OBJECTIVE: To demonstrate that DBS of the NAcc is an effective tr

OBJECTIVE: To demonstrate that DBS of the NAcc is an effective treatment modality for depression and PD-1/PD-L1 Inhibitor 3 clinical trial that chemical and structural changes associated with these behavioral changes are markers of neuroplasticity.

METHODS: A deep brain stimulator was placed in the NAcc of male Wistar-Kyoto rats. Groups were divided into sham (no stimulation), intermittent (3 h/d for 2 weeks), or continuous (constant stimulation for 2 weeks). Exploratory and anxietylike behaviors were evaluated with the open-field test before and after stimulation.

Tissue samples of the prefrontal cortex (PFC) were processed with Western blot analysis of markers of noradrenergic activity that included the noradrenergic synthesizing enzyme tyrosine SB431542 manufacturer hydroxylase. Analysis of tissue levels for catecholamines was achieved with high-performance liquid chromatography. Morphological properties of cortical pyramidal neurons were assessed with Golgi-Cox staining.

RESULTS: Subjects undergoing intermittent and continuous stimulation of the NAcc exhibited an increase in exploratory behavior and reduced anxietylike behaviors. Tyrosine hydroxylase expression levels were decreased in the PFC after intermittent

and continuous DBS, and dopamine and norepinephrine levels were decreased after continuous stimulation. Golgi-Cox staining indicated that DBS increased the length of apical and basilar dendrites in pyramidal neurons of the PFC.

CONCLUSION: Deep brain stimulation induces behavioral improvement

in and neurochemical and morphological alterations of the PFC that demonstrate changes within the circuitry of the brain different from the target area of stimulation. This observed dendritic plasticity may underlie the therapeutic efficacy of this treatment.”
“The mammalian Target Of Rapamycin (mTOR) serine/threonine kinase belongs to two multi-protein complexes, referred to as mTORC1 and mTORC2. mTOR-generated signals have critical roles in leukemic cell biology by controlling mRNA translation of genes that promote proliferation and survival. However, allosteric inhibition of mTORC1 by rapamycin has only modest effects in T-cell acute lymphoblastic leukemia (T-ALL). Recently, ATP-competitive Tozasertib inhibitors specific for the mTOR kinase active site have been developed. In this study, we have explored the therapeutic potential of active-site mTOR inhibitors against both T-ALL cell lines and primary samples from T-ALL patients displaying activation of mTORC1 and mTORC2. The inhibitors affected T-ALL cell viability by inducing cell-cycle arrest in G(0)/G(1) phase, apoptosis and autophagy. Western blot analysis demonstrated a Ser 473 Akt dephosphorylation (indicative of mTORC2 inhibition) and a dephosphorylation of mTORC1 downstream targets.

Incision size was 12 to 18 mm and the incision was closed by inse

Incision size was 12 to 18 mm and the incision was closed by inserting a mini Hemovac (R) closed drain. No narcotic supplementation was required postoperatively and there were no complications during followup.

Conclusions: Single incision miniature pyeloplasty with ipsilateral inguinal herniorrhaphy in an extensively dilated pelvis and ipsilateral inguinal hernia is technically feasible and safe in selected cases. The exact incision site must be reconfirmed intraoperatively by physical examination

or renal ultrasound. The technique adds the advantages of minimally invasive procedures (small incision, negligible postoperative pain) to the short operative time and high success rate of the open approach.”
“GsMTx4, a peptide inhibitor for mechanosensitive ion channels (MSCs), promoted neurite outgrowth from PC12 cells in Nutlin-3 manufacturer the presence of NGF in a dose-dependent manner between 5 and 10011,M peptide. Enhanced neurite growth required >12 h of peptide exposure in cells grown with NGF. Adsorption of GsMTx4 to serum proteins learn more in the media lowered the free peptide concentration of 100 mu M to a free concentration of 5 mu M, a concentration shown to completely

inhibit MSCs in the patch clamp assay. Outside-out patches from PC12 cells grown in NGF had mechanically activated cation channels that were reversibly inhibited by GsMTx4. These results are similar to those observed by Gomez and co-workers [4] in Xenopus spinal cord. The inhibition of mechanosensitive channels by GsMTx4 may be a useful approach to accelerate regeneration of neurons in neurodegenerative diseases and spinal cord injury. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Purpose: In this prospective, randomized, double-blinded study we sought to evaluate the efficacy and safety of combined use of intravenous ketorolac and acetaminophen in small children undergoing outpatient inguinal hernia repair.

Materials and Methods:

We studied 55 children 1 to 5 years old who were undergoing elective repair of unilateral inguinal hernia. After induction of general anesthesia children in the experimental group (28 patients) received 1 mg/kg ketorolac and 20 mg/kg acetaminophen intravenously. In the control group (27 patients) the same volume of A-769662 purchase saline was administered. All patients received 1 mu g/kg fentanyl intravenously before incision. We also evaluated the number of patients requiring postoperative rescue fentanyl, total fentanyl consumption, pain scores and side effects.

Results: Significantly fewer patients receiving ketorolac-acetaminophen received postoperative rescue fentanyl compared to controls (28.6% vs 81.5%). A significantly lower total dose of fentanyl was administered to patients receiving ketorolac-acetaminophen compared to controls (0.54 vs 1.37 mu g/kg). Pain scores were significantly higher in the control group immediately postoperatively but eventually decreased.

These results indicate a smooth transition

between mucila

These results indicate a smooth transition

between mucilage and the cell wall in Netrium.”
“Chronic infections with viruses such as hepatitis B virus, hepatitis C virus, and HIV constitute a major global public health problem. Studies of chronic viral infections in humans and mice show that persistent antigenic stimulation induces dysregulation of T cell responses; virus-specific T cells either undergo clonal deletion or lose their ability to display the full spectrum of effector functions, a condition termed functional exhaustion. The ability to generate and retain sufficient numbers of functionally competent T cells, therefore, becomes vitally important NU7026 in controlling chronic viral infections. Our understanding of the mechanisms governing T cell homeostasis during chronic viral infections, however, is poor. The phosphatidylinositol 3-kinase (PI3K)/Akt find more signaling pathway controls cell fate decisions in many cell types by

modulating the activity of downstream effectors, including the FOX() family of transcription factors. We have observed dynamic, in vivo alterations in the phosphorylation levels of three key proteins (Akt, FOXO1/FOXO3 [FOXO1/3], and mammalian target of rapamycin [mTOR]) involved in this signaling cascade and have identified the transcription factor FOXO3 as a negative regulator of the magnitude and effector function of CD8 T cells during chronic lymphocytic choriomeningitis virus

(LCMV) infection in mice. We report that ablation of FOXO3 in T cells reduced apoptosis, increased the abundance of polyfunctional virus-specific CD8 T cells, and improved viral control. Thus, FOXO3 is a promising candidate target for immunotherapies of chronic viral infection.”
“BACKGROUND: High-field, intraoperative magnetic resonance imaging (iMRI) achieves free tumor margins in glioma surgery by involving anatomic neuronavigation and sophisticated functional imaging.

OBJECTIVE: To evaluate the role of perfusion-weighted iMRI as an aid to detect residual tumor and to guide its resection.

METHODS: Twenty-two patients undergoing intraoperative scanning (in a dual-room 1.5-T magnet setting) during the resection of high-grade gliomas were examined with perfusion-weighted VX-809 solubility dmso iMRI. The generated relative cerebral blood volume (rCBV) maps were scrutinized for any hot spots indicative of tumor remnants, and region-of-interest analysis was performed. Differences among the rCBV region-of-interest estimates in residual tumor, free tumor margins, and normal white matter were analyzed. Histopathology of the tissue specimens and the neurosurgeon’s intraoperative macroscopic estimations were considered the reference standards.

RESULTS: In all cases, diagnostic rCBV perfusion maps were generated.

The time estimation ratio (TER, ratio of the subjective estimated

The time estimation ratio (TER, ratio of the subjective estimated time interval to actual time interval) decreased

significantly from the first to the sixth trial in both the NS and DS experiments. TER correlated positively with slow wave sleep (SWS) in both experiments, suggesting that SWS was a determining factor in accurate time estimation, irrespective of circadian phase they slept. No other sleep parameters showed steady influence on TEA. The present findings demonstrate that longer period of SWS is associated with the longer sleep time they subjectively experienced during sleep. (C) 2008 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.”
“Purpose: Catheter obstruction from mucus plugging and urinary leakage

https://www.selleckchem.com/products/gsk621.html are common problems after enterocystoplasty. A large suprapubic catheter and frequent bladder irrigation with normal saline are routinely used in the postoperative period to decrease catheter plugging. In this study we evaluated the use of a somatostatin analogue (Sandostatin(R)) to decrease mucus production by the intestinal segment after selleck chemicals enterocystoplasty.

Materials and Methods: We performed enterocystoplasty using ileal segments (20 to 30 cm) in 40 patients. In 20 patients Sandostatin (0.05 mg subcutaneously) was started 1 hour before the procedure and was then administered every 8 hours for 15 days. Bladder irrigation was performed whenever drainage from the suprapubic catheter caused blockage. The drain was removed 24 to 48 hours after the resumption of oral feeding if urine leakage was insignificant. We then compared the number of bladder irrigations required, mucus volume, time to remove the drain and hospital Quizartinib nmr stay between the groups.

Results: Only 5 patients in the treatment group required bladder irrigation. The mean number of bladder irrigations for

each patient was 0.35 +/- 0.67 in the group receiving Sandostatin and 10.35 +/- 2.13 for the control group (p<0.001). Mean mucus volumes on postoperative day 3 were 4.42 +/- 1.95 and 42.5 +/- 5.14 ml in the treatment and control groups, respectively (p<0.001). Mean time to remove the drain was 6.35 days for the Sandostatin group and 6.8 days for the control group. Mean hospital stay was 7.4 and 7.9 days for the treatment and control groups, respectively (p<0.05).

Conclusions: Sandostatin caused a marked decrease in mucus production by the intestinal segment with patients receiving Sandostatin no longer requiring routine postoperative bladder irrigation and having a shorter hospital stay.”
“The role of cholinergic basal forebrain inputs to cerebral cortex in regulating regional nerve growth factor (NGF) secretion was examined in adult (4-6 months) and aged (29-31 months) rats. Halothane-anesthetized rats received unilateral electrical stimulation of the nucleus basalis of Meynert (NBM).

fed state differences in mesolimbic responsivity would be greater

fed state differences in mesolimbic responsivity would be greater post-relative to pre-surgery. fMRI was used to asses

neural responsivity to high- and low-calorie food cues in five women 1 mo pre- and 1 mo post-RYGB. Scans were repeated in fasted and fed states. Significant post RYGB decreases in the insula, ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) responsivity were found in the fasted state. These changes were larger than neural changes in the fed state, which were non-significant. Preoperatively, fasted vs. fed differences in neural responsivity were greater in the precuneus, with large but nonsignificant clusters in the vmPFC and dlPFC. Postoperatively, however, AZD5363 molecular weight no Entrectinib molecular weight fasted vs. fed differences in neural responsivity were noted. Results were opposite to that predicted and appear inconsistent

with the initial hypothesis that postoperative increases in postprandial gut peptides are the primary driver of postoperative changes in neural responsivity. (c) 2012 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.”
“Theiler’s murine encephalomyelitis virus (TMEV) results in a persistent central nervous system infection (CNS) and immunemediated demyelination in mice. TMEV largely persists in macrophages (M phi s) in the CNS, and infected M phi s in vitro undergo apoptosis, whereas the infection of other rodent cells produces necrosis. We have found that necrosis is the dominant form of cell death in BeAn virus-infected BHK-21 cells but that similar to 20% of cells undergo apoptosis. Mcl-1 was highly expressed in BHK-21 cells, and protein levels decreased upon infection, consistent with onset of apoptosis. In infected BHK-21 cells in which Mcl-1 expression was knocked down using silencing RNAs there was a 3-fold increase in apoptotic cell death compared to parental cells. The apoptotic program 3-Methyladenine concentration switched on by BeAn virus is similar to that in mouse M phi s, with hallmarks of activation of the intrinsic apoptotic

pathway in a tumor suppressor protein p53-dependent manner. Infection of stable Mc1-1-knockdown cells led to restricted virus titers and increased physical to infectious particle (PFU) ratios, with additional data suggesting that a late step in the viral life cycle after viral RNA replication, protein synthesis, and polyprotein processing is affected by apoptosis. Together, these results indicate that Mcl-1 acts as a critical prosurvival factor that protects against apoptosis and allows high yields of infectious virus in BHK-21 cells.”
“Background: Impairments in executive functions and non-verbal memory are considered potential endophenotype markers of obsessive-compulsive disorder (OCD). For the neuropsychological deficits to be considered endophenotypes, they should be demonstrable in unaffected family members.

Our results suggest that

Our results suggest that Fedratinib datasheet the changes in dendritic spine density in the hippocampus may be one of the pathophysiological mechanisms underlying the development of and recovery from depression, and the neuronal plasticity of CA1 is first impaired during the development of depression.”
“Herpes simplex virus 1 (HSV-1) was shown to contain catalase, an enzyme able to detoxify hydrogen peroxide by converting it to water and oxygen. Studies

with a catalase inhibitor indicated that virus-associated catalase can have a role in protecting the virus from oxidative inactivation. HSV-1 was found to be more sensitive to killing by hydrogen peroxide in the presence of a catalase inhibitor than in its absence. The results suggest a protective role for catalase during the time HSV-1 spends in the oxidizing environment outside a host cell.”
“While recent years have witnessed a growing interest in Voluntary Task Switching (VTS), the control mechanisms that are required in order to switch tasks on a voluntary basis remain to be identified. Starting from the finding that in VTS the proportion of task repetitions is usually higher than the proportion of task switches (task-repetition bias), the present electrophysiological learn more study tests and confirms the hypothesis that, during VTS, one initially re-selects the previously executed task, before correcting this bias and selecting

the alternative task. On the one hand, these findings allow us to describe how people switch cognitive tasks voluntarily. On the other hand, our approach underlines the usefulness of electrophysiological measures in understanding the processes by which voluntary behavior occurs.”
“Dysfunctional glutamate neurotransmission has been implicated in the pathophysiology of schizophrenia. Abnormal expressions in schizophrenia of ionotropic glutamate receptors (iGluRs) and the proteins

that regulate their trafficking have been found to be region and subunit specific in brain, suggesting that abnormal trafficking of iGluRs may contribute toward altered glutamatergic neurotransmission. selleck chemical The post-translational modification N-glycosylation of iGluR subunits can be used as a proxy for their intracellular localization. Receptor complexes assemble in the lumen of the endoplasmic reticulum, where N-glycosylation begins with the addition of N-linked oligomannose glycans, and is subsequently trimmed and replaced by more elaborate glycans while trafficking through the Golgi apparatus. Previously, we found abnormalities in N-glycosylation of the GluR2 AMPA receptor subunit in schizophrenia. Here, we investigated N-glycosylation of N-methyl-d-aspartate and kainate (KA) receptor subunits in the dorsolateral prefrontal cortex from patients with schizophrenia and a comparison group.

Hypoxic treatment (1% O-2) of syncytiotrophoblasts enhanced level

Hypoxic treatment (1% O-2) of syncytiotrophoblasts enhanced levels of ceruloplasmin mRNA approximately 25-fold, a significantly greater upregulation than that noted for PAI-1 and sFlt-1, suggesting that enhanced ceruloplasmin expression is a sensitive marker of syncytial hypoxia. We suggest that syncytial ceruloplasmin and its associated ferroxidase activity, induced

by the hypoxia accompanying severe PE, is important in an endogenous cellular program to mitigate the damaging effects of subsequent reperfusion injury at this site.”
“Drug addicts have deficits in frontocortical function and cognition even long after the discontinuation of drug use. It is not clear, however, whether the cognitive deficits are a consequence of drug use, or are present prior to drug use, and thus are a potential predisposing

this website factor for addiction. To determine if self-administration of cocaine is capable of producing long-lasting alterations in cognition, rats were allowed access to cocaine for either 1 h/day (short access, ShA) or 6 h/day (long access, LgA) for 3 weeks. Between 1 and 30 days after the last self-administration session, we examined performance on a cognitively demanding test of sustained attention that requires an intact medial prefrontal cortex. The expression levels of dopamine D1 and D2 receptor mRNA and D2 protein in the prefrontal cortex were also examined. Early after discontinuation of drug use, LgA (but not ShA) animals were markedly impaired on the sustained attention task. Although the LgA animals improved over time, they continued to show a persistent Lazertinib mw pattern of performance deficits indicative of a disruption of cognitive flexibility up to 30 days after the discontinuation of drug use. This was accompanied by a significant decrease in DA D2 (but not D1) mRNA

in the medial and orbital prefrontal cortex, and D2 receptor protein in the medial prefrontal cortex of LgA (but not ShA) 17-DMAG (Alvespimycin) HCl animals. These findings establish that repeated cocaine use is capable of producing persistent alterations in the prefrontal cortex and in cognitive function, and illustrate the usefulness of extended access self-administration procedures for studying the neurobiology of addiction.”
“The liver is frequently exposed to insults, including toxic chemicals and alcohol, viral infection or metabolic overload. Although it can fully regenerate after acute injury, chronic liver damage causes liver fibrosis and cirrhosis, which can result in complete liver failure. In this study, we demonstrate that the NF-E2-relatedfactor 2 (Nrf2) transcription factor protects the liver from acute and chronic toxin-mediated damage. Repair of the liver injury that occurs after a single treatment with the hepatotoxin carbon tetrachloride (CCl4) was severely delayed in Nrf2-deficient mice.

A battery of neuropsychological tests was performed 3 times: preo

A battery of neuropsychological tests was performed 3 times: preoperatively and postoperatively at 1 and 4 weeks after coil embolization.

RESULTS: The incidence of cognitive

impairment after coiling in patients with UIAs was 44% (17 of 39) at 1 week and 19% (7 of 37) at 4 weeks after coil embolization. DWI within 1 day after coil embolization revealed that 60% of patients (24 of 40) showed CSILs. However, no significant difference was found in any mean cognitive scores or in the number of cognitively impaired variables between patients with and without CSILs at weeks 1 and 4. Additional correlation analysis revealed no correlations between the number of CSILs on DWI and the cognitive sum z score at both 1 and 4 weeks.

CONCLUSION: Exhaustive neuropsychological evaluation of UIA patients who underwent coil embolization check details demonstrated recovery

or improvements from baseline cognitive function after 4 weeks, although some patients still showed cognitive deficits at 4 weeks after the procedure. However, we found no statistically significant relationship between the presence and number of CSILs on DWI and cognitive changes after the procedure.”
“Endogenous hepadnaviruses (hepatitis B viruses [HBVs]) were recently discovered in the genomes of passerine birds. We mined six additional Gemcitabine avian genomes and discovered multiple copies of endogenous HBVs in the budgerigar (order Psittaciformes), designated eBHBV. A phylogenetic analysis reveals that the endogenous hepadnaviruses are more diverse than their exogenous counterparts and that the endogenous and exogenous hepadnaviruses form distinct lineages even when sampled from the same avian order, indicative of multiple genomic integration events.”
“BACKGROUND: Subarachnoid hemorrhage (SAH) is found to have no vascular origin by initial catheter angiography in approximately 15% of cases. The most appropriate course for the type and frequency of additional diagnostic workup remains controversial.

OBJECTIVE: To retrospectively assess the diagnostic

yield of short-term and long-term repeat catheter angiography in the era of advanced imaging.

METHODS: Between 2003 and 2011, 254 consecutive patients diagnosed with SAH had negative initial angiography. SAH was perimesencephalic (PM) in 46.5% and non-perimesencephalic (NPM) in 53.5%. Angiography was Ganetespib mouse repeated at 1-week (short-term) and 6-week (long-term) intervals from the initial negative angiogram.

RESULTS: Ten of 254 patients had a vascular source of hemorrhage on short-term follow-up angiography with a diagnostic yield of 3.9%. One hundred seventy-four patients with negative findings on the first 2 angiograms received a third angiogram, and 7 of these patients were found to have a vascular abnormality. The estimated yield of this third angiogram was 4.0%. The overall diagnostic yield of repeat angiography was 0% in the PM group and 12.5% in the NPM group.

Withdrawal symptoms (jumping, diarrhea, weight loss, rearing, pen

Withdrawal symptoms (jumping, diarrhea, weight loss, rearing, penile licking and paw tremor) observed MEK162 nmr in the group treated with morphine was persistently increased during 3 days. On the other hand, withdrawal symptoms such as diarrhea, weight loss and rearing in beta-endorphin-treated group were increased after a single injection with beta-endorphin, but gradually decreased after the repeated injection. Furthermore, no jumping behavior, penile licking and paw tremor in beta-endorphin-treated group were observed throughout the whole period of time. In addition, the hypothalamic

changes of several signal molecules such as pERK, pCaMK-II alpha, c-FOS and pCREB expression were observed during the presence or absence of withdrawal responses induced by morphine or beta-endorphin administered once or repeatedly. Both hypothalamic pCaMK-II alpha and c-FOS expressions were increased by naloxone treatment in acutely administered morphine group, whereas only pCaMK-II alpha expression was elevated by naloxone treatment in repeatedly administered morphine group. In contrast with the findings in morphine-treated

group, only pCaMK-II alpha expression was decreased by naloxone treatment in repeatedly administered beta-endorphin group. Our results suggest that profiles of the withdrawal symptoms induced by morphine and beta-endorphin administered supraspinally www.selleckchem.com/products/Cediranib.html appear to be differentially regulated. The pCaMK-II LDC000067 mouse alpha and the c-FOS protein expression may play important roles for the regulation of naloxone-precipitated withdrawal

symptoms such as jumping, diarrhea, weight loss, rearing, penile licking and paw tremor induced by morphine-treated group, whereas the phosphorylation of hypothalamic pCaMK-II alpha appears to be involved only in the regulation of naloxone-precipitated withdrawal symptoms such as diarrhea, weight loss and rearing in beta-endorphin-treated group. (C) 2012 IBRO. Published by Elsevier Ltd. All rights reserved.”
“There is considerable excitement about the potential for epigenetic information to contribute to heritable variation in many species. Our understanding of the molecular mechanisms of epigenetic inheritance is rapidly growing, and it is now possible to profile the epigenome at high resolution. Epigenetic information plays a role in developmental gene regulation, response to the environment, and in natural variation of gene expression levels. Because of these central roles, there is the potential for epigenetics to play a role in crop improvement strategies including the selection for favorable epigenetic states, creation of novel epialleles, and regulation of transgene expression. In this review we consider the potential, and the limitations, of epigenetic variation in crop improvement.

The data indicate that peripheral nerve injury changes not only p

The data indicate that peripheral nerve injury changes not only protein expression

C646 chemical structure but also protein subcellular distribution in dorsal horn cells. These changes might participate in the central mechanism that underlies the maintenance of neuropathic pain.”
“The cortical cholinergic innervation, which is important for memory and cognition, has been implicated in schizophrenia. To experimentally analyze such a possible role of the cholinergic system, we have used the dissociative drug phencyclidine (PCP), known to produce schizophrenia-like psychosis in humans, to model aspects of schizophrenia in rats. We previously showed that induced cortical cholinergic hypofunction leads to enhanced PCP-induced locomotor activity and attenuated social interaction. After PCP, rats lacking cortical cholinergic innervation also

show impaired declarative memory. To Galunisertib directly study the role of the basalo-cortical cholinergic projections for PCP-induced neural activation in different cortical areas, we have now monitored the rapid (30 and 60 min) effects of low doses of PCP (2 and 3 mg/kg) on neural activation as reflected by transcriptional activation of c-fos in cortical areas, using quantitative in situ hybridization. We find an almost pan-cortical neural induction of c-fos mRNA with doses of PCP low enough not to alter levels of either BDNF or Nogo receptor mRNA levels. Specific unilateral lesioning of the uncrossed cholinergic projections to the cortical mantle by 192-IgG-saporin immunotoxin delivery to nc basalis (NBM) caused a striking ipsilateral decrease of the PCP-induced cortical c-fos mRNA induction, www.selleck.cn/products/sc75741.html restricted to areas which had become effectively denervated. Because PCP at low doses is unlikely to directly influence cortical neurons, we suggest that it acts by activation of the cholinergic input, which in turn leads to cortical c-fos mRNA increases. Our results are compatible with a role for the cholinergic system in symptoms of schizophrenia,

by showing that the basalocortical cholinergic projections are needed in order for PCP to have full activating effects on cortical neurons. (C) 2012 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Treatment of multiple myeloma has evolved over the last decade, most notably with the introduction of highly effective novel agents. It is now possible to aim for deep disease responses in a greater number of patients in an attempt to prolong remission duration and survival. Initially introduced in the relapsed setting, the novel agents, namely thalidomide, bortezomib and lenalidomide, are now being increasingly incorporated into upfront treatment strategies, raising questions about the feasibility of ‘retreatment’ with such agents. Also, in a disease that is characterized by multiple relapses, the ‘sequencing’ of the different effective options is an important question.