Trachoma accounts for 15% of blindness worldwide, affecting the world's poorest communities. How can the disease be controlled? Trachoma is almost exclusively a disease of poor families and communities living in developing countries. It accounts for 15% of blindness worldwide—around 6 million people [Chlamydia trachomatis, an obligate intracellular bacterium. Only serovars A, B, Ba, and C are implicated in trachoma.Trachoma, a chronic keratoconjunctivitis, is caused by episodes of infection with Trachoma is the second leading cause of blindness worldwide . AccordiHumankind has known trachoma since antiquity. Ibn-e-Isa, an Arab physician, was the first person to describe the different stages of trachoma and noted trichiasis as one of its sequelae. So prevalent was the disease not so long ago that trachoma hospitals were established in many parts of Europe and America . The disTransmission occurs from eye to eye via hands, clothing, and other fomites. Flies have been identified as a major vector for the infection's spread . The preThe disease tends to cluster in certain communities within a village and certain families within a neighborhood. Women, especially in rural areas, are affected twice as often as men .Trachoma initially presents in childhood as red eye—itching, redness, and pain. The essential lesion is a trachomatous follicle (lymphoid cell aggregate) occurring typically in the upper tarsal conjunctiva . The rouIn a subgroup of individuals, fibrosis occurs because of repeated infections, resulting in scarring of the conjunctiva (scarring trachoma). In scarring trachoma, the upper eyelid is shortened and distorted (entropion) and the lashes abrade the eye (trichiasis). Blindness results from corneal opacification, which is related to the degree of entropion or trichiasis .Based on the presence or absence of some of the key signs of the disease, WHO has developed a simplified grading system for the assessment of trachoma  11,12].,12.11,12Herbert's pits  and Arlt's line  are two other classical features of the disease.WHO currently recommends the “SAFE” strategy for the management of trachoma: Surgery for trichiasis, Antibiotics for active disease, Facial hygiene, Environmental improvement to reduce the transmission of the disease ,14,15.People with trachomatous trichiasis are at risk of blindness, and so treating these people is the first priority for the SAFE strategy. An evidence-based review of the SAFE strategy found that trichiasis surgery can alleviate discomfort and improve vision, though the evidence is less clear on whether such surgery prevents corneal opacification . The revThere are different types of surgical procedures to correct trachomatous trichiasis . Their hIn addition to recurrence, there are other problems with the surgical approach to managing trachoma. It cannot correct all the complications, such as dry eyes. Even more important, and the main obstacle to preventing blindness from trachoma, is the low rate of uptake of surgery by communities with trachomatous trichiasis . BarrierOffering surgery at the community level, rather than in distant medical facilities, is one strategy that could reduce travel times and costs and increase uptake. A cluster randomized controlled trial of village-based surgery versus health-center-based surgery in Gambia found a significantly higher uptake rate with the village-based service .The use of antibiotics aims to treat active infection and eliminate the reservoir. WHO currently recommends two regimens for the treatment of trachoma in endemic regions. These are 1% topical tetracycline ointment (twice daily for six weeks) or a single dose of oral azithromycin (1 g in adults and 20 mg/kg in children) [Although antibiotics are a cornerstone of the SAFE strategy, clinical trials of antibiotics versus control (no treatment, placebo, or vitamin tablets) have produced conflicting results and are difficult to pool because of their heterogeneity. A recent Cochrane systematic review concluded “there is some evidence that antibiotics reduce active trachoma but results are not consistent and cannot be pooled” . The revSeveral questions remain about the use of antibiotics, such as who should receive them and how often. Lietman and colleagues have developed a mathematical model of frequency of treatment that uses available epidemiological data from a variety of countries . Based oGood facial hygiene aims to reduce transmission, the risk of autoinfection in a community, and the risk of attracting flies ,15. ManyA Cochrane systematic review found evidence that face washing combined with topical tetracycline can be effective in reducing severe active trachoma . HoweverInterventions aimed at promoting facial hygiene have not yielded expected results in all settings, as behavioral change is not always readily achievable.This component of the SAFE strategy also aims to reduce transmission of trachoma by eliminating or reducing its risk factors, some of which are ubiquitous while others are specific to a region. Improving access to water is a key element. Other measures, such as provision of latrines to reduce the fly population, have also been found effective in reducing transmission . Such enAs mentioned previously, there is an important association between water and trachoma—though the association is not a simple one. The distance to the water source constrains the amount of water used for hygiene practices. Improving access to water on its own, however, may not be enough. In the case-control study in Gambia, families with trachoma used less water per person per day for washing children than families without the disease, regardless of the amount of water available . In otheTrachoma is a disease of poor, underprivileged, and socioeconomically disadvantaged communities. It affects people who have little or no say in public decision making . InvestiStill, there is some room for optimism, given WHO's vision of the global elimination of trachoma by the year 2020 and the efforts of the International Trachoma Initiative and other non-governmental organizations. The implementation of the SAFE strategy to eliminate blinding trachoma has already proven effective in several countries . Many coAlthough the new initiatives in trachoma control are encouraging, trachoma elimination programs clearly need to be extended to many more countries. In addition, there are three crucial steps that still need to be undertaken if blindness from trachoma is to be eliminated.www.wsscc.org) in trachoma control efforts. Similar partnerships need to be strengthened [First, there needs to be more emphasis on the “F” and “E” components of the SAFE strategy. Antibiotics and surgery alone will not eliminate trachoma; work also needs to be done to eliminate the risk factors and decrease the transmission of the disease in affected communities. Such primary prevention is more likely to have a sustainable impact but requires a prolonged effort and investment ,24. Becangthened . Socioecngthened .Second, research into different aspects of the disease should continue. Work on a vaccine for trachoma, although not successful thus far, should receive more attention . Future Third, awareness about the disease and the SAFE strategy need to be promoted globally. At the same time, local, cost-effective solutions to trachoma need to be encouraged. Provision of pit latrines to reduce fly populations is just one such measure .Unless these steps are taken, trachoma will continue to be a major cause of blindness in communities in the developing world .


The reduced number of hospital beds and an ageing population have resulted in growing demands for home nursing. We know very little about the comprehensive care of these patients. The objectives were to identify the care, in addition to primary health care, of patients with primary-care home nursing to give a comprehensive view of their care and to investigate how personal, social and functional factors influence the use of specialised medical care.One-third (158) of all patients receiving primary-care home nursing in an area were sampled, and 73 % (116) were included. Their care from October 1995 until October 1996 was investigated by sending questionnaires to district nurses and home-help providers and by collecting retrospective data from primary-care records and official statistics. We used non-parametric statistical methods, i.e. medians and minimum – maximum, χ2, and the Mann-Whitney test, since the data were not normally distributed. Conditional logistic regression was used to study whether personal, social or functional factors influenced the chance (expressed as odds ratio) that study patients had made visits to or had received inpatient care from specialised medical care during the study year.56 % of the patients had been hospitalised. 73 % had made outpatient visits to specialised medical care. The care took place at 14 different hospitals, and more than 22 specialities were involved, but local care predominated. Almost all patients visited doctors, usually in both primary and specialised medical care. Patients who saw doctors in specialised care had more help from all other categories of care. Patients who received help from their families made more visits to specialised medical care and patients with severe ADL dependence made fewer visits.The care of patients with primary-care home nursing is complex. Apart from home nursing, all patients also made outpatient visits to doctors, usually in both primary and specialised medical care. Many different caregivers and professions were involved. Reduced functional capacity decreased and help from family members increased the chance of having received outpatient specialised medical care. This raises questions concerning the medical care for patients with both medical and functional problems. This article describes the situation in a suburban area in Sweden, and concerns the comprehensive medical care of patients with primary-care home nursing, i.e. patients who require regular assistance from nurses in their homes in order to maintain their health and manage their health problems. This does not include hospital-at-home care, where a multiprofessional team is responsible for the medical care.The use of inpatient hospital care in Sweden as in many other Western countries has diminished in recent decades. In combination with an ageing population with greater needs for medical care, this has resulted in an increase in different forms of home care. The overall situation is similar in many countries, although local conditions may vary considerably -4.The shift of care from the hospital to the home "has had an enormous impact on care recipients, their families and friends, and in-home service providers."  and "is Much is known about the medical care, especially inpatient and outpatient hospital care of older persons, and that factors like age, health problems and socio-economic conditions influence the utilisation of inpatient hospital care ,7. HospiIn a previous paper  we have In view of the lack of knowledge in this expanding field, we considered it important to investigate and describe the comprehensive care of patients with home nursing as a starting point for further research and development.The objectives of the present paper are as follows:To identify the specialised medical care of patients who were receiving primary-care home nursing.To give a comprehensive view of the care of these patients.To investigate how personal, social and functional factors and help by relatives influenced the use of specialised medical care by these patients.The study was performed in a suburban area of Stockholm with 40 000 inhabitants, 18 percent of whom were 70 years of age or older. The care of patients, with primary-care home nursing, who lived in ordinary houses or flats was studied. Patients in the study area who received regular nursing care at home for a period of more than two weeks from the district nurses in primary health care were registered as primary-care home nursing patients  or outpatient departments in the city. Two emergency hospitals, two geriatric hospitals and two wards for psychiatric inpatient care were located in or close to the study area.During the registration week (21 to 27 October 1996), 486 patients in the study area had primary-care home nursing. Using a random table, we selected one-third of the patients of each district nurse for the study.The study was designed as a retrospective study of the comprehensive medical care of patients with primary-care home nursing, including the medical care they received both in their homes and in other places. It was also designed to study whether non medical factors that are common among patients with home nursing may have influenced the care. The data were not obtained from the patients, but from records and from the family physicians and district nurses responsible for the patients' primary health care, i.e. professionals dealing with the patients' medical problems. Data were also obtained from the official statistics of the Swedish County Councils, a source that is generally considered by researchers to be of high quality and well suited for scientific purposes. A description of the patients and the care performed by family physicians, district nurses and assistant nurses was given in a previous article .The hypotheses were- that care outside the home comprises a substantial part of the total care of patients with home nursing.- that personal, social and functional factors may influence the use of medical care outside the homeInformation concerning the situation during the registration week was obtained from questionnaires distributed the week following the registration week. Retrospective data from the study year (28 October 1995 to 27 October 1996) were obtained from the official statistics, and the family physician (21 family physicians) and nursing (20 district nurses) primary health care records.The official statistics were used to identify and describe inpatient care and outpatient visits in specialised medical care, and the number of home and practice visits to/by the nurses in primary health care. Notes in the family physician records were used to describe the family physician care (reason for contact, who had been in contact and measures undertaken) as well as the diagnoses of the patients . Notes iGroup 1 were either without functional deficiencies or dependent only regarding cleaning, shopping and/or transport, patient in Group 2 were, in additions, dependent with respect to cooking, bathing and/or dressing, but not eating, and patients in Group 3 were in addition dependent concerning eating. The factor mobility was excluded from the ADL groups, as this was assessed separately using data from other questions. The factors toileting and continence were excluded, as the answers were not consistent when compared with answers to questions concerning the same functions in other parts of the questionnaire.Personal, social and functional data concerning the situation during registration week, as well as patients' symptoms, and help from relatives at that time, were obtained from the questionnaires. When possible, validated questions that had been tested in other studies were used, but some were modified to suit the situation in home nursing. These revisions were made by the Stockholm Gerontology Research Centre in cooperation with a group of district nurses . PersonaSymptoms were registered in a 23-item protocol originally used in studies of nursing homes, but modified to suit the situation in home nursing. The questionnaires also included questions about how long the patient had had home nursing, and whether the patient had had contact with any private doctor in specialised medical care.The questions were thus chosen so that the district nurses responsible for the care could answer them without additional patients assessments, either because the information would be well known to them since they were responsible for the nursing care or because the answers were based on assessment tools used in the regular care, such as that used for ADL.Questionnaires sent to the home-help providers focused on whether the patient had home help Table .From the randomised one-third of selected patients (n = 158), we excluded 42, . Information about all patients from one district nurse was excluded (12 patients), since it was obvious that she had not understood the questions, leaving 116 patients (73%).Information could not be obtained from all sources for all patients. Visits to private doctors in specialised medical care and to private physiotherapists are not included, as they were not included in the official statistics. According to questionnaire responses from the district nurses, 11 patients saw private doctors in specialised medical care on a regular basis. We have no information about private physiotherapists.As the number of visits and care periods did not have a normal distribution, we used non-parametric statistical methods, i.e. medians and minimum – maximum. The Mann-Whitney test and χ2 were used to compare differences between groups. Conditional logistic regression was used to study whether personal, social or functional factors influenced the chance (expressed as odds ratio) that study patients had made visits to or had had inpatient specialised medical care during the study year. We used a case control design where patients with specialised care were cases and patients without this care were controls. The different factors were first tested by univariate logistic regression. The factors that showed significant influences were included in a multiple logistic regression model. One of these factors (home help) showed no significant influence when included in the model, and it was therefore excluded from the main effect model . The facThe study was approved by the Research Ethics Committee at Huddinge University Hospital. This approval included the design of the study as well as the way informed consent was obtained from the individual patients.Eighty-nine of the 116 study patients (77%) lived alone, 86 patients (74%) were women and 41 (35%) received substantial assistance from family members according to the district nurses. Sixty-eight patients (65%) had home help. Patients who lived alone were less likely to have assistance from family members than those who lived with a relative (31% compared to 58%, p < 0.05), but on the other hand they were more likely to have home help (76% compared to 29%, p < 0.001). Patients who got help from family members were less likely to have home help (51% compared to 75%, p < 0.05).More than half of the patients had been admitted to hospital during the study year Table . Among tThe median values for all study patients were one care period and four days in care. The average number of care periods and days in inpatient care in Stockholm for the persons 75 to 84 years of age, and 85 years of age or older, were 0.6 of a care period and five days in inpatient care and 0.8 of a care period and seven days in inpatient care, respectively .During the study year a majority of the patients made outpatient visits to hospitals and outpatient departments Table . In all,The median value for visits to doctors in specialised care for all study patients was one visit. The average numbers of outpatient visits to doctors outside primary health care (excluding doctors in private practice) in Stockholm for persons 75–84 years of age and 85 years of age or older were 1.7 and 0.8, respectively .In the 104 cases where a family physician record was found, a visit to either their family physician or a doctor in outpatient specialised care, or both, was found for 95 patients (91%) median 3 visits). Approximately one third (32 %) of the patients saw doctors from two or more specialities, GP care not included. Thirty-eight study patients (33%) had visited a physiotherapist or an occupational therapist . Of these, 141 visits (49%) took place in primary health care and comprised 23 (20%) of the study patients  as the participants but might have had more severe conditions, as patients who had died or were admitted to hospital during the registration week were excluded. These patients probably did not receive less medical care than those who were included. Information about a few patients was missing from some sources. All practices had roughly the same proportion of drop-outs and missing data, and the reasons can be considered to be random. The results should then be valid for all patients with primary-care home nursing, in the study area. As the patients are similar to those with home nursing described in other studies, this study may serve as a reference for further investigation of the care of patients with home nursing.These patients who had primary-care home nursing also had many instances of specialised inpatient and outpatient medical care. However, their care did not differ substantially from that of the average population of comparable age in Stockholm County during 1996 . This isThere was one group with significantly more medical care than the others, i.e. those patients who made outpatient visits to doctors in specialised care. The probable reason is that they had more severe medical conditions, but this is not possible to confirm in the present study.Inpatient care seemed to be strongly associated with more outpatient contacts in specialised care, but not with more contacts in primary health care. It is not possible to say whether this was the result of a greater need for specialised care, or the result of a tendency to keep the patients in specialised care .Patients with no visits from a family physician received neither more nor less medical or nursing care elsewhere. The rest of the care was apparently not influenced by the low priority this was given by the family physicians.The care of an individual patient often included several caregivers from different organisations. For the individual patient who meets many different persons and goes to many different places, this means a lack of continuity. For this group of elderly patients with complicated medical problems, reduced mobility, reduced cognitive ability and reduced ADL-capacity, the risk that the individual caregiver does not have the proper information when decisions are made must be extremely great, especially taking into account the problems involved in the exchange of information between primary care and specialised care . On an oIn Sweden, the share of health care expenditures allocated to primary health care is often low (12 – 21 %) compared to other parts of Western Europe, where it is frequently 20 percent or more . FurtherWe found that functional and social factors influenced the chance of a patient having made outpatient visits to specialised medical care. Severe ADL dependence reduced the chance and receiving help from family members increased the chance. The fact that patients with severe ADL dependence do not make many outpatient visits is not surprising as reduced function limits the possibility to get to locations outside the home. The findings that help from family members increased the chance of having made outpatient visits to specialised medical care is not surprising either, in view of the age and functional problems of the patients. Relatives might be more observant concerning new symptoms, might easier establish contact and assist in transportation of the patients, than professional caregivers. Is the care organised so that old patients with multiple diseases and reduced functions need the help of a relative in order to get outpatient specialised medical care? Or do patients who get help from family members have more severe medical problems, even though there are no differences in primary-health-care diagnoses? Further studies are needed in this area.The picture that evolves from our study is that the care of patients with home nursing is more complex than has previously been assumed. In parallel with their primary-care home nursing, all patients had contact with doctors, often from both primary and specialised medical care. The situation resembles that in a hospital ward, where many different caregivers and many different professions are involved in the care of the same patient, but without the ward's geographical and temporal unity. This renders it almost impossible for the individual patient to get continuity in all aspects of care, and the possibility of cost effective care of good quality is diminished.Patients with home nursing have complicated medical problems and both nurses and doctors are involved in their care, contrary to the previous belief that some patients are cared for by nurses alone. Instead, there seems to be one group of patients with home nursing who also need both primary and specialised care, and who have greater care needs than other patients with home nursing.That reduced function decreases and help from family members increases the chance of getting outpatient, specialised medical care raises questions concerning the medical care for patients with both medical and functional problems.Our conclusions are based on a study in one suburban area, and further studies are needed in order to confirm them.ADL Activities of Daily LivingENT Ear Nose and ThroatNone declared.SM designed and carried out the study, performed the statistical analysis, participated in the interpretation of results, wrote the initial draft of the manuscript and made subsequent revisions. AKF participated in the interpretation of results and made critical revisions of the manuscript. Both authors have read and approved the final manuscript.The pre-publication history for this paper can be accessed here:


The eyes may be the window to the soul for poets, but for neuroscientists, they serve a more practical purpose. Of the 100 trillion or so cells that make up the human body, over 100 billion are dedicated to the structure and operation of the brain alone. Given the molecular and functional complexity inherent in such numbers, neuroscientists have historically focused on a more tractable system, the vertebrate retina, to study central nervous system development and physiology. Cells in the retina are packaged into highly ordered anatomical layers, based on their specialized functions. This organizational structure is characteristic of other regions of the central nervous system, and allows the brain to take in and integrate sensory information simultaneously, using discrete computational units. Creating such functional microprocessors depends on making the right cell at the right place and time.During development, cells undergo periods of proliferation and increasing specialization (differentiation), generating seven types of retinal cells  in a precise order at specific times. Mature, specialized cells arise from a pool of proliferating progenitors—cells that have already committed to becoming a retinal cell but haven't yet settled on a particular cell type. But progenitors are not all alike; they display intrinsic differences in their “competence” to produce a particular subset of retinal cells at a particular stage of development. These differences may help ensure that ganglion cells, for example, are established before photoreceptors, since photoreceptors rely on ganglion cells to transmit their signals to the brain.Which path a cell ultimately chooses stems from a combination of both intrinsic competence factors—likely determined by a cell's gene expression program—and external signals from the cell's environment. Progenitors give rise to “postmitotic” cells (cells that have exited the cell cycle and ceased proliferating), which go on to express characteristics associated with a specific cell type.Beyond this framework, the molecular underpinnings of retinal development remain obscure. Differentiated cells exhibit a gene expression program unique to their cell type, but it's not clear what accounts for underlying differences among progenitors, for example, or what factors usher retinal cells into their respective specialties. To map the genetic landscape of retinal development, Constance Cepko and colleagues looked for genes expressed in retinal cells passing through various competence levels and making cell fate choices. They determined gene expression profiles by collecting bits of gene transcripts from the retinal tissue of developing mice at two-day intervals, starting with mice entering neurogenesis and ending with mice about six and a half days old. They also collected gene expression data from postnatal day 10 and from adult mice.The authors then examined the cellular expression patterns of 1,051 of the genes that showed dynamic patterns by genomic expression profiling. Cepko and colleagues then pegged these genes to specific cell types to create a “molecular atlas of gene expression in the developing retina.”  Nearly every gene known to direct retinal cell differentiation was detected in this analysis and showed high levels of expression. Genes required for cell fate choices showed peak expression near or after cells exited the cell cycle, supporting the idea that similar controls operate to put the brakes on cell proliferation and to determine cell fate. Many uncharacterized genes were expressed only in certain progenitor subsets, making them good candidates as cell fate determinants for different subtypes of retinal cells. A promising list of candidate genes for retinal development and function appear in this molecular atlas, along with candidates for retinal disease. Since many degenerative retinal diseases stem from defects in development, these genes will help researchers focus their search for therapies. And if the eye truly is the window of the nervous system, these findings may suggest general principles of cell fate determination for the developing brain, spinal cord, and other regions of the vertebrate nervous system.


Patients with metastatic breast cancer (MBC) are frequently exposed to high cumulative doses of anthracyclines and are at risk of resistance and cardiotoxicity. This phase II trial evaluated the efficacy and toxicity of docetaxel plus cisplatin, as salvage chemotherapy in patients with MBC resistant to prior anthracyclines.2 followed by cisplatin 60 mg/m2 every 3 weeks for a maximum of 6 cycles or until disease progression.Patients with MBC that had progressed after at least one prior chemotherapy regimen containing anthracyclines received docetaxel 75 mg/mBetween Jan 2000 and May 2002, 24 patients with tumors primary resistant and 15 with secondary resistant disease were accrued. All 39 patients were evaluable for safety and 36 for efficacy. The objective response rate was 31% (95% CI, 16–45%) with 3 complete responses. The median time to disease progression was 7 months, and the median overall survival was 23 months (median follow-up of 41 months). Neutropenia was the most frequently observed severe hematologic toxicity (39% of patients), whereas asthenia and nausea were the most common non-hematologic toxicities. No treatment-related death was observed.In conclusion, we found docetaxel plus cisplatin to be an active and safe chemotherapy regimen for patients with MBC resistant to anthracyclines. In the management of breast cancer, anthracycline-based chemotherapy regimens remain standard adjuvant or first-line palliative treatment. Furthermore, some patients cannot be treated with anthracyclines due to impaired cardiac function. It is thus important to identify active, well-tolerated, not anthracycline cross-resistant, salvage regimens .Taxanes (docetaxel and paclitaxel) are currently the most extensively studied new chemotherapeutic agents for metastatic breast cancer (MBC). Single-agent docetaxel has demonstrated significant survival advantages over other recognized regimens in 2 large randomized trials in patients with anthracycline-pretreated MBC . Phase ICisplatin monotherapy has shown response rate of 9% in salvage settings, and 50% as first-line therapy . BecauseEligible patients had measurable or assessable histologically confirmed breast cancer that had progressed after at least one prior chemotherapy regimen containing anthracyclines. All patients had Eastern Cooperative Oncology Group performance status of 2 or lower and adequate bone marrow, hepatic, and renal function, defined as white blood cells ≥4000/μL, absolute neutrophil count ≥1500/μL, platelets ≥100,000/μL, total bilirubin ≤2.0 mg/dL, transaminases ≤3 times the upper normal limit, and serum creatinine ≤1.5 mg/dL. Concurrent radiation or hormonal therapy was not allowed; however, patients with clinically stable metastases of the brain or other sites who had completed radiation therapy were permitted. Patients were eligible regardless of the nature of prior therapy, including high-dose therapy with stem cell support and prior exposure to paclitaxel. Any prior antitumor treatment had been completed at least 1 month before entering this study. Patients were excluded if they had severe comorbid illness, symptomatic peripheral neuropathy of any origin, or a history of anaphylaxis of any type. All patients were provided a thorough explanation of the study, and they signed informed consent prior to enrollment into the study.Patients were classified as primary and secondary anthracycline-resistant. Primary anthracycline-resistance was defined as relapse during or within 12 months after anthracycline-based adjuvant therapy, or disease progression with no intervening response during anthracycline-containing chemotherapy for MBC. Secondary resistance was defined as relapse more than 12 months after receiving adjuvant anthracycline chemotherapy, or disease progression at some time after a documented clinical response to anthracycline-based chemotherapy for MBC.Pretreatment evaluation included a complete medical history and physical examination, a computed tomographic (CT) scan of the chest and abdomen, magnetic resonance imaging (MRI) of the brain, and a bone scintigraphy to assess the extent of disease. Follow-up consisted of physical examination, monitoring of toxic effects, a complete blood count, liver function tests, chest radiography, and CT scan as clinically indicated.Tumor response and toxicity were recorded in accordance with the World Health Organization (WHO) criteria. Responses were assessed every 2 cycles of chemotherapy, and patients were evaluated before each new treatment cycle for toxicities.®, Aventis, Bridgewater, NJ) 75 mg/m2 given by a 1-hour intravenous infusion immediately followed by cisplatin 60 mg/m2 in a 2-hour infusion. Cycles were repeated every 3 weeks if the patient's blood count had returned to normal and non-hematologic toxicities had resolved. Dosage of subsequent cycles was adjusted according to the observed toxicities that developed during the preceding cycle. The treatment continued for a maximum of 6 cycles or until disease progression. All patients received standard supportive care regimen consisting of adequate hydration, dexamethasone, and antiemetic therapy according to the guidelines of the American Society of Clinical Oncology [The treatment consisted of docetaxel . Comparisons were performed using chi-square test and survival curves were generated using Kaplan-Meier method. Results were considered significant at the P = .05.Between Jan 2000 and May 2002, 24 patients with tumors primary resistant and 15 with secondary resistant disease were accrued. Among 39 patients assessable for safety, 3 were not evaluable for response due to early discontinuation of treatment.Baseline characteristics of the eligible patients are listed in Table According to the "intent-to-treat" analysis, the objective response rate was 31% . There were 3 complete responses, 12 partial responses and 15 patients had stable disease. The three patients who obtained a complete response had non-visceral metastatic pattern (neck lymph nodes and/or soft tissue lesions). Most patients who achieved a response did so at the end of the third cycle .At a median follow-up of 40.5 months (95% CI, 36.4–44.6 months), the median time to progression was 6.6 months (95% CI, 3.9–9.4 months) and the median overall survival was 22.9 months (95% CI, 17.2–28.5 months). The time to progression in responders were 16.7 months (P < 0.0001). The Kaplan-Meier method was used to estimate overall survival and time to progression, as shown in Figure We observed no significant differences in overall response rate or survival between primary and secondary anthracycline-resistant groups. The overall survival and time to progression were higher in patients with objective response (P < 0.0001 and P = 0.05, respectively).Patients received a median of 6 cycles (range, 1–6) of docetaxel plus cisplatin. Relative dose intensities were 84% (95% CI, 73–96%) and 86% (95% CI, 75–97%) for docetaxel and cisplatin, respectively. Twenty-four patients (62%) completed 6 cycles of chemotherapy as planned; Nine patients had progression of disease while receiving treatment and 6 patients discontinued treatment because of toxicity. Treatment delay was occurred in 54 cycles (29%).Toxicity was evaluable in all 39 patients and 189 chemotherapy cycles. Even if the most frequent hematological toxicity was neutropenia (grade 3/4 in 22% of treatment cycles), only 12 episodes of non-fatal febrile neutropenia were observed. The most commonly encountered non-hematologic toxicities were asthenia and nausea. Other toxicities are reported per patient and per cycle in Table et al. also reported, in a similar patient population, 36% response rate and 69 weeks median survival with docetaxel 75 mg/m2 every 3 weeks[Single-agent docetaxel has been considered a standard treatment for patients with anthracycline-pretreated MBC for several years. Docetaxel monotherapy often demonstrated response rates of 50% or more in this setting ,18. Ahn y 3 weeks.Platinum-based combinations also have significant activity in previously treated as well as previously untreated patients. In several small clinical trials testing the cisplatin-based regimens, response rates of 50%-83% were reported . The Noret al. evaluated docetaxel 75 mg/m2 plus cisplatin 80 mg/m2 every 3 weeks in 38 patients with anthracycline-resistant MBC, giving an objective response rate of 36% [2 and cisplatin 80 mg/m2 in patients with anthracycline-pretreated MBC [et al. combined biweekly paclitaxel with cisplatin and achieved a response rate of 85% with few septic events [There are relatively few completed clinical studies involving platinum-based combination chemotherapy for anthracycline-resistant MBC. Spielmann e of 36% . Japanesated MBC . They reated MBC . Gelmon c events .et al. suggested that the status of anthracycline-resistance is important for the prediction of response to second-line treatment with docetaxel [We classified "anthracycline-resistant" into primary and secondary. Ando ocetaxel . However2 every 3 weeks, rather than 75 mg/m2 cited in a phase I study [This study demonstrated that a combination of docetaxel plus cisplatin in a 3-week cycle was an effective and well-tolerated regimen for patients with anthracycline-resistant MBC. In this study, the use of docetaxel plus cisplatin resulted in an overall response rate of 31% and the median time to progression was 7 months. Significant improvements in the actuarial survival rate and time to progression were observed in the group of patients who achieved objective responses. The main toxicities, gastrointestinal, hematological and asthenia, were manageable with dose adjustment and supportive care. Dose intensities of more than 80% were delivered and 61% of patients completed 6 cycles of chemotherapy, which is considered acceptable and expected. We used the planned dose of cisplatin 60 mg/m I study , becauseWith the increasing use of anthracycline-based chemotherapy as adjuvant treatment, as well as first-line chemotherapy against MBC, patients are frequently exposed to high cumulative doses of anthracyclines and are therefore at risk of resistance and cardiotoxicity . This coIn summary, the combination of docetaxel plus cisplatin is active and safe in patients with anthracycline-resistant MBC. The activity observed in anthracycline-resistant and heavily-pretreated patients suggests relative non-cross-resistance with other drug combinations. Therefore, we hope that this study could result in a prospective trial to determine whether this activity translates into actual improvement in survival and quality of life in patients with anthracycline-resistant MBC.The author(s) declare that they have no competing interests.SHP collected the data, performed the statistical analysis and drafted the manuscript. EKC, SB, JHL, YDL followed the patients. DBS designed the study, followed the patients and helped with the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here: