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.