A phase II trial of erlotinib monotherapy in pretreated patients (pts) with non-small cell lung cancer (NSCLC) who do not possess active EGFR mutations

8067

Background: Efficacy of gefitinib therapy strongly depends on the presence of active EGFR mutations in Asian NSCLC pts, with objective response rates (ORR) of 71.2% and only 1.1% in active mutant-positive (EGFRmt+) and -negative (EGFRmt-) tumors, respectively [Mok T, ESMO2008]. Recently, the survival advantage of erlotinib, another TKI, is observed even in pts with EGFRmt- tumors (HR=0.74, p=0.09 [Zhu C, JCO2008]), indicating such subpopulation might also benefit from this TKI. The aim of this trial was to evaluate its efficacy and toxicity in Japanese pts with relapsedEGFRmt- tumors. Methods: Primary endpoint was ORR. Patients with EGFRmt--NSCLC previously treated with one to three chemotherapy regimens were enrolled in this trial. The mutation status was assessed by the PCR clamp methods. Erlotinib was administered at a dose of 150mg/day until disease progression or unacceptable toxicities. Results: Thirty pts were enrolled between Jan and Dec 2008. Median duration of erlotinib treatment was 60 days. All pts were assessable for efficacy and safety. Demographics of the pts were as follows: M/F:24/6, Ad/others:20/10, ECOG-PS 0/1/2:7/19/4, and smoker/non-smoker:22/8. Platinum-based regimens were commonly used as the prior chemotherapy. Objective response was obtained in one pt (3.3%; RECIST). Seventeen pts obtained SD (56.7%). Toxicity profiles were almost tolerable with the treatment interruption in 11 pts (median duration; 10 days). Skin rash was common (grades 1, 2 and 3 in 7, 15, and 7 pts, respectively; NCI-CTCAE ver3). One pt developed grade 4 pulmonary embolism, but it seemed due to disease progression. Other 2 pts developed interstitial lung disease (grades 2 and 3 in one pt each). No treatment-related deaths (TRD) occurred. With a median follow-up time of 6.4 months, MST and MPFS time were 8.6 and 2.1 months, respectively. Conclusions: This is a first prospective biomarker study showing that erlotinib therapy for pretreated pts with EGFRmt- tumors seems as almost effective and safe as the standard docetaxel therapy (PR: 5.8%, SD: 42.7%, MST: 7.0 months, MTTP: 2.5 months and TRD: 4.9% [Shepherd JCO2000]).

No significant financial relationships to disclose.

A randomized phase II study of a combination of docetaxel and S-1 versus docetaxel monotherapy in pts with NSCLC previously treated with platinum-based chemotherapy: Results of Okayama Lung Cancer Study Group (OLCSG) trial 0503

8058

Background: Recent studies have demonstrated that docetaxel (DOC) monotherapy provides a significant survival prolongation in relapsed pts with NSCLC. However, its benefit remains modest and further improvement is needed. S-1 is a newly developed oral 5-fluorouracil derivative, possessing a promising anti-tumor activity in NSCLC. Based on a superior effect of combination of DOC and 5-fluorouracil derivative (capecitabine) to DOC alone in anthracycline-pretreated breast cancer pts, we conducted a randomized phase II study to evaluate the clinical significance of adding S-1 to DOC in the second-line setting. Methods: Pts with relapsed NSCLC to the first-line platinum-based chemotherapy were randomly allocated to DOC monotherapy (A arm; 60 mg/m2, day 1, q 3 wks) or a combination chemotherapy (B arm) of DOC (40 mg/m2, day 1, q 3 wks) and S-1 (80 mg/m2, days 1 to 15). The doses of arm B were determined based on the results of a phase I study conducted for Japanese pts with gastric cancer (Anticancer Res 24: 1843, 2004). The primary endpoint was response rate and secondary endpoints included OS, PFS and toxicity. Results: Between 2005 and 2008, 60 pts were enrolled (A/B: 29/31 pts). Demographics of the pts were as follows: M/F: 49/11, Ad/others: 40/20, ECOG-PS 0/1: 38/22. A median number of courses administered was 4 (range: 1 to 6). Objective response was obtained in 6 (20.7%) and 5 pts (16.1%) in arms A and B, respectively. With a median follow-up time of 16.9 months, MST and median PFST in arm A were longer than arm B (22.9 vs. 8.7 months and 3.7 vs. 3.4 months, respectively). The major toxicity was myelosuppression, with grade 4 neutropenia of 62% vs. 29%, whereas thrombocytopenia was generally mild. Grade 3 febrile neutropenia was observed in 4 and 1 pts, none of whom further developed grade 5 toxicity. Other grade 3 or greater non-hematological adverse events included fever (B: 1 pt), pneumonitis (B: 1 pt), liver dysfunction (B: 2 pts), skin rash (B: 1 pt), and all of them were improved with an appropriate supportive care. Conclusions: The trial suggests that docetaxel monotherapy remains a standard therapy for NSCLC pts who relapsed to platinum-based chemotherapy.

No significant financial relationships to disclose.

Evaluation of erlotinib treatment after gefitinib failure in Japanese recurrent non-small cell lung cancer patients

e19008

Background: Both gefitinib (G) and erlotinib (E) belong to the family of epidermal growth factor receptor-tyrosine kinase inhibitors that has shown positive results in the treatment of advanced/recurrent non-small-cell lung cancer (NSCLC). Recent studies suggested a distinction in efficacy between G and E. In fact, there is a subgroup of patients who had clinically meaningful benefit with E therapy after G failure, but little is known about the factors that predict disease control or the risk factors that develop toxicity in these patients. Our aim is to evaluate the efficacy and toxicity of E after G failure in the largest scale study to date. Methods: We retrospectively evaluated the efficacy and toxicity of E therapy and analyzed factors that contributed to disease control in patients had experienced G failure. EGFR mutational analysis was performed in evaluable cases. Results: From January 2008 to December 2008, seventy-seven patients were treated with E after G failure in our institutions. Of these 77 patients, 11 had a partial response (PR) and 21 had a stable disease (SD), resulting in a best response rate of 14% and a disease control rate (DCR) of 42%. Thirty of 56 (54%) patients who had benefited from prior G therapy achieved disease control, while only 2 of 20 (10%) patients who had experienced initial progressive disease to G therapy obtained SD (P<0.001) . Twenty-seven of 48 (56%) patients with performance status (PS) 0/1 achieved disease control, but a DCR of PS 2/3/4 patients was only 17% (5 of 29) (P<0.001). EGFR mutation status, smoking history, and gender had little relationship to disease control. In 4 of 11 patients who achieved PR, E was effective for brain metastases. The most common side effects of E therapy were skin rash and diarrhea, as described in previous studies. Notably in approximately 30% of poor PS patients, grade 3 to 4 non-hematological toxicity including severe general malaise and anorexia was observed. Conclusions: E may be effective as a salvage therapy for some Japanese NSCLC patients after G failure, especially in those who had benefited from prior G treatment and/or those who maintain a good PS. Interestingly, E was effective for brain metastases of some patients after G failure.

No significant financial relationships to disclose.

Molecular analyses of bacterial DNA in extirpated heart valves from patients with infective endocarditis

BACKGROUND/AIMS

Infective endocarditis (IE) is caused by a microbial infection of the endothelial surface of the heart. Although blood culture examinations are commonly used to determine the associated bacterial species, molecular techniques, which enable rapid identification of targeted bacterial species, have recently been applied in clinical cases.

METHODS

Nine heart valve specimens from IE patients (six subacute cases and three acute cases) were extirpated and collected, then bacterial DNA was extracted. Bacterial species in the specimens were determined by two different molecular methods and the results were compared with those from a conventional blood culture technique. In addition, a comparison between the two molecular methods was carried out using known numbers of six streptococcal species.

RESULTS

The conventional blood culture method revealed the bacterial species in eight cases, while one was found to be negative. Multiple species were identified in most of the cases by both molecular methods; however, those specified by one method were not always consistent with those specified by the other. Furthermore, the species determined by the blood culture technique were not always identified by the molecular methods. We also found that the two molecular methods used in the present study were extremely sensitive to detect from 1 to 100 cells of individual oral streptococcal species.

CONCLUSION

Our results suggest that species specified by molecular methods may have disseminated incidentally into the bloodstream, so interpretation of such results should be carefully undertaken in clinical situations.

Detection of oral bacteria in cardiovascular specimens

BACKGROUND/AIMS

Oral bacteria, including cariogenic and periodontal pathogens, are thought to be etiological factors in the development of cardiovascular diseases. To define this relationship, we analyzed the distribution of oral bacterial species in cardiovascular specimens.

METHOD

Following acceptance into the study, 203 consecutive patients were analyzed, from whom 82 aortic valve specimens, 35 mitral valve specimens, and 86 aortic aneurysmal wall specimens, of which 16 contained aneurysmal thrombus tissues, were obtained. In addition, a total of 58 dental plaque specimens were collected from the same group of patients who underwent heart valve replacement or removal of aortic aneurysms. Bacterial DNA was extracted from both cardiovascular tissues and dental plaque in those cases and then species-specific polymerase chain reaction assays were used to analyze the occurrences of six oral streptococcal and six periodontal bacterial species.

RESULTS

Streptococcus mutans was the most frequently detected species in the cardiovascular specimens, followed by Aggregatibacter actinomycetemcomitans. As for dental plaque specimens from patients who underwent cardiovascular operations, most of the tested periodontitis-related species as well as oral streptococci were detected at high frequencies. Furthermore, the positive rate of S. mutans in cardiovascular specimens from patients whose dental plaque specimens were also positive for S. mutans was 78%, which was significantly higher than any other tested species when the same analysis was performed.

CONCLUSION

Our results suggest that specific oral bacterial species, such as S. mutans and A. actinomycetemcomitans, are related to bacteremia and may be etiologic factors for the development of cardiovascular diseases.

18 RELATIONSHIP BETWEEN MULTIPLE OVULATIONS AND CONCEPTION IN LACTATING DAIRY COWS

The relationship between multiple ovulations and various factors involved in conception in lactating Holstein cows was investigated in this study. A total of 53 AI cows housed in a free-stall barn were assigned to this study. They were offered a balanced TMR ad libitum during the experimental period. Cows were milked at 0830 and 1900 h. Milk yields were recorded at each milking. Estrus was detected by radiotelemetric pedometers (Yoshioka et al. 2007 Reprod. Fertil. Dev. 19, 129). The body condition score (BCS) of cows was recorded at estrus. Artificial insemination was performed according to the pedometry data. Pregnancy was diagnosed 42 days post-AI by transrectal ultrasonography. Ovulation was assessed by transrectal ultrasonography of the ovary every 3 h from the end of estrus. Ovulation time was measured from the onset of estrus to ovulation. Milk production of each cow was determined from 14 days before the day of estrus. Blood samples for estradiol-17β (E2) were collected at the peak of estrus, and for progesterone (P4), samples were collected on Days 0, 3, 6, 9, and 12 (estrus = Day 0). The E2 and P4 concentrations were measured by enzyme immunoassay. Preovulatory follicles at estrus and CL on Day 0, 3, 6, 9, and 12 were monitored by transrectal ultrasonography. The overall incidence of multiple ovulations was 28.3% (15/53). There was no difference in duration of estrus between cows with multiple ovulations and cows with single ovulations (10.2 h, n = 15 v. 9.8 h, n = 38). Ovulation time was longer for cows with multiple ovulations than that for cows with single ovulations (30.4 h, n = 10 v. 28.7 h, n = 26; P = 0.0545). In all cases of multiple ovulations, 2 follicles ovulated simultaneously. The milk production of cows with multiple ovulations was higher than that of cows with single ovulations (40.1, n = 15 v. 36.2 kg d–1, n = 38; P = 0.0515); however, BCS showed the opposite results (2.86, n = 15 v. 3.13, n = 38; P < 0.05). There was a significant inverse correlation between milk production and BCS in cows with multiple ovulations (r = –0.768; P < 0.01). The E2 concentrations showed no difference between cows with multiple and single ovulations (9.6 pg mL–1, n = 8 v. 8.2 pg mL–1, n = 23). The diameters of preovulatory dominant follicles and secondary follicles at estrus in cows with multiple ovulations were significantly smaller than those in cows with single ovulations (18.2 and 14.2 mm, n = 14 v. 19.9 mm, n = 38, respectively; P < 0.05). Cows with multiple ovulations showed a significantly higher P4 concentration and a larger CL than those with single ovulations from Day 3 to 12. The conception rate for AI was significantly higher for cows with multiple ovulations than for cows with single ovulations (73.3%, n = 15 v. 36.2%, n = 38; P < 0.05). Our results showed that high conception rates, high levels of milk production, and low BCS were associated with multiple ovulations.

Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee

BACKGROUND

Bone marrow edema (BME) is a condition detectable with magnetic resonance imaging (MRI) and is present in different stages of osteoarthritis (OA). Its pathogenesis is still not completely known.

PURPOSE

To evaluate the longitudinal occurrence and persistence of BME in early OA of the knee.

MATERIAL AND METHODS

Twenty-three patients (eight females, 15 males; mean age 55.5+/-10.3 years) were scanned with a 1.5T MR imaging unit (sagittal fat-suppressed intermediate-weighted fast spin echo; 4-mm section thickness, 1-mm intersection gap, 256 x 192 matrix, 120-mm field of view). Images were obtained in all 23 patients at two time points (TPs) and in 12 patients at three TPs. Images were evaluated by two readers independently; discrepancies in image grading were reviewed and evaluated in consensus. A four-point image-grading scale was used (absence of BME to severe BME). Four main anatomical regions were evaluated (medial femur, lateral femur, medial tibia, lateral tibia), which were subcategorized into anterior, central, and posterior regions.

RESULTS

One hundred five areas of BME in the 23 patients were found at all three TPs. In 16 areas, the BME was consistent at the same location over time, in seven locations the BME became larger, in six areas the BME became smaller, and in 16 locations it could not be detected in follow-up MRIs. In one case, the BME was smaller at TP2 but increased at TP3. In eight cases, only at the last time point could a BME be detected.

CONCLUSION

BME is not a static phenomenon but changes over time. Correlation to physical activity and local inflammatory reaction should be evaluated.

Targeted dendrimer-based contrast agents for articular cartilage assessment by MR imaging

OBJECTIVE

Magnetic resonance (MR) imaging with contrast media has shown promise for articular cartilage assessment. Dendrimer-linked nitroxides, a new family of MR contrast agents targeted to glycosaminoglycan, may improve cartilage evaluation. This study is designed to determine the ability of dendrimer-linked nitroxides to enhance articular cartilage and measure the intra-articular life-time of these agents.

DESIGN

Cartilage T(1) was evaluated using immature bovine patella in solutions of five different dendrimer-linked nitroxides, saline or Gd-DTPA at 1.5T. The "relaxivity per dose" (change in cartilage 1/T(1) produced by a given concentration of agent) was calculated. The half-life of joint fluid enhancement was measured at 2T after solutions of three dendrimer-linked nitroxides, Gd-DTPA, and saline were injected into rabbit stifle joints. Twenty-four hours after injection, the joints were examined grossly and by histology for toxicity.

RESULTS

All but the largest dendrimer-linked nitroxide were able to intensely enhance articular cartilage on MR. Relaxivity per dose measurements were between 3.5 and 68 times greater than Gd-DTPA. The largest nitroxide appeared to be excluded from articular cartilage. Intra-articular half-lives of the dendrimer-linked nitroxides were sufficiently long (160-208 min) for in vivo MR imaging to be performed. Histological assessments of joints showed minimal synovial inflammatory and necrosis scores 1 day post-injection that were similar for all agents, including Gd-DTPA.

CONCLUSION

Dendrimer-linked nitroxides strongly enhance cartilage and are promising as articular cartilage-specific MR contrast agents. The intra-articular life-time is sufficient for imaging studies and, in initial evaluation, the agents exhibit minimal toxicity in rabbit joints.

Distribution of Porphyromonas gingivalis fimA genotypes in cardiovascular specimens from Japanese patients

INTRODUCTION

Porphyromonas gingivalis, a major periodontal pathogen, is gaining increasing attention for its possible association with cardiovascular diseases. Its fimbriae are classified into six genotypes (types I-V and Ib) based on the diversity of the fimA genes encoding the fimbrial subunits. In this study, fimA genotypic distribution was analyzed in P. gingivalis-infected cardiovascular specimens.

METHODS

A total of 112 heart valves and 80 atheromatous plaque specimens were collected from patients undergoing cardiovascular surgery, as well as 56 dental plaque specimens. Bacterial DNA was extracted from each, and polymerase chain reaction analysis was carried out with a P. gingivalis-specific set of primers. P. gingivalis-positive specimens were further analyzed to discriminate the fimA genotype using polymerase chain reaction with fimA type-specific primer sets.

RESULTS

P. gingivalis was detected in 10.4% of the cardiovascular specimens and 50.0% of the dental plaque samples. In the latter, type II was most frequently detected (35.7%), followed by types I (28.6%) and IV (21.4%), while types IV and II were detected with considerable frequencies of 45.0% and 30.0%, respectively, in the cardiovascular specimens. In contrast, the occurrence of type I was limited (5.0%) in the cardiovascular specimens.

CONCLUSION

These results suggest that specific fimA genotypic clones, which are reportedly associated with periodontitis, are also frequently harbored in cardiovascular specimens, indicating the possible involvement of type II and IV clones in the initiation and progression of cardiovascular diseases.

298 EFFECT OF TWO DIFFERENT DOSES OF FOLLICLE-STIMULATING HORMONE IN ALUMINUM HYDROXIDE GEL BY A SINGLE INJECTION ON ESTRUS AND SUPEROVULATORY RESPONSE IN HOLSTEIN CATTLE

We investigated the effect of administration of different dosage of FSH in aluminum hydroxide gel (Gel; an adjuvant and absorbent of large molecules) by a single injection on induction of estrus, superovulatory response, and embryo recovery in Holstein cattle. In this study, six cloprostenol-synchronized [PGF (0.75 mg, IM); Clopromate C; Sumitomo Pharmaceuticals Co., Tokyo, Japan], nonlactating Holstein cows were divided into three groups (Gel-40, Gel-30, Controls) between days 8 and 11 (day 0 = the day of estrus) in a Latin square design. Forty mg (Gel-40 group) FSH (Antrin-R10; Kawasaki Mitaka Pharmaceutical Co., Tokyo, Japan) or 30 mg (Gel-30 group) FSH were mixed with 5 mL Gel and administered by a single injection into fat in the ischiorectal fossa. The control group received 40 mg pFSH twice daily for 4 d in decreasing doses (8, 8, 6, 6, 4, 4, 2, and 2 mg) into the ischiorectal fossa. Then, all cows received PGF (0.75 mg, IM) twice on the third day of the treatment, and cows were inseminated at 48 and 60 h after second PGF treatment; embryo recovery was performed 7 d later. Follicular development was monitored ultrasonically every 24 h from the first FSH treatment to ovulation, and the numbers of medium (MF, 5–8 mm) and large (LF, >8 mm) sized follicles, and corpora lutea (CL) were counted on the day of embryo recovery. Estrous status was determined by walking activity of cows as an estrous index. Each cow was fitted with a pedometer (Gyuho; Comtec, Miyazaki, Japan) that measures total amount of walking activity per hour, and data of individual cows were sent to a personal computer in real time. Estrus was defined as an increase in number of steps to more than the value of mean steps plus standard deviation recorded for the preceding 240 h. Data were analyzed by one-way ANOVA. There was no significant difference among the Gel-40, Gel-30, and control groups for the mean ( � SD) duration of estrus (22.3 � 5.2 h, 18.0 � 2.8 h and 18.5 � 5.3 h, respectively), increments of estrous activity (398.3 � 135.3%, 388.9 � 44.4% and 393.9 � 82.1%, respectively), and the mean interval from the first PGF to onset of estrus (35.5 � 2.2 h, 37.8 � 5.7 h and 39.3 � 5.6 h, respectively). There was no significant difference among the Gel-40, Gel-30, and control groups for the mean number of large follicles at the time of estrus (21.3 � 10.2, 21.5 � 7.6 and 21.0 � 9.4, respectively), number of CL at the time of ova/embryo collection (21.5 � 10.2, 19.2 � 4.9, and 20.5 � 9.5, respectively), the total number of ova/embyos recovered (12.3 � 8.3, 12.5 � 7.8, and 13.8 � 9.2, respectively), or transferable embyos (3.3 � 4.8, 4.5 � 3.5, and 5.5 � 4.5, respectively). Results suggested that administration of 30 mg of FSH in 5 mL Gel by a single injection in the ischiorectal fossa was effective in inducing superstimulation in Holstein cattle. This work was supported by a grant of the Research Project for Utilizing Advanced Technology (04–1676).

206 EFFECT OF FOLLICULAR WAVE SYNCHRONIZATION AND SUPERSTIMULATION ON IN VITRO EMBRYO PRODUCTION

We previously reported that follicular wave synchronization, by removal of the dominant follicle on Day 5 after ovum pickup (OPU), was effective in increasing oocyte quality in the developing follicles (Imai et al. 2006 32th Annual Conference of the IETS, poster presentation no. 277). The current study was designed to examine the effect of superstimulatory treatment to induce subsequent follicular wave synchronization on embryo production by OPU and IVM-IVF-IVC in Holstein dry cows. Cows were reared under the same feeding and environmental conditions, and 2 OPU sessions were conducted in each cow. In the first session, OPU was performed in 8 cows on arbitrary days of the estrous cycle by using a 7.5-MHz linear transducer with needle (Cova needle, Misawa Medical, Tokyo, Japan) connected to an ultrasound scanner (SSD-1200, Aloka, Tokyo, Japan). Follicles larger than 8 mm in diameter were then aspirated and a CIDR was inserted on Day 5 (the day of first OPU session = Day 0). Cows then received 30 mg of FSH (Antrin-R10; Kawasaki Mitaka Pharmaceutical Co., Tokyo, Japan) twice a day from Days 7 to 10 in decreasing doses (6, 6, 4, 4, 3, 3, 2, 2 mg) by i.m. injection. Cloprostenol (PGF; Clopromate C; Sumitomo Pharmaceuticals Co., Tokyo, Japan; 0.75 mg) was administered in the morning of Day 9 (third day of superstimulation). The second OPU session was performed 48 h after PGF administration (Day 11), and only follicles larger than 5 mm in diameter were aspirated. The CIDR was removed from the cows just before OPU. Collected oocytes were evaluated by their cumulus cell morphology, cytoplasmic color, and density. Grades 1 and 2 COC were matured, fertilized, and cultured as described by Imai et al. [2006 J. Reprod. Dev. 52(Suppl.), S19–S29]. Embryo development was assessed by the cleavage rate on Day 2 and by the blastocyst formation rate on Days 7 to 8 (the day of insemination = Day 0). Data were analyzed by Student's t-test. There were no differences in the mean (� SD) number of aspirated follicles or collected oocytes between the first (32.5 � 6.8 and 26.0 � 12.7, respectively) and second (29.3 � 10.4 and 19.0 � 9.4, respectively) OPU sessions (P > 0.1). The percentage of Grade 1 and 2 oocytes for the second OPU session (90.5 � 13.8%) was significantly higher (P < 0.01) than for the first OPU session (63.1 � 6.3%), and significant differences were found for cleavage (79.4 � 14.1, 61.8 � 25.1, P < 0.01) and blastocyst rates (68.1 � 16.7, 24.2 � 22.3, P < 0.001) between sessions. The mean numbers of blastocysts obtained per session were 4.3 � 2.9 and 12.8 � 8.7 in the first and second sessions, respectively (P < 0.01). These results indicate that superstimulatory treatment and subsequent follicular wave synchronization were effective on in vitro embryo production by increasing the oocyte quality.

Phase I study of amrubicin (AMR) for patients (pts) with previously treated small cell lung cancer (SCLC)

18209

Background: Amrubicin, a totally synthetic 9-amino-anthracycline, has been demonstrated to have excellent antitumor activity against previously untreated SCLC. However, severe hematological toxicities were observed in previously treated SCLC when given at doses of 40 to 45 mg/m2, days 1–3. We sought to determine the maximum tolerable dose (MTD) and toxicity of amrubicin for pts with previously treated SCLC. Methods: Pts with confirmed SCLC, ECOG PS 0–1, and 20 to 74 years of age, with a history of receiving one or two regimens were eligible for the study. Pts were divided into two groups. Group R (-) consisted of pts without history of radiotherapy except prophylactic cranial irradiation. Group R (+) consisted of pts with history of irradiation up to two fields including thoracic radiotherapy. AMR was initially given at 35 mg/m2, iv, days 1–3, every 3 weeks in both groups. The dose was then increased to 40 and 45 mg/m2. Three pts were treated at each dose level in the absence of a dose limiting toxicity (DLT). All pts received prophylactic hG- CSF between days 8–13. DLT was defined as neutrophil nadir <500/μL lasting more than 4 days, neutropenic fever and neutrophil nadir <1000/μL, platelet nadir <20,000/μL or ≥ grade 3 non-hematologic toxicities. Results: Fourteen pts were enrolled, 10m/4f. The median age was 62 years (range 34–82). Two of 6 pts in the first cohort in group R (-) had dose-limiting neutropenia. The dose escalation is ongoing. Three pts in the first cohort in group R (+) had no dose-limiting toxicities. A subsequent 5 pts were treated at dose-level 2, and 3 pts had dose-limiting neutropenia. The MTD in group R (+) was 40 mg/m2. A response rate of 62% was observed. Median survival time was 12 months. No treatment-related death was observed. Conclusions: The MTD in group R (-) was not determined. The MTD in group R (+) was determined as 40 mg/m2. Further data will be presented.

No significant financial relationships to disclose.

Detection and serotype distribution of Actinobacillus actinomycetemcomitans in cardiovascular specimens from Japanese patients

Actinobacillus actinomycetemcomitans, an important pathogen in periodontitis, has also been detected in cardiovascular tissues. Sixty heart valves were collected during valve replacement surgery from 60 patients (one from each), 10 were from patients with infective endocarditis (IE group) and 50 were from patients with other valvular diseases (non-IE group). In addition, 46 samples of aneurysmal tissue were taken from 46 patients with a thoracic or abdominal aneurysm (Aneurysm group, one from each). Dental plaque samples were taken from 54 of the patients, 31 in the IE and non-IE groups and 23 in the aneurysm group. First, the distribution of A. actinomycetemcomitans in all specimens was analysed using a polymerase chain reaction method, which resulted in a positive reaction in 33 (31.1%) of the cardiovascular specimens and 25 (46.3%) of the dental plaque samples. Next, using serotype-specific sets of primers, the serotype distribution of A. actinomycetemcomitans in the cardiovascular specimens and dental plaque samples was found to be significantly different compared to dental plaque samples from Japanese subjects reported previously.

Longitudinal in vivo reproducibility of cartilage volume and surface in osteoarthritis of the knee

OBJECTIVE

The aim of this study was to evaluate the longitudinal reproducibility of cartilage volume and surface area measurements in moderate osteoarthritis (OA) of the knee.

MATERIALS AND METHODS

We analysed 5 MRI (GE 1.5T, sagittal 3D SPGR) data sets of patients with osteoarthritis (OA) of the knee (Kellgren Lawrence grade I-II). Two scans were performed: one baseline scan and one follow-up scan 3 months later (96 +/- 10 days). For segmentation, 3D Slicer 2.5 software was used. Two segmentations were performed by two readers independently who were blinded to the scan dates. Tibial and femoral cartilage volume and surface were determined. Longitudinal and cross-sectional precision errors were calculated using the standard deviation (SD) and coefficient of variation (CV%=100x[SD/mean]) from the repeated measurements in each patient. The in vivo reproducibility was then calculated as the root mean square of these individual reproducibility errors.

RESULTS

The cross-sectional root mean squared coefficient of variation (RMSE-CV) was 1.2, 2.2 and 2.4% for surface area measurements (femur, medial and lateral tibia respectively) and 1.4, 1.8 and 1.3% for the corresponding cartilage volumes. Longitudinal RMSE-CV was 3.3, 3.1 and 3.7% for the surface area measurements (femur, medial and lateral tibia respectively) and 2.3, 3.3 and 2.4% for femur, medial and lateral tibia cartilage volumes.

CONCLUSION

The longitudinal in vivo reproducibility of cartilage surface and volume measurements in the knee using this segmentation method is excellent. To the best of our knowledge we measured, for the first time, the longitudinal reproducibility of cartilage volume and surface area in participants with mild to moderate OA.

21 RELATIONSHIP BETWEEN DURATION OF ESTRUS BEHAVIOR DETERMINED BY RADIOTELEMETORY SYSTEM AND THREE FACTORS (MILK PRODUCTION, STEROID HORMONE, AND OVULATION TIME) IN DAIRY COWS

Many studies have reported on the low fertility of dairy herds during the past several years. The object of this study was to investigate the relationships between duration of estrus and various factors (milk production, peripheral steroid hormones, and period from estrus to ovulation). All primiparous and multiparous Holstein cows (n = 62) were fitted pedometers (Gyuho; Comtec, Miyazaki, Japan) that measure total counts of walking activity per hour and send the individual cow

388 SUPEROVULATION TREATMENT BY A SINGLE INJECTION OF FSH WITH ALUMINUM HYDROXIDE GEL IN HOLSTEIN CATTLE

The objective of this study was to examine the effect of administration of FSH in aluminum hydroxide gel (Gel; an adjuvant and adsorbent of large molecules) by a single injection on superovulatory response and embryo recovery in cattle. In this study, cloprostenol-synchronized (PGF; Clopromate C; Sumitomo Pharmaceuticals Co., Tokyo, Japan) nonlactating Holstein cows were divided into 2 groups (Gel-treated and Controls) between Days 8 and 11 after estrus in 2 experiments in a crossover design. In Experiment 1, 40 mg FSH (Antrin-R10; Kawasaki Mitaka Pharmaceutical Co., Tokyo, Japan) was mixed with 10 mL aluminum hydroxide suspended in saline at a concentration of 3 mg Al mL-1 and administered by a single IM injection (n = 12; 10 mL-Gel group). Blood samples were collected at 0, 1, 2, 4, 8, and 12 h, and thereafter every 24 h until embryo recovery for measurement of FSH levels in a time-resolved fluoroimmunoassay. In Experiment 2, 40 mg FSH was mixed with 5 mL Gel and injected into fat in the inguinal region (n = 8, 5 mL-Gel group). The Control group in both experiments (n = 2 and n = 8, respectively) received 40 mg FSH twice daily for 4 days in decreasing doses (8, 8, 6, 6, 4, 4, 2, and 2 mg) by IM injection (Experiment 1), or in the inguinal region (Experiment 2). PGF (0.75 mg) was administered twice on the third day of treatment, and cows were inseminated 48 and 60 h after second PGF dose; embryo recovery was performed 7 days later. Follicular development was monitored ultrasonically every 24 h from the first FSH treatment to ovulation, and the numbers of medium (MF, 5–8 mm) and large (LF, &gt;8 mm) follicles, and corpora lutea (CL) were counted on the day of embryo recovery. Data were analyzed by Student&apos;s t-test. In Experiment 1, there were no differences in the mean (� SD) number of CL or transferable embryos between the 10 mL-Gel (10.5 � 9.6 and 6.0 � 8.0, respectively) and Control (14.8 � 9.6 and 9.0 � 6.6, respectively) groups (P &gt; 0.1). The growth of LF and MF in the 10 mL-Gel group occurred 24 h earlier than in the Control group (24 and 48 h after initiation of FSH treatment, respectively; P &lt; 0.05). However, follicle growth stopped at 72 h in the 10 mL-Gel group and at 96 h in the Control group (P &lt; 0.01). FSH concentrations in the 10 mL-Gel group increased markedly to 2.0 � 0.7 ng mL-1 at 12 h, remained there at 24 h, and decreased to 1.0 � 0.3 ng mL-1 at 72 h, whereas FSH concentrations in the Control group increased gradually to 1.1 � 0.3 ng mL-1 at 24 h, remained at 1.2 � 0.3 ng mL-1 from 24 to 96 h, and then decreased to baseline (0.9 � 0.3 ng mL-1) at 120 h (P &lt; 0.05). In Experiment 2, no significant differences in number of CL or transferable embryos were found between the 5 mL-Gel (11.8 � 13.0 and 4.1 � 4.0, respectively) and Control (12.0 � 11.0 and 4.0 � 3.1, respectively) groups, and follicular growth profiles did not differ between groups (P &gt; 0.4). Results suggest that administration of FSH in 5 mL Gel by a single injection in the inguinal region is effective in inducing superstimulation in Holstein cattle. This work was supported by a grant of the Research Project for Utilizing Advanced Technology (04-1676).

Cultivation of human corneal limbal stem cells in Mebiol gel--A thermo-reversible gelation polymer

BACKGROUND & OBJECTIVES

Cultivated limbal stem cell transplantation is being used as a current treatment modality for limbal stem cell deficiency. However, use of allogenic biological material as substrate is associated with risks of transmission of certain diseases and allograft rejection. Therefore development of non-toxic biodegradable synthetic polymers is important. We undertook this study to evaluate the use of a synthetic polymer Mebiol gel as a substrate for the growth of limbal phenotype cells and cornea phenotype cells from limbal explants.

METHODS

Human cadaveric limbal explants cells were cultivated on Mebiol gel. The proliferative capacity of cultivated cells was analyzed with thymidine incorporation studies. Immunostaining for presumed limbal stem cell association markers and cornea differentiation markers was performed and confirmed with reverse transcription (RT-PCR).

RESULTS

The limbal explants underwent proliferation in vitro. The cultivated cells expressed the presumed limbal stem cell association markers (ABCG2 and p63), the transient amplifying cell markers (connexin 43, integrin alpha9) and the cornea differentiation marker (K3). RT PCR confirmed the immunohistochemical data.

INTERPRETATION & CONCLUSION

Our findings showed that the synthetic polymer Mebiol gel was able to support limbal explant proliferation. The cultured cells expressed presumed limbal stem cell association markers, transient amplifying cells and cornea phenotype markers. Mebiol Gel can be used as a scaffold for growing limbal explants.

Associations among preoperative MRI features and functional status following arthroscopic partial meniscectomy

BACKGROUND

Arthroscopic partial meniscectomy (APM) is the most frequently performed orthopedic procedure. Functional outcomes of APM are variable, particularly among patients with underlying knee osteoarthritis. While most patients undergoing APM have knee magnetic resonance imaging (MRI) performed preoperatively, the prognostic value of knee MRI in predicting the functional outcomes of APM has not been evaluated.

METHODS

We studied patients who had APM performed by one of five participating surgeons at one institution in 2002. The preoperative MRI scans of these patients were assessed using a standardized rating system by an independent observer who was not involved in the care of the patients and who was blinded to patient outcomes. Patients completed a questionnaire in the summer of 2003, 6-18 months postoperatively. The questionnaire included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and items on satisfaction with the results of surgery. We used bivariate and multivariate techniques to evaluate the associations between MRI findings, other preoperative findings, and the functional status and pain scales of the KOOS.

RESULTS

Eighty-three patients were included in the analyses. The outcome of surgery was variable with average KOOS functional score of 77 and range of 15-100. One-quarter of patients were somewhat or very dissatisfied with the results of surgery and 17% were using a cane at the time of follow-up. In bivariate analyses, preoperative predictors of KOOS function score at follow-up included preoperative functional status and several MRI findings including the extent of cartilage damage, bone marrow edema in the medial compartment, and length of the tear. Multivariate analyses showed that after adjusting for preoperative functional status, the extent of cartilage signal abnormality in the medial compartment on MRI remained an independent predictor of functional status, 6-18 months following surgery. Specifically, preoperative functional status explained 21% of the variability in follow-up KOOS functional status score and the extent of medial tibial cartilage damage on MRI explained an additional 16%. Analyses of knee pain 1 year following APM yielded similar findings, with preoperative functional status accounting for 17% of the variability in pain scores and medial tibial cartilage damage accounting for an additional 13%.

CONCLUSIONS

Preoperative MRI findings of cartilage damage have independent prognostic value in predicting the functional outcome of APM. This study was limited by a cross-sectional design with retrospective recall of preoperative functional status. Thus, the findings need to be confirmed in prospective investigations.