Optimizing management of ruxolitinib in patients with myelofibrosis: the need for individualized dosing

Ruxolitinib, an oral JAK1 and JAK2 inhibitor, is approved in the US for patients with intermediate or high-risk myelofibrosis (MF), a chronic neoplasm associated with aberrant myeloproliferation, progressive bone marrow fibrosis, splenomegaly, and burdensome symptoms. Phase III clinical studies have shown that ruxolitinib reduces splenomegaly and alleviates MF-related symptoms, with concomitant improvements in quality of life measures, for the overwhelming majority of treated patients. In addition, ruxolitinib provided an overall survival advantage as compared with either placebo or what was previously considered best available therapy in the two phase III studies. The most common adverse events with ruxolitinib treatment include dose-dependent anemia and thrombocytopenia, which are expected based on its mechanism of action. Experience from the phase III studies shows that these hematologic events can be managed effectively with dose modifications, temporary treatment interruptions, as well as red blood cell transfusions in the case of anemia and, importantly, are rarely cause for permanent treatment discontinuation. This review summarizes data supporting appropriate individualized patient management through careful monitoring of blood counts and dose titration as needed in order to maximize treatment benefit.     

The need to 'maintain the rage'

Personal reflections are presented on the need to ensure that appropriate attention is given to malaria. The importance of political and financial commitments is stressed and the investment in people is considered a major priority.     

Combined therapy of patients with recurring anogenital herpes infection

Up-to-date conceptions of etiology and epidemiology of anogenital herpetic infection are described. The main mechanisms of immunological shifts in subjects with anogenital Herpes infection are discussed. The efficacy and safety of cycloferon in the combined treatment of patients with recurring anogenital herptic infection were estimated. The clinical efficacy of the combined therapy (acyclovir in a dose of 200 mg 5 times a day for 5 days + cycloferon liniment applied topically on the eruptions twice a day for 5 days) was 85% or 25% higher vs. the control.     

The need for conservation and management of Philippine coral reefs

Synopsis The biological diversity and productivity of Philippine coral reefs are threatened by siltation, destructive fishing methods, coral and shell collecting and overfishing. Destructive fishing includes: the widespread, illegal use of explosives; poisons such as sodium cyanide; muro-ami and kayakas fishing; and trawling. The recent decline in catch rates threatens the livelihood of 700 000 near-shore subsistence fishermen who catch 55% of the total landings. The new government under Corazon Aquino wishes to protect the marine environment through the creation of a viable marine conservation management plan, enforcement of existing laws and through cooperation between government, non-government and international agencies to provide education and research. The Department of Agriculture, which has the authority for fisheries, has designated the International Marinelife Alliance as the lead non-government agency involved with fund raising, net-training and finding alternatives to destructive fishing methods.This essay addresses the societal relationships of village fishery to government, aid organizations, and science. Vadim Vladykov always maintained close relationship with fishermen and devoted over a year of his life to helping develop fisheries in Iran.     

Achieving landscape-scale deer management for biodiversity conservation: The need to consider sources and sinks

Hyper-herbivory following predator removal is a global issue. Across North America and Europe, increasing deer numbers are affecting biodiversity and human epidemiology, but effectiveness of deer management in heterogeneous landscapes remains poorly understood. In forest habitats in Europe, deer numbers are rarely assessed and management is mainly based on impacts. Even where managed areas achieve stable or improving impact levels, the extent to which they act as sinks or persist as sources exporting deer to the wider landscape remains unknown. We present a framework to quantify effectiveness of deer management at the landscape scale. Applied across 234 km² of Eastern England, we assessed management of invasive Reeve's muntjac (Muntiacus reevesi) and native roe (Capreolus capreolus), measuring deer density (using thermal imaging distance transects 780 km/year), fertility, neonatal survival, and culling to quantify source-sink dynamics over 2008–2010. Despite management that removed 23–40% of the annual population, 1,287 (95% CI: 289–2,680) muntjac and 585 (454–1,533) roe deer dispersed annually into the wider landscape, consistent with their ongoing range expansion. For roe deer, culled individuals comprised fewer young deer than predicted by a Leslie matrix model assuming a closed population, consistent with age-dependent emigration. In this landscape, for roe and muntjac, an annual cull of at least 60% and 53%, respectively, is required to offset annual production. Failure to quantify deer numbers and productivity has allowed high density populations to persist as regional sources contributing to range expansion, despite deliberative management programs, and without recognition by managers who considered numbers and impacts to be stable. Reversing an unfavorable condition of woodland biodiversity requires appropriate culls across large contiguous areas, supported by knowledge of deer numbers and fertility. © 2013 The Wildlife Society.     

Identification and management of GCK-MODY complicating pregnancy in Chinese patients with gestational diabetes

Molecular and Cellular Biochemistry - Precise differentiation of glucokinase (GCK) monogenic diabetes from gestational diabetes mellitus (GDM) is critical for accurate management of the pregnancy...