Primary breast diffuse large B‐cell lymphoma (PB‐DLBCL) is a rare subtype of DLBCL with limited data on patterns of failure. This multicenter study aimed to define the optimum treatment strategy and patterns of failure for PB‐DLBCL patients. We retrospectively reviewed data on 108 PB‐DLBCL patients from 21 Chinese medical centers. Only patients with localized disease (involvement of breast and localized lymph nodes) were included. After a median follow‐up of 3.2 years, 32% of patients developed progression or relapse. A continuous pattern of relapse was observed, characterized by frequent late relapses in the contralateral breast and central nervous system (CNS). Although rituximab significantly reduced the overall cumulative risk of progression or relapse (5‐year cumulative risk 57% vs 24%, P = .029), it had limited effect on the reduction of breast relapse (P = .46). Consolidative radiotherapy significantly decreased the risk of breast relapse, even in the subgroup of patients treated with rituximab (5‐year cumulative risk 21.2% vs 0%, P = .012). A continuous risk of CNS progression or relapse up to 8.2 years from diagnosis was observed (10‐year cumulative risk 28.3%), with a median time to CNS relapse of 3.1 years. Neither rituximab nor prophylactic intrathecal chemotherapy significantly decreased the risk of CNS relapse. In summary, our study indicates that PB‐DLBCL has a continuous pattern of relapse, especially with frequent late relapses in the CNS and contralateral breast. Rituximab and RT confer complementary benefit in the reduction of relapse. However, neither the addition of rituximab nor prophylactic intrathecal chemotherapy could effectively prevent CNS relapse for PB‐DLBCL patients.

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Hypertension is an increasingly common health problem that affects more than 1 billion people throughout the world. Antihypertensive drugs are the current pharmacotherapy of choice, however uncontrolled blood pressure (BP) accounts for 7.1 million deaths worldwide each year. Little is known about the efficacy of clinical pharmacist's pharmaceutical care on BP control and medication adherence. The aim of this study was to describe if pharmaceutical care could improve antihypertensive medication adherence and BP control, especially by clinical pharmacists recommendations. This report evaluates the clinical pharmacist interventions during a prospective randomized controlled trial. Out patients with essential hypertension were enrolled in a bimestrial follow-up during 6-month period study; patients were randomly allocated either intervention group (IG) or to control group (CG). Pharmacist interventions involved recommendations to physicians, educational and counseling directly to the patient. The main outcome measure for this analysis was the measure of systolic blood pressure (SBP), diastolic blood pressure (DBP), BP control and medication adherence using a validated questionnaire assessed at the baseline visit and the end of pharmaceutical care. Data from 278 patients were included and analyzed (139 in CG and 139 in IG). There were no significant differences (P < 0.05) in both groups at the baseline. Changes in drug therapy were recommended 192 times for IG patients, the majority of these, involved adding a new antihypertensive drug (42.7%); the largest numbers of pharmacist recommendations (39.6%) were made at the baseline visit. At the end, BP was controlled among significant patients more in IG (76.4%) than in CG (50.6%) (P = 0.0000). Significant lower SBP (-8.5 mmHg, P = 0.0001) and DBP (-4.7 mmHg, P = 0.0013) levels were observed in IG. Low medication adherence, there was also significantly difference between two groups at the end (24.8% versus 41.7%, P = 0.0014). Clinical pharmacist recommendations for alterations in pharmacotherapy intervention can significantly improve medication adherence and BP control in patients with hypertension. Clinical pharmacist recommendations can complement physicians in the management of hypertensive patients. Pharmacist interventions are effective in improving anti-hypertensive medication adherence and reducing systolic and diastolic blood pressure. Pharmacists can effectively participate in health education and promotion to improve blood pressure control.

Pseudomonas aeruginosa is a Gram-negative γ-proteobacterium that forms part of the normal human microbiota and it is also an opportunistic pathogen, responsible for 30% of all nosocomial urinary tract infections. P. aeruginosa carries a highly branched respiratory chain that allows the colonization of many environments, such as the urinary tract, catheters and other medical devices. P. aeruginosa respiratory chain contains three different NADH dehydrogenases (complex I, NQR and NDH-2), whose physiologic roles have not been elucidated, and up to five terminal oxidases: three cytochrome c oxidases (COx), a cytochrome bo 3 oxidase (CYO) and a cyanide-insensitive cytochrome bd-like oxidase (CIO). In this work, we studied the composition of the respiratory chain of P. aeruginosa cells cultured in Luria Broth (LB) and modified artificial urine media (mAUM), to understand the metabolic adaptations of this microorganism to the growth in urine. Our results show that the COx oxidases play major roles in mAUM, while P. aeruginosa relies on CYO when growing in LB medium. Moreover, our data demonstrate that the proton-pumping NQR complex is the main NADH dehydrogenase in both LB and mAUM. This enzyme is resistant to HQNO, an inhibitory molecule produced by P. aeruginosa, and may provide an advantage against the natural antibacterial agents produced by this organism. This work offers a clear picture of the composition of this pathogen's aerobic respiratory chain and the main roles that NQR and terminal oxidases play in urine, which is essential to understand its physiology and could be used to develop new antibiotics against this notorious multidrug-resistant microorganism.