no age differences existed for seeking non-medical establishment information. In individuals with high levels of desire for information, older adults reported more information-seeking from non-medical sources than did younger adults.

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AbstractThis essay is a preliminary sketch for a book that examines Michelangelo Buonarroti’s final eighteen years, from his appointment as architect of St. Peter’s until his death in 1564, that is, from age seventy-one to a few weeks shy of eighty-nine. This period represents nearly a quarter of his approximately seventy-five-year artistic career, yet it remains the least familiar segment of Michelangelo’s long life. It is paradoxical that in the final phase of his career, Michelangelo remained prodigiously creative and influential without being prolific — as he had been earlier in his career. His late life was concerned less with making things than with finding the courage and devotion to continue tasks that he knew he would never see to fruition, and this despite the loss of his closest friends, greatest patron, and his entire family.

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Noted British actress Fanny Kemble lived eighty-four years on and off the theatrical and political stages of the nineteenth century. Kemble was an active writer who authored her first five-act play, Francis the First, at the age of eighteen. She would go on to write at least ten other published works, including a second full-length play, multiple journals recording her personal observations, notes on Shakespeare, and poetry collections. While Kemble remained devoted to writing as personal practice throughout her life, her most well-known piece of writing is her 1863 Journal of a Residence on a Georgian Plantation in 1838–1839. Kemble's journal documents her outrage and disgust at the living conditions, harsh daily existence, and enslaved individuals she encountered while living on the two Sea Island plantations that her husband, Pierce Butler, inherited off the coast of Georgia.

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AbstractThis paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Sideeffects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still ‘responders’ with an apnoea index (AI) reduction of >50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Sideeffects are common, but diminish with time.

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<p>The concept of Five-Factor Model (FFM) of Personality describes the basic dimension of human behavior, thinking, and emotions that related to the job. The FFM currently getting popular and reach more attention to from the scholars and practitioners as well, particularly in the area of human resource management. Therefore, the main goal of current research is to compile and to test the dimensions of FFM and its measure empirically. Eighty-four self report measures distributed to the 238 employees who work both for public and private organizations at the Northern Sumatera Island, Indonesia. The respondents are currently completing their graduate programs at the University of Bengkulu. Two-hundred-and-eighteen questionnaires completed and returned by respondents, and analyzed using Factor Analysis with Varimax Approach to extract them in to the several components. Based on the analyses, research confirmed the 5 dimensions for FFM, which is conscientiousness (18 items), extraversion-introversion (18 items), agreeableness (12 items), openness to experience (14 items), and emotional stability (12 items). The result strictly recommended that the use of FFP as a means of Human Resource Practices such as selection, promotion, training, and the like.</p><p><br />Keywords: Agreeableness, Conscientiousness, Emotional Stability, Extraversion, Openness to Experiences, Personality</p>

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Muscadine grape (Vitis rotundifolia) is the first native North American grape to be domesticated. During the past century, breeding programs have created a large collection of muscadine cultivars. Muscadine cultivars are usually identified by evaluating morphological traits and checking breeding records, which can be ambiguous and unauthentic. During this study, simple sequence repeat (SSR) markers were used to generate DNA fingerprinting profiles to identify muscadine cultivars and verify their reported pedigrees. Eighty-nine Vitis accessions were genotyped using 20 SSRs from 13 linkage groups. From these, 81 unique subgenus Muscadinia accessions were identified, and a core set of five SSR markers was able to distinguish all of them. Eighteen misidentifications were found, and five previously unknown accessions were matched with cultivars in the dataset. The profiles of 12 cultivars were not consistent with their reported parentage–progeny relationships. Genetic diversity was analyzed at four levels: all V. rotundifolia cultivars (N = 67); current cultivars (N = 39); historical cultivars (N = 28); and wild V. rotundifolia accessions (N = 9). There was substantial genetic diversity in both wild and historically cultivated muscadines. The principle coordinate analysis (PCoA) showed clear separation among subgenus Vitis cultivars, wild muscadine accessions, and cultivated muscadines, with PCoA1 and PCoA2 explaining 11.0% and 9.3% of the total variation, respectively.

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Magnetic resonance imaging (MRI) has been used to study the history of multiple sclerosis (MS). We analyze the relationship between MRI activity in the first scan compared to the subsequent five scans, and we evaluate whether a shorter observation period of 3 months may predict the subsequent 3 months. Monthly enhanced MRI was performed in 103 relapsing remitting (RR) MS patients for 6 months. Thirty-five per cent of patients had an inactive scan on the initial examination. More than 80% of them developed MRI activity during the following 5 months. Eighteen per cent of patients had three consecutive inactive scans; 65% of them had at least one active scan on the subsequent 3 monthly MRI's. The relationship between the first scan and all subsequent scans demonstrates a clear weakening over time. Eighty-two per cent of patients had at least one active scan during the initial 3 consecutive months, the chance of becoming inactive decreased from 23% to 0% over the subsequent 3 months, according with the mean number of enhancing lesions during the first 3 months. These results suggest that neither a single scan nor a short baseline of 3 months may adequately describe the natural history of disease in an individual RRMS patient.

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The opening pages of the annals of the Roman monarchy tell of long-lived rulers and thriving families. Augustus lived to the ripe age of seventy-six, survived by his wife of fifty-one years, Livia, who died at eighty-six, while her son Tiberius bettered his predecessor's record by two more years. Augustus’ sister Octavia gave birth to five children, all of whom lived long enough to get married; Agrippa left at least half a dozen children, and perhaps more; Germanicus, despite his tender age at death, was survived by no fewer than three sons and three daughters. At the same time, longevity and abundant offspring went hand in hand with early death and misery. More than a few luminaries of Augustus’ court were less fortunate than their elders: Marcellus died at twenty-three, the elder Drusus at twenty-nine, Augustus’ heirs Gaius and Lucius Caesar at twenty-three and eighteen. Drusus had lost a number of children save three that survived; Germanicus buried three of his six sons as infants.

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Objective: To compare dental arch relationship and craniofacial morphology of patients with CUCLP in pre-adolescence from five cleft centers including a center using NAM. Design: Retrospective cohort study. Setting: Five cleft centers in North America. Patients: One hundred eighty-two subjects with repaired CUCLP from the five cleft centers participated in the craniofacial form study. One hundred forty-eight subjects from four of the five centers participated in the dental arch relationship study. Methods: Digital dental models were assessed using the GOSLON Yardstick. Eighteen cephalometric measurements were performed. Measurement means, by center, were compared. Analysis of variance and Tukey-Kramer analysis were used to compare GOSLON scores and cephalometric measurements. Results: The center that performed neither PSOT (including NAM) nor primary bone grafting exhibited the most favorable mean GOSLON score. The same center also showed the highest mean SNA, ANB, and ANS-N-Pg angles. However, the mean ANB and ANS-N-Pg angles were not significantly different from those of the center using NAM. No statistically significant differences were seen for mandibular prominence, vertical dimensions, or dental inclinations. The center with NAM also showed a significantly smaller nasoform angle than two of the four other centers. Conclusion: The centers that used NAM and other forms of PSOT did not have better dental arch relationships or craniofacial morphology compared with the centers that performed only primary lip repair. However, this study was not designed to investigate the cause-and-effect relationship between specific outcomes and particular features of those protocols.

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AbstractObjectiveMuch is known about national trends in child undernutrition, but there is little information on how socio-economic inequalities are evolving over time. We aimed to assess socio-economic inequalities in stunting prevalence over time.DesignWe selected nationally representative surveys carried out since the mid-1990s for which information was available on asset indices and on child anthropometry. We identified twenty-five countries that had at least two surveys over an interval of 10 years or more, totalling eighty-seven surveys. Stunting prevalence was calculated according to wealth quintiles. Absolute and relative inequalities were calculated and time trends were obtained by regression.SettingNationally representative household surveys from twenty-five low- and middle-income countries.SubjectsChildren <5 years of age.ResultsNational prevalence declined significantly in twenty-two of the twenty-five countries. In eighteen out of twenty-five countries, relative reductions were higher among the rich than among the poor. Overall, there was no indication that inequalities improved. Striking examples are Nepal, with a 17·0 percentage points decline in stunting per decade, but where inequalities increased sharply; and Brazil, where stunting fell by 6·7 percentage points and inequalities were all but eliminated.ConclusionsGlobal progress in reducing stunting has not been accompanied by improved equity, but countries varied markedly in how successful they were in reducing prevalence among the poorest children. It is important to document how some countries were able to reduce inequalities, so that these lessons can be used to foster global progress, particularly in light of the increased importance of within-country inequalities in the post-2015 agenda.

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Objectives: To review and compare current Health Technology Assessment (HTA) activities for medical devices (MDs) across European HTA institutions.Methods: A comprehensive approach was adopted to identify institutions involved in HTA in European countries. We systematically searched institutional Web sites and other online sources by using a structured tool to extract information on the role and link to decision making, structure, scope, process, methodological approach, and available HTA reports for each included institution.Results: Information was obtained from eighty-four institutions, forty-seven of which were analyzed. Fifty-four methodological documents from twenty-three agencies in eighteen countries were identified. Only five agencies had separate documents for the assessment of MDs. A few agencies made separate provisions for the assessment of MDs in their general methods. The amount of publicly available HTA reports on MDs varied by device category and agency remit.Conclusions: Despite growing consensus on their importance and international initiatives, such as the EUnetHTA Core Model®, specific tools for the assessment of MDs are rarely developed and implemented at the national level. Separate additional signposts incorporated in existing general methods guides may be sufficient for the evaluation of MDs.

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BACKGROUND: Little is known about the frequency and nature of pain in dreams. Several authors have suggested that pain may be beyond the representational capability of dreaming.OBJECTIVE: To obtain more detailed information on the nature and prevalence of pain in a larger sample of everyday dreams collected through home logs. To examine the context within which dreamed pain occurs and to assess participants' retrospective recall of past experiences of pain in dreams.METHOD: One hundred and eighty-five participants completed a battery of questionnaires and recorded their dreams for two consecutive weeks.RESULTS: Retrospective responses to the questionnaire indicate that close to 50% of individuals report having experienced pain in their dreams at least once. A total of 3045 dreams were reported in the home dream logs. Eighteen of these dreams contained unambiguous references to the subject experiencing pain.DISCUSSION: Pain sensations in dreams are reported as being realistic, localized to a specific area of the body, typically resulting from violent encounters with other characters and often accompanied by intense affect. A model is proposed to explain how sensory experiences such as pain can be produced in the dream state.CONCLUSION: Cognitive systems that contribute to the representation of pain imagery are sometimes functional during dreaming.

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Abstract Pentostatin is a nucleoside analogue, it is a potent irreversible inhibitor of adenosine diaminase ADA. The triphosphate form of pentostatin is incorporated into DNA strand breaks. This effect is potentiated by the presence of an alkylating agent such as Cytoxan. Combination approaches will maximize the inhibition of DNA repair with less myelosuppression. A total of twenty five patients diagnosed with chronic lymphocytic leukmia treated with pentostatin combination in the last four years, nineteen patients had refractory CLL. Six patients has newely diagnosis with adverse features such as high risk cytogenetic/FISH abnormality, elevated serum Beta 2 microglobuline, elevated LDH, presence of the B symptoms, doubling time less than a year and progressive enlargment of spleen and lymph nodes. All patients had stage III-IV Rai classification. Fifteen males and ten females, eighty five percent were african american. Mean age is 52 years (range 46–70). Median follow up was eighteen months (range4–42 months). Thirteen patients recieved the combination of Pentostatin, Cytoxan and Rituxan. Rituxan or Rituximab is a chiemeric human monoclonal antibodies against CD expressing B cell lymphocytes. Pentostatin 4 mg/M2, Cytoxan 300 mg/M2 and Rituxan 375 mg/M2 given one day one every 28 days. Three patients recieved pentostatin and cytoxan. Nine patients recieved pentostatin and rituxan. Eighty percent of the patients recieved a minimum of six cycles. Complete response CR and near complete response nCR were confirmed by peripheral blood flowcytometric study. Ten patients achieved CR, nCR and fifteen patients achieved PR. One patient had short PR response less than six months post completing therapy. Five patients had autologous bone marrow transplant post CR, nCR response. Median time to progression is not reached. Toxicity observed with pentostain combination was minimal as compaired to retrospective analysis of Fludarabin whether as a single agent or in combination with cytoxan or rituxan. Bone marrow necrosis and tumor lysis syndrome were not seen. Neutropenic fever that required hospitaliztion is less than 10% as compaired to Fludarabin 40%. Growth factor G-CSF required less with pentostin combination. However, warm autoimmune hemolytic anemia was seen more during pentostatin therapy rather than prior to initiating therapy. Conclusion: Pentostatin has less myelosuppressive effect and equal response as compaired retrospectively to Fludarabine. Head to head randomized prospective study is needed.

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Background: Considerable evidence demonstrates the importance of dithiocarbamates especially disulfiram as anticancer drugs. However there are no systematic reviews outlining how their metal-binding ability is related to their anticancer activity. This review aims to summarize chemical features and metal-binding activity of disulfiram and its metabolite DEDTC, and discuss different mechanisms of action of disulfiram and their contributions to the drug's anticancer activity. Methods: We undertook a disulfiram-related search on bibliographic databases of peerreviewed research literature, including many historic papers and in vitro, in vivo, preclinical and clinical studies. The selected papers were carefully reviewed and summarized. Results: More than five hundreds of papers were obtained in the initial search and one hundred eighteen (118) papers were included in the review, most of which deal with chemical and biological aspects of Disulfiram and the relationship of its chemical and biological properties. Eighty one (81) papers outline biological aspects of dithiocarbamates, and fifty seven (57) papers report biological activity of Disulfiram as an inhibitor of proteasomes or inhibitor of aldehyde dehydrogenase enzymes, interaction with other anticancer drugs, or mechanism of action related to reactive oxygen species. Other papers reviewed focus on chemical aspects of dithiocarbamates. Conclusion: This review confirms the importance of chemical features of compounds such as Disulfiram to their biological activities, and supports repurposing DSF as a potential anticancer agent.

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Objectives: As part of a review of guidelines for sleep laboratories, this study summarizes the quality and relevance of evidence cited in support of recommendations on investigations for individuals with sleep disorders.Methods: Quality of evidence in support of each recommendation was rated as A (from well-conducted, prospective controlled studies), B (from controlled studies and case series, with minor shortcomings), or C (from case series or case series plus controlled studies with substantial limitations). Relevance of the cited evidence was also rated from A to C, in decreasing order of merit.Results: Of eighty-one recommendations from thirty-seven guidelines, forty-six were supported by evidence from primary studies. Six recommendations were supported by category A evidence, fifteen by category B, and twenty-five recommendations by category C. The cited evidence was highly relevant to eighteen recommendations, of some relevance for twenty-two and of little or no relevance to six. Four recommendations were informed by an absence of available evidence. For the other thirty-one, no evidence was provided in support.Conclusions: The approach used provided a concise overview of recommendations and supporting evidence for decision-makers. Guidelines on the use of sleep laboratory investigations contain much detailed information, but evidence supporting several recommendations is of limited quality and relevance. Furthermore, good-quality studies of many sleep laboratory applications are needed to assist both health policy formulation and clinical practice.

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AbstractLittle is known about long-term effects of homeopathic treatment. Following a double-blind, placebo controlled trial of classical homeopathy in chronic headaches, we conducted a 1-year observational study of 18 patients following the double-blind phase, and a complete follow-up study of all trial participants. Eighteen patients received free treatment for daily diary data (frequency, intensity, duration of headaches) over the course of 1 y. All patients enrolled in the double-blind study were sent a 6-week headache diary, a follow-up questionnaire, a personality inventory and a complaint list. Eighty-seven, of the original 98 patients enrolled returned questionnaires, 81 returned diaries. There was no additional change from the end of the trial to the one-year follow-up. The improvement seen at the end of the 12-week trial was stable after 1 y. No differential effects according to treatment after the trial could be seen. Patients with no treatment following the trial had the most improvement after 1 y. Five of 18 patients can be counted responders according to ARIMA analysis of single-case time-series. Patients with double diagnoses and longer treatment duration tended to have clearer improvements than the rest of the patients. Approximately 30% of patients in homeopathic treatment will benefit after 1 y of treatment. There is no indication of a specific, or of a delayed effect of homeopathy.

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Introduction: Neonatal period is the most susceptible period of life due to different causes, which in most cases are preventable. Every year millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU) for various indications. One of the Millennium Development Goals is to reduce under five mortality by two thirds by 2015. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to NICU. Materials and Methods: A retrospective study was conducted at level III Neonatal NICU of a tertiary -care teaching hospital from January, 2012 to December, 2012. Results: Total of 361 neonates were admitted in NICU. Eighty six neonates (23.8%) were admitted due to prematurity and 73 (20.2%) with birth asphyxia. Among birth asphyxia, 40(54.8%)were in HIE III, 27.4% and 17.8% in HIE II and HIE I, respectively. One hundred eighteen (32.6%) cases were diagnosed as sepsis. The overall mortality was 20.2% during hospital stay. Conclusions: Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortality. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8447 J. Nepal Paediatr. Soc. 2013;33(3):177-181

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Bone marrow transplantation (BMT) is now an option for some patients with sickle cell disease (SCD). Many SCD patients are multiply transfused with red blood cells (RBCs), and may be immunized to alloantigens other than erythrocyte antigens. Because platelet refractoriness is a significant complication during BMT, we wished to determine the prevalence of alloimmunization to platelets in transfused SCD patients. Sera collected from 47 transfused and 14 untransfused SCD patients were screened for HLA and platelet-specific antibodies. Transfusion and RBC antibody histories were reviewed. A subset of the patients were rescreened 1 year later. Eighty-five percent of patients with at least 50 RBC transfusions (22 of 26), 48% of patients with less than 50 transfusions (10 of 21), and none of 14 untransfused patients demonstrated platelet alloimmunization (P < .05). Platelet alloimmunization was more prevalent than RBC alloimmunization (20% to 30%). Half of the platelet reactivity was chloroquine-elutable. Eighteen of 22 patients (82%) on chronic RBC transfusion remained platelet-alloimmunized 11 to 22 months after initial testing. In summary, 85% of heavily transfused SCD patients are alloimmunized to HLA and/or platelet-specific antigens. These patients may be refractory to platelet transfusion, a condition that would increase their risk during BMT. Leukodepletion in the transfusion support of SCD patients should be considered to prevent platelet alloimmunization.

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Introduction. Patient satisfaction with the care they receive can beinfluenced negatively by a language barrier between the physician andpatient. However, there is a paucity of information regarding the consequencesof a language barrier on physician satisfaction, althoughthis barrier has the potential to decrease physician wellness. Thisstudy sought to determine if a language barrier is a source of professionaldissatisfaction in family medicine physicians in rural Kansas. Methods. In a cross-sectional study, members of the Kansas Academyof Family Physicians who practiced in the rural Kansas countieswith the highest percentage of Hispanic residents were surveyed. Aquestionnaire was developed to determine the demographics of thephysician, details regarding his or her practice, and percentage of Hispanicand Spanish-speaking only (SSO) patients in their practice.Physicians also were queried as to their level of Spanish-speakingability, availability of certified interpreters, and their satisfaction withcaring for their SSO patients. Results. Fifty-two physicians were identified and sent questionnairesby mail. Eighteen questionnaires were completed and returned, resultingin a 34% response rate. Respondents remained anonymous. In thepractices surveyed, 61% of practice settings had a Hispanic-patientpopulation greater than 25%. Only one of the eighteen respondentshad greater than 25% of SSO patients in his or her practice. A certifiedinterpreter was used less than 25% of the time in over 75% ofthe clinical encounters with SSO patients. Seventy-five percent ofphysicians reported no difficulty establishing trust and rapport withtheir SSO patients. Eighty-nine percent of respondents rated theirrelationship with SSO patients as good to excellent, and 83% weresatisfied with the care they were able to provide this group. Seventyeightpercent of respondents reported that their ability to care forSSO patients decreased or had no effect on their professional satisfaction.Seventy-eight percent of physicians also rated their overallprofessional satisfaction in regards to their physician/patient relationshipas good to excellent. However, language barriers affectedphysician-patient relationships, physician satisfaction with care, andprofessional satisfaction. Conclusion. Language barrier affected physician’s relationships withSSO patients, led to decreased physician satisfaction with the carethey provided and to decreased professional satisfaction.KS J Med 2017;10(4):79-83.

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Background: Ilite (Alnus jorullensis) is a very important pioneer species for the regeneration of temperate forests but also the source of fuel for the inhabitants of the Cofre de Perote National Park in Veracruz, Mexico. Questions: How much ilite is consumed by families in the Cofre de Perote National Park? What type of population structure is exhibited by Alnus jorullensis? Are there differences in population structure of this species between years? What is the diameter of the individuals extracted for firewood? Study site and dates: The population structure of ilite was evaluated during April 2016 and April 2017 in five localities of the Cofre de Perote National Park. Methods: Eighty families in these localities were interviewed about the use of firewood. Eighteen permanent plots of 20 × 50 m were established in order to record total height and diameter at breast height (130 cm) of standing trees of A. jorullensis and the basal diameter of its stumps. Results: Families in the study area indicated that they use in average 2 loads of ilite as firewood per week and extract adult individuals. Population density of ilite decreased from 2016 to 2017, in both years juvenile individuals were predominant, with a low presence of seedlings. Population structure did not differ between years. The basal diameters of stumps measured between 6 and 214 cm. Conclusions: Extraction of A. jorullensis did not change its population structure between years, however local inhabitants perceive that this activity and clandestine logging are affecting their availability.

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A survey was mailed to all institutions in Canada licensed to use radiopharmaceuticals. Questions addressed meal type; mode of preparation; and means, ranges and SD of emptying times. Seventy-eight per cent of 222 facilities responded, including all 55 teaching centres. Eighty-five per cent of teaching and 56% of nonteaching centres perform solid phase gastric emptying studies (GES). The majority use99mTc sulphur colloid (Tc-SC) added to eggs before cooking as the standard meal. Twenty-five per cent of teaching and 21% of nonteaching centres perform liquid phase GES. Most use a watery solution of111In-diethylenetriamine pentaacetic acid. Gastric emptying for solid phase GES, expressed as time for 50% emptying (mean t½), varied from 42 to 105 mins for centres using the Tc-SC egg meal. Twenty-eight per cent of teaching centres used ±2 SD to define their normal range, 26% used ±1 SD, 6% used ±1.5 SD, and 40% did not know the number of SD used. Twenty per cent of non-teaching centres used ±2 SD, 12% used ±1 SD and 68% did not know how many SD were used. For liquid phase GES, mean t½varied from 20 to 60 mins. Eighteen per cent of centres used healthy volunteers to establish or validate normal ranges. There is substantial variability among the normal ranges for radionuclide solid and liquid phase GES in both teaching and nonteaching centres across Canada. A minority of facilities have established or validated their own normal ranges in healthy volunteers. There is a need for a more standardized protocol and range of normal, with internal validation by each institution.

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The current recommendation for strict metabolic control of type 1 diabetes mellitus requires the administration of supraphysiological doses of insulin, which might result in insulin-mediated stimulation of androgen synthesis, as occurs in insulin-resistant states. At present, the prevalence of hyperandrogenic disorders in women with type 1 diabetes mellitus is unknown. Eighty-five women with type 1 diabetes mellitus were evaluated for symptoms and signs of hyperandrogenism. In 68 of the patients, several serum androgen and hormone concentrations were measured. The polycystic ovary syndrome (PCOS) was defined by the presence of menstrual dysfunction, together with clinical and/or biochemical evidence of hyperandrogenism, and exclusion of other etiologies. Eighteen healthy women, menstruating regularly, served as controls for the androgenic profiles. Thirty-three patients (38.8%) presented hyperandrogenic disorders (16 had PCOS, and 17 had hirsutism without menstrual dysfunction). Type 1 diabetic patients with PCOS presented increased serum total and free testosterone concentrations, and serum androstenedione levels, but had normal serum sex hormone-binding globulin and dehydroepiandrosterone-sulfate levels. Hirsute type 1 diabetic women without menstrual dysfunction presented normal serum androgen levels. There were no significant differences between hyperandrogenic and nonhyperandrogenic type 1 diabetes mellitus women in clinical variables such as the duration of diabetes, age at diagnosis of diabetes, conventional or intensive insulin therapy, mean daily insulin dosage, or metabolic control. In conclusion, women with type 1 diabetes mellitus have a high prevalence of hyperandrogenic disorders, including PCOS and hirsutism.

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PURPOSE A prospective study was performed to determine the outcome of patients with esophageal cancer who received preoperative radiation therapy and chemotherapy followed by esophagectomy, and to determine the role of preresection esophagogastroduodenoscopy (EGD) in predicting the patients in whom surgery could possibly be omitted, and the impact of surgery on survival. MATERIALS AND METHODS Thirty-five patients with localized carcinoma of the esophagus received concurrent external-beam radiotherapy and chemotherapy followed by esophagectomy. Patients received 45 Gy in 25 fractions. Chemotherapy consisted of continuous infusion fluorouracil (5-FU; 1,000 mg/m2/d) on days 1 through 4 and 29 through 32 and cisplatin (100 mg/m2) on day 1. Patients underwent an Ivor-Lewis esophagectomy 18 to 33 days after completion of radiotherapy. RESULTS Eighty percent of the patients had squamous cell carcinoma and 20% had adenocarcinoma. In addition, 51% had a pathologic complete response (CR). Twenty-two of the 35 underwent a preresection EGD before resection. Seventeen of the 22 (77%) had negative pathology from the preresection EGD, but seven of the 17 (41%) had residual tumor at surgery. The median survival and disease-free survival rates for all patients were 25.8 months and 32.8 months, respectively. Eighteen patients (51%) had no tumor at resection. The median survival for these patients was 36.8 months; the median disease-free survival time has not been reached. The median survival and disease-free survival rate for the patients with residual tumor in the surgical specimen were 12.9 months and 10.8 months, respectively. CONCLUSION Preresection EGD is not reliable for determining the presence of residual disease or the patients in whom surgery could be omitted. Twenty-five percent of the patients with residual tumor in the resected surgical specimen were long-term survivors; this suggests a benefit from esophagectomy after concurrent radiotherapy and chemotherapy.

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Pulmonary tuberculosis (PTB) and chronic obstructive pulmonary disease (COPD) are important causes of mortality and morbidity in Malaysia. The number of tuberculosis (TB) cases in Malaysia appears to be increasing and there were 500,000 Malaysians diagnosed with COPD in 2016. A substantial number of PTB patients go on to develop post tubular airway disease. Past infection with TB has been shown to contribute to the aetiology of COPD. We conducted a one year cross-sectional study in outpatient setting involving adult subjects in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with a history of pulmonary tuberculosis three years prior to the study. We excluded subjects with bronchial asthma, COPD, interstitial lung disease and bronchiectasis. Airflow obstruction was defined as FEV1: FVC ratio <0.70. The COPD Assessment Test (CAT) questionnaire was used. Eighty-two subjects were recruited with a median age of 52.5 years (IQR 36-62). Male predominance (56.1%) with 29 (35.4%) smokers. Eighteen (22%) subjects had airflow obstruction. Six (33%) out of these subjects were smokers. Fourteen(17%) had restrictive pattern and 50 (61%) had normal spirometry results. Five subjects (22.22%) had mild obstruction, 7 (44.44%) moderate obstruction, and 6 (33.33%) had severe obstruction. There was a positive correlation between chest X-ray abnormalities and age with airflow obstruction (P<0.05). Abnormal spirometry pattern was found in 39% of subjects. Post TB-COPD incidence was 22% in those who completed TB treatment. There appeared to be an association between abnormal chest radiograph findings with airflow obstruction in subjects with history of PTB.

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This prospective study was conducted in the department of pediatric surgery, BIRDEM General Hospital and other Private Hospital in Dhakato evaluate the morphological parameters after orchiopexy in Undescended testis (UDT). Fifty five children of cryptorchidism in the age group of 6 months to12 years were included in the study from September 2012 to March 2017. Patients' clinical characteristics, age at the time of orchiopexy, pre-operative ultrasonogram finding and intraoperative findings were recorded. On follow up postoperative complications and scrotal ultrasonogram findings were also recorded. Total 45 patients received regular ultrasound follow-up in next 6 months. Testicular length, width, position of the testes and any abnormal findings were documented. The testicular volume was then calculated with Hansen formula:Testicular volume= length (L) x width (W)2 x 0.52. The mean age at operation was 4.15 years. Sixty eightpercent of undescended testes were palpable, 97% of which could be initially placed in the scrotal position by surgery. Ninety threepercent remained in the scrotum at 6-month follow up. In 32% of cases, the testes were impalpable, 47% were intra-abdominal and 15.7% were absent. Eighty seven percent of all impalpable testes could be placed in the scrotum. At 6 months follow up, only 69% were in the scrotal position. Eighteen percent of impalpable testes and 2.4% of palpable testes underwent atrophy. The volume of scrotalized testis increased significantly after orchiopexy though the volume of undescended testis was smaller than that of normal descended testis in all age subgroups and revealed a slow growing trend.Medicine Today 2017 Vol.29(1): 35-38

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The aim of this study is to examine the teacher candidates&rsquo; technology competencies and perceptions in terms of various variables (gender, type of education, department, whether they have their own computers or not, the situation of connecting to the Internet). The study is a survey model, and the research group consists of five hundred eighteen teacher candidates studying in nine different departments in the spring term of 2018&ndash;2019 academic year at Atat&uuml;rk University Kazım Karabekir Education Faculty. &ldquo;Technology Perception Scale&rdquo; and &ldquo;Computer Competency Scale&rdquo;, which is developed by Tınmaz (2004), were used as data collection tools. The Cronbach alpha value of the Technology Perception Scale was calculated as ninety-four, and the Computer Competency Scale was eighty-eight. Independent Samples &ldquo;T&rdquo; test and Kruskal Wallis &ldquo;H&rdquo; test were used for data analysis. It has been concluded that there is no significant difference in terms of technology competencies of the teacher candidates in terms of education type, department, having own computer or not, and internet connection variabilities but there is a significant difference in terms of technology competencies in terms of gender (in favor of male) and there is a significant difference in terms of perceptions of gender (in favor of men), type of education (in favor of evening education), department, whether having a computer or not (in favor of having a computer) and the variables of connecting to the Internet.&nbsp;

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Introduction The aim of this article is to present an experience of two prospective studies from the International Childhood Liver Tumor Strategy Group (SIOPEL 2 [S2] and SIOPEL [S3]) trials and to evaluate whether modified platinum- and doxorubicin-based chemotherapy is capable of increasing tumor resectability and changing patient outcomes. Methods Between 1995 and 2006, 20 patients with hepatocellular carcinoma (HCC) were included in the S2 trial and 70 were included in the S3 trial. Eighty-five patients remained evaluable. Results Response to preoperative chemotherapy was observed in 29 of 72 patients (40%) who did not have primary surgery, whereas 13 patients underwent upfront surgery. Thirty-three patients had a delayed resection. Thirty-nine tumors never became resectable. Complete tumor resection was achieved in 34 patients (40%), including seven of those treated with liver transplantation (LTX). After a median follow-up period of 75 months, 63 patients (74%) had an event (a progression during treatment, a relapse after treatment, or death from any cause). Sixty patients died. Twenty-three of 46 patients (50%) who underwent tumor resection died. Eighteen of 27 patients (63%) with complete tumor resection (without LTX) and 20 of 34 patients (59%) with LTX survived. Only one of seven patients (14%) with microscopically involved margins survived. Overall survival at 5 years was 22%. Conclusion Survival in pediatric HCC is more likely when complete tumor resection can be achieved. Intensification of platinum agents in the S2 and S3 trials has not resulted in improved survival. New treatment approaches in pediatric HCC should be postulated.

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Purpose This multi-institutional registry study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). Patients and Methods A multi-institutional data registry that included 405 patients with DMPM treated by a uniform approach that used CRS and HIPEC was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival. Results Follow-up was complete in 401 patients (99%). The median follow-up period for the patients who were alive was 33 months (range, 1 to 235 months). The mean age was 50 years (standard deviation [SD], 14 years). Three hundred eighteen patients (79%) had epithelial tumors. Twenty-five patients (6%) had positive lymph nodes. The mean peritoneal cancer index was 20. One hundred eighty-seven patients (46%) had complete or near-complete cytoreduction. Three hundred seventy-two patients (92%) received HIPEC. One hundred twenty-seven patients (31%) had grades 3 to 4 complications. Nine patients (2%) died perioperatively. The mean length of hospital stay was 22 days (SD, 15 days). The overall median survival was 53 months (1 to 235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis: epithelial subtype (P < .001), absence of lymph node metastasis (P < .001), completeness of cytoreduction scores of CC-0 or CC-1 (P < .001), and HIPEC (P = .002). Conclusion The data suggest that CRS combined with HIPEC achieved prolonged survival in selected patients with DMPM.

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Purpose: Analysis of patients with late relapse (LR) of germ cell tumor (GCT) with reports on clinical characteristics, outcomes, and molecular and cytogenetic features. Patients and Methods: Eighty-three patients evaluated at Indiana University from 1993 through 2000 for relapse of GCT more than 2 years from initial therapy were reviewed. Available specimens were investigated for expression of the transcription regulator FoxD3 and apurinic/apyrimidinic endonuclease and the presence of chromosome 12 abnormalities. Results: Median interval from initial presentation to LR was 85 months. Forty-three of 49 LR patients who underwent surgery were rendered disease free (NED), and 20 (46.5%) remain continuously NED. Thirty-two patients received chemotherapy, but only six (18.8%) obtained a complete remission. Five of these patients remain continuously NED after chemotherapy alone, including three who were chemotherapy naïve. Eighteen of these 32 patients were successfully rendered NED by postchemotherapy surgery, and 12 remain continuously NED. Two patients continue on observation with no treatment for their LR. Overall, 69 of the 81 treated patients (85.2%) ultimately achieved an NED state, and 38 (46.9%) remain continuously NED with median follow-up from LR therapy of 24.5 months (range, 1 to 83 months), whereas nine other patients are currently NED after therapy for subsequent relapses. Because of the small numbers of specimens tested, we were unable to draw any definitive conclusions from the molecular and cytogenetic analyses. Conclusion: GCT patients require lifetime follow-up. At the time of LR, surgical resection alone remains our preferred therapy.

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Objective – To determine if library instruction has an effect on resources cited in student reports. Design – Citation analysis. Setting – The study took place in the medical school of a large American university. Subjects - One hundred eighteen of 120 first-year medical student reports were analyzed. Two reports did not include any works cited and were excluded from the study. Methods - Over the course of 3 years, 15 20-minute library instruction sessions were conducted. The sessions, based on five clinical cases presented each year were conducted approximately two weeks before each report due date. Eighty-five case-specific resources were demonstrated, with teaching plans being modified from year to year based on the frequency of citation of a particular resource cited the prior year. A LibGuide online course guide also directed students to specific resources shown in the class, with content updated every year based on citation trends from the previous year. Every citation referenced in a report was then categorized into a) those that were discussed during an instruction session, b) those found on a course guide, c) those accessible through the library, d) those available from course material (i.e., PowerPoint presentation, lecture notes), or e) those which did not fall under any of the other categories. A citation could be included in multiple categories. Main Results – The 118 reports included 2983 citations. Over the 3 year period, an average of 77.51% of all citations were from library resources, 49.55% of the citations from a resource demonstrated in the class, and 21.68% from resources found in the course guide. Although citations from sources discussed in class did not increase significantly from year to year, the percent of citations from resources on the course guide significantly increased from 19.40% to 25.63%. Conclusion – Medical students cite library resources emphasized during instruction sessions.

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The purpose of this study was to evaluate the frequency of multifocal osteonecrosis in patients with sickle cell disease. Between 1980 and 1989, 200 patients with sickle cell disease were treated in our institution for osteonecrosis. The patient population consisted of 102 males and 88 females with a mean age of twenty-six years at the time of presentation (range, eighteen to thirty-five years) and was followed until the year 2005. This cohort of patients was follow-up during average 15 years (until the year 2005). Multifocal osteonecrosis was defined as a disease of 3 or more anatomic sites. At the time of presentation, 49 patients were identified as having multifocal osteonecrosis. At the most recent follow-up, 87 patients had multifocal osteonecrosis. So at the last follow up among these eighty-seven patients, the occurrence of osteonecrosis was 158 lesions of the proximal femur associated with 151 proximal humerus osteonecroses, thirty-three lateral femoral condyle osteonecroses, twenty-eight distal femoral metaphysis osteonecroses, twenty-seven medial femoral condyle osteonecroses, twenty-three tibial plateau osteonecroses, twenty-one upper tibial metaphysis osteonecroses and forteen ankle osteonecroses. The total number of osteonecrosis was 455 in these 87 patients. The epiphyseal lesions were more frequent than the metadiaphyseal lesions excepted in the proximal tibia (Table 3). In conclusion, in patients with sickle cell disease, the risk of multifocal osteonecrosis is very high. In patients with hip osteonecrosis, the other joints should be evaluated with radiograph and MRI if the joint is symptomatic. In patients with osteonecrosis of the knee, shoulder or ankle, the patients’ hip should be evaluated by radiographs or MRI, regardless of whether the hip is symptomatic.

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Abstract Background and Aims The role of hepcidin in inflammatory bowel disease [IBD] in children with anaemia is poorly understood. However, it has been shown that vitamin D suppresses hepcidin expression. We aimed to assess serum hepcidin levels and the effect of vitamin D treatment on those levels in newly diagnosed IBD paediatric patients. Methods Eighty-five children were prospectively recruited in the Dana-Dwek Children’s Hospital [40 newly diagnosed IBD, 45 healthy controls, 47% female, mean age 13.5 ± 3.4 years]. Blood samples for measurement of interleukin 6 [IL-6], C-reactive protein [CRP], hepcidin, iron parameters and 25-hydroxyvitamin D [25-(OH)-D] levels were obtained at baseline. Patients with mild-to-moderate signs and symptoms of IBD were treated with 4000 units of vitamin D daily for 2 weeks, after which the blood tests were repeated. Results Basal hepcidin, IL-6, CRP and platelet counts were significantly higher, and haemoglobin, serum iron and transferrin levels were significantly lower in the IBD children compared to controls [p < 0.001]. Eighteen patients completed 2 weeks of treatment with vitamin D. Following treatment, serum 25-(OH)-D concentrations increased by 40% [from 22.5 to 32.5 ng/mL], and serum hepcidin, CRP and ferritin levels decreased by 81%, 81% and 40% [from 33.9 to 6.7 ng/mL, from 23.9 to 4.7 mg/L, and from 27 to 16 ng/mL, respectively] [p ≤ 0.001]. Conclusion Serum hepcidin levels were significantly higher in IBD paediatric patients compared to controls. Following vitamin D treatment, serum hepcidin concentration decreased significantly. These findings suggest a potential role for vitamin D in treating anaemia in IBD children. ClinicalTrials.gov number NCT03145896

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PURPOSE To determine what consumers and providers would want to discuss about breast cancer susceptibility testing (BCST) and their preferred role in testing decisions. METHODS We surveyed 426 at-risk women, 143 nurse practitioners, and 296 physicians in five specialties in Maryland. RESULTS All groups believe it is important to discuss how the chance of breast cancer can be reduced and what the chances are of getting breast cancer if the test is positive. Both provider groups attributed more importance than consumers to discussing whether cancer can occur if the test is negative. Discussing the risk of depression and anxiety was more important to providers than consumers. Eighty-two percent of women would want their providers to make a recommendation about testing, but only 43% of nurse practitioners and 68% of physicians would do so. Eighteen percent of physicians underestimated the importance of informed consent for testing and 34% of discussing the risk of insurance discrimination. Fewer than 6% of women, if found to have a mutation, would be likely to undergo prophylactic mastectomy, whereas 12% of nurse practitioners and 34% of physicians would be likely to recommend such surgery. One third of respondents in all three groups supported testing a 13-year old daughter of a mutation-carrier. CONCLUSION Physicians should place greater value on informed consent and discussing practical aspects of testing, and physicians and nurse practitioners should pay more attention to the limitations of testing children, insurance discrimination, and consumers' desire for provider recommendations. In light of the limited discordance between nurse practitioners and consumers, nurse practitioners can play an increasing role in education and counseling about BCST.

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PURPOSE In an attempt to understand some of the complex issues related to the participation of cancer patients in phase I trials, and the perceptions of patients toward these trials, we conducted a pilot survey study of 30 cancer patients who had given informed consent to participate in a phase I trial at our institution. Concurrently, the oncologists identified by the surveyed patients as responsible for their care were surveyed as well. PATIENTS AND METHODS Twenty-seven of 30 consecutive patients agreed to and completed the survey. Patients were surveyed before they received any investigational agents. Eighteen oncologists participated in this survey study. RESULTS Eighty-five percent of patients decided to participate in a phase I trial for reasons of possible therapeutic benefit, 11% because of advice/trust of physicians, and 4% because of family pressures. Ninety-three percent said that they understood all (33%) or most (60%) of the information provided about the trials in which they had decided to participate. Only 33% were able to state the purpose of the trial in which they were participating, with patients able to state the purpose of phase I trials being more educated (P = .01). Surveyed oncologists had wide-ranging beliefs regarding expectations of possible benefits and toxicities for their patients participating in phase I trials. CONCLUSION Cancer patients who participate in phase I trials are strongly motivated by the hope of therapeutic benefit. Altruistic feelings appear to have a limited and inconsequential role in motivating patients to participate in these trials. Cancer patients who participate in phase I trials appear to have an adequate self-perceived knowledge of the risks of investigational agents. However, only a minority of patients appear to have an adequate understanding of the purpose of phase I trials as dose-escalation/dose-determination studies.

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Purpose To assess the long-term efficacy and toxicity of front-line cisplatin-based chemotherapy in patients with stage IIA or IIB testicular seminoma. Patients and Methods Untreated patients with pure seminoma of the testis after orchiectomy, with clinical stage IIA or IIB, were considered eligible for this prospective observational study. Chemotherapy consisted of either four cycles of cisplatin and etoposide or three cycles of cisplatin, etoposide, and bleomycin. Results Between April 1994 and March 2003, 72 patients were entered onto the study at 26 participating centers. Eighteen patients had stage IIA disease, and 54 patients had stage IIB disease. Eighty-three percent of patients achieved complete response, and 17% achieved partial response with residual mass. After a median follow-up time of 71.5 months, six patients with stage IIB disease experienced relapse, and one of these patients died as a result of seminoma. Three patients experienced non–seminoma-related deaths (two died from a further esophageal carcinoma, and one died from an upper digestive hemorrhage). The estimated 5-year progression-free survival rates for patients with stage IIA or IIB disease were 100% and 87% (95% CI, 77.5% to 97%), respectively. Five-year progression-free and overall survival rates for the whole group were 90% (95% CI, 82% to 98%) and 95% (95% CI, 89% to 100%), respectively. Severe granulocytopenia and thrombocytopenia were observed in eight and two patients, respectively. Mild to moderate emesis, stomatitis, and diarrhea were the most common nonhematologic effects. Conclusion Chemotherapy is a highly effective and well-tolerated treatment for patients with stage IIA or IIB seminoma and represents an available alternative that could avoid some of the serious late effects associated with radiotherapy. Further studies focusing on long-term toxicities of different treatment modalities are needed.

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This study aimed 1) to explore Iranian EFL teachers’ attitudes towards the different aspects of the English textbooks prospect used at the first three grades of high school in Iran 2) to probe any relationship between the teachers 'attitudes towards prospect series and their TKT level. A questionnaire and a structured interview were utilized as instruments in this research. The questionnaire was structured in 3 units: The first unit was intended to record the respondents’ demographic information such as their age, sex, field of study, university, and teaching experience; the second unit including 24 items was intended to discover the respondents’ level of TKT; and the third unit including 28 items was designed to elicit the teachers’ attitudes towards the current high school textbooks. This questionnaire of attitude was designed in the form of Likert scale including strongly disagree, disagree, slightly disagree, agree, slightly agree and strongly agree. The data of the study were collected through administering the questionnaire to 80 teachers from Amol, Isfahan and Tehran. Also, semi-organized interviews have been carried out with twelve teachers selected from the eighty to cross-check the results of the study. Due to the rate of the absence, seventy of them completed the questionnaire. After administering questionnaire, the data were analyzed descriptively and inferentially. Out of the total seventy participants, Twenty five of them scored 3 in their TKT. Out of these 25 participants, two of them were intermediate achievers in the attitudinal questionnaire. Eighteen of them were high achievers and five of them were very high achievers. Also, forty five participants scored 4 in their TKT. Out of these 45 participants, one of them was intermediate achiever, thirty five of them were high achievers and finally nine of them were very high achievers. In order to measure whether Iranian EFL Teachers' attitudes towards the Book series ''Prospect'' taught in Iran's Schools and their TKT are related to each other, the researchers used Pearson Chi 2 and Fisher's Exact and the Pearson chi 2 p-value was 0.516 and the Fisher's exact p-value was 0.642. Since they are above %0.05, we can conclude that there is no significant relationship between Iranian EFL Teachers' attitudes towards the Book series ''Prospect'' taught in Iran's Schools and their TKT. The analytic study on the scores of the participants revealed the facts that a) the participants had positive (high) attitudes towards the English series Prospect b) There is not any significant relationship between the teachers’ positive attitudes towards the new text books and their TKT level.Keywords: Iranian, EFL Teachers, Attitude, Textbooks, High School, TKT

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Introduction:The importance of Cardiac Implant Registry (CIR) for ensuring a long-term follow-up in post-marked surveillance has been recognized and approved, but there is a lack of consensus standards on how to establish a CIR. The aim of this study is to investigate the structure and key elements of CIRs in the past decade (2006–2016) and to provide recommendations on “best practice” approaches.Methods:A systematic search on CIR was employed in line with the PRISMA guidelines. The following databases were searched: the PubMed (Medline), ScienceDirect, EMBASE and the Scopus database. After identifying the existing CIR, an inductive approach was used to explore key elements emerging in the identified registries.Results:The following eighty-two registries were identified: eighteen ICD registries, seven CRT registries, five pacemaker registries, and six Cardiovascular Implantable Electronic Device (CIED) registries which combined ICD, pacemaker and CRT implantation data; as well as twenty-two coronary stent registries and twenty-four TAVI registries. While seventy-one national or local registries are from a single country, forty-four are from European countries, and nine are located in USA. The following criteria have been summarized from the identified registries, including: registry working group, ethic issues, transparency, research objective, inclusion criteria, compulsory participation, endpoint, sample size, data collection basem*nt, data collection methods, data entry, data validation and statistical analysis.Conclusions:For HTA as well as regulatory decision making, medical device registries provide a “real-world” picture for patients, physicians, manufacturers, payers, decision-makers and other stakeholders. CIRs are important for regulatory decisions concerning the safety and approval issues of medical devices; for payers CIRs provide evidence on the medical device benefits and drive the decision as to whether the product should be reimbursed or not; for hospitals data from CIRs are important for sound procurement decisions, and CIRs also help patients and their physicians to reach a joint decision on which of the products is the most appropriate. However, many current CIRs are still lacking standards to inform on patient safety and ensure transparency.

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Abstract Clostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus present in the bacterial flora of the colon is the principal cause of nosocomial diarrhoea in adults. Aim: Assessment of favouring factors of Clostridium difficile infections as well as the interactions between them, in critically ill hospitalized patients undergoing complex medical and surgical treatments. Material and Methods: A retrospective case-control study involving eighty patients admitted in the Intensive Care Unit (ICU) of the County Clinical Emergency Hospital Tîrgu-Mureş was conducted between January and October 2014. Patients aged eighteen years and over, who had undergone complex medical and surgical treatment, were divided into two subgroups. Group 1 included patients who developed diarrhoea but were not diagnosed as having a Clostridium difficile infection (CDI). Group 2 included patients who developed diarrhoea due to CDI as indicated by a positive culture and the expression of exotoxin. The assessed parameters were age, length of stay (LOS), antibiotic spectrum, association with proton pump inhibitors (PPI) or H2-receptor antagonists, immunological status, the presence or lack of gastrointestinal tract surgery. Results: The mean age was 64.6 years with an average LOS of 10 days. Fifty-six percent of patients came to the ICU from internal medicine wards and forty-three percent from surgical wards. 20.5% of them were immunosuppressed. Co-association of ceftriaxone and pantoprazole significantly increased the risk of CDI compared to co-administration of any other antibiotic or pantoprazole (p=0.01). The odds ratio for Pantoprazole together with any antibiotic versus antibiotic therapy alone was significantly higher (p=0.018) with a sevenfold increase in the risk of positive exotoxin increase. Conclusions: Antibiotic use is associated with “no risk to develop CDI” in the first five days of administration. PPIs associated therapy increased the risk of CDI in first seventy-two hours regardless of the antibiotic type, and contributes to an active expression of CD exotoxin.

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Although fatigue is common among multiple sclerosis (MS) patients, evaluation of this symptom is difficult due to the subjectivity and variability of the complaint. We proposed the Fatigue Descriptive Scale (FDS) as a tool to evaluate the severity and quality of fatigue in a group of patients suffering from MS. As a way to demonstrate the usefulness of this scale we applied the FDS in a group of 155 patients (105 women and 50 men) with clinically-definite multiple sclerosis, as outlined according to Poser’s criteria. Age was 36.2±11.1 years (range 12-62) and time of evolution was 8.3±9.4 years (range 1-44). The Fatigue Severity Scale (FSS) was also used. Descriptive statistics techniques and techniques for nonparametric distribution (Spearman Rank, Kruskal-Wallis ANOVA) were used. One hundred and eighteen patients reported fatigue (73 spontaneously, 45 when questioned). All descriptions of fatigue were ranked according to FDS categories. Eighty-five patients defined the symptom as fatigue with exercise, 26 as asthenia and seven as the worsening of other symptoms. Fatigue by itself produced limited or disrupted activity in 78 patients; work-related functions were limited in 48 patients; social relations were limited in 29 patients; and self-care was difficult for one patient. Fifty-six patients suffered fatigue daily. FDS score was 4.9±3.9 (range 0-13). FSS was 3.1±1.7 (range 0.2-6.6). FDS and FSS of Krupp were highly correlated (R=0.87, p<0.001). Therefore, in comparison with other scales, the FDS shows remarkable usefulness in classifying, periodicity, and severity of fatigue in MS patients. The high correlation with the FSS implies that it is a valid method to measure the severity of fatigue, as was demonstrated in our paper proposing the FDS. The importance of this new scale is its ability to inform the clinicians in a very quick, easy, and at the same time complete way, how severe the fatigue really is and how it affects the patient.

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✓ This prospective review of adult patients with head injuries examines the incidence of head injuries due to falls caused by seizures, the incidence and severity of intracranial hematomas, and the morbidity and mortality rates in this patient population. A head injury was attributed to a fall caused by a seizure if the seizure was witnessed to have caused the fall, or the patient had a known seizure history, appeared postictal or was found convulsing after the fall, and no other cause for the fall was evident. A total of 1760 adult head-injured patients were consecutively admitted to the authors' service between 1986 and 1993. Five hundred eighty-two head injuries (33.1%) were due to falls and 22 (3.8%) of these were caused by seizures. Based on the prevalence rates for epilepsy in the general population of 0.5 to 2%, these results indicate that epileptics are several times more likely to suffer a head injury due to a fall. Mass lesions were found in 20 (90.9%) of these 22 patients and the remaining two patients suffered mild diffuse head injuries. There was a high incidence of extraaxial mass lesions: 17 (85%) of the 20 intracranial hematomas were either epidural (five cases) or acute subdural (12 cases) hematomas. Eighteen (81.8%) of the 22 patients required evacuation of a hematoma. Both the incidence of intracranial hematomas (90.9% vs. 39.8%; p < 0.001, chi-square analysis) and the rate of hematoma evacuation (81.8% vs. 32.3%; p < 0.001) was significantly greater in patients injured in falls due to seizures (22 cases) than in the group injured in falls from all other causes (560 cases). The higher incidence of hematomas and the need for evacuation were not explained by differences in age, severity of head injury, or incidence of alcohol intoxication. Despite the greater incidence of mass lesions and the need for operative treatment in patients injured because of seizures, their mortality rate was similar to that of patients injured in falls from other causes. On the basis of their review of patients admitted to a neurosurgical center with complaints of head injury, the authors conclude that patients with head injuries due to a fall caused by a seizure should undergo computerized tomography scanning early in their management. Until a mass lesion has been excluded, any decrease in level of consciousness or focal neurological deficit should not be attributed to the seizure itself.

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Abstract Introduction: ATL in advanced stage is a lymphoid malignancy with poor prognosis, its mean survival time being a few months. Allogeneic hematopoietic stem cell transplantation has been shown to be potentially curative approach, but the availability of HLA-matched donor, either of related or unrelated, limits its application to many of the patients. Cord blood has been widely used as an alternative donor cells. We report here the feasibility of RICBT for patients with advanced ATL. Patients and Methods: Eighteen patients with advanced ATL, including 11 acute type and 7 lymphoma type, who underwent RICBT between March 2002 and June 2005 at our institution, were retrospectively analyzed. Eighty percent of them were chemo-refractory at the time of transplant. Median age of the patients was 59 years (27–79). Pretransplant conditioning regimen consisted of fludarabine 125 mg/m2, melphalan 80 mg/m2 and TBI 4 Gy. GVHD prophylaxis was either cyclosporine (CSP, n=11) or tacrolimus (TAC, n=7) alone. The median number of infused nucleated cells and CD34 positive cells were 2.83 (1.95–4.83) x 107 and 1.00 (0.40–2.91) x 105, respectively. All the patients received CB units with HLA mismatches at 1 (n=8) or 2 (n=10) loci. Results: Neutrophil and platelet engraftment were observed in 15 (83.3%, median 16 days) and 14 patients (77.8 %, median 42 days). Two died before engraftment. Five of the engrafted patients (30%) developed acute GVHD (grade II–IV). Although 14 out of 15 patients who survived over 30 days achieved complete remission, 6 died of non-relapse mortality (NRM) within 100 days post-transplant (5 sepsis, 1 encephalitis), and another 6 died of relapse (median 225 days post-transplant). Five of the 7 patients who were alive beyond 100 days developed chronic GVHD (4 limited, 1 extensive). One patient experienced rapid tumor regression along with the chronic GVHD after cessation of TAC at day 146 post-transplant, indicating possible GvATL effect. Estimated 1-year overall and progression-free survival rates were 27.9 +/− 9.0 % and 17.2 +/− 12.8 %, respectively. Among 9 survivors beyond 100 days post-transplant, 5 remain alive at median follow-up of 17 months but only 2 of them remain progression free. Univariate analyses revealed high age (over 60), poor ECOG performance status (over 2) and high sIL-2R level (over 10000IU/L) as poor factors for survival. TAC dramatically decreased the day 100 mortality (14.3%) compared with CSP (45.5%). Conclusion: This pilot study indicates that our RICBT is feasible even for the ATL patients in advanced stage. Day 100 mortality was improved by using TAC but eventually the overall survival decreased to comparable level with CSP. To further improve the outcome, RICBT should be investigated for patients in early stage of the disease, or new approach to prevent late relapse should be explored.

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AML (acute myeloid leukemia) patients with relapsed refractory diseases or in poor physical conditions have very limited choices of appropriate treatment regimens, and most alternative options are costly. Here, we reported that an affordable regimen with combined recombinant human interferon-α-1b (IFN-α1b), thalidomide, and recombinant interleukin-2 (IL-2) (the ITI regimen) achieved varying degrees of therapeutic effects in AML patients of various disease status and vulnerabilities. ITI regimen was administrated as follow: a subcutaneous injection of IFN-α1b 60 μg qod, IL-2 1 million unit qod, and 200mg thalidomide tablet orally taken every night before sleep. Group A Sixty-eight patients who were with relapsed or refractory AML were enrolled, sixty finished at least one course, a response rate (CR+CRi) of 16.7% (10/60) was observed, and, and 7 (11.7%) patients achieved partial remission.(Table 1) Group B Eighteen patients with morphologically complete remission and consistently positive MRD were enrolled, each patients underwent ITI regimen for 2 months at least. According to the criteria of the WHO risk stratification, 7 were with a favorable risk, 8 were with a intermediate risk, and 3 were with a high risk. Patients with FLT3-ITD mutations were treated with oral sorafenib during early induction and consolidation treatment. These 18 patients received conventional dosage of ITI regimen. Seven patients had a negative MRD after 1 or 2 months. The MRD levels of 3 patients significantly decreased after one or two months. Five patients suffered a Morphological relapse. Another 3 patients failed to the conventional dosage of ITI regimen with an increased MRD rate, but it decreased after we made a modification of IFN-α1b and IL-2 administration daily. The response rate of the 18 patients in Group B was 72.2%, where MRD < 0.01% was defined as the negative threshold. (Table 2) Group C Eighty-eight patients with MRD-negative AML after consolidation were enrolled. Among the 88 patients with initial CR, 11 (12.5%) relapsed during the maintenance period (Figure 1). All these 11 patients relapsed within 2 years, with a median recurrence period of 20 months, of which 2, 4, and 5 patients, respectively, were with favorable, intermediate, and high risk. The indicated that this regimen effectively reduced the relapse rate.(Table 3) Disclosures No relevant conflicts of interest to declare.

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Background: Therapeutic approaches to spinal cord stimulation (SCS) continue to evolve and improve patient outcomes in patients receiving SCS therapy secondary to failed back surgery syndrome. Objectives: The aim of this study was to evaluate pain relief and other patient outcomes of SCS using selected high-dose programming parameters. Study Design: This was a prospective cohort study. Setting: This study took place at 11 centers in North America. Methods: Forty-four SCS-naive patients underwent trialing, starting with 1,000 Hz frequency, 90 µs pulse width followed by 300 Hz frequency, 800 µs pulse width, if pain relief was inadequate. Patients with 50% or greater pain relief were eligible for permanent implantation. Patient’s pain rating, global impression of change, health-related quality of life, functional disability, satisfaction/ recommendation, stimulation perception, device programming, and adverse events were assessed at 3 months postimplant. Results: There were significant improvements from baseline in mean Numeric Rating Scale (NRS11) pain scores for overall pain (7.5 to 3.8; P < 0.01), back pain (7.2 to 3.4; P < 0.01), leg pain (7.2 to 3.1; P < 0.01), Oswestry Disability Index (ODI) score (51.5 to 32.1; P < 0.01), and European Quality of Life–Five Dimensions, version 5L score (EQ-5D-5L) (0.58 to 0.74; P < 0.01). Twentyeight of 32 patients (88%) had significant, favorable improvement in Patient Global Impression of Change (PGIC). Eighty-four percent of patients were “satisfied,” and 78.1% would “definitely” recommend SCS. Eighteen patients (56%) used 1,000 Hz frequency and 90 µs pulse width exclusively; these patients experienced mean NRS-11 overall pain score improvement of 4.7 points. Device-, therapy-, or procedure-related adverse events were experienced in 19 patients (40%, 19 of 48), and all events resolved without reoperation and were similar to those observed with traditional SCS systems. Limitations: There was no active or sham comparator group, and therefore the reported effects may not be solely attributable to therapy effects and may be related to other, nonspecific effects of SCS. Conclusions: Improvements in pain relief, PGIC, EQ-5D-5L, ODI, and patient satisfaction were all clinically relevant and statistically significant. Future studies are needed to understand how these high-dose parameters perform versus a standard comparator. Key words: Spinal cord stimulation, high-frequency electrical stimulation, failed back surgery syndrome, neurostimulation, prospective, nonrandomized study

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Background:Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.Objectives:To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.Methods:This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.Results:This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.Conclusion:Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.Disclosure of Interests:None declared

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ABSTRACTThis paper reports on a longitudinal study of old people over the age of sixty-five living in rural Wales. Particular attention is paid to those who were over eighty in 1983, compared with the 1979 over-eighties. Whilst the findings demonstrate increased inputs of statutory domiciliary support with increased dependency, such support is clearly supplementary to the role of informal services. The paper shows that despite increased levels of dependency amongst the old elderly, levels of domiciliary services have not kept pace. Rationing mechanisms appear to focus services on the over-eighty-fives so that levels of support to younger age groups are essentially reduced.

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Abstract High-dose chemotherapy (HDC) with autologous hematopoietic stem cell transplantation (ASCT) is the treatment of choice for patients (pts) with AL amyloidosis (AL) eligible for this therapy. Because of a high treatment-related mortality (TRM), pts admitted for HDC have to be selected by risk analysis. It is unclear whether pts should receive HDC directly after diagnosis or after an intensive pre-treatment with induction and/or mobilization chemotherapy. We have retrospectively analyzed all pts with AL admitted to our centre. The first aim of the study was to analyze the influence of prior chemotherapy on survival. Secondly, pts at high risk not to proceed to HDC should be identified by clinical parameters at first contact. 186 pts have been admitted to our centre since 1998 with the diagnosis of AL. 172 pts were ≤ 70 years of age and were tested regarding eligibility for HDC and ASCT. Major eligibility criteria were cardiac disease &lt; NYHA stage IV and performance status (PS) &lt; 4. Eighty-three pts (median age 56 years, range 34–69; AL n=71, multiple myeloma &gt;stage I with AL, n=10, NHL with AL, n=2) fulfilled the major eligibility criteria and started either (re-) induction (n=57) or mobilization chemotherapy (n=20) or went directly to HDC after G-CSF stimulated stem cell harvest (n=6). Induction treatment consisted of VAD/AD in 34 pts, pulsed dexamethasone (D) in 24 pts or other regimens in 2 pts. Mobilization chemotherapy included cyclophosphamide (C) in 2 pts, CAD (C/adriamycin/D) in 44 pts, ifosfamide in 13 pts and other regimens in 2 pts. Overall, in 72 pts stem cell mobilization has been performed. Sixty-five pts have been treated with HDC. The estimated overall survival for the whole group is 60% (last event at 54 months, median follow-up 22 months). Fifty-six out of 65 transplanted pts are alive. Three pts died of TRM (5%), 6 pts died of AL progression. Eighteen pts (22%) have not been transplanted for several reasons which is comparable to the 16% reported by Oran et al. (BMT 2005). These included organ progression after induction chemotherapy in 13 pts and chemotherapy-induced mortality in 5 pts resulting in an overall TRM prior to HDM of 6%. Currently, only 2 out of these 18 pts are still alive, 11 pts died of organ progression after the decision against HDC. Our analysis shows that induction chemotherapy does not result in increased mortality prior to (6%) and after (5%) HDC compared to published data using G-CSF alone for mobilization (4% and 6%, Oran, BMT 2005). Significant factors for prediction not to proceed to HDC were number of organs involved (p=0.04) and NYHA stage (p=0.006) at first contact (multivariate analysis). Whether this intensive approach will finally lead to improved survival might be shown with a longer observation after HDC and ASCT.

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Abstract Abstract 2600 Poster Board II-576 In t-MDS/t-AML the chromosomal pattern is not only essential for prognostic evaluation and choice of therapy, but it also reflects the etiology of the disease, being strictly related to the type of previous anticancer chemotherapy. In fact, it has been highlighted that different alternative genetic pathways and cooperating genetic abnormalities play a pivotal role in the pathogenesis of t-MDS/t-AML (Pedersen-Bjergaard et al, 2006). Even more recently, it has been revealed that deletions or mutations of the TET2 gene, a tumour suppressor gene mapped at 4q24, are shared by many disparate myeloid disorders and are an early event in their pathogenesis (Delhommeau et al, 2009). TET2 mutations, identified by DNA sequencing, occur in 24% of t-MDS/t-AML patients, while its deletion, as identified by FISH, occurs in only 5% of patients. Based on these findings, the present study employed FISH to establish the incidence of band 4q24 deletions/structural defects in a series of 89 t-MDS/t-AML examined between January 1993 and January 2009 and to estimate whether TET2 deletion was correlated with a peculiar genetic pathway or with particular clinical data. There were forty-five females and forty-four males, whose median age was 58 years (range 25–78). Twenty patients had previously been affected with Hodgkin's lymphoma, eighteen with breast cancer, twelve with essential thrombocytemia, seven with polycythemia vera, seven with non Hodgkin's lymphomas, three with ovary cancer and twenty-two with solid tumours. Nine patients had received radiotherapy (RT) only, forty-seven chemotherapy only and thirty-three both treatment modalities. Overall, alkylating agents (AA) were given to fifty-seven patients, topoisomerase inhibitors (TI) to twenty-three and antracyclines (A) to five patients. Patients treated with AA developed t-MDS after a median time of 62 months (range 55–76) and t-MDS had a median duration of 6 months (range 4–14). In contrast, patients treated with TI and A developed t-AML without a preceding t-MDS after a median time of 18 months (range 12–26). At our observation, eighty-one patients presented with t-AML, (according to WHO twenty-one patients were diagnosed as M0, nineteen as M1, ten as M2, three as M3, four as M4, three as M5 and four as M7) and eight patients as t-MDS (according to WHO five patients were classified as RA and three as RAEB-2). At diagnosis, 76 patients (85%) presented clonal cytogenetic abnormalities involving chromosome 5 only (23.6%), chromosome 7 only (28.9%), both chromosomes (25%) and recurring balanced rearrangements (15.7%). A structural defect of chromosome 4 was revealed by conventional cytogenetics (CC) in three patients. A der(4)t(1;4)(p22;q23), a deleted chromosome 4 and a t(3;4)(q21;q24) were revealed in one patient each. Up to now FISH with the 144B4 (mapped at 14q22.3), 810D13, 571L19, 414I7 (all mapped at 4q23), 356L5 and 16G16 (both covering the TET2 gene at band 4q24), 642P17, 788K3, 752J12 (all mapped at 4q24) and 66J16 (mapped at 4q25) probes was carried out in 13 patients. All these probes were obtained from BACPAC Resources Center at C.H.O.R.I. (Oakland, USA), labelled and applied as previously reported. The cut-off values for interphase FISH (i-FISH) were obtained from the analysis of 300 nuclei from ten normal samples and were fixed at 10%. The patient with the unbalanced t(1;4) translocation showed that 88% of interphase and mitotic cells had lost the 356L5, 16G16, 788K3 and 642P17 probes and had maintained the 752J12 and 66J6 probes. So, this patient presented a loss of the TET2 gene and of the 788K3 and 642P17 probes even if the breakpoint of the chromosomal translocation was localized at band 4q25. The other two patients presented a cryptic deletion of the 356L5, 16G16 and 788K3 probes. In conclusion, our data confirm that in t-MDS/t-AML i) specific chromosomal defects are strictly related to the type of chemotherapy administered for a previous cancer and flag the alteration of disparate molecular pathways; ii) TET2 deletion as investigated by FISH is a rather rare event and does not seem to be correlated with any specific defect. Disclosures: No relevant conflicts of interest to declare.

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Abstract Background : A substantial proportion of older patients with AML are considered unlikely to benefit from an intensive treatment approach. They often receive either best supportive care (BSC), low dose treatment such as Low Dose Ara-C (LDAC), or clinical trials of novel agents. In one of the few randomised studies where patients were prospectively considered likely to be unfit for intensive therapy, LDAC was superior to BSC with 18% v 1% patients achieving CR. No patients with high risk cytogenetics (Grimwade 1998), achieved CR (Burnett 2007). Laromustine (Cloretazine®) is a novel sulfonylhydrazine alkylating agent which preferentially targets the O6 position of guanine resulting in DNA cross-links. Laromustine has previously shown clinical activity in patients with de novo AML and high risk MDS (Giles et al. JCO 2007). A confirmatory phase II study of single agent laromustine was conducted in previously untreated patients ≥ 60 years old with de novo AML, prospectively considered likely to be unfit for intensive chemotherapy. Patients had at least one poor risk factor, defined by age ≥70, performance status 2, unfavorable cytogenetics, or cardiac, pulmonary or hepatic dysfunction. Eighty-five patients received induction therapy with 600 mg/m2 laromustine. Second induction cycles were administered in 14 patients after partial response or hematologic improvement. Eighteen patients received at least one consolidation cycle of cytarabine 400 mg/m2/day CIV for 5 days. Methods: A retrospective non-randomised comparison was performed between the 85 patients treated with laromustine, and 121 patients satisfying the same entry criteria, treated in the AML 14 trial with either BSC or LDAC. Outcomes were compared using Mantel-Haenszel and logrank methods for unadjusted comparisons, and regression methods for adjusted analyses. Results : Patients in AML14 were slightly older than those treated with laromustine (median age 75 v 73), and tended to have higher white blood cell counts; by contrast, there were significantly fewer cardiac or respiratory comorbidities reported in the AML14 population. Other important risk factors such as performance status and cytogenetics were similar between the groups. Responses overall (CR/CRp) were seen in 33% (28/85) of patients treated with laromustine, compared with 2% (1/60) and 23% (14/61) in patients treated with BSC and LDAC (p&lt;0.0001, p=0.2, respectively). In particular, 1 patient with −5/del(5q), and 3 patients with −7/del(7q) cytogenetics experienced a CR with laromustine; patients in AML 14 with adverse cytogenetics saw no remissions. Survival was significantly improved in the laromustine group compared to BSC (1 year survival 20% v 8%, unadjusted HR 0.58 [0.40–0.84] p=0.004), and roughly comparable to that of LDAC (1 year survival 20% v 25%, HR 1.04 [0.73–1.49] p=0.8). Analyses adjusted for differences in baseline demographics, and using propensity scores gave consistent figures. Conclusions: Retrospective comparison of unrandomised data has significant limitations even though care has been taken to match for factors known to be predictive for survival. Laromustine was able to achieve a higher CR rate than LDAC or BSC, and produced remissions in groups where no remissions have previously been seen with LDAC or BSC. Laromustine gave significantly better survival than BSC, and demonstrated similar survival to LDAC.