Survival update for the phase III study of pemetrexed vs docetaxel in non-small cell lung cancer (NSCLC)

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Background: Results from a large, randomized, phase III study of pemetrexed vs docetaxel as second-line treatment for advanced NSCLC indicated that pemetrexed, a novel multitargeted antifolate, has a median survival time (8.3 months) similar to that of docetaxel (7.9 months) with a more favorable safety profile [JCO 2004;22:1589–97]. This updated analysis reflects data available 23 months after the original analysis, which was performed Jan 2003 (after 519 deaths). Methods: Pts (n = 571) were randomized from March 2001 to Feb 2002 to receive either pemetrexed (500 mg/m2 IV infusion), supplemented with vitamin B12 injections and folic acid, or docetaxel (75 mg/m2 IV infusion) on day 1 of a 21-day cycle. An unadjusted survival analysis was performed and a Cox multiple regression analysis (n = 532) was done to adjust for factors (other than treatment intervention) that affected survival including ECOG performance status (PS), disease stage, and time since last chemotherapy. Percent retention was performed using the Rothmann method. Results: The updated survival analysis (performed after 519 deaths) indicated similar median survival times for pemetrexed (8.3 months; 95% CI: 7.0–9.4) and docetaxel (8.0 months; 95% CI: 6.6–9.3), and comparable hazard ratios (HR) (original 0.99 [95% CI: .82–1.20] vs updated 0.97 [95% CI: .81–1.15]). Percent of docetaxel benefit over best supportive care retained by pemetrexed was similar in both analyses: original 102% (95% CI: 52%-157%) vs updated 106% (95% CI: 68%-163%). Cox multiple regression analysis again showed that the two drugs were similar in survival after adjusting for factors significantly associated with increased survival. Conclusions: These updated survival analyses consistently demonstrate that second-line pemetrexed has similar survival to docetaxel in pts with NSCLC. Given the continued finding of comparable therapeutic efficacy, pemetrexed may be considered a standard second line therapy.

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Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries

OBJECTIVES

To examine functional outcomes from a rehabilitation programme and to compare two methods for evaluating cost efficiency of rehabilitation in patients with severe complex disability.

SUBJECTS AND SETTING

Two hundred and ninety seven consecutive admissions to a specialist inpatient rehabilitation unit following severe acquired brain injury.

METHODS

Retrospective analysis of routinely collected data, including the Functional Independence Measure (FIM), Barthel Index, and Northwick Park Dependency Score and Care Needs Assessment (NPDS/NPCNA), which provides a generic estimation of dependency, care hours. and weekly cost of continuing care in the community. Patients were analysed in three groups according to dependency on admission: "low" (NPDS<10 (n=83)); "medium" (NPDS10-24 (n=112)); "high" (NPDS>24 (n=102)).

RESULTS

Mean length of stay (LOS) 112 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in "weekly cost of care" was greatest in the high dependency group at pound639 per week (95% CI 488 to 789)), as compared with the medium (pound323/week (95% CI 217 to 428)), and low (pound111/week (95% CI 42 to 179)) dependency groups. Despite their longer LOS, time taken to offset the initial cost of rehabilitation was only 16.3 months in the high dependency group, compared with 21.5 months (medium dependency) and 38.8 months (low dependency). FIM efficiency (FIM gain/LOS) appeared greatest in the medium dependency group (0.25), compared with the low (0.17) and high (0.16) dependency groups.

CONCLUSIONS

The NPDS/NPCNA detected changes in dependency potentially associated with substantial savings in the cost of ongoing care, especially in high dependency patients. Floor effects in responsiveness of the FIM may lead to underestimation of efficiency of rehabilitation in higher dependency patients.

T-cell sensitisation to hepatitis B virus surface antigens

The present study was conducted to explore the immunity to hepatitis B surface antigens (HBsAg) of ad and ay subtypes at the cellular level among adult individuals. Peripheral blood mononuclear cells (PBMCs) obtained from acute hepatitis B virus (HBV) infected patients, chronic HBV infected patients, recovered subjects from HBV infection and uninfected vaccinated controls were stimulated with HBsAg ad and HBsAg ay subtypes in vitro. Stimulated PBMCs were incubated in CO(2) for production of interferon-gamma (IFN-gamma), which was measured from the supernatant of cultured PBMCs by an in-house ELISA technique. The mean +/- SE of IFN-gamma levels produced by PBMCs in response to HBsAg ad among the acute, chronic, recovered and control groups were 282.5+/-134.51 pg/ml, 307.45+/-94.84 pg/ml, 915.62+/-170.80 pg/ml and 511.67+/-161.22 pg/ml respectively, while on stimulation by HBsAg ay, the levels were 246.25+/-103.50 pg/ml, 374.70+/-104.02 pg/ml, 1040 +/-140.76 pg/ml and 465.83+/-166.26 pg/ml respectively among the above mentioned groups. The results of this study showed that PBMCs were non-responsive to stimulation by both HBsAg ad and HBsAg ay subtypes in acute and chronic patients with HBV infection. The recovered group responded significantly to both subtypes of HBsAg and the control group did not. The study indicates that although the patients with acute and chronic HBV infection showed weak or no IFN-gamma response to the HBsAg, subjects showed strong IFN-gamma response to the surface antigens on recovery from HBV infection.

A comparison of immunohistochemical and silver staining methods for the detection of diffuse plaques in the aged canine brain

Plaques and amyloid angiopathy represent frequent findings in the aging canine brain, whereas neuritic (senile) plaques and neurofibrillary tangles, the hallmark of Alzheimer's disease in humans, have only rarely been described in this species. Most studies on canine age-related CNS changes have used the modified (mod.) Bielschowsky method. Therefore, it remains to be determined, whether results obtained represent species-specific age-related changes or are due to the use of inappropriate methods. Consequently, the aim of this study was to compare the usefulness of various methods for the detection of age-related changes in the canine CNS. In a preliminary study, 130 brains from dogs between 1 month and 18 years of age were screened for the presence of A-beta protein using a monoclonal antibody against the beta-amyloid peptide. Thereafter, 30 brains of aged dogs, 10-18 years of age, out of the 130, were comparatively investigated by immunohistochemistry and silver stains such as the method of Campbell-Switzer, Reusche, Gallyas, modified (mod.) Bielschowsky and mod. Bodian as well as the Congo red-stain. Vascular amyloid angiopathy, plaques and A-beta protein deposits in the hippocampus/dentate gyrus were an age-dependent process starting at the age of 8 years and increased in a linear fashion with age. In contrast, plaque density did not rise in a similar age-related fashion in aged dogs. Moreover, great individual variations were observed in aged animals. Immunohistology was by far the most sensitive method for detection of diffuse plaques and amyloid angiopathy, followed by the Campbell-Switzer, Reusche, mod. Bielschowsky, and mod. Bodian technique. Neurofibrillary tangles and Congo red positive neuritic plaques were not found with any method. Immunohistochemically, two plaque types, both resembling diffuse human plaques, occurring in the superficial or deep cortical layers, were detected. Cluster analysis suggested the presence of three subgroups such as aged dogs with a low, medium and high number of plaques. Summarized, detection of plaques depends strongly upon the method used and the aging canine brain displays diffuse plaques and amyloid angiopathy but lacks neurofibrillary tangles and classic/neuritic and Congo red positive plaques. Cluster analysis indicated, that genetic factors might be important as predisposition for the development of diffuse plaques in dogs. The observed findings substantiate previous observations, that the canine brain represents an important model to study the pathogenesis of diffuse plaques and amyloid angiopathy in the absence of other Alzheimer disease characteristic lesions.

Human subtelomere structure and variation

Work towards completion of the human reference genome sequence has revealed a great deal of complexity and plasticity in human subtelomeric regions. The highly variable subtelomeric repeat regions are filled with recently shuffled genomic segments, many of which contain sequences matching transcripts and transcript fragments; the rapid duplication and combinatorial evolution of these regions has generated an extremely diverse set of subtelomeric alleles in the human species, the complexity and potential significance of which is only beginning to be understood. This review summarizes recent progress in analyzing human subtelomeric sequence assemblies and large-scale variation in human subtelomere regions.

Recruitment of sperm donors: the Newcastle-upon-Tyne experience 1994–2003

BACKGROUND

The demand for sperm donors has continued despite the introduction of ICSI. This study was undertaken in the light of impending changes in donor anonymity laws to evaluate the recruitment process of sperm donors.

METHODS

Retrospective analysis of 1101 potential sperm donors in a tertiary referral centre between January 1994 and August 2003. The main outcome measures were to determine the demographic details, recruitment rate and reasons for rejection of donors.

RESULTS

The majority of the applicants were aged <36 years (88.07%), students (54.88%), without a partner (53.47%), unmarried (85.38%) and without proven fecundity (78.67%). Only 3.63% of the applicants were released as donors, 30.79% defaulted, whilst 64.48% were rejected. The most common reason for rejection was suboptimal semen quality (85.07%). Over the years, the numbers of the applicants and released donors have declined significantly. The overall clinical pregnancy rate from donor sperm during this period was 23.52%.

CONCLUSIONS

In this successful anonymous sperm donor programme only a small proportion of the applicants are released as donors. The significant decline in released sperm donors coupled with the potential effects of loss of donor anonymity means that new strategies for sperm donor recruitment are urgently required.

Antimicrobial activity of chitosan against vibrios from freshwater prawn Macrobrachium rosenbergii larval rearing systems

Chitosan is a biocompatible and biodegradable natural polymer with established antimicrobial properties against specific microorganisms. The present study demonstrates its antibacterial activity against 48 isolates of Vibrio species from prawn larval rearing systems. The antibacterial activity had a positive correlation with the concentration of chitosan. This work opens up avenues for using chitosan as a prophylactic biopolymer for protecting prawn larvae from vibriosis.

A Superconducting Magnet UCN Trap for Precise Neutron Lifetime Measurements

Finite-element methods along with Monte Carlo simulations were used to design a magnetic storage device for ultracold neutrons (UCN) to measure their lifetime. A setup was determined which should make it possible to confine UCN with negligible losses and detect the protons emerging from β-decay with high efficiency: stacked superconducting solenoids create the magnetic storage field, an electrostatic extraction field inside the storage volume assures high proton collection efficiency. Alongside with the optimization of the magnetic and electrostatic design, the properties of the trap were investigated through extensive Monte Carlo simulation.

First Ever Storage of Ultracold Neutrons in a Magnetic Trap Made of Permanent Magnets

Further improvement in the accuracy of any neutron lifetime experiment by means of ultracold neutrons (UCN) in material bottles is limited due to unavoidable systematic effects when the UCN are reflected from the walls. However, such effects can be excluded in principle if magnetic trapping of UCN is used. The storage of UCN in a small magnetic trap made of permanent magnets was demonstrated for the first time ever. The measured storage time in this feasibility study was (882 ± 16) s. At this level of accuracy no depolarization was observed.

First measurement of the transverse spin asymmetries of the deuteron in semi-inclusive deep inelastic scattering

First measurements of the Collins and Sivers asymmetries of charged hadrons produced in deep-inelastic scattering of muons on a transversely polarized 6LiD target are presented. The data were taken in 2002 with the COMPASS spectrometer using the muon beam of the CERN SPS at 160 GeV/c. The Collins asymmetry turns out to be compatible with zero, as does the measured Sivers asymmetry within the present statistical errors.

CHHIPS (Controlling Hypertension and Hypotension Immediately Post-Stroke) Pilot Trial: rationale and design

RATIONALE

High and low blood pressure (BP) levels are common following acute stroke, with up to 60% of patients being hypertensive (SBP > 160 mmHg) and nearly 20% having relative hypotension (SBP < or = 140 mmHg), within the first few hours of ictus, both conditions being associated with an adverse prognosis. At present, the optimum management of blood pressure in the immediate post-stroke period is unclear.

OBJECTIVE

The primary aim of the Controlling Hypertension and Hypotension Immediately Post-Stroke (CHHIPS) Pilot Trial is to assess whether hypertension and relative hypotension, manipulated therapeutically in the first 24 h following acute stroke, affects short-term outcome measures.

DESIGN

The CHHIPS Pilot Trial is a UK based multi-centre, randomized, double-blind, placebo-controlled, titrated dose trial.

SETTING

Acute stroke and medical units in teaching and district general hospitals, in the UK.

PATIENTS

The CHHIPS Pilot Study aims to recruit 2050 patients, with clinically suspected stroke, confirmed by brain imaging, who have no compelling indication or contraindication for BP manipulation.

STUDY OUTCOMES

The primary outcome measure will be the effects of acute pressor therapy (initiated < or = 12 h from stroke onset) or depressor therapy (started < or = 24 h post-ictus) on death and dependency at 14 days post-stroke. Secondary outcome measures will include the influence of therapy on early neurological deterioration, the effectiveness of treatment in manipulating BP levels, the influence of time to treatment and stroke type on response and a cost-effectiveness analysis.