Peach palm shells (Bactris gasipaes Kunth) bioconversion by Lentinula edodes: Potential as new bioproducts for beef cattle feeding

This paper aims to develop and assess the in vitro effects on ruminal fermentation and greenhouse gas parameters of new bioproducts for beef cattle diets, carried out by solid-state fermentation of peach palm shells colonized by Lentinula edodes (SSF) and after Shiitake mushroom cultivation in axenic blocks (SMS). In vitro experiments were performed to assess the in vitro gas production, digestibility, and fiber degradation of formulated total diets. Bioproducts presented high β-glucans (9.44---11.27 %) and protein (10.04---8.35 %) contents, as well as similar digestibility to conventional diets. SMS diet had the lowest methane and carbon dioxide (19.1 and 84.1 mM/g OM) production, and the SSF diet presented lower carbon dioxide production (98.9 mM/g OM) than other diets, whereas methane was similar. This study highlighted a sustainable use of byproducts for beef cattle diets, promising for digestibility, nutritional value, β-glucans incorporation, and environmental impact mitigation, favoring the circular bioeconomy.

Tannin-based product in feedlot diet as a strategy to reduce enteric methane emissions of Nellore cattle finished under tropical conditions

A total of 120 Nellore bulls, [initial body weight (BW) = 307 ± 11.6 kg and 12 mo of age] were allocated into 12 collective pens (10 bulls per pen) in a commercial feedlot to evaluate the effects of a specific blend of tannin and saponins on enteric methane (CH4) emissions. The study was a completely randomized design, in which pens were considered the experimental units (N = 6 pens per treatment) and were randomly allocated into one of two treatments: 1) Control (CON), a basal diet with monensin supplementation (25 mg/kg dry matter [DM]; Rumensin, Elanco Animal Health, Greenfield, IN, USA), or 2) Control + a specific blend of tannin and saponins (TAN; 7 g/kg DM; composed of quebracho and chestnut tannin extracts along with carriers from cereals rich in saponins; SilvaFeed BX, Silvateam, San Michele Mondovi, CN, Italy). After the adaptation period (20 d), the experiment was divided into two phases: growing phase (21 to 53 d; total of 33 d) and fattening phase (54 to 139 d; total of 86 d). Enteric methane emissions were estimated using the sulfur hexafluoride (SF6) tracer gas technique. Interactions between treatment and period (growing vs. fattening) were detected for daily CH4 emissions, in which animals fed TAN reduced CH4 emissions by 17.3% during the fattening period compared to bulls fed CON (P = 0.05). In addition, bulls fed TAN had lower CH4 emissions expressed by dry matter intake (DMI) during the fattening period compared to bulls fed CON (P = 0.06). The findings presented herein indicate that a specific blend of tannin and saponins can be used as a strategy to reduce enteric CH4 emissions and its intensity of Nellore bulls finished in feedlot systems under tropical conditions.

Use of Heating Methods and Xylose to Increase Rumen Undegradable Protein of Alternative Protein Sources: 2) Cottonseed Meal

The ruminal kinetics of protein sources may be changed by heat and sugar treatments. Thus, these processing methods may be used as alternatives to increase beef-cattle diets’ rumen undegradable protein (RUP). We aimed to evaluate the effects of processing cottonseed meals with autoclave, conventional, and microwave ovens, with and without using xylose, on the ruminal kinetics degradation parameters and intestinal digestibility (ID). In situ studies were conducted, and each sample was incubated in the rumen to determine dry matter (DM) and crude protein (CP) rumen degradation kinetics. In vitro studies were also conducted to evaluate ID. The control treatment had a greater soluble fraction for DM and CP than processed cottonseed meals (p < 0.05). The addition of xylose decreased both DM and CP water-soluble fractions (fraction A) of cottonseed meal heated in a conventional oven (p < 0.05). Compared to the control, we observed a decrease in effective degradability and increased RUP for all processed methods (p < 0.05). Furthermore, conventional and microwave ovens showed greater ID than the control. Moreover, xylose-treated groups heated in the autoclave and conventional ovens had greater ID than xylose-untreated cottonseed meal. Under these experimental conditions, cottonseed RUP was increased by the evaluated processing methods.

Impairment of sperm DNA methylation in male infertility: a meta-analytic study

Considering the widespread use of assisted reproductive techniques (ART), DNA methylation of specific genes involved in spermatogenesis achieves increasingly clinical relevance, representing a possible explanation of increased incidence of syndromes related to genomic imprinting in medically assisted pregnancies. Several trials suggested a relationship between male sub-fertility and sperm DNA methylation, although its weight on seminal parameters alteration is still a matter of debate. To evaluate whether aberrant sperm DNA methylation of imprinted genes is associated with impaired sperm parameters. Meta-analysis of controlled clinical trials evaluating imprinted genes sperm DNA methylation comparing men with idiopathic infertility to fertile controls. Twenty-four studies were included, allowing a meta-analytic evaluation for H19, MEST, SNRPN, and LINE-1. When a high heterogeneity of the results was demonstrated, the random effect model was used. H19 methylation levels resulted significantly lower in 879 infertile compared with 562 fertile men (7.53%, 95% CI: 5.14-9.93%, p < 0.001), suggesting a 9.91-fold higher risk ratio to show aberrant sperm DNA methylation (95% CI: 5.55-17.70, p < 0.001, I²  = 19%) in infertile men. The mean MEST methylation level was significantly higher in 846 infertile compared with 353 fertile men (3.35%, 95% CI: 1.41-5.29%, p < 0.001), as well as for SNRPN comparing 301 infertile men with 124 controls (3.23%, 95% CI: 0.75-5.72%, p < 0.001). LINE-1 methylation levels did not differ between 291 infertile men and 198 controls (0.44%, 95% CI: -2.04-1.16%, p = 0.63). The meta-analytic approach demonstrated that male infertility is associated with altered sperm methylation at H19, MEST, and SNRPN. Although its role in infertility remains unclear, sperm DNA methylation could be associated with the epigenetic risk in ART. In this setting, before proposing this analysis in clinical practice, an accurate identification of the most representative genes and a cost-effectiveness evaluation should be assessed in ad hoc prospective studies.

Profiling the onset of somatic embryogenesis in Arabidopsis

BACKGROUND

Totipotency is the ability of a cell to regenerate a whole organism. Plant somatic embryogenesis (SE) is a remarkable example of totipotency because somatic cells reverse differentiation, respond to an appropriate stimulus and initiate embryo development. Although SE is an ideal system to investigate de-differentiation and differentiation, we still lack a deep molecular understanding of the phenomenon due to experimental restraints.

RESULTS

We applied the INTACT method to specifically isolate the nuclei of those cells undergoing SE among the majority of non-embryogenic cells that make up a callus. We compared the transcriptome of embryogenic cells to the one of proliferating callus cells. Our analyses revealed that embryogenic cells are transcriptionally rather than metabolically active. Embryogenic cells shut off biochemical pathways involved in carbohydrate and lipid metabolism and activate the transcriptional machinery. Furthermore, we show how early in SE, ground tissue and leaf primordia specification are switched on before the specification of a shoot apical meristem.

CONCLUSIONS

This is the first attempt to specifically profile embryogenic cells among the different cell types that constitute plant in vitro tissue cultures. Our comparative analyses provide insights in the gene networks regulating SE and open new research avenues in the field of plant regeneration.

Pre-miR146a expression in follicular carcinomas of the thyroid

INTRODUCTION

Micro-RNA, a new class of small, non-coding RNAs, have been shown to be deregulated in several human carcinomas. In particular, SNP rs2910164 in pre-miR146a appears to be correlated with papillary thyroid carcinoma and may be involved in its genetic predisposition. Since data on follicular thyroid carcinomas (FTC) are lacking, we evaluated the involvement of SNP rs2910164 in FTC.

METHODS

Thirty-nine cases of FTC and 20 follicular adenomas, defined according to WHO criteria, were selected. DNA and RNA were extracted from formalin-fixed paraffin-embedded blocks of both neoplastic and non-neoplastic areas. The DNA region of pre-miR146a, containing SNP rs2910164, was sequenced. Total RNA including miRNAs was used for stem-loop RT reactions, and applying a standard TaqMan PCR kit protocol for real-time PCR. Wilcoxon signed-rank test and Friedman test were used for statistical analyses.

RESULTS

In 31% of FTC, the G allele was observed in neoplastic tissues, compared with the non-neoplastic areas (p < 0.05), whereas the CC phenotype was completely absent in tumours. Moreover, the expression of pre-miR146a was found to be significantly down-regulated in neoplastic tissues from FTC cases (p = 0.043), although no significant differences were seen in follicular thyroid adenomas.

DISCUSSION

The expression profile of pre-miR146a can be correlated with FTC tumourigenesis. The G allele in SNP rs2910164 appears to be correlated with the transition from normal to neoplastic tissue. The GG and GC alleles appear to be associated with an increased risk for FTC, while the CC allele seems to play a protective role.

Selection for feed efficiency traits and correlated genetic responses in feed intake and weight gain of Nellore cattle

The objectives of this study were to estimate genetic parameters for indicator traits of feed efficiency and to recommend traits that would result in better responses to selection for increased weaning weight (weaning weight adjusted to 210 d of age [W210]), ADG, and metabolic BW (BW(0.75)) and lower DMI. Records of W210 from 8,004 Nellore animals born between 1978 and 2011 and postweaning performance test records from 678 males and females born between 2004 and 2011 were used. The following feed efficiency traits were evaluated: G:F, partial efficiency of growth (PEG), relative growth rate (RGR), Kleiber's ratio (KR), residual feed intake (RFI), residual weight gain (RWG), and residual intake and gain (RIG). Covariance and variance components were estimated by the restricted maximum likelihood method using multitrait analysis under an animal model. Estimates of genetic gain and correlated responses were obtained considering single-stage and 2-stage selection. Heritability estimates were 0.22 ± 0.03 (W210), 0.60 ± 0.08 (DMI), 0.42 ± 0.08 (ADG), 0.56 ± 0.06 (BW(0.75)), 0.19 ± 0.07 (G:F), 0.25 ± 0.09 (PEG), 0.19 ± 0.07 (RGR), 0.22 ± 0.07 (KR), 0.33 ± 0.10 (RFI), 0.13 ± 0.07 (RWG), and 0.19 ± 0.08 (RIG). The genetic correlations of DMI with W210 (0.64 ± 0.10), ADG (0.87 ± 0.06), and BW(0.75) (0.84 ± 0.05) were high. The only efficiency traits showing favorable responses to selection for lower DMI were G:F, PEG, RFI, and RIG. However, the use of G:F, PEG, or RFI as a selection criterion results in unfavorable correlated responses in some growth traits. The linear combination of RFI and RWG through RIG is the best selection criterion to obtain favorable responses in postweaning growth and feed intake of Nellore cattle in single-stage selection. Genetic gains in feed efficiency are expected even after preselection for W210 and subsequent feed efficiency testing of the preselected animals.

Of blades and branches: understanding and expanding the Arabidopsis ad/abaxial regulatory network through target gene identification

HD-ZIPIII and KANADI transcription factors have opposing and dramatic affects on plant development. Analysis of mutants shows these proteins to be master regulators of ad/abaxial (i.e., upper/lower) leaf polarity, leaf blade outgrowth, and branch formation. Because these factors do their work by regulating other genes, we have focused our attention on defining their targets. We have found overlap between the ad/abaxial regulatory pathway and hormone signaling pathways, especially pathways of abscisic acid and auxin signaling. This has led to the discovery that abscisic acid signaling acts upstream of HD-ZIPIII and KANADI in the control of germination and may ultimately explain how environmental stress pathways control new growth at the shoot apex. Auxin signaling conversely is downstream from HD-ZIPIII and KANADI action with these factors controlling targets at all steps of auxin action-biosynthesis, transport, regulation of transport, and signaling. Based on these findings, we propose a model in which the HD-ZIPIII and KANADI factors pattern auxin response in the embryo. Finally, many genes targeted for control by HD-ZIPIII and KANADI proteins are themselves transcription factors-indicating these master regulators call up tissue specific subprograms of transcriptional control to affect the many polar differences observed across tissues.

The tumor microenvironment: biology of a complex cellular and tissue society

The tumor microenvironment is a "complex society" of many cell types and their extracellular matrix. All these cell types and the matrix take part to the generation of a tumor "tissue". It is well established that preneoplastic proliferating cells cannot give origin to a tumor without an appropriate blood supply. In fact, angiogenesis could be considered the rate limiting step of tumor growth. In this context microenvironment components play a pivotal role in the regulation of the angiogenic switch and in cancer progression. For these reasons the comprehension of biological and molecular mechanisms involved in the relationship between tumor cells and the microenvironment could unveil new therapeutic and preventive approaches to cancer. In this complex scenario molecular imaging of the microenvironment is crucial to dissect cellular and stromal dynamic contributions.

Genome sequence, comparative analysis, and population genetics of the domestic horse

We report a high-quality draft sequence of the genome of the horse (Equus caballus). The genome is relatively repetitive but has little segmental duplication. Chromosomes appear to have undergone few historical rearrangements: 53% of equine chromosomes show conserved synteny to a single human chromosome. Equine chromosome 11 is shown to have an evolutionary new centromere devoid of centromeric satellite DNA, suggesting that centromeric function may arise before satellite repeat accumulation. Linkage disequilibrium, showing the influences of early domestication of large herds of female horses, is intermediate in length between dog and human, and there is long-range haplotype sharing among breeds.

Postoperative analgesia after cesarean section by continued administration of levobupivacaine with the On-Q Painbuster system over the fascia vs ketorolac + morphine i.v

OBJECTIVE

This study aimed to detect if continuous local infusion of levobupivacaine with the On-Q Painbuster system provided postoperative analgesia of similar quality to morphine + ketorolac i.v. in patients undergoing cesarean section.

MATERIALS AND METHODS

Using a randomized prospective double-blind study, 20 women undergoing cesarean section with a standardized spinal technique were randomly assigned into two groups to receive either 10 mg morphine + 120 mg ketorolac + saline solution up to 96 ml with an elastomeric pump i.v. (group A) or local infusion of levobupivacaine 0.2% with the On-Q PAINBUSTER system (group B). Both groups were administered ketorolac i.v. in bolus in case of pain.

RESULTS

The two groups differed in their VAS scores with group A experiencing significantly less pain than group B; the consumption of analgesics was significantly lower in group A than in group B.

CONCLUSIONS

The i.v. system with morphine and ketorolac is more effective than levobupivacaine subcutaneous infusion in reducing postoperative pain associated with cesarean section.

Efficiency of transient transformation in tobacco protoplasts is independent of plasmid amount

We describe an optimized protocol for the transient transformation of tobacco protoplasts mediated by polyethylene-glycol (PEG). As expected, the quantitative beta-glucuronidase (Gus) activity driven by pCaMVGus was dependent on the amount of plasmid used. Nevertheless, we demonstrate by an immunodetection method that transformation efficiency did not depend on the amount of plasmid used but on the limitation imposed by cell competence. In fact, we obtained the same percentage of transformed cells (about 60%) using a wide range of plasmid concentrations (0.1-10 microg per test). Finally, we show that, when we used two plasmid types in a mixture at a concentration ranging from 0.1 to 10 microg for each, all transformed cells expressed proteins encoded by both plasmids. Transient expression and co-transformation experiments are routinely used methods and, probably, the major results from this work were assumed by many researchers in this field, but our data experimentally support this assumption.

[Isolated atrophy of the infraspinatus muscle in baseball players]

Atrophy of infraspinatus muscle caused by suprascapular nerve entrapment is a typical disease of overhead sports such as volleyball, baseball and javelin. The chronic distress of suprascapular nerve infraspinatus branch may derive from nerve kinking and friction caused by an entrapment at the spino-glenoid notch, often repeated during external-rotation and abduction of shoulder. From 1999 to 2000 4 athletes, out of 143 professional baseball players, were found suffering from this disease. The diagnosis was confirmed by MNR and EMG, while a isokinetic test quantified a loss of strength in external-rotation and allowed a standard parameter for the treatment result evaluation. The 4 athletes were submitted to a non-invasive rehabilitation protocol, thanks to electrostimulation and isokinetic exercises, aiming at strengthening the extrarotator muscles and restoring a suited musclar balance. A subjective improvement was verified and confirmed by isokinetic test in all the players; moreover no surgery was needed.

Thalidomide: an old sedative-hypnotic with anticancer activity?

Thalidomide is a synthetic derivative of glutamic acid with sedative-hypnotic activity, which caused devastating teratogenic effects in the 1960s. This paper reviews the possible mechanisms of its teratogenic effect, its new therapeutic indications, the proposed mechanisms for its antitumor activity and, finally, reviews published studies of its application in oncology. Current data demonstrates that thalidomide is clinically promising in multiple myeloma, glioblastoma multiforme and renal cell cancer. Furthermore, a beneficial effect of the drug has been proposed in cancer-related cachexia, which merits further investigation. Well-designed, randomized studies are warranted to establish the possible indications of thalidomide as an antitumor compound.

Cisplatin and escalating doses of paclitaxel and epirubicin in advanced ovarian cancer. A phase I study

PURPOSE

The combination of paclitaxel and cisplatin is considered the standard regimen for advanced ovarian cancer (AOC). A meta-analysis has shown that the incorporation of anthracyclines into first-line chemotherapy might improve long-term survival by 7-10%. We designed a phase I-II study in patients with AOC using a combination of a fixed dose of cisplatin with paclitaxel and epirubicin both given at escalating doses every 3 weeks. The objectives of this study were to determine both the maximum tolerated dose (MTD) and the antitumor activity of this combination.

METHODS

Six different dose levels were planned. The starting doses were cisplatin 75 mg/m2, paclitaxel 140 mg/m2, and epirubicin 50 mg/m2. The doses of paclitaxel were escalated in 20-mg/m2 increments, alternating with 20-mg/m2 increments of epirubicin. Ten patients with AOC entered the phase I study. Three patients each were enrolled at level I and level II and four patients at level III, and at each level, 15 courses were administered. Patients received a median of five courses.

RESULTS

Nonhematological toxicity was generally mild, except for grade 3 mucositis in one course at levels II and III, and grade 3 vomiting in one course at levels I and III. Hematological toxicities were grade 3-4 neutropenia in 60%, 47% and 60% of courses at levels I, II and III, respectively, and grade 3 anemia in one course at level III. At level III two of four patients developed a dose-limiting toxicity which was grade 4 neutropenia lasting more than 1 week.

CONCLUSIONS

The MTD was reached at level II with cisplatin 75 mg/m2, paclitaxel 160 mg/m2, and epirubicin 50 mg/m2. The phase II part of the study is currently ongoing.

Ifosfamide and vinorelbine in advanced pretreated ovarian cancer: a phase II study

PURPOSE

The response rate to salvage chemotherapy in advanced ovarian cancer (AOC) has been disappointing in patients who do not respond or relapse after platinum-containing regimens. Ifosfamide (IFO) showed an overall response rate of 20% and vinorelbine (VNR) 15.6%. Trials of the association of these two drugs for AOC have not yet been published.

PATIENTS AND METHODS

Between April 1996 and August 1997, 17 patients with AOC were treated with intravenous IFO 2000 mg/m2 per day, days 1 to 3, with mesna uroprotection, and VNR 25 mg/m2 per day, days 1 and 8, every 3 weeks. All patients but one had been heavily pretreated. All patients had been treated with platinum compounds and 16/17 with taxanes.

RESULTS

All 17 patients were evaluable for toxicity, and 16 for response (one lost to follow-up). One patient showed a partial response, 12 progressive disease and three stable disease. No complete responses were observed. The main toxicity was neutropenia (grade 3-4 in 82% of patients) with neutropenic fever in 17.6% of patients. In 70.5% of patients (19/59 of courses) VNR was not administered on day 8. In four patients (10/59 courses) the dose was reduced by 25% for persistent leukopenia grade 2-3. Other toxicities were not significant.

CONCLUSIONS

This combination showed no activity in this set of patients. The poor outcome, as compared with the significant activity reported with the agents used singly, could be ascribed to the patients' characteristics, the low dose intensity of VNR administered and possible cross-resistance between the study drugs and previously used agents.

Resazurin detection of energy metabolism changes in serum-starved PC12 cells and of neuroprotective agent effect

Resazurin is a dye, which becomes fluorescent when reduced by oxidoreductases within viable cells. Measurement of resazurin fluorescence is therefore an indicator of the cell's energy metabolism. Resazurin was used here to detect metabolic changes in PC12 cells following serum starvation. Serum withdrawal is a cytotoxic environmental change resulting in cell death in cultured cell lines as well as in primary cells of various tissue origins, including nerve cells. In particular, PC12 cells have been widely employed as a neuronal cell model and a large number of studies generated. Many molecular and morphological changes occur in PC12 cells after serum withdrawal, and apoptotic cell death is the final consequence. We show that resazurin can detect the metabolic impairment in serum-deprived PC12 cells and can measure the neuroprotective properties of PACAP 1-38, as early as day 1 after serum withdrawal. Resazurin constitutes an advantageous tool to discriminate between healthy and metabolically impaired cells, since fluorescence produced by the reduced dye can be measured in living cells without a lysis step. The experiment is fast, inexpensive, uses a small amount of cells and can easily be automated.

[Duodenal schwannoma. Clinical considerations]

The recent observation of a case of schwannoma in the second part of the duodenum lead the authors to a literature survey in order to state the present knowledge of this subject. Schwannoma is an ectodermal neoplasm arising from the nerve sheath that envelop axons. In the gastrointestinal tract these tumours can concern cells of the myentericus and submucosus plexus of the intestinal wall. A duodenal location is extremely rare. Gastroduodenal endoscopy, abdominal ultrasonography and CT scan were found as important investigatory tools, but only histological examination of the excised tissue suggests the definitive diagnosis. Therapy consists in the radical excision of the tumour; this is rarely obtained by endoscopic way because of the submucosal neoplastic growth. Then a surgical laparotomic approach is more often required and it allows to perform local excisions through a duodenotomy, partial duodenectomy or ampullectomy and more complex operations, like a cephalic duodenopancreatectomy, in front of extended papillar involvement. The latter was the suitable treatment for radical removing of the juxtapapillar schwannoma reported by the authors; the uneventful postoperative course, the patient's excellent general conditions and nutriture at 12 months confirm the validity of the therapeutic policy.

Doxifluridine in colorectal cancer patients resistant to 5-fluorouracil (5-FU) containing regimens

Doxifluridine (5-dFUR) is a fluoropyrimidine derivative, which is preferentially converted to 5-fluorouracil (5-FU) within tumour tissues. Although the activity of 5-FU in metastatic colorectal cancer is well recognised, resistance to this agent is frequently observed and remains its major limitation. The aim of this phase II study was to evaluate the activity of oral and i.v. 5-dFUR in metastatic or locally advanced colorectal cancer patients, who had been previously treated with a 5-FU containing regimen in either an adjuvant or metastatic setting. We treated 48 patients who, on the basis of tumour progression during, or within 8 weeks of the discontinuation of 5-FU therapy, were considered 5-FU resistant, 14 of the patients received 5-dFUR 3000 mg/m2 as a 1-h i.v. infusion, combined with L-leucovorin 25 mg/dose on days 1-5, every 3 weeks; the remaining 34 received oral 5-dFUR 1200 mg/m2 for 5 days followed by 5 days off. Oral L-leucovorin 25 mg/dose was administered 2 h before 5-dFUR. On the basis of WHO criteria, 4/14 (29%, 95% CI 4-51) partial responses were noted in the i.v. treated patients, and 4/34 (12%, 95% CI 1-23) in those treated orally. The radiological examinations documenting the response were a CT scan in 4 cases, ultrasound in 2 and NMR in 2. The median response duration was 6 months (range 3-11+), whereas the median time to treatment failure was 4 months (range 2-17). The responses were achieved in cases previously treated with a median of 9250 mg/m2 (range 5500-18,650) of 5-FU. No CTC-NC1 grade 4 toxicity was observed, although grade 3 diarrhoea occurred in 5 of the orally treated and in 3 of the intravenously treated patients. This is the first report documenting the efficacy of 5-dFUR in patients resistant to 5-FU therapy, and suggests that there is an absence of complete cross-resistance between these two fluoropyrimidines.

Phase II study of vinorelbine in patients with pretreated advanced ovarian cancer: activity in platinum-resistant disease

PURPOSE

The aim of the study was to evaluate the activity of vinorelbine (VNLB) in a population of advanced ovarian cancer patients, with particular attention to defining its role in platinum-resistant disease.

PATIENTS AND METHODS

Thirty-three patients were recruited and treated with VNLB 25 mg/m2 intravenously (IV) weekly. the median age was 53 years, performance status 0 to 2, and number of previous chemotherapy regimens two (range, one to five). Twenty-four patients were platinum-resistant; the remaining nine either were platinum-sensitive (four cases) or had undetermined sensitivity (five cases).

RESULTS

The mean delivered dose-intensity of VNLB was 67% of the planned level, because 60% of the cycles were delayed due to neutropenia or anemia. Four partial responses (PRs) and one complete response (CR) were observed, for an overall response rate of 15% (95% exact confidence interval, 5.1% to 31.9%). All the responses occurred in the subgroup of 24 platinum-resistant cases, in whom the response rate was 21% (95% exact confidence interval, 7.1% to 42.1%). Seven patients became stabilized on VNLB, and 27% of the cases showed a reduction in serum cancer antigen 125 (CA 125) levels. G3/G4 side effects consisted of neutropenia, anemia, and worsening of preexisting peripheral neuropathy. No treatment-related deaths occurred.

CONCLUSION

VNLB led to a 21% response rate in the population of heavily pretreated and platinum-resistant ovarian cancer patients. Further studies of VNLB alone or in combination with taxanes are warranted in patients with less pretreatment.

Dextran/aspirin versus heparin/dihydroergotamine in preventing thrombosis after hip fractures

In a randomised trial we compared the effects of two different antithrombotic regimens on the incidence of venographically established deep venous thrombosis (DVT) in 83 patients undergoing surgery for fracture of the femoral neck. Group A received dextran 40 peroperatively plus 0.5 g aspirin a day beginning before operation and continuing for 10 days after. Group B received heparin calcium 5000 iu subcutaneously plus dihydroergotamine (DHE) 0.5 mg intramuscularly, given 8-hourly, beginning before operation and continuing for 10 days after. Two patients in Group A and three in Group B developed proximal DVT, while the incidence of all DVT was 33% in Group A and 29% in Group B, a difference which was not significant. Haemorrhagic complications were much more common in the dextran/aspirin group: the volume of drainage fluid, the number of patients transfused and quantity of blood transfused, and the drop in haemoglobin level were all significantly greater in Group A. We conclude that the DHE/heparin regime is preferable to dextran/aspirin because it is safer and no less effective.

[Giant cell arteritis: diagnostic value of a second biopsy of the temporal artery (author's transl)]

A 79-year old female patient with antecedents of headache and fever, was admitted because of fatigue, anorexia, anemia and elevated ESR. After admission she presented with rheumatic polymyalgia and synovial effusion in the knee. A first biopsy of the temporal artery was normal. After dismissing other possible causes a second biopsy of the contralateral temporal artery was bone and confirmed giant cell arteritis. Diagnostic value of a second temporal artery biopsy is discussed and justified by: a) a confirmed diagnosis is necessary for prolonged treatment with corticosteroids, b) if it is decided to treat the rheumatic polymyalgia with lower doses of corticosteroids than for temporal arteritis the certainty that no temporal arteritis is present and c) shortening the hospital stay and lowering the cost and number of diagnostic procedures. The frequency of arthritis and synovial effusion in temporal arteritis are also discussed.