Dose modification for haematological toxicity: a survey of Australian medical oncologists.

BACKGROUND: Evidence supporting dose modifications to reduce serious treatment-related adverse events of antineoplastic therapy is limited and frequently based on clinical trial protocols, which are not always generalisable to community patients. eviQ is an online resource with treatment protocols and recommendations for dose modification formulated by expert opinion and evidence-based review. Original recommended haematological thresholds to delay treatment were: neutrophil count <1.5 × 109 /L and platelet count <100 × 109 /L. AIMS: To evaluate the current practices of Australian medical oncologists with regard to haematological dose modifications for antineoplastic treatments, and to determine rates of adherence to eviQ recommendations. METHODS: An online survey regarding haematological dose modifications was distributed to over 400 Medical Oncology Group of Australia members and eviQ medical oncology reference committee members via email. Responses were collated on 18 December 2017. RESULTS: Of 153 respondents, 67% indicated that they did not follow the eviQ haematological dose modification guidelines; 8% delayed curative intent treatment at neutrophil counts <1.5 × 109 /L, compared with 36% for palliative treatment; most delayed treatment at neutrophil counts <1.0 × 109 /L (94% curative and 97% palliative respectively). 70% of clinicians delayed palliative treatment at platelet counts <100 × 109 /L, compared to 34% with curative treatment. No respondents indicated the original haematological cut-off levels were too aggressive. CONCLUSION: The majority of responding medical oncologists indicated that they did not follow the eviQ haematological dose modification guidelines, which were viewed as too conservative. Subsequent to this survey, eviQ reviewed and updated haematological dose modification recommendations.

Real-time measurements of landfill atmospheric ammonia using mobile white cell differential optical absorption spectroscopy system and engineering applications.

The real-time measurement of atmospheric ammonia at municipal solid waste (MSW) landfills and adjacent areas is necessary for landfill management and the health of nearby residence. Continuous, fast, and real-time monitoring of landfill odor gases is a challenge, especially for ammonia. To our knowledge, this was the first study for the characteristics and seasonal variabilities of atmospheric ammonia at a whole landfill using a Mobile White cell Differential Optical Absorption Spectroscopy (MW-DOAS) system, which also simultaneously offers high sensitivity and fast response. Results show that atmospheric ammonia levels at various landfill areas were significantly dependent on the characteristics of areas, such as municipal solid waste-related areas, leachate-related areas, sludge-related areas, and fly ash-related area, the atmospheric ammonia peak or average level at the active leachate pool of the active MSW site was the highest among all areas of the whole landfill, and the ammonia concentrations at the closed MSW landfill sites were low and dependent on the ages. Moreover, it was found that the seasonal variabilities of ammonia concentrations at most of those areas were significantly dependent on the ambient temperature, and ambient temperature variation caused the atmospheric ammonia level at the active leachate pool and active MSW landfill site in the summer survey to raise 3.5 times and 5.58 times than in the winter survey, respectively. Implications: Continuous, fast, and real-time monitoring ambient ammonia at or nearby a landfill is critical for landfill operators and local EPAs. This study demonstrates that the mobile White cell Differential Optical Absorption Spectroscopy (MW-DOAS) system is an effective tool for real-time monitoring ambient ammonia of a whole landfill. The results in this article provided a guideline to the characteristics and seasonal changes of ambient ammonia at various types of areas of a whole landfill as well as the impact of age to ambient ammonia at the closed landfill areas.

Ronacaleret, a calcium-sensing receptor antagonist, has no significant effect on radial fracture healing time: results of a randomized, double-blinded, placebo-controlled Phase II clinical trial.

BACKGROUND: Fractures cause significant morbidity, mortality, and use of health care resources. An oral agent that enhances fracture healing could reduce costs and prevent future disabilities. In Phase I studies, ronacaleret, a novel calcium-sensing receptor antagonist, stimulated parathyroid hormone (PTH) release and increased bone formation markers, suggesting that it may act as an effective oral anabolic agent to enhance fracture healing. METHODS: This was a randomized, double-blind, placebo-controlled, parallel-group, clinical trial in 85 male and female subjects who had sustained a closed, unilateral, extra-articular fracture of the distal radius and were receiving conservative treatment. Subjects were randomly assigned in a double-blind manner to ronacaleret 200 mg twice daily, ronacaleret 400 mg once daily or matching placebo and followed for 12 weeks. Fracture healing was assessed by radiographs and quantitative computed tomography (CT), and bone turnover markers were measured. The study was terminated early for futility based on the results of an unplanned interim analysis. RESULTS: There were no significant differences between treatment groups in time to radiographic fracture healing (74, 65 and 68 days for placebo, 200 mg twice daily and 400 mg once daily dose groups, respectively), cortical bridging, grip strength, pain and swelling, time to cast removal, or range of motion. Markers of bone formation and levels of whole PTH, intact PTH and serum calcium increased following treatment with ronacaleret. CONCLUSION: Ronacaleret had no significant effect on duration of healing by radiograph or CT scan, time to cast removal, clinical symptoms, grip strength, or range of motion.

Transitional cell carcinoma in the paediatric population: be aware of unusual aetiologies.

This is a case report of a 12 year old girl who presented with a rare condition in paediatrics, transitional cell carcinoma of the bladder. It is important because it is readily treated by endoscopic means if diagnosed early. Potential aetiologies for this unusual condition are explored.