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Solingen, Germany

von Minckwitz G.,German Breast Group | von Minckwitz G.,University Hospital | Rezai M.,Breast Center | Fasching P.A.,University Hospital | And 15 more authors.
Annals of Oncology | Year: 2014

Background: The GeparQuattro study showed that adding capecitabine or prolonging the duration of anthracyclinetaxane-based neoadjuvant chemotherapy from 24 to 36 weeks did not increase pathological complete response (pCR) rates. Trastuzumab-treated patients with HER2-positive disease showed a higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone. We here present disease-free (DFS) and overall survival (OS) analyses. Patients and methods: Patients (n = 1495) with cT ≥ 3 tumors, or negative hormone-receptor status, or positive hormone-receptor and clinically node-positive disease received four times epirubicin/cyclophosphamide and were thereafter randomly assigned to four times docetaxel (Taxotere), or four times docetaxel/capecitabine over 24 weeks, or four times docetaxel followed by capecitabine over 36 weeks. Patients with HER2-positive tumors received 1 year of trastuzumab, starting with the first chemotherapy cycle. Follow-up was available for a median of 5.4 years. Results: Outcome was not improved for patients receiving capecitabine (HR 0.92; P = 0.463 for DFS and HR 93; P = 0.618 for OS) as well as for patients receiving 36 weeks of chemotherapy (HR 0.97; P = 0.818 for DFS and HR 0.97; P = 0.825 for OS). Trastuzumab-treated patients with HER2-positive disease showed similar DFS (P = 0.305) but a significantly better adjusted OS (P = 0.040) when compared with patients with HER2-negative disease treated with chemotherapy alone. Recorded long-term cardiac toxicity was low. Conclusions: Long-term results, similar to the results of pCR, do not support the use of capecitabine in the neoadjuvant setting in addition to an anthracycline-taxane-based chemotherapy. However, the results support previous data showing a benefit of trastuzumab as predicted by higher pCR rates. Clinical trial number: NCT 00288002, www.clinicaltrials.gov. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. Source

Betlehem J.,University of Pecs | Schaefer J.,Bethanien Hospital
Disasters | Year: 2010

This paper describes emergency medical preparedness during FIFA (Fédération Internationale de Football Association) World Cup matches in Frankfurt, Germany, in 2006. The methods employed were document analysis and personal observation of games over five days in June-July 2006. The medical authorities in Frankfurt drew on a wide range of scientific literature and experiences to elaborate a National Concept. They paid attention to different models of handling mass catastrophes in shaping the final version of the document. The participation of designated authorities, associations, and volunteer organisations was coordinated sufficiently and the games in Frankfurt proceeded without great incident, even though more than 300,000 people in total attended. The adopted emergency medical procedure was appropriate for a mass gathering event. Official and volunteer organisations collaborated precisely in emergency preparedness. While one uniform concept for all mass gatherings events cannot be developed, case reports and experiences are useful tools. © 2009 Overseas Development Institute. Source

Henein M.Y.,Umea University | Koulaouzidis G.,Umea University | Granasen G.,Umea University | Wiklund U.,Umea University | And 2 more authors.
International Journal of Cardiology | Year: 2013

Background and aim Coronary artery calcium score (CACs) is an established quantitative tool for assessing subclinical atherosclerosis. The aim of this study was to assess in a meta-analysis model the natural history and reproducibility of CACs measurements obtained from St Francis and EBEAT trials. Methods We analysed data from 649 individuals: 443 on placebo with 2 year follow-up from St Francis trial (Study A) and 209 on 10 mg atorvastatin with 1 year follow-up of EBEAT trial (Study B). Total CACs and that in the left coronary artery (LCA) branches, left main stem (LMS), left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were analysed. In view of the wide CACs spectrum, data were logarithmically transformed before the analyses and mixed model analysis was used to evaluate the change of CACs over time. Results The overall agreement between the two measurements was fairly good, showing a small but significant increase in CAC: 68% of the group as a whole presented an increase in CACs, 23% of the cohort had negligible change in CACs of < 10% irrespective of the baseline CACs; and the remaining 10% showed a fall in CACs. Both studies showed similar patterns. The analysis of individual coronary arteries showed significantly higher variability of measurements in the RCA than in the LCA. Males had higher baseline CACs than females, but the rate of progression was not different between genders, irrespectively of age and baseline score. Conclusion The natural history of CACs was overtime progression in the majority of subjects, irrespective of gender. The higher variability in RCA measurements could be related to the low baseline CACs or exaggerated movement of the right side atrioventricular ring, whereas those for LCA branches are influenced by the branch allocation of the CACs. Large changes to and from zero, might be related to technical limitations. © 2013 Elsevier Ireland Ltd. Source

Henein M.,Umea University | Granasen G.,Umea University | Wiklund U.,Umea University | Schmermund A.,Bethanien Hospital | And 3 more authors.
International Journal of Cardiology | Year: 2015

Background: In randomized clinical trials statins and placebo treated patients showed the same degree of coronary artery calcium (CAC) progression. We reanalyzed data from two clinical trials to further investigate the time and dose dependent effects of statins on CAC. Additionally, we investigated whether CAC progression was associated with incident cardiovascular events. Methods and results: Data were pooled from two clinical trials: St. Francis Heart Study (SFHS) (419 and 432 patients treated with placebo and 20 mg atorvastatin daily, respectively) and EBEAT Study (164 and 179 patients respectively treated with 10 mg and 80 mg atorvastatin daily). CAC scores were assessed at baseline, 2 years and 4-6 years in SFHS; in EBEAT they were measured at baseline and 12 months. After a short-term follow-up (12 to 24months) placebo and low dose atorvastatin showed a similar CAC increase, although 80mg/daily atorvastatin increased CAC an additional 12-14% over placebo (p b 0.001). In the long-term, atorvastatin caused a greater progression of CAC compared to placebo (additional 1.1%, p = 0.04). In SFHS 42 cardiovascular events occurred after the second CT scan. The baseline and progression of CAC were greater in patients with events. However, only baseline CAC and family history of premature cardiovascular disease but not CAC progression were independent predictors of events. Conclusions: Despite a greater CAC increase with high dose and long-term statin therapy, events did not occur more frequently in statin treated patients. This suggests that CAC growth under treatmentwith statins represents plaque repair rather than continuing plaque expansion. © 2015 Elsevier Ireland Ltd. All rights reserved. Source

Gondocs Z.,Hungarian National Ambulance Service | Olah A.,University of Pecs | Marton-Simora J.,University of Pecs | Nagy G.,University of Pecs | And 2 more authors.
Journal of Emergency Medicine | Year: 2010

Background: In Hungary, prehospital emergency medical services are provided by the National Ambulance Service. The 60th anniversary of the National Ambulance Service provides a good opportunity to give an overview of the current trends in prehospital emergency medical care in Hungary. Objectives: In this report, a description of the organizational structure and the latest developments in the National Ambulance Service are described with the intention to highlight future directions in emergency medical services, as well as the influence of international trends in emergency patient care. Results: In Hungary, the ambulance cars are staffed by two or three crew members trained in rescue, stabilization of the patient's status, transport, and advanced care of traumatic and medical emergencies. There are three major levels of care provided by ambulance personnel: a basic level ambulance crew (Emergency Medical Technician Unit), a second level (Ambulance Officer Unit), and the highest level (Emergency Physician Unit). The personnel on the latter two units are trained in all aspects of Basic Life Support and Advanced Life Support procedures for prehospital emergency care. Following the latest international developments in medical rescue devices and guidelines, all staff are retrained yearly. Recently, private services for transportation for non-acute illnesses have been introduced, allowing the National Ambulance Service to concentrate on emergencies only. Conclusions: Although the Hungarian Ambulance Service has a very long and meaningful past and a respected professional development, new challenges facing prehospital emergency care are inevitable and continuous development is necessary. Copyright © 2010 Elsevier Inc. Source

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