Third-Line Chemotherapy for Metastatic Urothelial Cancer: A Retrospective Observational Study.

The prognosis of locally advanced (T3/T4 or N1) and metastatic disease urothelial carcinoma is poor. In this retrospective study, we reviewed data about patients receiving third-line chemotherapy for metastatic disease, in view of the lack of data in this setting.We retrospectively analyzed medical records of patients with a pathologic diagnosis of urothelial carcinoma treated with systemic chemotherapy for metastatic disease at 4 participating Institutions between January, 2010, and January, 2015. Cox proportional hazards regression was used to evaluate the association of the chemotherapy agent used versus others with overall survival, adjusted for 5 externally validated prognostic factors in advanced urothelial carcinoma.Of 182 patients that received first-line chemotherapy/adjuvant chemotherapy as defined above, 116 patients (63.73%) received second-line salvage treatment. Fifty-two patients were finally included in this analysis, whereas 9 were excluded due to missing data. Third-line chemotherapy was based on cyclophosphamide, platinum, vinflunine, taxanes, and gemcitabine in 16, 12, 11, 10, and 3 patients, respectively. Median PFS (progression-free survival) and OS (overall survival) of the population were 13 (10-17) and 31 (28-36) weeks. Single-agent cyclophosphamide was associated with a PFS of 18 (13-22) and an OS of 38 (33-41) weeks, whereas platinum-based combinations were associated with a PFS of 5 weeks and an OS of 8 weeks. Multivariate analysis showed improved survival in patients treated with cyclophosphamide (hazard ratio (HR) = 0.42; 95% CI: 0.20-0.89; P = 0.025) and a worse survival in those treated with platinum-based regimens (HR: 4.37; 95% CI = 1.95-9.77; P < 0.01).We observed a significantly longer overall survival in patients receiving single-agent cyclophosphamide, with few grade 3 to 4 toxicities. Further studies should assess the efficacy of metronomic single-agent cyclophosphamide in advanced lines of treatment, as it may yield a survival benefit with low costs and no detrimental effects on quality of life.

Aminaphtone therapy in patients with type 1 diabetes and albuminuria: a case report.

INTRODUCTION: Microalbuminuria in type 1 diabetes is the earliest manifestation of diabetic microangiopathy (nephropathy). To date, the pharmacological approach to microangiopathy has not been shown to be useful. By using aminaphtone to control nephrologic complications of insulin-dependent diabetes mellitus we first obtained a significant improvement in microalbuminuria confirming this new pharmacological approach for insulin-dependent diabetes mellitus organospecific complications control. CASE PRESENTATION: After being treated with standard therapy for insulin-dependent diabetes mellitus (insulin) for more than 20 years, a 49-year-old white man affected by insulin-dependent diabetes mellitus adopted the standard therapy aminaphtone for a period of 2 months.This therapy allowed a significant reduction of proteinuria from baseline evaluation that immediately increased after he stopped aminaphtone therapy. CONCLUSIONS: Aminaphtone therapy, used globally in the treatment and prevention of endothelial dysfunctions, could be an interesting option for patients with insulin-dependent diabetes mellitus with the express purpose of preventing diabetic nephropathy.

Left Atrial Volume Index as Indicator of Left Ventricular Diastolic Dysfunction: Comparation between Left Atrial Volume Index and Tissue Myocardial Performance Index.

BACKGROUND: To point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed. METHODS: In 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index, ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as: iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values. RESULTS: Results shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls. CONCLUSION: LAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.