Post-treatment Strategies Research Articles

Investigation of partially pre-mixed charge compression ignition engine characteristics implemented with toroidal combustion chamber and exhaust gas recirculation

ABSTRACT Many pre- and post-treatment strategies have been instigated in compression ignition engines to meet the stringent vehicular emissions norms. The partially pre-mixed charged compression ignition (PCCI) combustion technique has shown a significant reduction in emissions without much affecting the efficiency of the conventional diesel engine by emitting low nitrogen oxides and smoke emissions simultaneously. However, the PCCI engine has also shown some limitations by producing higher hydrocarbon (HC) and carbon monoxide (CO) emissions from the engines. The toroidal combustion chamber has proven its potential to reduce the HC and CO emissions from the conventional engine. Therefore, in the current experimental study, PCCI engine characteristics were investigated with toroidal piston geometry and compared with conventional engine characteristics having hemispherical combustion chamber (HCC). The experiments were performed on single-cylinder, four strokes, direct injection, diesel engine modified to operate on PCCI mode. The homogeneous mixture for PCCI combustion was obtained with an external mixture formation technique with a fuel vaporizer (retrofit device). The tests were conducted with 15% and 30% diesel vapor without and with 10% exhaust gas recirculation and then compared with the conventional engine. The investigation results show that better air–fuel mixing results in low engine emissions. NOx emissions were reduced by 29% and 36%, and smoke opacity was decreased by 33% and 38% with 15% and 30% diesel vapor with EGR with a marginal decrement in thermal efficiency compared to conventional engine.

Abstract PS7-37: Learning from breast cancer clinical trials how to capture recurrence estimates for North American cancer registries: A systematic review

Abstract Background: There are currently approximately 3.5 million breast cancer survivors in the U.S. This number will continue to rise due to the medical and scientific advances that have improved diagnostic tools and standards of care for women treated for breast cancer. The increasing number of breast cancer survivors also means that the population at risk for cancer recurrence will increase. Cancer recurrence is defined as a cancer that was treated, reduced to undetectable levels, and later returned either locally, regionally, or distantly. After a recurrence diagnosis, patients’ experience reduced health outcomes and quality of life as well as the financial burden of additional treatments. Post-treatment surveillance strategies are critical for the early detection of recurrences so that interventions can be more effective at ensuring long term survival and quality of life. Currently, risk factors for breast cancer recurrence are not well understood in part due to limited population level data in cancer registries world-wide. The clinical endpoints that provide recurrence estimates are disease free survival (DFS), relapse free survival (RFS), and time to recurrence (TTR). Studies that provide recurrence estimates are limited to clinical trials (which lack diversity and represent less than 5% of cancer patients) and prospective cohorts that follow patients for a defined number of years. Currently, population-based cancer registries in North America do not collect recurrence data from patients that would allow the calculation of DFS, RFS, and TTR. The absence of population level data has limited the understanding of cancer patients’ individual risks and evidence-based recommendations for recurrence prevention strategies. Moreover, recurrence data on cancers with long term latency (greater than 5-10 years) such as estrogen receptor positive breast cancer are limited.Purpose: We seek to identify which data elements and surveillance strategies are collected for recurrence data in breast cancer clinical trials. Our long-term goal is to implement these data elements into the Surveillance, Epidemiology, and End Results (SEER) program to facilitate the calculation of breast cancer recurrence estimates at the U.S. population level.Methods: We performed a systematic literature review evaluating phase II-IV clinical trials, their reported clinical outcomes, surveillance strategies, and their diagnostic tests that confirm recurrence. We used PubMed, clinicaltrials.gov, EMBASE, and the Cochrane Library for search terms “recurrence”, “relapse”, “recurrence free survival”, “surgery”, “adjuvant therapy” in breast cancer for our literature search. Inclusion criteria included clinical trials with published results, trials that compared outcomes of surgical resections, surgery with adjuvant treatments, or multiple adjuvant treatments. We included trials that provided DFS, RFS, TTR, recurrence rate, recurrence free interval, progression free survival, and time to progression. We excluded trials that did not provide recurrence estimates and those that performed recurrence modeling.Conclusion: From our review, we identified data elements and recurrence estimates for breast cancer that are collected in clinical trials but are not included in North American registries. New data elements need to be included in North American cancer registries to calculate population-based estimates for recurrence. Citation Format: Esmeralda Ramirez-Pena, Sarah Hussey, Serban Negoita, Brandy Heckman-Stoddard. Learning from breast cancer clinical trials how to capture recurrence estimates for North American cancer registries: A systematic review [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-37.

Prophylaxis of Post-Inflammatory Hyperpigmentation From Energy-Based Device Treatments: A Review

Post-inflammatory hyperpigmentation (PIH) is an acquired hypermelanosis that can result from inflammatory dermatologic disease, trauma, or iatrogenesis from procedures. This condition disproportionately affects individuals with skin of color, and it can place a significant psychosocial burden on affected patients. The management of PIH is, therefore, of great interest to clinicians, especially dermatologists. The treatment of established PIH has long been a principal focus within the literature, with publications on the topic outnumbering publications on prophylaxis of PIH. Prophylaxis strategies to prevent PIH vary greatly in clinical practice, likely due to the absence of an evidence-based consensus. Published approaches to PIH prophylaxis include pretreatment (topical alpha hydroxy acids, retinoids, hydroquinone, and brimonidine) and post-treatment strategies (photoprotection, corticosteroids, and tranexamic acid). This review will examine the current literature on prophylaxis of PIH from energy-based device treatments.

Generation of High Quality Biogenic Silica by Combustion of Rice Husk and Rice Straw Combined with Pre- and Post-Treatment Strategies—A Review

Utilization of biomass either as a renewable energy source or for the generation of biogenic materials has received considerable interest during the past years. In the case of rice husk (RH) and rice straw (RS) with high silica contents in the fuel ash, these approaches can be combined to produce high-grade biogenic silica with purities >98 wt % from combustion residues. The overall process can be considered nearly neutral in terms of CO2 emission and global warming, but it can also address disposal challenges of rice husk and rice straw. For the resulting biogenic silica, several advanced application opportunities exist, e.g., as adsorbents, catalysts, drug delivery systems, etc. This article provides a comprehensive literature review on rice husk and rice straw combustion as well as applied strategies for raw material pre-treatment and/or post-treatment of resulting ashes to obtain high quality biogenic silica. Purity of up to 97.2 wt % SiO2 can be reached by combustion of untreated material. With appropriate fuel pre-treatment and ash post-treatment, biogenic silica with purity up to 99.7 wt % can be achieved. Studies were performed almost exclusively at a laboratory scale.

Stem cell therapy for knee osteoarthritis: a narrative review of a rapidly evolving treatment with implications for physical therapy management

Background: Stem cell therapy has emerged as a new, exciting treatment for repair of articular cartilage in osteoarthritis (OA), which currently has no cure. Regenerative cell therapies can potentially offer alternatives to total joint replacement for patients with OA. A variety of cell-based therapies have been developed involving the use of autologous and allogeneic mesenchymal stem cells (MSCs). To date, these stem cell therapies have been shown to be safe and efficacious, but information on the long-term clinical outcomes for joint function is lacking. Also lacking is information regarding post-treatment rehabilitation strategies and their effects.Objectives: The purpose of this narrative review was to evaluate the current literature in relation to stem cell therapy for knee OA and to highlight the importance of physical therapists establishing and researching suitable care management and rehabilitation procedures for patients receiving stem cell therapy.Major findings: The results of this literature review show that MSCs have been safe and effective at reducing pain and improving joint functionality and cartilage quality. The review also found that both autologous and allogeneic stem cells were able to produce similar clinical improvements in pain scores and cartilage repair and restoration. There is a lack of research evaluating the influence of rehabilitation on cartilage repair.Conclusions: Current research shows that significant improvements in joint pain and function continue for approximately 2-year post-stem cell procedure. There is currently a lack of research into rehabilitation protocols which could potentially improve joint function further.

Whole body periodic acceleration improves survival and microvascular leak in a murine endotoxin model.

Sepsis is a life threatening condition which produces multi-organ dysfunction with profound circulatory and cellular derangements. Administration of E.Coli endotoxin (LPS) produces systemic inflammatory effects of sepsis including disruption of endothelial barrier, and if severe enough death. Whole body periodic acceleration (pGz) is the headward-footward motion of the body. pGz has been shown to induce pulsatile shear stress to the endothelium, thereby releasing vascular and cardio protective mediators. The purpose of this study was to determine whether or not pGz performed as a pre-treatment or post-treatment strategy improves survival in a lethal murine endotoxin model.This study was designed as a prospective randomized controlled study in mice. pGz was performed in mice as pre-treatment (pGz-LPS, 3 days prior to LPS), post-treatment (LPS- pGz, 30 min after LPS) strategies or Control (LPS-CONT), in a lethal murine model of endotoxemia. Endotoxemia was induced with intraperitoneal injection of E.Coli LPS (40mg/kg). In a separate group of mice, a nonspecific nitric oxide synthase inhibitor (L-NAME) was provided in their drinking water and pGz-LPS and LPS-pGz performed to determine the effect of nitric oxide (NO) inhibition on survival. In another subset of mice, micro vascular leakage was determined. Behavioral scoring around the clock was performed in all mice at 30 min intervals after LPS administration, until 48 hrs. survival or death. LPS induced 100% mortality in LPS-CONT animals by 30 hrs. In contrast, survival to 48 hrs. occurred in 60% of pGz-LPS and 80% of LPS-pGz. L-NAME abolished the survival effects of pGz. Microvascular leakage was markedly reduced in both pre and post pGz treated animals and was associated with increased tyrosine kinase endothelial-enriched tunica interna endothelial cell kinase 2 (TIE2) receptor and its phosphorylation (p-TIE2). In a murine model of lethal endotoxemia, pGz performed as a pre or post treatment strategy significantly improved survival, and markedly reduced microvascular leakage. The effect was modulated, in part, by NO since a non-selective inhibitor of NO abolished the pGz survival effect.

Tribological Behavior of Carbon Based Coatings Adapted to Lubricant-Free Forming Conditions

In conventional deep drawing lubricants are applied to achieve low friction and wear. However, most lubricants contain environmental harmful ingredients. Global trends like sustainability and efficient resource usage motivate the development of lubricant-free deep drawing. However, dry contact conditions lead to intensive interaction between tool and workpiece especially for aluminum alloys with high adhesion tendency towards tool steel. First investigations revealed promising results for diamond like carbon (DLC) coated tools in lubricant-free tests. Therefore, in this study the lubricant-free friction and wear behavior of DLC coatings is investigated in strip drawing tests. To ensure industrial-like conditions commonly used deep drawing steel with zinc coating and an aluminum alloy were selected as sheet material. The properties of DLC coatings were modified at different scales to attain tailored tribological conditions. A laser based heat treatment achieved an increase of sp2 hybridization and thus leads to increased friction. Different mechanical pre- and post-treatment strategies like polishing and brushing proved that a smooth tool surface is beneficial for the tribological conditions in dry contacts. With laser generated structures a modification of friction was realized with varying degree of coverage for DC04. In contact with AA5182 the application of structures is limited due to adhesion.

Unveiling a Key Intermediate in Solvent Vapor Postannealing to Enlarge Crystalline Domains of Organometal Halide Perovskite Films

Hybrid organic/inorganic perovskite solar cells (PSCs) have shown great potential in meeting the future challenges in energy and environment. Solvent‐vapor‐assisted posttreatment strategies are developed to improve the perovskite film quality for achieving higher efficiency. However, the intrinsic working mechanisms of these strategies have not been well understood yet. This study identifies an MA2Pb3I8(DMSO)2 intermediate phase formed during the annealing process of methylammonium lead triiodide in dimethyl sulfoxide (DMSO) atmosphere and located the reaction sites at perovskite grain boundaries by observing and rationalizing the growth of nanorods of the intermediate. This enables us to propose and validate an intermediate‐assisted grain‐coarsening model, which highlights the activation energy reduction for grain boundary migration. Leveraging this mechanism, this study uses MABr/DMSO mixed vapor to further enhance grain boundary migration kinetics and successfully obtain even larger grains, leading to an impressive improvement in power conversion efficiency (17.64%) relative to the pristine PSCs (15.13%). The revelation of grain boundary migration‐assisted grain growth provides a guide for the future development of polycrystalline perovskite thin‐film solar cells.

Predicted benefit of alternative post-treatment surveillance strategies in stage II and III colon cancer survivors.

3623Background: Early diagnosis of recurrence may provide the opportunity for cure among colon cancer survivors. Randomized studies comparing post-treatment surveillance strategies suggest that pat...

How clinicians make decisions regarding surveillance and treatment of colorectal cancer (CRC) patients.

263 Background: The goal of post-treatment surveillance of CRC patients is to identify recurrences among patients eligible for salvage surgery or palliative chemotherapy. However, patient ineligibility for treatment of recurrence may contribute to variation in surveillance practices. The aim of this study was to evaluate patient factors that affect clinician decisions regarding surveillance and salvage treatment eligibility among CRC patients. Methods: A custom 41-item survey was developed, incorporating modified criteria for adult comorbidity evaluation. A convenience sample of physicians who treat CRC was recruited from the ALLIANCE GI Cancer Committee. All participants completed an anonymous written survey of objective and subjective information about salvage treatment eligibility and the impact on surveillance in these patients. Results: Respondents were medical oncologists (n = 16; n = 11 with > 10 yrs experience) and surgical oncologists (n = 4). Patients with average comorbidity were considered ineligible for curative salvage surgery at median age 85 yrs (IQR: 80, 90), life expectancy 3 yrs (IQR: 2, 4.8) or ECOG ≥ 2 (IQR: 2,3). Patients were considered ineligible for palliative chemotherapy at median age 90 (IQR: 80, 92.5), life expectancy ≤ 2 years (IQR: 1.5, 3) or ECOG status ≤ 3 (IQR: 3, 3). Patients with above average comorbidity were considered ineligible for salvage surgery at median age 80 yrs (IQR: 75, 80) and palliative chemotherapy at median age 80 yrs (IQR: 75, 85). 8 comorbidities were identified by > 75% of the respondents as determinants of treatment ineligibility. 12 respondents (60%) indicated follow-up of patients ineligible for treatment should be continued based on patient desire, ongoing management of late effects, and continuity of care. However, a majority (n = 15) responded that clinic visits only should be continued without further testing. Conclusions: Considerable agreement was observed regarding patient characteristics that lead to ineligibility for treatment of recurrent disease. This information can aid shared clinical decision-making for post-treatment surveillance strategies and may potentially reduce variation in surveillance practice.

Bisphosphonate-related osteonecrosis of the jaw: an Italian post-marketing surveillance analysis

Objective: Although bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is well recognized, little is known about it in terms of pathophysiology, epidemiology or management. We analyzed all suspected BRONJ reports sent to the Italian Pharmacovigilance Adverse Event Spontaneous Reporting System (Rete Nazionale Farmacovigilanza [RNF]) to determine their pattern and add new information about this relevant issue.Research design and methods: All suspected BRONJ sent to the RNF between 2003 and 2011 were retrieved. After a case-by-case assessment procedure, we analyzed BP type, BP exposure time and time since last use.Results: Between 2003 and 2011, 555 reports of osteonecrosis of the jaw (ONJ) after BP administration were recorded in the RNF. These events occurred mostly in patients affected by cancer (77.84%) in which zoledronate was the most frequently suspected BP. Most patients experienced ONJ after long-term use of the drug (median time of BP exposure being between 1.3 and 8.8 years). Interestingly, 139 (25.05%) cases of ONJ occurred between 2 and 121 months after BP withdrawal.Conclusion: This study shows that BRONJ can occur much earlier than hitherto reported, adds new data on BRONJ onset following ibandronate treatment and reveals that patients who cease BP-based therapy develop ONJ, raising the question of post-treatment monitoring strategies.

Influence of post-treatment strategies on the properties of activated chars from broiler manure

There are a myriad of carbonaceous precursors that can be used advantageously to produce activated carbons or chars, due to their low cost, availability and intrinsic properties. Because of the nature of the raw material, production of granular activated chars from broiler manure results in a significant ash fraction. This study was conducted to determine the influence of several pre- and post-treatment strategies in various physicochemical and adsorptive properties of the resulting activated chars. Pelletized samples of broiler litter and cake were pyrolyzed at 700°C for 1h followed by a 45min steam activation at 800°C at different water flow rates from 1 to 5mLmin−1. For each activation strategy, samples were either water-rinsed or acid-washed and rinsed or used as is (no acid wash/rinse). Activated char’s physicochemical and adsorptive properties towards copper ions were selectively affected by both pre- and post-treatments. Percent ash reduction after either rinsing or acid washing ranged from 1.1 to 15.1% but washed activated chars were still alkaline with pH ranging from 8.4 to 9.1. Acid washing or water rinsing had no significant effect in the ability of the activated char to adsorb copper ions, however it significantly affected surface area, pH, ash content and carbon content. Instead, manure type (litter versus cake) and the activation water flow rate were determining factors in copper ion adsorption which ranged from 38mgg−1 to 104mgg−1 of activated char. Moreover, strong positive correlations were found between copper uptake and concentration of certain elements in the activated char such as phosphorous, sulfur, calcium and sodium. Rinsing could suffice as a post treatment strategy for ash reduction since no significant differences in the carbon properties were observed between rinsed and acid wash treatments.

Physician age and surveillance intensity following curative-intent treatment for breast cancer patients.

6081 Background: Breast carcinoma is a large health care concern for patients, physicians, and society. 2.5 million women have been treated for breast cancer and are candidates for surveillance in the US. We have documented dramatic variation in post-treatment surveillance strategies utilized by ASCO experts caring for such patients. Since it is often asserted that younger physicians order more tests than older physicians, we sought to measure the effect of clinician age on post-treatment surveillance intensity for breast cancer patients by analyzing a recent survey of ASCO members. Methods: We surveyed the 3245 ASCO members who indicated that breast cancer treatment was a major focus of their practice. 4 succinct clinical vignettes describing generally healthy women with breast cancer of varying prognoses and a menu of 12 surveillance modalities were offered. The menu was chosen after a literature search indicated that no other surveillance tests were commonly used. We analyzed data from one of the 4 idealized vignettes only (the patient with TNM IIA carcinoma) and stratified responses by clinician age. Practice patterns were compared by years after completion of training (0-10, 11-20, 21-30, 30-40, >40 years), a surrogate measure of physician age. Statistical analysis employed ANOVA. Results: There were 1012 responses; 915 were evaluable. Statistically significant differences were observed across age strata for CBC, liver function tests (LFTs), and serum CEA level only. For example, ASCO clinicians in practice for 0-10 years after completion of training recommended CBCs 1.3 + 1.4 (mean + SD) times in year 1. Those > 40 years after completion of training recommended CBCs 2.4 + 1.3 times in year 1 (p<0.001). Conclusions: Younger physicians recommend statistically significantly fewer CBCs, LFTs, and serum CEA levels during post-treatment surveillance than older physicians. However, the magnitude of the difference is clinically small for all 3 modalities and does not explain the known overall variation in surveillance practice among clinically active experts.

The Influence of Post-Treatment Strategies in Inkjet Printing on the Morphology of Layers and the Functional Performances of Electronic Devices

A UV curable ink is deposited on substrates by inkjet technology with constant jetting parameters and identical digital images. As the ink is composed of non evaporating liquids the patterns stay wet until being exposed to UV light. This enables the precise control of the transition from the liquid to the solid phase. By adjusting the time scales and energy levels of the post-treatment processes diverse pattern morphologies with different three-dimensional profiles are generated. We investigate the influence of the employed post-treatment strategies on 3D-functionalities. In addition, different treated UV ink layers are used in simple electronic devices and characterized by their performance. The results reveal exemplarily the significance of the process steps after the deposition of each single drop.

Risk of recurrent high-grade cervical intraepithelial neoplasia after successful treatment: a long-term multi-cohort study

15% of women treated for high-grade cervical intraepithelial neoplasia (CIN grade 2 or 3) develop residual or recurrent CIN grade 2 or 3 or cervical cancer, most of which are diagnosed within 2 years of treatment. To gain more insight into the long-term predictive value of different post-treatment strategies, we assessed the long-term cumulative risk of post-treatment CIN grade 2 or 3 or cancer and different follow-up algorithms to identify women at risk of residual or recurrent disease. Women who were included in three studies in the Netherlands and who were treated for CIN grade 2 or 3 between July, 1988, and November, 2004, were followed up by cytology and testing for high-risk human papillomavirus (hrHPV) at 6, 12, and 24 months after treatment, and subsequently received cytological screening every 5 years. The primary endpoint was the cumulative risk of post-treatment CIN grade 2 or higher by December, 2009. We also assessed the cumulative risk of CIN grade 2 or higher in women with three consecutive negative cytological smears and women with negative co-testing with cytology and hrHPV at months 6 and 24. This study is registered in the Dutch trial register, NTR1468. 435 women were included, 76 (17%) of whom developed post-treatment CIN grade 2 or higher, of which 39 were CIN grade 3 or higher. The 5-year risk of developing post-treatment CIN grade 2 or higher was 16·5% (95% CI 13·0-20·7) and the 10-year risk was 18·3% (13·8-24·0). The 5-year risk of developing post-treatment CIN grade 3 or higher was 8·6% (95% CI 6·0-12·1) and the 10-year risk was 9·2% (5·8-14·2). Women with three consecutive negative cytological smears had a CIN grade 2 or higher risk of 2·9% (95% CI 1·2-7·1) in the next 5 years and of 5·2% (2·1-12·4) in the next 10 years. The 5-year risk of CIN grade 3 or higher was 0·7% (95% CI 0·0-3·9) and the 10-year risk was 0·7% (0·0-6·3). Women with negative results for co-testing had a 5-year risk of CIN grade 2 or higher of 1·0% (95% CI 0·2-4·6) and a 10-year risk of 3·6% (1·1-10·7). The 5-year risk of CIN grade 3 or higher was 0·0% (95% CI 0·0-3·0) and the 10-year risk was 0·0% (0·0-5·3). The 5-year risk of post-treatment CIN grade 2 or higher in women with three consecutive negative cytological smears or negative co-testing for cytology and hrHPV at 6 and 24 months was similar to that of women with normal cytology in population-based screening and therefore justifies their return to regular screening. VU University Medical Center, Erasmus University Medical Center, Netherlands.

Immunophenotypical Sequential MRD Assessment in AML for Prediction of Relapse and Definition of Putative Future Intervention Time Points.

Immunophenotypical assessment of minimal residual disease (MRD) has been shown by us (Feller et al, Leukemia 18:1380, 2004) and others (San Miguel et al., Blood 98: 1746, 2001, Venditti et al., Blood 96: 3948, 2000) to be predictive for clinical outcome in AML both in patients treated with standard chemotherapy (SD) and high dose chemotherapy followed by autologous (AutoTQ) or allogeneic (AlloTQ) transplantation. Directly after consolidation therapy using a cut-off of 0.11% in the high MRD group the risk of relapse was 7.2 fold than in the low MRD group (Feller et al., 2004). Using that cut-off level, in the present study another important issue, i.e. sequential MRD assessments after end of treatment were done to i) prove consistancy of low MRD% in patients that remain in CR, ii) prove the ability to predict relapse using increase of MRD% and iii) assess the minimally required inter-sampling period to make MRD assessment clinically useful. To enable such 124 samples of 33 patients (<60 years) were included: 16 after SD, 8 after AutoTQ and 9 after AlloTQ. All time points refer to post-treatment periods, time point zero reflecting end of therapy.Of 16 patients studied after SD, 15 had MRD <0.11%. Of these, 12 are in CR with a median follow-up of 30.5 (range 9–46) months. In these 12 patients MRD remained consistently <0.11 %, (mean of 3 sequential MRD assessments per patient). Of these 15 patients 3 relapsed after 9, 9 and 26 months, but in these cases the last time point of MRD assessment (still <0.11%) unfortunately was at least 6 months before relapse. One patient who started with MRD>0.11 relapsed within 2 months after that MRD assessment.Of 8 patients studied after AutoTQ, 6 had MRD <0.11%. Of these, 4 are in CR with a follow-up of 6, 15, 40 and 72 months. Again, MRD remained consistently <0.11% (mean of 3 assessments per patient). Of these 6 patients 2 relapsed after 13 and 43 months, with relapse predictable using 3 months assessment intervals. Two patients had >0.11% MRD and relapsed after 5 and 11 months and within 3 months after the last MRD assessment, with no previous sign of forthcoming increase. Of 9 patients studied after AlloTQ, 2 had MRD <0.11%; thet are still in remission after 47 and 53 months. Again, MRD remained consistently <0.11 % (6 and 7 MRD assessments in these 2 patients).Of these 9 patients 2 relapsed too fast to have the opportunity to assess MRD. In addition, 5/9 had MRD >0.11%, of whom 2/5 relapsed after 6 and 7 months which was 4 and 2 months resp., after their last MRD assessment, with no previous sign of forthcoming increase. A remarkable phenomenon was observed in the other 3/5 patients: a large drop in MRD% down to detection level (0.01%) occurred 3–10 months after end of therapy. 2 of these 3 patients are still in CR (at 11 and 33 months), 1/3 relapsed after 26 months, 5 months after last MRD assessment with no previous sign of increase. The unique decrease of MRD% may be speculated to result from graft versus leukemia effects.These results show: 1) consistently low MRD% in sequential MRD assessments during persisting CR; 2) increases of MRD% which consistently predict relapse; 3) a minimally required inter-sampling period of 3 months for patients with MRD <0.11% and probably <3 months for patients with MRD>0.11%; 4) a strong decrease of MRD in part of the allogeneically transplanted patients.Results show the feasibility of sequential post-treatment MRD assessment that ultimately will contribute to design of post-treatment strategies in AML.

Costs of follow-up after potentially curative treatment for extremity soft-tissue sarcoma

Soft-tissue sarcoma is an uncommon cancer with the potential for high rates of recurrence after initial therapy. Multiple surveillance strategies have been developed to follow patients after primary treatment. The purpose of this study was to quantify the costs associated with various published post-treatment surveillance strategies. A literature review covering the years 1982-2003 was performed to find all modern published surveillance methods for extremity soft-tissue sarcoma. Only articles describing an explicit 5-year follow-up strategy were included. Total costs of 5-year follow-up were calculated for each strategy using Medicare-allowed charges as a proxy. Thirty-four articles depicting 54 strategies were identified. Total Medicare-allowed charges in year 2003 dollars ranged from 485 dollars for follow-up of low-grade sarcoma to 21,235 dollars for follow-up of high-grade sarcoma, a 42.8-fold cost differential. The average charge for these 54 strategies was 6,401 dollars. Physical examination and chest x-ray were the most commonly used screening modalities. Several guidelines have been proposed for extremity soft-tissue sarcoma patient follow-up, most prominently those of the National Comprehensive Cancer Network. The literature has yet to reflect the consensus these guidelines suggest. This study shows wide disparity in the costs of 54 specific methods of following soft-tissue sarcoma patients. Clinical trials are needed to identify an optimal surveillance strategy, one balancing gains in survival, quality of life, costs, and societal willingness to expend resources. Such trials have not been conducted due to the rarity of extremity soft-tissue sarcomas and the costs associated with conducting long-term trials. Alternatively, prospective evaluation of imaging modalities used in follow-up should be assessed as part of other trials. Computer simulation analysis also holds great promise as an assessment tool for surveillance strategies because patient participation is not required.

How surgeon age affects post-treatment surveillance strategies for melanoma patients.

The intensity of post-treatment melanoma patient follow-up varies widely among physicians. We investigated whether physician age accounts for the observed variation in surveillance intensity among plastic surgeons. A custom-designed questionnaire was mailed to USA and non-USA surgeons, all of whom were members of the American Society of Plastic and Reconstructive Surgeons. Subjects were asked how they use 14 specific follow-up modalities during years 1-5 and 10 following primary treatment for patients with cutaneous melanoma. Repeated-measures analysis of variance was used to compare practice patterns by TNM stage, year post-surgery, and age. Of the 3,032 questionnaires mailed, 1,142 (38%) were returned. Of those returned, 395 (35%) were evaluable. Non-evaluability was usually due to lack of melanoma patient follow-up in surgeons' practices. Follow-up strategies for most of the 14 modalities were highly correlated across TNM stages and years post-surgery, as expected. The pattern of testing varied significantly by surgeon age for 3 modalities (complete blood count, liver function tests, and chest X-ray), but the variation was quite small. We concluded that the post-treatment surveillance practice patterns of ASPRS members caring for patients with cutaneous melanoma vary only marginally with physician age. Continuing medical education could account for this observation.

Test-of-Cure for Asymptomatic Genital Chlamydial Infections in Women

Asymptomatic genital infection caused by Chlamydia trachomatis is common, and one or more test-of-cure consultations in such cases is routine. The economic implications of two post-treatment strategies, either no test-of-cure, or one test-of-cure consultation with a single test for C. trachomatis, renewed treatment, and another test-of-cure of those still chlamydia-positive, and so on, have been compared. The costs of the test-of-cure strategy are twice those of the no-test regimen. Without test-of-cure, 79 more cases of pelvic inflammatory disease, 8 cases of infertility requiring treatment, and 2 cases of ectopic pregnancy would occur for every 10,000 patients. It is concluded that routine test-of-cure of asymptomatic genital chlamydial infections after treatment is not cost beneficial.