As we reported previously (Eur J Cancer 1991;27(SI2): 107; Ann Oncol 1994;5(S8):66) treatment with CBDCA, MTX and VBL is as effective as M-VAC in advanced bladder cancer with long-term survival and ...can be safely given in an outpatient basis and in pts with impaired renal function. We designed a multicentric study, randomizing pts to receive NCT followed by cistectomy (branch A) or cistectomy alone (branch B). We present the results of pts treated in one institution.
The inclusion criteria were transitional IBC T3b–4aN0M0, T2–3aN0M0 with obstructive uropathy or presence of diffuse Tis, and creatinine <130 x 1.25 μmol/L. The schedule of NCT was: MTX 30 mg/m
2 and VBL 4 mg/m
2 (d
+
1, +8) and CBDCA 350 mg/m
2 (d +2); 3 cycles, every 4 weeks. All surgical specimens were reviewed by one pathologist*.The minimum follow-up was 2 years. Sixty-six pts were analyzed: 33 pts in branch A, 33 pts in branch B.
Postoperatory mortality was 3%. Response rates were: pCR and pPR 20% and 23% in branch A, and 3% and 12% in branch B. The pCR differences (17%, Cl 2–32%) and the pCR
+
pPR differences (28%, Cl 7–50%) were statistically significant with p
<
0.04 and p < 0.02 respectively. There were no survival differences between the two branches. Five-year survival was 50%.
It's the first time that NCT in IBC has demonstrated more pathological responses than the transuretral resection alone. More pts and more trials are needed to confirm these results. The absence of survival differences could be due to chemotherapy selection of pts with a good prognosis in branch A.
Knowledge of the abundance distribution of star forming regions and young clusters is critical to investigate a variety of issues, from triggered star formation and chemical enrichment by nearby ...supernova explosions to the ability to form planetary systems.In spite of this, detailed abundance studies are currently available for relatively few regions. In this context, we present the analysis of the metallicity of the Gamma Velorum cluster, based on the products distributed in the first internal release of the Gaia-ESO Survey. The Gamma Velorum candidate members have been observed with FLAMES, using both UVES and Giraffe, depending on the target brightness and spectral type. In order to derive a solid metallicity determination for the cluster, membership of the observed stars must be first assessed. To this aim, we use several membership criteria including radial velocities, surface gravity estimates, and the detection of the photospheric lithium line. Out of the 80 targets observed with UVES, we identify 14 high-probability members. We find that the metallicity of the cluster is slightly subsolar, with a mean Fe/H=-0.057+/-0.018 dex. Although J08095427-4721419 is one of the high-probability members, its metallicity is significantly larger than the cluster average. We speculate about its origin as the result of recent accretion episodes of rocky bodies of ~60 M_Sun hydrogen-depleted material from the circumstellar disk.
To calibrate automatic pipelines that determine atmospheric parameters of stars, one needs a sample of stars -- ``benchmark stars'' -- with well defined parameters to be used as a reference We ...provide a detailed documentation of the determination of the iron abundance of the 34 FGK-type benchmark stars selected to be the pillars for calibration of the one billion Gaia stars. They cover a wide range of temperatures, surface gravities and metallicities. Up to seven different methods were used to analyze an observed spectral library of high resolution and high signal-to-noise ratio. The metallicity was determined assuming a value of effective temperature and surface gravity obtained from fundamental relations, i.e. these parameters were known a priori independently from the spectra. We present a set of metallicity values obtained in a homogeneous way for our sample of Benchmark Stars. In addition to this value, we provide a detailed documentation of the associated uncertainties. Finally, we report for the first time a value of the metallicity of the cool giant psi Phe.
Context. Recent metallicity determinations in young open clusters and star-forming regions suggest that the latter may be characterized by a slightly lower metallicity than the Sun and older clusters ...in the solar vicinity. However, these results are based on small statistics and inhomogeneous analyses. The Gaia-ESO Survey is observing and homogeneously analyzing large samples of stars in several young clusters and star-forming regions, hence allowing us to further investigate this issue. Aims. We present a new metallicity determination of the Chamaeleon I star-forming region, based on the products distributed in the first internal release of the Gaia-ESO Survey. Methods. 48 candidate members of Chamaeleon I have been observed with the high-resolution spectrograph UVES. We use the surface gravity, lithium line equivalent width and position in the Hertzsprung-Russell diagram to confirm the cluster members and we use the iron abundance to derive the mean metallicity of the region. Results. Out of the 48 targets, we confirm 15 high probability members. Considering the metallicity measurements for 9 of them, we find that the iron abundance of Chamaeleon I is slightly subsolar with a mean value Fe/H=-0.08+/-0.04 dex. This result is in agreement with the metallicity determination of other nearby star-forming regions and suggests that the chemical pattern of the youngest stars in the solar neighborhood is indeed more metal-poor than the Sun. We argue that this evidence may be related to the chemical distribution of the Gould Belt that contains most of the nearby star-forming regions and young clusters.
The disposition kinetics of amikacin were established in 12 patients with varying degrees of renal impairment (Clcr less than 70 ml/min) after i.m. administration of a dose of 7.5 mg antibiotic/kg ...body wt. Administered intramuscularly, amikacin follows a single-compartment open kinetic model. A decrease may be observed in the absorption and elimination processes in this kind of patient, and mathematical relationships may be established between the variation in the pharmacokinetic parameters and the creatinine clearance. The decrease observed in the elimination constant of amikacin is similar to that observed after i.v. administration of the antibiotic. A dosage regimen for administration of the antibiotic is proposed for this kind of patient on the basis of desired peak and trough serum levels obtained throughout treatment.
An attempt was made to evaluate the frequency of the different diseases in a given population and health area so as to establish health policy programs. A method of comparison of results was used for ...two pediatric clinics in two health centers, and the frequency of the different chronic diseases in the overall children population attending both centers (asthma, urinary tract infections, gastroesophageal reflux, febrile seizures, psychomotor retardation and heart diseases) was evaluated. The results of the study were similar for both clinics and also to those by other authors of comparable assessments, except for gastroesophageal reflux. Asthma and urinary tract infection had frequencies ranging from 4.3 to 5% and from 4.15 to 5%, respectively. It should also be remarked that 29% of children with esophageal reflux in our sample had episodes of urinary tract infection.
BACKGROUND: Comparison studies of calcineurin inhibitors as cornerstone immunosuppressants in renal transplantation have demonstrated that tacrolimus consistently reduces acute rejection rates and, ...in some studies, also improves long-term renal outcome in comparison to cyclosporin A (CsA). The aim of the present 2 year follow-up of the European Tacrolimus vs Cyclosporin A Microemulsion Renal Transplantation Study was to investigate long-term clinical outcome in terms of rate of acute rejection, graft and patient survival and graft function. METHODS: The European Tacrolimus vs Cyclosporin A Microemulsion Renal Transplantation Study was a randomized, comparative 6 month trial of the calcineurin inhibitors tacrolimus and CsA in combination with both azathioprine and steroids. The intent-to-treat population (ITT) consisted of 286 patients in the tacrolimus arm and 271 in the CsA microemulsion (CsA-ME) arm. Whereas whole blood level targets were 10-20 and 5-15 ng/ml for tacrolimus and 100-400 and 100-200 ng/ml for CsA during months 0-3 and 4-6, respectively, during the investigator-driven follow-up after termination of the main study (months 7-24) no specific calcineurin inhibitor target levels were required. Follow-up data were collected at 2 years post-transplantation from 237 (82.9% of the ITT population) patients who received tacrolimus and 222 (81.9% of the ITT population) patients who received CsA-ME. RESULTS: Calculated on ITT populations, mortality (2.0% vs 3.3%; P<0.05 in Kaplan-Meier analysis) was lower, but rate of graft loss (9.3% vs 11.2%; P = 0.12 in Kaplan-Meier analysis) was not significantly different after 2 years with tacrolimus- vs CsA-ME-based immunosuppression. Biopsy-proven acute rejection was significantly lower (19.6%) with tacrolimus than with CsA-ME (37.3%) during months 0-6 (P<0.0001), but was not significantly different during months 7-12 and 13-24 of follow-up (1.7% and 0.8% with tacrolimus and 4.7% and 0.9% with CsA-ME, respectively). A composite endpoint consisting of graft loss, patient death and biopsy-proven acute rejection occurred significantly more frequently in CsA-ME patients than in tacrolimus patients (42.8% vs 25.9%; P<0.001) during 24 months follow-up. Renal function 2 years post-transplant, measured by serum creatinine concentrations, was significantly better in tacrolimus-based compared with CsA-ME-based immunosuppression (136.9 vs 161.6 micromol/l; P<0.01). Cornerstone immunosuppression remained unchanged in 82.5% and 66.2% of patients treated with tacrolimus and CsA-ME, respectively. At 2 years, more patients in the tacrolimus arm were off steroids and received calcineurin inhibitor monotherapy, and fewer tacrolimus patients remained on a triple immunosuppressive regimen. The cardiovascular risk profile was affected favourably in the tacrolimus arm, with lower cholesterol and triglyceride concentrations (despite less use of cholesterol-lowering drugs); no significant difference in requirement for antidiabetic medication was noted. CONCLUSIONS: The 2 year study results confirm that tacrolimus is a highly efficacious cornerstone immunosuppressant in kidney transplantation. Tacrolimus-based immunosuppression may induce long-term benefits with regard to graft function and graft survival. The overall side-effect profile is considered to be favourable.
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