RESUMO
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity. Currently, there is a paucity of randomized prospective data to inform on optimal front-line chemoimmunotherapy (CIT) and use of consolidative mediastinal radiation (RT). To assess if distinct CIT approaches are associated with disparate survival outcomes, we performed a systematic review and meta-analysis comparing dose-intensive (DI-CIT) versus standard CIT for the front-line treatment of PMBCL. Standard approach (S-CIT) was defined as R-CHOP-21/CHOP-21, with or without RT. DI-CIT were defined as regimens with increased frequency, dose, and/or number of systemic agents. We reviewed data on 4,068 patients (2,517 DI-CIT; 1,551 S-CIT) with a new diagnosis of PMBCL. Overall survival for DI-CIT patients was 88% (95% CI: 85-90) compared to 80% for the S-CIT cohort (95% CI: 74-85). Meta-regression revealed an 8% overall survival (OS) benefit for the DI-CIT group (P<0.01). Survival benefit was maintained when analyzing rituximab only regimens; OS was 91% (95% CI: 89-93) for the rituximab-DI-CIT arm compared to 86% (95% CI: 82-89) for the R-CHOP-21 arm (P=0.03). Importantly, 55% (95% CI: 43-65) of the S-CIT group received RT compared to 22% (95% CI: 15-31) of DI-CIT patients (meta-regression P<0.01). To our knowledge, this is the largest meta-analysis reporting efficacy outcomes for the front-line treatment of PMBCL. DI-CIT demonstrates a survival benefit, with significantly less radiation exposure, curtailing long-term toxicities associated with radiotherapy. As we await results of randomized prospective trials, our study supports the use of dose-intensive chemoimmunotherapy for the treatment of PMBCL.
Assuntos
Linfoma de Células B , Exposição à Radiação , Humanos , Estudos Prospectivos , Rituximab/uso terapêutico , Linfócitos B , Linfoma de Células B/tratamento farmacológicoRESUMO
We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.
Assuntos
Humanos , Recursos Audiovisuais , Educação em Saúde/métodos , Cooperação Internacional , Esquistossomose/prevenção & controle , África Subsaariana , CD-ROM , Saúde Global , Londres , Avaliação de Programas e Projetos de Saúde , Ensino/métodosRESUMO
AIM: To evaluate setting time, solubility and disintegration, flow, film thickness, and dimensional change following setting in a dual-cured resin root canal sealer Epiphany compared with an epoxy-resin-based sealer AH Plus. METHODOLOGY: The experiments were performed according to ANSI/ADA Specification 57 which tests the physicochemical properties of endodontic sealing materials. Five samples of each material were tested for each of the properties. In addition, deionized distilled water from the solubility test of Epiphany was submitted for analysis of the cations Fe, Ni, Ca, Mg, Zn, Na, and K in an atomic absorption spectrometer. Three samples were analysed. RESULTS: There were no statistical differences (P>0.05) in flow (AH Plus: 38.57 mm; Epiphany: 35.74 mm) and film thickness (AH Plus: 10.6 microm; Epiphany: 20.1 microm). The solubility (AH Plus: 0.21%; Epiphany: 3.41%) and dimensional alterations following setting (AH Plus: expansion of 1.3%; Epiphany: expansion of 8.1%) were statistically different (P<0.05). The setting times of both sealants were in accordance with ANSI/ADA requirements. CONCLUSIONS: Setting time, flow, and film thickness tests for both cements conformed to ANSI/ADA standards. Dimensional alteration test for both cements were greater than values considered acceptable by ANSI/ADA. Epiphany values regarding solubility were also greater than values considered acceptable by ANSI/ADA.
Assuntos
Resinas Epóxi/química , Materiais Restauradores do Canal Radicular/química , Cálcio/análise , Fenômenos Químicos , Físico-Química , Humanos , Ferro/análise , Magnésio/análise , Teste de Materiais , Níquel/análise , Potássio/análise , Reologia , Sódio/análise , Solubilidade , Espectrofotometria Atômica , Propriedades de Superfície , Fatores de Tempo , Água/química , Zinco/análiseRESUMO
We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.