Nikolaos Makris

Carfilzomib (CFZ) improves survival in relapsed/refractory multiple myeloma but is associated with cardiovascular adverse events (CVAEs). We prospectively investigated the effect of CFZ on endothelial function and associations with CVAEs. Forty-eight patients treated with Kd (CFZ 20/56 mg/m² and dexamethasone) underwent serial endothelial function evaluation, using brachial artery flow-mediated dilatation (FMD) and 26S proteasome activity (PrA) measurement in PBMCs; patients were followed until disease progression or cycle 6 for a median of 10 months. FMD and PrA decreased acutely after the first dose (p < 0.01) and FMD decreased at cycles 3 and 6 compared to baseline (p ≤ 0.05). FMD changes were associated with CFZ-induced PrA changes (p < 0.05) and lower PrA recovery during first cycle was associated with more prominent FMD decrease (p = 0.034 for group interaction). During treatment, 25 patients developed Grade ≥3 CVAEs. Low baseline FMD (HR 2.57 lowest vs. higher tertiles, 95% CI 1.081–6.1) was an independent predictor of CVAEs. During treatment, an acute FMD decrease >40% at the end of first cycle was also independently associated with CVAEs (HR = 3.91, 95% CI 1.29–11.83). Kd treatment impairs endothelial function which is associated with PrA inhibition and recovery. Both pre- and posttreatment FMD predicted CFZ-related CVAEs supporting its role as a possible cardiovascular toxicity biomarker.

Over 15 million premature infants are born annually around the world. It has been optimistically yet incorrectly proposed, that healthy preterm infants without major complications eventually catch-up developmentally to term infants. Research shows these preterm infants remain increasingly disadvantaged on many neurodevelopmental outcomes. Parental touch, especially during skin-to-skin contact (SSC) has the potential to reduce the adverse consequences of prematurity. SSC is an evidenced based strategy that increases parental proximity and provides an interactive environment known to enhance infant physiologic stability and affective closeness between parent and infant. Evidence suggests SSC activates oxytocin release in mothers, fathers and infants.

The purpose of this study was to evaluate the efficacy and safety of local cervical application of mepivacaine hydrochloride for reducing pain associated with hysteroscopy. Among the patients who underwent hysteroscopic evaluation over a 6-year period (1994-1999) at the hysteroscopy unit of the First Department of Obstetrics and Gynecology of the University of Athens, in 245 anesthesia was necessary. In 45 patients, general anesthesia was decided on, for various reasons. The remaining 200 patients were randomized into two groups of 100. Patients of the study group were given local anesthesia by local cervical injection of mepivacaine hydrochloride, and patients in the control group received normal saline injection. All patients evaluated their pain, using an 11-point (0-10) analog scale, during the procedure as well as 30 and 60 min afterward. The use of local mepivacaine effectively and safely reduced pain associated with hysteroscopy and endometrial biopsy, as the mean value of pain assessment in the study group was notably inferior to that reported by the control group. Still, when unpaired Student's t test was applied for statistical evaluation, the difference was statistically nonsignificant.