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Multiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits. © 2018 The Authors

Chronic myeloid leukemia (CML) treatment is based on company-sponsored and academic trials testing different tyrosine kinase inhibitors (TKIs) as first-line therapy. These studies included patients selected according to many inclusion–exclusion criteria, particularly age and comorbidities, with specific treatment obligations. In daily clinical practice (real-life), inclusion–exclusion criteria do not exist, and the treatment outcome does not only depend on the choice of first-line TKI but also on second- and third-line TKIs. To investigate in a real-life setting the response and the outcome on first-line imatinib, with switch to second generation TKIs in case of unsatisfying response or intolerance, we analyzed all newly diagnosed patients (N = 236), living in two Italian regions, registered in a prospective study according to population-based criteria and treated front-line with imatinib. A switch from imatinib to second-generation TKIs was reported in 14% of patients for side effects and in 24% for failure or suboptimal response, with an improvement of molecular response in 57% of them. The 5-year overall survival (OS) and leukemia-related survival (LRS) were 85% and 93%, respectively; the 4-year rates of MR3.0 and MR4.0 were 75% and 48%, respectively. Cardiovascular complications were reported in 4% of patients treated with imatinib alone and in 6% of patients receiving nilotinib as second-line. Older age (≥70 years) affected OS, but not LRS. These data provide an unbiased reference on the CML management and on the results of TKI treatment in real-life, according to ELN recommendations, using imatinib as first-line treatment and second-generation TKIs as second-line therapy. Am. J. Hematol. 92:82–87, 2017. © 2016 Wiley Periodicals, Inc.

To describe the imaging features of pulmonary artery sarcoma and the related problems of differential diagnosis

This study was conducted to develop and calibrate a detailed 3-dimensional finite element model of the porcine lumbar spine and to compare this model with various configurations in flexion and extension. Computed tomography scans obtained from the L4–L5 lumbar segment of a Landrace × Large White pig were used to generate a solid volume. The various passive components were characterized by using a step-by-step calibration procedure in which the material properties of the anatomic structures were modified to match the corresponding in vitro data set-points retrieved from the literature. The range of motion of the totally assembled intact model was assessed under a 10-Nm flexion–extension moment and compared with data from a bilateral complete and hemifacetectomy configuration. In addition, the results from our porcine model were compared with published data regarding range of motion in a human finite element model in order to predict the configuration of the porcine model that most closely represented the human spine. Both the intact and hemifacetectomy configurations of the porcine model were comparable to the human spine. However, qualitative analysis of the instantaneous axis of rotation revealed a dissimilarity between the intact porcine model and human spine behavior, indicating the hemifacetectomy configuration of the porcine model as the most appropriate for spinal instrumentation studies. The present 3-dimensional finite element porcine model offers an additional tool to improve understanding of the biomechanics of the porcine spine and to decrease the expense of spinal research.

A new method for rearing the citrus flower moth (Prays citri Mill.) (Lepidoptera, Yponomeutidae) on lemon [Citrus limon (L.) Burm.] callus is reported. In the present research callus (an undifferentiated mass of plant cells that can be grown under sterile conditions on an artificial medium in vitro) was induced from lemon stigma and style explants cultured on Murashige and Skoog (MS) medium supplemented with 500 mg l(-1) malt extract, 13.3 mu M 6-benzylaminopurine, and 146 mM sucrose. Also somatic embryogenesis and plant regeneration were obtained from the cultures of styles and stigmas of lemon. Adults were obtained from larvae on infested flowers collected in the field. Different oviposition substrates were used: white oval pearls (WOP), black oval pearls (BOP), rooted shoots (RS) of lemon obtained in vitro, and artificial flowers containing lemon callus (AF). Larvae were reared on lemon callus. Adults oviposited on RS, on WOP, and on AF. BOP were rejected as oviposition substrates. The flower moth reared on callus oviposited fertile eggs. In our tests P. citri completed three generations on callus or on callus plus shoots. In the latter case the larvae preferred callus and fed on shoots only after callus was completely eaten. The life cycle on callus at 23 +/- 1 degrees C lasted about 21 days. There were significant differences between oviposition substrates for what concerns the number of eggs laid. It was observed that females generally preferred WOP (about 25 eggs/female) to AF (about 20 eggs/female) or RS (about 12 eggs/female) as oviposition substrate. Nevertheless the percentage of eggs that developed into adults was higher when AF sealed with stretched Parafilm were used (about 70% of eggs developed into adults). The method of rearing P. citri with AF was labour-saving and the feeding substrate (callus) had less tendency to become mouldy or decompose than when WOP and RS were used. Since such a diet is available for the insect all year round and callus can be produced in unlimited quantity, it could be possible to obtain a mass production of this moth.

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