Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database.

Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.

Occupational safety and health and temporary agency work in multiemployer restaurants.

BACKGROUND: Current occupational safety and health (OSH) literature calls for sociotechnical, system-level approaches that increase understanding of the underlying reasons for insufficient OSH performance in nonstandard employment that is associated with lower labour and social security protection when compared with traditional forms of work. OBJECTIVE: This study focused on temporary agency work (TAW) which is a central form of nonstandard employment. The objective was to explore OSH issues in temporary agency work (TAW) in small and medium-sized multiemployer restaurants in Finland and discuss the issues from the perspectives of the agency worker, user company and agency. METHODS: A directed content analysis method was used to examine the data obtained from semi-structured interviews (n = 20) with agency workers, restaurant managers and experts representing the temporary work agencies, a pension insurer, and a labour union. The balanced work system theory was used as a framework for this qualitative analysis. RESULTS: A variety of OSH risks and hazards in TAW were identified. In addition, the complexity of OSH management was highlighted in this triangular employment relationship between the agency worker, the user company, and the agency. CONCLUSION: This study reveals problems related to OSH in TAW. Restaurants are entities separate from agencies, so establishing and adhering to a common process of OSH management is not simple.

Coupled heat pulse propagation in two-fluid plasmas.

Because of the large mass differences between electrons and ions, the heat diffusion in electron-ion plasmas exhibits more complex behavior than simple heat diffusion found in typical gas mixtures. In particular, heat is diffused in two distinct, but coupled, channels. Conventional single fluid models neglect the resulting complexity, and can often inaccurately interpret the results of heat pulse experiments. However, by recognizing the sensitivity of the electron temperature evolution to the ion diffusivity, not only can previous experiments be interpreted correctly, but informative simultaneous measurements can be made of both ion and electron heat channels.

Suppression of Tearing Modes by Radio Frequency Current Condensation.

Currents driven by radio frequency (rf) waves in the interior of magnetic islands can stabilize deleterious tearing modes in tokamaks. Present analyses of stabilization assume that the local electron acceleration is unaffected by the presence of the island. However, the power deposition and electron acceleration are sensitive to the perturbation of the temperature. The nonlinear feedback on the power deposition in the island increases the temperature perturbation, and can lead to a bifurcation of the solution to the steady-state heat diffusion equation. The combination of the nonlinearly enhanced temperature perturbation with the rf current drive sensitivity to the temperature leads to an rf current condensation effect, which can increase the efficiency of rf current drive stabilization and reduce its sensitivity to radial misalignment of the ray trajectories. The threshold for the effect is in a regime that has been encountered in experiments, and will likely be encountered in ITER.

Second primary malignancies in multiple myeloma: an overview and IMWG consensus.

Background: Therapeutic advancements following the introduction of autologous stem cell transplantation and 'novel' agents have significantly improved clinical outcomes for patients with multiple myeloma (MM). Increased life expectancy, however, has led to renewed concerns about the long-term risk of second primary malignancies (SPMs). This review outlines the most up-to-date knowledge of possible host-, disease-, and treatment-related risk factors for the development of SPMs in patients with MM, and provides practical recommendations to assist physicians. Design: A Panel of International Myeloma Working Group members reviewed the most relevant data published in the literature as full papers, or presented at meetings of the American Society of Clinical Oncology, American Society of Hematology, European Hematology Association, or International Myeloma Workshops, up to June 2016. Here, we present the recommendations of the Panel, based on this literature review. Results: Overall, the risk of SPMs in MM is low, multifactorial, and partially related to the length of patients' survival and MM intrinsic susceptibility. Studies suggest a significantly increased incidence of SPMs when lenalidomide is administered either following, or concurrently with, oral melphalan. Increased SPM incidence has also been reported with lenalidomide maintenance following high-dose melphalan, albeit to a lesser degree. In both cases, the risk of death from MM was significantly higher than the risk of death from SPMs, with lenalidomide possibly providing a survival benefit. No increase in SPM incidence was reported with lenalidomide plus dexamethasone (without melphalan), or with bortezomib plus oral melphalan, dexamethasone, or thalidomide. Conclusion: In general, the risk of SPMs should not alter the current therapeutic decision-making process in MM. However, regimens such as lenalidomide plus dexamethasone should be preferred to prolonged exposure to lenalidomide plus oral melphalan. SPM risk should be carefully discussed with the patient in the context of benefits and risks of different treatment options.

New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG).

Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.

Knockdown of Slingshot 2 (SSH2) serine phosphatase induces Caspase3 activation in human carcinoma cell lines with the loss of the Birt-Hogg-Dubé tumour suppressor gene (FLCN).

Birt-Hogg-Dubé (BHD) syndrome, is a dominantly inherited familial cancer syndrome associated with susceptibility to renal cell carcinoma (RCC) caused by inactivating mutations in the folliculin (FLCN) gene. The precise functions of the FLCN gene product are still under investigation but RCC from BHD patients show loss of the wild-type allele consistent with a tumor suppressor gene function. In a search for potential synthetic-lethal targets for FLCN using a phosphatase siRNA library screening approach, we found that knockdown of SSH2 serine phosphatase (one of the three members of Slingshot family and previously implicated in actin reorganization) specifically induced Caspase3/7 activity in a dose-dependent manner (up to six-fold increase, 10 nM, 72 h) in two human FLCN-deficient cell lines (BHD-origin renal cell carcinoma UOK257 and thyroid carcinoma FTC133) but not in their folliculin expressing isogenic cell lines. SSH2 siRNA-induced knockdown was accompanied by increased expression of SSH1 and SSH3 (suggesting a compensatory regulatory mechanism among members of SSH family). FLCN-null cells exhibited evidence of dysregulated cofilin de/phosphorylation pathways. Knockdown of SSH2 in FLCN-null cells was associated with an alteration in cell cycle kinetics (20% increase in G1, 30% and 40% decrease in S and G2M, respectively). Combination treatment of multiple SSH family (SSH2 plus SSH1 and/or SSH3) siRNAs potentiated induction of Caspase3/7 activity and changes in the cell cycle kinetics. These data indicate that: (a) apoptotic cell death in FLCN-null cells can be triggered by SSH2 knockdown through cell cycle arrest; (b) SSH2 represents a potential therapeutic target for the development of agents for the treatment of BHD syndrome and, possibly, related tumors.

Layout and results from the initial operation of the high-resolution x-ray imaging crystal spectrometer on the Large Helical Device.

First results of ion and electron temperature profile measurements from the x-ray imaging crystal spectrometer (XICS) diagnostic on the Large Helical Device (LHD) are presented. This diagnostic system has been operational since the beginning of the 2011 LHD experimental campaign and is the first application of the XICS diagnostic technique to helical plasma geometry. The XICS diagnostic provides measurements of ion and electron temperature profiles in LHD with a spatial resolution of 2 cm and a maximum time resolution of 5 ms (typically 20 ms). Ion temperature profiles from the XICS diagnostic are possible under conditions where charge exchange recombination spectroscopy (CXRS) is not possible (high density) or is perturbative to the plasma (low density or radio frequency heated plasmas). Measurements are made by using a spherically bent crystal to provide a spectrally resolved 1D image of the plasma from line integrated emission of helium-like Ar(16 +). The final hardware design and configuration are detailed along with the calibration procedures. Line-integrated ion and electron temperature measurements are presented, and the measurement accuracy is discussed. Finally central temperature measurements from the XICS system are compared to measurements from the Thomson scattering and CXRS systems, showing excellent agreement.

Lymphoid tumours and breast cancer in ataxia telangiectasia; substantial protective effect of residual ATM kinase activity against childhood tumours.

BACKGROUND: Immunodeficiency in ataxia telangiectasia (A-T) is less severe in patients expressing some mutant or normal ATM kinase activity. We, therefore, determined whether expression of residual ATM kinase activity also protected against tumour development in A-T. METHODS: From a total of 296 consecutive genetically confirmed A-T patients from the British Isles and the Netherlands, we identified 66 patients who developed a malignant tumour; 47 lymphoid tumours and 19 non-lymphoid tumours were diagnosed. We determined their ATM mutations, and whether cells from these patients expressed any ATM with residual ATM kinase activity. RESULTS: In childhood, total absence of ATM kinase activity was associated, almost exclusively, with development of lymphoid tumours. There was an overwhelming preponderance of tumours in patients <16 years without kinase activity compared with those with some residual activity, consistent with a substantial protective effect of residual ATM kinase activity against tumour development in childhood. In addition, the presence of eight breast cancers in A-T patients, a 30-fold increased risk, establishes breast cancer as part of the A-T phenotype. CONCLUSION: Overall, a spectrum of tumour types is associated with A-T, consistent with involvement of ATM in different mechanisms of tumour formation. Tumour type was influenced by ATM allelic heterogeneity, residual ATM kinase activity and age.

Objectives and layout of a high-resolution x-ray imaging crystal spectrometer for the large helical device.

A high-resolution x-ray imaging crystal spectrometer, whose concept was tested on NSTX and Alcator C-Mod, is being designed for the large helical device (LHD). This instrument will record spatially resolved spectra of helium-like Ar(16+) and will provide ion temperature profiles with spatial and temporal resolutions of <2 cm and ≥10 ms, respectively. The spectrometer layout and instrumental features are largely determined by the magnetic field structure of LHD. The stellarator equilibrium reconstruction codes, STELLOPT and PIES, will be used for the tomographic inversion of the spectral data.

Immunodeficiency in ataxia telangiectasia is correlated strongly with the presence of two null mutations in the ataxia telangiectasia mutated gene.

Immunodeficiency affects over half of all patients with ataxia telangiectasia (A-T) and when present can contribute significantly to morbidity and mortality. A retrospective review of clinical history, immunological findings, ataxia telangiectasia mutated (ATM) enzyme activity and ATM mutation type was conducted on 80 consecutive patients attending the National Clinic for Ataxia Telangiectasia, Nottingham, UK between 1994 and 2006. The aim was to characterize the immunodeficiency in A-T and determine its relationship to the ATM mutations present. Sixty-one patients had mutations resulting in complete loss of ATM kinase activity (group A) and 19 patients had leaky splice or missense mutations resulting in residual kinase activity (group B). There was a significantly higher proportion of patients with recurrent sinopulmonary infections in group A compared with group B (31 of 61 versus four of 19 P = 0.03) and a greater need for prophylactic antibiotics (30 of 61 versus one of 19 P = 0.001). Comparing group A with group B patients, 25 of 46 had undetectable/low immunoglobulin A (IgA) levels compared with none of 19; T cell lymphopenia was found in 28 of 56 compared with one of 18 and B cell lymphopenia in 35 of 55 compared with four of 18 patients (P = 0.00004, 0.001 and 0.003 respectively). Low IgG2 subclass levels and low levels of antibodies to pneumococcal polysaccharide were more common in group A than group B (16 of 27 versus one of 11 P = 0.01; 34/43 versus six of 17 P = 0.002) patients. Ig replacement therapy was required in 10 (12.5%) of the whole cohort, all in group A. In conclusion, A-T patients with no ATM kinase activity had a markedly more severe immunological phenotype than those expressing low levels of ATM activity.

Stabilization of the vertical mode in tokamaks by localized nonaxisymmetric fields.

Vertical instability of a tokamak plasma can be controlled by nonaxisymmetric magnetic fields localized near the plasma edge at the bottom and top of the torus. The required magnetic fields can be produced by a relatively simple set of parallelogram-shaped coils.

Atherosclerosis and vascular calcification in chronic renal failure.

Cardiovascular complications are a major clinical problem in patients with chronic kidney disease and end-stage renal failure; cardiac death accounts for approximately 40-50% of all deaths in these patients. Death from cardiovascular causes is up to 20 times more common in uremic patients than in the general population with the risk being even higher than in patients with diabetes mellitus. A high rate of myocardial infarction and excessive cardiac mortality have repeatedly been documented in patients with kidney disease and renal failure. Not only is the prevalence of myocardial infarction high, but also the case fatality rate is significantly higher in uremic patients with and without diabetes, respectively, compared to nonuremic patients. This is of particular interest since the prevalence of coronary atheroma in uremic patients was shown to be approximately 30% by autopsy and coronary angiography studies. Thus, coronary factors, i.e. atherosclerosis, and non-coronary factors may play an important role in the genesis of cardiac complications in the renal patient. In addition, renal failure recently has also be identified as a predictor of mortality in different stages of peripheral vascular disease. In particular, marked differences in the pathogenesis, morphology and course of atherosclerosis and arteriosclerosis under the conditions of renal failure have been documented. Among others increased plaque formation and particularly higher proportion and intensity of vascular calcification have been found in clinical and autopsy studies. In addition to the so-called classical or traditional risk factors, an important role for nonclassical risk factors such as microinflammation, hyperphosphatemia and oxidative stress has been documented in patients with renal failure and is discussed in detail.

Seasonal differences in the onset of the EBV-positive and -negative forms of paediatric Hodgkin's lymphoma.

In this study, we have shown that there are seasonal differences in the onset of the (Epstein-Barr virus) EBV-positive and -negative forms of paediatric Hodgkin's lymphoma (HL). This suggests aetiological differences between the two forms of this disease. EBV-positive HL might be a rare consequence of primary EBV infection.

Eliminating islands in high-pressure free-boundary stellarator magnetohydrodynamic equilibrium solutions.

Magnetic islands in free-boundary stellarator equilibria are suppressed using a procedure that iterates the plasma equilibrium equations and, at each iteration, adjusts the coil geometry to cancel resonant fields produced by the plasma. The coils are constrained to satisfy certain measures of engineering acceptability and the plasma is constrained to ensure kink stability. As the iterations continue, the coil geometry and the plasma simultaneously converge to an equilibrium in which the island content is negligible. The method is applied with success to a candidate plasma and coil design for the National Compact Stellarator Experiment [Phys. Plasmas 8, 2083 (2001)]].

[The monitoring of gas bubbles with a pulsed Doppler ultrasonic locator in humans working in a space suit]. / Monitoring gazovykh puzyr'kov ul'trazvukovym impul'sno-dopplerovskim lokatorom u cheloveka pri rabote v skafandre.

Presented are results of gas bubbles monitoring in decompressed humans with the use of an ultrasonic pulse-Doppler locator (PDL). Unlike the classic Doppler bubbles detectors with continuous US emission, PDL is adjusted for reception of echo from a chosen volume of the right ventricle cavity; thus, the clutter due to cardiac beats and human locomotion is successfully rejected. During simulation of Russian EVAs, venous gas bubbles were detected in 3 out of 5 experiments with test-subjects clothed in everyday wear and in 2 out of 3 experiments with suited test-subjects.

Physician gets marketing assistance from progressive hospital.

Increasing a physician's office volume is beneficial to the hospital where the physician practices. Hospital assistance in marketing the physician's services can therefore be rewarding to both parties and enhance physician allegiance to the hospital providing the support. A theoretical model for such marketing support is reviewed step by step, through analysis of existing practice, targeting markets, selecting desirable improvements and changes, and advertising the practice. The successful results are profiled.