CENE: Canadian Entrepreneurs in New England.

http://www.thecene.org/#!48-hours-in-the-hub/c11nc "48 Hours in the Hub": Cambridge Mass. Fall 2013 Program 48 Hours in the Hub is put on in conjunction with the Consulate General of Canada in Boston. Twice a year, 20 of Canada's most promising startups are invited to Boston/Cambridge for two days of mentorship, workshops, investor meetings, strategic partner visits and networking. (Comment: Several BIOMEDICAL firms) Biography - Consul General Patrick Binns Mr. Binns began his career in northern Alberta as a community development officer. In 1972 he moved to Prince Edward Island where he became Assistant Manager of the Rural Development Council. He served in P.E.I.'s public service from 1974 to 1978 and was a recipient of the Queen's Silver Jubilee Medal for Outstanding Public Service. From 1978 to 1984, he served in P.E.I.'s Provincial Legislature and held many cabinet portfolios. From 1984 to 1988, he was the Member of Parliament for Cardigan and served as a Parliamentary Secretary. From 1988 to 1996, he was President of Island Bean Ltd. and Pat Binns and Associates. He became leader of the Progressive Conservative Party of P.E.I. and the province's 30th Premier in 1996. Mr. Binns' government was re-elected to two more terms. During his 11 years as Premier, Mr. Binns established the P.E.I. Cancer Treatment Centre, founded and led Team Atlantic trade missions abroad and promoted the bio-science industry. From 2007 to 2010 he has served as Ambassador of Canada to Ireland. He is currently Consul General of Canada for New England and resides in Boston. Mr. Binns and his wife Carol maintain their farm property in Prince Edward Island. They have four adult children, Rob, Mark, Brad and Lilly as well as four grandchildren. Binns established an edible bean farm in Hopefield (Island Bean Limited) and operated a management consultant firm, Pat Binns & Associates.

HEATHCARE EUROPA: DENMARK : PRIVATE PRIMARY CARE

Danish primary care market to open in 2014 Denmark is set to massively liberalise its primary care sector in 2014. This comes after a ground-breaking DKK 200m (€26.82m) a year contract tendered out for primary and outpatient care services was successfully tendered by the Sjaelland region in May 2013 and won by Aleris. Is Denmark set to follow Sweden in liberalising its healthcare system, creating a huge new Nordic market? Falck thinks so: the ambulance provider has just acquired medical recruitment company Skandinavisk Halsovard. We talk to CEO of Falck’s healthcare services division Jan Steenhard, Skandinavisk’s continuing Director Borje Eriksson and former Global Health Partner and Capio CEO Per Batelson.

HEREDITARY ANGIOEDEMA: : Differential diagnosis non-itchy swelling.

www.HAEi.org HAE International MARBURG, GERMANY — 23 February 2013 - CSL Behring announced the results of a cost-effectiveness analysis showing that on-demand treatment of hereditary angioedema (HAE) attacks with Berinert®, C1 Esterase Inhibitor (Human), provides cost savings to payers when compared with the use of two other therapies approved in the U.S. for the acute treatment of HAE. The data were presented at the 2013 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting. The cost study, which compared Berinert to Firazyr® and Kalbitor™, analyzed differential dosing and administration costs indirectly using current, publically available prices. Results were weighted by typical re-dosing frequencies. The study included no head-to-head comparison of product efficacy or safety. “On-demand treatment options for acute swelling attacks of HAE differ widely in the doses administered per patient and price per administration, weighted partially by the need for re-dosing,” said Timothy J. Craig, D.O., Professor of Medicine and Pediatrics at Penn State University in Hershey, Pennsylvania, and one of the study’s investigators. “These factors significantly impact the overall cost of therapy. Our first-ever analysis of the differential costs to resolve HAE attacks found Berinert to be the least costly of these treatments, reflecting its minimal re-dosing frequency as the therapy is prescribed based on each individual’s weight.” Estimates for re-dosing frequencies for the HAE treatments were based on clinical trial data for all three Food and Drug Administration-approved products. The re-dosing frequency for Berinert (studied in the I.M.P.A.C.T. 1 and I.M.P.A.C.T. 2 trials) was 1 percent, while Firazyr® (FAST-1, FAST-2 and FAST-3) was 7 percent and Kalbitor™ (EDEMA1, EDEMA3 and EDEMA4) was 20 percent. Berinert is dosed based on weight, ranging from two to five vials (500 IU each) for patients weighing 50 to 150 kg. Berinert was the least costly on-demand treatment option for HAE in a typical patient with 75 kg per body weight needing three vials per treatment episode. Per attack, Berinert was estimated to save patients $79.29 to $4,659 compared to Firazyr® and $2,628 to $7,208 compared to Kalbitor™. Berinert is approved for on-demand treatment of acute abdominal, facial or laryngeal attacks of HAE in adults and adolescents, and is approved for patient self-administration after proper training by a healthcare professional.

McGILL UNIV: FREE CONFERENCES REPORTS

http://www.mednet.ca/en/credits.html Latest Reports 8th World Congress of Melanoma - New Advances in the Treatment of Basal Cell Carcinoma: Targeting the Hedgehog Signaling Pathway XXIV Congress of the International Society on Thrombosis and Haemostasis (ISTH)/ 59th Annual Scientific and Standardization Committee (SSC) Meeting - Potential for Advances in the Treatment of Hemophilia A 73rd Scientific Sessions of the American Diabetes Association (ADA) - New Antidiabetic Medications Yield Flatter PK, More Predictable Blood Glucose Levels than Standards 73rd Scientific Sessions of the American Diabetes Association (ADA) - Clarity Grows on the Role of SGLT2 Inhibitors in Routine Control of Type 2 Diabetes SLEEP 2013 - 27th Annual Meeting of the Associated Professional Sleep Societies - Sleep-Wake Systems Intersected: A New Dawn in the Treatment of Sleep Disorders Digestive Diseases Week 2013 - Progress in Control of Constipation: Highly Specific Agents Change Treatment Algorithm International Conference of the American Thoracic Society - Updates in the Treatment of Chronic Thromboembolic Pulmonary and Pulmonary Arterial Hypertension Primary Care Today 2013 - Update on Benign Prostatic Hyperplasia in Primary Care 23rd European Congress on Clinical Microbiology and Infectious Diseases - Serum Antifungal Concentrations Are Fundamental to Cure of Invasive Aspergillosis 8th Congress of the European Crohn’s and Colitis Organisation - The Potential of IV Iron Treatment in IBD Patients with Iron Deficiency Anemia 54th Annual Meeting of the American Society of Hematology - Emerging Concepts in the Management of Iron Deficiency Anemia 54th Annual Meeting of the American Society of Hematology - Seeking Better Outcomes for Indolent Lymphomas 10th Canadian Immunization Conference - Invasive Meningococcal Disease: Focus on the New Serogroup B Disease Vaccine 10th Canadian Immunization Conference - Improving Influenza Protection in Seniors with Adjuvanted Vaccines 10th Canadian Immunization Conference - Nasopharyngeal colonization and disease transmission: Eradication of Vaccine-Specific Organisms Dramatically Reduces Disease Incidence in Recipients/Non-Recipients Alike 4th European Multidisciplinary Meeting on Urological Cancers (EMUC 2012) - Targeting the Androgen Receptor in Castrate-resistant Prostate Cancer: A Step Forward 63rd McGill Annual Refresher Course for Family Physicians - Update on Family Medicine: Oral Anticoagulants, Stroke Management, Ovarian Cancer 76th Annual Meeting of the American College of Rheumatology (ACR) - Protection Against Radiologic Progression in Rheumatoid Arthritis with JAK Inhibition Appears Similar to IV Biologics 65th Annual Meeting of the Canadian Cardiovascular Society - Effective Event Reduction in the Era of New Oral Anticoagulants: Pursuing Options 2012 Canadian Hypertension Congress - A Template for Improved Blood Pressure Control and Better Adherence: Integrating Third Generation b-blockers and Single-pill Multiple Mechanism Combinations 2012 Kidney Week of the American Society of Nephrology (ASN) - Options for Iron Correction and Erythropoiesis Stimulation: Better Benefit:Risk Through Individualized Therapy 21st Congress of the European Academy of Dermatology and Venereology (EADV) - Progress in Advanced Basal-cell Carcinoma: Exploring Hedgehog Pathway Inhibition 37th European Society of Medical Oncology Congress (ESMO) - Exploring Benefits of Multitargeted Therapy for Metastatic Colorectal Cancer and Gastrointestinal Stromal Tumours 89th Annual Meeting of the Canadian Paediatric Society - Prevention and Minimization of Potential Complications from Infection and Disorders in Infancy 2012 Annual European Congress of Rheumatology (EULAR) - Progress in Oral Biologics for Rheumatoid Arthritis 28th CINP World Congress of Neuropsychopharmacology - Resetting the Internal Master Clock: A Novel Approach to the Treatment of Depression 48th Annual Meeting of the American Society of Clinical Oncology - Hormone Activity Suppression in Castration-resistant Prostate Cancer 10th Annual Primary Care Today Conference - Preventing Allergies in Infants: Focus on Atopic Dermatitis 15th International Congress of Endocrinology and 14th European Congress of Endocrinology (ICE-ECE) - Hyponatremia: Optimizing Clinical Approaches 22nd European Congress on Clinical Microbiology and Infectious Diseases (ECCMID) - Primary Treatment of Invasive Aspergillosis in Hematology Patients

SWISS HAEMATOLOGY SOCIETY: HAEMATOLOGY NOTES

http://ssh.bio-med.ch/media/shared/uploaded/Files/9/9/6.pdf

COURSERA

About Coursera® We believe in connecting people to a great education so that anyone around the world can learn without limits. Coursera is an education company that partners with the top universities and organizations in the world to offer courses online for anyone to take, for free. Our technology enables our partners to teach millions of students rather than hundreds. We envision a future where everyone has access to a world-class education that has so far been available to a select few. We aim to empower people with education that will improve their lives, the lives of their families, and the communities they live in.

UTRECHT: MYELOMA IMMUNOTHERAPY

Immunotherapy of Myeloma and other haematological tumors printPrint Laat de tekst voorlezen met ReadSpeakerLees voor Immunotherapy of Myeloma and other haematological tumors Myeloma and several other haematological cancers can be treated by cellular immunotherapy, as illustrated by the success of allogeneic stem cell transplantation (allo-SCT) and donor lymphocyte infusions (DLI) to induce long term remissions in a fraction of patients. This donor T-cell-mediated therapeutic Graft-vs-Tumor effect (GvT) is, however, frequently inefficiently developed, compromised by several tumor microenvironment-related immune escape mechanisms and is furthermore associated with severe complications such as Graft-vs-Host Disease (GvHD). Set out to improve the efficacy and safety of immune therapies of myeloma and other haematological malignancies, the research in the haemato-oncology group is focused on three important areas: 1. Separating GvT and GvHD by: a) Identification of GvT-associated Tumor antigens and minor Histocompatibility antigens (mHag) by Genome wide genetic association analyses (GWAS) and by reverse immunology. b) Development and clinical application therapeutic dendritic cell vaccines loaded with GvT associated mHags. c) Development and clinical application adoptive immunotherapy strategies based on GvT associated mHags. d) Defining the appropriate conditions to separate GvT from GvHD using regulatory T cells. e) Development of effective cancer vaccines by protein misfolding. 2. Understanding and eliminating tumor microenvironment-related immune escape mechanisms. a) Identification, in vitro and in vivo modulation of (intra) cellular mechanisms of immune suppression and immune resistance within the bone marrow, the natural microenvironment of myeloma microenvironment. Specific attention is given to p53, Notch and WNT signalling pathways. b) identification and modulation of (intra) cellular immune suppressive/resistance mechanisms leading to extramedullar Myeloma outgrowth. 3. Development of efficient targeted antibody therapy for MM by combining novel therapeutic antibodies with immune stimulatory agents like lenalidomide, pomalidomide, bortezomib and others. The research mission of Haemato-oncology lab is strongly linked to the clinical goals of the Department of Haematology, which is one of the largest SCT centres in the Netherlands and functions as a reference centre for Multiple Myeloma (MM) patients. The preclinical research is carried out in advanced in vitro models as well as in humanized in vivo murine models that are developed with a longstanding collaboration with Dr. A.C.M. Martens. Faculty Dr. Tuna Mutis Prof. dr. Henk Lokhorst Recent publications - Groen, R.W., W.A. Noort, R.A. Raymakers, H.J. Prins, L. Aalders, F.M. Hofhuis, P. Moerer, J.F. van Velzen, A.C. Bloem, B. van Kessel, H. Rozemuller, E. van Binsbergen, A. Buijs, H. Yuan, J.D. de Bruijn, M. de Weers, P.W. Parren, J.J. Schuringa, H.M. Lokhorst, T. Mutis, and A.C. Martens (2012). Reconstructing the human hematopoietic niche in immunodeficient mice: opportunities for studying primary multiple myeloma. Blood 120, e9-e16. - Kneppers, E. B. van der Holt, M.J. Kersten, S. Zweegman, E. Meijer, G. Huls, J.J. Cornelissen, J.J. Janssen, C. Huisman, P.B. Cornelisse, C.P. Bruijnen, M. Emmelot, P. Sonneveld, H.M. Lokhorst, T. Mutis, M.C. Minnema –(2011) Lenalidomide maintenance following non-myeloablative allogeneic stem cell transplantation in multiple myeloma is not feasible: results of the HOVON 76 trial. Blood 118, 2413-2419 - Veer, M. van der, M. de Weers, B. van Kessel, J.M. Bakker, S. Wittebol, P.W.H.I. Parren, H.M. Lokhorst, T. Mutis (2011) Towards effective immunotherapy of myeloma: enhanced elimination of myeloma cells by combination of lenalidomide with the human CD38 monoclonal antibody daratumumab. Haematologica 96, 284-290

SYMPTOM DIAGNOSIS

http://www.smw.ch/content/smw-2013-13829 Review article | Published 19 September 2013, doi:10.4414/smw.2013.13829 Cite this as: Swiss Med Wkly. 2013;143:w13829 The last century of symptom-oriented research in emergency presentations – have we made any progress? Roland Bingisser, Christian Hans Nickel Emergency Department, University Hospital, Basel, Switzerland Summary This review is dedicated to the last century of symptom-oriented research, taking three symptom complexes as typical examples of medical progress, and focusing on emergency presentations. Landmark publications in each area are discussed, with an attempt to focus on the methods used to achieve major breakthroughs. In abdominal pain, progress was achieved over a century ago by correlating symptoms and surgical pathology. Most diagnoses were made by using the clinical tools elaborated with careful observation and clinical examination. Together with the later reported outcomes, surgeons had an early and powerful tool for symptom-oriented research. In dyspnoea, progress was achieved much later, as a universal definition had to be elaborated over decades by consolidating clinical research, predominantly symptom-pathology correlation, and experimental research, such as function testing and experiments with animals and humans. In nonspecific presentations in emergency situations, progress has been achieved only recently, most probably owing to the fact that elderly patients are presenting in steeply increasing numbers, and the hallmark of disease presentation in the elderly seems to be less specific symptoms and complaints. This may be caused by altered physiology, polymorbidity, polypharmacy and the multiple difficulties encountered when taking histories in the elderly. Taken together, symptom-oriented research has been an important contributor to medical progress in the last century. Though it may be challenged by image- and laboratory-oriented research, it will remain part of patient-centred research because the epidemiology of symptoms, their clinical outcomes and their diagnostic importance according to severity will be the basis for the diagnostic process.

SIEMENS: SYMBIA INTEVO

Siemens Symbia Intevo xSPECT, the difference between seeing and knowing Siemens Symbia Intevo's precise alignment of SPECT and CT enables accurate, consistent and reproducible quantification. Symbia Intevo¹ – the world's first xSPECT system – combines the high sensitivity of single-photon emission computed tomography (SPECT) with the high specificity of CT. Completely integrating data from both modalities, Symbia Intevo generates high resolution and, for the first time ever, quantitative images. Higher resolution frame of reference In conventional SPECT/CT imaging, the SPECT image has always been reconstructed using SPECT's low-fidelity frame of reference. For this reason, the CT resolution has been downgraded dramatically to the level of SPECT to enable the mechanical fusion of both datasets. Siemens' new xSPECT modality reconstructs both the SPECT and CT portions of the image using the high resolution CT frame of reference for precise, accurate alignment that facilitates the extraction and deep integration of medically relevant information. This ability is also the basis for differentiating between tissue boundaries in bone imaging. With the xSPECT Bone feature, physicians can provide additional support for detection and distinguishing between cancerous lesions and degenerative disorders. First truly quantitative SPECT Symbia Intevo's precise alignment of SPECT and CT provides physicians with essential volumetric information from the CT scan, enabling accurate, consistent and reproducible quantification – a numerical indication of a tumor's level of metabolic activity. With the xSPECT Quant feature, the physician can apply quantitative information to aid in the assessment of whether a patient's course of treatment has regressed, stabilized or grown – an assessment that is difficult to make with a purely visual assessment of the tumor. Reduced CT dose While Symbia Intevo uses more CT data than ever before, Siemens is still able to limit patient dose by offering combined applications to reduce exposure (CARE). Unique to Siemens, these applications include the CARE Dose4D technique, which can reduce patient CT radiation dose by up to 68 percent.² Increased productivity and throughput Symbia Intevo also offers applications to improve productivity and patient throughput. For example, Siemens' AUTOFORM collimator – a standard feature on Symbia Intevo – captures up to 26 percent more counts, or photons that are generated from radiotracer activity as compared to conventional collimators.² This increased number of counts potentially reduces image acquisition time for increased patient throughput. Learn more about the technology behind Symbia Intevo and the xSPECT modality here.

GRONINGEN UNIV. MULTIPLE MYELOMA (KAHLER"S DISEASE)

http://www.hematologiegroningen.nl/patienten/content/3Kahler.htm (good slides)

DAILY MAIL: GBP 6 -million for Cerebral Palsy

Legal firm IRWIN MITCHELL UK & SPAIN Location(s): Leeds Tel. 0870 1500 100 Fax. 0113 234 3322 PARTNER Rachelle Mahapatra "I have been the head of clinical negligence at the Leeds office since 1995 acting for patients in claims against doctors and hospitals. I am particularly interested in mistakes made surrounding the delivery of unborn babies causing injury sometimes serious to the baby or their mother, complications of abdominal surgery and late diagnosis of cancer. The department in Leeds covers all aspects of clinical negligence.-2421722/ Parents-schoolgirl-8-suffered-brain-damage-birth-staff-failures-win-multimillion-pound-payout.html

DAILY MAIL: HEPATITIS E

HEPATITIS E - UK: PORK SAUSAGES, ALERT ************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sun 15 Sep 2013 Source: The Daily Mail, Mail-online, Health [edited] As many as one in 10 sausages is infected with a potentially deadly virus that causes liver damage, scientists warn. They are concerned that rising numbers of Britons are being struck down with hepatitis E after eating contaminated pork. The infection was once considered very rare, but cases have risen by nearly 40 per cent in a year, and there were 657 in 2012. The virus usually causes only relatively mild symptoms such as sickness, a temperature and muscle pain, which clear up by themselves within a month. But it can be fatal for the elderly, cancer victims, pregnant women and others with existing liver problems. Around one in 50 of those infected will die, rising to one in 5 pregnant women, according to statistics. Experts say sausages have to be cooked at 70 C (158 F) for at least 20 minutes to kill the virus, but they say that most Britons do not leave them in the oven for this long. Tests have showed that it can survive at 60 C after an hour. A report published last week by the Department for Environment, Food, and Rural Affairs says 10 per cent of sausages recently sampled were found to contain the virus. It states that there is increasing evidence that hepatitis E, which is common in the developing world, where it is usually transmitted through contaminated water, is a food-borne infection and adds that it is increasingly being recognised as a major disease. All forms of hepatitis cause swelling of the liver, which in severe cases can cause severe damage to the organ, liver cancer and death. More than half of those infected with hepatitis E are men over 50, who are more susceptible as they tend to drink more and their livers are weaker. The virus is particularly harmful for pregnant women who catch it in the final 3 months of their pregnancy because it can lead to acute liver failure, and one in 5 expectant mothers who catch the virus will die. Dr Harry Dalton, a consultant at the Royal Cornwall Hospital in Truro and one of Britain's leading experts on hepatitis E, said: "This is emerging as a serious problem. About 85 per cent of British pigs carry the virus, which is quite hardy. Sausages have to be cooked at 70 C for 20 minutes to kill it, and that is longer than most sausages ever get cooked. Anyone cooking with sausages or other pork products should take stringent hygiene precautions including washing their hands and cleaning work surfaces." Sausages are regarded as the most dangerous product, as they often contain liver meat and traces of pig's blood as well as a casing from the animal's intestine. -- Communicated by: ProMED-mail [The following is the DEFRA statement entitled: "Hepatitis E and detection in pork and pork products," , referred to in the above press report. "There has been recent publicity about hepatitis E infection in humans. This relates to an increase in 2010-11 in the proportion of cases of hepatitis E diagnosed where there is no history of travel by the affected person. A recent publication (Berto and others, 2012) reported PCR detection of hepatitis E virus in 13 percent of pig faeces and 3 percent of pig livers at slaughter and 10 percent of pork sausages at retail. Whether virus is infective at these different stages was not established. The report of an extensive case control study in humans is expected in 2013 and may identify risk factors and assist in determining whether there is evidence to support the putative link with consumption of pork and pork products. In the meantime, a multi-agency, joint-funded abattoir survey of pigs, expected to be conducted in early 2013, will seek to establish the prevalence of infection in slaughter pigs in the UK. This is highlighted here as an issue which may cause adverse publicity for the pig industry at what is already a difficult time." See: . Hepatitis E is a liver disease caused by hepatitis E virus: a non-enveloped, positive-sense, single-stranded ribonucleic acid virus. Hepatitis E virus is transmitted usually mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. The hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes have been identified, which include: foodborne transmission from ingestion of products derived from infected animals, transfusion of infected blood products, and vertical transmission from a pregnant woman to her fetus. The incubation period following exposure to the hepatitis E virus ranges from 3-8 weeks, with a mean of 40 days. The period of communicability is unknown. Typical signs and symptoms of hepatitis include: jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools, anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting. Overall population mortality rates from hepatitis E range from 0.5 to 4.0 percent. Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20 percent among pregnant women in their 3rd trimester. Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people. (From: ). Previously, ProMED-mail reported cases of hepatitis E in France associated with undercooked pork sausage meat. - Mod.CP

SCOTLAND: LEGIONELLA LONGBEACHAE from compost

] Date: Fri 13 Sep 2013 Source: This Is Jersey/Jersey Evening Post [edited] A health board is investigating 4 cases of the infection [due to] _Legionella longbeachae_ linked to gardening compost. 2 patients are being treated in intensive care while 2 more have been discharged from hospital, NHS Lothian said. The 4 people affected are keen gardeners between the ages of 62 and 84. Dr Richard Othieno, NHS Lothian consultant in public health and chair of the incident management team, said: "This type of _Legionella_ is quite rare in that unlike other strains it has never been identified in man-made water systems, like cooling towers. We are working with experts to trace the source of the infection and samples of the compost have been sent for testing. We know that all of the 4 cases are keen gardeners and had purchased different products containing compost prior to acquiring the infection. Gardening is a healthy hobby but there are risks and it is important that people take some simple precautions when working in their garden or with gardening products. I would like to add further reassurance that the risk to the wider public is low." The symptoms of _Legionella longbeachae_ [infection] include headaches, diarrhoea, or a dry cough followed by pneumonia. Most people recover after treatment with antibiotics but those with underlying medical problems are more vulnerable, the health board said. It is not known exactly how the infection is passed from compost to people but health experts assume it is through breathing in very small dust particles or drops of contaminated water. The infection is not transmitted from person to person. Anyone handling garden materials such as potting mix, mulches, composts, or garden soils is advised to open bags carefully, wear gloves and keep doors to greenhouses or sheds open when potting plants or filling hanging baskets. Gardeners are also advised to wear a mask if the air is dusty, particularly indoors, and to wash their hands immediately after using compost and before smoking. There is no link between the current cases and the outbreak of [infection due to] _Legionella pneumophila_ in southwest Edinburgh in 2012, NHS Lothian said.

PLASMA CELL CANCER CLASSIFICATION from "LEUKEMIA"

Experts Publish Consensus Risk Classification For Multiple Myeloma Published: Sep 13, 2013 5:24 pm An international panel of multiple myeloma experts, known as the Inter­national Myeloma Working Group (IMWG), recently released a consen­sus statement on risk stratification for patients with multiple myeloma. Risk stratification refers to the classification of patients into different cate­gories based on likely disease outcome. The new IMWG risk stratification, for example, has three risk categories: low-risk, standard-risk, and high-risk. In the new system, determination of a patient’s risk classification is based on three factors: a patient’s disease stage according to the Inter­national Staging System (ISS); the presence of certain chromosomal abnormalities in the patient’s myeloma cells based on results of so-called FISH testing; and patient age. Patients who are ISS stage II or III and whose myeloma cells contain the translocation t(4;14) or the deletion del(17p13) are classified as high-risk. About 20 percent of patients are expected to fall in this category at the time of diagnosis, with median overall survival of two years from diagnosis. Patients who are ISS stage I or II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients also are expected to fall in this category at diagnosis, with median overall survival of more than 10 years from diagnosis. The remaining 60 percent of patients are classified as standard-risk, with median overall survival of seven years from diagnosis. Despite agreeing on how to classify patients into low-risk, standard-risk, and high-risk groups, the expert panel does not recommend that their stratification be used to determine a myeloma patient’s initial therapy. Some major treatment centers – notably the Mayo Clinic – favor a “risk-adapted” approach to myeloma therapy, in which a myeloma patient’s initial therapy is guided by their risk classification. The expert panel, however, does not believe that such an approach is generally warranted at this time. In addition to the risk stratification described above and a discussion of risk-adapted therapy, the newly published consensus statement presents the experts’ current opinions on the need for risk stratification and explains the criteria that can be used for risk stratification. The Need For Risk Stratification According to the consensus statement, one of the foremost reasons for risk stratification is to inform a patient of his or her prognosis. It allows physicians to provide an expected survival time in answer to the patient’s question, “How long do I have to live?” (see related Beacon article on myeloma prognosis). Secondly, the experts argue that risk stratification may pave the way for risk-adapted therapy. In risk-adapted therapy, a patient’s treatment is tailored to their risk category. For example, high-risk patients receive more intensive treatment than low-risk patients (see related Beacon article). This approach aims to minimize side effects while maximizing the benefits of treatment. Risk-adapted therapy is commonly used for acute myeloid leukemia and Hodgkin lymphoma, diseases in which low-risk patients can be cured with non-intensive treatment. However, there is an argument that this approach does not apply to myeloma, since myeloma is still considered incurable. Instead, all myeloma patients should receive the most effective treatment available. The researchers suggest that the identification of low-risk myeloma patients, who are likely to live 10 years or longer, may strengthen the case for risk-adapted therapy in myeloma. The investigators also note that risk stratification provides a useful framework for testing new therapeutic strategies. For instance, they suggest that strategies without high-dose chemotherapy and stem cell transplantation can be tested for low-risk patients, while more potent strategies need to be tested for high-risk patients who have poor outcome with current treatment strategies. Factors That Can Be Used For Risk Stratification In order to arrive at meaningful risk stratification criteria, the experts considered a number of factors that have been found to be associated with poorer myeloma prognosis. They divided these risk factors into host-related factors (related to the patient) and tumor-related factors (related to the myeloma cells). Age The researchers conclude that the most important host-related factor in determining myeloma risk is age. Several previous studies have shown that younger age at myeloma diagnosis is strongly associated with longer survival (see related Beacon news and the Beacon’s recent article on multiple myeloma survival by race and age). Chromosomal Abnormalities And Gene Expression Profiles According to the consensus, the most important tumor-related risk factors are the presence of certain chromosomal abnormalities and the gene expression profile of the patient’s myeloma cells. Chromosomal abnormalities are changes in the structure of the cell’s genetic material. These changes can occur through deletions, insertions, duplications, or the movement of pieces of genetic material. The experts note that the translocation t(4;14) and the deletion del(17p13) are consistently associated with poor survival across a number of studies. The effects of the translocation t(14;16) and 1q21 gain on disease prognosis have remained controversial. However, the researchers note that the lack of 1q21 gain could be useful in identifying patients with good prognosis. Since a number of studies have revealed variations in prognosis even among individuals with chromosomal abnormalities, the experts conclude that the use of chromosomal abnormalities as a stand-alone risk factor may not be optimal. However, they suggest that combining information about chromosomal abnormalities with other factors could improve their prognostic value. Gene expression profiling simultaneously measures the activity of thousands of genes in a patient’s myeloma cells, creating a snapshot, or profile, of everything going on inside the cells. Previous studies have identified a number of gene expression profiles that are associated with poor disease prognosis. The experts note, however, that the clinical application of gene expression profiling remains limited due to three important factors: (1) the lack of a unified and standardized gene expression profile for myeloma cells, (2) the perception of a lack of reproducibility for the technique, and (3) the difficulty faced by physicians in analyzing and interpreting the complex data generated from gene expression profiling. To address the lack of a standardized profile, the IMWG is currently conducting a study that combines a number of known gene expression profiles to generate a unified set of profiles, which will then be tested. Disease Stage The International Staging System (ISS) uses a combination of b2-microglobulin levels and albumin levels in the blood to classify patients into three disease stages. Studies have shown that advanced disease stage is linked to poorer survival. The ISS, however, does not take chromosomal abnormalities into account. Based on more recent studies, the experts note in the consensus statement that a model that combines both ISS staging and chromosomal abnormalities could be more effective in predicting risk. They add that results from a recent IMWG analysis showed that ISS staging and the presence or absence of t(4;14) and del(17p13) can reliably segregate patients into three risk groups. Responsiveness Of Tumor To Treatment How a patient’s myeloma responds to treatment is a risk factor that can only be determined after treatment. According to the experts, not achieving at least a partial response to treatment – or at least a very good partial response to stem cell transplantation – is reflective of resistance to treatment and associated with poorer disease outcome. The experts state, however, that early relapse or an inability to maintain response to treatment is an indicator of very poor prognosis. Consensus Definition Of Risk Groups From among the various risk factors discussed above, the researchers sought to identify the most relevant factors to use for stratification. A study published by the IMWG in March showed that combining ISS stage with data about chromosomal abnormalities significantly improved risk assessment in myeloma. In particular, the study identified three key chromosomal abnormalities – t(4;14), del(17p13), and 1q21 gain, measured using the technique known as fluorescence in situ hybridization (FISH). The experts used the results of this previously published study to guide their final consensus risk stratification, which is as follows: High Risk – Patients who are ISS stage II/III and whose myeloma cells contain the translocation t(4;14) or the deletion del(17p13) are classified as high-risk. About 20 percent of patients are expected to fall in this category, with median overall survival of two years from diagnosis. Low Risk – Patients who are ISS stage I/II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients are expected to fall in this category, with median overall survival of more than 10 years from diagnosis. Standard Risk – The remaining 60 percent of patients are classified as standard-risk, with median overall survival of seven years from diagnosis. The experts note that the two tumor-related factors used in the new stratification – ISS stage, which is based on b2-microglobulin and albumin levels in the blood, as well as the chromosomal abnormalities t(4;14), del(17p13), and 1q21 gain (measured using FISH) – are based on robust laboratory tests and are applicable to more than 90 percent of all myeloma patients. Experts Not Yet Ready To Recommend Risk-Adapted Therapy Despite the definition of what the experts believe is a robust risk stratification system for myeloma, the panel notes in its consensus statement that “We are still not in a position to recommend different treatments for patients in different risk groups.” Instead, the experts recommend that “all patients should receive the most optimal treatment tested in Phase 3 clinical trials and currently available,” with dose modification according to patient-related factors. The only exception stated in the consensus report is that the experts recommend the use of Velcade (bortezomib)-based initial and maintenance regimens for patients with t(4;14). The researchers made this recommendation based on several studies showing that Velcade-based treatment attenuates the increased risk associated with the t(4;14) abnormality. Although the experts do not recommend risk-adapted therapy at this time, they note that risk stratification can offer a useful framework for deciding among treatment options. For instance, they note that a low-risk patient could potentially choose a regimen with lower cost and toxicity, even if it was associated with slightly reduced efficacy. The researchers explain that such decisions are also dependent upon the treatment philosophy of the physician, who can take either a cure approach (aggressive treatment with the aim of achieving a complete response) or a control approach (less aggressive treatment with a focus on disease control and quality of life) toward treating the disease. The experts recommend that future studies should aim to further refine the risk groups defined in the consensus statement, based on the underlying biology of the myeloma cells. For further information, please see the consensus report in the journal Leukemia.

Mr.T.LeDUC site : WORLD DISEASE STATS & LIFE EXPECTANCY

http://www.worldlifeexpectancy.com/members.php World Life Expectancy is the latest in a series of Educational Experiences developed by LeDuc Media. The Site’s purpose is to stimulate meaningful research on this important subject through leading Academic Institutions worldwide, while displaying the data in ways the less informed visitor can understand and use. Gathering meaningful Life Expectancy data from every corner of the Globe is an expensive and time-consuming process and with the help of our sponsors, we intend to continue to make it available for free. Our goal is to assist people everywhere in living longer and more productive lives. In the short time the Site has been in existance it has received over 1,000,000 Visitors from 148 countries and is being used everyday by major universities, government institutions, corporations and even K-12 schools in local communities. We are especially pleased to see the number of Military organizations using the Site and are hopeful this trend will continue.

TORONTO: Canadian Cancer Research Alliance conference

The Canadian Cancer Research Alliance is proud to host the second Canadian Cancer Research Conference, taking place from Sunday November 3 to Wednesday November 6, 2013 at the Sheraton Centre Toronto Hotel in Toronto, Ontario. The conference will: Showcase the breadth and excellence of Canadian cancer research to both the research community and the public; Provide a single venue for researchers from across the cancer research spectrum and cancer sites; Expose researchers to new areas of cancer research, new techniques and infrastructures and facilities to support research; Allow for cross-fertilization between research disciplines; and Provide networking opportunities for researchers at all levels of their careers. The conference is targeted to all involved in cancer research from the lab to clinic to policy and will also incorporate special sessions for trainees and new principal investigators. We look forward to seeing you in November 2013! The conference will be conducted in English, which has become the international language of science.

UK: PRIVATE(charitable) BUCKINGHAM UNIVERSITY MEDICAL SCHOOL

http://www.buckingham.ac.uk/medicine/undergrad/mbchb MBChB after 4.5 years. 2 pre-med + 2.5 clinical. No limit to Overseas (non-EU) students. Oxbridge-style tutorials.

SWEDEN: OCKELBO virus.

-- Communicated by: ProMED [Ockelbo virus was 1st isolated in 1982 in Sweden. It is antigenically related to Sindbis virus. The disease in humans is characterized by arthritis, rash, and fever, although many infections are asymptomatic. Antibodies to the virus have been found throughout Sweden with highest prevalence in the central part of the country. The virus is transmitted by _Culex_ mosquitoes, with transmission to humans occurring from late July until killing frosts in October. Neutralizing antibodies have been found in 3 orders of birds in Sweden. Passerine birds are infected most frequently and may be amplifying hosts of the virus. - Mod. TY] [More information on the actual numbers of cases and other epidemiologic information on these cases would be greatly appreciated. For a map of Sweden showing the location of Harnosand, see . For a map of Sweden showing the location of Pitea, see . For the HealthMap/ProMED-mail map of Sweden, see . - Mod.MPP]

LANCET: London Dr.W.FRANKLAND Allergist @ 101y

Bill Frankland: active allergist at 101 Richard Lane Bill Frankland celebrated his 101st birthday earlier this year, and is still active in academic research, after nearly 70 years as a leading allergist. “I keep myself busy”, he says cheerfully, when we meet at his mews apartment in central London. “I am author or co-author of three papers out at the moment, and they will be published later this year. ”http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961821-8/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3=E24A35F

Australia New South Wales: Organs as inheritable property

Organs as inheritable property? J Med Ethics Published online 30 August 2013 Authors: Teck Chuan Voo, Soren Holm “…This paper argues that organs should be inheritable if they were to be socially and legally recognised as tradable property. It also seeks to contribute to the idea of organs as inheritable property by providing a defence of a default position of the family of a dead person as the inheritors of transplantable organs. In the course of discussion, various succession rules for organs—which might exclude the right to destroy and waste transplantable organs—will be suggested. Lastly, we consider some objections to organs as inheritable. Our intention in this paper is to provoke further thought on whether ownership of one’s organs should be assimilated to property ownership…” - See more at: http://ehln.org/?p=31030#sthash.KHJpozeN.dpuf

UK FINANCIAL TIMES: Medical info sold.

Health app users have new symptom to fear Lifestyle data being passed to third parties Health apps run into privacy snags Big Mother is watching you

DAILY MAIL: NHS to pay for ZOSTAVAX for those 70-79y.

Monday, Sep 02 2013 NHS to offer shingles jab for patients in their 70s: Programme aims to protect those who are most vulnerable Government advisers ruled that vaccinating people in their 80s is not cost-effective An estimated 800,000 people will be eligible for the vaccine in the first year Read more: http://www.dailymail.co.uk/news/article-2408633/NHS-offer-shingles-jab-patients-70s-Programme-aims-protect-vulnerable.html#ixzz2dhZk1TZ9 Follow us: @MailOnline on Twitter | DailyMail on Facebook

SYRIA: Cutaneous Leishmaniasis."ALEPPO BOIL"

Harvard PROMED> 100,000 in N.Syria/Turkish border has Cut.Leishmaniasis. http://www.promedmail.org